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Interactions: antineoplastics: may increase potential for bone marrow suppression. Monitor
patient carefully
Nursing considerations:
Monitor fluid intake and output; daily urine output of at least 2L maintenance of neutral or
slightly alkaline urine are desirable
Periodically monitor CBC and hepatic and renal function, especially at start of therapy
Patient Teaching
Action: thought to inhibit prostaglandin synthesis, impeding, clyclooxygenase 2,to produce anti
inflammatory, analgesics, and anti-pyretic effects.
Nursing considerations
Patient teaching
Indications: severe or complicated bone or joint infection, severe respiratory tract infections,
severe skin or skin-structure infection
Action: Inhibits bacterial DNA synthesis, mainly by blocking DNA gyrase, bactericidal
May increase alkaline phosphatise, ALT, AST, bilirubin, BUN, creatinine, LDH, and GGT levels
May increase eosinophil count. May decrease WBC, neutrophil, and platelet counts
Nursing Considerations:
Avoid caffeine
Indication: hypokalemia
Nursing Consideration:
Drug is commonly used orally with potassium-wasting diuretics to maintain potassium levels
Patient Teaching
Take with or after meals with full glass of water or fruit juice to lessen GI distress
Vitamin B complex
Dosage: 1 tab OD
Nursing Responsibilities
Brand name: Plasil
Therapeutic class:anti-emetics
Pharmacologic class:
Dosage: 1 amp IV q8
Intravenous
Prophylaxis of chemotherapy-induced nausea and vomiting
Adult: For highly emetogenic drugs/regimens: Initially, 2 mg/kg by slow inj over at least 15 min,
30 min before chemotherapy. Repeat 2 hrly for 2 doses, then 3 hrly for 3 doses. For less
emetogenic drugs/regimens: 1 mg/kg may be used. Max duration: 5 days.
MOA: Metoclopramide blocks dopamine receptors and in higher doses, it also blocks serotonin
receptors in chemoreceptor trigger zone of the CNS. It enhances the response to acetylcholine
of tissue in upper GI tract causing enhanced motility and accelerated gastric emptying w/o
stimulating gastric, biliary, or pancreatic secretions. It also increases lower esophageal sphincter
tone.
Levodopa: levodopa and metoclopromide have opposite effectson dopamine receptors. Avoid
using together
Nursing Considerations
Monitor bowel sound
Monitor for fever, CNS symptoms, irregular pulse, cardiac arrhythmias, or abnormal BP
Monitor for involuntary movements of face, tongue, and extremities, which may indicate tardive
dyskinesia
Patient teaching
Heraclene forte
Appetite enhancer
Indications / Uses: used to help the body process protein; increase muscle mass and strength;
improve mental concentration; and to treat depression, anxiety, and panic attacks
MOA: Dibencozide increases the protein "efficiency coefficient" ie, the percentage of "bound
nitrogen" for protein build-up in the body compared to "ingested nitrogen" with food intake.
The initial sign of effectiveness is manifested by a marked increase in appetite.
Thus, dibencozide facilitates optimum utilization of dietary protein intake, contributes to the
formation and repair of body tissues and stimulates appetite.
Dibencozide is a form of vitamin B12. Vitamin B12 is important for producing new blood cells.
Chloramphenicol might decrease new blood cells. Taking chloramphenicol for a long time might
decrease the effects of dibencozide on new blood cells. But most people only take chloramphenicol
for a short time so this interaction isn't a big problem.
Epoetin
Epoetin 10,000 u SQ
Ther. Class.
antianemics
Pharm. Class.
hormones
erythropoiesis stimulating agents (ESA)
Indication:
This medication is used to treat anemia (low red blood cell count) in people with long-term
serious kidney disease (chronic kidney failure), receiving chemotherapy for some types of cancer. It
may also be used in anemic patients to reduce the need for blood transfusions before certain
planned surgeries that have a high risk of blood loss (usually given with an anticoagulant/"blood
thinner" medication such as warfarin to lower the risk of serious blood clots). Epoetin alfa works by
signaling the bone marrow to make more red blood cells. This medication is very similar to the
natural substance in your body (erythropoietin) that prevents anemia.
Side Effects
Headache, body aches, cough, or injection site irritation/pain may occur. If any of these effects last
or get worse, tell your doctor or pharmacist promptly.
Remember that your doctor has prescribed this medication because he or she has judged that the
benefit to you is greater than the risk of side effects. Many people using this medication do not have
serious side effects.
Rarely, this medication may suddenly stop working well after a period of time because your body
may make antibodies to it. A very serious anemia can result. Tell your doctor right away if symptoms
of anemia return (such as increased tiredness, low energy, pale skin color, shortness of breath).
