University of the Philippines Manila

COLLEGE OF NURSING
Pedro Gil St., Malate, Manila

DRUG STUDY

Name of Student: Cruz, Jessica Mae C.

DRUG TRADE/ PHARMACOL INDICATIONS AND CONTRA- ADVERSE EFFECTS DESIRED ACTION ON NURSING RESPONSIBILITIES/ PRECAUTIONS
ORDER BRAND OGIC ACTION INDICATIONS OF THE DRUG THE CLIENT
NAME OF DRUG
Omeprazol Omepron Gastric acid- INDICATIONS: CNS: Headache, Treatment of active Assessment
e 20mg tab pump inhibitor: dizziness, asthenia, benign gastric ulcer
OD Suppresses Short-term treatment of active vertigo, insomnia, History: Hypersensitivity to omeprazole or any of its
gastric acid duodenal ulcer; First-line therapy in apathy, anxiety, components; pregnancy, lactation
secretion by treatment of heartburn or symptoms paresthesias, dream
specific of gastroesophageal reflux disease abnormalities
inhibition of Physical: Skin lesions; T; reflexes, affect; urinary output,
(GERD); Short-term treatment of abdominal exam; respiratory auscultation
the hydrogen- active benign gastric ulcer; GERD, Dermatologic: Rash,
potassium severe erosive esophagitis, poorly inflammation,
ATPase enzyme responsive symptomatic GERD; Long- urticaria, pruritus, Interventions
system at the term therapy: Treatment of pathologic alopecia, dry skin
secretory hypersecretory conditions (Zollinger- Administer before meals. Caution patient to swallow
surface of the Ellison syndrome, multiple adenomas, capsules whole—not to open, chew, or crush them.
gastric parietal GI: Diarrhea,
systemic mastocytosis); Eradication of abdominal pain,
cells; blocks H. pylori with amoxicillin or
the final step nausea, vomiting, Arrange for further evaluation of patient after 8 wk of
metronidazole and clarithromycin; constipation, dry therapy for gastroreflux disorders; not intended for
of acid Prilosec OTC: Treatment of frequent
production. mouth, tongue maintenance therapy. Symptomatic improvement does not
heartburn (2 or more days per wk); atrophy rule out gastric cancer, which did occur in preclinical
Unlabeled use: Posterior laryngitis; studies.
enhance efficacy of pancreatin for the
treatment of steatorrhea in cystic Respiratory: URI
fibrosis symptoms, cough, Administer antacids with omeprazole, if needed.
epistaxis
CONTRAINDICATIONS: Teaching points
Contraindicated with hypersensitivity Other: Cancer in
to omeprazole or its components; preclinical studies, Take the drug before meals. Swallow the capsules whole;
Use cautiously with pregnancy, back pain, fever do not chew, open, or crush them. This drug will need to be
lactation. taken for up to 8 wk (short-term therapy) or for a prolonged
period (> 5 yr in some cases).

Have regular medical follow-up visits.

These side effects may occur: Dizziness (avoid driving or

performing hazardous tasks); headache (request
medications); nausea, vomiting, diarrhea (maintain proper
nutrition); symptoms of upper respiratory tract infection,
cough (do not self-medicate; consult with your health care
provider if uncomfortable).

