Pharm

Front 1

Interferon alfa-2a (Roferon-A)
Pharmacotherapeutics

Back 1

Pharmacotherapeutics
Hairy cell leukemia, Kaposi sarcoma, malignant melanoma, chronic hepatitis B and C.

Front 2

Interferon alfa-2a (Roferon-A)
Codynamics

Back 2

Pharmacodynamics
Proteins capable of modifying the immune response and antiproliferation action against tumor cells
Produced by recombinant DNA techniques

Front 3

Interferon alfa-2a (Roferon-A)
Contraindications

Back 3

Contraindications and precautions
Pancreatitis, hepatic, renal disease, depressed bone marrow function, and cardiac disease

Front 4

Interferon alfa-2a (Roferon-A)
AE

Back 4

Adverse effects
(CNS) Dizziness, confusion, lethargy
(GI) flu-like symptoms, anorexia, nausea, malaise, myalgia, changes in taste and weight loss
Serious: depression, anemia, thrombocytopenia, suicidal ideation

Front 5

Interferon alfa-2a (Roferon-A)
Min.

Back 5

Minimizing adverse effects
Premedicate patients with drugs such as acetaminophen and/or diphenhydramine to reduce the flu-like adverse effects.

Front 6

Interferon alfa-2a (Roferon-A)
Max

Back 6

Maximizing therapeutic effects
Reconstitute and store following manufacturers' instructions.
Baseline blood counts and chemistries before therapy and monthly during therapy.

Front 7

Interferon alfa-2a (Roferon-A)
Education

Back 7

Patient and family education
Explain that interferon alfa-2a inhibits the growth of tumor cells.
How to reconstitute the powder into a solution, date and refrigerate the reconstituted solution.
Avoid crowds
Report sign of infection and bleeding
Soft toothbrushes and electric razors
Periodic labs before and at least monthly during therapy.

Front 8

Cyclosporine (Sandimmune, Neoral)
AEW

Back 8

Adverse effects
Moderate HTN, neurotoxic including tremors, hirsutism, and gum hyperplasia
Serious: renal toxicity, hepatic toxicity, bone marrow suppression

Front 9

Cyclosporine (Sandimmune, Neoral)
Codynamics

Back 9

Pharmacodynamics
Inhibits normal immune response (cellular and humoral) by inhibiting interleukin-2 a factor necessary for initiation of T-cell activity

Front 10

Cyclosporine (Sandimmune, Neoral)
Therapeutics

Back 10

Pharmacotherapeutics
Prevention and treatment of rejection in renal, cardiac, and hepatic transplants
Severe active RA
Graft vs host disease in bone marrow transplants

Front 11

Cyclosporine (Sandimmune, Neoral)
Contraindications

Back 11

Contraindications and precautions
Hypersensitivity to polyoxyethylated castor oil
Alcohol

Front 12

Cyclosporine (Sandimmune, Neoral)
MAx

Back 12

Maximizing therapeutic effects
Start as soon after transplantation as possible.
Use oral form -as soon as possible.

Front 13

Cyclosporine (Sandimmune, Neoral)
Min

Back 13

Minimizing adverse effects
Arrange for periodic blood tests to monitor for renal, hepatic, and hematologic effects of the medication.

Front 14

Cyclosporine (Sandimmune, Neoral)
Education

Back 14

Patient and family education
Life-long therapy to prevent rejection
Importance of preventing infection.
Avoid food and grapefruit juice.
Caution not to discontinue taking this drug without consulting with their prescribers.

