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MEDICATIONS

MEDICATIONS. Symptom Control of Cancer Treatment. ANTIEMETICS. ZOFRAN (Ondansetron) Oral, Intravenous

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MEDICATIONS

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  1. MEDICATIONS Symptom Control of Cancer Treatment

  2. ANTIEMETICS • ZOFRAN (Ondansetron) • Oral, Intravenous • Side effects: headache, diarrhea, constipation, abdominal pain, transient increase in AST (heart muscle and liver enzyme; elevated with cellular damage) or ALT (hepatocellular enzyme; elevated with liver damage) • Nursing Implications: • give diluted IV dose (approx. 32 mg) 30 min. before chemotherapy • Give oral dose, 8 mg. before chemo and then TID x 2days

  3. ANTIEMETICS • REGLAN (Metoclopramide) • IV, oral • Side Effects: drowsiness, extrapyramidole rxn, restlessness, dysrhythmias, anxiety • Nursing Implications: • Administer IV dose 30min. before administration of chemo • Oral: Administer 30 min before meals and at hs

  4. ANTIEMETICS • PROCHLORPERAZINE (Compazine) • Oral, IM, Rectal • Side Effects: EPS, orthostatic hypotension, blurred vision, dry mouth, constipation, urine retention, photosensitivity • Nursing considerations: • Use cautiously with other CNS depressants (including alcohol), medications that lower BP, patients with liver disease • Do not exceed recommended dose • Protect from light

  5. Antidiarrheal • LOMOTIL (diphenolylate/atropine) • Given PO tabs, liquid • Side Effects: sedation, dizziness, dry mouth, urinary retention, rash • Nursing Implications: Watch for physical dependence; Know that it should work within 48 hrs.; give Naloxone as antidote for respiratory depression

  6. NSAID • NAPROXYN, ANAPROX • Nonsteroidalantiinflammatoryagent • Side Effects: Agranulocytosis, headache, dizziness, drowsiness, peripheral edema, visual distubances, GI upset (occult blood loss, peptic ulcers), prolonged bleeding time, tinnitus • Nursing Implications: Know that concurrent use with alcohol, acetylsalicylic acid, and steroids will increase chance of GI bleeding. Know that it may interact with Coumadin (Warfarin). Give with food. Avoid use in patient allergic to acetylsalicyclic acid. Advise patient that it may take 4 weeks to show benefit

  7. Antidepressant • AMITRIPTYLINE (Elavil) • Tricyclic Antidepressant • PO, IM • Side Effects: Tremors, orthostatic hypotension, urinary retention • Nursing Implications: used in combination with narcotics in neuropathies and postherpetic neuralgia (esp. with burning pain). Therapeutic effect takes 2-3 weeks.

  8. Antianxiety • ATIVAN (Lorazepam) • PO • Side Effects: drowsiness, headache, diarrhea, respiratory depression • Nursing Implications: Smoking decreases effectiveness. This med decreases nausea esp. when given before and during chemotherapy

  9. Medications Treatment of and Symptom Control of HIV/AIDS

  10. Medications - Treatment of and Symptom Control of HIV/AIDS • Antiretroviral Therapy (the “umbrella” of categories) • Includes: • Nucleoside Reverse Transcriptase Inhibitors • Combination Medications • Nonnucleoside Reverse Transcriptase Inhibitors • Protease Inhibitors

  11. Medications - Treatment of and Symptom Control of HIV/AIDS • Combination Therapy: now the “standard” • Combining medications makes it difficult for the virus to develop resistance to the drugs • Can slow progression of the disease • Medication “cocktails”: 2+ medications combined and given together (usually prefer 3 or more medications together)

  12. Medications: Nursing Role • Timing of medication and Adherence to medication regimen are critical for gaining quantity and improving quality of life • Timing: TID = q 8 hrs (not 3x while pt. awake) • When medication is not given regularly, blood level concentration of the med falls  allows HIV to develop resistance • Adherence: • The patient needs to be educated on the importance of adhering to their medication regimen once they leave the facility or hospital

