Medication and Food Interactions

• Medications can interact with food, other drugs, and supplements, potentially leading to adverse effects or altered drug efficacy.

MAOI Food Interactions

• Monoamine oxidase inhibitors (MAOIs) have significant interactions with tyramine-rich foods.
• Tyramine-rich foods include smoked sausage, aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein supplements, soups, soy sauce, some beers, and red wine.

Warfarin Food Interactions

• Foods high in vitamin K should be avoided while taking warfarin due to their impact on blood clotting.
• These foods include collard greens, kale, spinach, and other dark green leafy vegetables.

Dairy and Medication Interactions

• Dairy products can delay the absorption of certain medications, bind to the drug, and decrease its effects.

Grapefruit Juice and Medication Interactions

• Grapefruit juice can decrease the metabolism of some drugs, leading to increased drug effects and potential toxicity.

Older Adults and Adverse Effects

• Older adults are more likely to experience adverse drug reactions due to slower metabolism and excretion processes.

Lisinopril

• An ACE inhibitor medication.
• Used for hypertension and congestive heart failure.
• Works by competitively inhibiting angiotensin-converting enzyme (ACE), which stops the production of angiotensin II.
• Contraindicated in pregnancy, hyperkalemia, and angioedema.
• Adverse effects include dizziness, fatigue, headache, persistent cough, and hypotension.
• NSAIDs (ibuprofen, aspirin, naproxen, diclofenac) can cause acute renal failure when combined with Lisinopril.
• Important interventions include oral administration, discontinuing medication if a dry cough develops, and regularly monitoring blood pressure.
• Assess BP, apical pulse, and respiratory status due to the risk of a dry, hacking cough and check serum potassium, sodium, and chloride levels as ordered.
• Monitor blood pressure, take with or without food, immediately report rash, cough, dysgeusia or infections, rising slowly from sitting, and avoid activities that require alertness.

Diuretics

• Loop diuretics such as furosemide, bumetanide, and torsemide.
• Thiazide diuretics such as hydrochlorothiazide, chlorothiazide, and methyclothiazide.
• Potassium-sparing diuretics such as spironolactone and amiloride.
• Osmotic diuretics such as mannitol.

Other Antihypertensives

• ACE inhibitors (-pril).
• ARBs (-sartan).
• Beta-blockers (-olol).
• Calcium channel blockers (-dipine).
• Co-administration can result in hypotensive effects and hyperkalemia.

Lithium

• Can result in lithium toxicity.

Metoprolol

• Selective beta-adrenergic blocker (beta-1), cardioselective.
• Metoprolol tartrate comes in an immediate-release form.
• Metoprolol succinate comes in an extended-release form.
• Used for angina, myocardial infarction, hypertension, dysrhythmias, and as an antianginal.
• Mechanism of action (MOA) is selective beta-1 antagonist.
• Contraindicated in systolic heart failure, bradycardia, or heart block, and should not be stopped abruptly; caution with asthma/COPD.
• Side effects include bradycardia, decreased cardiac output, bronchoconstriction, decreased renin from kidneys, masked hypoglycemia, fatigue, insomnia, weakness.
• Interacts with calcium channel blockers like verapamil and diltiazem.
• Monitor blood pressure, ECG, and pulse frequently and assess apical pulse
• If pulse is less than 90 and heart rate less than 60, hold medication and notify the provider; monitor ECG and blood pressure.
• Do not discontinue medication without consulting provider, avoid sudden changes in position, self-monitor blood pressure at home daily, taper medication, and note that it may mask signs of hypoglycemia.

Furosemide

• Loop diuretic and antihypertensive.
• Indicated for edema and hypertension.
• Works by blocking sodium reabsorption in the loop of Henle and distal renal tubule, leading to increased excretion of fluid, sodium, and potassium.
• Contraindicated in patients with sulfa allergy, hepatic coma, severe electrolyte loss, and hypersensitivity.
• Side effects include hypokalemia, exfoliative dermatitis, photosensitivity, aplastic anemia, and ototoxicity.
• Interacts with NSAIDs, digoxin, corticosteroids, lithium, antidiabetic drugs, vancomycin, and aminoglycosides
• Assess for hypovolemia and monitor blood glucose levels in diabetic patients, and electrolyte levels.
• If used for hypertension, self-monitor BP and weight by keeping a log at home; get up slowly to minimize postural hypotension; report weight loss, lightheadedness, GI distress, or general weakness; consume foods high in potassium; notify provider if any tinnitus occurs.

