CHEMOTHERAPEUTIC AGENTS proliferating cells are less sensitive to chemotherapy.
❖ synthetic chemicals used to interfere with the
functioning of foreign cell populations, causing cell
death; this term is frequently used to refer to the drug
therapy of neoplasms, but it also refers to drug
therapy affecting any foreign cell.
➢ Antimetabolites
➢ Antibiotics
➢ Alkylating agents
➢ Microtubule inhibitors
➢ Steroid hormones and their anatagonist
➢ Monoclonal Antibodies
➢ Tyrosine kinase inhibitors
Principles of Cancer Chemotherapy
➢ cause a lethal cytotoxic event or apoptosis in the
cancer cells that can arrest the progression of tumor
growth. The attack is generally directed toward DNA
or against metabolic sites essential to cell replication.
➢ Unfortunately, most traditional anticancer drugs do
not specifically recognize neoplastic cells but, rather,
affect all kinds of proliferating cells, both normal and
abnormal. Therefore, almost all antitumor agents
have a steep dose–response curve for both
therapeutic and toxic effects.
A. Treatment strategies
1. Goals of treatment
The ultimate goal of chemotherapy is a cure (that is,
long-term, disease-free survival). A true cure requires the
eradication of every neoplastic cell. If a cure is not attainable,
then the goal becomes control of the disease (prevent the
cancer from enlarging and spreading) to extend survival and
maintain quality of life.
- chemotherapeutic drugs may be used to relieve
symptoms caused by the cancer and improve the
quality of life, even though the drugs may not extend
survival.
2. Indications for treatment
Chemotherapy is sometimes used when neoplasms
are disseminated and are not amenable to surgery.
Chemotherapy may also be used as a supplemental treatment
to attack micrometastases following surgery and radiation
treatment, in which case it is called adjuvant chemotherapy.
(any type of therapy that follows the primary treatment).
➢ Chemotherapy given prior to the surgical procedure in
an attempt to shrink the cancer is referred to as
neoadjuvant chemotherapy,
➢ and chemotherapy given in lower doses to assist in
prolonging remission is known as maintenance
chemotherapy.
3. Tumor susceptibility and the growth cycle
The fraction of tumor cells that are in the replicative
cycle (“growth fraction”) influences susceptibility to most
cancer chemotherapeutic agents. Rapidly dividing cells are
generally more sensitive to chemotherapy, whereas slowly
In general, nondividing cells usually survive the toxic
effects of many chemotherapeutic agents.
B. Treatment regimens and scheduling
Drug dosages are usually calculated on the basis of
body surface area, in an effort to tailor the dosage to
each patient.
1. Log kill phenomenon
Destruction of cancer cells by chemotherapeutic
agents follows firstorder kinetics (that is, a given dose
of drug destroys a constant fraction of cells). The term
“log kill” is used to describe this phenomenon.
2. Pharmacologic sanctuaries
Leukemic or other tumor cells find sanctuary
in tissues such as the central nervous system (CNS),
where transport constraints prevent certain
chemotherapeutic agents from entrance.
Therefore, a patient may require irradiation of the
craniospinal axis or intrathecal administration of drugs
to eliminate leukemic cells at that site. Similarly, drugs
may be unable to penetrate certain areas of solid
tumors.
3. Treatment protocols
Combination chemotherapy is more successful than
single-drug treatment in most cancers for which
chemotherapy is effective.
a. Combination chemotherapy - Cytotoxic
agents with different toxicities, and with
different molecular sites and mechanisms of
action, are usually combined at full doses.
This results in higher response rates, due to
additive and/or potentiated cytotoxic effects,
and nonoverlapping host toxicities.
In contrast, agents with similar
dose-limiting toxicities, such as
myelosuppression, nephrotoxicity, or
cardiotoxicity, can be combined safely only by
reducing the doses of each.
b. Advantages of combinations - advantages of
combination chemotherapy are that it
1) provides maximal cell killing within the
range of tolerated toxicity,
2) is effective against a broader range of cell
lines in the heterogeneous tumor population,
and
3) may delay or prevent the development of
resistant cell lines.
c. Treatment protocols - Many cancer treatment
protocols have been developed, and each is
applicable to a particular neoplastic state.
They are usually identified by an acronym. For
example, a common regimen called R-CHOP,
used for the treatment of non-Hodgkin
lymphoma, consists of rituximab,
 cyclophosphamide, hydroxydaunorubicin
(doxorubicin), Oncovin (vincristine), and prednisone.
Therapy is scheduled intermittently to allow
recovery or rescue of the immune system, which is
also affected by the chemotherapeutic agents, thus
reducing the risk of serious infection.
C. Resistance and toxicity with chemotherapy
Cancer drugs are toxins that present a lethal threat to
the cells. It is, therefore, not surprising that cells have evolved
elaborate defense mechanisms to protect themselves from
chemical toxins, including chemotherapeutic agents.
1. Resistance
Some neoplastic cells (for example, melanoma) are
inherently resistant to most anticancer drugs. Other tumor
types may acquire resistance to the cytotoxic effects of a drug
by mutating, particularly after prolonged administration of
suboptimal doses. The development of drug resistance is
minimized by short-term, intensive, intermittent therapy with
combinations of drugs. Drug combinations are also effective
against a broader range of resistant cells in the tumor
population. .
2. Multidrug resistance
Stepwise selection of an amplified gene that codes for
a transmembrane protein (P-glycoprotein for “permeability”
glycoprotein) is responsible for multidrug resistance. This
resistance is due to adenosine triphosphate– dependent
pumping of drugs out of the cell in the presence of
Pglycoprotein.
Cross-resistance following the use of structurally
unrelated agents also occurs.
Note: P-glycoprotein is normally expressed at low levels in
most cell types, but higher levels are found in the kidney, liver,
pancreas, small intestine, colon, and adrenal gland. It has
been suggested that the presence of Pglycoprotein may
account for the intrinsic resistance to chemotherapy observed
with adenocarcinomas.]
3. Toxicity
Therapy aimed at killing rapidly dividing cancer cells
also affects normal cells undergoing rapid proliferation (for
example, cells of the buccal mucosa, bone marrow,
gastrointestinal [GI] mucosa, and hair follicles), contributing to
the toxic manifestations of chemotherapy.
a. Common adverse effects
Myelosuppression, also known as bone marrow
suppression or bone marrow depression, is another
unwanted adverse effect of certain antineoplastics. It
commonly results from drug- or radiation-induced
destruction of rapidly dividing cells in the bone
marrow, primarily the cellular precursors of WBCs,
RBCs, and platelets.
Extravasation is the unintended leakage of a
chemotherapy drug (with vesicant potential) into the
surrounding tissues outside of the IV line.
Extravasation is a serious complication with
chemotherapy. Specific treatment of extravasations
varies depending on the drug.
Reduction in fertility is a major concern in
postpubertal patients. Cancer also complicates 1 in
1000 pregnancies. Chemotherapy drugs are classified
as pregnancy category D( studies, adequate
wellcontrolled or observational, in pregnant women
have demonstrated a risk to the fetus. However, the
benefits of the therapy outweigh the potential risk) or
X.( Category X is the only rating that denotes a drug is
absolutely contraindicated for use during pregnancy )
a. Common adverse effects
Most chemotherapeutic agents have a narrow
therapeutic index. Severe vomiting, stomatitis, bone
marrow suppression, and alopecia occur to varying
extents during therapy with most antineoplastic
agents.
- Vomiting is often controlled by the
administration of antiemetic drugs.
- myelosuppression that predisposes to
infection, are common to many
chemotherapeutic agents
- other adverse reactions are confined to
specific agents, such as:
● bladder toxicity with cyclophosphamide
● cardiotoxicity with doxorubicin
● pulmonary fibrosis with bleomycin.
b Minimizing adverse effects
Some toxic reactions may be ameliorated by
interventions, such as the use of cytoprotectant
drugs, local perfusion of the tumor (for example, a
sarcoma of the arm), removal of some marrow of the
patient prior to intensive treatment and then
reimplantation afterward, or intensive hydration and
diuresis to prevent bladder toxicities.
4 Treatment-induced tumors
Because most antineoplastic agents are
mutagens, neoplasms (for example, acute
nonlymphocytic leukemia) may arise 10 or more years
after the original cancer was cured.
[Note: Treatment-induced neoplasms are especially a
problem after therapy with alkylating agents.] Most
tumors that develop from cancer chemotherapeutic
agents respond well to treatment strategies
III. Antimetabolites
structurally related to normal compounds
that exist within the cell. They generally interfere with
the availability of normal purine or pyrimidine
nucleotide precursors, either by inhibiting their
synthesis or by competing with them in DNA or RNA
synthesis.
A. Methotrexate, pemetrexed, and pralatrexate
The vitamin folic acid plays a central role in a
variety of metabolic reactions involving the transfer of
one-carbon units and is essential for cell replication.
Folic acid is obtained mainly from dietary sources
and from that produced by intestinal flora. Methotrexate
[meth-oh-TREK-sate] (MTX), pemetrexed
[pem-e-TREX-ed], and pralatrexate [pral-a-TREX-ate] are
antifolate agents.
1. Mechanism of action
MTX is structurally related to folic acid and acts as
an antagonist of the vitamin by inhibiting mammalian
dihydrofolate reductase (DHFR), the enzyme that converts
folic acid to its active, coenzyme form, tetrahydrofolic acid
(FH4 ).
Pemetrexed is an antimetabolite similar in
mechanism to methotrexate. However, in addition to
inhibiting DHFR, it also inhibits thymidylate synthase and
other enzymes involved in folate metabolism and DNA
synthesis.
Pralatrexate is an antimetabolite that also inhibits
DHFR
2. Therapeutic uses
MTX, usually in combination with other drugs, is
effective against acute lymphocytic leukemia, Burkitt
lymphoma in children, breast cancer, bladder cancer, and
head and neck carcinomas. In addition, low-dose MTX is
effective as a single agent against certain inflammatory
diseases, such as severe psoriasis and rheumatoid
arthritis, as well as Crohn disease. All patients receiving
MTX require close monitoring for possible toxic effects.
Pemetrexed is primarily used in non–small cell
lung cancer.
Pralatrexate is used in relapsed or refractory
T-cell lymphoma.
3. Adverse effects
Adverse effects of MTX N/V/D, Stomatitis, rash,
alopecia, myelosuppression, high dose renal damage
IT: neurologic toxicities
Pemetrexed and pralatrexate should be given
with folic acid and vitamin B12 supplements to reduce
hematologic and GI toxicities. Pretreatment with
corticosteroids to prevent cutaneous reactions is
recommended with pemetrexed.
PURINE ANTAGONISTS
- cladribine, fludarabine, mercaptopurine,
pentostatin, and thioguanine.
- Mercaptopurine and thioguanine are
administered orally, whereas the other three are
available only in injectable form. These drugs are
used largely in the treatment of leukemia and
lymphoma.