  13. Nucleoside Reverse Transcriptase Inhibitors • “nucleoside analogs”, “nukes” • ZIDOVUDINE (AZT, Retrovir) • Drug of choice to be used initially in combination therapy in antiretroviral-naive patients • Comments: • headache, nausea – usually resolve within a month. • Bone marrow suppression occurs after long-term use (6mo – 2 yrs • Anemia can be treated with blood transfusions or EPO • Consider treating neutropenia with CSF – eg. Neutrogen

  14. Nucleoside Reverse Transcriptase Inhibitors • ZIDOVUDINE cont. • Side Effects: • Anemia, fever, malaise, headache, nausea, insomnia, myalgia, confusion, aggitation, seizures, hepatomegaly

  15. Nucleoside Reverse Transcriptase Inhibitors • Stavudine (Zerit) • PO • Comments: Crosses the blood-brain barrier. Used in combination therapy for patients who are intolerant of AZT. Decrease dose in patients with impaired renal function • Side Effects: Painful peripheral neuropathy, elevated AST/ALT, anemia, headache, rash, abdominal pain, diarrhea

  16. Nucleoside Reverse Transcriptase Inhibitors • Abacavir (Ziagen) • PO • Comments: 3% develop hypersensitivity AEB flu-like sx.; Life-threatening development of Stevens- Johnson syndrome [a rare, serious disorder in which your skin and mucous membranes react severely to a medication or infection. Often, Stevens-Johnson syndrome begins with flu-like symptoms, followed by a painful red or purplish rash that spreads and blisters, eventually causing the top layer of your skin to die and shed. ] STOP THE DRUG IMMEDIATELY and do not re-challenge  death

  17. Nucleoside Reverse Transcriptase Inhibitors • ABACAVIR cont. • Comments: (cont.) Avoid alcohol  increased level of medication in the blood. No dietary restrictions • Side Effects: n/v, rash, headache, fatigue

  18. Combination Medications • TENOFOVIR (Viread) • PO • Comments: Do not combine with Epivir (lamivudine) and Ziagen (abacavir). People taking “ddl” (Videx) should take Tenofovir 2 hrs before or 1 hours after didanosine. No food restrictions. • Side effects: Mild, some n/v, loss of appetite; potential for renal failure, bone mineral density loss

  19. Combination Medications • Other examples of combination medications: • Combivir: zidovudine + lamivudine • Trizivir: zidovudine+lamivudine+abacavir • Epzicom: abacavir+lamivudine

  20. Nonnucleoside Reverse Transcriptase Inhibitors • Nevirapine (Viramune) • PO • Comments: used in combination therapy. Report any new rash IMMEDIATELY – may progress to Stevens-Johnson syndrome  death • Side Effects: Rash, thrombocytopenia, fever, headaches, nausea

  21. Nonnucleoside Reverse Transcriptase Inhibitors • Efavirenz (Sustiva) • PO • Comments: may cause hyperlipidemia; monitor cholesterol and triglycerides regularlly • Side Effects: Initial dizziness, insomnia, transient rash, vivid dreams, nightmares, difficulty concentrating

  22. Protease Inhibitor • These drugs directly reduce the ability of HIV to replicate (make copies of itself inside cells)

  23. Protease Inhibitors • RITONAVIR (Norvir) • PO • Comments: Titration/escalation of doses important due to side effects. Take with food. Has many drug interactions. • Side Effects: n/v/d, circumoral paresthesis (numbness and tingling), peripheral paresthesias, taste alterations, general weakness, increased liver enzymes, elevated cholesteral and triglyceride levels

  24. Protease Inhibitors • FOSAMPRENAVIR (Lexiva, FPV) • PO • Comments: No food restrictions. <1% get serious skin reactions, including Steven-Johnson syndrome. This is a Sulfa drug. • Side Effects: n/v/d, rash, numbness around mouth, abdominal pain

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