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Pharmacology Mod 8

Immune, Antibiotic, Chemotherapeutic

QuestionAnswer
Drug therapy for cancer includes antimetabolites, alkylating agents, antitumor antibiotics, antimitotics, hormonal agents, biologic response modifiers, targeted antineoplastic drugs
antimetabolites include what Folic acid analog (methotrexate (Trexall)), Pyrimidine Analog (cytarabine (Cytosar-U)), Purine Analog (mercaptopurine (Purinethol))
indications for folic acid analogs acute lymphocytic leukemia in children, lymphomas, choriocarcinoma, inoperable sarcomas of the head, neck, and pelvis, rheumatoid arthritis, psoriasis
prototype folic acid analogs methotrexate (Trexall)
adverse effects of folic acid analogs bone marrow suppression, liver damage, oral and GI ulcerations, pulmonary fibrosis
interventions for folic acid analogs monitor for bone marrow suppression (CBC, Hgb, monitor for fever, monitor for bleeding & bruising), avoid bruising (small guage needles), monitor for oral and GI ulcerations (pain, bloody vomit & stools), monitor liver function tests, observe for jaundice
administration of folic acid analogs oral/IM/IV/intrathecal, may give oral with or without food, give and vary intervals of doses depending on type of cancer, IV form: incompatible with multiple other drugs in solution, must have special training
instructions for folic acid analogs risk for bone marrow suppression (report fever, sore throat, easy bruising, fatigue, cook foods well, frequent oral care), report blood in vomit & stools, avoid alcohol, report jaundice, report difficulty breathing, pregnancy risk D/X
interactions with folic acid analogs digoxin, NSAIDs, salicylates, alcohol, folic acid, sulfonamides
indications for pyrimidine analog myelocytic & acute lymphocytic leukemias, non hodgkins lympoma, prevent & treat meningitis caused by leukemia, maintains remission in above cancers
prototype pyrimidine analog drug cytarabine (Cytosar-U)
adverse effects of pyrimidine analog GI effects (nausea, vomiting, esophagitis), bone marrow suppression (occurs at predictable times, following treatment with cytarabine)
interventions for pyrimidine analog monitor for GI symptoms (administer antiemetic, monitor weight & I&O), monitor for bone marrow suppression (CBC, hemoglobin, hematocrit),
administration of pyrimidine analog subcut/IV/intrathecal, subcut form 1-2 times weekly, intrathecal form daily for 4 consecutive days, decrease normal dose in renal impairment
patient instructions for pyrimidine analog take antiemetic as prescribed, eat small frequent meals, notifty about prolonged N/V, risk for bone marrow suppression, pregnancy category D
interactions with pyrimidine analog digoxin, aminoglycoside antibiotics, immunizations with live viruses
indications for purine analogs acute lymphocytic & acute myelogenous leukemia, temporary remission in chronic granulocytic leukemia
prototype purine analogs mercaptopurine (Purinethol) others: thiogaunine (Tabloid), fludarabine (Fludara), cladribine (Leustatin)
action of purine analogs DNA can't form due to the inability of the cell to synthesize necessary nucleic acids
adverse effects of purine analogs GI symptoms: N/V/D, intestinal ulceration, bone marrow suppression (occurs at predictable times, following treatment with purine analogs), liver toxicity (usually mild)
interventions for purine analogs monitor GI symptoms-which may indicate need for decreased dose, administer antiemetic PRN, monitor weight and I&O, monitor for bone marrow suppression, monitor for liver toxicity (baseline & periodic levels of bilrubin & liver transaminase for elevation
administration of purine analogs oral only, once daily with or without meals, base dose on weight of patient
patient instructions for purine analogs report GI symptoms & take antiemetic, risk for bone marrow suppression, avoid alcohol, report abdominal pain, report decreased appetite, report jaundice, pregnancy risk category D
interactions with purine analogs allopurinol (Zyloprim), warfarin (Coumadin),
alkylating agents include what nitrogen mustards, nitrosoureas, platinum compounds
