DRUG STUDY

DRUG
Methotrexate
Brand Name:
Amethoptertin,
Folex, Trexall

CLASSIFICATION

INDICATION

Antineoplastic,
antirheumatic,
immunosuppressant,
antimetabolite

Trophoblastic neoplasms
(choriocarcinoma,
Hydatidiform Mole)
Leukemia
Breast, head and neck
carcinoma
Severe psoriasis and
rheumatoid arthritis
unresponsive to
conventional therapy
Ectopic pregnancy
Lymphosarcoma
Mycosis fungoides

ADVERSE EFFECT
1. Dizziness
2. Drowsiness
3. Headaches
4. Malaise
5. Anorexia
6. Nausea and
vomiting
7. Hepatoxicity
8. Alopecia
9. Ulcerative
stomatitis
10. Leukopenia
11. Chills and fever
12. Photosensivity
13. Thrombocytopeni
a
14. Hyperurecemia

CONTRAINDICATIONS
Known allergic
hypersensitivity to
the drug
Pregnancy

NURSING INTERVENTION
1. Solutions for
injection must be
prepared in a biologic
cabinet. Gloves,
gown and mask are
worn while preparing
Methotrexate has caused
and handling the
fetal death and/or congenital
medication.
anomalies, therefore, it is not
2. Administer
recommended in women of
Allopurinol per
childbearing potential unless
doctors order to
there is imperative medical
decrease uric acid
evidence that the benefits can
levels.
be expected to outweigh the
3. Instruct patient to
considered risks. Pregnant
avoid caffeine as it
psoriatic patients should not
may decrease the
receive this drug.
efficacy of the drug.
4. To prevent
Concomitant use of
hematologic toxicity
other drugs that has a
(platelet levels are
hepatotoxic potential
decreased)
(including alcohol)
salicylates, NSAIDs,
should be avoided.
phenytoin,
tetracycline and
chlorampenicol
should be avoided.

Dexamethason
e
Brand Name:
Cortastat, Dalalone,
Decadrol, Decaject,
Deronil,
Dexacorten,
Dexameth,
Dexasone, Dexone,
Hexadrol,
Primethasone,
Solurex

Long- acting
corticosteroid

1. Management of
cerebral edema
2. Diagnostic agent
in adrenal
disorders
3. Relieves
inflammation
4. Allergic disorders
5. Asthma
6. Arthritis

Side Effects
1. Acne
2. Decreased wound
healing
3. Depression
4. Vomiting
5. Easy bruising
6. Headache
7. Increased hair
growth
8. Insomnia
9. Restlessness
10. Stomach irritation
11. Irregular or absent
menstruation
12. Dizziness

Adverse reactions
If these signs and
symptoms will be noted
instruct the patient to call
or notify the physician
immediately.
1. Skin rash
2. Swollen face, legs
or ankles (fluid
retention)
3. Vision problems (
Dexamethasone
may cause
cataracts and

1. Hypersensitivity
2. Active untreated
infection
3. Lactation
4. Systemic fungal
infection
Use Cautiously in:
1. Children (chronic use
may result in
decreased growth)
2. Stress (surgery or
infections)
3. Potential infections as
dexamethasone may
mask the signs of
infection such as
fever and
inflammation.
4. Pregnancy (safety is
not established with
the sue of the drug
during pregnancy)

1. Monitor intake and

output of patient.
2. Observe the patient for
peripheral edema,
steady weight gain,
rales or crackles or
dyspnea. Notify the
physician immediately
if these clinical
manifestations are
noted.
3. Periodic growth
evaluation for children
should be done time to
time.
4. For patients with
cerebral edema, assess
then for level of
consciousness changes
and headache during
the therapy.
5. Guaiac-test stools
should be carried out.
Guaiac-positive stools
should be reported to
the physician
immediately.
6. Administer with meals
to minimize GI
irritation.
7. For patients with
difficulty swallowing,
tablets can be crushed
and administered with

increased
intraocular
pressure)
4. Cold or infection
that last for a long
time
5. Muscle weakness
6. Black or tarry stool
(suggestive of
peptic ulceration
caused by
Dexamethasone
use)