Ipratropium

• Anticholinergic bronchodilator, administered via inhalation as a short-acting medication.
• Indicated for asthma and COPD but not for acute symptoms.
• Causes bronchodilation by blocking cholinergic receptors in bronchial smooth muscle.
• Contraindicated in patients with allergies (atropine, peanuts, soy)
• Use with caution in patients with narrow-angle glaucoma or prostate enlargement.
• Adverse effects include dry mouth (hoarseness), urinary retention, pharyngitis, heart palpitations, and increased intraocular pressure.
• Possible drug interactions can occur if taken with other anticholinergic bronchodilators.
• Usual adult dose is two puffs, taken as prescribed, and the proper use of inhaled administration should be demonstrated to the patient using only the prescribed dose to avoid possible adverse effects.
• Health history should be assessed for heart palpitations, GI distress, benign prostatic hyperplasia and urinary retention, and glaucoma, and previous uses of multi dose inhalers should be assessed.
• After inhalation, rinse the mouth to decrease unpleasant taste, and with two inhalers, wait 5 minutes between administrations
• Sip fluids and suck on hard sugar-free candies to control dry mouth.

Albuterol

• Beta-2 agonist (short-acting).
• Indicated for asthma, COPD, and Bronchospasm.
• Acts as a bronchodilator
• Contraindicated in patients with allergies, uncontrolled hypertension, uncontrolled dysrhythmia, or high risk for stroke.
• Adverse effects include insomnia, restlessness, anorexia, hyperglycemia, vascular headache, tremor, and anginal pain.
• Non-selective beta-blockers, monoamine oxidase inhibitors, and other sympathomimetics should be avoided.
• Administer 2 puffs as the usual dose, and if using one MDI, wait 1-2 minutes between puffs. If using another inhaled drug wait 2-5 minutes
• A spacer device may be indicated to increase the amount of drug delivered.
• Assess for allergies and contraindications in patients with dysrhythmias and those at risk of stroke, and assess caffeine intake (coffee, tea, chocolate, candy, and sodas) and use of OTC medications.
• Do not exceed prescribed dose, observe for any impending indications of asthma, and maintain a log of the frequency and intensity of exacerbations
• Notify provider if there is an increase in the frequency and indication of asthma exacerbations.

Methylcellulose

• Bulk-forming laxative.
• Constipation, IBS, and diverticulosis are indications.
• The MOA increase water absorption and helps produce normal, formed stools, with few systemic effects.
• Contraindicated in patients with GI obstruction and hepatitis.
• Adverse effects include fluid disturbances, electrolyte imbalance, gas, and allergy.

Pantoprazole

• Proton pump inhibitor, available in IV and PO forms.
• Indicated for GERD, heartburn, and Zollinger-Ellison Syndrome.
• Inhibits gastric parietal cell hydrogen - potassium ATPase, decreasing gastric acid secretion.
• Contraindicated in patients with allergies
• Adverse effects include osteoporosis (bone fractures), GI tract infections, and Hypomagnesemia.
• Interacts with diazepam, phenytoin, warfarin, digoxin, and ampicillin.
• Given orally without crushing or splitting tablet, and IV dosage must be ordered with correct dilutional fluids, infused over recommended time periods.
• Assess swallowing capacity because of oral capsules size, patients history with an emphasis on any history of GI tract infections due to decreased acid medicated antimicrobial protection.
• Educate and report diarrhea, abdominal pain, and bloody stools.

