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ANTHELMINTICS

 Group of drugs that affect various systems Thiabendazole


within the worms, causing them to die Action: interferes with parasitic metabolism
 Most of these drugs are poorly absorbed in Use: threadworm, pinworm
the gastrointestinal tract Adverse Effects: dizziness, drowsiness, headache,
 Approximately 98% of the drug remains n/v, malodor of urine
effective as it passes through the GI tract and is Nursing Implications:
excreted in the feces 1.) give with food
2.) chew tablets before swallow
Pyrantel 3.) avoid activities such as driving and working with
Action: paralyzes intestinal tract of worm machineries
Use: roundworm, pinworm, hookworm
Adverse Effects: n/v, anorexia, abdominal cramping, Praziquantel
diarrhea Action: enhances permeability of the cell membranes
Nursing Implications: of the parasite to calcium
1.) give with milk or fruit juice Use: schistosomes and flukes
2.) entire dose must be taken at once Adverse Effects: headache, dizziness, abdominal
3.) offer small frequent meals pain, increased liver enzymes
Nursing Implications:
Mebendazole 1.) give with food or liquids
Action: inhibits glucose and other nutrient uptake of 2.) do not chew
helminth 3.) do not breastfeed
Use: roundworm, pinworm, threadworm, hookworm
Adverse Effects: abdominal cramping

ANTINEOPLASTIC AGENTS

 Destroy cancer cells and may also kill 7.) Monitor CBC, I & O, liver and renal function
normal cells tests
 Clients must be closely monitors due to  Discharge Teaching:
many toxic adverse effects 1.) Eat frequent small portions of high-calorie,
 General Adverse Effects: n/v, anorexia, high protein, bland, low-residue foods
diarrhea and constipation, stomatitis, alopecia, 2.) Avoid highly seasoned foods, drink clear
bone marrow depression (leucopenia, anemia liquids if nauseated
and thrombocytopenia), hepatic toxicity, 3.) Frequent rest periods
hyperuricemia, fatigue 4.) Expect alopecia and purchase scarves and
 Nursing Implications: wigs
1.) Handle antineoplastic agents carefully – 5.) Repeat fever, use good hand-washing
mutagenic and possibly carcinogenic technique, avoid individuals with URTI
2.) Nurses should wear gloves, long-sleeved 6.) Use soft toothbrush and baking soda, rinse
cover gown, protective goggles and mask as to minimize stomatitis
appropriate 7.) Use progressive relaxation exercises or
3.) Monitor IV site closely to assess for liquid imagery to help cope with nausea
extravasation and stop IV if it occurs
4.) Treat used equipment as hazardous waste
5.) Administer antiemetic if ordered as prior to
chemotherapy and up to 48 hours afterwards
6.) Inspect oral cavity daily

ALKYLATING AGENTS

Prototype: Cyclophosphamide (Cytoxan) Use: leukemias, multiple myeloma, neuroblastoma,


Action: produces cytotoxic effects by damaging DNA ovarian, breast, lung cancers, Hodgkin’s disease,
and interfering with cell replication Ewing’s sarcoma
Adverse Effects: hemorrhagic & nonhemorrhagic
cystitis, gonodal suppression
Nursing Implications: Related Drugs:
1.) force fluids 1.) Cisplatin
2.) assess for signs & symptoms of unexplained 2.) Busulfan
bleeding 3.) Chlorambuc
3.) assess leukocyte count frequently
4.) instruct client to report hematuria or dysuria
immediately

ANTIMETABOLITES

Prototype: Methotrexate with Leucovorin Adverse Effects: hemorrhagic & nonhemorrhagic


Action: Leucovorin calcium is a folic acid analog that cystitis, gonodal suppression
interferes with mitotic process by blocking folinic acid Nursing Implications: Leucovorin calcium is frequently
Use: acute lymphoblastic leukemia, cancer of breast, given to prevent toxicity when high doses of
lung, testes, ovary, head and neck, choriocarcinoma methotrexate are given

ANTIBIOTIC ANTINEOPLASTIC AGENTS

Prototype: Doxorubicin HCl (Adriamycin) 3.) do not mix with other drugs
Action: attaches to DNA and prevents DNA synthesis 4.) frequent mouth care
in vulnerable cells 5.) client needs sufficient fluids to prevent
Use: cancer of thyroid, lung, bladder, breast and hyperuricemia
ovary, acute leukemia, sarcoma, Ewing’s sarcoma, 6.) urine is red colored for 1-2 days after
neuroblastoma, lymphomas administration – clears within 48 hrs.
Adverse Effects: n/v, hyperpigmnetation of skin and Related Drugs:
nails, alopecia, stomatitis, agranulocytosis 1.) Bleomycin
Nursing Implications: 2.) Dactinomycin
1.) do not give SC or IM – local reaction & skin 3.) Daunorubicin
necrosis can occur 4.) Mitomycin
2.) IV use: reconstitute with normal saline or sterile 5.) Plicamycin
water; protect from sunlight; red steaking over vein
and facial flushing are signs of too rapid
administration

