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26 Cards in this Set

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Antibacterial
Trimethoprim Sulf. (Bactrim, Septra)
Trimethoprim Sulf. (Bactrim, Septra)

Implications:
Px PCP (pneumonia) in HIV+

Actions:
Inhibits metabolism of folic acid in bacteria.

S.E.
Nausea, Vomiting, rash, phlebitis IV site, HEPATIC TOX INCREASE, Alt/BUN/Cr, AGRANULOCYTOSIS, APLASTIC ANEMIA, decreased WBC/Platelet

Nursing Implications:
Assess: Cough, SOB, Fever, fatigue, check allergy to sulfa, I/O, increase fluid 12-1500 cc/day to px stones.

Pt. teaching:
Take med w/ 8 oz H2O
Wear sunscreen
Call Dr: rash, sore throat, fever, bleed/bruising, Toxic w/ dilantin--seizure.
Antifungal
Diflucan (Fluconazole)
Diflucan (Fluconazole)

Indications
Tx of fungal infection. Broad spectrum fungistatic agent for oropharyngeal/esophageal candidiasis, cryptococcal mengingitis.

Actions:
inhibit synthesis of fungal sterols-competent of cell wall.

Side effects:
N, V, D, H/A, rash
Hepatic/Renal TOXIC
Increase Alt/BUN/Cr
Monitor liver function, BUN, Cr.

NR implications:
Monitor liver function, BUN, Creatinine

Pt. teaching
Call dr. w/ abd. pain, fever, severe diarrhea, liver dysfunction (fatigue, anorexia, N/V, jaundice, dark urine/ pale stools
Antiviral
Acyclovir (Zovirax)
Acyclovir (Zovirax)

Indications PO: Tx/px recurrent genital herpes. IV: treatment severe initial genital herpes in non immunosuppress or mucus/cutaneous herpes or shingles in immunosuppressed.

Actions: Interferes w/ viral DNA synthesis

S.E.
N/V/D, H/A, dizzy, pain, phlebitis, gingival hyperplasia
RENAL TOXIC, THROMBOCYTOPENIA
Increased hydration to px nephrotoxic, monitor neurological status in pt. w/ herpes

Pt. teaching
NO OTC creams, lotions, ointment--delay heal or spread. Not cure or prevention. Good oral care to px gingival hyperplasia
Antiretrovirals/Protease Inhibitor
Indiniver (Crixivan)
Indiniver (Crixivan)

Indications:
Management of HIV infection--used in combination w/ other antiretroviral agents Changed way we treat AIDS and they live longer CAUTION ON DRUG INTERACTIONS

Actions
Interferes with protease enzymes role in making new copies of HIV.

S.E.
D, N, rash, H/A, KETOACIDOSIS, MEPHROLITHIASIS-KIDNEY STONES
HYPERBILIRUBINEIA-CHECK LIVER FUNCTION

NR IMPLICATIONS:
TAKE ON EMPTY STOMACH!!! 1 HOUR BEFORE OR 2 HOURS AFTER MEALS.
Drug interaction with Rifabutin, terfenadine, astemizole, midazolam, triazolam. Resistance develops in majority of pt within a few weeks

Pt. Teaching
MOISTURE SENSITIVE-Keep in original container
Can lead to hyperglycemia
Drink 1.5 liters H20.
Antiretrovirals
Protease Inhibitor
Saquinavier (Fortovase, Invirase) 1st one approved
Saquinavier (Fortovase, Invirase)

Indications:
Management of HIV infection--used in combination w/other antiretroviral agents. Caution drug interactions

Actions:
Interferes w/ protease enzymes role in making new copies of HIV.

S.E
D, N, Abdominal discomfort, seizures

NR implications:
Give w/ food w/ in 2 hours
Drug int: terfenadine, astemizole, rifabutin, Phenobarbitol,phyentoin, desamethosone, carbamazepine.
Pt.teaching: Can--Hyperglycemia, Rare can cause bullous skin eruptions w/ polyarthritis.
Antiretrovirals/Nucleoside Reverse transcytase Inhibitor (NRTI/NUKES)
Zidovudine (ZDV, AZT, Retrovir-can take if pregnant)
Zidovudine (ZDV, AZT) Retrovir

Indications:
Manage HIV infection in combination w/other antiretrovirals
Retrovir decreases fetal transmit

Actions:
Nukes become part of HIV's DNA-detail its building process. Damage viral DNA can't take control of cell's DNA

S.E.
ANEMIA, NEUTROPENIA, SEIZURES, (H/A, N-DECREASES OVER weeks).