Clarithromycin

• Macrolide antibiotic.
• Indicated for H. pylori infections.
• Works by inhibiting protein synthesis.
• Contraindicated in patients with documented drug allergies.
• Adverse effects include nausea, vomiting, ototoxicity, and QT prolongation.
• Interacts with (moxifloxacin, pimozide, thioridazine), Theophylline, warfarin, and digoxin.
• Macrolides should not be taken before or after fruit juices, OTC drugs, herbal products, and dietary supplements should not be combined
• Immediately report if there is any report of chest pain, palpitations, dizziness, jaundice, rash, and hearing loss.
• Must assess cardiac function and vital signs of palpitations, chest pain, and ECG changes, along with history of liver disease.

Tobramycin

• Aminoglycoside.
• Indicated for Pseudomonas bacterial infections of the eyes.
• Works by inhibiting protein synthesis.
• Contraindicated in patients who are hypersensitive to aminoglycoside antibiotics or during pregnancy.
• Adverse effects include nephrotoxicity and ototoxicity.
• It interacts with vancomycin, cyclosporine, amphotericin B.
• The concurrent use of loop diuretics increases the risk of ototoxicity in patients on warfarin.
• Give as ordered, and ensure adequate hydration (up to 3000 ml/day unless contraindicated).
• Any changes in hearing or ringing for the provider to be notified for next steps.

Tobramycin Assessments

• Assess for hypersensitivity, preexisting health conditions, and neurologic and renal function and health history.
• Known to have nephrotoxicity and ototoxicity therefore assess hearing and monitor creatinine, BUN, urinalysis, peak and trough blood levels.
• If tinnitus or hearing loss or headaches occur, nausea, vertigo, notify the provider or client has superinfection.

Phentolamine

• Nonselective alpha-adrenergic antagonist (alpha adrenergic blocker)
• Indicated for hypertension and extravasation
• Works by reversible alpha receptor antagonist short acting
• Contraindicated in patients with allergies, peripheral vascular disease (PVD), coronary artery disease (CAD), peptic ulcer, sepsis
• Adverse effects include first dose phenomenon, orthostatic hypotension, headache, constipation, and dizziness
• Beta blockers, alcohol, erectile dysfunction drugs, and epinephrine can result in interactions.
• Educate the client on slowly changing positions, monitoring blood pressure regularly, assessing their apical pulse, monitor for allergies, monitor blood pressure.

Cholinergic Blockers

• Cholinergic blockers natural plant alkaloids such as atropine, belladonna, hyoscyamine, and scopolamine.
• Cholinergic blockers synthetic and semisynthetic drugs such as benztropine, biperiden, darifenacin, dicyclomine, fesoterodine, glycopyrrolate, homatropine, ipratropium, mepenzolate, methscopolomine, oxybutynin, procyclidine, propantheline, solifenacin, tolterodine, trihexyphenidyl, and trospium.
• Blocks or inhibits acetylcholine
• Indicated for decreasing muscle rigidity and muscle tremors (Parkinson's disease), IBS, and incontinence
• Contraindicated in patients with allergies and medical conditions such as angle-closure glaucoma, acute asthma, myasthenia gravis, and GI or GU obstruction
• Side effects include dysrhythmias, irritability, hallucinations, ataxia, dilated pupils, dry mouth, and decreased sweating
• Check compatibility of drugs given together for patient safety, if given ophthalmic check concentration of drug and apply light pressure with a tissue to the inner canthus of the eye 30-60 seconds reduce systemic absorption of drug.
• Amantadine, antihistamines, tricyclic antidepressants, and digoxin are possible interactions.
• Use cautiously when exercising due to reduced sweating avoid during while sedated or blurred vision occurs
• Encourage to stay in shaded cool areas when warm, stay hydrated, wear hats and clothing that protects from sun, no excessive heat, wear dark tinted glasses or sunglasses to protect from light.