Cladribine
- Cladribine (Leustatin) is indicated specifically for
the treatment of a certain type of leukemia
known as hairy cell leukemia, so named because
of the appearance of its cancerous cells under the
microscope.
Fludarabine
- Fludarabine (Fludara), like cladribine, also has a
very specific single indication—in this case,
chronic lymphocytic leukemia.
PYRIMIDINE ANTAGONISTS
The currently available pyrimidine antagonists are
capecitabine, cytarabine, floxuridine, fluorouracil, and
gemcitabine. These drugs are used more commonly than
the purine antagonists. They are available only in
parenteral formulations except for capecitabine, which is
currently available only in tablet form.
Capecitabine
- Capecitabine (Xeloda) is a pyrimidine antagonist
indicated primarily for the treatment of
metastatic breast cancer and colon cancer.
contraindicated in patients with known
hypersensitivity to it or to fluorouracil and in
patients with severe renal impairment.
Cytarabine
- Cytarabine (ara-C) (Cytosar) is used primarily for
the treatment of leukemias (acute myelocytic and
lymphocytic leukemia and meningeal leukemia)
and non-Hodgkin lymphomas. It is available only
in injectable form and may be given IV,
subcutaneously, or intrathecally.
Cytarabine has a unique set of adverse reactions, called
“cytarabine syndrome.” Cytarabine syndrome is
characterized by :
- fever
-muscle and bone pain
-maculopapular rash
-conjunctivitis, and
-malaise.
It usually occurs 6 to 12 hours following
cytarabine administration. The syndrome may be treated
or prevented by the use of corticosteroids.
Fluorouracil
- Fluorouracil (5-FU) (Efudex, Adrucil) is used in a
variety of treatment regimens, including the
palliative treatment of cancers of the colon,
rectum, stomach, breast, and pancreas. It also is
used in the adjuvant setting in the treatment of
breast and colorectal cancer.
Gemcitabine
- Gemcitabine (Gemzar) is an antineoplastic drug
structurally related to cytarabine. Gemcitabine is
believed to have antitumor activity superior to
that of cytarabine. It is used as first-line therapy
for locally advanced or metastatic cancer of the
pancreas and for the treatment of non– small cell
lung cancer. Gemcitabine is increasingly used to
treat other solid tumors, including breast cancer
MITOTIC INHIBORS
- include natural products obtained from the
periwinkle plant and semisynthetic drugs
obtained from the mandrake plant (also known as
the “may apple”). Periwinkle plant- antineoplastic
alkaloids vinca alkaloids include :
● Vinblastine
● Vincristine
● vinorelbine
Mechanism of Action and Drug Effects
● The vinca alkaloids (vincristine, vinblastine, and
vinorelbine) bind to the protein tubulin during the
metaphase of mitosis (M 2195 phase).
● This prevents the assembly of key structures
called microtubules. This, in turn, results in the
dissolution of other important structures known
as mitotic spindles.
● Without these mitotic spindles, cells cannot
reproduce properly. This results in inhibition of
cell division and cell death.
Indications
● Mitotic inhibitors are used to treat a variety of
solid tumors and some hematologic malignancies.
● used in combination with chemotherapy
regimens to enhance the overall cytotoxic effect.
Adverse Effects:
● hair loss
● nausea and vomiting
● myelosuppression
Toxicity and management of extravasation Mitotic Inhibitor
and Etoposide Extravasation: Listed Specific Antidote
DRUG ANTIDOTE METHOD
PREPARATION
ETOPOSIDE TENIPOSIDE Hyaluronidase(Wyda 1. Inject 1-6mL into the
VINBLASTINE se) 150units/mL: extravasated site with
VINCRISTINE add 1mL Nacl (150 multiple SC injections.
units/mL) 2. Repeat SC dosing over
the next few hours.
3. Apply warm
compresses (no total
dose established).
Interactions
A variety of drug interactions are possible with most
antineoplastic drugs, some more significant than others.
The use of multiple antineoplastic drugs can cause
severe neutropenia and infection, due to additive bone
marrow suppression.
Monitor and treat patients accordingly for
hematologic toxicity and infections.
Selected Mitotic Inhibitors and Etoposide: Common Drug
Interactions
ALKALOID TOPOISOMERASE II INHIBITORS
Etoposide and teniposide are derivatives of
epipodophyllotoxin. They exert their cytotoxic effects by
inhibiting the enzyme topoisomerase II, which causes breaks
in DNA strands.
Etoposide
- Etoposide (VP-16) (generic) is a topoisomerase II
inhibitor. Its structure, mechanism of action, and
adverse effect profile are similar to those of
teniposide. It is believed to kill cancer cells in the late
S phase and the G2 phase of the cell cycle.
● It is indicated for the treatment of small-cell
lung cancer and testicular cancer.
● available in both oral and injectable forms
Indications: Selected Mitotic Inhibitors and Etoposide
Paclitaxel
● Paclitaxel (Taxol) is a natural mitotic inhibitor that
was originally isolated from the bark of the Pacific
yew tree. Water insoluble (hydrophobic), and for this
reason it is put into a solution containing oil rather
than water. The particular oil used is a type of castor
oil called Cremophor EL, the same oil with which
cyclosporine is formulated.
● available only in injectable form
Vincristine
● Vincristine is an alkaloid isolated from the periwinkle
plant that is indicated for the treatment of acute
lymphocytic leukemia and other cancers.
● It is available only in injectable form.
● most significant neurotoxin of the cytotoxic drug
class, but it continues to be used in part because of
its relative lack of bone marrow suppression.
● World Health Organization and the Institute for Safe
Medication Practices suggest that vincristine be
diluted in 25 to 50 mL of fluid and never dispensed
via a syringe, to prevent this lethal error from
occurring.
TOPOISOMERASE I INHIBITORS
Topoisomerase I inhibitors are a relatively new class
of chemotherapy drugs. The two drugs currently available in
this class are topotecan and irinotecan.
● Both are semisynthetic analogues of the compound
camptothecin.
Mechanism of Action and Drug Effects
● The camptothecins inhibit proper DNA function in
the S phase by binding to the DNA–topoisomerase I
complex. This complex normally allows DNA strands
to be temporarily cleaved and then reattached in a
critical step known as relegation. The binding of the
camptothecin drugs to this complex retards this
relegation process, which results in a DNA strand
break
Indications
● to treat ovarian and colorectal cancer
● Topotecan has been shown to be effective even in
cases of metastatic ovarian cancer that have failed to
respond to platinum-containing regimens (e.g.,
cisplatin, carboplatin) and paclitaxel.
● Topotecan is also used to treat small-cell lung cancer.
● Irinotecan is currently approved for the treatment of
metastatic colorectal cancer, small-cell lung cancer,
and cervical cancer
Adverse Effects
● The main adverse effect of topotecan is bone marrow
suppression.
● include mild to moderate nausea, vomiting, and
diarrhea; headache; rash; muscle weakness; and
cough.
● Irinotecan causes more severe adverse effects than
topotecan. In addition to producing similar
hematologic adverse effects, it has been associated
with severe diarrhea known as cholinergic diarrhea.
● There is a moderate risk for nausea and vomiting
with irinotecan, which requires appropriate
supportive care such as IV rehydration and
antiemetic drug therapy.
Interactions
● Topotecan has a unique drug interaction involving
the granulocyte colony-stimulating factor filgrastim.
Filgrastim is commonly used to enhance WBC
recovery after chemotherapy.
● Topotecan is given along with filgrastim,
myelosuppression has actually been shown to be
worsened.
● It is recommended that filgrastim be administered 24
hours after completion of the topotecan infusion.
● Laxatives and diuretics are not given with irinotecan
because of the potential to worsen the dehydration
resulting from the severe diarrhea that this drug can
produce.
● irinotecan when given with fluorouracil and
leucovorin- Severe cardiovascular toxicity, including
thrombosis, pulmonary embolism, stroke, and acute
fatal myocardial infarction.
Irinotecan: Common Drug Interaction
Irinotecan
● Irinotecan (Camptosar) is often given with both
fluorouracil and leucovorin.
● It is available only in injectable form.
Topotecan
● After initial therapy with other antineoplastics,
cancer cells commonly become resistant to their
effects. The use of topotecan (Hycamtin) to treat
ovarian cancer and small cell lung cancer.
● available only in injectable form.
ANTINEOPLASTIC ENZYMES
● Two antineoplastic enzymes are commercially
available: asparaginase and pegaspargase.
Indications:
● treatment of acute lymphocytic leukemia.
Adverse Effects:
● impaired pancreatic function. This can lead to
hyperglycemia and severe or fatal pancreatitis.
dermatologic, hepatic, genitourinary, neurologic,
musculoskeletal, GI, and cardiovascular effects.
Asparaginase
● Asparaginase (Elspar) is used for the treatment of
acute lymphocytic leukemia.
● catalyzes the conversion of the amino acid
asparagine to aspartic acid and ammonia
Pegaspargase
● Pegaspargase (Oncaspar) has a mechanism of action,
indications, and contraindications similar to those of
asparaginase.
● same enzyme that has been formulated so as to
reduce its allergenic potential. This process involves
the chemical conjugation of the enzyme with units of
a relatively inert compound known as monomethoxy
polyethylene glycol.
NURSING PROCESS
Assessment:
For altered nutritional status and impaired oral
mucosa:
● focus on weight loss, abnormal serum
protein-albumin and BUN levels (a negative nitrogen
status due to low protein levels would be indicated
by a decreasing BUN level), weakness, fatigue,
lethargy, poor skin turgor, and pale conjunctiva
● Assess oral mucosa for any signs and symptoms of
stomatitis, such as pain or burning in the mouth,
difficulty swallowing, taste changes, viscous saliva,
dryness, cracking, and/or fissures with or without
bleeding of the mucosa.
For effects on the GI mucosa:
● Assess bowel sounds (hyperactive, hypoactive, or
normoactive).
● Assess the presence of diarrhea, such as frequent,
loose stools (more than three stools per day),
urgency, and abdominal cramping.
● Consistency, odor, amount, and color.
● Inquire about any nausea and vomiting, and
determine whether symptoms are acute, delayed, or
anticipatory (occurring in the future); if vomiting
occurs, assess/document the color, amount,
consistency, frequency, and odor and if any blood is
present (hematemesis).
● The presence of blood in the stool, vomitus, and/or
sputum needs to be reported promptly to the health
care provider
For alopecia:
● Assess the patient's views, concerns, and emotions
about potential hair loss.
● Assess the patient's need to prepare for hair loss,
either by leaving the hair as it is and allowing it to fall
out on its own; having the hair cut short; or wearing
a scarf, hat, bandana, or hair wrap and/or purchasing
a wig before the hair is actually lost.
