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  1. Chemotherapy Definition
    Use of chemicals to kill cancer cells
  2. Chemotherapy Purpose
    • Palliation of symptoms
    • Control of tumor growth
    • Achieve a cure
  3. Chemotherapy Side Effects
    • Bone marrow suppression
    • *Neutropenia - immunosuppression
    • *Thrombocytopenia - bleeding
    • *Anemia - fatigue

    • GI discomfort
    • *N/V/D
    • *Anorexia
    • *Stomatitis

    • Alopecia
    • *Hair loss

    • Reproductive toxicity
    • *Congenital abnormalities
    • *Menopausal symptoms
    • *Infertility

    • Hyperuricemia
    • *Renal damage

    • Extravasation
    • *Infiltration of caustic chemical agents (vesicants)
    • *S/S: swelling, pain, cool/pale @ site
    • *Tissue necrosis
  4. Chemotherapy nursing interventions
    • Bone marrow suppression
    • *Monitor WBC, neutrophils, platelet count, Hgb/Hct
    • *Assess for bruising or bleeding
    • *Instruct client to avoid crowds & contact with infectious individuals
    • *Allow rest periods

    • GI discomfort
    • *Administer antimetics before tx
    • *Offer foods & fluids

    • Alopecia
    • *Advise client hair loss will occur 7-10 days after starting chemo & can last 2 months after last dose
    • *Advise client choose hair piece prior

    • Reproductive toxicity
    • *Advise females against becoming pregnant during treatment
    • *Advise males to bank sperm prior to treatment

    • Hyperuricemia
    • *Monitor kidney function
    • *Increase fluid intake
    • *Measure I&O
    • *Administer med allopurinol if uric acid level elevated

    • Extravasation
    • *Be familiar with caustic drugs
    • *Stop chemotherapy immediately
    • *Only administer IV chemo if trained/qualified
  5. High/Low growth fraction
    % of cell actually dividing
  6. High growth fraction
    Occurs when cancer cells are rapidly developing (as seen in earlier stages) - early stage = best response to chemotherapy
  7. Benefits vs cons of out-pt chemotherapy
    • Benefits
    • *Cost effective
    • *Convenient
    • *Comfortable

    • Disadvantages
    • *Unavailable if qualified family member or friend is unable to administer & monitor safely
    • *Hydration may be indadequate in comparison to hospital setting
    • *If very ill or if close monitoring required - must be hospitalized
    • *Family member may not readily detect side effects/adverse reactions
  8. Biological Response Modifiers
    Agents/treatments used to enhance the body's immune system
  9. BMR - Colony Stimulating Factor (CSFs)
    Proteins that stimulate ore regulate the growth, maturation, & differentiation of bone marrow stem cells. CSFs decrease length of post-treatment neutropenia

    • Epogen (Epoetin) - stimulated RBC production; erythropoetin is a glucoprotein produced by the kidneys that stimulate RBC production in response to hypoxia
    • *Administer until Hct 30-33%, then decrease dose
    • *W/E: HTN crisis, cardiac compromise, H/A
  10. BMR - Granulocyte Colony-Stimulating Factor (F-CSF)
    Glycoproteins that regulate production of neutrophils helping to decrease incidence of infection

    • Filgrastim (Neupogen) - Stimulates WBC production
    • *S/E: Generalized bone pain
    • *Do NOT administer within 24 hours of cytotoxic agents - sensitive bone marrow (myeloid) cells to chemotherapy
  11. BMR - Interferons
    Naturally occurring proteins produced by different cells within the immune system

    • Interferon alfa - interferes with ability of a virus in infected cells to replicate & spread to non-infected cells
    • *Administer in Hep B & multiple sclerosis
    • *S/E: H/A, fatigue, aches, fever, chills (flu-like symptoms)
  12. BMR - Interleukins
    Groups of proteins produced by the body's WBCs

    Interleukin-2 (Proleukin) - used for activation of cellular immunity & inhibition of tumor growth for metastatic renal cell carcinoma
  13. Sedative-Hypnotic/Analgesics - Indications for use
    • CNS depression
    • *Sedation
    • *Hypnotic effect (sleep)
    • *Anesthesia

    Anxiety relief
  14. Sedative-Hypnotic/Analgesics - Side effects/adverse reactions
    • Hangover
    • REM rebound
    • Dependence
    • Tolerance
    • Excessive depression
    • Respiratory depression
    • Hypersensitivity
  15. Sedative-Hypnotic/Analgesics - Geriatric considerations
    • Idenfity cause of insomnia
    • Increase chance for dependency
    • Increased CNS depression & confusion
    • Increased incidence of sleep disturbances
    • Increased side effects
  16. Barbituates
    • Ultrashort - acting
    • *Thiopental sodium (Pentothal)
    • *Short-term use only
    • *General anesthetic

    • Short - acting
    • *Pentobarbital (Nembutal)
    • *Induces sleep; may cause pt to awaken early
    • *Monitor v/s closely

    • Intermediate - acting
    • *Butabarbital (Butisol)
    • *Sustains sleep for long periods of time. Admin 1 hour prior to; not used for pts who have difficulty falling asleep
    • *Monitor v/s very closely