Front 15

Prednisone (Deltasone)
Therapeutics

Back 15

Pharmacotherapeutics
Anti-inflammatory and immunosuppressive

Front 16

Prednisone (Deltasone)
Codynamics

Back 16

Pharmacodynamics
Suppresses inflammation and normal immune response, numerous metabolic effects, endogenous cortisol replacement, minimal mineralocorticoid activity

Front 17

Prednisone (Deltasone)
Contraindications

Back 17

Contraindications and precautions
Active untreated infections

Front 18

Prednisone
AE

Back 18

Adverse effects
CNS (anxiety, mood swings, insomnia, headache); CV (HTN); EENT (cataracts); GI complaints (anorexia, nausea, vomiting, peptic ulceration); Derm (decreased wound healing, hirsutism, ecchymosis); Endo (adrenal suppression, hyperglycemia) F and E (fluid retention, hypokalemia); MS (muscle wasting, osteoporosis); cushingoid appearance and susceptibility to infection
Serious: acute adrenal insufficiency due to HPA axis suppression following prednisone withdrawal

Front 19

Prednisone
Implement

Back 19

Implementation
Administer daily doses or alternate-day doses of glucocorticoids early in the morning.
Increase the dosage in times of stress Monitor the patient, especially the surgical patient, carefully for signs of infection.
Give with meals or antacids

Front 20

Prednisone
Assess

Back 20

Assessments
Signs of adrenal insufficiency
Hypotension, weight loss, nausea, vomiting, anorexia, lethargy, hypoglycemia
Monitor I/O, daily weight

Front 21

Prednisone
Education

Back 21

Patient and family education
Once a day dosing in the morning
Do not abruptly stop taking the drug .
Avoid crowds and people with infection
Notify all health care providers about glucocorticoid therapy.
Bone health and prevention of falls
Wear medical identification
Report unusual swelling, weight gain visual disturbances
Diet high in protein, calcium and potassium and avoid alcohol

Front 22

Fludrocortisone (Florinef)
Therapeutics

Back 22

Pharmacotherapeutics
Sodium loss and hypotension associated with adrenocortical insufficiency (given with hydrocortisone).

Front 23

Fludrocortisone (Florinef)
Codynamics

Back 23

Pharmacodynamics
Acts on the distal renal tubule to enhance the reabsorption of sodium and to increase the urinary excretion of both potassium and hydrogen ions.

Front 24

Fludrocortisone (Florinef)
Contraindications

Back 24

Contraindications and precautions
Systemic fungal infections.
CHF

Front 25

Fludrocortisone (Florinef)
AE

Back 25

Adverse effects
Dizziness, headache, HTN, edema, anorexia, hypokalemia, muscle weakness

Front 26

Fludrocortisone (Florinef)
Education

Back 26

Patient and family education
Take as prescribed.
Don not stop abruptly
Encourage patients to wear a medical identification bracelet.
Eat potassium-rich foods and moderate sodium intake.

Front 27

Fludrocortisone (Florinef)
Assessment

Back 27

Ongoing assessment and evaluation
Monitor for edema, weight gain, hypertension, cardiac arrhythmias, or muscular weakness

Front 28

5-fluorouracil (5-FU)
Therapeutics

Back 28

Pharmacotherapeutics
Wide spectrum of solid tumors.

Front 29

5-fluorouracil (5-FU)
Codynamics

Back 29

Pharmacodynamics
Inhibits DNA and RNA synthesis by preventing thymidine production—cell cycle s phase specific.

Front 30

5-fluorouracil (5-FU)
Contraindications

Back 30

Contraindications and precautions
Pregnancy and lactation, poor nutritional status, decreased bone marrow reserve, or a potentially serious infection

Front 31

5-fluorouracil (5-FU)
AE

Back 31

Adverse effects
GI (diarrhea, nausea, stomatitis); Derm (alopecia, rash, photosensitivity) Heme (myelosuppression)
Dose limiting effects: myelosuppression, evidenced by anemia, leukopenia, and thrombocytopenia

Front 32

5-fluorouracil (5-FU)
Max

Back 32

Maximizing therapeutic effects
Potentiate antineoplastic activity of 5-FU by the addition of reduced folates, such as leucovorin calcium.
Make sure that the solution is stored at controlled temperature.

Front 33

5-fluorouracil (5-FU)
Min

Back 33

Minimizing adverse effects
Monitor the patient closely because hematologic and GI toxicities can be fatal despite dosage reductions.

