What type of drugs are used to stimulate production of red blood cells and platelets is common in clients with chemotherapy-induced anemia and thrombocytopenia.
The growth factor, ? is used to stimulated red blood cells
Erythropoietin (Epogen, Procrit, Aranesp)
? is an example of a growth factor to stimulate the production of platelets.
Antiemetic medications to relieve chemotherapy-induced nausea and vomiting (CINV) are usually given when?
Name a Serotonin antagonists are a classification of medications used to treat CINV (Chemo-induced N/V)
What are the serious adverse effects associated with serotonin antagonists (Zofran) that make the patient a fall risk?
What education should you provide for the client on a serotonin antagonist to decrease his risk for a fall?
Change positions slowly
What do Biologic response modifiers (BRMs) modify?
the patient’s biologic responses to tumor cells
Two common types of biologic response modifiers (BRMs) used as cancer therapy are
Biologic response modifiers (BRMs) induce manifestations of inflammation during and just after drug administration including
- flu-like symptoms.
Clients receiving interleukins (a biologic response modifier) may experience ?
fluid shifts from the intravascular space to interstitial space (capillary leak syndrome); ultimately leading to hypotension and peripheral edema.
Interferons (a biologic response modifier) have been effective to some degree in the treatment of
- renal cell carcinoma
- ovarian cancer.
What do interferons (a biologic response modifier) do to cells?
slow tumor cell division
Adverse effects related to the administration of interferons (a biologic response modifier) are worse at
Interferons (a biologic response modifier) cause ?
Monoclonal antibodies (Rituxan) bind to
their target antigens
Monoclonal antibody therapy combines actions from
- targeted therapy
What is monoclonal (Rituxan )therapy used for?
combines the actions of immunotherapy and targeted therapy to help specific cancers
The most well-known monoclonal antibody agent is
Rituximab (Rituxan) works by binding with a protein on the surface of cancer cell membranes to prevent
During the administration of a monoclonal antibody agent (rituximab), a priority intervention for the nurse is to closely monitor for
an allergic reaction
Molecularly targeted therapies (Rituxan) work by targeting an overexpressed substance present on SOME cancer cells with the ultimate goal of
stopping the growth and progression of the cancer
Molecularly targeted therapies (Rituxan) work by ?
targeting an overexpressed substance present on SOME cancer cells
A molecularly targeted agent (Rituxan) will NOT work unless
the cancer cell overexpresses the actual substance that the agent can effectively target and disrupt
Will molecularly targeted therapy benefit ALL patients with the same type of cancer?
- The target therapy drugs will not work unless the cancer cell overexpresses the actual target substance
What are Tyrosine kinase inhibitors (TKIs)?
a classification of common targeted therapy agents used for cancer
What are the three most common adverse effects/complications associated with TKI use?
- Fluid retention
- electrolyte imbalances
- bone-marrow suppression
Hormonal agents are noncytoxic medications that are effective against tumors that are ? by hormones.
SUPPORTED or SUPPRESSED
Androgen receptor blockers are hormone antagonists used to suppress ?
An example of an androgen receptor blocker that blocks testosterone at the receptor site is ?
Men taking flutamide should be warned about the following adverse effects related to decreased testosterone:
- hot flashes
- decreased libido
Tamoxifen (Nolvadex) is an estrogen receptor antagonist that is mainly used for the treatment of
estrogen receptor-positive breast cancer
Name an estrogen receptor antagonist that is mainly used for the treatment of estrogen receptor-positive breast cancer.
A serious potential complication associated with tamoxifen
What specific education should the nurse provide a client regarding Tamoxifen (nolvadex)?
- Monitor for abnormal bleeding
- Annual GYN exam and PAP smear
? is a disease-modifying antirheumatic drug (DMARD) that has both cytoxic properties and immunomodular properties.
There are numerous potential adverse effects/complications related to methotrexate use, name some:
- Increased risk for infection
- Hepatic toxicity
- Ulcerative stomatitis
- Fetal death/congenital abnormalities
What laboratory tests should be monitored for a patient on methotrexate?