ANTINEOPLASTICS AFFECTING HORMONAL BALANCE

Estrogen Nursing Implications: monitor WBC count


1.) Diethylstilbestrol (DES) – for breast & prostate
cancer 2.) Antiadrenal - Aminoglutethamide
2.) Ethinyl Estradiol – for breast & prostate cancer Use: adrenal & metastatic breast cancer
– monitor males for signs & symptoms of Adverse Effects: adrenal insufficiency, severe
feminization pancytopenia
Nursing Implications: may cause drowsiness,
Androgen orthostatic hypotension
1.) Fluoxymesterone – for breast & renal cancer
2.) Testosterone Cypionate – for breast cancer 3.) Gonadotropin Releasing Hormone – Leuprolide
(Lupron)
Use: prostate cancer
Antihormonal Agents Adverse Effects: hot flashes, hematuria
1.) Antiestrogen – Tamoxifen (Nolvadex) Nursing Implications: monitor & rotate injection
Use: advanced breast cancer in pre & post sites
menopausal women
Adverse Effects: most common are similar to signs
& symptoms of menopause (not flashes & flushing),
n/v, decreased WBC
MITOTIC INHIBITORS
Prototype: Vincristine (Oncovin) Nursing Implications:
Action: acts on cells undergoing mitosis thus stopping 1.) do not give IM or SC
cell division 2.) can be given through direct IV over 1 minute
Use: acute leukemia, lymphoma, cancer of breast, 3.) monitor bowel function & neurochecks
brain, cervix, testes, Wilm’s tumor Related Drugs:
Adverse Effects: peripheral neuropathy, paresthesias, 1.) Etoposide
loss of deep tendon reflex, jaw pain, cramps, 2.) Vinblastine
constipation, stomatitis, n/v, phlebitis, hyponatremia, 3.) Pacitaxel
leucopenia, alopecia, photosensitivity

MISCELLANEOUS ANTINEOPLASTIC AGENTS

A. L - Asparaginase C. Procarbazine
Action: enzyme that destroys aspagise, an amino acid - similar to alkylating agents
necessary for protein synthesis of leukemia cells Use: Hodgkin’s disease, multiple myeloma, malignant
Use: acute lymphocytic leukemia melanoma
Adverse Effects: anorexia, n/v, anaphylaxis, Adverse Effects: altered reproductive potential,
hepatotoxicity, hemorrhagic pancreatitis anorexia,n/v, leukopenia
Nursing Implications: don’t shake vial Nursing Implications: drug is a MAO-inhibitor; avoid
* only give drug in a clear solution tyramines

B. Hydroxyurea
Action: urea derivative that kills granulocytes;
prevents DNA synthesis in cell cycle
Use: chronic myelogenous leukemia, malignant
melanoma, cancers of head, neck, ovary

IMMNOSUPPRESSANTS

Prototype1: Azathioprine
Action: not fully understood
Use: adjunct to prevent rejection of renal Prototype 2: Cyclosporine
transplants,severe rheumatoid arthritis Use: Prophylaxis for recipients of kidney, heart and
Adverse Effects: hypersensitivity, pancreatitis, liver transplants to prevent organ rejection
hypotwension, pulmonary edema, hepatoxicity, Adverse Effects: Anaphylaxis in IV use, nephrotoxicity
secondary infection, alopecia, n/v, anorexia hepatoxicity, hypertension, infections, tremors and
Nursing Implications: monitor for signs & symptoms of hyperplasia.
infection and rejection; take with food Nursing Implications:
Related Drug: 1. With IV use epinephrine
Mycophenolate – Used to prevent and treat 2. Protect IV infusion from light
rejection of renal transplants 3. Mix PO medication in milk or orange juice at room
temperature
Related Drug:
Tacrolimus - Used to prevent rejection with kidney,
heart and liver transplants; given orally or IV.

HEAVY METAL ANTAGONISTS

1.) Deferoxamine Mesylate


- for iron intoxication
- may turn urine red 2.) Edetate Calcium Disodium (Calcium EDTA)
- use infusion - for renal poisoning
pump - can cause renal toxicity
- may cause - may increase ICP; do not give IV if with
hypotension, tachycardia, allergic reaction and pain encephalopathy.
on injection.
3.) Dimercaprol (BAL in Oil) 4.) Edetate Disodium (Disodium EDTA)
- given IM in combination with Ca EDTA to treat lead - for hypercalcemic crisis
poisoning
- also used to treat arsenic, mercury, and gold toxicity
- painful on injection and can cause hypertension and
tachycardia in large doses

HERBAL DRUGS

1.) Gingko Biloba 9.) Saw Palmetto


- improves memory - for enlarge prostate and urinary inflammation
- increase blood pressure - mild diuretic
- increase risk of bleeding - contraindicated in pregnancy and lactation

2.) St. John’s Wort 10.) Valerian


- antianxiety, anti-inflammatory, antidepressive and - Mild sleep aid
sedative agent - muscle relaxant
- decrease effectiveness of Digoxin - for relieve of nervous stomach
- intensity or prolong effects of narcotics and - for stress relief
anesthetic agents - contraindicated in infants and pregnant women

3.) Ginseng
- increase physical stamina and mental concentration
- potential for bleeding in post-menopausal females
- contraindicated in pregnancy and lactation

4.) Garlic
- lower cholesterol & triglyceride level and blood
pressure
- fibrinolytic
- antimicrobial
- potential for increase bleeding especially for
individuals taking anti-clotting medications

5.) Feverfew
- prevent migraine, headaches, arthritis, and
rheumatic diseases
- contraindicated in pregnancy and lactation

6.) Kava-Kava
- for nervousness, anxiety or restlessness
- used as muscle relaxant
- antispasmodic, anticonvulsant
- potential for increase effects of certain antiseizure
medications, intensifying psychoacting agents
- contraindicated in pregnancy and lactation

7.) Licorice
- expectorant, anti-inflammatory, anti-allergic, for
stomach ulcers

8.) Ginger
- for motion sickness, n/v, vertigo, stomach aches, aid
in digestion
- potential for increased bleeding in clients already
taking anti-clotting medication