indications for nitrogen mustards broad spectrum chemo agent- use alone or with other agents to treat: leukemias, multiple myeloma, lymphomas, solid tumors of head/ovary/breast, lung cancer
prototype nitrogen mustards drug cyclophosphamide others: mechlorethamine (Mustargen), chlorambucil (Leukeran)
adverse effects of nitrogen mustards hair loss (alopecia), sever GI effetcs: N/V (especially at high doses), bone marrow suppression (low WBC count most common), kidney toxicity, electrolyte imbalance (hyperkalemia, hyponatremia)
interventions for nitrogen mustards monitor for hair loss, premedicate with antiemetic, supplement with IV fluids, monitor weight and I&O, monitor for bone marrow suppression, monitor for signs of infection, protect patient from people with infections, monitor electrolytes (lab results)
administration of nitrogen mustards oral/IV, give oral dose without food for best absorption, but give with food if severe nausea and vomiting occurs
instructions for nitrogen mustards warn patient of hair loss (use wigs, hats, scarves), advise that hair will grow back, report persistent N/V, take antiemetic, bone marrow suppression, void before drug is given, increase fluid intake, report hematuria,
instructions for nitrogen mustards contd. report weakness/palpitations/muscle twitching (electrolyte imbalance), pregnancy risk category D, use reliable form of contraception during chemotherapy
interactions with nitrogen mustards doxorubicin, succinylcholine
indications for nitrosoureas use alone or with other agents to treat: primary and metastatic brain tumors, lympomas, multiple myeloma, melanoma, hepatoma, GI adenocarcinoma
prototype nitrosoureas drug carmustine (BiCNU) other: Iomustine (CeeNU)
adverse effects of nitrosoureas severe GI effects (N/V), bone marrow suppression (related to size of dose), decreased lung function (possible leading to irreversible pulmonary fibrosis), vesicant (local thrombophlebitis, extravasation & tissue damage)
interventions for nitrosoureas monitor for GI symptoms (antiemetic, monitor weight and I&O), monitor for bone marrow suppression, monitor for decreased lung function, symptoms of lung infection: listen to breath sounds, monitor pulmonary function testing, administer corticosteroids PRN
administration of nitrosoureas specially trained & certified, central line preferable, done use veins near joints of hand, monitor for thrombophlebitis or infiltration, topical & IV
instructions for nitrosoureas take antiemetic, small frequent meals, bone marrow suppression, report cough/shortness of breath/fever, report IV site pain/redness/swelling, pregnancy risk category D, use reliable form of conception
interactions with nitrosoureas cimetidine
indications for platinum compounds combination with other chemotherapy agents to treat metastatic testicular or ovarian cancer, off label to treat head & neck cancers or carcinoma of the bladder or uterine lining
prototype platinum compound drug cisplatin others: carboplatin (Paraplatin), oxaliplatin (Eloxatin)
adverse effects of platinum compounds GI distress (N/V, 1 hour after infusion begins), bone marrow suppression (related to size of dose), kidney toxicity, ototoxicity, apaphylactiv reaction (allergy to platinum)
interventions for platinum compounds monitor for neprhotoxicity & ototoxicity (baseline audiometric & kidney function testing, adequate hydration before/during/after administration, monitor weight, expect decrease in dosage for signs of nephro or ototoxicity), premedicate with antiemetic
interventions for platinum compounds contd. monitor for bone marrow suppression, monitor for paresthesia in extremities, monitor for signs of allergy or anaphylaxis, have epinephrine ready
administration of platinum compounds IV, dose based on patients weight, do not use equipment that contains aluminum, wear gloves, flush area with water if solution touches skin
instructions for platinum compounds report flank pain/decreased urination/weight gain/itching skin/N/V/loss of appetite/dry mucous membranes, report hearing loss/vertigo/tinnitus, take antiemetic, eat small frequent meals, risk for bone marrow suppression
