Symptom Control of Cancer Treatment MEDICATIONS Symptom Control of Cancer Treatment

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

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

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

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

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

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.

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

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

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

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)

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

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

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

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

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

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

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

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

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

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

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

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

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