Name of Medication (generic & trade) Darbepoetin (Aranesp) Drug Classification Hematopoietic agent Route Intravenous Time/frequency__________________________Dosage____________________________ Recommended Safe Dose (calculate for peds) SUBCUT/IV 0.45 mcg/kg as a single inj, titrate max target Hgb of 12 g/dl Reason YOUR patient is receiving medication Anemia associated with chronic renal failure MOA stimulates erythropoiesis by the same mechanism as endogenous erythropoietin; in response to hypoxia, erythropoietin is produced in the kidney and released into the bloodstream, where it interacts with progenitor stem cells to increase red cell production Adverse Effects CNS: seizures, sweating, headache, dizziness, stroke CV: hypo/hypertension, cardiac arrest, angina pectoris, thrombosis, CHF, acute MI, dysrhythmias, chest pain, transient ischemic attacks, edema GI: diarrhea, vomiting, nausea, abdominal pain, constipation HEMA: red cell aplasia MISC: infection, fatigue, fever, death, fluid overload, vascular access hemorrhage, dehydration, sepsis MS: bone pain, myalgia, limb pain, back pain RESP: upper respiratory infection, dyspnea, cough, bronchitis, pulmonary embolism SYST: allergic reactions, anaphylaxis____________________________________________________ Nursing Considerations Assess for serious allergic reactions: rash, urticaria, if anaphylaxis occurs, stop the product and administer emergency treatment (rare) Assess blood studies: ferritin, transferrin monthly; transferrin sat ? 20%, ferritin ? 100 mg/mL; Hgb 2x / week until stabilized in target range; then at regular intervals; those with endogenous erythropoietin levels of < 500 mL/L respond to this agent Assess renal studies: urinalysis, protein, blood, BUN, creatine Assess BP, Hct; check for BP rising as Hct rises; antihypertensives may be needed Assess CV status: hypertension may occur rapidly, leading to hypertensive encephalopathy; Hgb > 12 g/dL may lead to death Assess I and O ratio; report drop in output to < 50 mL/hour Assess for seizures if Hgb is increased within 2 weeks by 4 pts Assess for CNS symptoms: cold sensation, sweating, pain in long bones Assess dialysis patients for thrill, bruit of shunts; monitor for circulation impairment Name of Medication (generic & trade) Pegfilgrastim (Neulasta) Drug Classification hematopoietic agent Route Subcutaneous Time/frequency__________________________Dosage____________________________ Recommended Safe Dose (calculate for peds) SUBCUT 6 mg give once per chemotherapy cycle__________________________ Reason YOUR patient is receiving medication Prevent infection____________________________________________________ MOA Stimulates proliferation and differentiation of neutrophils_____________________________________________________ Adverse Effects CNS: fever, fatigue, headache, dizziness, insomnia, peripheral edema GI: nausea, vomiting, diarrhea, mucositis, anorexia, constipation, dyspepsia, abdominal pain, stomatitis, splenic rupture HEMA: leukocytosis, granulocytopenia, sickle cell crisis, hemoglobin S disease with crisis MISC: anaphylaxis, influenza-like syndrome MS: skeletal pain RESP: respiratory distress syndrome Nursing Considerations Assess for allergic reactions, anaphylaxis: rash, urticaria; discontinue this product, have emergency equipment nearby Monitor blood studies: CBC, platelet count before treatment and twice weekly; neutrophil counts may be increased for 2 days after therapy Monitor BP, respirations, pulse before, during therapy Assess for bone pain, give mild analgesics Give using single-use vials; after dose is withdrawn, do not reenter vial Do not use 6-mg fixed dose in infants, children, or others < 45 kg Inspect sol for discoloration, particulates; if present, do not use Do not use administer in the period 14 days before and 24 hours after cytotoxic chemotherapy Store in refrigerator; do not freeze; may store at room temperature up to 6 hours, avoid shaking, protect from light Name of Medication (generic & trade) Dexamethasone (Decadron) Drug Classification Corticosteroid, synthetic Route Intravenous Time/frequency__________________________Dosage____________________________ Recommended Safe Dose (calculate for peds) PO 0.75 ? 