Report severe headache, worsening of symptoms, fever,

 chills.
Tramadol Tramadol Has an Indication: CNS: SEIZURES, Relief from pain History: Hypersensitivity to tramadol; pregnancy; acute
50mg tab 1 analgesic Moderate to severe pain. dizziness, headache, intoxication with alcohol, opioids, psychotropic drugs or
tab q6h effect in all the somnolence, anxiety, other centrally acting analgesics; lactation; seizures;
RTC usual test Contraindicated in: CNS stimulation, concomitant use of CNS depressants or MAOIs; renal or
models for confusion, coordination hepatic impairment; past or present history of opioid
centrally acting disturbance, euphoria, addiction
analgesics. On  Hypersensitivity malaise, nervousness,
parenteral  Cross-sensitivity with opioids may sleep disorder, Physical Exam: Skin color, texture, lesions; orientation,
administration, occur weakness. reflexes, bilateral grip strength, affect; P, auscultation, BP;
the intensity of  Patients who are acutely EENT: visual bowel sounds, normal output; liver and kidney function
the effect is intoxicated with alcohol, disturbances. tests
equivalent to sedative/hypnotics, centrally CV: vasodilation.
that of other acting analgesics, opioid GI: constipation,
opioid nausea, abdominal Control environment (temperature, lighting) if sweating or
analgesics, or psychotropic agents
analgesics eg, pain, anorexia, CNS effects occur.
 Patients who are physically
Pentazocine dependent on opioids (may diarrhea, dry mouth,
and pethidine. precipitate withdrawal) dyspepsia, flatulence, Teaching points
The onset of vomiting.
activity is rapid  Not recommended for use during GU: menopausal
pregnancy or lactation. Limit use in patients with past or present history of
and the symptoms, urinary addiction to or dependence on opioids.
duration of the retention/frequency.
effect is similar Use Cautiously in: Derm: pruritus,
to that of sweating. These side effects may occur: Dizziness, sedation,
morphine. Neuro: hypertonia. drowsiness, impaired visual acuity (avoid driving or
 Geriatric patients (not to exceed performing tasks that require alertness); nausea, loss of
Tramadol HCL Misc: physical
300 mg/day in patients >75 yr) appetite (lie quietly, eat frequent small meals).
is a pure dependence,
agonist. The  Patients with a history of epilepsy psychological
morphine or risk factors for seizures dependence, Report severe nausea, dizziness, severe constipation
antagonist,  Renal impairment (increased tolerance.
naloxone, dosing interval recommended if
neutralizes the CCr >30 ml/min)
analgesic  Hepatic impairment (increased
effect. interval recommended in patients
with cirrhosis)
 Patients receiving MAO inhibitors
or CNS depressants
 Increased intracranial pressure or
head trauma
 Acute abdomen (may preclude
accurate clinical assessment)
 Patients with a history of opioid
dependence or who have recently
received large doses of opioids
 Children <16 yr (safety not
established).

Amlodipine Norvasc Inhibits the Indications: CNS: Dizziness, light- Management of Assessment
10mg/tab movement of headedness, essential HPN
OD po calcium ions headache, asthenia,
across the Angina pectoris due to coronary artery fatigue, lethargy History: Allergy to amlodipine, impaired hepatic or renal
membranes of spasm (Prinzmetal's variant angina) function, sick sinus syndrome, heart block, lactation, CHF
cardiac and CV: Peripheral edema,
arterial muscle arrhythmias
cells; inhibits Chronic stable angina, alone or in Physical: Skin lesions, color, edema; P, BP, baseline ECG,
transmembran combination with other agents peripheral perfusion, auscultation; R, adventitious sounds;
e calcium flow, Dermatologic: liver evaluation, GI normal output; liver and renal function
which results Essential hypertension, alone or in Flushing, rash tests, urinalysis
in the combination with other
depression of antihypertensives GI: Nausea, abdominal Interventions
impulse discomfort
formation in Contraindications: Monitor patient carefully (BP, cardiac rhythm, and output)
specialized while adjusting drug to therapeutic dose; use special
cardiac Contraindicated with allergy to caution if patient has CHF.
pacemaker amlodipine, impaired hepatic or renal
cells, slowing function, sick sinus syndrome, heart
of the velocity Monitor BP very carefully if patient is also on nitrates.
block (second or third degree),
of conduction lactation.
of the cardiac Use cautiously with CHF, pregnancy. Monitor cardiac rhythm regularly during stabilization of
impulse, dosage and periodically during long-term therapy.
depression of
myocardial Administer drug without regard to meals.
contractility,
and dilation of
coronary Teaching points
arteries and
arterioles and Take with meals if upset stomach occurs.
peripheral
arterioles; These side effects may occur: Nausea, vomiting (eat small,
these effects frequent meals); headache (adjust lighting, noise, and
lead to temperature; medication may be ordered).
decreased
cardiac work,
decreased Report irregular heartbeat, shortness of breath, swelling of
cardiac oxygen the hands or feet, pronounced dizziness, constipation.
consumption,
and in patients
with
vasospastic
(Prinzmetal's)
angina,
increased
delivery of
oxygen to
cardiac cells.
Doxofylline Doxofylli Indications: Nausea, vomiting Treatment of Caution:
400mg ½ ne Bronchial asthma and pulmonary epigastric pain, pulmonary disease Liver disease, CHF, chronic obstructive lung disease,
tab BID disease with spastic bronchial cephalalgia, irritability, with spastic bronchial concomitant infections, pregnancy
component insomnia, tachycardia, component
extrasystole,
Contraindications: tachypnea,
Acute MI, hypotension, lactation hyperglycemia,
 albuminuria