instructions for platinum compounds contd. report numbness/tingling/decreased sensation in hands or feet, report rash/swelling or airway/ shortness of breath
interactions with platinum compounds other nephrotoxic drugs, other ototoxic drugs
Antitumor Antibiotics include anthracyclines
indications for anthracyclines regular IV form treats: acute leukemias, lymphomas, wilms tumor, neuroblastoma, sarcomas of bone & soft tissue, thyroid cancer, transitional cell bladder cancer, breast & ovarian cancers injectable form: multiple myeloma, ovarian cancer, breast cancer
prototype anthracycline drug doxorubicin (Adriamycin, Doxil) others: daunorubicin (Cerubidine & DaunoXome), epirubicin (Ellence), mitoxantrone (Novantrone)
adverse effects of anthracyclines severe bone marrow suppression, thrombocytopenia, anemia, alopecia, red urine & tears (1-2 days after infusion), cardiac toxicity, hepatic toxicity
interventions of anthracyclines monitor for red urine & alopecia, monitor for bone marrow suppression, determine cardiac function prior/during/after treatment, monitor for dysrhythmias, assess vitals, administer ACE inhibtor (cardiac protective agent), monitor for liver toxicity
instructions for anthracyclines risk for bone marrow suppression, warn patient of red urine & alopecia, compliance with cardiac and liver function tests, report rapid heart beat/palpitations/shortness of breath/chest pain/anorexia/vomiting/abdominal pain/itching skin/jaundice
interactions with anthracyclines barbiturates, prolong QT interval, streptozocin
antimitotics include Vinca alkaloid, taxanes, topoisomerase inhibitors
indications for vinca alkaloid acute leukemias, lymphomas, wilms tumor, neuroblastoma, breast & lung, soft tissue sarcomas
prototype vinca alkaloid drug vincristine others: vinblastine (Velban), vinorelbine (Navelbine)
adverse effects of vinca alkaloids peripheral neuropathy, tissue damage if IV infiltration & extravasation occurs, alopecia, severe constipation & upper colon impaction
interventions for vinca alkaloids monitor for peripheral neuropathy (check deep tendon reflexes, monitor for decreased strenght or movement of hands & feet, expect decreased dose if occurs), monitor for infiltration, monitor for constipation
administration of vinca alkaloids IV, dose based on weight, avoid contact of drug with eyes (corneal damage may occur)
instructions for vinca alkaloids report paresthesias (decrease in sensation or strength of hands & feet), report pain/swelling/pallor/redness of IV site, alopecia may occur, report constipation/hard stools/decrease in bowel movements
interactions with vinca alkaloids digoxin, phenytoin, mutomycin
indications for taxanes cancers: ovarian, breast, kaposis sarcoma, non small cell lung cancer
prototype taxane drug paclitaxel (Taxol, Abraxane) others: decetaxel (Taxotere)
Adverse effects of taxanes bradycardia, peripheral neuropathy, bone marrow suppresson, allergic reaction (difficulty breathing, swelling of face, throat, rash, itching)
interventions for taxanes monitor for signs of bradycardia, monitor vitals frequently during infusion, monitor patients with preexisting cardiac diseases, monitor for peripherl neuropathy (check deep tendon reflexes (especially achiles), monitor for decreased strength)
interventions for taxanes contd. monitor for bone marrow suppression (CBC), monitor for allergic reaction
instructions for taxanes make patient aware of need for frequent monitoring, report palpitations & chest pain, potential for peripheral neuropathy, risk for bone marrow suppression, risk for allergic reaction (report swelling of mouth, throat, neck, rash, itching)
interactions with taxanes cisplatin, doxorubicin, beta blockers, digoxin, verapamil, anticoagulants, thrombolytics, NSAIDs, platelet inhibitors
indications for topoisomerase inhibitors treats cancers that other anticancer drugs can't treat successfully, metastatic ovarian cancer, small cell lung cancer
prototype topoisomerase inhibitor drug topotecan (Hycamtin) others: irinotecan (Camptosar)