9 mg/day, in divided doses every 6-12 hour; or phosphate IM 0.5 ? 9 mg/day divided every 6-12 hours; or acetate IM 4-16 mg every 1-3 weeks)____________________________________ Reason YOUR patient is receiving medication reduce inflammation MOA Decreases inflammation by suppression of migration of polymorphonuclear leukocytes, fibroblasts, reversal of increased capillary permeability and lysosomal stabilization Adverse Effects CNS: depression, flushing, sweating, headache, mood changes, euphoria, psychosis, seizures, insomnia CV: hypertension, circulatory collapse, thrombophlebitis, embolism, tachycardia, edema, cardiomyopathy EENT: fungal infections, increased intraocular pressure, blurred vision, cataracts, glaucoma ENDO: hypothalamic-pituitary-adrenal axis suppression, hyperglycemia, sodium, fluid retention GI: diarrhea, nausea, abdominal distension, GI hemorrhage, increased appetite, pancreatitis HEMA: thrombocytopenia, transient leukocytosis INTEG: acne, poor wound healing, ecchymosis, petechiae, hirsutism META: hypokalemia MS: fractures, osteoporosis, weakness, arthralgia, myopathy Nursing Considerations Monitor K, blood, urine glucose while on long-term therapy; hypokalemia and hyperglycemia Monitor weight daily; notify prescriber of weekly gain > 5 lb. Monitor BP every 4 hours, pulse; notify prescriber of chest pain Monitor I and O ratio; be alert for decreasing urinary output, increasing edema Monitor plasma cortisol levels long-term therapy (normal: 138-635 nmol/L SI units when assess at 8 am), prolonged use can cause cushingoid symptoms Assess infection: fever, WBC, even after withdrawal medication; product masks infection Assess potassium depletion: paresthesias, fatigue, nausea, vomiting, depression, polyuria, dysrhythmias, weakness Assess edema, hypertension, cardiac symptoms Assess mental status: affect, mood, behavioral changes, aggression Name of Medication (generic & trade) Vancomycin (Vancomycin) Drug Classification Antiinfective ? miscellaneous Route Intravenous Time/frequency Every 12 hours Dosage 1250 mg = 250 mL sol Rate = 183 mL/hour Recommended Safe Dose (calculate for peds) Serious staphylococcal infections: Adult: IV 500 mg (7.5 mg/kg) q6-8 hours or 1 g (15 mg/kg) every 12 hours Pseudomembranous/staphylococcal enterocolitis: Adult: PO 125-500 mg every 6 hours for 7-10 days Endocarditis prophylaxis for dental procedure: Adult: IV 1 g over 1 hour; 1 hour before dental procedure Renal Dose: Adult: IV CCr> 70 mL/min no dosage adjustment; CCr 50-70 mL/min loading dose of 15 mg/kg, reduce dose to 750 mg ? 1 g every 18-24 hours; CCr < 49 mL/min initial loading dose of 15 mg/kg, with subsequent dosing based on concentration, may be every 24-72 hours or longer Reason YOUR patient is receiving medication directed against gram-positive organisms and active against Enterococcus species MOA inhibits bacterial cell wall synthesis, blocks glycopeptides Adverse Effects CV: Cardiac arrest, vascular collapse (rare), hypotension EENT: ototoxicity, permanent deafness, and tinnitus, nystagmus GI: Nausea, pseudomembranous colitis GU: nephrotoxicity: increase BUN, creatine, and albumin, fatal uremia HEMA: leukopenia, eosinophilia, neutropenia INTEG: chills, fever, rash, thrombophlebitis at inj site, urticaria, pruritus, necrosis (Red Man product syndrome), skin/subcutaneous tissue disorders RESP: wheezing, dyspnea SYST: anaphylaxis, superinfection Nursing Considerations Assess for infection: WBC, urine, stools, sputum, wound characteristics, throughout treatment Monitor I & O ratio; report hematuria, oliguria because nephrotoxicity may occur Monitor any patient with compromised renal system (BUN, creatinine); product is excreted slowly in poor renal system function; toxicity may occur rapidly Monitor blood tests: WBC; serum levels; peak 1 hour after 1 hour inf 25-40 mg/mL; trough before next dose 5-10 mg/mL Obtain C & S before product therapy; product may be given as soon as culture is performed Assess auditory function during, after treatment; hearing loss, ringing, roaring in ears; product should be discontinued Monitor BP during administration; sudden drop may indicate Red Man syndrome Assess for signs of infection Assess respiratory