Symptom Control of Cancer Treatment
MEDICATIONS
ANTIEMETICSZOFRAN (Ondansetron)
Oral, IntravenousSide 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
chemotherapyGive oral dose, 8 mg. before chemo and then TID x
2days
ANTIEMETICSREGLAN (Metoclopramide)
IV, oralSide Effects: drowsiness, extrapyramidole
rxn, restlessness, dysrhythmias, anxietyNursing Implications:
Administer IV dose 30min. before administration of chemo
Oral: Administer 30 min before meals and at hs
ANTIEMETICSPROCHLORPERAZINE (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 doseProtect from light
AntidiarrhealLOMOTIL (diphenolylate/atropine)
Given PO tabs, liquidSide Effects: sedation, dizziness, dry mouth,
urinary retention, rashNursing Implications: Watch for physical
dependence; Know that it should work within 48 hrs.; give Naloxone as antidote for respiratory depression
NSAIDNAPROXYN, 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
AntidepressantAMITRIPTYLINE (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)
POSide Effects: drowsiness, headache, diarrhea,
respiratory depressionNursing Implications: Smoking decreases
effectiveness. This med decreases nausea esp. when given before and during chemotherapy
Treatment of and Symptom Control of HIV/AIDS
Medications
Medications - Treatment of and Symptom Control of HIV/AIDS
Antiretroviral Therapy (the “umbrella” of categories)
Includes: Nucleoside Reverse Transcriptase InhibitorsCombination MedicationsNonnucleoside Reverse Transcriptase
InhibitorsProtease Inhibitors
Medications - Treatment of and Symptom Control of HIV/AIDSCombination Therapy: now the “standard”
Combining medications makes it difficult for the virus to develop resistance to the drugsCan slow progression of the diseaseMedication “cocktails”: 2+ medications
combined and given together (usually prefer 3 or more medications together)
Medications: Nursing RoleTiming 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 yrsAnemia can be treated with blood transfusions or
EPOConsider treating neutropenia with CSF – eg.
Neutrogen
Nucleoside Reverse Transcriptase InhibitorsZIDOVUDINE cont.Side Effects:
Anemia, fever, malaise, headache, nausea, insomnia, myalgia, confusion, aggitation, seizures, hepatomegaly
Nucleoside Reverse Transcriptase InhibitorsStavudine (Zerit)
POComments: 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 InhibitorsAbacavir (Ziagen)
POComments: 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 InhibitorsABACAVIR cont.
Comments: (cont.) Avoid alcohol increased level of medication in the blood. No dietary restrictions
Side Effects: n/v, rash, headache, fatigue
Combination MedicationsTENOFOVIR (Viread)
POComments: 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 MedicationsOther examples of combination
medications:Combivir: zidovudine + lamivudineTrizivir: zidovudine+lamivudine+abacavirEpzicom: abacavir+lamivudine
Nonnucleoside Reverse Transcriptase InhibitorsNevirapine (Viramune)
POComments: 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 InhibitorsEfavirenz (Sustiva)
POComments: 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 InhibitorsRITONAVIR (Norvir)
POComments: 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 InhibitorsFOSAMPRENAVIR (Lexiva, FPV)
POComments: 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