Name of Student: Monica Carla C.

Mamuric
Name of Client: Herman Lee
Age: 66 y/o
Sex: Male Civil Status: M Bed: B4
Medical Diagnosis: Laryngeal subglottic carcinoma s/p laryngectomy
Drug Name: Carboplatin
Drug Order:
Drug classification antineoplastic agent; alkylating agent function
Drug Action: Carboplatin is a platinum compound that is a chemotherapeutic agent. It produces interstrand DNA crosslinkages, thus interfering with DNA, RNA, and protein synthesis. Carboplatin is cell-cycle nonspecific, i.e., effective throughout
the entire cell life cycle.
Indications for patient:

Combination therapy for laryngeal cancer

Contraindications:
History of severe reactions to carboplatin or other platinum compounds, severe bone marrow depression; significant bleeding;
impaired renal function; pregnancy and lactation.
Adverse effects:
Body as a Whole: Hypersensitivity reactions, ototoxicity
GI: Mild to moderate nausea and vomiting, anorexia, hypogeusia, dysgeusia, mucositis, diarrhea, constipation, elevated liver
enzymes.
Hematologic: Thrombocytopenia, leukopenia, neutropenia, anemia.
Metabolic: Mild hyponatremia, hypomagnesemia, hypocalcemia, and hypokalemia.
CNS: Peripheral neuropathy.
Skin: Rash, alopecia.

Special Senses: Tinnitus.

Urogenital: Nephrotoxicity.
Interactions:
Drug: AMINOGLYCOSIDES, loop diuretics may increase the risk of ototoxicity and nephrotoxicity. May decrease phenytoin
levels.
Nursing Responsibilities:
Administration:
PREPARE IV Infusion: Do not use needles or IV sets
containing aluminum. Immediately before use,
reconstitute with either sterile water for injection or D5W
or NS as follows:
50-mg vial plus 5 mL diluent; 150-mg vial plus 15mL
diluent; 450-mg vial plus 45 mL diluent. All dilutions yield
10 mg/mL. May be further diluted to 0.5 mg/mL with
D5W or NS.
ADMINISTER IV Infusion: Give IV solution over 15 min or
longer, depending on total amount of solution and patient
tolerance. Lengthening duration of administration may
decrease nausea and vomiting.
INCOMPATIBILITIES Solution/additive: Sodium
bicarbonate,fluorouracil,mesna. Y-site: Amphotericin B
cholesteryl complex.
Premedication with a parenteral antiemetic 1/2 h
before and on a scheduled basis thereafter is

normally used.
Do not repeat doses until the neutrophil count is at
least 2000/mm3 and platelet count at least 100,00/
mm3.
Protect from light. Reconstituted solutions are stable for 8 h at room temperature; discard solutions 8 h after dilution.
Nursing responsibilities:
Monitor closely during first 15 min of infusion, since allergic reactions have occurred within minutes of carboplatin
administration.
Lab tests: Baseline and periodic CBC with differential, platelet count, Hgb and Hct. Monitor periodically kidney function
with creatinine clearance tests and serum electrolytes, may cause increased serum bilirubin, alk phosphatase, AST
Monitor results of peripheral blood counts. Median nadir occurs at day 21. Leukopenia, neutropenia, and
thrombocytopenia are dose related and may produce dose-limiting toxicity.
Monitor for peripheral neuropathy (e.g., paresthesias), ototoxicity, and visual disturbances.
Monitor for signs of anaphylaxis (rash, urticaria, pruritus, facial swelling, wheezing, hypotension)
Monitor serum electrolyte studies, because carboplatin has been associated with decreases in sodium, potassium,
calcium, and magnesium. Special precautions may be warranted for patients on diuretic therapy.