Etoricoxib Etoricoxi Indications: Asthenia/fatigue, Relief of chronic pain Special precautions:

90mg/tab b Acute and chronic treatment of dizziness, lower Advanced renal disease, preexisting edema, hypertension
OD osteoarthritis and RA. Treatment of extremity edema, HPN, or heart failure, liver dysfunction, previous acute asthmatic
acute gouty arthritis and primary dyspepsia, heartburn, attacks, urticaria or rhinitis precipitated by salicylates or
dysmenorrhea. Relief of acute and nausea, increased non selective COX inhibitors
chronic pain ALT/AST
Metoclopra Metoclop Stimulates Indications CNS: Restlessness, Prevention of nausea Assessment
mide 10mg ramide motility of drowsiness, fatigue, and vomiting
IV q8h upper GI tract Relief of symptoms of acute and lassitude, insomnia, associated with History: Allergy to metoclopramide, GI hemorrhage,
without recurrent diabetic gastroparesis extrapyramidal emetogenic cancer mechanical obstruction or perforation, pheochromocytoma,
stimulating reactions, chemotherapy epilepsy, lactation, previously detected breast cancer
gastric, biliary, parkinsonism-like
or pancreatic Short-term therapy (4–12 wk) for reactions, akathisia,
secretions; adults with symptomatic dystonia, myoclonus, Physical: Orientation, reflexes, affect; P, BP; bowel
appears to gastroesophageal reflux who fail to dizziness, anxiety sounds, normal output; EEG
sensitize respond to conventional therapy
tissues to CV: Transient Interventions
action of Parenteral: Prevention of nausea and hypertension
acetylcholine; vomiting associated with emetogenic Monitor BP carefully during IV administration.
relaxes pyloric cancer chemotherapy
sphincter, GI: Nausea, diarrhea
which, when Monitor for extrapyramidal reactions, and consult physician
Prophylaxis of postoperative nausea if they occur.
combined with and vomiting when nasogastric suction
effects on is undesirable
motility, Monitor diabetic patients, arrange for alteration in insulin
accelerates dose or timing if diabetic control is compromised by
gastric Single-dose parenteral use: Facilitation alterations in timing of food absorption.
emptying and of small-bowel intubation when tube
intestinal does not pass the pylorus with
conventional maneuvers Keep diphenhydramine injection readily available in case
transit; little extrapyramidal reactions occur (50 mg IM).
effect on
gallbladder or Single-dose parenteral use: Stimulation
colon motility; of gastric emptying and intestinal Have phentolamine readily available in case of
increases lower transit of barium when delayed hypertensive crisis (most likely to occur with undiagnosed
esophageal emptying interferes with radiologic pheochromocytoma).
sphincter exam of the stomach or small intestine
pressure; has Teaching points
sedative Unlabeled uses: Improvement of
properties; lactation (doses of 30–45 mg/day); Take this drug exactly as prescribed.
induces treatment of nausea and vomiting of a
release of variety of etiologies: emesis during
prolactin. Do not use alcohol, sleep remedies, sedatives; serious
pregnancy and labor, gastric ulcer, sedation could occur.
anorexia nervosa
These side effects may occur: Drowsiness, dizziness (do not
Contraindications and cautions drive or perform other tasks that require alertness);
restlessness, anxiety, depression, headache, insomnia
Contraindicated with allergy to (reversible); nausea, diarrhea.
metoclopramide; GI hemorrhage,
mechanical obstruction or perforation;
pheochromocytoma (may cause
 hypertensive crisis); epilepsy. Report involuntary movement of the face, eyes, or limbs,
severe depression, severe diarrhea.
Use cautiously with previously
detected breast cancer (one third of
such tumors are prolactin dependent);
lactation, pregnancy.

