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, Malate, Manila DRUG STUDY Name of Student: Cruz, Jessica Mae C. DRUG ORDER Omeprazol e 20mg tab OD TRADE/ BRAND NAME Omepron PHARMACOL OGIC ACTION OF DRUG Gastric acidpump inhibitor: Suppresses gastric acid secretion by specific inhibition of the hydrogenpotassium ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid production. INDICATIONS AND CONTRAINDICATIONS INDICATIONS: Short-term treatment of active duodenal ulcer; First-line therapy in treatment of heartburn or symptoms of gastroesophageal reflux disease (GERD); Short-term treatment of active benign gastric ulcer; GERD, severe erosive esophagitis, poorly responsive symptomatic GERD; Longterm therapy: Treatment of pathologic hypersecretory conditions (ZollingerEllison syndrome, multiple adenomas, systemic mastocytosis); Eradication of H. pylori with amoxicillin or metronidazole and clarithromycin; Prilosec OTC: Treatment of frequent heartburn (2 or more days per wk); Unlabeled use: Posterior laryngitis; enhance efficacy of pancreatin for the treatment of steatorrhea in cystic fibrosis CONTRAINDICATIONS: Contraindicated with hypersensitivity to omeprazole or its components; Use cautiously with pregnancy, lactation. ADVERSE EFFECTS OF THE DRUG CNS: Headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety, paresthesias, dream abnormalities Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin GI: Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue atrophy Respiratory: URI symptoms, cough, epistaxis Other: Cancer in preclinical studies, back pain, fever DESIRED ACTION ON THE CLIENT Treatment of active benign gastric ulcer NURSING RESPONSIBILITIES/ PRECAUTIONS Assessment History: Hypersensitivity to omeprazole or any of its components; pregnancy, lactation Physical: Skin lesions; T; reflexes, affect; urinary output, abdominal exam; respiratory auscultation Interventions Administer before meals. Caution patient to swallow capsules whole—not to open, chew, or crush them. Arrange for further evaluation of patient after 8 wk of therapy for gastroreflux disorders; not intended for maintenance therapy. Symptomatic improvement does not rule out gastric cancer, which did occur in preclinical studies. Administer antacids with omeprazole, if needed. Teaching points Take the drug before meals. Swallow the capsules whole; do not chew, open, or crush them. This drug will need to be 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,
Tramadol 50mg tab 1 tab q6h RTC
Has an analgesic effect in all the usual test models for centrally acting analgesics. On parenteral administration, the intensity of the effect is equivalent to that of other opioid analgesics eg, Pentazocine and pethidine. The onset of activity is rapid and the duration of the effect is similar to that of morphine. Tramadol HCL is a pure agonist. The morphine antagonist, naloxone, neutralizes the analgesic effect.
Indication: Moderate to severe pain. Contraindicated in:
Hypersensitivity Cross-sensitivity with opioids may occur Patients who are acutely intoxicated with alcohol, sedative/hypnotics, centrally acting analgesics, opioid analgesics, or psychotropic agents Patients who are physically dependent on opioids (may precipitate withdrawal) Not recommended for use during pregnancy or lactation.
Use Cautiously in:
Geriatric patients (not to exceed 300 mg/day in patients >75 yr) Patients with a history of epilepsy or risk factors for seizures Renal impairment (increased dosing interval recommended if CCr >30 ml/min) Hepatic impairment (increased 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).
CNS: SEIZURES, dizziness, headache, somnolence, anxiety, CNS stimulation, confusion, coordination disturbance, euphoria, malaise, nervousness, sleep disorder, weakness. EENT: visual disturbances. CV: vasodilation. GI: constipation, nausea, abdominal pain, anorexia, diarrhea, dry mouth, dyspepsia, flatulence, vomiting. GU: menopausal symptoms, urinary retention/frequency. Derm: pruritus, sweating. Neuro: hypertonia. Misc: physical dependence, psychological dependence, tolerance.