Name of Student: Monica Carla C. Mamuric

Name of Client: Herman Lee
Age: 66 y/o
Sex: Male Civil Status: M Bed: B4
Medical Diagnosis: Laryngeal subglottic carcinoma s/p laryngectomy
Drug Name: Diphenhydramine
Trade name: Allerdry, Banophen, Genahist, Benadryl, Diphen, Diphenhist, Nytol
Drug Order: 500 mg/amp
Drug classification: Ethanolamine; antihistamine, anticholinergic, antitussive, antiemetic
Drug action: Antagonizes the effects of histamine at H1-receptor sites; does not bind to or inactivate histamine; Significant
CNS depressant and anticholinergic properties.
Indications for patient:
Decrease hypersensitivity to chemotherapeutic agents
Symptomatic relief of fever and pain
Contraindications:
Hypersensitivity
Acute attacks of asthma
Lactation
Known alcohol intolerance (some liquid product
Adverse effects:
CNS: drowsiness, dizziness, headache, paradoxical excitation (increased in children).
EENT: blurred vision, tinnitus.
CV: hypotension, palpitations
GI: anorexia, dry mouth, constipation, diarrhea.
GU: dysuria, frequency, urinary retention.
Derm: photosensitivity.

 Local: pain at IM site.

Nursing Responsibilities:
Cough Suppressant: Assess frequency and nature of cough, lung sounds, and amount and type of sputum
produced. Unless contraindicated, maintain fluid intake of 15002000 ml daily to decrease viscosity of bronchial
secretions.
Pruritus: Assess degree of itching, skin rash, and inflammation.
Prevention and Treatment of Anaphylaxis: Assess for urticaria and for patency of airway.
Allergic Rhinitis: Assess degree of nasal stuffiness, rhinorrhea, and sneezing.
Monitor BP, especially in elderly (increased risk of hypotension)

Name of Student: Monica Carla C. Mamuric

Name of Client: Herman Lee
Age: 66 y/o
Sex: Male Civil Status: M Bed: B4
Medical Diagnosis: Laryngeal subglottic carcinoma s/p laryngectomy, recurrent liver metastases
Docetaxel
FUNC. CLASS: Anti-neoplastic
CHEM CLASS: Antimicrotubule
stool; Renal clearance is relatively low at about 10%
USE: Breast, Non-small cell lung, Prostate, Gastric Cancer, Suamous cell carcinoma of the head and neck
Off-label uses: Ovarian, Pancreatic, Head and Neck, Esophagus, Sarcoma, Uterine, Bladder
Indication for Patient:
Head and Neck Cancer (Laryngeal cancer)
Contraindications: Hypersensitivity; Hypersensitivity to polysorbate 80; Known alcohol intolerance; Neutrophil count <1500/mm3; Liver impairment (serum bilirubin
>upper limit of normal, ALT and/or AST >1.5 times upper limit of normal, with alkaline phosphatase >2.5 times upper limit
of normal); pregnancy, lactation
ROUTE OF ADMIN: Intravenous infusion ONLY, over 60 minutes
PRETREATMENT GUIDELINES: CBC and baseline liver fcn; DO NOT ADMIN if total bilirubin >=ULN or AST/ALT >1.5
times ULN, and alkaline phosphate >2.5 times ULN
SIDE EFFECTS: Irritant, potential vesicant, fatigue, myelosuppresion, hypersensitivity reaction, fluid retention
syndrome, rash, nail changes, alopecia, mucositis, peripheral neuropathy, hyperlacrimation 2o to ductal stenosis, which
can be treated with stent placement. Pt needs referral to Optha
STORAGE: Unreconstituted vials: unopened vials require protection from bright light; may be stored at room temp or
refrigerated