Ceftriaxone Ceftriaxo Bind to the Indications: CNS: SEIZURES(high Treatment of IV: Monitor injection site frequently for phlebitis (pain,
2g IV OD ne bacterial cell doses). respiratory tract redness, swelling). Change sites every 48–72 hr to prevent
(-)ANST wall membrane, Skin and skin structure infections; GI: infection phlebitis.
causing cell Bone and joint infections; Urinary and PSEUDOMEMBRANOUS
death. gynecologic infections including COLITIS, diarrhea, Intermittent Infusion: Reconstitute each 250-mg vial
gonorrhea or respiratory tract nausea, vomiting, with 2.4 ml, each 500-mg vial with 4.8 ml, each 1-g vial
infections; Intra-abdominal infections; cramps, pseudolithiasis with 9.6 ml, and each 2-g vial with 19.2 ml of sterile water
Septicemia (ceftriaxone). for injection, 0.9% NaCl, or D5W for a concentration of 100
Derm: rashes, mg/ml. Solution may be further diluted in 50–100 ml of
urticaria. 0.9% NaCl, D5W, D10W, D5/0.45% NaCl, or LR. Solution
Contraindicated in: Hemat: bleeding, may appear light yellow to amber. Solution is stable for 3
blood dyscrasias, days at room temperature.
Hypersensitivity to cephalosporins; hemolytic anemia.
Serious hypersensitivity to penicillins; Local: pain at IM site,
Hypersensitivity to L-arginine (Ceptaz phlebitisat IV site. Rate: Administer over 15–30 min in adults and 10–30 min
formulation only); Carnitine deficiency Misc: allergic in newborns or children.
or inborn errors of metabolism reactions including
(cefditoren only). ANAPHYLAXIS and PATIENT/FAMILY TEACHING
SERUM SICKNESS,
superinfection. Instruct patient to take medication at evenly spaced times
and to finish the medication completely, even if feeling
better. Missed doses should be taken as soon as possible
unless almost time for next dose; do not double doses.
Advise patient that sharing of this medication may be
dangerous.

Advise patient to report signs of superinfection (furry

overgrowth on the tongue, vaginal itching or discharge,
loose or foul-smelling stools) and allergy.

Caution patients that concurrent use of alcohol with

cefoperazone may cause a disulfiram-like reaction
(abdominal cramps, nausea, vomiting, headache,
hypotension, palpitations, dyspnea, tachycardia, sweating,
flushing). Alcohol and alcohol-containing medications
should be avoided during and for several days after
therapy.