For bone marrow suppression:
● Assess for signs and symptoms of anemia (e.g., pallor
of the skin, oral mucous membranes, and
conjunctiva; fatigue; lethargy; loss of interest in
activities; shortness of breath; inability to
concentrate) or a decrease in RBCs, hemoglobin
level, and hematocrit.
● Assess for signs and symptoms of leukopenia
(decrease in WBCs), including fever; chills;
tachycardia; abnormal breath sounds; productive
cough with purulent, green, or rust-colored sputum;
change in the color of urine; lethargy; fatigue; and
acute confusion.
For possible sterility, teratogenesis, and damage to ovaries
with amenorrhea:
● In adult male patients, assess baseline reproductive
history, with attention to sexual functioning,
fathering of children, and past and current
reproductive or sexual problems or concerns.
● In female adult patients, in addition to the relevant
aspects already mentioned, inquire about fertility,
menstrual and childbearing history, and age of onset
of menses and menopause, if applicable.
Human Need Statements
1. Altered gastrointestinal elimination, diarrhea, related
to the adverse effects of antineoplastic drugs
2. Altered freedom from pain, acute pain, related to the
disease process and drug-induced joint pain,
stomatitis, GI distress, and other discomforts
associated with antineoplastic cell cycle–specific
therapy
3. Altered safety needs, risk for injury, from infection
related to druginduced bone marrow suppression
with possible leukopenia and neutropenia
Planning:
Outcome Identification
1. Patient regains as near normal as possible bowel
elimination patterns with control of diarrhea through
dietary restrictions, hydration, and during
antineoplastic therapy.
2. Patient achieves improved comfort levels with
reporting of pain before it is uncontrollable/severe
with improved nonpharmacologic and pharmacologic
pain control, and symptom and adverse effect
management.
3. The patient remains free from infection while under
the influence of chemotherapeutic treatment and
through thorough handwashing, hydration, balanced
diet, mouth care, and avoiding crowds.
Implementation
● With antineoplastic therapy, nursing considerations
related to reducing fear and anxiety include
establishing a therapeutic relationship beginning
with trust and empathy.
● Approach the patient in a warm, empathic, and
supportive manner while projecting professional
confidence in providing nursing care.
● Provide individualized explanations and teaching
about the patient's illness, care, and treatments that
are appropriate to the patient's educational level.
● Collaborate with all members of the health care team
● Management of stomatitis or excessive oral mucosa
dryness and irritation include the following:
● Instruct the patient to rinse mouth with water every
2 hours while awake and to keep mouth and teeth
clean.
● The health care provider may prescribe a specific oral
 cleansing solution and/or topical/local agent to help
manage oral discomfort. Zilactin-B or the use of
Zovirax (alcohol-free) - recommends the use of a
mixture of 1 teaspoon of salt or baking soda in 8
ounces of water.
● The health care provider may advise swallowing of
the solution if there is discomfort with swallowing
● Advise against the use of lemon, glycerin, undiluted
peroxide, or alcoholcontaining products because they
are drying and irritating to the oral mucosa
● Recommend use of a soft-bristle toothbrush or
soft-tipped toothette or swab with solutions of
diluted warm saline; soak soft-bristle toothbrush in
warm water to soften even more prior to use. If a
soft-bristle toothbrush not available, a mouth swab
may be formed by the use of a popsicle stick covered
with gauze.
● If dentures are worn, encourage the patient to
remove and clean them frequently and, if stomatitis
is severe, to insert only at mealtimes.
● A Waterpik may be used, if within the patient's
budget.
● Advise using OTC saliva substitutes, keeping the lips
moist, and sucking on sugarless candy or gum to
stimulate saliva flow.
● Flossing will be discouraged if platelet count is not
adequate.
● Stress that spicy, acidic/citrus, rough or course
textured, and hot or cold beverages/foods, alcohol,
and tobacco must be avoided because they are
irritants
Nausea and/or vomiting
● Educate the patient on nonpharmacologic measures
to prevent nausea and vomiting and enhance
comfort.
● stagger the intake of small meals throughout the day
● eating a light bland meal several hours prior to
treatment,
● Avoid sweet, fried, or fatty foods, cool beverages,
avoiding unpleasant smells, meditation and deep
breathing, and sipping on ginger tea or ginger ale
that has lost carbonation.
● Premedication with antiemetics 30 to 60 minutes
before administration of the antineoplastic(s) is the
preferred treatment protocol to help reduce nausea
and vomiting, prevent dehydration and malnutrition,
and promote comfort.
● Diarrhea is also a common adverse effect of
antineoplastic therapy.
● nursing interventions to help with diarrhea include:
● Advise the patient to avoid or limit oral intake of
irritating, spicy, and gasproducing foods; caffeine;
high-fiber foods; alcohol; very hot or cold foods or
beverages; and lactose-containing foods and
beverages.
● Consult appropriate personnel, as ordered, to help
the patient and family plan meals and arrange ways
to meet the patient's dietary and bowel elimination
needs.
● Administer opioids (e.g., paregoric) or synthetic
opioids (e.g., loperamide, diphenoxylate
hydrochloride) as prescribed, for their antidiarrheal
properties. Adsorbents-protectants and antisecretory
drugs may also help to reduce GI upset and diarrhea.
Nutritional concerns, the following measures may prove
beneficial in improving oral intake and nutritional status:
● Perform a 24-hour recall of food intake with inclusion
of a typical week's diet for the patient.
● Use antiemetic therapy, pain management, mouth
care, and hydration, as ordered, to reduce the
adverse effects of therapy and improve appetite.
● To ease taste alterations, advise the patient to
consume mild-tasting foods and to use chicken,
turkey, cheese, or Greek yogurt for protein sources,
as tolerated.
● Provide plastic rather than metal utensils if the
patient complains of a metallic taste.
● Encourage eating foods that are easy to swallow,
such as custards; gelatins; puddings; milkshakes;
eggnog; commercially prepared high-protein,
highcalorie supplemental shakes/puddings; mashed
white or sweet potatoes; blended drinks with
crushed ice, fruit, and yogurt; nutritional supplement
drinks and snacks; frozen popsicles; and lactose-free
ice cream.
● Instruct the patient to avoid sticky or dry foods.
● Encourage the consumption of small, frequent meals
in an environment that is conducive to eating (e.g.,
free of odors and excess noise).
● Appetite stimulants such as megestrol acetate or
dronabinol may be helpful.
● Encourage the patient to practice energy
conservation, with frequent rest periods before and
after meals.
● Alopecia is an adverse effect associated with many of
the antineoplastics and is very disturbing regardless
of age or gender.
● Educate the patient and family about the possibility
of hair loss and provide a timeline for when it will
most likely occur.
● Hair loss may occur all over the body and not just on
the scalp, including eyelash, eyebrow, armpit, and
pubic hair loss.
● Hair loss typically begins anywhere from 2 to 4 weeks
after treatment has started and may fall out quickly
in clumps or may occur slowly.
● Hair loss generally continues throughout treatment
and for up to weeks afterwards, and it may vary from
thinning to complete balding depending on the
specific treatment regimen.
● Antineoplastic-induced bone marrow suppression
leads to anemias, leukopenia, neutropenia, and
thrombocytopenia.
● Anemias result in fatigue and loss of energy and are
common adverse effects of therapy and the
malignant disease process.
● Anemias may require blood transfusions, peripheral
blood stem cell treatment, or treatment with
prescribed medications such as iron preparations,
folic acid, or erythropoietic growth factors (e.g.,
epoetin, darbepoetinalfa).
● These injections may be given at home and may be
administered at the first sign of a decrease in RBC
counts. Conservation of energy and planning of care
is very important in minimizing patient fatigue.
● Risk for infection from leukopenia or neutropenia
and/or immunosuppression is one of the more
significant adverse effects that require close
attention.
● Inform the patient and family and/or caregivers that
when WBC counts are low, the patient is at high risk
for infection and that defenses remain low until the
counts recover.
● Following standard precautions and using good
handwashing technique are most important in
preventing transmission of infection in the hospital
and home settings.
● Encourage patients with immune suppression to be
aware of their environments and persons to avoid,
such as individuals who have recently been
vaccinated (who may have a subclinical infection) or
who have a cold or flu or other symptoms of an
infection.
● Educate patients on the importance of performing
oral care frequently and to turn, cough, and deep
breathe to help prevent stasis of respiratory
secretions.
● Thrombocytopenia is another adverse effect of
antineoplastic therapy and increases the patient's
risk for bleeding.
● Monitor platelet counts, coagulation studies, RBC
counts, hemoglobin levels, and hematocrit values,
and report any decreases
● The reproductive tract, causes destruction of the
germinal epithelium of the testes and damage to the
ovaries and to a fetus (teratogenesis). Other
problems may include sterility; amenorrhea;
premature menopausal symptoms of hot flashes,
decreased vaginal secretions, mood changes, or
irritability; and decreased libido or sexual
dysfunction.
● Stress to female patients of childbearing age who are
sexually active that they need to protect themselves
against pregnancy because of the risk for embryonic
death. Encourage contraceptive measures during
chemotherapy and for up to 8 weeks after
discontinuation of therapy; however, some
antineoplastic drugs require the use of contraception
for up to 2 years after completion of treatment
because of the long-term risk for fetal genetic
abnormalities.
● Use extreme caution in handling and administration
of cytarabine by the various routes (IV,
subcutaneous, or intrathecal). Other major concerns
with cytarabine therapy are bone marrow
suppression and cytarabine syndrome. If high
dosages are used, cytarabine may also cause central
nervous system, GI, and/or pulmonary toxicity.
● Do not add fluorouracil to any other IV infusions;
administer the drug by itself in the appropriate
diluent.
● If extravasation of a vesicant occurs, the drug is
usually discontinued immediately; leave the IV
cannula in place (for possible use of antidotes
through the cannula to access the affected area)
● Gemcitabine, another antimetabolite, is dosed based
on absolute granulocyte counts and platelet nadirs.
Keep IV solutions at room temperature to avoid
crystallization, and use within 24 hours. Give
infusions as ordered. Antiemetics and antidiarrheals
may be needed.
● For the mitotic inhibitors, specifically the taxane
family of drugs and docetaxel in particular,
premedication protocols are usually specified and
include the administration of oral corticosteroids
(e.g., dexamethasone) beginning several days before
day 1 of therapy to help decrease the risk for
hypersensitivity
● With the topoisomerase I inhibitors irinotecan and
topotecan, monitor blood counts closely with every
treatment.
● Handle the enzyme antineoplastics asparaginase and
pegaspargase with extreme caution and care.
● The patient may receive an intradermal test dose of
asparaginase before therapy begins or if a week or
longer has passed between doses.
● With asparaginase and pegaspargase, if the solution
comes in contact with the skin, thoroughly wash or
rinse the area with copious amounts of water for a
minimum of 15 minutes.
● During therapy, if there are signs and symptoms of
oliguria, anuria (renal failure), or pancreatitis, the
drug will most likely be discontinued.