MIXING INSTRUCTIONS: Allow refrigerated vials to stand at least 5 minutes at room temperature before reconstitution,
Vials are available as 80-mg or 20-mg concentrate as single dose blister packs with diluents; do not reuse single dose
vials. Once diluent added to concentrate, resulting concentration is 10 mg/ml-must be further diluted. Gently invert
repeatedly. Do not shake initial diluted solution. Withdraw ordered dose and further dilute in appropriate volume of 5%
dextrose or 0.9%NaCl to final concentration of 0.3-0.74 mg/ml. Thoroughly mix by manual rotation.
PRODUCT STABILITY: Reconstituted solution is good for 8 hour at room temperature or refrigerated.
COMPATABILITY WITH OTHER DRUGS/IV FLUIDS: Compat with 5%dextrose or 0.9%NaCl
DRUG INTERXNS: Radiosensitizing effect; CYP3A4 inhibitors such as ketoconazole, erythromycin, cyclosporine,
terfeneradine, nifedipine can inhibit docetaxel metabolism; CYP3A4 inducers such as phenytoin, carbamazepine,
Phenobarbital, and St. Johns Wort may decrease serum level of docetaxel. Infuse docetaxel prior to platinum compounds
to decrease toxicity.
NSG/SPECIAL CONSIDERATIONS:
Pts should receive steroid premedication to decrease the incidence and severity of hypersensitivity reactions and fluid
retention; Use only glass, polypropylene bottles, or polypropylene bags for drug admin;
Administer slowly with rapidly flowing IV due to vesicant potential;
Flush peripheral line before removal to reduce potential for leakage of drug into the skin;
Teach patient fatigue prevention strategies

Name of Student: Monica Carla C. Mamuric

Name of Client: Herman Lee
Age: 66 y/o
Sex: Male Civil Status: M Bed: B4
Medical Diagnosis: Laryngeal subglottic carcinoma s/p laryngectomy, recurrent liver metastases
Drug Name: 5-fluorouracil
Trade Name: Adrucil, Efudex, Fluoroplex, 5-FU
Drug Order:
Drug classification:
Drug action: Inhibits the formation of thymidine, which is necessary for DNA Synthesis; causes abnormal RNA synthesis;
Acts synergistically with methotrexate; Cell cycle phase specifi c for the S phase.
Indications for patient:
Head and neck cancer
Contraindications: allergy, pregnancy, lactation
Adverse effects:
Myelosuppression may be dose limiting, but less common withcontinuous infusion.
Mucositis is most common DLT with continuous infusions. Symptoms of erythema, soreness, and ulceration may begin
within 58 days of therapy. Sucking on ice chips as tolerated may decrease PO stomatitis, esopharyngitis
Diarrhea can be severe, even life- threatening, especially when 5-FU is given in higher doses with leucovorin.
Nausea, vomiting, and anorexia occur less frequently, butare more common when 5-FU is given simultaneously with
radiation to the abdomen.
Skin and nail bed changes occur, especially with continuous infusion. Partial nail loss can occur as well as banding.
Palmarplantar erythrodysesthesias can be severe, necessitating dose reduction and treatment delays. Hyperpigmentation
and photosensitivity are common. Patients are cautioned to protect themselves from the sun.
Excessive lacrimation due to tear duct stenosis and blurred vision occur in about 25% of patients.
Headache, cerebellar ataxia, nystagmus, and confusion occur with higher doses.
Administering 5-FU based on the patients circadian rhythm may lessen toxicity in general.

 Alopecia is dose dependent.