Instruct patient to notify health care professional if fever

and diarrhea develop, especially if stool contains blood,
pus, or mucus. Advise patient not to treat diarrhea without
consulting health care professional.
Captopril Catapres Blocks ACE Indications CV: Tachycardia, Management of HPN Assessment
25mg/tab s from angina pectoris, MI,
1tab NGT converting Treatment of hypertension alone or in Raynaud's syndrome, History: Allergy to captopril, history of angioedema,
prn (if angiotensin I to combination with thiazide-type CHF, hypotension in impaired renal function, CHF, salt or volume depletion,
BP>160/10 angiotensin II, diuretics; Treatment of CHF in patients salt- or volume- pregnancy, lactation
0) a powerful unresponsive to conventional therapy; depleted patients
vasoconstrictor used with diuretics and digitalis;
, leading to Physical: Skin color, lesions, turgor; T; P, BP, peripheral
Treatment of diabetic nephropathy; Dermatologic: Rash, perfusion; mucous membranes, bowel sounds, liver
decreased Treatment of left ventricular pruritus, pemphigoid-
blood pressure, evaluation; urinalysis, renal and liver function tests, CBC
dysfunction after MI; Unlabeled uses: like reaction, scalded and differential
decreased Management of hypertensive crises; mouth sensation,
aldosterone treatment of rheumatoid arthritis; exfoliative dermatitis,
secretion, a diagnosis of anatomic renal artery photosensitivity, Interventions
small increase stenosis, hypertension related to alopecia
in serum scleroderma renal crisis; diagnosis of Administer 1 hr before or 2 hr after meals.
potassium primary aldosteronism, idiopathic
levels, and GI: Gastric irritation,
edema; Bartter's syndrome; Raynaud's aphthous ulcers, Alert surgeon and mark patient's chart with notice that
sodium and syndrome
fluid loss; peptic ulcers, captopril is being taken; the angiotensin II formation
increased dysgeusia, cholestatic subsequent to compensatory renin release during surgery
prostaglandin Contraindications and cautions jaundice, will be blocked; hypotension may be reversed with volume
synthesis also hepatocellular injury, expansion.
may be Contraindicated with allergy to anorexia, constipation
involved in the captopril, history of angiodema; Use Monitor patient closely for fall in BP secondary to reduction
antihypertensi cautiously with impaired renal GU: Proteinuria, renal in fluid volume (excessive perspiration and dehydration,
ve action. function; CHF; salt or volume insufficiency, renal vomiting, diarrhea); excessive hypotension may occur.
depletion, lactation, pregnancy. failure, polyuria,
oliguria, urinary Reduce dosage in patients with impaired renal function.
frequency
Teaching points
Hematologic:
Neutropenia,
agranulocytosis, Take drug 1 hr before or 2 hr after meals; do not take with
thrombocytopenia, food. Do not stop without consulting your health care
hemolytic anemia, provider.
pancytopenia
Be careful of drop in blood pressure (occurs most often with
Other: Cough, diarrhea, sweating, vomiting, dehydration); if light-
malaise, dry mouth, headedness or dizziness occurs, consult your health care
lymphadenopathy provider.

Avoid over-the-counter medications, especially cough, cold,

allergy medications that may contain ingredients that will
interact with ACE inhibitors. Consult your health care
provider.

These side effects may occur: GI upset, loss of appetite,

change in taste perception (limited effects, will pass);
mouth sores (perform frequent mouth care); rash; fast
heart rate; dizziness, light-headedness (usually passes
after the first few days; change position slowly, and limit
 your activities to those that do not require alertness and
precision).

Report mouth sores; sore throat, fever, chills; swelling of

the hands, feet; irregular heartbeat, chest pains; swelling
of the face, eyes, lips, tongue, difficulty breathing.

Cisplatin Cisplatin Inhibits DNA Indications CNS: SEIZURES, Chemotherapeutic ASSESSMENT

synthesis by malaise, weakness. agent used in the
producing Alone or in combination (with other EENT: ototoxicity, management of lung Monitor blood pressure, pulse, respiratory rate, and
cross-linking of antineoplastics, surgery, or radiation) tinnitus. cancer temperature frequently during administration. Report
parent DNA in the management of: Metastatic GI: severe nausea, significant changes.
strands (cell- testicular and ovarian carcinoma; vomiting, diarrhea,
cycle phase– Advanced bladder cancer; Head and hepatotoxicity.
nonspecific). GU: nephrotoxicity, Monitor intake and output and specific gravity frequently
neck cancer; Cervical cancer; Lung throughout therapy. Report discrepancies immediately. To
cancer; Other tumors. sterility.
Derm: alopecia. reduce the risk of nephrotoxicity, a urinary output of at
Therapeutic least 100 ml/hr should be maintained for 4 hr before
Effects: Death F and E:
Contraindicated in: hypocalcemia, initiating and for at least 24 hr after administration.
of rapidly
replicating hypokalemia,
cells, Hypersensitivity; Pregnancy or hypomagnesemia. Encourage patient to drink 2000–3000 ml/day to promote
particularly lactation. Hemat: LEUKOPENIA, excretion of uric acid. Allopurinol and alkalinization of the
malignant THROMBOCYTOPENIA, urine may be used to help prevent uric acid nephropathy.
ones. Use Cautiously in: anemia.
Local: phlebitis at IV Assess patency of IV site frequently during therapy.
site. Cisplatin may cause severe irritation and necrosis of tissue
Hearing loss; Renal impairment Metab:
(dosage reduction recommended); if extravasation occurs. If a large amount of highly
hyperuricemia. concentrated cisplatin solution extravasates, mix 4 ml of
Congestive heart failure; Electrolyte Neuro: peripheral
abnormalities; Active infections; Bone 10% sodium thiosulfate with 6 ml of sterile water or 1.6 ml
neuropathy. of 25% sodium thiosulfate with 8.4 ml of sterile water and
marrow depression; Chronic Misc: anaphylactoid
debilitating illnesses; Patients with inject 1–4 ml (1 ml for each ml extravasated) through
reactions. existing line or cannula. Inject SC if needle has been
childbearing potential.
removed. Sodium thiosulfate inactivates cisplatin.