status: rate, character, wheezing, tightness in chest Identify allergies before treatment, reaction of each medication Give antihistamine if Red Man syndrome occurs: decreased BP, flushing of neck, face Give dose based on serum concentration Give in equal intervals around the clock to maintain blood levels Store at room temperature for up to 2 weeks after reconstitution Have adrenaline, suction, tracheostomy set, endotracheal intubation equipment on unit; anaphylaxis may occur Provide adepuate fluids (2 L) to prevent nephrotoxicity IT route: Use preservative-free 0.9% NaCl (2-5 mg/mL final conc) Intermittent IV route: Give after reconstitution with 10 mL of sterile water for inj (500 mg/10 mL); further dilution is needed for IV, 500 mg/100 mL of 0.9% NaCl, D5W given as intermittent inf over 1 hour; decrease rate of inf if Red Man syndrome occurs Name of mediation (generic and trade) Epoetin (Procrit) Drug classification Antiemetic, biologic modifier, hormone________ Route Subcutaneous and Intravenous_____________________ Time/Frequency ______________________________________ Dosage ___________________________________ Recommended safe dose SUBCUT/IV 50-100 units/kg 3X/week, then adjust to maintain the target Hct of 30% - 36% Reason your patient is receiving medication decreases anemia and increase RBCs MOA erythropoietin is one factor controlling rate of red cell production; product is developed by recombinant DNA technology Adverse Effects CNS: seizures, coldness, sweating, headache CV: hypertension, hypertensive encephalopathy, CHF, edema, DVT INTEG: pruritus, rash, inj site reaction MISC: iron deficiency MS: bone pain RESP: cough Nursing considerations Monitor renal studies: urinalysis, protein, blood, BUN, creatinine, I and O; report drop in output < 50 mL/hr Monitor blood studies: ferritin, transferrin monthly, transferrin sat ? 20 %; ferritin ? 100 ng/mL; Hct 2X/week until stabilized in target range (30%-36%), then at regular intervals; those with endogenous erythropoietin levels of < 500 units/L respond to this agent; check symptoms of anemia: fatigue, pallor, dyspnea; monitor Hct 2X/ week in chronic renal failure; those being treated with zidovudine or cancer patients should be monitored weekly, then periodically after stabilization; death may occur in Hgb > 12 g/dl Assess for CNS symptoms: coldness, sweating, pain in long bones Assess CV status: BP before, during treatment; hypertension may occur rapidly, leading to hypertension encephalopathy; antihypertensives may be needed Assess patient during hemodialysis for bruits, thrills, or shunts; product prevents severe anemia in chronic renal failure; clotting may need to be treated with increased anticoagulant Assess for seizures if Hct is increased within 2 weeks by 4 pts Monitor serum iron levels, ferritin, transferrin levels; iron therapy may be needed to prevent recurring anemia Monitor BP, check for rising BP as Hct rises Monitor blood studies: BUN, creatine, uric acid, platelets, WBC, phosphorus, potassium, bleeding time; Hct, Hgb, RBCs, reticulocytes should be checked in chronic renal failure For hypersensitivity reactions: skin rashes, urticaria (rare), antibody development does not occur For pure cell aplasia (PRCA) in absence of other causes, evaluate by testing sera for recombinant erythropoietin antibodies; any loss of response to Epoetin should be evaluated Name of Medication (generic & trade) Trastuzumba (Herceptin) Drug Classification antineoplastic ? miscellaneous Route Intravenous Time/frequency__________________________Dosage____________________________ Recommended Safe Dose (calculate for peds) IV 4 mg/kg given over 90 min, then maintenance 2 mg/kg given over 30 min; do not give as IV push or bolus; may be given in combination with other antineoplastic Reason YOUR patient is receiving medication Patient has breast cancer MOA DNA- derived monoclonal antibody selectively binds to extracellular portion of human epidermal growth factor receptor 2 (HER2); it inhibits proliferation of cancer cells Adverse Effects CNS: dizziness, numbness, paresthesias, depression, insomnia, neuropathy, peripheral neuritis CV: tachycardia, CHF GI: nausea, vomiting, anorexia, diarrhea, abdominal