Relief from pain
chills. History: Hypersensitivity to tramadol; pregnancy; acute intoxication with alcohol, opioids, psychotropic drugs or other centrally acting analgesics; lactation; seizures; concomitant use of CNS depressants or MAOIs; renal or hepatic impairment; past or present history of opioid addiction Physical Exam: Skin color, texture, lesions; orientation, reflexes, bilateral grip strength, affect; P, auscultation, BP; bowel sounds, normal output; liver and kidney function tests Control environment (temperature, lighting) if sweating or CNS effects occur. Teaching points Limit use in patients with past or present history of addiction to or dependence on opioids. These side effects may occur: Dizziness, sedation, drowsiness, impaired visual acuity (avoid driving or performing tasks that require alertness); nausea, loss of appetite (lie quietly, eat frequent small meals). Report severe nausea, dizziness, severe constipation
Inhibits the movement of
CNS: Dizziness, lightheadedness,
Management of essential HPN
calcium ions across the membranes of cardiac and arterial muscle cells; inhibits transmembran e calcium flow, which results in the depression of impulse formation in specialized cardiac pacemaker cells, slowing of the velocity of conduction of the cardiac impulse, depression of myocardial contractility, and dilation of coronary arteries and arterioles and peripheral arterioles; these effects lead to decreased cardiac work, decreased cardiac oxygen consumption, and in patients with vasospastic (Prinzmetal's) angina, increased delivery of oxygen to cardiac cells. Doxofylli ne
Angina pectoris due to coronary artery spasm (Prinzmetal's variant angina) Chronic stable angina, alone or in combination with other agents Essential hypertension, alone or in combination with other antihypertensives Contraindications: Contraindicated with allergy to amlodipine, impaired hepatic or renal function, sick sinus syndrome, heart block (second or third degree), lactation. Use cautiously with CHF, pregnancy.
headache, asthenia, fatigue, lethargy CV: Peripheral edema, arrhythmias Dermatologic: Flushing, rash GI: Nausea, abdominal discomfort
History: Allergy to amlodipine, impaired hepatic or renal function, sick sinus syndrome, heart block, lactation, CHF Physical: Skin lesions, color, edema; P, BP, baseline ECG, peripheral perfusion, auscultation; R, adventitious sounds; liver evaluation, GI normal output; liver and renal function tests, urinalysis Interventions Monitor patient carefully (BP, cardiac rhythm, and output) while adjusting drug to therapeutic dose; use special caution if patient has CHF. Monitor BP very carefully if patient is also on nitrates. Monitor cardiac rhythm regularly during stabilization of dosage and periodically during long-term therapy. Administer drug without regard to meals. Teaching points Take with meals if upset stomach occurs. These side effects may occur: Nausea, vomiting (eat small, frequent meals); headache (adjust lighting, noise, and temperature; medication may be ordered). Report irregular heartbeat, shortness of breath, swelling of the hands or feet, pronounced dizziness, constipation.
Doxofylline 400mg ½ tab BID
Indications: Bronchial asthma and pulmonary disease with spastic bronchial component Contraindications: Acute MI, hypotension, lactation
Nausea, vomiting epigastric pain, cephalalgia, irritability, insomnia, tachycardia, extrasystole, tachypnea, hyperglycemia,
Treatment of pulmonary disease with spastic bronchial component
Caution: Liver disease, CHF, chronic obstructive lung disease, concomitant infections, pregnancy
albuminuria Etoricoxib 90mg/tab OD Etoricoxi b Indications: Acute and chronic treatment of osteoarthritis and RA. Treatment of acute gouty arthritis and primary dysmenorrhea. Relief of acute and chronic pain Indications Relief of symptoms of acute and recurrent diabetic gastroparesis Short-term therapy (4–12 wk) for adults with symptomatic gastroesophageal reflux who fail to respond to conventional therapy Parenteral: Prevention of nausea and vomiting associated with emetogenic cancer chemotherapy Prophylaxis of postoperative nausea and vomiting when nasogastric suction is undesirable Single-dose parenteral use: Facilitation of small-bowel intubation when tube does not pass the pylorus with conventional maneuvers Single-dose parenteral use: Stimulation of gastric emptying and intestinal transit of barium when delayed emptying interferes with radiologic exam of the stomach or small intestine Unlabeled uses: Improvement of lactation (doses of 30–45 mg/day); treatment of nausea and vomiting of a variety of etiologies: emesis during pregnancy and labor, gastric ulcer, anorexia nervosa Contraindications and cautions Contraindicated with allergy to metoclopramide; GI hemorrhage, mechanical obstruction or perforation; pheochromocytoma (may cause Asthenia/fatigue, dizziness, lower extremity edema, HPN, dyspepsia, heartburn, nausea, increased ALT/AST CNS: Restlessness, drowsiness, fatigue, lassitude, insomnia, extrapyramidal reactions, parkinsonism-like reactions, akathisia, dystonia, myoclonus, dizziness, anxiety CV: Transient hypertension GI: Nausea, diarrhea Monitor for extrapyramidal reactions, and consult physician if they occur. Monitor diabetic patients, arrange for alteration in insulin dose or timing if diabetic control is compromised by alterations in timing of food absorption. Keep diphenhydramine injection readily available in case extrapyramidal reactions occur (50 mg IM). Have phentolamine readily available in case of hypertensive crisis (most likely to occur with undiagnosed pheochromocytoma). Teaching points Take this drug exactly as prescribed. Do not use alcohol, sleep remedies, sedatives; serious sedation could occur. These side effects may occur: Drowsiness, dizziness (do not drive or perform other tasks that require alertness); restlessness, anxiety, depression, headache, insomnia (reversible); nausea, diarrhea. Relief of chronic pain Special precautions: Advanced renal disease, preexisting edema, hypertension or heart failure, liver dysfunction, previous acute asthmatic attacks, urticaria or rhinitis precipitated by salicylates or non selective COX inhibitors Assessment History: Allergy to metoclopramide, GI hemorrhage, mechanical obstruction or perforation, pheochromocytoma, epilepsy, lactation, previously detected breast cancer Physical: Orientation, reflexes, affect; P, BP; bowel sounds, normal output; EEG Interventions Monitor BP carefully during IV administration.