NR implications
Use both ddl and AZT to decrease drug resistance
Pt. teaching: Give w/ food or w/o food. Don't use with Acyclovir-neurotoxic Acetaminophen increased granulocytopenia.
Antiretrovirals nucleoside reverse transcriptase inhibitors (NRTI/NUKES)
Medication: Didanozine (ddl, Videx)
Medication: Didanozine (ddl, Videx)

Indications:
Manage HIV infection in combination w/ other antiretrovirals

Actions:
Following intracellular conversion to its active form, inhibits viral DNA synthesis and subsequent viral replication

Side Effects:
CARDIOMYOPATHY, CHF, chest pain, PANCREATITIS/HEPATOMEGALY/STEATOSIS, oral ulcers, abd. pain, anorexia, diarrhea, dysphagia, esophageal ulcerations increased liver enzymes, N/V
LACTIC ACIDOSIS, Peripheral neuropathy.

NR implications:
Monitor pt for signs and symptoms of peripheral neuropathy. Monitor pts for symptoms of pancreatitis. If these symptoms or associated lab test signs occur, discontinue zalcitabine, rising serum amylase, lipase, triglyceride, and decreasing calcium levels may indicate pancreatitis. Monitor liver function.

Pt. teaching:
No ETOH Advise pt not to take other meds including antacids, without consulting health care professional. Notify health care professional promptly if S/S of peripheral neuropathy or pancreatitis occur. Take on empty stomach may cause hyperglycemia.
Antiretrovirals, fusion inhibitors
Enfuvirtide
Fuzeon, T-20
Enfuvirtide
Fuzeon, T-20

Indications:
Management of HIV infection in combination with other antiretrovirals in patients with evidence of progressive HIV-1 replication despite ongoing treatment

Actions:
prevents entry of HIV-1 into cells by interfering with the fusion of the virus with cellular membranes

S.E.
Fatigue, pneuonia, diarrhea, nausea, pancreatitis, injection site reactions, myalgia, hypersensitivity reactions.

NR implications:
Assess for change in severity of HIV symptoms of oppurtunistic infections. Injection site reactions S/S of pneumonia.

Pt teaching:
Emphasize importance of administering enfuvirtide exactly as directed. Always used in comb. with other antiretrovirals. Tell pt. to notify health care professional if signs of injection site infection
Review
Antibacterial
Side Effects of Trimethoprim Sulf. (Bactrim, Septra)
S.E. N/V, rash, phlebitis IV site, Hepatic Tox increase, Alt/BUN/Cr
Agranulocytosis, Aplastic Anemia, Decrease WBC/Platelets
Review
Antifungal Diflucan (Fluconazole)
S.E.
N, V, D, H/A, rash, Hepatic/Renal toxic
Increase Alt/BUN/Cr
Review
Antiviral
Acyclovir (Zovirax)
S.E.
N, V, D, H/A, dizzy, pain, phlebitis, gingival hyperplasia, Renal Toxic, Thrombocytopenia
Review
Antiretrovirals Protease Inhibitor
Indiniver (Crixivan)
S.E.
D, N, rash, H/A, ketoacidosis, mephrolithiasis-kidney stones
hyperbilirubinemia
check liver function
Review
Antiretrovirals Protease Inhibitor
Indiniver (Crixivan)
Nursing Implications
Take on EMPTY stomach 1 hour before or 2 hour after meals
Drug interaction w/ Rifabutin, terfenadine, astemizole, midazolam, triazolam. Resistance develops in majority of pt within a few weeks.
Review
Antiretrovirals/Protease inhibitor
Saquinavier (Fortovase, Invirase) (1st one approved)
S.E.
Diarrhea, nausea, abdominal discomfort, seizures
Review
Antiretrovirals/Protease inhibitor
Saquinavier (Fortovase, Invirase) (1st one approved)
Nursing implications
Give with food within 2 hours
Drug interactions: terfenadine, astemizole, rifampin, rifabutin, Phenobarbitol, phyenytoin, desamethosone, carbamazepine.
What AIDS med can a pt take when pregnant with AIDS
Zidovudine-ZDV, AZT,) Retrovir

Antiretrovirals/Nucleoside Reverse transcytase Inhibitor
NRTI/NUKES
Antiretrovirals/Nucleoside Reverse transcytase Inhibitor
NRTI/NUKES
Zidovudine-ZDV, AZT,) Retrovir
S.E.
S.E. Anemia, Neutropenia, Seizures, (H/A, N-decreases over weeks).
Antiretrovirals/Nucleoside Reverse transcytase Inhibitor
NRTI/NUKES
Didanozine (ddl, Videx)
S.E.
Cardiomyopathy, CHF, chest pain, Pancreatitis/Hepatomegaly/Steatosis, oral ulcers, abdominal pain, anorexia, diarrhea, dysphagia, esophageal ulcerations, increased liver enzymes, N/V
Lactic Acidosis peripheral Neuropathy
Antiretrovirals/Nucleoside Reverse transcytase Inhibitor
NRTI/NUKES
Didanozine (ddl, Videx)
Pt. teaching
No alcohol ETOH
Advise pt not to take other meds includng antacids, without consulting health care professional, notify health care professional promptly if S/S of peripheral neuropathy or pancreatitis occur. Take on empty stomach. May cause hyperglycemia
Alkylating Agent
Cyclophosphamide
(Cytoxan)
Alkylating Agent
Cyclophosphamide
(Cytoxan)
Indications:
Alone/Combination tx
Hodgkin, leukemia,
ovarianlbreast ca

