C.

Drug Studies

DRUG NAME: Erythropoietin

PHARMACOLOGIC CLASS: Colony stimulating factors

THERAPEUTIC CLASS: Recombinant human erythropoietins

DRUG FORM/DOSAGES: Injection 2000 units/mL, 3000 units/mL, 4000 units/mL,

10,000units/mL, 20,000 units/mL, 40,000 units/Ml

MODE OF ACTION:

Mimics effects of erythropoietin. Functions as a growth factor and a differentiating factor,

entertaining RBC production.

INDICATIONS:

Anemia caused by chronic renal disease. Anemia from zidovudine therapy (in HIV infected
patient).

CONTRAINDICATIONS:

Contraindicated in patients with hypertensive to products derived from mammal cells or albumin
(human), in those with uncontrolled hypertension and in patients receiving myelosuppressive
chemotherapy when the anticipated outcome is cure.

SIDE EFFECTS/ADVERSE EFFECT:

CNS: asthenia, dizziness, fatigue, headache, paresthesia, pyrexia, seizures

CV: edema, HPN, increased clotting of arteriovenous graft,

EENT: pharyngitis

GI: abdominal pain and constipation, (in children), diarrhea, nausea, vomiting

Metab: Hyperglycemia, hypokalemia, hyperphosphatemia, hyperuricemia

Musculoskeletal: arthralgia, myalgia, bone pain, muscle spasm

Respi: cough, shortness of breath, upper respi. infections

Skin: injection site reactions, rash, urticaria

NURSING RESPONSIBILITIES:

 Patients with chronic renal disease have an increased risk of death and serious adverse
CV events, including stroke, when erythropoiesis-stimulating agents are used to increase
hemoglobin level to more than 11 g/dL. Individualize therapy use the lowest dosage
needed to reduce the need for RBC transfusion.
 Before starting IV therapy, evaluate the patients iron status. Patients should receive
adequate iron supplementation beginning no later than epoetin alfa treatments starts and
continuing throughout therapy. Patient may also need vit. B12 and folic acid.
 Monitor BP before therapy. Most patients with chronic renal failure have HPN. BP may
increase especially when hematocrit increases in the early part of the therapy.
 In patients with non-small lung cancer and breast, head and neck, lymphoid and cervical
cancer, there is a risk of tumor growth and shortened survival when hemoglobin levels of
12 g/dL are achieved. Use the lowest dosage needed to avoid RBC transfusion. Use only
for treatment of anemia due to concomitant myelosuppressive chemotherapy and
discontinue drug following chemotherapy course.
 Institute diet restrictions or drug therapy to control BP.
 Monitor hemoglobin level twice weekly until it stabilizes in the target range and
maintenance dose is established, then continue to monitor at regular intervals. Resume
twice-weekly testing after any dosage adjustments.
 When used in HIV infected adults, dosage recommendations are for thaose with
endogenous erythropoietin levels of 500 units/L or less and cumulative zidovudine doses
of 4.2 g/week or less.
 Monitor blood counts; elevate hematocrit may cause excessive clotting. For patient with
chronic renal disease, monitor hemoglobin levels weekly until stable and then at last
monthly.
 Patient may need additional heparin to prevent clotting during dialysis treatments.
 Due to increasing risk of DVT, consider prophylaxis.
 Evaluate patient who experiences a lack or loss of pure red cell aplasia.
DRUG NAME: HEPARIN SODIUM

PHARMACOLOGIC CLASS: Anticoagulants

THERAPEUTIC CLASS: Anticoagulants

DRUG FORM/ DOSAGES: Full-dose continuous IV infusion therapy

Full-dose subcutaneous therapy

Full-dose intermittent I.V therapy

MODE OF ACTION:

Accelerates formation of antithrombin III-thrombin complex and deactivates thrombin, preventing

conversion of fibrinogen to fibrin.

INDICATIONS:

DVT,M.I, P.E,

For prevention of venous thrombosis, pulmonary emboli, atrial fibrillation with embolization and
post-operative DVT.

CONTRAINDICATIONS:

Hypersensitivity, uncontrolled bleeding, severe thrombocytopenia, open wounds (full-dose).

Products containing benzyl alcohol should not be used in premature infants.

Use cautiously in: severe liver kidney or liver disease, retinopathy (hypertensive or diabetic).
Untreated HPN, ulcer disease, spinal or brain injury, history of congenital or acquired bleeding
disorder, malignancy, OB: maybe used during pregnancy, but used with caution during last
trimester and in immediate PP period; GERI: women>60 yr have increased risk of bleeding.