● The intramuscular route of administration is usually
preferred because it carries a lower risk for causing
clotting abnormalities, GI disorders, and renal and
hepatic toxicity.
● Never use cloudy solutions. Pancreatitis is
problematic with these drugs and can be serious.
● Monitor for symptoms such as severe abdominal
 pain with nausea and vomiting and monitor serum
lipase and amylase levels.
● If any signs or symptoms of pancreatitis occur, the
prescriber will usually discontinue the drugs
immediately
Evaluation
● Focus evaluation of nursing care on reviewing
whether goals and outcomes are being met, as well
as monitoring for therapeutic responses and adverse
and toxic effects associated with antineoplastic
therapy.
● Therapeutic responses may manifest as clinical
improvement, a decrease in tumor size, and decrease
in metastatic spread
HORMONAL AGENTS AND TARGETED DRUGS
- Used for breast cancer and prostate cancer,
mimic or suppress the actions of endogenous
hormones
- Principal treatment modalities are surgery,
radiation, cytotoxic drugs (chemotherapy), and
hormonal drugs
• For a woman with early breast cancer, treatment
typically consists of surgery (using total mastectomy
or partial mastectomy [lumpectomy]) followed by
local radiation. After that, chemotherapy is used to
kill cells left behind after surgery and radiation and to
kill cells that may have metastasized to other sites.
Finally, hormonal agents are taken for several years to
reduce recurrence
- chemotherapy is used before surgery—so-called
neoadjuvant therapy—to shrink large tumors and
thereby permit lumpectomy in women who would
otherwise require mastectomy.
- Hormonal agents for breast cancer fall into two
major groups: antiestrogens (e.g., tamoxifen
[Soltamox]) - block receptors for estrogen,
- aromatase inhibitors (e.g., anastrozole [Arimidex])-
block estrogen biosynthesis
TAMOXIFEN
- gold standard for endocrine treatment of breast
cancer
Mechanism of Action in Breast Cancer
● a prodrug that undergoes hepatic conversion to
active metabolites. These metabolites then block
ERs on breast cancer cells and thereby prevent
receptor activation by estradiol, the principal
endogenous estrogen
Pharmacokinetics
● Tamoxifen is readily absorbed following oral
administration.
● Because clearance is slow, once-daily dosing is
adequate.
Use for Treatment of Breast Cancer
● two treatment applications:
(1) as adjuvant therapy to suppress growth of
residual cancer cells following surgery and
(2) treatment of metastatic disease.
Adverse Effects
● hot flashes,
● fluid retention
● vaginal discharge
● nausea, vomiting,
● menstrual irregularities.
• In women with bone metastases, tamoxifen may cause
transient hypercalcemia and a flare in bone pain
•poses a small risk of thromboembolic events, including
deep vein thrombosis, pulmonary embolism, and stroke.
•endometrial cancer
Dosage and Administration
● The usual dosage for adjuvant treatment of breast
cancer is 20 mg PO once a day. Larger doses do
not increase benefits. In most cases, treatment
should continue for 5 years. The dosage for
prevention of breast cancer in high-risk women is
20 mg PO daily for 5 to 10 years
TOREMIFENE
Actions and Use
● Toremifene [Fareston] is an antiestrogen indicated
for metastatic breast cancer in postmenopausal
women with ER-positive tumors or tumors for which
ER status is unknown
Pharmacokinetics
● Toremifene is well absorbed following oral
administration. Plasma levels peak in 3 hours
FULVESTRANT
Actions and Use
● Fulvestrant [Faslodex] is an antiestrogen indicated
for metastatic ER-positive breast cancer in
postmenopausal women
● pure estrogen receptor antagonist. As with other
antiestrogens, benefits derive from depriving breast
cancer cells of required hormonal stimulation
Pharmacokinetics
● Plasma levels peak about 7 days after IM injection
and remain therapeutic for at least 1 month.
Adverse Effects and Drug Interactions
● Fulvestrant is generally well tolerated. The most
common adverse effects are GI disturbances, hot
flashes, headache, pharyngitis, and bone and back
pain. Thromboembolism can occur but is
uncommon. In contrast to tamoxifen, fulvestrant
poses no risk of endometrial cancer.
● Fulvestrant has no known drug interactions
Preparations, Dosage, and Administration
● Fulvestrant is supplied in solution (50 mg/mL) for
administration by slow IM injection (1 to 2 minutes).
The dosage is 500 mg on days 1, 15, and 29,
followed by 500 mg once a month thereafter. Each
dose is administered as two 5-mL injections, one
into each buttock.
 DRUGS FOR PROSTATE CANCER
● For men with localized prostate cancer, the
preferred treatments are surgery and radiation, with
or without adjunctive use of drugs. For men with
metastatic prostate cancer, drug therapy and
castration are the only options.
Agents for androgen deprivation therapy (ADT)
LEUPROLIDE
● Leuprolide is indicated for advanced carcinoma of
the prostate. Palliation is the primary benefit. For
patients with prostate cancer, leuprolide represents
an alternative to orchiectomy (surgical castration).
Leuprolide may be administered daily (subQ);
monthly (IM); or every 3, 4, or 6 months (IM)
Mechanism of Action
● Cells of the prostate, both normal and neoplastic,
are androgen dependent. Leuprolide provides
palliation by suppressing androgen production in
the testes. During the initial phase of treatment,
leuprolide mimics GnRH. That is, the drug acts on
the pituitary to stimulate release of interstitial
cell–stimulating hormone (ICSH), which acts on the
testes to increase production of testosterone. As a
result, there may be a transient “flare” in prostate
cancer symptoms. However, with continuous
exposure to leuprolide, GnRH receptors in the
pituitary become desensitized. As a result, release
of ICSH declines, causing testosterone production to
decline too. After several weeks of treatment,
testosterone levels are equivalent to those seen
after surgical castration. Because leuprolide therapy
mimics the effects of orchiectomy, treatment is
often referred to as chemical castration.
Adverse Effects
● Leuprolide is generally well tolerated. Hot flashes
are the most common adverse effect, but these
usually decline as treatment continues. Reduced
testosterone may also lead to erectile dysfunction,
loss of libido, gynecomastia, reduced muscle mass,
new-onset diabetes, myocardial infarction, and
stroke.
● may increase the risk of osteoporosis and related
fractures. Bone loss can be minimized by consuming
adequate calcium and vitamin D and by performing
regular weight-bearing exercise.
Preparations, Dosage, and Administration
● Leuprolide is supplied in two basic formulations for
parenteral dosing:
● Leuprolide short-acting injection [Lupron ] is
supplied as a 5-mg/ mL solution for subQ
administration. The recommended dosage is 1 mg
once a day.
● Leuprolide depot injection is available in single-dose
kits under two brand names: Lupron Depot (for IM
injection) and Eligard (for subQ injection). With
either product, the dosage is 7.5 mg once a month,
22.5 mg every 3 months, 30 mg every 4 months, or
45 mg every 6 months.
TRIPTORELIN, GOSERELIN, HISTRELIN
- are GnRH analogs indicated for palliative treatment of
advanced prostate cancer. All three have the same
mechanism and adverse effects of leuprolide, our prototype
GnRH agonist. Preparations, dosage, and administration are
as follows:
● Triptorelin [Trelstar] is administered by IM injection.
The recommended dosage is 3.75 mg once a month,
11.25 mg once every 3 months, or 22.5 mg once
every 6 months.
● Goserelin [Zoladex] is formulated as pellets (3.6 mg
and 10.8 mg) for subQ implantation in the upper
abdominal wall. The 3.6-mg pellets are implanted
every 4 weeks, and the 10.8-mg pellets are
implanted every 12 weeks.
● Histrelin [Vantas] is formulated as a 50-mg pellet for
subQ implantation in the inner aspect of the upper
arm once every 12 months.
TARGETED ANTI CANCER DRUGS
● Targeted anticancer drugs are designed to bind with
specific molecules (targets) with the goal of
suppressing tumor growth. The hope is that these
drugs will be more selective than hormones and
cytotoxic anticancer drugs, and hence will be able to
destroy cancer cells while leaving normal cells
untouched
● How do targeted drugs work? Many of these drugs
are antibodies that bind with specific antigens on
tumor cells; others are small molecules that inhibit
intracellular enzymes. Some antibodies mark cancer
cells for immune attack, some block cell-surface
receptors, some deliver toxic drugs or radioactivity,
and some inhibit angiogenesis and thereby deprive
tumor cells of their blood supply
EGFR (epidermal growth factor receptor )Tyrosine Kinase
Inhibitors
CETUXIMAB
● Cetuximab [Erbitux] is a monoclonal antibody that
blocks EGFRs. The drug is approved for refractory
colorectal cancer and for carcinoma of the head and
neck. Infusion reactions, acneiform rash, low
magnesium, and GI symptoms are common.
Mechanism of Action.
● Cetuximab acts as a competitive antagonist at
EGFRs. As noted, these receptors, which help
regulate cell growth, are overexpressed in certain
cancers, including those of the colon and rectum.
EGFR blockade inhibits cell growth and promotes
apoptosis. In animal studies, cetuximab decreased
growth and survival of cancer cells that overexpress
EGFR, but had no effect on cancer cells that lack
EGFR.
Therapeutic Uses
● Colorectal Cancer. Cetuximab is approved for
metastatic, EGFR-positive colorectal cancer. The
drug may be added to an irinotecan-based regimen
(if the cancer has progressed despite irinotecan
treatment), or it may be used alone (in patients who
 cannot tolerate irinotecan). In clinical trials, DRUGS FOR ADJUVANT THERAPY OF BREAST CANCER
cetuximab delayed tumor growth and promoted
tumor regression. Treatment improves quality of life
and can improve survival rate at 3 years.
● Head and Neck Cancer. Cetuximab, in combination
with radiation, is approved for initial treatment of
locally or regionally advanced squamous cell
carcinoma of the head and neck. In addition, the
drug can be used for recurrent or metastatic cancers
that have progressed despite treatment with a
platinum-based regimen.
Adverse Effects
● Cetuximab causes adverse effects in most patients.
The effects of greatest concern are severe infusion DRUGS FOR PROSTATE CANCER
reactions, severe rash, and interstitial lung disease
(ILD). Cetuximab causes severe infusion reactions in
2% to 5% of patients. Manifestations include
rapid-onset airway obstruction, hypotension, shock,
loss of consciousness, myocardial infarction, and
cardiopulmonary arrest.
● Severe reactions can happen with any infusion, but
most (90%) occur with the first infusion. If a severe
reaction develops, cetuximab should be
discontinued immediately and never used again.
Agents for medical management—epinephrine,
glucocorticoids, IV antihistamines, bronchodilators,
and oxygen—should always be on hand.
