1. Symptom Control of Cancer Treatment
MEDICATIONS
Symptom Control of Cancer Treatment

2. ANTIEMETICS ZOFRAN (Ondansetron) Oral, Intravenous
Side effects: headache, diarrhea, constipation, abdominal pain, transient increase in AST (heart muscle and liver enzyme; elevated with cellular damage) or ALT (hepatocellular enzyme; elevated with liver damage)
Nursing Implications:
give diluted IV dose (approx. 32 mg) 30 min. before chemotherapy
Give oral dose, 8 mg. before chemo and then TID x 2days

3. ANTIEMETICS REGLAN (Metoclopramide) IV, oral
Side Effects: drowsiness, extrapyramidole rxn, restlessness, dysrhythmias, anxiety
Nursing Implications:
Administer IV dose 30min. before administration of chemo
Oral: Administer 30 min before meals and at hs

4. ANTIEMETICS PROCHLORPERAZINE (Compazine) Oral, IM, Rectal
Side Effects: EPS, orthostatic hypotension, blurred vision, dry mouth, constipation, urine retention, photosensitivity
Nursing considerations:
Use cautiously with other CNS depressants (including alcohol), medications that lower BP, patients with liver disease
Do not exceed recommended dose
Protect from light

5. Antidiarrheal LOMOTIL (diphenolylate/atropine) Given PO tabs, liquid
Side Effects: sedation, dizziness, dry mouth, urinary retention, rash
Nursing Implications: Watch for physical dependence; Know that it should work within 48 hrs.; give Naloxone as antidote for respiratory depression

6. NSAID NAPROXYN, ANAPROX Nonsteroidal antiinflammatory agent
Side Effects: Agranulocytosis, headache, dizziness, drowsiness, peripheral edema, visual distubances, GI upset (occult blood loss, peptic ulcers), prolonged bleeding time, tinnitus
Nursing Implications: Know that concurrent use with alcohol, acetylsalicylic acid, and steroids will increase chance of GI bleeding. Know that it may interact with Coumadin (Warfarin). Give with food. Avoid use in patient allergic to acetylsalicyclic acid. Advise patient that it may take 4 weeks to show benefit

7. Antidepressant AMITRIPTYLINE (Elavil) Tricyclic Antidepressant PO, IM
Side Effects: Tremors, orthostatic hypotension, urinary retention
Nursing Implications: used in combination with narcotics in neuropathies and postherpetic neuralgia (esp. with burning pain). Therapeutic effect takes 2-3 weeks.

8. Antianxiety ATIVAN (Lorazepam) PO
Side Effects: drowsiness, headache, diarrhea, respiratory depression
Nursing Implications: Smoking decreases effectiveness. This med decreases nausea esp. when given before and during chemotherapy

9. Treatment of and Symptom Control of HIV/AIDS
Medications
Treatment of and Symptom Control of HIV/AIDS

10. Medications - Treatment of and Symptom Control of HIV/AIDS
Antiretroviral Therapy (the “umbrella” of categories)
Includes:
Nucleoside Reverse Transcriptase Inhibitors
Combination Medications
Nonnucleoside Reverse Transcriptase Inhibitors
Protease Inhibitors

11. Medications - Treatment of and Symptom Control of HIV/AIDS
Combination Therapy: now the “standard”
Combining medications makes it difficult for the virus to develop resistance to the drugs
Can slow progression of the disease
Medication “cocktails”: 2+ medications combined and given together (usually prefer 3 or more medications together)

12. Medications: Nursing Role
Timing of medication and Adherence to medication regimen are critical for gaining quantity and improving quality of life
Timing: TID = q 8 hrs (not 3x while pt. awake)
When medication is not given regularly, blood level concentration of the med falls  allows HIV to develop resistance
Adherence:
The patient needs to be educated on the importance of adhering to their medication regimen once they leave the facility or hospital

13. Nucleoside Reverse Transcriptase Inhibitors
“nucleoside analogs”, “nukes”
ZIDOVUDINE (AZT, Retrovir)
Drug of choice to be used initially in combination therapy in antiretroviral-naive patients
Comments:
headache, nausea – usually resolve within a month.
Bone marrow suppression occurs after long-term use (6mo – 2 yrs
Anemia can be treated with blood transfusions or EPO
Consider treating neutropenia with CSF – eg. Neutrogen

14. Nucleoside Reverse Transcriptase Inhibitors
ZIDOVUDINE cont.
Side Effects:
Anemia, fever, malaise, headache, nausea, insomnia, myalgia, confusion, aggitation, seizures, hepatomegaly

15. Nucleoside Reverse Transcriptase Inhibitors
Stavudine (Zerit) PO
Comments: Crosses the blood-brain barrier. Used in combination therapy for patients who are intolerant of AZT. Decrease dose in patients with impaired renal function
Side Effects: Painful peripheral neuropathy, elevated AST/ALT, anemia, headache, rash, abdominal pain, diarrhea

16. Nucleoside Reverse Transcriptase Inhibitors
Abacavir (Ziagen) PO
Comments: 3% develop hypersensitivity AEB flu-like sx.; Life-threatening development of Stevens- Johnson syndrome [a rare, serious disorder in which your skin and mucous membranes react severely to a medication or infection. Often, Stevens-Johnson syndrome begins with flu-like symptoms, followed by a painful red or purplish rash that spreads and blisters, eventually causing the top layer of your skin to die and shed. ] STOP THE DRUG IMMEDIATELY and do not re-challenge  death

17. Nucleoside Reverse Transcriptase Inhibitors
ABACAVIR cont.
Comments: (cont.) Avoid alcohol  increased level of medication in the blood. No dietary restrictions
Side Effects: n/v, rash, headache, fatigue

18. Combination Medications
TENOFOVIR (Viread) PO
Comments: Do not combine with Epivir (lamivudine) and Ziagen (abacavir). People taking “ddl” (Videx) should take Tenofovir 2 hrs before or 1 hours after didanosine. No food restrictions.
Side effects: Mild, some n/v, loss of appetite; potential for renal failure, bone mineral density loss

19. Combination Medications
Other examples of combination medications:
Combivir: zidovudine + lamivudine
Trizivir: zidovudine+lamivudine+abacavir
Epzicom: abacavir+lamivudine

20. Nonnucleoside Reverse Transcriptase Inhibitors
Nevirapine (Viramune) PO
Comments: used in combination therapy. Report any new rash IMMEDIATELY – may progress to Stevens- Johnson syndrome  death
Side Effects: Rash, thrombocytopenia, fever, headaches, nausea

21. Nonnucleoside Reverse Transcriptase Inhibitors
Efavirenz (Sustiva) PO
Comments: may cause hyperlipidemia; monitor cholesterol and triglycerides regularlly
Side Effects: Initial dizziness, insomnia, transient rash, vivid dreams, nightmares, difficulty concentrating

22. Protease Inhibitor
These drugs directly reduce the ability of HIV to replicate (make copies of itself inside cells)

23. Protease Inhibitors RITONAVIR (Norvir) PO
Comments: Titration/escalation of doses important due to side effects. Take with food. Has many drug interactions.
Side Effects: n/v/d, circumoral paresthesis (numbness and tingling), peripheral paresthesias, taste alterations, general weakness, increased liver enzymes, elevated cholesteral and triglyceride levels

24. Protease Inhibitors FOSAMPRENAVIR (Lexiva, FPV) PO
Comments: No food restrictions. <1% get serious skin reactions, including Steven-Johnson syndrome. This is a Sulfa drug.
Side Effects: n/v/d, rash, numbness around mouth, abdominal pain