Extreme caution in: severe uncontrolled HPN, bleeding disorders, GI:

bleeding/ulceration/pathology, hemorrhagic stroke, recent CNS/ophthalmologic surgery, active
bleeding ulceration, history of thrombocytopenia r/t heparin.
SIDE EFFECTS/ADVERSE REACTIONS:

GI: drug-induced hepatitis; DERM: alopecia (long-term use), rashes, urticaria, Hemat: bleeding,
anemia, thrombocytopenia (can occur after several weeks after discontinuation of therapy).
Local: pain at injection site; MS: osteoporosis (long –term use; Misc: fever, hypersensitivity.

NURSING RESPONSIBILITIES:

 Although heparin use is clearly hazardous in certain conditions, its risks and benefits must
be evaluated.
 If a woman needs anticoagulant during pregnancy, most prescribers use heparin. Some
commercially available heparin injections contain benzyl alcohol. Avoid using these
products in neonates and pregnant women if possible.
 Drug requirements are higher in early phases of thrombogenic diseases and febrile
states, they are lower when patient’s conditions stabilizes.
 Elderly patients should usually start at lower dosage.
 Check order and vial carefully; heparin comes in various concentrations. Its strength of
the entire container followed by how much medication is in 1ml. Products with both old
and new labels will be available during a transition period.
 Don’t change concentrations of infusions unless absolutely necessary. This is common
source of dosage errors.
 Avoid I.M injections of other drugs to prevent or minimize hematoma.
 Regularly inspect patients for bleeding gums. Bruises on arms/legs, petechiae, nose
bleeds, melena, tarry stools, hematuria and hematemesis.
 Monitor V/S.
 To treat severe overdose, protamine sulfate (1% solution), a heparin antagonist. Dosage
is based on the dose of heparin, its route of administration, and the time since it was
given. Generally, 1 to 5 mg of protamine per 100 units of heparin is given if only a few
minutes have elapsed; and 0.25 to 0.375 mg protamine per 100 units heparin, if two hr or
more have elapsed. Don’t give more than 50 mg of protamine in a10-min period.
 Abrupt withdrawal may cause increased coagulability; warfarin therapy usually overlaps
heparin therapy for continuation of prophylaxis or treatment.
DRUG NAME: CLEXANE

BRAND NAME: ENOXAPARIN SODIUM

PHARMACOLOGIC CLASS: Low-molecular weight heparin

THERAPEUTIC CLASS: Anticoagulant

DRUG FORM/ DOSAGES:

Multi-dose vial: (Adults)

 100 mg/mL (3mLvial)

Prefilled syringe:

 30 mg/0.3 mL,40 mg/0.4 mL, 60 mg/0.6 mL, 80 mg/0.8 mL, 100 mg/mL, 120 mg/0.8 mL,
150 mg/mL

Multi-dose vial: (Pediatric)

 100 mg/3 mL

Prefilled syringe:

 30 mg/0.3 mL,40 mg/0.4 mL, 60 mg/0.6 mL, 80 mg/0.8 mL, 100 mg/mL, 120 mg/0.8 mL,
150 mg/mL

Geriatric: increase risk of bleeding with doses of 1.5 mg/kg/day or 1 mg/kg q 12 hr.

Dosing considerations: risk of serious adverse reactions increases in the elderly. Body weight
<45 kg may require dose adjustment.

MODE OF ACTION:

Inhibits thrombus and clot formation by blocking factor Xa and factor IIa. This inhibition
accelerates formation of antithrombin III- thrombin complex (a coagulation inhibitor), thereby
deactivating thrombin and preventing conversion of fibrinogen to fibrin.
INDICATIONS:

Prevents pulmonary embolism and DVT after hip and knee replacement surgery, abdominal
surgery, patients with acute illness who are at increased risk because of decreased mobility. To
prevent ischemic complications of unstable angina and non-Q- wave, MI with oral aspirin
therapy.

CONTRAINDICATIONS:

 Hypersensitivity to drug heparin, sulphites, benzyl alcohol or pork products.

 Thrombocytopenia.
 Active major bleeding.

SIDE EFFECTS/ADVERSE REACTIONS:

CNS: dizziness, headache, insomnia, confusion, CVA

CV: edema, chest pain, atrial fibrillation, heart failure

GI: urinary retention

Hemat: anemia, bleeding tendency, thrombocytopenia, hemorrhage

Metabolic: hyperkalemia

Skin: bruising, pruritus, rash, urticaria. Other: fever, pain, irritation or erythema at injection site.