pain, hepatotoxicity HEMA: anemia, leukopenia INTEG: rash, acne, herpes simplex META: edema, peripheral edema MISC: flu-like symptoms; fever, headache, chills MS: arthralgia, bone pain RESP: cough, dyspnea, pharyngitis, rhinitis, sinusitis, pneumonia SYST: anaphylaxis, angioedema Nursing Considerations Monitor CBC, HER2 over expression Assess for symptoms of infection; may be masked by product Assess CNS reaction: LOC, mental status, dizziness, confusion Assess for CHF and other cardiac symptoms: dyspnea, coughing, gallop; obtain a full cardiac workup including ECG, echocardiogram, mitigated angiogram Assess for hypersensitivity reactions, anaphylaxis monitor for potentially fatal infusion reactions: fever, chills, nausea, vomiting, pain, headache, dizziness, hypotension; discontinue product Name of Medication (generic & trade) Docetaxel (Taxotere) Drug Classification antineoplastic ? miscellaneous Route Intravenous Time/frequency__________________________Dosage____________________________ Recommended Safe Dose (calculate for peds)locally advanced or metastatic breast cancer after failure of other chemotherapy: IV 60-100 mg/m2 given over 1 hour every 3 weeks; if neutrophil count is < 500/mm3 for > 1 week, reduce dose by 25% Operable node positive breast cancer: IV (TAC regimen) 75 mg/m2 1 hour after DOXOrubicin 50 mg/m2 and cyclophosphamide 500 mg/m2 every 3 weeks for 6 cycles Adjuvant treatment of operable stage I-III invasive breast cancer in combination with cyclophosphamide: IV (TC) regimen Docetaxel 75 mg/m2 every 21 days for 4 cycles Locally advanced or metastatic non-small-cell lung cancer after failure of cisplatin chemotherapy: IV 75 mg/m2 over 1 hour every 3 weeks; if neutrophil count is < 500/mm3 for > 1 week, reduce dose to 55 mg/m2; if patient develops grade 3 peripheral neuropathy, stop product Adjuvant post-surgery treatment of operable node-positive breast cancer: IV 75 mg/m2 given over 1 hour, given 1 hour after DOXOrubicin 50 mg/m2, cyclophosphamide 500 mg/m2 every 3 weeks X 6 cycles Reason YOUR patient is receiving medication breast cancer MOA inhibits the reorganization of microtubule network needed for interphase and mitotic cellular functions; also causes abnormal bundles of microtubules during cell cycle and multiple esters of microtubules during mitosis Adverse Effects CNS: seizures CV: hypotension, fluid retention, peripheral edema, flushing, MI, sinus tachycardia GI: nausea, vomiting, diarrhea, hepatotoxicity, stomatitis, colitis HEMA: neutropenia, leukopenia, thrombocytopenia, anemia, bleeding, infections, myelosuppression INTEG: alopecia, nail pain, rash, skin eruptions MISC: amenorrhea, fever of unknown origin, secondary malignancy, Stevens-Johnson syndrome MS: arthralgia, myalgia, back pain NEURO: peripheral neuropathy RESP: dyspnea, pulmonary edema, fibrosis, embolism SYST: hypersensitivity reactions, AML, death Nursing Considerations Assess CNS changes: confusion, paresthesias, dysethenia, pain, weakness: if severe, product should be discontinued Check Buccal cavity every 8 hours for dryness, sores or ulceration, white patches, oral pain, bleeding, dysphagia; obtain prescription for viscous lidocaine (Xylocaine) to use in mouth Assess symptoms indicating severe allergic reaction, anaphylaxis: rash, pruritus, urticaria, purpuric skin lesions, itching, flushing Monitor CBC, differential, platelet count weekly; withhold product if WBC is <1500/mm3 or platelet count is < 100,000/mm3, notify prescriber of results Monitor renal function tests: BUN, creatinine, serum uric acid, urine CCr before, during therapy; check I&O ratio; report fall in urine output < 30 mL/hr Monitor temp every 4 hours (may indicate beginning of infection) Monitor liver function tests before, during therapy (bilirubin, AST, ALT, LDH) as needed or monthly; check for jaundice of skin and sclera, dark urine, clay-colored stools, itchy skin, abdominal pain fever, diarrhea Assess for bleeding: hematuria, stool guaiac, bruising or petechiae, mucosa or orifices every 8 hours; check for inflammation of mucosa, breaks in skin Assess effects of alopecia on body image; discuss feelings about body changes
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