Ataxia occurs in elderly patients. Other CNS changes include headache, drowsiness, and blurred vision
Drug-drug: irinotecan, bone marrow depressants- dec antibody response to live-virus vaccines
Y-Site Compatibility: allopurinol, amifostine, aztreonam, bleomycin, cefepime, cisplatin, cyclophosphamide, doxorubicin,
doxorubicin liposome, etoposide, fludarabine, furosemide, gemcitabine, granisetron, heparin, hydrocortisone, leucovorin,
linezolid, mannitol, melphalan, methotrexate, metoclopramide, mitomycin, paclitaxel, pemetrexed, piperacillin/tazobactam,
potassium chloride, propofol, sargramostim, teniposide, thiotepa, vinblastine, vincristine, vitamin B complex with C.
Y-Site Incompatibility: aldesleukin, amphotericin B cholesteryl sulfate complex droperidol, filgrastim, lansoprazole,
topotecan, vinorelbine.
Additive Compatibility: bleomycin, cyclophosphamide, D5/LR, etoposide, floxuridine, ifosfamide, methotrexate,
mitoxantrone, vincristine.
Additive Incompatibility: carboplatin, cisplatin, cytarabine, diazepam, doxorubicin, epirubicin, fentanyl, leucovorin,
metoclopramide, morphine.
Nursing Responsibilities:
Monitor VS
Assess for bleeding, vomiting, consistency of stools
Assess IV sites for inflammation or infiltration
Assess skin for palmar-plantar erythrodysthesia (tingling of hands and feet followed by pain erythema and
swelling
Monitor I and O. Adjust diet.
May cause decreased plasma albumin
Administration precautions: may be given a variety of ways: IV as a continuous infusion, IV push, arterial
infusion, intracavitary, or intraperitoneally.
Store at room temperature and protect from light.

Name of Student: Monica Carla C. Mamuric

Drug Name: Dexamethasone (DexPak)
Drug classification: Long-acting corticosteroids
Drug action: anti-inflammatory, suppress adrenal function
Indications for patient:

Adjunctive mgt of nausea and vomiting from chemotherapy

Mgt of cerebral edema

Anti-inflammatory

Prevent resp distress syndrome in the newborn

Airway edema prior to extubation

Contraindications:

Active untreated infection

Lactation

Known alcohol, bisuflite or tartrazine hypersensitivity or intolerance

Admin of live virus vaccines

Use cautiously in:

Chronic treatment

Hypothyroidism

Cirrhosis

Children

Stress

Pregnancy

Neonates
Adverse effects:

CNS: Depression, Euphoria, Headache, Inc ICP, personality changes, psychoses, restlessness| EENT: Cataracts, Inc
intraocular pressure CV: Hypertension
GI: Peptic ulceration, anorexia, nausea, vomiting| Derm: acne, dec wound healing, fragility, ecchymoses, fragility,
hirsutism, petechiae Endo: Adrenal suppression, hyperglycemia| F&E: Fluid retention, hypokalemia, hypokalemic
alkalosis| Hemat: Thromboembolism, thrombophlebitis| Metab: Weight gain| MS: Muscle wasting, osteoporosis, aseptic
necrosis of joints, muscle pain| Misc: Cushingoid appearance, inc susceptibility to infection
Drug-Drug interactions: Hypokalemia with thiazide and loop diuretics or amphotericin B, inc risk of digoxin toxicity |Inc
req for insulin or oral hypoglycemic agent |Phenytoin, Phenobarbital and rifampin inc metabolism,|Hormonal
contraceptives dec metabolism|Inc GI effects with NSAIDS|dec antibody response and inc risk of adverse rxns from live
virus vaccines inc conc of cyclosporine and tacrolimus|inc risk of tendon rupture from fluoroquinolones|antacids dec
absorption|dec isoniazid levels and effectiveness|
Nursing Responsibilities:

Assess involved systems

Assess for adrenal insufficiency (hypotension, weight loss, weakness, anusea, vomiting, anorecia, lethary,
confusion, restlessness)

Monitor I/O and daily weight; observe for peripheral edema, wt gain, rales/crackles, dyspnea

Children should have periodic evaluations of growth

Assess for LOC and headache

Monitor serum electrolytes and glucose

Lab test;may increase hyperglycemia, hyoppkalemia, may increase sodium conc

Direct IV: Diluent: May be given undiluted | Conc: 4-10 mg/ml | Rate: Administer over 1-4 min if dose is <10mg|
Intermittent infusion: Diluent: High-dose therapy should be added to D5W or 0.9NaCl, solution clear and colorless to
light yellow | Storage: Use diluted solution w/in 24 hr|Conc: Up to 10mg/ml|Rate: Infuse over 15-30 min
Syringe compatibility: granisitron, metoclopramide, palonosetron, ranitidine, sufentanil