● To reduce the risk of a severe reaction,
premedication with an IV antihistamine (e.g., 50 mg
diphenhydramine) is recommended. DRUGS FOR EYE AND EARS DISORDER
● Acne-like rash, mainly on the face and upper torso, OPTHALMIC EYE DISORDERS:
develops in 88% of patients and is severe in 12%. Glucoma – under constant IOP (increased) –> increased
Severe rash has led to Staphylococcus aureus sepsis pressure –> ocular damage (optic nerve damage) –>
and abscesses that require incision and drainage. decreased peripheral vision –> blindness
● Sunlight can exacerbate dermatologic reactions, and Types:
● Chronic open-angle – most common; open drainage
hence patients should limit sun exposure, use a
sunblock, and wear protective clothing. Very rarely, blockage in the angle of the eye –> nerve damage
cetuximab has been associated with interstitial lung –> gradual IOP and painless vision loss
● Angle closure – complete blockage on the drainage
disease, characterized by inflammation, scarring,
and hardening of the lungs. angle of the eye –> pressure builds up rapidly –>
● One case of fatal interstitial pneumonitis with severe eye pain, blurred vision, headache, rainbow
pulmonary edema has been reported. Whether haloes around lights, nausea, and vomiting –>
cetuximab is truly the cause of these lung disorders blindness
has not been established.
● The combination of cetuximab and irinotecan often
causes GI toxicity, manifesting as diarrhea, nausea,
abdominal pain, vomiting, anorexia, and
constipation.
● In clinical trials, hypomagnesemia developed in 55%
of patients and was severe in 6% to 17%.
Magnesium supplements are often required.
Dosage and Administration.
● Cetuximab [Erbitux] is given by slow IV infusion.
Treatment consists of a loading dose (400 mg/m2
infused over 2 hours) followed by maintenance
doses (250 mg/m2 infused over 1 hour), given
either weekly (for head and neck cancer) or every
other week (for colorectal cancer).

MIOTICS:
Drug Name: Carbachol, Pilocarpine
Action: Miotics (drugs that cause the pupil to contract)
improve the outflow of aqueous as part of the treatment of
glaucoma and reduce the risk of a posteriorly luxated lens
entering the anterior chamber.
Indications for use: Antiglaucoma miotics are used to reduce
intraocular pressure in the following conditions: To treat
glaucoma, a progressive disease that damages the optic
nerve. Glaucoma is most often characterized by elevated
intraocular pressure which can further damage the nerve.
Pre-Assessment/Nursing interventions:
● Assess patients for cardiac problems (e.g. heart
conduction system problems, heart blocks).
● Check patient eye pressure before miotics
administration.
Post Administration /Nursing intervention:
● Because miotic agents can produce paradoxical
pupillary block by moving the lens–iris diaphragm
forward, patients should be re-examined by
gonioscopy after miotic therapy has commenced to
determine whether the angle has narrowed.
● Regularly patient eye pressure with Shultz
tonometry.
Side Effects:
● Systemic side effects include nausea, vomiting,
tenesmus, abdominal spasm, salivation,
lacrimation, sweating, pulmonary edema, and
bronchial spasm.
● The systemic side effects can best be minimized
initially through proper use of the medication and
nasolacrimal occlusion.
Adverse Effects / Toxic Effects:
● Systemic side effects include nausea, vomiting,
tenesmus, abdominal spasm, salivation,
lacrimation, sweating, pulmonary edema, and
bronchial spasm.
Contraindications / Drug to Drug interactions / Food
Interactions:
● These effects are dose-dependent and have been
demonstrated both with the laser flare cell meter
and fluorophotometry. For this reason, miotics
should be avoided in uveitic glaucoma, neovascular
glaucoma, or any other condition where the
blood–aqueous barrier is already compromised
MYDRIATICS:
Drug Name: epinephrine, phenylephrine (Altafrin), atropine
(Isopto Atropine), cyclopentolate (Cyclogyl), homatropine
(Homatropaire), scopolamine, tropicamide (Mydriacyl)
Class: Adrenergic agonists, Antimuscarinics
Action:
Mydriatic effects: stimulation of the iris dilator
muscle → pupillary dilation; stimulation of the iris
dilator muscle → pupillary dilation
Cycloplegic effects: paralysis of the ciliary muscle of
the eye → loss of lens accommodation
Indications for use: Eye exams; Ophthalmic procedures
Routes of Administration:
● Topical: eye drops and ointment
Side Effects:
● Photophobia
● Blurred vision
● Systemic absorption: confusion, drowsiness, dry
mouth, flushing, tachycardia, hypertension,
constipation
Contraindications:
● Narrow-angle glaucoma
Nursing Consideration:
● Ensure medications are labeled with name,
strength, amount, and expiration date.
● Client education: Purpose of medication: provide
comfort during the procedure; facilitate
ophthalmologist examination of the eye
● Drops may sting with application
 ● Side effects: blurry vision; increased sensitivity to
light
● Avoid light
● Wear sunglasses
● Avoiding scratching or rubbing the eye
Administration:
● Verify correct eye needing medication
● Position client: leaning back and looking at the
ceiling
● Gently pull down on the skin below the eye
● Administer the prescribed number of drops into the
center of the conjunctival sac
● Avoid getting drops directly on the cornea or
touching the tip of the dropper to the eye
● Ask the client to close their eyes and gently apply
pressure over the eyelid above the lacrimal duct
Monitoring:
● Monitor for side effects and evaluate for the
therapeutic response of the medication
CONJUNCTIVITIS
- pink eye, ‘sore eyes’
- an inflammation of the thin, clear membrane that
covers the white part of the eye and the eyelids (the
conjunctiva). -may be itchy or painful.
4 types of conjunctivitis:
1. Viral conjunctivitis
- affects only one eye causing excessive eye watering
and a light discharge from the eye.
2. Bacterial conjunctivitis
- affects both eyes causing a heavy greenish
discharge.
3. Allergic conjunctivitis
- affects both eyes causing itching and redness and
excessive tearing.
- itchy and red nose
4. Giant papillary conjunctivitis (GPC)
- affects both eyes causing contact lens intolerance,
itching, heavy discharge, and tearing and red bumps
on the underside of the eyelids.
CORNEAL ABRASION
- a cut or scratch on the cornea, which is the clear,
protective membrane covering the colored part of
the eye (iris)
- can be caused by sand, dust, dirt, and shavings from
materials such as metal, fingernails, tree branches,
rubbing your eyes, and even contact lenses can also
scratch the cornea
- patients with weak outer layer of the cornea that
can sustain an abrasion for no apparent reason.
- heal properly with the proper treatment
- abrasion can reappear months following the
originally injury.
- painful because of the sensitivity of the cornea
‘sand in the eye” sensation
- eyes become teary and red
- vision is blurry and light hurts their eyes
(photophobia)
- cause headaches
- fluorescein sodium and fluress (fluorescein sodium
and benoxinate HCl) are used to diagnose corneal
abrasions and to locate lesions or foreign objects in
the eye.
Fluorescein - dye used to demonstrate defects in corneal
epithelium and is excreted in nasal secretions if the lacrimal
(tear) duct is patent.
When fluorescence strips are used to examine the eye:
● Corneal scratches turn bright red.
● Foreign bodies are surrounded by a green ring.
● Loss of conjunctiva appears orange yellow.
Fluress is a dye and a local anesthetic and is used for short
corneal and conjunctival procedures such as removing
foreign bodies from the eye.
Eye Medication
Topical Anesthetics
- used to anesthetize the eye for comprehensive eye
examinations
- removal of foreign bodies from the eye
- onset occurs in 1 minute and lasts for 15 minutes -
blink reflex is temporarily lost
- corneal epithelium is temporarily dried
- patient is required to wear a protective eye patch
until the effects of the drug wear off
Anti-infectives and Antimicrobials
- administered for eye infections such as
conjunctivitis
- can cause local skin and eye irritation
Lubricants ● Demonstrate the proper technique to administer
- used to alleviate the discomfort that is associated eye drops and ointment
with dry eyes ● Make sure that the patient knows how to maintain a
- to moisten contact lenses and artificial eyes sterile technique so the eyedrop per does not
- maintain the integrity of the epithelial surface become contaminated.
- moisten the eye during anesthesia and ● Tell the patient about expected side effects such as
unconsciousness blurry vision and that administering the medication
Miotics at bedtime can avoid problems that could arise from
- lower intraocular pressure in open-angle glaucoma temporary loss of vision.
allowing increased blood flow to the retina ● Should record each time they administer the
- results in less retinal damage and prevents the loss medication, especially for patients who are
of vision confused or forgetful and could accidentally receive
2 types of miotics: an overdose of the medication.
- direct-acting cholinergics ● The patient should not stop taking the medication
- cholinesterase inhibitors without consulting his or her healthcare provide
- may experience headache, eye pain, decreased
vision, brow pain, and less frequently hyperemia of
the conjunctivia (red eye).
- systemically absorbed resulting in the patient
experiencing nausea, vomiting, diarrhea, frequent
urination, precipitation of asthma attacks,
increased salivation, diaphoresis, muscle
weakness, and respiratory difficulty
Carbonic Anhydrase Inhibitors
- used as a long-term treatment for open-angle
glaucoma
- decreasing intraocular pressure by interfering with
the production of aqueous humor
- can experience lethargy, anorexia, drowsiness,
paresthesia, depression, polyuria, nausea,
vomiting, hypokalemia, and renal calculi (adverse
side effects : patients frequently discontinue taking
carbonic anhydrase inhibitors)
- contraindicated in the first trimester of pregnancy
and for patients who are allergic to sulfonamides
Osmotics
- preoperative and postoperative medications
- used to reduce intraocular pressure by decreasing
vitreous humor volume
- used in the emergency treatment of closed-angle
glaucoma
- patients can experience headache, nausea,
vomiting, and diarrhea
- elderly patients can become disoriented
Anticholinergic mydriatics and cycloplegics
- used in diagnostic procedures and ophthalmic
surgery
- anticholinergic mydriatics > dilate the pupils
- cycloplegics > paralyze eye muscles
- patients experience tachycardia, photophobia,
dryness of the mouth, edema, conjunctivitis, and
dermatitis
Patient Education for Eye Medication
● Patients should understand the effects of their eye
disorder and the effects of the medication treating
the condition.
● Patients are anxious about eye disorders fearing
that they could lose their vision.
 EAR DISORDERS
3 parts: the external, middle, and inner ear.
EXTERNAL EAR: pinna and the external auditory canal -
transmits sound to the middle ear.
MIDDLE EAR: an air-filled cavity that contains auditory
ossicles (malleus, incus, and stapes)
- forward the sound to the inner ear where the
eardrum is located.
- pressure on both sides of the eardrum is equalized
by the eustachian tube that connects to the
nasopharynx.
- the eardrum could rupture if pressure becomes
unequal.
INNER EAR: contains a series of canals called the labyrinths
- made up of the vestibule, cochlea, and semicircular
canals.