adverse effects of topoisomerase inhibitors moderately severe GI symptoms (N/V/D, constipation, abdominal pain), bone marrow suppression (neutrophils in particular), thrombocytopenia, anemia, alopecia
interventions for topoisomerase inhibitors monitor for GI symptoms (antiemetic PRN), monitor for bone marrow suppression, expect prescriptions for transfusion of platelets and packed RBCs, monitor for alopecia
instructions for topoisomerase inhibitors request & take antiemetic, eat small frequent meals, fluids, notify if prolonged N/V, risk for bone marrow suppression, inform that hair loss may occur
interactions with topoisomerase inhibitors filgrastim, anticoagulants, NSAIDs, antipletelet drugs
hormonal agents include gonadotropin releasing hormone agonists, androgen receptor blockers, estrogen receptor blockers, aromatase inhibitors, monoclonal antibody
indications for gonadotropin releasing hormone agonists advanced prostate cancer, palliative treatment, drug therapy is alternative to orchiectomy
prototype gonadotropin releasing hormone agonist drug leuprolide (Lupron & Lupron Depot) others: triptorelin (Treslstar Depot & Trelstar LA), goserelin (Zoladex)
expected therapeutic effects of gonadotropin releasing hormone agonists testosterone production by the testes isnt stimulated & stops, prostate gland tissue shrinks (including both normal & cancerous cells)
indications for androgen receptor blockers prostate cancer in both early stages & after metastasis
prototype androgen receptor blocker drug flutamide others: bicalutamide (Casodex), nilutamide (Nilandron)
expected action of androgen receptor blockers blocks effects of androgens produced by the adrenal gland, results in slower progression of prostate cancer with decreased pain
adverse effects of androgen receptor blockers liver toxicity, gynecomastia (growth of breast tissue), hot flashes, decreased libido, impotence
interventions for androgen receptor blockers monitor baseline liver function monthly for first few months of treatment, monitor for symptoms of decreased liver function, monitor for gynecomastia
instructions for androgen receptor blockers report anorexia/abdominal pain/nausea/jaundice/dark urine, be aware that gynecomastia/hot flashes/decreased sexual function may occur
interactions with androgen receptor blockers warfarin (coumadin)
indications for estrogen receptor blockers estrogen receptor (ER) positive metastatic breast cancer, prevents occurence of breast cancer in high risk wormen
prototype androgen receptor blocker drug tamoxifen (Soltamox) others: toremifene (Fareston), raloxifene (Evista)
adverse effects of androgen receptor blockers GI symptoms (N/V), hot flashes, retinopathy, cataracts, decreased visual acuity, risk for uterine cancer, endometrial hyperplasia, increased risk for thrombophlebitis, thromboembolism
interventions for androgen receptor blockers monitor for GI effects, monitor for hot flashes, monitor for visual disturbances, assis with endometrial biposies as needed, monitor for leg pain/sudden chest pain/shortness of breath/signs of stroke
instructions for androgen receptor blockers report persisten N/V to provider, report severe hot flashes, report blurred vision, regular opthmalic exams, report abnormal menstrual bleeding, report leg pain/swelling/sudden chest pain/shortness of breath/weakness on one side of body
interactions with androgen receptor blockers SSRI, phenytoin, erythromycin, vincristine, other anticancer drugs
indications for aromatase inhibitors either early or advanced estrogen receptor positive breast cancer in postmenopausal women
prototype aromatase inhibitor drug anastrozole (Amrimidex) others: letrozole (Femara), exemestane (Aromasin)
adverse effects of aromatase inhibitors muscle pain & weakness, GI symptoms (N/V/D, constipation, anorexia), osteoporosis, increased risk for fractures
interventions for aromatase inhibitors muscle pain & weakness (acetaminophen if ok), antiemetic for persistent nausea, monitor patients weight, sufficient fluid intake, monitor bone density screening tests