Severe and protracted nausea and vomiting usually occur

1–4 hr after a dose; vomiting may last for 24 hr. Parenteral
antiemetic agents should be administered 30–45 min
before therapy and routinely around the clock for the next
24 hr. Monitor amount of emesis and notify physician or
other health care professional if emesis exceeds guidelines
to prevent dehydration. Nausea and anorexia may persist
for up to 1 wk.

Monitor for bone marrow depression.Assess for bleeding

(bleeding gums, bruising, petechiae, stools, urine, and
emesis) and avoid IM injections and taking rectal
temperatures if platelet count is low. Apply pressure to
venipuncture sites for 10 min. Assess for signs of infection
during neutropenia. Anemia may occur. Monitor for
increased fatigue, dyspnea, and orthostatic hypotension.

Monitor for signs of anaphylaxis (facial edema, wheezing,

dizziness, fainting, tachycardia, hypotension). Discontinue
medication immediately and report symptoms. Epinephrine
and resuscitation equipment should be readily available.

Medication may cause ototoxicity and neurotoxicity. Assess

patient frequently for dizziness, tinnitus, hearing loss, loss
of coordination, loss of taste, or numbness and tingling of
extremities; may be irreversible. Notify physician or other
health care professional promptly if these occur.
Audiometry should be performed before initiation of
therapy and before subsequent doses. Hearing loss is more
frequent with children and usually occurs first with high
frequencies and may be unilateral or bilateral.

Monitor inadvertent cisplatin overdose. Doses >100

mg/m2/cycle once every 3–4 wk are rarely used.
Differentiate daily doses from total dose/cycle. Symptoms
of high cumulative doses include muscle cramps (localized,
painful involuntary skeletal muscle contractions of sudden
onset ad short duration) and are usually associated with
advanced stages of peripheral neuropathy.

Lab Test Considerations: Monitor CBC with differential

and platelet count before and routinely throughout course
of therapy. The nadir of leukopenia, thrombocytopenia, and
anemia occurs within 18–23 days and recovery 39 days
after a dose. Withhold further doses until WBC is
>4000/mm3 and platelet count is >100,000/mm3.

Monitor BUN, serum creatinine, and CCr before initiation of

therapy and before each course of cisplatin to detect
nephrotoxicity. May cause increased BUN and creatinine
and decreased calcium, magnesium, phosphate, sodium,
and potassium levels that usually occur the 2nd wk after a
dose. Do not administer additional doses until BUN is <25
mg/100 ml and serum creatinine is <1.5 mg/100 ml. May
cause increased uric acid level, which usually peaks 3–5
days after a dose.

May cause transiently increased serum bilirubin and AST

concentrations.

May cause positive Coombs' test result.

POTENTIAL NURSING DIAGNOSES

Infection, risk for (Adverse Reactions).

Injury, risk for (Side Effects).

Knowledge deficit, related to medication regimen

(Patient/Family Teaching).

IMPLEMENTATION

General Info: Do not confuse with carboplatin. To prevent

confusion, orders should include generic and brand names.

Cisplatin should be administered under the supervision of a

physician experienced in the use of cancer
chemotherapeutic agents.

Hydrate patient with at least 1–2 liters of IV fluid 8–12 hr

before initiating therapy with cisplatin. Amifostine may be
administered to minimize nephrotoxicity.