Clozapine

• Atypical antipsychotic (-pine).
• Indicated for treatment-resistant schizophrenia.
• MOA blocks dopamine receptors.
• Contraindicated for allergies, significant CNS depression, brain damage, liver or kidney disease, blood dyscrasias, and uncontrolled epilepsy.
• Can result in neutropenia, agranulocytosis, hemolytic anemia, neuroleptic malignant syndrome, Extrapyramidal symptoms (EPS), and tardive dyskinesia.
• Extrapyramidal symptoms include restlessness, involuntary movements, and muscular tensions produced by antipsychotic medications
• Tardive dyskinesia includes involuntary movements of the facial muscles, tongue, and limbs.
• Alcohol, other CNS depressants, and antihypertensives can interact with clozapine.
• Encourage client to take as prescribed for effectiveness
• Different levels of paranoia or delusions may lead to the patient to mistrust you and all members of care team.
• Assess all body systems, suicidal ideation, BP, extrapyramidal symptoms, history and mental status before initiating.

Acetaminophen

• Analgesic and antipyretic
• Indicated for mild to moderate pain and fever.
• MOA is a COX inhibitor (reversible)
• Allergies, hypersensitivity, liver disease, major burns, allergy, and G6PD deficiency are all contraindications.
• Side effects include rash, fever, chest pain, liver toxicity and failure, and bone marrow suppression.
• Acetylcysteine functions as the antidote for acetaminophen
• Warfarin, heparin, alcohol, phenytoin, barbiturates, isoniazid, rifampin, beta blockers, and anti-cholinergic drugs can result in possible interactions.
• Manage with mild pain less than 3 with acetaminophen, assess pain, fever, allergies, other drugs.

Salicylate Toxicity

• Usually from aspirin.
• Tinnitus is a common symptom in adults.
• Causes tachycardia, headache, confusion, nausea, vomiting, sweating, and hyperventilation
• Can cause metabolic acidosis and dimness of vision in children.

Salicylate

• Sodium bicarbonate is the antidote.
• Common adverse effects include tinnitus, GI bleeding, GI upset, and rash.
• Salicylate contraindications include pregnancy, peptic ulcer disease, and bleeding disorders.
• Should be avoided during/following febrile illness in children due to risk of Reyes syndrome.
• Inhibits prostaglandin synthesis, decreases inflammation and platelet aggregation through its MOA.
• Used for fever, pain, arthritis, thromboprevention, MI, and Kawasaki disease.
• Food, milk, or meals helps administer without crushing or breaking. Serum levels should be examined
• Assess duration, onset, location, and type of inflammation and/or pain the patient is experiencing monitor for tinnitus.
• Other NSAIDs can reduce NSAID absorption, additive GI toxicities.

Colchicine

• Treats acute gout.
• Decreases pain and inflammation.
• Binds and stabilizes tubulin to inhibit microtubule polymerization, impairing neutrophil chemotaxis and degranulation, and interfering with WBC functions to decrease inflammation as the MOA.
• Contraindicated with hypersensitivity to concurrent colchicine and the use of strong CYP3A 4/5 patients with renal or hepatic failure.
• Adverse effects include nausea, vomiting, abdominal pain, diarrhea, myopathy, neutropenia, aplastic anemia, alopecia (GI upset), and thrombocytopenia.
• Educate the client to not consume grapefruit juice.

Topical Anesthetics

• EMLA Ease pain of the needle puncture sight.
• Transdermal lidocaine patch offers pain relief in terms of postherpetic neuralgia.
• Used therapeutically in terms of postherpetic neuralgia, eye examinations, skin suturing, and numbing of the skin before injection.
• The MOA involves direct application to the skin and mucous membranes to relieve or prevent pain from being sensed and inhibits the conduction of nerve fibers which reduces pain or pruritus.
• Systemic absorption can lead to severe hypertension, cardiovascular and respiratory compromise and allergic reactions.
• Vascular disease, aneurysms, and hypertension can contraindicate the use of topical anesthetics.
• Vasoconstrictors can be used to confine the local anesthetics to the local area, systemic absorption can severely elevate patients BP.
• EMLA: needs to be applied to intact skin one hour before routine procedures or superficial puncture, and two hours before hand.
• Lidocaine/prilocaine (ELMA) lasts 1 hour and topical anesthetics for the eyes may last 30 seconds, avoid touching while numbing as it can result in eye damage, notify the provider if there is indications of systemic infusion.

