Medel Notes - Chemotherapeutic Agents PDF

Medel Notes HES 005 Chemotherapeutic Agents Chemotherapeutic drugs are used to eliminate both invasive organisms (such as bacteria, viruses, parasites, protozoa, and fungi) and abnormal cells within the body (like ne...

Medel Notes HES 005 Chemotherapeutic Agents Chemotherapeutic drugs are used to eliminate both invasive organisms (such as bacteria, viruses, parasites, protozoa, and fungi) and abnormal cells within the body (like neoplasms and cancers). Purpose of Chemotherapeutic Drugs: Destroy organisms invading the body (e.g., bacteria, viruses, parasites, protozoa, fungi) Eliminate abnormal cells within the body (e.g., neoplasms, cancers) Mechanism of Action: Alter cellular function Disrupt cellular integrity, causing cell death Prevent cellular reproduction, leading to eventual cell death Selective Toxicity: Most chemotherapeutic agents do not have complete selective toxicity Affect normal cells to some extent Importance of Cellular Understanding: Comprehend the actions and adverse effects of chemotherapeutic agents Determine interventions to increase therapeutic effectiveness Understand the basic structure and function of cells Classifications: Anti-infective Agents Antibiotics Antiviral Agents Antifungal Agents Antiprotozoal Agents Anthelmintic Agents Antineoplastic Agents CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 1 of 54  Medel Notes HES 005 Introduction to Cell Physiology Learning Objectives Upon completion of this chapter, you will be able to: 1. Identify the parts of the human cell. 2. Describe the role of each organelle found within the cell cytoplasm. 3. Explain the unique properties of the cell membrane. 4. Describe three processes used by the cell to move things across the cell membrane. 5. Outline the cell cycle, including the activities going on within the cell in each phase. Parts of the Human Cell 1. Nucleus: Contains genetic material (DNA) and controls the production of proteins by the cell. 2. Cell Membrane: Separates the inside of the cell from the outside environment and regulates what enters and leaves the cell. 3. Cytoplasm: Contains various organelles important to cell function. Unique Properties of the Cell Membrane Fluid Barrier: Made of lipids and proteins; controls what enters and leaves the cell. Proteins: o Receptor Sites: Specific substances can bind here. o Histocompatibility Markers: Identify the cell as a self-cell. Channels/Pores: Facilitate the movement of specific substances needed for normal functioning. Organelles and Their Roles 1. Mitochondria: Rod-shaped organelles that produce energy in the form of ATP for use by cells. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 2 of 54  Medel Notes HES 005 2. Ribosomes: Sites of protein production within the cell cytoplasm. The specific proteins produced are determined by the genetic material within the nucleus. 3. Golgi Apparatus: Packages particular substances for removal from the cell (e.g., neurotransmitters, hormones). 4. Lysosomes: Packets of digestive enzymes located in the cytoplasm. These enzymes destroy injured or nonfunctioning parts of the cell and promote cellular disintegration when the cell dies. Processes for Moving Substances Across the Cell Membrane 1. Endocytosis: Moving substances into a cell by extending the cell membrane around the substance and engulfing it. o Pinocytosis: Engulfing necessary materials. o Phagocytosis: Engulfing and destroying bacteria or other proteins by white blood cells. 2. Exocytosis: Removing substances from a cell by moving them toward the cell membrane and then changing the cell membrane to allow passage out of the cell. Homeostasis and Transport Mechanisms Diffusion: Movement of solutes from high concentration to low concentration across a concentration gradient. Does not require energy. Osmosis: Movement of water from an area low in solutes to an area high in solutes. Exerts osmotic pressure against the cell membrane. Does not require energy. Active Transport: Movement of particular substances against a concentration gradient. Requires energy and is important for maintaining cell homeostasis. The Cell Cycle G0 Phase: Resting phase where the cell is not actively dividing. G1 Phase: Production of proteins for DNA synthesis. S Phase: Synthesis of DNA. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 3 of 54  Medel Notes HES 005 G2 Phase: Manufacture of materials needed for mitotic spindle production. M Phase: Mitotic phase where the cell splits to form two identical daughter cells. Relevance to Chemotherapeutic Drugs Chemotherapeutic drugs act on cells to cause cell death or alteration. Understanding the properties and functions of the cell helps in comprehending the actions and adverse effects of these drugs, and determining interventions that enhance therapeutic effectiveness. Anti-infective Agents Learning Objectives Upon completion of this chapter, you will be able to: 1. Explain what is meant by selective toxicity and discuss its importance in anti-infective therapies. 2. Differentiate between broad-spectrum and narrow-spectrum drugs. 3. Define resistance to anti-infectives and discuss the emergence of resistant strains. 4. Explain three ways to minimize resistance. 5. Describe three common adverse reactions associated with the use of anti-infectives. Introduction to Anti-infective Agents Anti-infective agents are drugs utilized to exert effects on invading foreign organisms in the body, especially those that can cause infection. The scientific investigation of anti-infectives began in the 1920s after Paul Ehrlich developed synthetic chemicals that would be effective only against certain proteins or enzyme systems used by infecting organisms and not by human cells. Mechanisms of Action The table below summarizes the mechanisms of action of commonly encountered anti-infectives: CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 4 of 54  Medel Notes HES 005 Anti-infective Mechanism of Action Interferes with the biosynthesis of the Penicillins pathogen cell wall. Sulfonamides, Inhibits the use of essential substances antimycobacterials, needed for growth or development. trimethoprim-sulfamethoxazole Interferes with steps involved in protein Aminoglycosides, macrolides, synthesis, thereby rendering cell division chloramphenicol non-functional. Interferes with DNA synthesis, leading to Fluoroquinolones an inability to divide and ultimately, cell death. Alters cell membrane permeability, leading Antifungals, antiprotozoals to leakage of essential cellular components and causing cell death. Therapeutic Action Goal of Therapy: Interference with the normal function of invading organisms to prevent reproduction and cause cell death. Narrow-Spectrum Anti-infectives: Effective against only a few microorganisms. Broad-Spectrum Anti-infectives: Interfere with biochemical reactions in many different kinds of microorganisms. Bactericidal Effects: Anti-infectives that cause cell death. Bacteriostatic Effects: Anti-infectives that interfere with the ability of cells to reproduce or divide. Resistance Over time, invading pathogens develop resistance to anti-infectives. Resistance is the ability of organisms to adapt to an anti-infective drug and produce cells that are no longer affected by that drug. Here are some ways microorganisms develop resistance: Enzyme Production: Bacteria produce enzymes (e.g., penicillinase) that inactivate drugs like penicillin. Cell Membrane Permeability Alteration: Prevents the drug from entering the cell. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 5 of 54  Medel Notes HES 005 Binding Site Alteration: Prevents the drug from being accepted into the cell. Chemical Production: Acts as an antagonist to the drug. Prevention of Resistance Nurses can facilitate the prevention of resistance through: 1. Drug Dosing: Collaborate with the physician for around-the-clock dosing to maintain a constant therapeutic level. 2. Drug Duration: Emphasize the importance of completing the full prescribed course of treatment. 3. Infection Control Measures: Implement strict infection control measures to prevent the spread of resistant organisms. Indications Across the Lifespan Children Caution: Early exposure can lead to early sensitivity. Antibiotic Use: Controversy exists regarding the use of antibiotics for pediatric ear infections, which may be viral. Monitoring: Increased susceptibility to GI and nervous system effects; monitor hydration and nutritional status. Adults Demand for Quick Cure: Adults often seek rapid relief, leading to overuse and resistance. Pregnancy and Nursing: Extra caution needed due to potential teratogenic effects and drug transfer into breast milk. Older Adults Atypical Presentation: May present with different symptoms than younger individuals. Culture and Sensitivity Tests: Important for determining infection type and extent. Monitoring: Increased susceptibility to severe GI, renal, and neurological effects; monitor nutritional status and hydration. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 6 of 54  Medel Notes HES 005 Adverse Effects Use of anti-infectives may result in these adverse effects: 1. Kidney Damage: Drugs like aminoglycosides can cause renal dysfunction or failure. Patients should be kept well-hydrated. 2. GI Toxicity: Many anti-infectives cause nausea, vomiting, stomach upset, and diarrhea. Some can cause hepatitis or liver failure. 3. Neurotoxicity: Some drugs can damage nerve tissue. For example, aminoglycosides can affect the 8th cranial nerve, causing dizziness and hearing loss; chloroquine can cause blindness by accumulating in the retina and optic nerve. 4. Hypersensitivity Reactions: Anti-infectives can induce allergic responses, either immediate or delayed. 5. Superinfections: Broad-spectrum anti-infectives can destroy normal flora, allowing opportunistic pathogens to invade tissues, leading to infections like those caused by Proteus and Pseudomonas. Key Points Selective Toxicity: Targeting specific proteins or enzymes in infecting organisms while minimizing harm to human cells. Broad-Spectrum vs. Narrow-Spectrum: Broad-spectrum affects many types of microorganisms; narrow-spectrum targets specific types. Resistance Prevention: Appropriate use, completing treatment courses, and infection control measures. Adverse Reactions: Kidney damage, GI toxicity, neurotoxicity, hypersensitivity, and superinfections. Antibiotics Learning Objectives Upon completion of this chapter, you will be able to: 1. Define antibiotics and their origins. 2. Describe the therapeutic actions, indications, pharmacokinetics, contraindications, cautions, common adverse reactions, and important drug–drug interactions of various classes of antibiotics. 3. Discuss the use of antibiotics across the lifespan. 4. Compare and contrast the prototype drugs from different classes of antibiotics. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 7 of 54  Medel Notes HES 005 5. Outline the nursing considerations, including important teaching points, for patients receiving antibiotics. Overview of Antibiotics Antibiotics are agents derived from living organisms, synthetic manufacturing, and genetic engineering used to inhibit specific bacteria. They can be bacteriostatic (inhibit bacterial growth) or bactericidal (kill bacteria). Major Classes of Antibiotics 1. Aminoglycosides: e.g., amikacin, gentamicin 2. Carbapenems: e.g., doripenem, ertapenem 3. Cephalosporins: Four generations with increasing spectrum of activity. 4. Fluoroquinolones: e.g., ciprofloxacin, levofloxacin 5. Penicillins and Penicillinase-Resistant Drugs: e.g., penicillin G, amoxicillin 6. Sulfonamides: e.g., sulfadiazine, cotrimoxazole 7. Tetracyclines: e.g., doxycycline, tetracycline 8. Antimycobacterials: e.g., rifampin, ethambutol 9. Other Antibiotics: e.g., ketolides, lincosamides, lipoglycopeptides, macrolides, monobactams Disease Spotlight: Bacteria and Antibiotics Bacteria are microorganisms that can invade the human body through various routes, including the respiratory tract, gastrointestinal tract, and skin. The immune response is triggered upon invasion, leading to inflammation, fever, and other symptoms. The goal of antibiotic therapy is to reduce the bacterial population to a level manageable by the immune system. Aminoglycosides Indications: Effective against gram-negative aerobic bacilli, including Pseudomonas aeruginosa, Escherichia coli, Proteus spp., Klebsiella- Enterobacter-Serratia group, Citrobacter spp., and Staphylococcus spp. Therapeutic Action: Bactericidal; inhibit protein synthesis by binding to bacterial ribosomes, causing misreading of the genetic code and cell death. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 8 of 54  Medel Notes HES 005 Pharmacokinetics: Route: IM, IV Onset: Rapid Peak: 30-90 min Duration: N/A Half-life (T1/2): 2-3 h Excretion: Kidney (urine) Contraindications: Allergy, renal/hepatic disease, preexisting hearing loss, active herpes or mycobacterial infections, myasthenia gravis, lactation. Adverse Effects: Ototoxicity, nephrotoxicity, CNS effects, bone marrow depression, GI effects, CV effects, hypersensitivity reactions. Interactions: Penicillins, cephalosporins, diuretics, anesthetics. Nursing Considerations Nursing Assessment: Assess for allergies, renal or hepatic disease, hearing loss, and active infections. Establish baseline hearing and renal function. Monitor for signs of ototoxicity and nephrotoxicity. Perform culture and sensitivity tests before starting therapy. Nursing Diagnoses: Risk for infection related to bone marrow suppression. Acute pain related to CNS effects. Deficient fluid volume related to diarrhea. Implementation: Administer the full course of antibiotics as prescribed. Monitor the infection site and signs and symptoms throughout therapy. Provide safety measures for CNS effects. Educate the patient on the importance of completing the therapy and potential side effects. Evaluation: Monitor patient response to therapy (decrease in infection symptoms). Monitor for adverse effects (ototoxicity, nephrotoxicity, CNS effects). CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 9 of 54  Medel Notes HES 005 Ensure patient understanding and compliance with therapy. Carbapenems Indications: Broad-spectrum antibiotic for serious infections such as intra- abdominal, urinary tract, skin, bone, joint, and gynecological infections. Therapeutic Action: Bactericidal; inhibit cell membrane synthesis. Pharmacokinetics: Route: IM, IV Onset: Rapid Peak: 30-120 min Duration: N/A Half-life (T1/2): 4 h Excretion: Kidney (urine); unchanged Contraindications: Allergy to carbapenems or beta-lactams, seizure disorders, meningitis, lactation. Adverse Effects: GI issues, CNS effects, superinfections. Interactions: Valproic acid, ganciclovir, probenecid. Nursing Considerations Nursing Assessment: Assess for allergies, seizure disorders, meningitis, and lactation status. Establish baseline renal and hepatic function. Monitor for GI and CNS adverse effects. Perform culture and sensitivity tests before starting therapy. Nursing Diagnoses: Risk for infection related to superinfections. Acute pain related to GI and CNS effects. Risk for imbalanced nutrition related to GI effects. Implementation: Administer the full course of antibiotics as prescribed. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 10 of 54  Medel Notes HES 005 Monitor for signs of GI and CNS adverse effects. Provide safety measures for CNS effects. Educate the patient on the importance of completing the therapy and potential side effects. Evaluation: Monitor patient response to therapy (decrease in infection symptoms). Monitor for adverse effects (GI, CNS, superinfections). Ensure patient understanding and compliance with therapy. Cephalosporins Indications: Treatment of infections caused by susceptible bacteria, including respiratory, skin, urinary tract infections, and otitis media. Therapeutic Action: Interfere with bacterial cell wall synthesis. Pharmacokinetics: Route: Oral, IM, IV Onset: N/A Peak: 30-60 min Duration: 8-10 h Half-life (T1/2): 30-60 min Excretion: Kidney (urine); unchanged Contraindications: Allergy to cephalosporins or penicillins, hepatic or renal impairment, pregnancy, and lactation. Adverse Effects: GI upset, CNS effects, nephrotoxicity, superinfections, local reactions at injection sites. Interactions: Aminoglycosides, oral anticoagulants, alcohol. Nursing Considerations Nursing Assessment: Assess for allergies, hepatic or renal impairment, pregnancy, and lactation status. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 11 of 54  Medel Notes HES 005 Establish baseline renal and hepatic function. Monitor for GI and CNS adverse effects. Perform culture and sensitivity tests before starting therapy. Nursing Diagnoses: Risk for infection related to superinfections. Acute pain related to GI and CNS effects. Risk for imbalanced nutrition related to GI effects. Implementation: Administer the full course of antibiotics as prescribed. Monitor for signs of GI and CNS adverse effects. Provide safety measures for CNS effects. Educate the patient on the importance of completing the therapy and potential side effects. Evaluation: Monitor patient response to therapy (decrease in infection symptoms). Monitor for adverse effects (GI, CNS, nephrotoxicity, superinfections). Ensure patient understanding and compliance with therapy. Fluoroquinolones Indications: Broad-spectrum activity against gram-negative bacteria, including respiratory, urinary tract, skin, and soft tissue infections. Therapeutic Action: Interfere with DNA