Syringe incompatibility: doxapram, glycopyrrolate, pantoprazole

Y-site compatibility: acyclovir, allopurinol, amifostine, amikacin, amphotericin B cholesteryl, amsacrine,
aztreonam, bivalirudin, cefepime, cisatracurium, cisplatin, cladribine, cyclophosphamide, cytarabine,
dexmedetomidine,docetaxel, doxorubicin,
doxorubicin liposome, etoposide phosphate, famotidine, fentanyl, filgrastim, fluconazole,fludarabine, foscarnet, gallium
nitrate, gatifloxacin, gemcitabine, granisetron, heparin,hydromorphone, lansoprazole, levofloxacin,
linezolid, lorazepam, melphalan, meperidine,meropenem, methadone,milrinone,
morphine, ondansetron, oxaliplatin, paclitaxel, pemetrexed, piperacillin/tazobactam, potassium, propofol, remifentanil,
sargramostim, sodium bicarbonate, sufentanil, tacrolimus, teniposide, theophylline, thiotepa, vinorelbine, vitamin B
complex with C, zidovudine
Y-Site Incompatibility: ciprofloxacin, fenoldopam, idarubicin, midazolam, topotecan
Additive compatibility: aminophylline, vleomycin, cimetidine, floxacillin, furosemide, granisetron, lidocaine, meropenem,
nafcillin, palonosetron, ranitidine
Additive incompatibility: daunorubicin, metaraminol, vancomycin

Name of Student: Monica Carla C. Mamuric

Drug Name: Metoclopramide
Trade Name: Apo-Metoclop, Maxolon, Metozolv, ODT, Nu-Metoclopramide,
Octamide PFS, Reglan
Drug Order:
Drug classification: Anti-emetic, dopaminergic blocker, GI stimulant
Drug action: Stimulates motility of upper GI tract without stimulating gastric, biliary, or pancreatic secretions; appear to
sensitize tissues to action of acetylcholine; relaxes pyloric sphincter, which, when combined with effects of motility,
accelerates gastric emptying and intestinal transit; increases lower esophageal sphincter pressure; has sedative
properties; induces release of prolactin
Indications for patient:
Symptomatic gastroesophageal reflux
Parenteral: prevention of n/v assoc. w/ emetogenic cancer chemotherapy
Contraindications:
Allergy
Mech. Obstruction or perforation
Gi hemorrhage
Pheochromocytoma
Adverse effects:
CNS: Restlessness, drowsiness, fatigue, lassitude, extrapyramidal reaction
CV: transient hypertension
GI: nausea, diarrhea
Desired Action:
The client will be able to prevent or relieve emesis.

Nursing Responsibilities:
Use cautiously w/ previously detected breast cancer, lactation, pregnancy, fluid overload, renal impairment
Do not mix chloramphenicol, sodium bicarbonate, cisplatin and erythromycin
Drug to drug: dec. absorption of digoxin; inc. tocxicity and immunosuppressive effects woth cyclosporine;
inc.neuromuscular blocking effects w/ succinylcholine
Monitor BP carefully during IV administration; VS
Monitor for extrapyramidal reactions
Arrange for alteration in insulin dose and timing
Have phentolamine readily available in case of hypertensive crisis (for pheochromocytoma)
Instruct pt not to use alcohol, sleep remedies and sedatives - serious sedation