Do not use aluminum needles or equipment during

preparation or administration. Aluminum reacts with this
drug, forms a black or brown precipitate, and renders the
drug ineffective.

Unopened vials of powder and constituted solution must

not be refrigerated.

Solution should be prepared in a biologic cabinet. Wear

gloves, gown, and mask while handling medication. If
powder or solution comes in contact with skin or mucosa,
wash thoroughly with soap and water. Discard equipment
in specially designated containers.

Intermittent Infusion: Reconstitute 10-mg vials with 10

ml of sterile water for injection and 50-mg vial with 50 ml.
Stable for 20 hr if reconstituted with sterile water, for 72 hr
with bacteriostatic water. Do not refrigerate, because
crystals will form. Solution should be clear and colorless;
discard if turbid or if it contains precipitates.

Dilution in 2 liters of 5% dextrose in 0.3% or 0.45% NaCl

containing 37.5 g of mannitol is recommended.

Rate: Infuse over 6–8 hr.

Continuous Infusion: Has been administered as

continuous infusion over 24 hr to 5 days with resultant
 decrease in nausea and vomiting. Clarify dose to ensure
cumulative dosage is not confused with daily dose; errors
may be fatal.

PATIENT/FAMILY TEACHING

Instruct patient to report pain at injection site immediately.

Instruct patient to notify health care professional promptly

if fever; chills; cough; hoarseness; sore throat; signs of
infection; lower back or side pain; painful or difficult
urination; bleeding gums; bruising; petechiae; blood in
stools, urine, or emesis; increased fatigue; dyspnea; or
orthostatic hypotension occurs. Caution patient to avoid
crowds and persons with known infections. Instruct patient
to use soft toothbrush and electric razor and to avoid falls.
Caution patient not to drink alcoholic beverages or take
medication containing aspirin or NSAIDs; may precipitate
gastric bleeding.

Instruct patient to report promptly any numbness or

tingling in extremities or face, difficulty with hearing or
tinnitus, unusual swelling, or joint pain.

Instruct patient not to receive any vaccinations without

advice of health care professional.

Advise patient of the need for contraception, although

cisplatin may cause infertility.

Emphasize the need for periodic lab tests to monitor for

side effects.

EVALUATION

Decrease in size or spread of malignancies. Therapy should

not be administered more frequently than every 3–4 wk,
and only if lab values are within acceptable parameters
and patient is not exhibiting signs of ototoxicity or other
serious adverse effects.

Etoposide Etoposid Damages DNA INDICATIONS CNS: drowsiness, Chemotherapeutic ASSESSMENT

e before mitosis fatigue, headache, agent used in the
(cycle- Alone and in combination with other vertigo. management of lung Monitor blood pressure before and every 15 min during
dependent and treatment modalities (other Resp: PULMONARY cancer infusion. If hypotension occurs, stop infusion and notify
phase- antineoplastics, radiation therapy, EDEMA, physician or other health care professional. After stabilizing
specific). surgery) in the management of: bronchospasm. blood pressure with IV fluids and supportive measures,

