Pharm Final Exam

• Antineoplastics


  Drugs that treat cancer
• Mechanism of action for antineoplastic drugs


  1. Cell cycle specific

  2. Cell cycle nonspecific
• Cell cycle specific antineoplastics


  • Exert influence during a specific phase of the cell cycle
  • Most effective against rapidly growing cancer cells
  • Not effective in G0 phase (resting)
• Cell cycle specific antineoplastics


  • Antimetabolites
  • Alkylating agents
  • Vinca alkaloids
• Cell cycle nonspecific antineoplastics


  • Act during any phase of the cell cycle including G0 phase (dormant phase)
  • Most effective against proliferation cells
  • More toxic, High dose= leukemia
• Cell cycle nonspecific antineoplastics


  • Alkylating agents
  • Antitumor antibiotics
  • Hormones
• Combination therapy


  Using multiple anticancer agents to enhance tumoricidal activity, increase chances of hitting cancer cells in all phases of cell cycle, maximize cell death, decrease drug resistance, and increase cancer cell destruction
• Nursing interventions for patients receiving anticancer agents


  1. Dose based on body surface area

  2. Multiple independent checks prior to administration

  3. Hold chemotherapy for severe dehydration, fever, neutropenia, thrombocytopenia, or tumor complications
• Common side effects of antineoplastic drugs


  • Myelosuppression (decreased RBCs, WBCs, platelets)
  • GI disturbances (nausea, vomiting, constipation, diarrhea, anorexia, weight loss, stomatitis/ulcers, reflux)
  • Other (hair loss, fatigue, pain, skin changes, infection, weakness, dehydration, cardiac, pulmonary)
• Symptom management for side effects of antineoplastic drugs


  1. Pharmacologic interventions (antiemetics, proton pump inhibitors, antidiarrheals, laxatives, antibiotics)

  2. Nursing interventions (referral to specialist, monitor labs, monitor for bleeding/infection, monitor IV site)
• Biologic response modifiers (immunotherapies)


  Substances naturally produced by the body and those developed in the lab that kill cancer cells directly and indirectly by enhancing the immune system's ability to kill abnormal cells, changing cancer cells to act like healthy cells, inhibiting normal cells from changing into cancer cells, enhancing the body's ability to repair/replace damaged cells, and preventing cancer from metastasizing
• Epoetin


  Stimulates red blood cell production in the bone marrow
• Epoetin


  • Used for anemia due to chronic renal failure or cancer chemotherapy
  • Side effects include headache, fatigue, hypertension, thrombosis, myalgia, arthralgia
• Filgrastim


  Regulates production of neutrophils
• Filgrastim


  • Used for myelodysplastic syndrome, myelosuppressive cancer chemotherapy, severe aplastic anemia, severe neutropenia, bone marrow transplantation for cancer
  • Side effects include GI distress, anorexia, alopecia, skin rash, fever, fatigue, headache, dizziness, sore throat, flu-like symptoms
• Benign prostatic hyperplasia (BPH)


  Enlargement of the prostate gland due to tissue hyperplasia
• Treatments for BPH


  • Alpha-adrenergic antagonists
  • 5-Alpha-reductase inhibitors
  • Anticholinergics
  • Phosphodiesterase-5 inhibitors
• Alpha-adrenergic antagonists for BPH


  • Side effects include dizziness, headache, orthostatic hypotension, decreased libido, URI, priapism
  • Patient education: avoid hypotensive episodes, take at bedtime, take with food
• 1. Alpha-reductase inhibitors for BPH


  • Side effects include decreased libido, erectile dysfunction, gynecomastia, orthostatic hypotension
  • Patient education: women of childbearing age must not handle crushed or broken tablets, wear gloves when handling
• Phosphodiesterase-5 inhibitors for BPH


  • Side effects include headache, dyspepsia, nasal congestion, nasopharyngitis, rare side effects include blurred vision, photosensitivity, hearing loss, tinnitus, seizures, priapism, urinary tract symptoms
  • Patient education: do not drink grapefruit juice, do not take with nitrates
• Phosphodiesterase-5 inhibitors


  Facilitate erection by enhancing blood flow to the penis
• Uses of phosphodiesterase-5 inhibitors


  • Erectile dysfunction, thyroid dysfunction causing sexual dysfunction, inhibited sexual desire
• First generation (conventional) antipsychotics