Actions
Non-cell cycle specific
Interfers w/ DNA structure,
unable to reproduce

S.E.
Hemorrhagic Cystitis
(bladder bleed) .decrease. bone
marrow, N,V, alopecia

NR. Implications

Adequate daily fluid
Monitor lab bone marrow
depression. A void
pregnancy




Pt. teaching
Call dr. difficult/pain/blood
in urination, bleed/bruising
Antimetabolite
5-Fluorouracil (5-FU)
Antimetabolite
5-Fluorouracil (5-FU)

Indications
Alone/Combination tx
colon, breast, rectal, gastric
cancers and pancreatic
carcinoma

Actions
Inhibits DNA and RNA
synthesis by preventing
thymidine production (cell-
cycle S-phase-specific)

S.E.
Diarrhea, N/V, stomatitis,
alopecia, maculopapular rash,
anemia, leucopenia,
thrombocytopenia acute
cerebral dysfunction

NR. Implications
Assess mucous membranes,
S/S infection, bleeding, Avoid
IM injections Watch for S/S
cerebral dysfunction
(weakness, ataxia, dizziness)

Pt. teaching

Call Dr. if S/S of infection abd,
pain bleeding gums/bruising
swelling of feet or legs blood
in urine Use sunscreen
Antineoplastics
Plant alkaloid

Etoposide (VePesid)
Antineoplastics
Plant alkaloid

Etoposide (VePesid)

Indications: Refractory testicular
neoplasms Small cell lung
carcinoma Used alone and
with others (antineoplastics,
radiation therapy, surgery

Actions
Damages DNA before mitosis
(cycle-dependent and phase-
specific)

S.E.
Pulmonary edema
bronchospasm. CHF , MI ,
hypotension (IV). N/V
alopecia. leukopenia
thrombocytopenia peripheral
neuropathy. ANAPHYLAXIS

NR implications
Monitor for hypersensitivity
reaction Assess for signs of
infection Monitor intake and
output, appetite, and
nutritional intake Monitor
liver function studies (AST,
AL T, LDH, bilirubin) and
renal function studies (BUN,
creatinine)

Pt. teaching
notify Dr. if rapid heartbeat,
difficulty breathing, abd. pain,
yellow skin, weakness,
paresthesia, S/S infection
Anti-estrogen


Tamoxifen (Nolvadex)
Anti-estrogen


Tamoxifen (Nolvadex)

Indications
Adjuvant/ px therapy to
breast cancer


Actions
Non-Cell specific, Don't
kill, suppress growth of
certain tissue w/out
cytotoxic action

S.E,
Hypercalcemia N,V, hot
flashes, depression, bone
pain


NR implications
Monitor CBC for Calcium
levels, leukopenia or
thrombocytopenia, Give
analgesics for bone pain


Pt. Teaching
Call dr. pain, swelling legs,
SOB, weak, dizzy, N,V,
Confusion H/A, blur vision
Cgranulocyte-Colony
Stimulating Factor (G-CSF)
Immunostimulant
Neupogen (Filgrastim, G-
CSF)
Cgranulocyte-Colony
Stimulating Factor (G-CSF)
Immunostimulant
Neupogen (Filgrastim, G-
CSF)

Indications
Px of febrile neutropenia &
assoc. infection due to bone
marrow depression

Actions
Glycoprotein, filgrastim
binds to & stimulated
immature neutrophils to
divide/activates mature ones
too.

S.E.
Bone Pain, Pain or redness at
SC site, Excessive
Leukocytosis


NR implications
Give daily, at least 24 H after
last does of chemotherapy up
to 2 weeks or until ANC
(Absolute Neutrophil count)
of 10,000, Monitor CBC
x2/wk


Pt. Teaching
Don't reuse needles
Cytotoxic Antibiotics
Doxorubicin
Adriamycin
Indications
Alone/Combination

Actions
Non-cell cycle specific
Binds to everything
Kills cells by damaging cell membrane

S.E. CARDIAC TOXIC, irritate injection site, decrease bone marrow, N/V, allopecia

NR. Implications
Monitor s/s cardiotoxicity
May produce red urine for 1-2 days, Not hematuria, vesicant-apply ice and elevate IV site
Not used to tx infection
Pt teaching
Call dr. irregular heartbeat, SOA swell in lower extremities, urine red for few days.
Recombinant monoclonal antibody
Rituximab
(Rituxan)
Indications: Tx of B-cell non-hodgkins lymphoma

Actions
Binds to CD20 antigen on surface of lymphoma cells preventing activation process for cell cycle initiation and differentiation

S.E. Hypotension, arrhythmias, anemia, neutropenia, tumor lysis syndrome
NR implications: Monitor S/S infection, ARDS V-fib, monitor for lysis syndrome

Pt teaching: Call Dr. if S/S of infection bleeding gums bruising blood in urine.