Front 34

5-fluorouracil (5-FU)
Education

Back 34

Patient/family education
Good oral care
Monitor for s/s of stomatitis and infection.
Avoid crowds
Advise the possibility of transient alopecia
Report blood in the urine, stool or emesis
Sun protection
Contraception plan during treatment
Periodic monitoring of CBC

Front 35

Vincristine (Oncovin)
Therapeutics

Back 35

Pharmacotherapeutics
Leukemia, Hodgkin's disease

Front 36

Vincristine (Oncovin)
Codynamics

Back 36

Pharmacodynamics
Binds to proteins of mitotic spindle causing arrest of the metaphase. Cell cycle M specific. Little or no effect on bone marrow.

Front 37

Vincristine (Oncovin)
AE

Back 37

.
Adverse effects
Nausea, vomiting, alopecia, tissue necrosis from extravasation, constipation and ileus, ascending peripheral neuropathy

Front 38

Vincristine (Oncovin)
Contrindications

Back 38

Contraindications and precautions
Pregancy, lactation, infection and decrease bone marrow reserve, hepatic impairment decrease dose.

Na

Front 39

Vincristine (Oncovin)
Implement

Back 39

Implementation
Protect drug from light.
Give an initial bolus through a new and patent free-flowing IV access.
Infuse over 1 minute

Front 40

Vincristine (Oncovin)
Education

Back 40

Patient and family education
Report symptoms of neurotoxicity
Increase bulk, fiber and exercise
Report IV infusion site issues.
Report increase joint pain and edema. Encourage intake of at least 2 liters

Front 41

Paclitaxel (Taxol)
Therapeutics

Back 41

Pharmacotherapeutics
Ovarian, breast cancers, AIDS related Kaposi’s sarcoma

Front 42

Paclitaxel (Taxol)
Codynamics

Back 42

Pharmacodynamics
Interferes with the normal cellular microtubular function required for interphase and mitosis

Front 43

Paclitaxel (Taxol)
Contraindications

Back 43

Contraindications and precautions
Hypersensitivity, ANC <1,500/mm3, pregnancy, lactation, hepatic impairment

Front 44

Paclitaxel (Taxol)
AE

Back 44

Adverse effects
Nausea, vomiting, alopecia, joint pains, peripheral neuropathies, bone marrow suppression, elevated liver enzymes, risk of severe hypersensitivity reaction including anaphylaxis, Steven-Johnson and TEN

Front 45

Paclitaxel (Taxol)
Implementation

Back 45

Implemention
Give premedication consisting of a steroid, antihistamine, and an H2-antagonist
Do not use PVC containers or tubing
Infuse over 3 to 24 hours
Monitor VS during first hour of infusion

Front 46

Paclitaxel (Taxol)
Education

Back 46

Patient/family education
Explain drug delivery methods.
Report s/s of infection, bleeding, weakness, paresthesias, gait disturbances
Avoid crowds
Avoid ASA and alcohol
Monitor the patient’s CBCs frequently.

Front 47

Topotecan (Hycamtin)
Therapeutics

Back 47

Pharmacotherapeutics
Ovarian and small cell lung cancer

Front 48

Topotecan (Hycamtin)
Codynamics

Back 48

Pharmacodynamics
Interferes with DNA synthesis by inhibiting the enzyme topoisomerase-I. Action is in the S phase

Front 49

Topotecan (Hycamtin)
Contraindications

Back 49

Contraindications and precautions
Pre-existing myelosuppression, pregnancy and lactation

Front 50

Topotecan (Hycamtin)
AE

Back 50

Adverse effects
Nausea, vomiting, diarrhea, headache, and alopecia
Serious: myelosuppression,
Drug interactions
Additive myelosuppression

Front 51

Topotecan (Hycamtin)
Implementation

Back 51

Implementation
Nausea and vomiting common-pretreatment with antiemitics
Assess for signs of bone marrow suppression

Front 52

Topotecan (Hycamtin)
Education

Back 52

Patient and family education
Importance of careful monitoring of blood counts
Avoidance of risk factors that might expose patient to sources of bleeding and infection.
Small and frequent meals and take antiemetics if needed.
If patient vomits after taking, do not replace dose
Review the signs and symptoms & which ones should be reported to a prescriber

Front 53

Cyclophosphamide (Cytoxan)
therapeutics

Back 53

Pharmacotherapeutics
Hodgkin's disease, leukemia, multiple myeloma, ovarian and breast cancer

Front 54

Cyclophosphamide (Cytoxan)
codynamics

Back 54

Pharmacodynamics
Inhibits DNS replication and RNA transcriptase and disrupts protein synthesis.