Glaucoma Medications

• Intraocular Pressure normal level is between 10 - 21 mmHg.
• Pilocarpine is a direct-acting cholinergic agonist.
• Indicated for glaucoma with pupillary constriction effects, chronic open angle and angle closure glaucoma.
• Nonselective muscarinic is the MOA, and contraindications involve hypersensitivity, severe eye infection, detach retina, or chronic obstructive pulmonary disease (COPD).
• Adverse effects are blurred vision, night blindness, brow ache.

Apraclonidine

• Alpha 2 agonist direct acting (sympothemetics).
• Short term adjunctive therapy is the indication for treating glaucoma.
• The MOA results with reduced IOP from decreasing aqueous humor production and improving outflow.
• Allergies can be a contraindication.
• Burning, eye pain, lacrimation, and conjunctival hyperemia are adverse effects.

Dipivefrin

• Sympathomimetic drug indicated for chronic open-angle glaucoma.
• Nonselective adrenergic agonists result for MOA
• Burning, eye pain, lacrimation, and conjunctival hyperemia may result from use of Dipivefrin.

Betaxolol

• Beta 1 selective beta blocker indicated for open-angle glaucoma, immediate treatment of acute angle closure.
• MOA as as non-selective beta-blocker decreases aqueous humor and intraocular pressure.
• Contraindications include allergy, COPD, asthma, heart block, and any ocular condition.
• Side effects include discomfort, burning, photophobia, blepharitis, keratitis, and corneal sensitivity.

Timolol

• Beta blocker, antiglaucoma agent acts as both beta 1 and beta 2 receptor and is indicated for open-angle glaucoma and ocular hypertension.
• Contraindications include bronchospasms, COPD, asthma, heart failure, and bradycardia. Blurred version, pain, photophobia are reported adverse effects.
• Helps to lower both elevated and normal IOP by decreasing the aqueous humor involved.

Glycerin

• Osmotic diuretic used for acute glaucoma episodes.
• Acts as an osmotic dehydrating agent which pulls fluid from aqueous and vitreous humors into the bloodstream.
• Contraindicated in patients with anuria, acute pulmonary edema, cardiac decompensation, or severe dehydration.
• Common side effects include nausea, vomiting, headache, fluid and electrolyte imbalance, irritation, and thrombosis at the injection site.

Mannitol

• Osmotic diuretic used for acute cerebral edema, blood transfusion reactions, and glaucoma.
• Contraindicated in patients with acute pulmonary edema, severe pulmonary congestion, and hypovolemia.
• Adverse effects include edema, headache, nausea, vomiting, and fluid and electrolyte imbalance.
• Acts by reducing ocular hypertension by causing the blood to become hypertonic in relation to both intraocular and spinal fluids.

Latanoprost

• Prostaglandin agonist and antiglaucoma agent indicated for glaucoma.
• Increases outflow of aqueous humor and can be used daily.
• Allergy is considered a contraindication
• Adverse effects can include foreign body sensation, punctuate epithelial keratopathy, stinging, conjunctival hyperemia (bloodshot eyes), blurred vision, itching, and burning.
• Concurrent administration of other eye drops containing the perceptive thimerosal may result in precipitation or to administer 5 minutes apart.

Lispro

• Rapid-acting insulin (subcutaneously).
• 15 to 30 minutes for onset and must be administered 15 minutes before meal.
• Indicated for diabetes mellitus type 1 and 2.
• Allergy, hypoglycemia, is common contraindication.
• Adverse effects include hypoglycemia
• Corticosteroids, estrogen, diuretics, thyroid drugs, and nonselective beta blockers can cause interactions.
• Monitor assessment, injection site, and blood glucose level and should roll vial in-between hands, check serum glucose level, 90 degree angle.

Sildenafil

• PDE5 inhibitor (phosphodiesterase 5)
• Indicated for erectile dysfunction and pulmonary arterial hypertension
• Contraindications include medications in the nitrate family, grapefruit juice, and caution in clients with cardiovascular disease, including QT prolongation
• Increase blood flow to the corpus cavernosum, vasodilation of the pulmonary vasculature.
• Adverse effects include hypotension, priapism, flushing, prolonged erection, and MI
• Interactions involve with nitrates, May threat vital risk of hypotension.