NURSING RESPONSIBILITIES:

Before:

 Monitor CBC and PLT count. Watch for s/sx of bleeding or bruising.
 Monitor fluid intake and output. Watch for fluid retention and edema.

During:

 Be aware that enoxaparin is high-alert drug.

 Use tuberculin syringe with multi-dose vial to ensure the accurate dosage.
 Don’t expel air bubble from syringe before administering.
  Inject drug SQ with patient in supine position. Alternate left and right anterolateral and
poster lateral abdominal wall sites.
 Don’t rub injection site. Don’t give IM or IV route.

After:

 If a patient will self-administer drug, teach proper injection technique.

 Instruct patient to promptly report irregular heartbeat, unusual bleeding, or bruising, rash
or hives.
 Teach patient safety measures to avoid bruising or bleeding.
 Advise patient to weigh himself regularly and to report gains.
 As appropriate, review all other significant life threatening adverse reactions and
interactions.
DRUG NAME: Metoclopramide Hydrochloride

BRAND NAME: Apo-Metoclop, Metonia, MetezolvODT, Reglan

PHARMACOLOGIC CLASS: Dopamine antagonists

THERAPEUTIC CLASS: GI stimulants

DRUG FORM/ DOSAGES: Injection: 5mg/mL

Syrup: 5 mg/mL

Tablets: 5 mg, 10 mg

Tablets (orally disintegrating): 5 mg

Route: P.O,I.V, I.M

MODE OF ACTION:

Stimulates motility on the upper GI tract, increases lower esopharyngeal sphincter tone and
blocks dopamine receptors at the chemoreceptor trigger zone.

INDICATIONS:

 To prevent or to reduce N/V from emetogenic cancer therapy.

 To prevent or to reduce post-operative N/V.
 To facilitate small-bowel intubation.
 To aid in radiologic exam.
 Delayed gastric emptying secondary to diabetic gastroparesis.
 GERD
 Gastroparesis
 Prevention and treatment of hiccups.
 N/V of pregnancy
 Adjunctive treatment of vascular headaches.
CONTRAINDICATIONS:

Hypersensitivity, possible GI obstruction or hemorrhage, history of seizure disorder,

pheochromocytoma, Parkinson’s disease.

Use cautiously in: history of depression, diabetes (may alter insulin response), renal impairment
(reduce CCr <50mL/min).

OB, lactation: safety not established;

Pedi: some syrup products may contain benzoate, a metabolite of benzyl alcohol which may
cause potentially fatal gasping syndrome in neonates. Prolonged high clearance in neonates
can result in high serum concentrations and an increase risks in methemoglobinemia. Side
effects are more common in children especially extrapyramidal reactions.

Geri: more susceptible to over sedation and extrapyramidal reactions.

SIDE EFFECTS:

CNS: anxiety, drowsiness, dystonic reactions, fatigue, lassitude, restlessness, alkathisia,

confusion, depression, dizziness, extrapyramidal symptoms, fever, headache, insomnia

CV: hypotension, transient hypertension

GI: bowel disorders, diarrhea, nausea

GU: Incontinence, urinary frequency, erectile dysfunction

Skin: Rash, urticarial

Other: loss of libido, prolactin secretion, gynecomastia, amenorrhea

ADVERSE EFFECTS:

CNS: seizures, suicidal ideation

CV: bradycardia, supraventricular tachycardia

Hematologic: agranulocytosis, neutropenia

NURSING RESPONSIBILITIES:

 Monitor bowel sounds, N/V, abdominal distention before and after administration.
 Monitor for neuroleptic malignant syndrome (hyperthermia, muscle rigidity, altered
consciousness, irregular pulse or BP, tachycardia or diaphoresis.
 Discontinue drug if s/sx of tardive dyskinesia develop. Avoid treatment for longer than 12
weeks except in rare cases in which therapeutic benefits is thought to outweigh risk of
tardive dyskinesia.
 Monitor for involuntary movements of face, tongue, and extremities which may indicate
tardive dyskinesia.
 Monitor for fever, CNS symptoms, irregular pulse, cardiac arrhythmias or abnormal BP
which may indicate neuroleptic malignant syndrome.
 Monitor for dizziness, headache or nervousness; this may indicate withdrawal. Instruct to
take ODT’s 30 mins. before food and at bedtime and not to repeat dose inadvertently
taken with food.
 Tell patient to avoid activities that require alertness 2 hr after doses.
 Advice patient not to take alcohol.