Front 55

Cyclophosphamide (Cytoxan)
Contraindications

Back 55

Contraindications and precautions
Bone marrow depression, infections, pregnancy and lactation

Front 56

Cyclophosphamide (Cytoxan)
AE

Back 56

Adverse effects
Resp (pulmonary fibrosis); CV (myocardial fibrosis): GI; GU (Hemorrhagic cystitis, hematuria) Derm( alopecia)
Dose-limiting effect: leukopenia

Front 57

Cyclophosphamide (Cytoxan)
Implementation

Back 57

Implementation
Give on empty stomach unless severe GI irritation
Give over 30 to 60 minutes
Vigorous hydration regimen of at least 3 L of fluid a day.
Monitor urine output vigilantly to ensure an output of at least half of the intake.
Dose modification may be considered in patients with impaired renal, hematologic, or hepatic function.

Front 58

Cyclophosphamide (Cytoxan)
Education

Back 58

Patient/family education
Drink large amounts of fluid, at least 3 L daily.
Contraception plan
Avoid crowds
Report s/s infection, bleeding, yellow discoloration of skin
Avoid alcohol
No vaccination
Periodic lab monitoring renal function and hematopoietic reserve.

Front 59

Doxorubicin (Adriamycin)
Therapeutics

Back 59

Pharmacotherapeutics
Hematologic cancers and solid tumors.

Front 60

Doxorubicin (Adriamycin)
Codynamics

Back 60

Pharmacodynamics
Intercalation between specific base pairs within the cancer cell’s DNA inhibiting DNNA and RNA synthesis; S-phase-cycle specific

Front 61

Doxorubicin (Adriamycin)
AE

Back 61

Adverse effects
Nausea, vomiting, alopecia, hyperuricemia
Serious: bone marrow suppression, cardiomyopathy

Front 62

Doxorubicin (Adriamycin)
Contraindications

Back 62

Contraindications and precautions
Severe CHF or any existing cardiomyopathy, bone marrow depression

Front 63

Doxorubicin (Adriamycin)
Implement

Back 63

Implementation
Cardioprotectant (dexrazoxane) in conjunction with anthracycline therapy.
Use large veins, with a new peripheral line for vesicant administration.
Monitor VS during administration
Encourage fluids or 2 to 3 l/d
May use allopurinol
Monitor cardiac toxicity

Front 64

Doxorubicin (Adriamycin)
education

Back 64

Patient and family education
Report s/s infection, bleeding, shortness of breath edema, chest pain
Avoid crowds
Reddish urine for 1-2 days
Alopecia, which is reversible
Report pain at infusion site.
Contraception should be used during and for at least 4 months after therapy
Care givers precaution with body fluids for 5 days

Front 65

Tamoxifen
Therapeutics

Back 65

Pharmacotherapeutics
Breast cancer.

Front 66

Tamoxifen
Codynamics

Back 66

Pharmacodynamics
Competes with estrogen for binding sites in tissues high in estrogen receptors, such as breast tissue.
Reduces DNA synthesis and estrogen response

Front 67

Tamoxifen
Contraindications

Back 67

Contraindications and precautions
Hypersensitivity

Front 68

Tamoxifen
AE

Back 68

Adverse effects
CV (PE, CVA, edema); GI (nausea, vomiting) GU (uterine malignancies); Metabolic (hot flashes); Heme (leukopenia, thrombocytopenia); hypercalcemia

Front 69

Tamoxifen
Implement

Back 69

Implementation
Administer with food or fluids id GI irritation is an issue
Do not give with antacid
Do not crush, break or chew
Monitor CBC, calcium, liver function and thyroxine levels

Front 70

Tamoxifen
Education

Back 70

Patient/family education
Contraceptive plan and hot flashes
Report bone pain
Report swelling of leg, shortness of air