Therapeutic Refractory testicular neoplasms; Small
Effects: Death cell lung carcinoma.
of rapidly
replicating Unlabelled Uses: Lymphomas and
cells,
some leukemias.
particularly
malignant
Contraindicated in: Hypersensitivity;
ones.
Pregnancy; Lactation; Known
intolerance to benzyl alcohol, ethyl
alcohol, polyethylene glycol (IV
etoposide only), or dextran (IV
etoposide phosphate only).
Use Cautiously in: Patients with
childbearing potential; Active
infections; Decreased bone marrow
reserve; Renal/hepatic impairment
(dosage modification may be
necessary); Other chronic debilitating
illnesses.
CV: CHF, MI,
hypotension (IV). infusion may be resumed at slower rate.
GI: nausea, vomiting.
Derm: alopecia.
Endo: sterility. Monitor for hypersensitivity reaction (fever, chills, pruritus,
urticaria, bronchospasm, tachycardia, hypotension). If
Hemat: leukopenia,
thrombocytopenia. these occur, stop infusion and notify physician. Keep
epinephrine, an antihistamine, corticosteroids, volume
Local: phlebitis at IV
site. expanders, and resuscitative equipment close by in the
event of an anaphylactic reaction.
MS: muscle cramps.
Neuro: peripheral
neuropathy. Assess for signs of infection (fever, chills, cough,
Misc: allergic hoarseness, lower back or side pain, sore throat, difficult or
reactions including painful urination). Notify physician if these symptoms
ANAPHYLAXIS, fever occur.
Assess for bleeding (bleeding gums, bruising, petechiae,
guaiac test stools, urine, and emesis). Avoid IM injections
and taking rectal temperatures. Apply pressure to
venipuncture sites for 10 min.
Monitor intake and output, appetite, and nutritional intake.
Etoposide causes nausea and vomiting in 30% of patients.
Prophylactic antiemetics may decrease frequency and
duration of nausea and vomiting.
Adjust diet as tolerated to help maintain fluid and
electrolyte balance and nutritional status.
Lab Test Considerations: Monitor CBC and differential
before and periodically throughout therapy. The nadir of
leukopenia occurs in 7–14 days. Notify physician if
leukocyte count is <1000/mm3. The nadir of
thrombocytopenia occurs in 9–16 days. Notify physician if
the platelet count is <75,000/mm3. Recovery of leukopenia
and thrombocytopenia occurs in 20 days.
Monitor liver function studies (AST, ALT, LDH, bilirubin) and
renal function studies (BUN, creatinine) before and
periodically throughout therapy to detect hepatotoxicity
and nephrotoxicity.
May cause increased uric acid. Monitor levels periodically
during therapy.
POTENTIAL NURSING DIAGNOSES
Injury, risk for (Side Effects).
Infection, risk for (Side Effects).

Knowledge deficit, related to medication regimen

(Patient/Family Teaching).

IMPLEMENTATION

General Info: Avoid contact with skin. Use Luer-Lok tubing

to prevent accidental leakage. If contact with skin occurs,
immediately wash skin with soap and water.

Solution should be prepared in a biologic cabinet. Wear

gloves, gown, and mask while handling medication. Discard
equipment in designated containers .

PO: Capsules should be refrigerated.

Etoposide (VePesid)

Intermittent Infusion: Dilute 5-ml vial with 250–500 ml

of D5W or 0.9% NaCl for a concentration of 200–400
mcg/ml. The 200-mcg/ml solution is stable for 96 hr. The
400-mcg/ml solution is stable for 48 hr. Concentrations
>400 mcg/ml are not recommended, because
crystallization is likely. Discard solution if crystals are
present.

Rate: Infuse slowly over 30–60 min. Temporary

hypotension may occur with infusion rates shorter than 30
min.

PATIENT/FAMILY TEACHING

Instruct patient to take etoposide exactly as directed, even

if nausea or vomiting occurs. If vomiting occurs shortly
after dose is taken, consult physician. If a dose is missed,
do not take at all.

Advise patient to notify health care professional if fever;

chills; sore throat or other signs of infection; bleeding
gums; bruising; petechiae; or blood in urine, stool, or
emesis occurs. Caution patient to avoid crowds and
persons with known infections. Instruct patient to use soft
toothbrush and electric razor. Patient should be cautioned
not to drink alcoholic beverages or take products
containing aspirin or NSAIDs.

Instruct patient to notify health care professional if rapid

heartbeat, difficulty breathing, abdominal pain, yellow skin,
weakness, paresthesia, or gait disturbances occur.

Instruct patient to inspect oral mucosa for redness and

ulceration. If mouth sores occur, advise patient to use
sponge brush and rinse mouth with water after eating and
drinking. Viscous lidocaine swishes may be used if pain
interferes with eating. Stomatitis pain may require
treatment with opioid analgesics.

Discuss with patient the possibility of hair loss. Explore

coping strategies.

Advise patient to use contraception.

Instruct patient not to receive any vaccinations without

advice of physician.

Emphasize the need for periodic lab tests to monitor for

side effects.

EVALUATION

Decrease in size or spread of malignancies in solid tumors

Improvement of hematologic status in leukemias.