Tell your doctor right away if you have any serious side effects, including: symptoms of heart
failure (such as shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight
gain).
Get medical help right away if you have any very serious side effects, including: seizures.
This medication may rarely cause serious (sometimes fatal) problems from blood clots (such
as heart attack, stroke, blood clots in the legs or lungs). Get medical help right away if you have:
shortness of breath/rapid breathing, chest/jaw/left arm pain, unusual sweating, confusion,
sudden dizziness/fainting, pain/swelling/warmth in the groin/calf, sudden/severe headaches,
trouble speaking, weakness on one side of the body, sudden vision changes, blood clots in
your hemodialysis vascular access site.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you
notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the
face/tongue/throat), severe dizziness, trouble breathing.
Precautions
Before using epoetin alfa, tell your doctor or pharmacist if you are allergic to it; or to epoetin alfa-
epbx; or to other drugs that cause more red blood cells to be made (such as darbepoetinalfa); or if
you have any other allergies. This product may contain inactive ingredients (such as benzyl alcohol,
polysorbate), which can cause allergic reactions or other problems. Talk to your pharmacist for more
details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: high
blood pressure, heart disease (such as heart failure, past heart attack/stroke), seizuredisorder,
severe anemia caused by antibodies to past erythropoietin-type treatment (pure red cell aplasia).
Nursing Responsibilities:
Monitor renal studies, urinalysis, protein, blood BUN, Creatinine, I/O, Assess CNS symptoms
Keep all lab appointments to have your red blood cell count/hemoglobin level tested regularly to
reduce the chance of this side effect.
MOA: Epoetin alfa is a man-made, injectable drug for treating anemia. Erythropoietin is a
protein that normally is made in the body by the kidney. It causes the bone marrow to produce
oxygen-carrying red blood cells. Under normal conditions, when the body senses a decrease in
red blood cells or a deficiency in the supply of oxygen, more erythropoietin is produced, and
this increases the number of red blood cells. When this natural mechanism is not working, it
may become necessary to stimulate the bone marrow to produce red blood cells. The
erythropoietin that is used for therapy, called epoetin alfa, is man-made. It is a product of the
genetic engineering of ovarian cells of the Chinese hamster and is produced through
recombinant DNA technology in bacteria. It does not cure the underlying cause of the anemia,
and unless the underlying cause can be reversed, treatment with epoetin alfa must be
continued indefinitely.
Kalium Durule
1 tab TID
Administration
Should be taken with food: Swallow whole w/ ½ glass of liqd, do not break/chew/crush. Do not
administer to a patient in a supine position.
electrolyte replenisher—
Nursing Responsibilities:
Instruct patient to report dark, tarry or bloody stools; weakness and unusual fatigue
Tergecef
Cefixime
Ther. Class.
anti-infectives
Pharm. Class.
third generation cephalosporins
Class: 3rd gen antibiotic cephalosporins
400mg 1 cap
Indications: For the treatment of the following infections due to susceptible microorganisms:
Acute bronchitis, acute exacerbations of chronic bronchitis, bronchiectasis with infection,
secondary infections in chronic respiratory tract diseases, pneumonia;
Administration
May be taken with or without food.
Contraindications
Hypersensitivity to cefixime or other cephalosporins, penicillins.
MOA:
Like all beta-lactam antibiotics, cefixime binds to specific penicillin-binding proteins (PBPs)
located inside the bacterial cell wall, causing the inhibition of the third and last stage of
bacterial cell wall synthesis. Cell lysis is then mediated by bacterial cell wall autolytic enzymes
such as autolysins; it is possible that cefixime interferes with an autolysin inhibitor.
Nursing Responsibilities
Aldazide
1 tab OD
Indications: edematous conditions and patients taking digitalis when other diuretics are
inadequate or inappropriate to maintain electrolyte balance
Drug Classification:
Diuretic
Mechanism of Action:
: competes with aldosterone for receptor sites in the distal
renalt u b u l e s , i n c r e a s i n g s o d i u m c h l o r i d e a n d w a t e r e xc r e ti o n w h i l e c o n s e r
v i n g potassium and hydrogen ions, may block the effect of aldosterone on arteriolar smooth
muscle as well
Special Precautions:
Acute or severe hepati c failure decompensated hepati c cirrhosis, pregnancy, lactation,
concominant administration of K supplements or other K sparing agents, SLE. Monitor fluid and
electrolytes
A d v e r s e r e a c ti o n :
G y n e c o m a s ti a , G I s y m p t o m s , l e t h a r g y , h e a d a c h e a n d thro
mbocytopenia, leukopenia, agranulocytosis, cutaneous eruptions,
pruritus,m e n t a l c o n f u s i o n , p a r e s t h e s i a , a c u t e p a n c r e a ti ti s , j a u n d i c e ,
o r t h o s t a ti c hypertension, muscle spasm, weakness, fever, ataxia
Contraindications:
Acute renal insufficiency, significant impairment of renal function,anuria, hyperkalemia
Nursing Responsibilities:
Educate patient to avoid hazardous activity such as driving until response todrug is known.