    • Long - acting
    • *Phenobarbital (Solfoton) & mephobarbital (Mebaral)
    • *Controls seizures
    • *Monitor v/s
  17. Benzodiazepines
    • Chlordiazepoxide (Librium)
    • *Antianxiety agent prescribed as a sedative-hypnotic to induce sleep
    • *May assist with alcohol withdrawals

    • Eemazepam (Restoril)
    • *Hypnotic effect

    • Lorazepam (Ativan)
    • *Antianxiety agent
    • *Can suppress NREM sleep
    • *Should not be used as sleep agent for longer than 3-4 weeks
    • *May aldo be used as an anticonvulsant / alcohol withdrawals

    • Diazepam (Valium)
    • *Antianxiety agent
    • *Can suppress NREM sleep
    • *Should not be used as sleep agent for longer thatn 3-4 weeks
    • *May also be used as an anticonvulsant

    • Midazolam hydrochloride (Versed)
    • *Antianxiety effect prescribed to produce sedation
    • *Impairs memory
  18. Benzodiazepine Antagonist
    • Flumazenil (Romazicon) IV
    • *Management of overdose or reversal of sedative effects
    • *0.2 mg over 30 seconds; may repeat with 0.3 mg in 30 seconds; 3 mg max
  19. Anesthetics - Balanced Anesthesia
    • Combination of drugs frequently used in general anesthesia
    • *Minimizes cardiovascular compromise
    • *Decreases amount of general anesthetic required
    • *Enhances recovery

    Hypnotic - admistered the night prior

    Narcotic analgesia and/or benzodiazepine - administered 1 hour prior

    Short acting - barbiturate - just prior to start of surgery

    Inhaled gas (nitrous oxide/O2)

    Muscle relaxant - prn
  20. Anesthetics - Spinal anesthesia
    • Local anesthetic - subaracnoid space (3rd or 4th lumbar)
    • Incorrect placement: respiratory muscle depression / failure
    • CSF leak
  21. Anesthetics - Epidural Anesthesia
    Placement of local anesthetic in outer covering of spinal cord or dura mater
  22. Anesthetic - local anethetic
    Lidocain (Xylocain) vs Lodocaine with Epinephrine
  23. Opioid Analgesics
    • Morphine Sulfate (Duramorph)
    • *Opioid extract; Potent
    • *Very frequently used
    • *Acute pain

    • Meperidine (Demerol)
    • *One of first synthetic opiods; shorter duration of action than morphine
    • *Acute / chronic pain
    • *Preferrred in pregnancy over morphine

    • Hydromorphone (Dilaudid)
    • *Semisynthetic opioid; similar effects & use to morphine
    • *6 x more potent than morphine
    • *Fewer hypnotic effects & less GI distress
    • *Faster onset & shorter duration of action than morphine

    • Fentanyl citrate (Sublimaze)
    • *Synthetic opioid, potent
    • *Produces analgesia & sedation
    • *Acute moderate & severe pain - surgical / procedural
    • *Rapid onset & short - acting

    • Patient controlled analgesia (PCA)
    • *Alternative therapy for analgesia administration; predetermined limits
    • *Patient controlled
    • *Loading dose
    • *Basal rate
    • *PCA dose
    • *Lock-out mode
  24. Opioid Antagonist
    • Naloxone hydrochloride (Narcan) IV
    • *Management of overdose or reversal of life-threatening opioid effects
    • *0.4 - 2 mg over 10-15 seconds; may repeat every 2-3 minutes; max 10 mg
  25. Narcotics - Indications for use
    • Inhibit release of substance P. Substance P is a chemical mediator that produces pain by stimulating release of pain producing substances. This inhibition blocks transmission of pain signals from peripheral tissues to the brain thus reducing perception of pain sensation in the brain.
    • Sedation
    • Inhibit inflammatory process
    • Decrease emotional distress associated with pain
  26. Narcotics - Side effects
    • Hypotension / orthostatic hypotension
    • Respiratory depression
    • Miosis
    • Urinary retention
    • Constipation
    • Addiction
    • Withdrawal syndrome
  27. Narcotics - elderly considerations
    • Enhanced side effects
    • Drug accumulation
    • Pain misperception
    • Altered pain assessment
  28. Emetics - Purpose
    Induce vomiting. Administered in cases of toxic ingestion.
  29. Emetics - Contraindications
    Ingestion of caustic substances (ammonia, chlorine bleach, toilet cleaners, battery acid), or petroleum distillates (gasoline, kerosene, paint thinners, lighter fluid). In such cases, administer activated charcoal instead.
  30. Antiulcer drugs - Proton Pump Inhibitors (PPIs)
    • Inhibits hydrogen/potassium adenosine triphosphate enzyme system to suppress gastric acid secretion
    • *Prevent release of gastric acid
    • *Block final step of acid production