Metoclopra mide 10mg IV q8h
Stimulates motility of upper GI tract without stimulating gastric, biliary, or pancreatic secretions; appears to sensitize tissues to action of acetylcholine; relaxes pyloric sphincter, which, when combined with effects on motility, accelerates gastric emptying and intestinal transit; little effect on gallbladder or colon motility; increases lower esophageal sphincter pressure; has sedative properties; induces release of prolactin.
Prevention of nausea and vomiting associated with emetogenic cancer chemotherapy
hypertensive crisis); epilepsy. Use cautiously with previously detected breast cancer (one third of such tumors are prolactin dependent); lactation, pregnancy.
Report involuntary movement of the face, eyes, or limbs, severe depression, severe diarrhea.
Ceftriaxone 2g IV OD (-)ANST
Ceftriaxo Bind to the ne bacterial cell wall membrane, causing cell death.
Indications: Skin and skin structure infections; Bone and joint infections; Urinary and gynecologic infections including gonorrhea or respiratory tract infections; Intra-abdominal infections; Septicemia Contraindicated in: Hypersensitivity to cephalosporins; Serious hypersensitivity to penicillins; Hypersensitivity to L-arginine (Ceptaz formulation only); Carnitine deficiency or inborn errors of metabolism (cefditoren only).
CNS: SEIZURES(high doses). GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting, cramps, pseudolithiasis (ceftriaxone). Derm: rashes, urticaria. Hemat: bleeding, blood dyscrasias, hemolytic anemia. Local: pain at IM site, phlebitisat IV site. Misc: allergic reactions including ANAPHYLAXIS and SERUM SICKNESS, superinfection.
Treatment of respiratory tract infection
IV: Monitor injection site frequently for phlebitis (pain, redness, swelling). Change sites every 48–72 hr to prevent phlebitis. Intermittent Infusion: Reconstitute each 250-mg vial with 2.4 ml, each 500-mg vial with 4.8 ml, each 1-g vial with 9.6 ml, and each 2-g vial with 19.2 ml of sterile water for injection, 0.9% NaCl, or D5W for a concentration of 100 mg/ml. Solution may be further diluted in 50–100 ml of 0.9% NaCl, D5W, D10W, D5/0.45% NaCl, or LR. Solution may appear light yellow to amber. Solution is stable for 3 days at room temperature. Rate: Administer over 15–30 min in adults and 10–30 min in newborns or children. PATIENT/FAMILY TEACHING 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 25mg/tab 1tab NGT prn (if BP>160/10 0)
Blocks ACE from converting angiotensin I to angiotensin II, a powerful vasoconstrictor , leading to decreased blood pressure, decreased aldosterone secretion, a small increase in serum potassium levels, and sodium and fluid loss; increased prostaglandin synthesis also may be involved in the antihypertensi ve action.
Indications Treatment of hypertension alone or in combination with thiazide-type diuretics; Treatment of CHF in patients unresponsive to conventional therapy; used with diuretics and digitalis; Treatment of diabetic nephropathy; Treatment of left ventricular dysfunction after MI; Unlabeled uses: Management of hypertensive crises; treatment of rheumatoid arthritis; diagnosis of anatomic renal artery stenosis, hypertension related to scleroderma renal crisis; diagnosis of primary aldosteronism, idiopathic edema; Bartter's syndrome; Raynaud's syndrome Contraindications and cautions Contraindicated with allergy to captopril, history of angiodema; Use cautiously with impaired renal function; CHF; salt or volume depletion, lactation, pregnancy.