  Strong blockade of dopamine in the CNS causing serious movement disorders (extrapyramidal symptoms)
• Second generation (atypical) antipsychotics


  Moderate blockage of dopamine in the CNS, much stronger blockage of receptors for serotonin, lower risk of extrapyramidal symptoms but higher risk of metabolic effects like weight gain, diabetes, and dyslipidemia
• First generation antipsychotic - Phenothiazine (piperazine sub-group): Fluphenazine


  • Blocks dopamine receptors in brain and controls psychotic symptoms
  • Side effects include sedation, dizziness, headache, blurred vision, seizures, cerebral edema, extrapyramidal symptoms, orthostatic hypotension, dysrhythmias, sexual dysfunction, urinary retention, dry mouth
  • Nursing considerations: given PO, IM, IV, liquid form may be preferred, MOUTH checks necessary, absorption faster with liquid, may cause pinkish-red urine, full effect in 3-6 weeks but observable response in 7-10 days, noncompliance is common
• First generation antipsychotic - Butyrophenone: Haloperidol

  • Alters the effect of dopamine on the CNS, treats psychoses, schizophrenia, ADHD, Tourette's
  • Contraindicated in narrow-angle glaucoma, CNS depression, severe hepatic/renal/cardiovascular disease, blood dyscrasias, Parkinson's
  • Side effects include extrapyramidal symptoms, parkinsonism, sedation, prolonged QT interval, orthostatic hypotension, weight gain, sexual dysfunction
  • Interactions: increased sedation with alcohol/CNS depressants/anticholinergics, decreased effects with phenobarbital/carbamazepine/caffeine
• Second generation antipsychotic: Clozapine


  • First atypical antipsychotic, used for severe schizophrenia unresponsive to traditional antipsychotics, treats negative and positive symptoms of schizophrenia
  • Side effects include sedation, tremors, blurred vision, dry mouth, constipation, tachycardia, orthostatic hypotension
  • Adverse effects include seizures, agranulocytosis (need to monitor WBC)
• Anxiolytics - Benzodiazepines


  Drugs that reduce anxiety
• Benzodiazepine withdrawal


  1. Gradually decrease dose over several days

  2. Withdrawal symptoms develop slowly in 2-10 days and may last several weeks

  3. Short-term use: tremor, agitation, nervousness, sweating, insomnia, anorexia

  4. Long-term use: paranoia, delirium, panic, hypertension, status epilepticus
• Tricyclic antidepressants (TCAs)


  Antidepressant drugs
• Tricyclic antidepressants


  • Side effects include orthostatic hypotension, sedation, seizures, sexual dysfunction, suicidal ideation, anticholinergic effects (tachycardia, urinary retention, constipation, dry mouth, blurred vision)
  • Adverse reactions: cardiotoxicity, life-threatening overdose due to anticholinergic and cholinergic blockade
  • Patient education: administration, monitoring for side effects
• Withdrawal


  Gradually decrease dose over several days
• Withdrawal symptoms from short term use


  • CNS: tremor, agitation, nervousness, sweating, insomnia
  • GI: anorexia
  • Other: muscle cramps
• Withdrawal from long term use

  • Paranoia, delirium, panic, hypertension, status epilepticus
• TCA's- Tricyclic Antidepressants


  Adverse effects: Cardiotoxicity, Overdose is life threatening
• TCA's


  • Orthostatic hypotension (block alpha-adrenergic receptors)
  • Sedation, seizures
  • Sexual dysfunction, suicidal ideation
  • Anticholinergic effects (tachycardia, urinary retention, constipation, dry mouth, and blurred vision)
• Patient Teaching for TCA's


  • Administration → start low and increase
  • Onset of therapeutic response is delayed regardless of dosage
  • Once daily dosing at bedtime
  • Caution in elderly
  • Gradually decreased to avoid withdrawal s/s
• SSRI-Selective Serotonin Reuptake Inhibitors


  • More commonly used to treat depression than TCAs due to fewer side effects
  • Do not cause hypotension, sedation, anticholinergic effects, or cardiotoxicity as do many of the TCAs
• SSRI Side Effects


  • CNS: HA, blurred vision, insomnia, nervousness
  • GI: dry mouth, N/V/D, anorexia
  • Other: sexual dysfunction
• SSRI Withdrawal syndrome


  Dizziness, HA, nausea, sensory disturbances, tremor, anxiety and dysphoria