- vestibule maintains equilibrium and balance.
- cochlea is the principal hearing organ.
Common ear disorders:
● cerumen (ear wax) impaction
● otitis external
● otitis media (infections of the external and middle
ear)
● vestibular disorders of the inner ear
CERUMEN IMPACTION
- produced by glands in the outer portion of the ear
canal.
- moves down the canal to the external os where the
cerumen is washed away.
- when this process fails, cerumen becomes impacted
- must be loosened by using ceruminolytics such as a
hydrogen peroxide solution (3% diluted to 1/2
strength with water)
- ear canal is irrigated with ceruminolytics, which
flushes cerumen deposits out of the ear canal.
- patients who have chronic cerumen impaction are
treated with drops of olive oil or mineral oil or by
Cerumenex and Debrox. Cerumenex is available by
prescription and Debrox is an over-the-counter
medication.
OTITIS EXTERNA AND OTITIS MEDIA
- infections of the external and middle ear,
respectively.
- treated with analgesics and antibiotics.
- commonly used antibiotics for ear infections.
- caused by a virus and should not be treated with an
antibiotic.
VESTIBULAR DISORDERS
- most frequently reported symptoms of vestibular
disorders are dizziness, unsteadiness or imbalance
when walking, vertigo, and nausea.
- symptoms may be quite mild, lasting minutes, or
quite severe, resulting in total disability.
- the vestibular system interacts with many other
parts of the nervous system, symptoms may also be
experienced as problems with vision, muscles,
thinking, and memory.
- may suffer headache and muscular aches in the
neck and back
- increased tendency to suffer from motion sickness,
and increased sensitivity to noise and bright lights.
- vestibular disorders often report fatigue and loss of
stamina and an inability to concentrate.
- difficulty with reading and speech may occur during
times of fatigue.
- when these symptoms are constant and disabling,
they may be accompanied by irritability, loss of
self-esteem, and/or depression.
Meniere’s disease, labyrinthitis, and inner ear infections
should cause vestibular disorders.
EAR PAIN
- usually resolves itself between 48 and 72 hours
from the onset of the pain.
- analgesics such as acetaminophen or ibuprofen
should be administered to relieve the pain in the
interim.
EAR CONGESTION
- caused by the improper drainage of the eustachian
tube.
- relieved by administering
antihistamine-decongestant medications such as
Actifed, Allerest, Dimetapp, Drixoral, Novafed,
Ornade, and Triaminic, all of which are available
over the counter
Patient Education for Ear Medication
● Patients should understand that they should not
place any foreign objects into their ear canal
including Q-Tips.
● Cerumenolytics should be used to remove
cerumen.
● Patients who are prone to swimmer’s ear (otitis
externa) should keep the ear canal dry by placing
two drops of alcohol in the ear canal.
 ● Many medications used to treat ear disorders are
sensitive to light, they should be kept in a
light-resistant container.
● All antibiotics must be taken for the prescribed
length of time (10–14 days), patient should not stop
taking antibiotics once the pain has subsided.
● The patient should report any change in hearing,
patients may not report the loss to their healthcare
professional because they consider the loss of
hearing as part of aging or due to exposure to
environmental noises.
DRUGS ACTING ON THE IMMUNE SYSTEM
Immunologic Agents
- body’s immune system is its natural defense against
microorganisms that cause diseases (pathogens)
and against cells that are not the body’s own cells,
such as transplanted organs.
- also treats its own abnormal cells, such as cancer
cells, as foreign and attacks it with the same energy
as it attacks microorganisms.
- when compromised through diseases including HIV,
the body loses its ability to fight off microorganisms
and destroy its own abnormal cells, patient
encounters more episodes of infection that can
ultimately lead to death.
Immunity
- the immune system is the body’s way of combating
the invasion of microscopic organisms such as
bacteria, viruses, molds, spores, pollens, protozoa,
and cells from transplant donors (human or animal).
- prevents an invasion from attacking internal organs
and, if that fails, the immune system neutralizes,
destroys, and eliminates any non-self proteins and
cells, including microorganisms.
Non-self proteins and cells also include self cells (the body’s
own cells) that have become infected or debilitated, an
example of malignant transformation that changes healthy
cells into cancer cells.
Self-tolerance
- ability of the immune system to differentiate
between the body’s own cells and non-self cells. -
able to recognize self-cells by using unique proteins
that are on the surface of all self-cells.
Identification code
- proteins from foreign cells / antigens, stimulate the
immune response of a host.
- e.g. bacteria invade your body, your immune system
detects the bacteria’s surface protein as not being a
self-cell -> triggers your immune system to launch
an attack against the bacteria.
- immune system originates in the bone marrow.
Mature immune system cells - released from the bone
marrow into the bloodstream where they circulate
throughout the body looking for invaders
3 processes necessary for immunity:
● Inflammation
● antibodymediated immunity (humoral immunity)
● cell-mediated immunity (CMI)
INFLAMMATION
- body’s protective response to injury to tissues.
Injury causes the release of three chemicals that
stimulate a vascular response that force fluid and white
blood cells to flow to the site of the injury. Stimulated nerve
endings signal the brain that there is an injury.
3 chemicals released:
● Histamines: works to bring more blood and lymph
fluid to the site of the invasion.
● Kinins: blood plasma proteins that influence smooth
muscle contractions, increase blood flow
throughout the body, increase the permeability of
small capillaries, and stimulate pain receptors.
● Prostaglandins: work as chemical messengers. They
do not move but work right in the cell where they
are synthesized. They are synthesized in every cell
in the body. These chemicals activate the
inflammatory response and produce pain and fever.
They are produced in response to the white blood
cells that flow to the area of injured tissue.
○ The injured tissue becomes red, swollen,
warm and loses its normal function. These,
along with pain, are the five cardinal signs
of inflammation.
○ Do not to confuse inflammation and
infection because they are not the same.
Only a small percentage of inflammation is
caused by infection from microorganisms.
○ Trauma, surgery, extreme heat or cold,
electricity, and caustic chemicals cause
most inflammation.
5 Cardinal Signs of Inflammation:
1. Calor (Heat): Increased blood flow also brings
warmth to the affected area. The heat is a result of
the metabolic activity of immune cells and the
vasodilation of blood vessels.
2. Rubor (Redness): Increased blood flow to the
affected area leads to redness. This occurs as blood
vessels dilate to allow more immune cells to reach
the site of injury or infection.
3. Tumor (Swelling): Increased permeability of blood
vessels allows fluid, proteins, and immune cells to
move into the tissue, causing swelling or edema.
This helps isolate the site of injury and promotes
tissue repair.
4. Dolor (Pain): Inflammation can stimulate nerve
endings, leading to pain. Chemicals released during
the inflammatory process, such as prostaglandins,
contribute to the sensation of pain.
5. Functio Laesa (Loss of Function ): Inflammatory
processes may result in a loss of normal function in
the affected area. This can be due to pain, swelling,
or tissue damage, and it reflects the body's attempt
to protect the injured or infected tissue,
2 Phases of Inflammation:
● VASCULAR PHASE
○ occurs 10 to 15 minutes after the tissue is
injured.
○ blood vessels dilate (vasodilation) and
become more permeable, enabling fluid
and white blood cells to leave the plasma
and flow to the injured tissue.
● DELAYED PHASE
○ when the injured tissue is infiltrated by
white blood cells (leukocytes or immune
cells), components found in the blood. The
three main types of leukocytes are
granulocyte (neutrophils, basophils, and
eosinophils), lymphocytes (B-cells, T-cells,
and natural killer cells), and monocytes.
○ found in the spleen, the lymphatic system,
and other tissues.
○ help defend the body against infectious
disease and foreign material as part of the
immune system.
● ANTIBODY-MEDIATED IMMUNITY
○ occurs when the immune system produces
antibodies that neutralize, eliminate, or
destroy an antigen (foreign protein).
Antibodies are produced by B lymphocytes.
The body must be exposed to sufficient
amounts of an antigen before the immune
system produces an antibody to combat the
antigen. Patients can be given vaccinations
that stimulate the immune system to
generate antibodies before the
microorganism actually invades the body. In
this way, the antibodies already exist and
can attack at the first sign of the
microorganism.
● CELL-MEDIATED IMMUNITY
○ also known as cellular immunity, uses
T-leukocytes (referred to as natural killer
cells or NK cells) to attack non-self cells.
Cellmediated immunity also causes the
body to release cytokines, which regulate
the activities of antibody-mediated
immunity and inflammation. Cell-mediated
immunity is especially useful in identifying
and ridding the body of self-cells that are
infected by organisms that live within host
cells and self-cells that mutate at the DNA
level transforming them into abnormal and
potentially harmful cells. Cell-mediated
immunity is critically important in
preventing development of cancer and
metastasis after exposure to carcinogens
DIETARY SUPPLEMENTS ALTERNATIVE AND COMPLEMENTARY
THERAPIES (HALAMANG GAMOT)
Herbals and Dietary Supplements
● Dietary supplement is a broad term for orally
administered alternative medicines and includes the
category of herbal supplements. Dietary supplements
are products that are intended to augment the diet
and include vitamins, minerals, herbs, or other
botanicals, amino acids, and enzymes. Dietary
supplements may be produced in many forms, such as
tablets, capsules, liquids, and powders. These
supplements may also be found in nutritional,
breakfast, snack, or health food bars; drinks; and
shakes.
● Herbs come from nature and have been used for
thousands of years to help maintain good health.
About 30% of all modern drugs are derived from
plants.
● Herbal medicine lost ground to new synthetic
medicines during the early part of the 20th century. In
the 1960s, concerns were expressed over the
iatrogenic effects of conventional medicine. These
concerns, along with a desire for more self-reliance,
led to a renewed interest in “natural health,” and, as a
result, the use of herbal products increased.
● Complementary medicine refers to the simultaneous
use of both traditional and alternative medicine. This
practice is also referred to as integrative medicine.
NCCAM classifies complementary and alternative
medicine into the following five categories:
(1) alternative medical systems
(2) mind-body interventions
(3) biologically based therapies
(4) manipulative and body-based methods
(5) energy therapies
● NCCAM- National Center for Complementary and
Alternative Medicine
Dietary Supplement and Nonprescription Drug Consumer
Protection Act
● The Dietary Supplement and Nonprescription Drug
Consumer Protection Act passed in 2006, mandates
reporting of serious adverse events for
nonprescription drugs and dietary supplements.
● The following events should be reported: deaths,
hospitalizations, life-threatening experiences,
persistent or significant disabilities, and birth
defects. Manufacturers and distributors must report
these to the FDA within 15 days.