Prednisone
Brand name:
Apo-Prednisone ,
Deltasone,
Meticorten,
Orasone, Panasol,
Prednicen-M,
Sterapred, Winpre

Corticosteroid
(intermediate acting),
Glucocorticoid,
Hormone

Replacement
therapy in adrenal
cortical
insufficiency
Hypercalcemia
associated with
cancer
Short-term
management of

Insomnia,
nervousness,
increased
appetite,
indigestion,
dizziness/lighthea
dedness,
headache,
hirsutism,

fluids or food.
However, capsules
should be swallowed
whole.
8. Educate the patient to
take missed doses as
soon as remembered,
unless almost time for
the next dose skip the
missed dose and
continue your regular
dosing schedule. Do
not take a double dose
to make up for a
missed one.
9. Instruct patient to
avoid people with
known infection and
contagious illnesses as
corticosteroids causes
immunosuppression
and may mask
symptoms of infection.

Hypersensitivity, serious
infections (except tuberculous
meningitis), varicella, systemic
fungal infections.

Administer once-aday doses before

9AM to mimic
normal peak
corticosteroid blood
levels.
Increase dosage when
patient is subject to
stress.

FLUTAMIDE
BRAND NAME(S):

Hormone therapy

various
inflammatory and
allergic disorders,
such as
rheumatoid
arthritis, collagen
diseases (eg, SLE),
dermatologic
diseases (eg,
pemphigus), status
asthmaticus, and
autoimmune
disorders
Hematologic
disorders:
Thrombocytopenia
purpura,
erythroblastopenia
Ulcerative colitis,
acute
exacerbations of
MS and palliation
in some leukemias
and lymphomas
Trichinosis with
neurologic or
myocardial
involvement

This medication is used to

treat men with prostate
cancer, and is used with

hypopigmentation
, diabetes
mellitus, glucose
intolerance,
hyperglycaemia,
arthralgia,
cataracts,
glaucoma,
epistaxis,
diaphoresis,
Cushing's
syndrome, edema,
fractures,
hallucinations,
hypertension,
muscle-wasting,
osteoporosis,
pancreatitis,
pituitary-adrenal
axis suppression,
seizures.

Most people do
not experience all
of the side effects

Liver Failure, Liver Problems,

Severe Liver Disease, High
Amount of Bilirubin in the

WARNING: Taper
doses when
discontinuing highdose or long-term
therapy to avoid
adrenal insufficiency.
Do not give live virus
vaccines with
immunosuppressive
doses of
corticosteroids.

Assessment & Drug Effects

Monitor therapeutic

Eulexin

other medications and

sometimes with radiation
treatments. Flutamide
belongs to a class of drugs
known as anti-androgens
(anti-testosterone).
Testosterone, a natural
hormone, helps prostate
cancer to grow and spread.
Flutamide works by blocking
the effects of testosterone,
thereby slowing the growth
and spread of prostate
cancer

listed.
Side effects are
often predictable
in terms of their
onset and
duration.
* Side effects are
almost always
reversible and
will go away after
treatment is
complete.
There are many
options to help
minimize or
prevent side
effects.
There is no
relationship
between the
presence or
severity of side
effects and the
effectiveness of
Flutamide.

Blood, Abnormal Liver Function

Tests, Pregnancy, A Mother
who is Producing Milk and
Breastfeeding, G6PD
Deficiency, Anemia from
Pyruvate Kinase and G6PD
Deficiencies, Deficiency of the
Blood Enzyme Cytochrome b5
Reductase,
Methemoglobinemia

response with acid

and alkaline
phosphatase tests,
bone and liver scans,
chest x-ray, and
physical exam.
Monitor for
symptomatic relief of
bone pain.
Assess for
development of
gynecomastia and
galactorrhea; if these
become bothersome,
dosage reduction may
be warranted.
Lab tests: Monitor
liver function and
serum bilirubin
periodically.
Monitor for and
report development of
a lupus-like
syndrome.