instructions for aromatase inhibitors acetaminophen for muscle pain if approved, report GI symptoms, take measures to prevent osteoporosis (increased calcium & vitamin D), take precautions to prevent falls, increase weight bearing exercise, dont smoke
interactions with aromatase inhibitors estrogen
indications for monoclonal antibody specific type of metastatic breast cancer
prototype aromatase inhibitors drug trastuzumab (Herceptin) other: lapatinib (Tykerb)
adverse effects of aromatase inhibitors allergic reaction (usually with first dose or within 12 hours of that infusion, bronchospasm with wheezing, hypotension, shortness of breath, uticaria), infusion reaction (chills, fever, flu like symptoms), heart failure, dysrhythmias
adverse effects of aromatase inhibitors contd. CNS symptoms (headache, insomnia, dizziness, paresthesias), N/V/D
interventions for aromatase inhibitors allergic reaction (stop infusion, prepare to treat with epinephrine), monitor & report flu like symptoms and temperature, monitor cardiac status prior/during treatment, treat N/V with antiemetic as needed
instructions for aromatase inhibitors report rash/shortness of breath/wheezing, report chills/flu like symptoms, report shortness or breath/edema/palpitations, report persistent headache/insomnia/dizziness/numbness & tingling of extremities, report persisten N/V/D
biologic response modifiers include interferon
indications for interferons hairy cell leukemia, chronig myelogenous leukemia, malignant myeloma, kaposis sarcoma, chronic hepatitis C
prototype interferon drug interferon alfa-2a (Roferon-A), interferon alfa-2b (Intron A)
adverse effects of interferons flu like symptoms, fever, fatigue, dizziness, insomnia, depression, tremor, headache, bone marrow suppression, abdominal pain, anorexia, weight loss, diarrhea
interventions for interferons flu like symptoms (medicate with acetaminophen if prescribed for fever & muscle ache), monitor for bone marrow suppression, monitor CBC (platelets, erythrocytes, leukocytes, hemoglobin, hematocrit), monitor & report persistent GI symptoms, well hydrated
instructions for interferons premedicate with acetaminophen, report CNS symptoms, avoid hazardous activities until effects of drug known, notify provider for easy bruising/bleeding/fatigue, report abdominal pain/weight loss/loss of appetite/persistent diarrhea
interactions with interferons other anticancer drugs, theophylline levels, doxorubicin, vinblastine
indications for antineoplastic drugs initial treatment of chronic myeloid leukemia, acute lymphoblastic leukemia, certain metastatic GI tumors
prototype antineoplastic drug imatinib (Gleevec) others: dasatinib (Sprycel), nilotinib (Tasigna)
adverse effects of antineoplastics N/V/D, musculoskeletal pain, muscle cramping, rash, bone barrow suppression, fluid retention
interventions for antineoplastics monitor GI symptoms (monitor weight, ensure enough fluid), monitor for musculoskeletal pain/muscle cramping/rash, monitor for bone marrow suppression, monitor CBC (neutrophils & thrombocytes in particular), monitor for fluid retention
instructions for antineoplastics report GI effects, report muscle & joint aches or muscle cramping, report rash & itching, risk for bone marrow suppression, report shortness of breath & edema
drug therapy for HIV includes viral entry blockers, enzyme inhibitors
viral entry inhibitors include entry & fusion inhibitors, CCR5 antagonist
indications for entry & fusion inhibitors advancded HIV disease or when there is a resistance to other types of drugs
prototype entry & fusion inhibitor drug enfuviritide (Fuzeon)
adverse effects of entry & fusion inhibitors injection site reactions, pneumonia (shortness of breath, cough, fever), allergic reactions (chills, fever, rash, nausea, hypotension, elevated liver enzymes)
interventions for entry & fusion inhibitors monitor for & report injection site reactions & infections, instruct in correct subcutaneous injection administration, monitor temp & signs of pneumonia, monitor & report signs of hypersensitivity