Alendronate

• Bisphosphonate.
• Indicated for osteoporosis.
• MOA involves inhabitation of osteoclast medication bone resorption..
• Esophageal abnormalities, hypersensitivity, hypocalcemia, inability to sit or stand upright for at least 30 minutes; and increased risk for adverse esophageal effects, are contraindications.
• Monitor bone density.
• Adverse effects include headache, nausea, diarrhea, increased, or recurrent bone pain and esophageal erosion.
• Drug allergy, esophageal dysfunction, hypocalcemia, inability to sit or stand upright for at least 30 minutes after taking this medication.
• Take on an empty stomach in the morning for 6-8 oz of water stand upright for 30 minutes after taking, ensure adequate intake of calcium and vitamin D, perform weight bearing exercises.

Glargine

• Long-acting insulin (subcutaneously).
• Indicated for type 1 and 2 diabetes mellitus.
• Contraindications include allergy and hypoglycemia. -Adverse effects may include hypoglycemia when monitoring blood glucose level and injection site. -1-2 hour for onset and 4-8 hour for peak.

Glipizide

• Second-generation sulfonylurea and antidiabetic (PO) indicated for type 2 diabetes mellitus
• Stimulates insulin release and decreases glucose output from the liver.
• Contraindications include sulfa allergy
• Common side effects include hypoglycemia or weight gain.
• The onset is one hour and Peak around 1-3 hours assessment includes to measure glucose level, alcohol use, allergies. To be taken 30 minutes before a meal.

Vasopressin

• Antidiuretic hormone (IV) natural or synthetic ADH- pituitary drugs.
• Indications are prevention or control polydipsia, polyuria, and dehydration.
• Acts as an antidiuretic hormone, ADH, secreted by the posterior pituitary gland
• Contraindications include chronic nephritis, ischemic heart disease, and hypersensitivity
• Side effects include increased blood pressure, fever, vertigo, headache, nausea, heartburn, cramps, uterine cramping, nasal irritation and congestion, tremor, and sweating.
• Carbamazepine, fludrocortisone, demeclocycline, norepinephrine, and lithium

Levothyroxine

• A synthetic thyroid hormone.
• Indicated for hypothyroidism and thyroid-stimulating hormone suppression.
• Acts as a synthetic form of thyroid hormones.
• Contraindicated in patients who have acute myocardial infarction, thyrotoxicosis, adrenal insufficiency, and hyperthyroidism, and adverse effects may result, tremors, tachycardia, dysrhythmias, palpitations, hypertension, insomnia, anxiety, diarrhea, cramps, menstrual irregularities, weight loss, sweating, and heat intolerance.
• Assesse T3, T4, and TSH levels.
• Interactions include phenytoin, fosphenytoin, cholestyramine, antacids, calcium, salts, iron, estrogen, and warfarin.
• Take on empty stomach with a full glass of water before breakfast and requires lifelong treatment.

Hydrocortisone

• Corticosteroid (glucocorticoids).
• Indicated for adrenal insufficiency, anaphylaxis, asthma, and COPD.
• Works by synthetic steroid in structure identical to cortisol.
• Contraindicated in patients who have active infections and allergies.
• Depression, flushing, sweating, hypertension, nausea, diarrhea, hyperglycemia, mood changes, euphoria, blurred vision, and thrombocytopenia.
• Do not stop suddenly (must taper slowly), and adverse effects include adrenal suppression.

Prednisone

• Corticosteroid.
• Indicated for allergic states, dermatologic diseases, endocrine disorders, neoplastic diseases, hematologic disorders, neoplastic diseases, nervous system, renal diseases, respiratory diseases, and rheumatic disorders.
• Decreases production of inflammatory cytokines and adhesion proteins during MOA.
• Contraindicated for hypersensitivity to prednisone or other glucocorticosteroids, administration of live vaccines, and fungal infections.
• Adverse effects results include long term therapy may result in crushing syndrome.