Take with meals or milk; avoid excessive ingestion of food high in potassium or use of salt
substitutes
Diuretic effect may be delayed 2-3 days and maximum hypertensive may bedelayed 2-3weeks;
monitor I and O ratios and daily weight, BP, serumelectrolytes (K, Na) and renal function
Doxofylline
Indication
Indicated for the treatment of chronic obstructive pulmonary disease (COPD), bronchial
asthma and pulmonary disease with spastic bronchial component.
Mechanism of action:
Adrenergic bronchodilators and phosphodiesterase inhibitors bothwork
by increasing intracellular level of cyclic-3’,5’- adenosine monophosphate(cAMP); adrenergics by
increasing production and phosphodiesterase inhibitors by decreasing breakdown. Increased
levels of cAMP produce
bronchodilation.C o r ti c o s t e r o i d s a c t b y d e c r e a s i n g a i r w a y i n fl a m m a ti o n . A n ti c
h o l i n e r g i c s (ipratropium) produce brondhodilati on by decreasing intracellular level
s of cyclic guanosine monophosphate (cGMP). Leukotriene receptor antagonists andmast cell
stabilizers decrease the release of substances that can contribute to bronchospasm.
Special Precaution:
Liver disease, CHF, chronic obstructive lung disease, concomitantinfections. Pregnancy.
Adverse Reaction:
Nausea, vomiting, epigastric pain, cephalalgia, irritability, insomnia,tachycardia, extrasystole,
tachypnea, hyperglycemia, albuminuria.
Nursing Responsibilities:
Assess lung sounds, pulse and blood pressure before administrati on and during
peak of medicati on. Not amount, color, and character of sputum produced.
Monitor pulmonary function tests before initiating therapy and periodically during therapy to
determine effectiveness of medication.
1 tab TID
Class: antiemetic
Indications
MOA: It works by blocking the action of a chemical messenger in the brain which causes the
feeling of nausea and vomiting, as well as increasing the movement or contractions of the
stomach and intestines, allowing food to move more easily through the stomach.
Contraindicated:
You have an allergy to Motilium, or any of the ingredients listed here;
You have a tumour of the pituitary gland called prolactinoma;
You have or have had liver disease;
An increase in stomach or bowel contractions, for example, if you have had bleeding, a
blockage or puncture in your gastrointestinal tract;
You have problems with your heart, including abnormal heartbeat;
Nursing responsibilities
Assess for nausea, vomiting, abdominal distention, and bowel sounds before and after
administration.
Monitor BP (sitting, standing, lying down) and pulse before and periodically during
therapy. May cause prolonged QT interval, tachycardia, and orthostatic hypotension,
especially in patients older than 60 yrs or taking >30 m g/day.
Monitor for symptoms related to hyperprolactinemia (menstrual abnormalities,
galactorrhea, sexual dysfunction).
Lab Test Considerations: May cause ↑ serum ALT, AST, and cholesterol.
Monitor serum prolactin prior to and periodically during therapy. May cause ↑ serum
prolactin levels.
Patient teaching
Instruct patient to take as directed. Advise patient to avoid grapefruit juice during
therapy.
Advise patient to notify health care professional if galactorrhea (excessive or
spontaneous flow of breast milk), gynecomastia (excessive development of male mammary
gland), menstrual irregularities (spotting or delayed periods), palpitations, irregular heart
beat (arrhythmia), dizziness, or fainting occur.
Advise female patient to notify health care professional if pregnancy is planned or
suspected or if breast feeding.
Febuxostat
40 mg 1 tab OD
Ther. Class.
antigout agents
Pharm. Class.
xanthine oxidase inhibitors
INDICATIONS:
Atenurix is a xanthine oxidase (XO) inhibitor indicated for the chronic management
ofhyperuricemia in patients with gout. Atenurix is not recommended for the treatment of
asymptomatichyperuricemia.
CONTRAINDICATIONS:
Coadministration with azathioprine, mercaptopurine, or theophylline.
ADVERSE EFFECTS:
Dizziness, Rash, Nausea, Abnormal LFTs, Arthralgia
NURSING RESPONSIBILITIES:
Instruct patients to contact health care provider if they experience chest pain, rash, shortness
ofbreath, or neurologic symptoms suggesting a stroke.
Levophed
Classification: Vasopressor
use with MAO inhibitors, methyldopa, doxapram or tricyclic antidepressantsmay result in severe
hypertension
Nursing Responsibilities