Patient & Family Education

Hot flashes
Swelling of the
breasts
(gynecomastia)
Loss of interest in
sex (decreased
libido)
Nipple discharge

Be aware of potential
adverse effects of
therapy.
Notify physician
immediately of the
following: Pain in

(galactorrhea)
Impotence
(inability to obtain
or sustain an
erection)
Diarrhea

Nausea and
vomiting
Increases in blood
tests measuring
liver function.
These return to
normal once
treatment is
discontinued.
Yellow-green
discoloration of
urine

CNS: Drowsiness,
confusion, depression,
anxiety, nervousness. GI:
Diarrhea, nausea, vomiting,
anorexia, hepatitis,
cholestatic jaundice,
encephalopathy, hepatic
necrosis, acute hepatic
failure, may increase ALT,
AST, bilirubin. Urogenital:
Hot flashes, loss of libido,
impotence. Hematologic:
Anemia, leukopenia,
thrombocytopenia. Skin:

upper abdomen,
yellowing of skin and
eyes, dark urine,
respiratory problems,
rashes on face,
difficulty urinating,
sore throat, fever,
chills.
Do not breast feed
while taking this
drug.

Rash. Body as a Whole:

Edema. Endocrine:
Gynecomastia,
galactorrhea.

Interactions

Bortezomib
Brand name:
Velcade

biologic response
modifier; proteosome
inhibitor

VELCADE (bortezomib) is
indicated for the treatment
of patients with multiple
myeloma. VELCADE is
indicated for the treatment
of patients with mantle cell
lymphoma who have
received at least
1 prior therapy.

Drug: may increase

INR in patients on
warfarin.

mild nausea,
vomiting, upset
stomach;
diarrhea,
constipation,
bloating;
headache, mild
dizziness;
muscle pain, bone
or joint pain;
sleep problems
(insomnia);
mild rash or
itching; or.
skin irritation
where the
medicine was
injected.

VELCADE is contraindicated in
patients with hypersensitivity
(not including local reactions)
to bortezomib, boron, or
mannitol, including
anaphylactic reactions.
VELCADE is contraindicated for
intrathecal administration.
Fatal events have occurred
with intrathecal administration
of VELCADE.

Assessment & Drug Effects

Monitor for and

report S&S of
neuropathy (e.g.,
hyperesthesia,
hypoesthesia,
paresthesia,
discomfort or
neuropathic pain).
Monitor postural vital
signs for orthostatic
hypotension.
Monitor I&O and
assess for S&S of
dehydration or
electrolyte imbalance
if vomiting and/or
diarrhea develop.
Lab tests: Frequent
CBC with platelet

Adverse effects
Body as a Whole: Asthenia,
weakness, fatigue, malaise,
fever, dehydration,
peripheral neuropathy,
rigors, herpes zoster. CNS:
Insomnia, headache,
paresthesia, dizziness,
anxiety. CV: Edema,
hypotension, orthostatic
hypotension. GI: Nausea,
vomiting, diarrhea,
anorexia, abdominal pain,
constipation, dyspepsia,
dysphagia. Hematologic:
Thrombocytopenia,
neutropenia, anemia.
Musculoskeletal:
Arthralgia, musculoskeletal
pain, bone pain, myalgia,
back pain, muscle cramps.
Respiratory: Dyspnea,
cough, upper respiratory
infection. Skin: Rash,
pruritus. Special Senses:
Blurred vision, diplopia.

Interactions
Drug: Hypoglycemia and
hyperglycemia have been
reported with antidiabetic
agents; antihypertensive

count; baseline and

periodic LFTs;
frequent blood
glucose in diabetics.
Patient & Family Education

Report promptly any

of the following:
dizziness, lightheadedness or
fainting spells;
numbness, tingling,
or other unusual
sensations; signs of
infection (e.g., fever,
chills, cough, sore
throat); bruising,
pinpoint red spots on
the skin; black, tarry
stools, nosebleeds, or
any other sign of
bleeding.
Do not drive or
engage in other
hazardous activities
until reaction to drug
is known.
Females should use
reliable methods of
contraception to
avoid pregnancy
while on this drug.

agents may exacerbate

hypotension;
anticoagulants,
antithymocyte globulin,
nsaids, platelet inhibitors,
aspirin, thrombolytic
agents may increase risk of
bleeding.

Do not breast feed

while taking this
drug.