Dietary Supplement Health and Education Act Of 1994
Dietary Supplement Health and Education Act (DSHEA)
● Alternative and Complementary Therapies
● Is intended to supplement the diet
● Contains one or more dietary ingredients (including
vitamins, minerals, herbs or other botanicals, amino
acids, and certain other substances) or their
constituents
● Is intended to be taken by mouth, in forms such as
tablet, capsule, powder, soft gel, gelcap, or liquid
 ● Is labeled as being a dietary supplement
• Manufacturers are required to ensure that their products
are safe and that the label information is truthful and not
misleading; however, they are not required to demonstrate
product safety before the product is sold.
• Packaging of all dietary supplements must bear the
wording “This statement has not been evaluated by the U.S.
Food and Drug Administration (FDA). This product is not
intended to diagnose, treat, cure, or prevent any disease.”
• Additionally, all labels are required to have the following
five components:
1. Name of the supplement
2. Amount of the supplement (net quantity)
3. Nutrition labeling
4. Ingredient list
5. Name and place of the manufacturer, packer, or
distributor
• Manufacturers of dietary supplements are allowed to
make three types of claims:
(1) health claims
(2) structure and function claims
(3) nutrient content claims.
• Herbal supplements can be marketed with suggested
dosages. The physiologic effects of the product can be
noted, but no claims can be made about preventing or
curing specific conditions.
• Health maintenance claims (e.g., “maintains a healthy
immune system”) and claims for relief of minor symptoms
related to life stages (e.g., “alleviates hot flashes”) are
acceptable because they do not relate to disease.
• Herbal products using a “may be beneficial” disclaimer,
rather than claims of definite benefit, are appropriate legally.
• Dietary supplement manufacturers are still required to
substantiate any claims they make. Consumers are reminded
that premarket testing for safety and efficacy is not required,
and manufacturing is not standardized.
• Current Good Manufacturing Practices
- FDA proposed standards for marketing and labeling
dietary supplements in 2003. Known as the Current
Good Manufacturing Practices (CGMPs), these
standards are multifaceted and require that package
labels give the quality and strength of all contents
and that products be free of contaminants and
impurities
● a seal of approval is awarded to products that meet
criteria similar to that of the CGMPs by four
organizations: the U.S. Pharmacopeial Convention
(USP), ConsumerLab.com, National Products
Association, and NSF International.
Adverse Effects
● With dietary supplements, as with conventional
drugs, the manufacturer is responsible for safety.
However, the similarity ends there. Under the
DSHEA, a product is presumed safe until proven
hazardous
Impurities, Adulterants, and Variability
● The DSHEA does not address the issues of
impurities, adulterants, or variability. As a result,
dangerous products have been allowed to reach
consumers. A few examples illustrate the problem:
● A combination product used to “cleanse the bowel”
caused a life-threatening heart block. Analysis
revealed contamination with Digitalis lanata, a plant
with powerful effects on the heart.
● The CGMPs ruling, issued by the FDA in 2007,
should prevent the sale of such products in the
future.
● Many dietary supplements and “natural” remedies
are used by the public for self-treatment.
● These substances, many derived from the folklore of
various cultures, commonly contain ingredients that
have been identified and that have known
therapeutic activities.
● Some of these substances have unknown
mechanisms of action but over the years have been
reliably used to relieve specific symptoms.
● There is an element of the placebo effect in using
some of these substances.
● The power of believing that something will work
and that there is some control over the problem is
often beneficial in achieving relief from pain or
suffering.
Why People Use Dietary Supplements:
- Perception that supplements are safer and healthier
than conventional drugs
- Sense of control over one’s care
- Emotional comfort from taking action
- Cultural influence
- Limited access to professional care
- Lack of health insurance
- Convenience
- Media hype and aggressive marketing
- Recommendations from family and friends
Dietary Supplement and Nonprescription Drug Consumer
Protection Act
● The Dietary Supplement and Nonprescription Drug
Consumer Protection Act passed in 2006, mandates
reporting of serious adverse events for
nonprescription drugs and dietary supplements. The
following events should be reported: deaths,
hospitalizations, life-threatening experiences,
persistent or significant disabilities, and birth
defects. Manufacturers and distributors must report
these to the FDA within 15 days.
DOH MOST COMMON & APPROVED HERBAL MEDICINES
AND PREPARATIONS
● Organizing Bodies:
○ DOH – Department of Health
○ FDA – Food and Drug Administration
○ PITAHC – Philippines Institute of Traditional
and Alternative Medicine
○ DOST-PICAARD – Department of Science
and Technology – Philippine Council for
 Agriculture, Aquatic, and Natural Resources
Research and Development
○ FDA – Food and Drug Administration
- As a regulatory agency under the
Department of Health, the Food and Drug
Administration, created under Republic Act
No. 3720, series of 1963, as amended by
Executive Order 175, series of 1987,
otherwise known as the “Food, Drugs and
Devices, and Cosmetics Act”, an
subsequently Republic Act No. 9711
otherwise known as
❖ “The Food and Drug Administration Act of 2009”, is
mandated to ensure the safety, efficacy or quality of
health products which include food, drugs,
cosmetics, devices, biologicals, vaccines, in-vitro
diagnostic reagents, radiation-emitting devices or
equipment, and household/urban hazardous
substances, including pesticides and toys, or
consumer products that may have an effect on
health which require regulations as determined by
the FDA,
❖ PITAHC – Philippines Institute of Traditional and
Alternative Medicine
➢ The Philippine Institute of Traditional and
Alternative Health Care is a person, corporation, partnership, association or other entity,
government-owned and controlled
corporation attached to the Department of
Health (DOH) which was created in
December 7, 1997 per Republic Act No.
8423, otherwise known as the Traditional
and Alternative Medicine Act (TAMA) of
1997 authored by Senator Juan M. Flavier.
➢ PITAHC is currently headed by
Director-General Annabelle Pabiona-De
Guzman, MD, FPAFP, MHA, MA Med (UK),
CESE under the direction of a Board of
Trustees composed of representatives from
different government agencies namely:
Department of Science and Technology
(DOST); Department of Environment and
Natural Resources (DENR); Department of
Agriculture (DA); Commission on Higher
Education (CHED); and representatives from
the industries/sectors namely: a physician
engaged in the practice of Traditional and
Complementary Medicine (T&CM); a
member from a duly recognized academe
engaged in T&CM research; a T&CM
practitioner who is not a physician; a
western medical practitioner preferably
from the Philippine Medical Association;
one member from the natural food industry
and one member from environmental
sector. The board is chaired by the
Secretary of Health.
➢ POWER and FUNCTIONS:
1. To plan and carry out research and development activities
in the areas of traditional and alternative health care and its
ultimate integration into the national health care delivery
system;
2. To verify, package and transfer economically viable
technologies in the field of traditional and alternative health
care, giving emphasis on the social engineering aspects
necessary for group endeavor;
3. To provide the database for policy formulation that will
stimulate and sustain production, marketing and
consumption of traditional and alternative health care
products;
4. To organize and develop continuing training programs for
physicians, nurses, pharmacists, physical therapists, and
other professional health workers and students, as well as
scientists, research managers and extension workers in the
field of traditional and alternative health care;
5. To formulate policies that would create public awareness
through educational activities, conventions, seminars,
conferences, and the like by focusing on the promotion of
healthy living for preventing disease, thereby uplifting the
health care industry;
7. To acquire or obtain from any governmental authority
whether national or local, foreign or domestic, or from any
such charters, franchises, licenses, rights, privileges,
assistance, financial or otherwise, and concessions as are
conducive to and necessary or proper for the attainment of
its purpose and objectives;
8. To receive and acquire from any person and/or
government and private entities, whether foreign or
domestic, grants, donations and contributions consisting of
such properties, real or personal, including funds and
valuable effects or things, as may useful, necessary or proper
to carry out its purposes and objectives and administer the
same in accordance with the terms of such grants, donations
and contributions, consistent with its purposes and
objectives;
9. To formulate a code of ethics and standards for the
practice of traditional and alternative health care modalities
for approval and adoption by the appropriate professional
and government agencies
10. To formulate standards and guidelines for the
manufacture, marketing and quality control of different
traditional and alternative health care materials and
products for approval and adoption by the Bureau of Food
and Drugs;
11. To coordinate with other institutions and agencies
involved in the research on herbal medicine;
12. To adopt and use a corporate seal;
13. To sue and be sued in its corporate name;
14. To succeed by its corporate name;
15. To adopt its by-laws and promulgate such rules and
regulations as may be necessary or proper to implement this
ACT, and to amend or repel the same from time to time;
16. To enter, into, make and execute contracts and
agreements of any kind or nature;
17. To borrow, raise or obtain funds, or to enter into any
financial or credit arrangement to support or carry out in
research programs, finance its capital and operating
expenses, subject to pertinent laws governing public debts
and expenditures;
PROCLAMATION NO. 698
● DECLARING THE MONTH OF NOVEMBER AS
“TRADITIONAL AND ALTERNATIVE HEALTH
MONTH”
• WHEREAS, the Traditional and Alternative Medicine Act
(TAMA) of 1997, R.A. No. 8423 declares that it is the policy
of the State to improve the quality and delivery of health
care services to the Filipino people through the
development of the traditional and alternative health care
and its integration into the national health care delivery
system;
PROCLAMATION NO. 698
● DECLARING THE MONTH OF NOVEMBER AS
“TRADITIONAL AND ALTERNATIVE HEALTH
MONTH”
• WHEREAS, the intent of this policy is to promote and be
able to provide an array of affordable, accessible and
effective traditional and complementary / alternative health
care options for our people to choose from;
• WHEREAS, the Philippine Institute of Traditional and
Alternative Health Care (PITAHC), created under R.A. No.
8423 in partnership with other government
agencies, non-government organizations, the herbal and
natural products industry, the private sector and
practitioners of traditional and complementary/alternative
health care modalities, are vigorously pursuing the
implementation of this policy;
• WHEREAS, since much of medical care in the country is
focused on primary health care, the first line of defense,
there is a need for our people to adopt a healthy lifestyle
and be aware of the existence of traditional and alternative
medicine which are effective and affordable for preventing
and healing a wide variety of diseases;
• WHEREAS, there are about 2,000 medicinal plants in the
Philippines and there is a need to accelerate the research
and development of these plants for medical use.
❖ DOST-PICAARD – Department of Science and
Technology – Philippine Council for Agriculture,
Aquatic, and Natural Resources Research and
Development
• The Philippines Council for Agriculture, Aquatic and
Natural Resources Research and Development (PCAARRD) is
one of the sectoral councils under the Department of
Science and Technology. It is tasked with providing a unified
and focused direction for the country’s agricultural research.
•L •S
•U •A
•B •N
•B •T
•Y •A
• Scientific Name; Vitex Negundo
• Filipino Name; Lagundi
• English Name; Five-Leaved Chaste Tree
• Where it is commonly available; Tropical East Africa,
Madagascar, from India to Japan, southward through
Malesia to Polynesia; distributed throughout the Philippines
• Pre-clinical; Antimutagenic, depressant on cardiac function
• Clinical: Antitussive (Philippine setting)
• How to use:
For cough:
➢ Boil crushed fresh lagundi leaves in a pot with 2
cups of water until only half of the water is left.