instructions for entry & fusion inhibitors rotate injection sites, avoid injecting into reddened/abraded/scarred skin, report tenderness/redness/swelling/hardened areas/itching/skin reactions, report cough/fever/shortness of breath, report sings of hypersensitivity
indications for CCR5 antagonists HIV-1 that bings with CCR5 and is resistant to other HIV drugs
prototype CCR5 antagonist drug maraviroc (Selzentry)
adverse effects of CCR5 antagonists CNS symptoms (dizziness, sleep disorders, paresthesias) musculoskeletal pain, cough, upper respiratory infections, liver damage, allergic reaction (rash)
interventions for CCR5 antagonists monitor for & report persistent CNS symptoms, medicate with analgesic if prescribed for musculoskeletal symptoms, monitor for respiratory symptoms, monitor & report rash/abdominal pain/jaundice
instructions for CCR5 antagonists report dizziness/insomnia/numbness, avoid hazardous activities, report persistent musculoskeletal pain, report cough/fever/upper respiratory symptoms (sinus infection), report onset of itch rash/loss of appetite, notify before taking any new OTC drug
enzyme inhibitors include NRTIs, NNRTIs, integrase inhibitor, protease inhibitors
indications for NRTIs symptoms of HIV infection, prevention of maternal HIV transmission to fetus
prototype NRTIs drug zidovudine (Retrovir, ZDV)
adverse effects of NRTIs bone marrow suppression (severe anema & neutropenia), N/V/D, abdominal pain, headache, insomnia, dizziness, fever, muscle aches
interventions for NRTIs bone marrow suppression (baseline hemoglobin & neutrophil), transfuse packed RBC as needed, report weight loss, monitor for CNS effects/fever/myalgia & treat with mild analgesics
instructions for NRTIs report increase in fatigue/pallor/fever/onset of infection, adhere to monthly blood sampling, report persistent GI symptoms, report persistent headache/insomnia/dizziness, report fever & myalgia, notify before taking any new OTC drugs
indications for NNRTIs symptoms of HIV-1 infection
prototype NNRTI drug delavirdine (Rescriptor, DLV)
adverse effects of NNRTIs rash (frequent), N/V/D, elevated liver enzymes
interventions for NNRTIs monitor for & report rash, rash that occurs along with fever/lesions in mouth & eyes/blisters/muscle pain requires stopping drug, report persistent GI effects, monitor weight (report significant decrease), periodic liver function tests
instructions for NNRTIs report rash and pruritis, report persistent N/V/D, notify before taking any new OTC drugs
indications for Integrase inhibitors HIV-1 resistant to over HIV drugs
prototype Integrase inhibitor drug raltegravir (Isentress)
adverse effects of Integrase inhibitors N/V/D, dizziness, headache
interventions for Integrase inhibitors monitor for persistent or intolerable GI symptoms, monitor for CNS symptoms
administration of Integrase inhibitors oral, must be combined with other HIV drugs, with or without food
instructions for Integrase inhibitors report persistent N/V/D, report dizziness & headache, take analgesic if prescribed for headache, avoid hazardous activities until effects are known
indications for protease inhibitors HIV-1 & HIV-2 in combination with reverse trascriptase inhibitor to prevent resistance, increase therapeutic effects of other antiretroviral drugs
prototype protease inhibitor drug ritonavir (Norvir) other: saquinavir (Invirase)
adverse effects of protease inhibitors hyperglycemia & diabetes, fat redistribution (thin extremities, face, & buttocks, increased abdominal fat, gynecomastia, buffalo hump), increased cholesterol & triglyceride levels, reduced bone density, liver toxicity, N/V/D/C, heartburn
interventions for protease inhibitors monitor for hyperglycemia (baseline & monitor blood glucose), monitor for fat redistribution, give prescribed anticholesterol drugs if prescribed, monitor bone density, monitor liver toxicity (baseline tests and monitor), monitor weight
instructions for protease inhibitors report increased thirst/hunger/urination, warn about fat redistribution, compliance with lipid profile every few months, increase intake of calcium & vitamin D, weight bearing exercises, avoid smoking, compliance with liver function tests
Created by: twohlers