-
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.
Growth Factors
-
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.
oprelvekin (Neumega)
-
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)
ondansetron (Zofran)
-
What are the serious adverse effects associated with serotonin antagonists (Zofran) that make the patient a fall risk?
- Bradycardia
- Hypotension
- Vertigo
-
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
- fever
- chills
- rigors
- 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
- melanoma
- 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
higher doses
-
Interferons (a biologic response modifier) cause ?
peripheral neuropathy
-
Monoclonal antibodies (Rituxan) bind to
their target antigens
-
Monoclonal antibody therapy combines actions from
- immunotherapy
- 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)
-
Rituximab (Rituxan) works by binding with a protein on the surface of cancer cell membranes to prevent
cell division
-
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?
- NO!
- 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 ?
prostate cancer
-
An example of an androgen receptor blocker that blocks testosterone at the receptor site is ?
Flutamide (Eulexin)
-
Men taking flutamide should be warned about the following adverse effects related to decreased testosterone:
- hot flashes
- decreased libido
- gynecomastia
-
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.
Tamoxifen (Nolvadex)
-
A serious potential complication associated with tamoxifen
endometrial cancer
-
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.
Methotrexate (Trexall)
-
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)
Etanercept (Enbrel)
-
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?
IV
-
What severe skin reaction is associated with infliximab (Remicade)?
Stevens-Johnson
-
There are MANY adverse effects/complications associated with glucocorticoid use, name some
- Immunosuppression
- Osteoporosis
- Adrenal suppression – taper off
- Fluid retention
- Weight gain
- GI issues – take H2 blocker (Pepcid)
- Hyperglycemia
- Hypokalemia
-
What is the appropriate client education related to the complication of osteoporosis from steroids?
- Calcium and Vit D supplements
- Bisphosphonates
-
What are the nursing considerations related to the complications of fluid retention with steroid use?
- Monitor for S/S
- Weight gain
- Edema
- Crackles
-
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
gradually (tapered)
-
Clients taking glucocorticoids should be warned against abruptly discontinuing the glucocorticoid that can lead to ?
adrenal suppression
-
? is a monoclonal antibody medication used in the treatment of SLE
Belimumab (Benlysta)
-
How should Belimumab (Benlysta) be infused?
slowly over one hour
-
Infusion reaction to belimumab (Benlysta) may include:
- IV site erythema
- edema
- pruritus
- anaphylaxis
-
? is another DMARD that is also classified as an anti-malarial drug.
Plaquenil (Hydorxychloroquine)
-
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
Life-cycle
-
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
- dosages
-
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
- phlebitis
- nephrotoxicity
- N/D
- HA
- gingival hyperplasia
- bone marrow suppression
- fever
-
Ensuring that the patient is adequately hydrated before, during, and after the receiving acyclovir can reduce the risk of the complication
nephrotoxicity
-
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)
- crystalluria.
-
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)
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