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