? is a DMARD that specifically works as a tumor necrosis factor antagonist (TFNA)
If signs and symptoms of an infection develop while a patient is on entanercept (Enbrel), the medication should be discontinued and the client tested for
Infliximab (Remicade) is also a TNFA. By what route is infliximab administered?
What severe skin reaction is associated with infliximab (Remicade)?
There are MANY adverse effects/complications associated with glucocorticoid use, name some
- Adrenal suppression – taper off
- Fluid retention
- Weight gain
- GI issues – take H2 blocker (Pepcid)
What is the appropriate client education related to the complication of osteoporosis from steroids?
- Calcium and Vit D supplements
What are the nursing considerations related to the complications of fluid retention with steroid use?
- Monitor for S/S
- Weight gain
What are the nursing considerations related to the complications of GI issues with steroid use?
- observe for S/S
- take H2 blocker (Pepcid, zantac…)
- watch for GI bleed (coffee ground emesis, black tarry stools)
What are the nursing considerations related to the complications of Hyperglycemia with steroid use?
- observe for S/S
- Monitor BS
- May need to adjust hypoglycemic meds
What are the nursing considerations related to the complications of Hypokalemia with steroid use?
- Observe for S/S
- Monitor potassium labs
- Increase potassium-rich foods
- Admin potassium supplements
The dosage of glucocorticoids is always adjusted and withdrawn
Clients taking glucocorticoids should be warned against abruptly discontinuing the glucocorticoid that can lead to ?
? is a monoclonal antibody medication used in the treatment of SLE
How should Belimumab (Benlysta) be infused?
slowly over one hour
Infusion reaction to belimumab (Benlysta) may include:
- IV site erythema
? is another DMARD that is also classified as an anti-malarial drug.
How does plaquenil decrease the risk of SLE-related skin lesions?
Decreases the absorption of ultraviolet light by the skin
What specific instructions regarding retinal damage with plaquenil, should the nurse provide the client?
- baseline eye exam prior to starting the med
- eye exam every 6 months
- stop med and notify provider if blurred vision
For HIV therapy - Fusion entry inhibitors and CCR5 antagonists act by:
preventing the virus from entering the cells
For HIV therapy NRTIs, NNRTIs, PIs, and INSTIs act by:
inhibiting enzymes needed for HIV replication.
The various classes of antiretroviral agents act on different stages of the HIV
Skipping doses OR taking decreased doses of antiretroviral medications can lead to
medication resistance and possible treatment failure.
Highly active antiretroviral therapy (HARRT, also called ART) involves using three-four antiretroviral medications in combination to reduce what?
- medication resistance
- adverse effects
The desired outcome of HAART is a reduction in the viral load and increase in ?
CD4 counts (immune system function)
There are MANY adverse effects associated with the use of antiretroviral medications, name some
- gingival hyperplasia
- bone marrow suppression
Ensuring that the patient is adequately hydrated before, during, and after the receiving acyclovir can reduce the risk of the complication
Antiretrovirals are available as combination products. ? is an example of a combination product (cART).
Truvada (emtricitabine and tenofovir)
A common respiratory infection among people with HIV infection is ?
p jiroveci pneumonia
The treatment of choice for PCP (p jiroveci pneumonia) is ?
trimethoprim and sulfamethoxazole (Septra, Bactrim).
Adverse effects associated with trimethoprim and sulfamethoxazole include ?
- rash (Steven-Johnson Syndrome)
- blood dyscrasias (hemolytic anemia, leukopenia, and thrombocytopenia)
What should the nurse teach the patient in regard to adverse effects associated with trimethoprim and sulfamethoxazole?
- Stop drug if a rash develops
- Labs baseline and periodically (CBC, K+)
- Report bleeding, sore throat, pallor
- Increase fluid intake (8-8 oz water daily)
- Monitor urine output
- Skin and eyes for yellowing (jaundice)