Name of Student: Monica Carla C. Mamuric

Name of Client: Herman Lee
Age: 66 y/o
Sex: Male Civil Status: M Bed: B4
Medical Diagnosis: Laryngeal subglottic carcinoma s/p laryngectomy, recurrent liver metastases
Drug: Ondansetron
Dosage:
Route:
Frequency:
Drug Classification: gastrointestinal agent; antiemetic; serotonin 5-HT3-receptor antagonist
Pharmacologic action of drug: Selective serotonin (5-HT3) receptor antagonist. Serotonin receptors are located centrally in the
chemoreceptor trigger zone (CTZ) and peripherally on the vagal nerve terminals. Serotonin is released from the wall of the small
intestine and stimulates the vagal efferents through the serotonin receptors and initiates the vomiting reflex.
Therapeutic Effects: Prevents nausea and vomiting associated with cancer chemotherapy and anesthesia.
Indications:
Prevention of nausea and vomiting associated with initial and repeated courses of cancer chemotherapy, Contraindications:
Hypersensitivity to ondansetron.
Adverse Effects:
CNS: Dizziness and light-headedness, headache, sedation.
GI: Diarrhea, constipation, dry mouth, transient increases in liver aminotransferases and bilirubin.
Body as a Whole: Hypersensitivity reactions.
Interactions:
Drug: Rifampin may decrease ondansetron levels.
Administration:
PREPARE Direct: May be given undiluted. IV Infusion: Dilute a single does in 50 mL of D5W or NS. May be further diluted in
selected IV solution.

ADMINISTER Direct: Give over at least 30 sec, 25 min preferred. IV Infusion: Give over 15 min. When three separate doses are
administered, infuse each over 15 min.
INCOMPATIBILITIES Solution/additive: Meropenem. Y-site: Acyclovir, allopurinol, aminophylline, amphotericin B, ampicillin,
ampicillin/sulbactam, amsacrine, cefepime, cefoperazone, fluorouracil, furosemide, ganciclovir, lorazepam, meropenem,
methylprednisolone, piperacillin, sargramostim, sodium bicarbonate, TPN.
Nursing responsibilities:
Monitor fluid and electrolyte status. Diarrhea, which may cause fluid and electrolyte imbalance, is a potential adverse effect of
the drug.
Monitor cardiovascular status, especially in patients with a history of coronary artery disease. Rare cases of tachycardia and
angina have been reported.

Name of Student: Monica Carla C. Mamuric

Name of Client: Herman Lee
Age: 66 y/o
Sex: Male Civil Status: M Bed: B4
Medical Diagnosis: Laryngeal subglottic carcinoma s/p laryngectomy, recurrent liver metastases
Drug Name: Ranitidine
Trade Name: Zantac, Zantac 75
Drug Order:
Drug classification: antiulcer agents; histamine H2 antagonists
Drug action: Inhibits the action of histamine at the H2-receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion.
Indications for patient:
Prevent nausea and vomiting
Prophylaxis of hyperacidity from chemotherapeutic drugs
Contraindications:
Allergy
Alcohol intolerance
phenylketonuria
Use cautiously: renal impairment , acute porphyria, geriatric, alcholic, lactation, pregnancy
Adverse effects:
CNS: confusion, dizziness, drowsiness, hallucinations, headache. CV: ARRHYTHMIAS. GI: consti-pation, diarrhea, nausea. GU:
decreased sperm count Endo: gynecomastia. Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, anemia, neutropenia,
thrombocytopenia. Local: pain at IM site. Misc: hypersensivity reactions, vasculitis.
Drug-drug:
decreased absorption of atazanavir, delavirdine, ketoconazole, and itraconazole.
Administration: IV, IM (Adults): 50 mg q 68 hr. Continuous IV infusion6.25 mg/hr. Gastric hypersecretory conditions1
mg/kg/hr; may be increased by 0.5 mg/kg/hr (not to exceed 2.5 mg/kg/hr). 0.5 mg/kg/dose once daily.
Nursing Responsibilities:

Assess for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate.
Geri: Assess geriatric and debilitated patients routinely for confusion. Report promptly.
Lab Test Considerations: Monitor CBC with differential periodically during therapy.
Antagonize effects of pentagastrin and histamine during gastric acid secretion testing. Avoid administration for 24 hr
before the test.
May cause false-negative results in skin tests using allergenic extracts. Histamine H2 antag-onists should be
discontinued 24 hr before the test.
May cause increase in serum creatinine.
False positive results for urine protei