DRUGS Test 4

o administer steroids and immunosuppressants as ordered to prevent rejection

 Cyclosporine (Sandimmune): does not cause significant bone marrow
depression; assess for HTN; blood chemistry alterations (hypermagnesemia,
hyperkalemia, decreased sodium bicarb); neruologic functioning
 Azathioprine (Imuran): assess for manifestations of anemia, leucopenia,
thrombocytopenia, oral lesions
 Cyclophosphamide (Cytoxan): assess for alopecia, HTN, kidney/liver toxicity,
leucopenia
 Antilymphocytic globulin (ALG), antithymocytic globulin (ATG): assess for
fever, chills, anaphylactic shock, HTN, rash, headache
 Corticosteroids (prednisone, solu-medrol): asses for peptic ulcer and GI
bleeding, sodium/water retention, muscle weakness, delayed healing, mood
alterations, hyperglycemia, and acne.

- chemotherapy
 5-fluorouracil (5-FU)
 leucovorin
 raltitrexed (Tomudex)

Anticancer Drugs
 Alkyating Agents: Cytoxan
• largest group of anticancer drugs
• analogue of nitrogen mustard – prescribed orally and IV
• kill cells by forming cross-links on DNA strands
• used to treat breast, lung, ovarian cancers; Hodgkin’s; leukemias; and lymphomas; an
immunosuppressant agent
• Side Effects
 bone marrow suppression
 alopecia
 n/v, diarrhea, wt loss
 hematuria
 impotence, sterility, ovarian fibrosis
• headache, dizziness, dermatitis
• Nursing Measures: well hydrated to prevent hemorrhagic cystitis (bleeding that results from
severe bladder inflammation)

 Antimetabolics: Methotrexate
• for treating solid tumors, sarcomas, choriocarcinoma, leukemia
• interferes with folic acid metabolism – result is inhibition of DNA synthesis and cell
reproduction
• at higher doses clients should be well hydrated
• keep urine pH 7.0 for drug solubility for excretion
• higher does require use of leucovorin as a rescue for normal cells
• Side Effects
 arachnoiditis (IT use only): assess for nuchal rigidity, headache, fever, confusion,
 drowsiness, weakness, or seizures
 anorexia, n/v, stomatitis
 hepatotoxicity
 anemia, leucopenia, thrombocytopenia
• Nursing Implementations
 injection preparation: biological cabnet – wear gloves, gown, and mask while handling
 assess for bleeding: avoid IM injections and rectal temperatures if platelet count is low
 assess for signs of infection during neutropenia
 encourage pt to drink at least 2 liters/day to decrease uric acid levels; allopurinol

 Anti-tumor Antibiotics: Adriamycin

• therapeutic effects
 affects bleeding time
 Doxorubicin
o to treat breast, bladder, ovarian, and lung cancers; leukemias; lymphomas
o inhibits DNA and RNA synthesis; immunosuppressant activity
 Plicamycin
o to correct hypercalcemia and hypercalciuria; to treat testicular carcinoma
o inhibits hypercalcemia action of Vit. D and action by the parathyroid hormone;
inhibits DNA and RNA synthesis
• side effects
 doxorubicin and plicamycin: stomatitis, anorexia, n/v, diarrhea, rash
 doxorubicin: alopecia
 plicamycin: dizziness, weakness, headache, mental depression
• Nursing Implementations
 avoid aspirin, anticoagulants, and thrombolytics
 cyclophosphamide with doxorubicin can increase chance of hemorrhagic cystitis

 Plant Alkaloids: Vinblastine (Velban)
• treatment of cancer: testes, breast, and kidney; lymphomas, lymphosarcomas, and
neuroblastomas
• binds to protein of mitotic spindle, causing metaphase arrest – cell replication halted
• side effects: n/v, alopecia

BURNS

 Travase ointment: enzymatic debrider to dissolve dead

tissue
 Elase ointment
 This medication breaks up and helps remove dead skin
and tissue to encourage healing of wounds. It is used to
promote healing of wounds such as burns, ulcers,
surgical wounds, circumcision or episiotomy.
o Pharmacological
♦ Analgesics
 early postburn period
• IV Morphine sulfate
 extraction from opium
  it can cause respiratory depression,
orthostatic hypotension, urinary retention
constipation
 antidote: narcan
• IM injections will not be absorbed adequately in
burned or edematous areas causing pooling of
medications in tissues – when mobilization begins,
inadvertently overdose
• Medicate 30 min. before wound care
♦ Sedative – benzodiazepine: zanax, valium
♦ Tetanus – potential for wound contamination
♦ Antibiotics
 Aminoglycoside
 adverse reaction: mainly nephrotoxicity
 may decrease K+ and magnesium levels
 urine output should be at least 600 ml/day
 check for hearing loss: ototoxiciy
 check that therapeutic drug monitoring (TDM) has
been ordered for peak and trough drug levels
 Gentamicin is 5-10 – blood should be drawn 45-60
min after drug has been administered for peak
levels and min before next drug dosing for trough
levels. Drug peak values should be 10-12 and
trough values should be 0.5-2
 monitor s/s of superinfection: stomatitis, vaginitis,
and/or genital itching

 Cephalosporin
 bactericidal
 assess allergies (do not give any type or class if
allergic)
 monitor s/s of superinfection: stomatitis, vaginitis,
and/or genital itching
 advise to ingest buttermilk or yogurt to prevent
superinfection
 instruct diabetic not to use Clinitest tablets for
urine glucose testing because of false results; Tes-
Tape or Clinistix may be used, or Chemstrip bG
may be used for blood glucose testing.
 take with food if GI irritation occurs
♦ Antimicrobial – sulfamylan, bacitracin, bactiban, silvadene;
 topical as well as systemic
 silver nitrate (sulfamylan)
 anti-infective cream for second and third degree
burns, particularly electrical burns
 possible pain on application
 provide daily baths for removal of previous
applied cream
 handle carefully; solution leaves a gray or black
stain on skin, clothing, and utensils
 keep drsg. wet with solution; dryness increases
concentration and causes precipitation of silver
salts in wound
 acid-base disturbance because it is a carbonic
anhydrase inhibitor
 may cause electrolyte imbalance if used
extensively (hypokalemia)
 silvadene cream
 antibiotic cream – prevent and treat infection of
second and third degree burns
 painless applications- alleviates pain(cooling
effect) and prevents drying
 observe for hypersensitivity reaction (sulfa) rash,
itching, burning sensation in unburned area
 excessive or extensive use may cause sulfa crystals
(crystalluria)
♦ H2 blockers – tagamet, zantac; prevent stress ulcer
 tagamet
 has many drug interactions and side effects
 by inhibiting hepatic drug metabolism, it enhances
effects of oral anticoagulants, theophylline,
caffeine, dilantin, valium, inderal, Phenobarbital,
and CCB
 zantac
 treatment of peptic ulcers, GERD, stress ulcer
 side effects: confusion, arrhythmias,
hepatotoxicity, anemia
 contraindications: severe renal or liver disease
 administer with meals or immediately after and at
HS; if dose is once daily administer at HS
 shake oral suspension

♦ Hespan
 Made from starch and acts as volume expander; is at least
effective as albumin; can exert osmotic effect for up to 36
hours
  All types of shock
 Use cautiously in CHF, renal failure, or bleeding disorders
(due to anticoagulant effect)
♦ Albumin
 Action: increase plasma colloid osmotic pressure; rapid
volume expansion
 All types of shock except cardiogenic
 Monitor for circulatory overload
 Side Effects: chills, fever, and urticaria