    Inhibit gastric acid secretion up to 90% greater than H2 blockers

    Prescribed for gastric ulcers & GERD

    • Omeprazole (Prilosec)
    • Lansoprazole (Prevacid)
    • Raberprazole (Aciphex)
    • Pantoprazole (Protonix)
    • Esomeprazole (Nexium)

    Can be combined in large doses with abx to treat H. pylori
  31. Antiulcer drugs - Histamine 2 Blockers (H2 antagonists)
    Popular drug for treatment of gastric & duodenal ulcers

    Prevent acid reflux in esophagus

    Block H2 receptors of pariteal cells in stomach

    • Cimetidine (Tagament)
    • *Blocks 70% of acid secretion for 4 hours
    • *Excreted unchanged in urine so good kidney function is essential; may cause elevated BUN/Cr
    • *Alert: May enhance effect of anticoagulants, theophylline, caffeine, (Dilantin), Valium, Inderal, Phenobarbital & calcium channel blockers

    • Ranitidine (Zantac) & Famotidine (Pepcid)
    • *More potent than cimetidine
    • *Block gastric acid & promote healing of ulcers by eliminating cause
    • *Have fewer side effects than cimetidine, but ranitidine may also increaes effect of anticoagulants
  32. Respiratory Decongestants - Nasal
    sympathomimetics - stimulate alpha-adernergic receptors - vascular constriction of the capilaries within the nasal mucosa

    • *Work promply at target organ, rather than systemically
    • *Oxymetazolne HCl (Afrin) Spray
  33. Respiratory Decongestants - Systemic
    Alpha-adernetgic agonists which relieve nasal decongestion for a longer period of time than nasal decongestants

    *Pseudoephedrine (Sudafed) PO
  34. Respiratory - Antitussives
    Suppresses couph reflexes by acting on the cough-control center in the medulla

    • *Cough is natural protective mechanism
    • *Narctotic & nonnarcotic
    • --Guaifensesin & codeine (Robitussin A-C) PO
  35. Respiratory - Beta2-adrenergics
    • Increase cyclic AMP - bronchial dilation
    • *Beta2 receptors - bronchodilation

    • Anaphylaxis/acute bronchospasm - epinephrine
    • Asthma/COPD bronchospasm - albuterol

    Side effects: mouth dryness, throat irritations, nervousness, tremors, dizziness, H/A, insomnia, hyperglycemia, tachycardia, palpitations, hypertension

    • *Should be administered 5 minutes before other inhalers to open airway first
    • *Consult MD if using OTC meds to ensure no meds interfere with the inhaler's effectiveness
    • *Fluid intake will help promote secretion removal & prevent mouth dryness
    • *Tolerance & decreased effectiveness may result with chronic use
    • *Smoking cessation education should be provided/encouraged
  36. Respiratory - Glucocorticoids
    Steroids used to treat respiratory disorders by producing anti-inflammatory effects

    • *Synergistic effect when administered with a beta2 agonist
    • *Inhaled glucocorticoid is preferred to PO
    • *Administer with food to avoid ulcer formation

    • Inhaled: throat irritation, hoarseness, dry mouth, coughing, fungal infections
    • PO/IV/: H/A, euphoria, confusion, sweating, insomnia, N/V, weakness, depression, PUD, psychosis, fluid retention, HTN, fluid & electrolyte imbalances.
  37. Respiratory - Mucolytics
    • Liquify & loosen thick mucous secretions for expectoration
    • Acetylcysteine is administered vian nebulizer; do not mix with other drugs
    • Administer 5 minutes after bronchodilator
    • Side effects: N/V, stomatitis, runny nose
  38. Respiratory - Leukotriene Antagonists & Inhibitors
    Leukotriene (LT) is a chemical mediator - inflammatory changes in the lungs - edema & bronchoconstriction

    LT modifiers reduce inflammatory symptoms of asthma

    • *Prophylactic & maintenance of chronic asthma
    • *Used most often for exercise-induced asthma; not to be used for acute asthma attack

    Montelukast sodium (Singulair) INH
  39. Respiratory - Theophylline
    • Stimulate CNS & respiration, dilate coronary & pulmonary vessels & cause dieresis.
    • Inactivates enzyme, phosphodiestrase to permis cyclic AMP function

    • Low therapeutic index/narrow therapeutic range (10-20 mcg/mL)
    • Toxicity may result easily & likely if level >20 mcg/mL

    • *Anorexia, N/V, gastric pain, increased gastric secretions, intestinal bleeding, nervousness, dizziness, irritability, cardiac dysrhythmias, tachycardia, palpitations, hypotension, hyperreflexia, seizures, H/A, insomnia
    • *May also cause hyperglycemia & decreased clotting time
    • *Has diuretic effect - avoid caffeinated products & increase fluid intake
    • *Rapid IV administration - hypotension, bradycardia, & palpitations. Administer slowly via IV pump
    • *Decreased liver metabolism - increased 1/2 life & effects - dosing should be decreased
    • *Increased liver metabolism - decreased 1/2 life & quicker drug elimination - dosing should be increased
    • *If given with a beta-adernergic agonist, a synergistic effect may result in cardiac dysrhythmias

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2012-04-29 02:11:58

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