Echinacea

• Immune stimulant.
• Indicated for upper respiratory tract infections.
• MOA stimulates the immune system.
• Contraindications include ragweed allergy, history of asthma, atopy, allergic rhinitis.
• GI effects, immunosuppressant drug interactions, allergic reactions are documented for side effects.

Ginko biloba

• Herbal supplement indicated for memory problems
• The MOA is antioxidant, vasoactive, antiapoptotic, anti-inflammatory, antiplatelet, and fibrinolytic properties, bleeding disorder, and surgery.
• Contraindications includes bleeding disorder and surgery.
• Interaction with anticoagulants (warfarin, heparin), antiplatelets (aspirin, clopidogrel).

Kava

• Depressant, herbal supplement used for stress and anxiety, the MOA alters the limbic system similar to benzodiazepams.
• Liver disease, alcoholism, and severe liver damage serve as severe side effects, alcohol, and barbiturates.

Flaxseed

• Herbal supplement.
• Indicated for chronic heart failure (CHF), hypertension, diabetes, and constipation.
• Contraindictiated of strictures or acute GI inflammation.and side effects include diarrhea, flatulence, and nausea.

Fluorouracil

• -Pyrimidine antagonists (antimetabolites)- used for palliative treatments of cancers of the colon, rectum, stomach, esophageal, head, neck, cervical, breast, renal, and pancreas. MOA is the inhibition of DNA and RNA synthesis.
• Hypersensitivity serves as a contraindication
• Bone marrow depression, nausea, vomiting, diarrhea, oral and GI ulceration, and anorexia result in side effects, and burning sensitivity, scaling, swelling, and tenderness can cause adverse effects that interact with warfarin.

Vincristine

• Mitotic inhibitor and vinca alkaloid for acute leukemia, Hodgkin disease, non-Hodgkin lymphoma, neuroblastoma, and Wilms tumor.
• Works by blocking microtubule polymerization and spindle formation
• Contraindications include pregnancy or lactation, radiation therapy, liver disease, neuromuscular disease, and hepatic impairment.

Methotrexate

• Folic acid analog, solid tumors such as breast, head and neck, and lung cancers, the management of acute lymphocytic leukemia and non Hodgkin's lymphomas, gestational choriocarcinoma acts to to stop cell reproduction needed for the synthesis of DNA by inhibiting folic acid conversion.
• Contraindications include renal and hepatic failure, blood dyscrasias, pregnancy or lactation. Adverse effects include infections, hepatotoxicity, bone marrow suppression, GI upset, and fetal death.
• Interactions include Salicylates, other NSAIDs, sulfonamides, penicillin, and tetracyclines.

Irinotecan

• Topoisomerase I inhibitor Indication includes metastatic colorectal cancer, small cell lung cancer,.
• MOA camptothecins inhibit proper DNA function in the S phase by binding to the DNA, resulting in severe diarrhea, moderate risk for nausea and vomiting.

Topotecan

• Topoisomerase 1 inhibitor for lung cancer, camptothecins inhibit improper DNA, resulting in bone marrow suppression, pregnancy
• Pregnant, lactating, and severe myelosuppression with a neutrophil (topotecan)

Asparaginase

• kills cancer by interrupting protein synthesis in leukemia cells indicated for asparaginase indications.
• hypersensitivity rxn & can occur for MOA
• Assess pancreatic function and abdominal pain/hyperglycemia of anaphylaxis, pregnant history of P and T

Cyclophosphamides

• Alkylating agents and indications are acute lymphomas and solid tumors
• Prevents from reproducing, resulting in Hemorrhagic cyclosis for MOA.and in contraindications such as height weight, baseline heairng

Doxorubicin

• Anthracyclines/aid relapsed Kaposis
• Binds altering, liver cardio toxicities, hypersensitivity/ toxicity

Imatinib - targetd Antineoplastic/ Leuinia action KEE, cml hepatic

• fatigue head ache rash etc

Tamoxifen - Hormone A, Est blockers STOPS, breast cancer

• Contradication, pregnancy - adverse effect hypertension, oedema weakness

Leuprolide - hormone; prostate/ prevent release/ prevents production

• rashes