CV: Tachycardia, angina pectoris, MI, Raynaud's syndrome, CHF, hypotension in salt- or volumedepleted patients Dermatologic: Rash, pruritus, pemphigoidlike reaction, scalded mouth sensation, exfoliative dermatitis, photosensitivity, alopecia GI: Gastric irritation, aphthous ulcers, peptic ulcers, dysgeusia, cholestatic jaundice, hepatocellular injury, anorexia, constipation GU: Proteinuria, renal insufficiency, renal failure, polyuria, oliguria, urinary frequency Hematologic: Neutropenia, agranulocytosis, thrombocytopenia, hemolytic anemia, pancytopenia Other: Cough, malaise, dry mouth, lymphadenopathy
Management of HPN
Assessment History: Allergy to captopril, history of angioedema, impaired renal function, CHF, salt or volume depletion, pregnancy, lactation Physical: Skin color, lesions, turgor; T; P, BP, peripheral perfusion; mucous membranes, bowel sounds, liver evaluation; urinalysis, renal and liver function tests, CBC and differential Interventions Administer 1 hr before or 2 hr after meals. Alert surgeon and mark patient's chart with notice that captopril is being taken; the angiotensin II formation subsequent to compensatory renin release during surgery will be blocked; hypotension may be reversed with volume expansion. Monitor patient closely for fall in BP secondary to reduction in fluid volume (excessive perspiration and dehydration, vomiting, diarrhea); excessive hypotension may occur. Reduce dosage in patients with impaired renal function. Teaching points Take drug 1 hr before or 2 hr after meals; do not take with food. Do not stop without consulting your health care provider. Be careful of drop in blood pressure (occurs most often with diarrhea, sweating, vomiting, dehydration); if lightheadedness or dizziness occurs, consult your health care 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.
Inhibits DNA synthesis by producing cross-linking of parent DNA strands (cellcycle phase– nonspecific). Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.
Indications Alone or in combination (with other antineoplastics, surgery, or radiation) in the management of: Metastatic testicular and ovarian carcinoma; Advanced bladder cancer; Head and neck cancer; Cervical cancer; Lung cancer; Other tumors. Contraindicated in: Hypersensitivity; Pregnancy or lactation. Use Cautiously in: Hearing loss; Renal impairment (dosage reduction recommended); Congestive heart failure; Electrolyte abnormalities; Active infections; Bone marrow depression; Chronic debilitating illnesses; Patients with childbearing potential.
CNS: SEIZURES, malaise, weakness. EENT: ototoxicity, tinnitus. GI: severe nausea, vomiting, diarrhea, hepatotoxicity. GU: nephrotoxicity, sterility. Derm: alopecia. F and E: hypocalcemia, hypokalemia, hypomagnesemia. Hemat: LEUKOPENIA, THROMBOCYTOPENIA, anemia. Local: phlebitis at IV site. Metab: hyperuricemia. Neuro: peripheral neuropathy. Misc: anaphylactoid reactions.
Chemotherapeutic agent used in the management of lung cancer
ASSESSMENT Monitor blood pressure, pulse, respiratory rate, and temperature frequently during administration. Report significant changes. Monitor intake and output and specific gravity frequently throughout therapy. Report discrepancies immediately. To reduce the risk of nephrotoxicity, a urinary output of at least 100 ml/hr should be maintained for 4 hr before initiating and for at least 24 hr after administration. Encourage patient to drink 2000–3000 ml/day to promote excretion of uric acid. Allopurinol and alkalinization of the urine may be used to help prevent uric acid nephropathy. Assess patency of IV site frequently during therapy. Cisplatin may cause severe irritation and necrosis of tissue if extravasation occurs. If a large amount of highly concentrated cisplatin solution extravasates, mix 4 ml of 10% sodium thiosulfate with 6 ml of sterile water or 1.6 ml of 25% sodium thiosulfate with 8.4 ml of sterile water and inject 1–4 ml (1 ml for each ml extravasated) through existing line or cannula. Inject SC if needle has been 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.
Damages DNA before mitosis (cycledependent and phasespecific).
INDICATIONS Alone and in combination with other treatment modalities (other antineoplastics, radiation therapy, surgery) in the management of:
CNS: drowsiness, fatigue, headache, vertigo. Resp: PULMONARY EDEMA, bronchospasm.
Chemotherapeutic agent used in the management of lung cancer
ASSESSMENT Monitor blood pressure before and every 15 min during infusion. If hypotension occurs, stop infusion and notify physician or other health care professional. After stabilizing blood pressure with IV fluids and supportive measures,
Therapeutic Effects: Death of rapidly replicating cells, particularly malignant ones.
Refractory testicular neoplasms; Small cell lung carcinoma. Unlabelled Uses: Lymphomas and some leukemias. Contraindicated in: Hypersensitivity; 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). GI: nausea, vomiting. Derm: alopecia. Endo: sterility. Hemat: leukopenia, thrombocytopenia. Local: phlebitis at IV site. MS: muscle cramps. Neuro: peripheral neuropathy. Misc: allergic reactions including ANAPHYLAXIS, fever
infusion may be resumed at slower rate. Monitor for hypersensitivity reaction (fever, chills, pruritus, urticaria, bronchospasm, tachycardia, hypotension). If these occur, stop infusion and notify physician. Keep epinephrine, an antihistamine, corticosteroids, volume expanders, and resuscitative equipment close by in the event of an anaphylactic reaction. Assess for signs of infection (fever, chills, cough, hoarseness, lower back or side pain, sore throat, difficult or painful urination). Notify physician if these symptoms 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.
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