Leave the pot uncovered when it starts boiling.
➢ Amount of crushed leaves according to patient’s
age: 1 1⁄2 tablespoons (2-6 years old); 3
tablespoons (7-12 years old); 6 tablespoons (13
years old and above).
• Scientific Name; Peperomia Pellucida
• Filipino Name; Ulasimang Bato/Pansit-pansitan
• English Name; Peperomia
• Where it is commonly available; Native to tropical
America; distributed throughout the Philippines
• Pre-clinical; Analgesic, antibacterial, antihyperuricemia,
anti-inflammatory, antioxidant
• Clinical; Antibacterial, anticancer, antioxidant, depressant,
anti-gout (Philippine setting)
• How to use them
Tips on how to control uric acid:
➢ Consult a doctor at a health center to diagnose your
symptoms, and to know the medicine for gout
including how to use pansit-pansitan to help in
controlling your uric acid levels.
➢ The doctor may advise to eat 1 cup (not crammed)
of leafy tops of pansit-pansitan thrice during the day
(as a salad). Also, the doctor may advise to boil 1
1/2 glasses (or 3 cups), not crammed, of
pansit-pansitan in 2 glasses of water until the water
reduces to half (boil for around 15 minutes), then
drink the 1/3 glass of boiled water thrice in the day
after eating.
• Scientific Name; Allium Sativum
• Filipino Name; Bawang
• English Name; Garlic
• Where it is commonly available; Native to Southern
Europe and Central Asia; cultivated throughout the world;
extensively grown in Batanes Islands, Batangas, Nueva Ecija,
Ilocos Norte, Mindoro, and Cotabato
• Pre-clinical; Antihyperlipidemic, Antihypertensive,
Fibrinolytic, antiplatelet, hypoglycemic, anti-inflammatory,
antispasmodic, antimicrobial
• Clinical; Hyperlipidemia, hypertension, arteriosclerosis
• How to use:
For high levels of blood cholesterol (Hypercholesterolemia)
➢ Consult with a health center for a formal diagnosis
and medical advice for hypercholesterolemia,
including the use of garlic to control blood
cholesterol levels.
 ➢ The health care professional may advise patients to
eat 2-3 garlic bulbs (soaked in vinegar, sterilized,
grilled, or fried in a little oil) 3 times a day with
breakfast, lunch, and dinner.
• Side effects: Vomiting, heartburn, diarrhea, allergies,
contact dermatitis, or asthma
• Not recommended because of these possible risks:
Use for snake or dog bites, which are both
emergency cases. Immediately wash the wound with soap
and water then bring the patient to a health center or
hospital.
• Scientific Name; Psidium Guajava
• Filipino Name; Bayabas
• English Name; Guava
• Where it is commonly available; Distributed throughout
the Philippines
• Pre-clinical; Analgesic, antidiarrheal, Antihyperglycemic,
anti-inflammatory and antipyretic, antimicrobial,
antioxidant, antispasmodic, antitussive, hemostatic effects,
inotropic effects.
• Clinical; Gingivitis, rotaviral, acute diarrhea
• How to use them
For scabies or wounds that discharge pus:
➢ Boil 1 or 2 handfuls of leafy tops of guavas in a small
pot containing water.
➢ Wash the wound with the lukewarm water after it
has cooled. Do this twice during the day until the
scabies will heal.
➢ Consult a doctor at a health center if the symptoms
persist, if sudden fever occurs or if there is redness
of the area around the scabies.
For dizziness:
➢ Crumple the fresh tops and let it be inhaled by the
person experiencing dizziness. Consult a doctor at a
health center if dizziness symptoms persisted.
Swollen gums:
➢ Boil one handful of leafy tops in a small pot with
water.
➢ Gargle with the lukewarm water after it has been
cooled. Do this twice during the day until your gums
feel better.
➢ Consult a doctor at a health center if symptoms still
persist or if sudden fever is developed.
Cleaning the vagina after giving birth:
➢ Boil one handful of leafy tops in a small pot with
water.
➢ Wash with the lukewarm water after it has cooled.
Taking a bath or for itchy skin:
➢ Boil enough leafy tops in a pot with water.
➢ Take a bath with the lukewarm water after it has
cooled.
• Scientific Name; Mentha Cordifolia
• Filipino Name; Yerba Buena
• English Name; Peppermint / Mint
• Where it is commonly available; Distributed throughout
the Philippines
• Pre-clinical; Analgesic, antimicrobial and antiparasitic,
antineoplastic
• Clinical; Analgesic (Philippine setting)
• How to use:
For toothaches:
➢ Boil the grinded and freshly picked yerba buena
leaves in a pot filled with 2 glasses of water until the
pot is only left with half-filled of water. Keep the lid
off the pot after bringing it to a boil.
➢ Let it cool completely and then strain it.
➢ Divide it into 2 portions. Drink 1 portion, then drink
another 1 portion after 3-4 hours if the pain still
persist.
➢ Dosage of minced sambong leaves based on
patient’s age: 3 tablespoons (7-12 years old); 6
tablespoons (13 years old and above)
➢ Visit a health center and consult about your illness if
the toothache is persisted.
• Headache:
➢ Compress or crush freshly picked leaves and use the
extract in massaging the forehead and top of head.
➢ Consult with a health center if the headache is
persisted.
• Scientific Name; Blumea Balsamifera
• Filipino Name; Sambong
• English Name; Ngai Camphor
Where it is commonly available; Found from India to
Southern China, through the Malay Peninsula to the
Moluccas; distributed throughout the Philippines
• Pre-clinical; Anti-cancer, anti-genotoxicity and
anti-mutagenicity, antimicrobial, anti-obesity, antioxidant,
dissolution of kidney stones
• Clinical; Diuretic and antiuricemic (Philippine setting)
• How to use:
For Kidney stones:
➢ Visit a health center to identify your illness, and the
treatment for kidney stones, including the use of
sambong leaves for medication.
➢ The health care professional may advice you to use
sambong as treatment through this method:
○ Boil the minced and freshly picked sambong
leaves in a pot filled with 2 glasses of water
until the pot is only left with half-filled of
water. Keep the lid off the pot after bringing
it to a boil.
○ Let it cool completely and then strain it.
○ Divide it into 3 portions. Drink 1 portion 3
times a day.
○ Drink 12 glasses of water or more daily.
○ Dosage of minced sambong leaves based
on patient’s age: 3 tablespoons (7-12 years
old); 6 tablespoons (13 years old and
above)
• Scientific Name: Momordica Charantia
• Filipino Name; Ampalaya
• English Name; Bitter Gourd
• Where it is commonly available; Found in tropical East
Africa, Madagascar, India to Japan, southward through
Malesia to Polynesia; distributed throughout the Philippines
• Pre-clinical; Antibacterial, antidiabetic, anticancer,
anti-inflammatory, antidiabetic, anti-tuberculosis, analgesic,
purgative, antiviral
• Clinical; Antimetabolic syndrome, antidiabetes
• How to use:
For diabetes:
➢ Consult a health center for a formal diagnosis and
medical advice for diabetes, including the use of
ampalaya leaves (Makiling variety) to help control
blood sugar levels.
➢ Health care professionals may advise patients to eat
1 cup of ampalaya leaves twice a day (as salad or as
an ingredient in meals).
➢ Health care professionals may also advise patients
to boil 2 cups of sprouts in 2
➢ glasses of water until only half of the water is left
(around 15 minutes of boiling), and to drink 1⁄3 of
the boiled water (decoction) thrice a day (30
minutes before meals)
• Scientific Name; Quisqualis Indica
• Filipino Name; Niyog-niyogan
• English Name; Rangoon Creeper
• Where it is commonly available; Found from India to the
Malay Peninsula and Southeast Aisa; widely distributed
throughout the Philippines
• Pre-clinical; Antipyretic, antihyperlipidemic,
anti-inflammatory
• Clinical; Anthelmintic
• How to use:
For intestinal worms:
➢ Get the seed from the parent plant and its withered
fruit.
➢ Eat it; chew it well and follow with drinking a half
full or 1 glass of water.
➢ Dosage of seeds to eat based on patient’s age: 4-5
seeds (4-6 years old); 6-7 seeds (7-12 years old);
8-10 seeds (13 years old and above).
➢ If there is still no worm that came out during a
bowel movement, you may use the same dosage
after 1 week.
➢ Possible side effects especially after overeating
seeds: nausea, hiccups, stomachache, or diarrhea.
Do not eat more that the recommended amount of
seeds
• Scientific Name; Carmona retusa
• Filipino Name; Tsaang Gubat
• English Name; Wild Tea
• Where it is commonly available; Found from India to
Southern China, Taiwan, and the Malay Peninsula;
distributed throughout the Philippines
• Pre-clinical; Anti-allergic, antidiarrheal, antimicrobial,
antimutagenic
• Clinical; Caries-preventive, antispasmodic (Philippine
setting)
• How to use:
For stomach pains:
➢ Boil the chopped and freshly picked forest tea
(tsaanggubat) leaves in a pot containing 1 glass of
water until the water is reduced to half its volume.
Remove the cover of the pot when it boils.
➢ Measurement of chopped leaves based on age: 1
1/2 tablespoons (7-12 years old); 3 tablespoons (13
years old or older); not recommended for children
below 7 years old.
➢ Let it cool and then strain.
➢ Drink. If stomach pain symptoms persist, consult
your doctor.
• Scientific Name; Senna Alata
• Filipino Name; Akapulko
• English Name; Ringworm Bush
• Where it is commonly available; Distributed throughout
the Philippines
• Pre-clinical; Anti-allergic activity, athelmintic, mosquito
repellent, insecticidal, snake bites
• Clinical; Antifungal, antiscabies
• How to use:
For ringworm (buni) and other fungal infections (an-an,
had-had, alipunga):
➢ Grind a sufficient amount of fresh akapulko leaves
as needed.
➢ Apply the extract on the affected area in your skin 2
times a day. Apply it daily within 3 weeks to
complety kill the fungus (a type of germs) that
causes ringworm (buni) and other fungal infections
(an-an, had-had, alipunga)
➢ Reminder: If you have an allergy to the extract of
Akapulko leaves, use the decoction of the leaves
instead. Boil a glass of grinded and freshly picked
leaves in a pot filled with 2 glasses of water until
approximately 1 glass of liquid is left in the boil. Use
this to wash the affected area 2 times a day. Do this
for up to 3 weeks.
• S – SAMBONG
• A – AKAPULKO
• N – NIYOG-NIYOGAN
• T – TSAANG GUBAT
• A – AMPALAYA
• L – LAGUNDI
• U – ULASIMANG BATO / PANSIT-PANSITAN
• B – BAYABAS
• B – BAWANG
• Y – YERBA BUENA