synthesis. Pharmacokinetics: Route: Oral, IV Onset: Varies (oral), 10 min (IV) Peak: 60-90 min (oral), 30 min (IV) Duration: 4-5 h Half-life (T1/2): 3.5-4 h Excretion: Liver (bile), kidney (urine) CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 12 of 54  Medel Notes HES 005 Contraindications: Allergy, pregnancy, lactation, seizure disorders. Adverse Effects: GI and CNS effects, risk of tendinitis and tendon rupture, photosensitivity. Interactions: Antacids, quinidine, theophylline, steroids. Nursing Considerations Nursing Assessment: Assess for allergies, pregnancy, lactation, and seizure disorders. Establish baseline renal and hepatic function. Monitor for GI and CNS adverse effects. Perform culture and sensitivity tests before starting therapy. Nursing Diagnoses: Risk for infection related to superinfections. Acute pain related to GI and CNS effects. Risk for injury related to tendinitis and tendon rupture. Implementation: Administer the full course of antibiotics as prescribed. Monitor for signs of GI and CNS adverse effects. Provide safety measures for CNS effects and tendinitis. Educate the patient on the importance of completing the therapy and potential side effects, including photosensitivity precautions. Evaluation: Monitor patient response to therapy (decrease in infection symptoms). Monitor for adverse effects (GI, CNS, tendinitis, photosensitivity). Ensure patient understanding and compliance with therapy. Penicillins and Penicillinase-Resistant Antibiotics Indications: Treatment of infections caused by susceptible bacteria, including respiratory, skin, and urinary tract infections. Therapeutic Action: Interfere with bacterial cell wall synthesis. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 13 of 54  Medel Notes HES 005 Pharmacokinetics: Route: Oral, IM, IV Onset: Varies (oral), rapid (IM, IV) Peak: 1 h (oral), N/A (IM, IV) Duration: 6-8 h Half-life (T1/2): 1-1.4 h Excretion: Kidney (urine) Contraindications: Allergy to penicillins or cephalosporins, renal disease, pregnancy, and lactation. Adverse Effects: GI upset, hypersensitivity reactions, superinfections. Interactions: Tetracyclines, aminoglycosides. Nursing Considerations Nursing Assessment: Assess for allergies, renal disease, pregnancy, and lactation status. Establish baseline renal function. Monitor for GI and hypersensitivity reactions. Perform culture and sensitivity tests before starting therapy. Nursing Diagnoses: Risk for infection related to superinfections. Acute pain related to GI effects. Risk for allergic reaction. Implementation: Administer the full course of antibiotics as prescribed. Monitor for signs of GI and hypersensitivity reactions. Provide safety measures for hypersensitivity reactions. Educate the patient on the importance of completing the therapy and potential side effects. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 14 of 54  Medel Notes HES 005 Evaluation: Monitor patient response to therapy (decrease in infection symptoms). Monitor for adverse effects (GI, hypersensitivity reactions, superinfections). Ensure patient understanding and compliance with therapy. Sulfonamides Indications: Treatment of infections caused by susceptible bacteria, including UTIs and trachoma. Therapeutic Action: Inhibit folic acid synthesis. Pharmacokinetics: Route: Oral Onset: Rapid Peak: 1-4 h Duration: N/A Half-life (T1/2): 8-10 h Excretion: Kidney (urine) Contraindications: Allergy to sulfonamides, sulfonylureas, or thiazide diuretics; renal disease; pregnancy; lactation. Adverse Effects: GI upset, renal effects, CNS effects, bone marrow depression, dermatological reactions. Interactions: Tolbutamide, tolazamide, glyburide, glipizide, chlorpropamide, cyclosporine. Nursing Considerations Nursing Assessment: Assess for allergies, renal disease, pregnancy, and lactation status. Establish baseline renal function. Monitor for GI, renal, and CNS adverse effects. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 15 of 54  Medel Notes HES 005 Perform culture and sensitivity tests before starting therapy. Nursing Diagnoses: Risk for infection related to superinfections. Acute pain related to GI and CNS effects. Risk for fluid volume deficit related to renal effects. Implementation: Administer the full course of antibiotics as prescribed. Monitor for signs of GI, renal, and CNS adverse effects. Provide safety measures for renal and CNS effects. Educate the patient on the importance of completing the therapy and potential side effects. Evaluation: Monitor patient response to therapy (decrease in infection symptoms). Monitor for adverse effects (GI, renal, CNS, dermatological reactions). Ensure patient understanding and compliance with therapy. Tetracyclines Indications: Treatment of infections caused by susceptible bacteria, including respiratory, urinary tract, and skin infections. Therapeutic Action: Inhibit protein synthesis. Pharmacokinetics: Route: Oral, topical Onset: Varies (oral), minimal absorption (topical) Peak: 2-4 h (oral) Duration: N/A Half-life (T1/2): 6-12 h Excretion: Kidney (urine) Contraindications: Allergy to tetracyclines, pregnancy, lactation, children under 8 years old, renal or hepatic dysfunction. Adverse Effects: GI upset, skeletal effects, dermatological reactions, superinfections, hematologic effects. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 16 of 54  Medel Notes HES 005 Interactions: Penicillin G, oral contraceptives, digoxin, calcium salts, magnesium salts, zinc salts, aluminum salts, bismuth salts, iron, urinary alkalinizers, charcoal. Nursing Considerations Nursing Assessment: Assess for allergies, pregnancy, lactation, renal or hepatic dysfunction. Establish baseline renal and hepatic function. Monitor for GI, skeletal, and dermatological adverse effects. Perform culture and sensitivity tests before starting therapy. Nursing Diagnoses: Risk for infection related to superinfections. Acute pain related to GI effects. Risk for fluid volume deficit related to GI effects. Implementation: Administer the full course of antibiotics as prescribed. Monitor for signs of GI, skeletal, and dermatological adverse effects. Provide safety measures for dermatological reactions. Educate the patient on the importance of completing the therapy and potential side effects, including avoiding sun exposure. Evaluation: Monitor patient response to therapy (decrease in infection symptoms). Monitor for adverse effects (GI, skeletal, dermatological reactions, superinfections). Ensure patient understanding and compliance with therapy. Antimycobacterials Indications: Treatment of tuberculosis and leprosy. Therapeutic Action: Act on the DNA and/or RNA of mycobacteria. Pharmacokinetics: Route: Oral Onset: Varies Peak: 1-2 h Duration: 24 h CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 17 of 54  Medel Notes HES 005 Half-life (T1/2): 1-4 h Excretion: Kidney (urine) Contraindications: Allergy to antimycobacterials, pregnancy, severe CNS dysfunction, hepatic or renal dysfunction. Adverse Effects: CNS effects, GI upset, discoloration of body fluids, hepatotoxicity. Interactions: Rifampin and INH, rifampin and rifabutin with beta blockers, corticosteroids, OCPs, oral anticoagulants, methadone, phenytoin, verapamil, ketoconazole, and cyclosporine. Nursing Considerations Nursing Assessment: Assess for allergies, pregnancy, CNS dysfunction, hepatic or renal dysfunction. Establish baseline renal and hepatic function. Monitor for CNS and GI adverse effects. Perform culture and sensitivity tests before starting therapy. Nursing Diagnoses: Risk for infection related to superinfections. Acute pain related to CNS and GI effects. Risk for fluid volume deficit related to GI effects. Implementation: Administer the full course of antimycobacterials as prescribed. Monitor for signs of CNS and GI adverse effects. Provide safety measures for CNS effects. Educate the patient on the importance of completing the therapy and potential side effects, including discoloration of body fluids. Evaluation: Monitor patient response to therapy (decrease in infection symptoms). Monitor for adverse effects (CNS, GI, discoloration of body fluids, hepatotoxicity). Ensure patient understanding and compliance with therapy. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 18 of 54  Medel Notes HES 005 Other Antibiotics Indications: Treatment of various infections, depending on the antibiotic class (e.g., community-acquired pneumonia, severe infections, complicated skin infections). Therapeutic Action: Varies by antibiotic class (e.g., protein synthesis inhibition, cell wall synthesis inhibition). Pharmacokinetics: Route: Oral, IM, IV, topical Onset: Varies by route and antibiotic class Peak: Varies by route and antibiotic class Duration: Varies by route and antibiotic class Half-life (T1/2): Varies by antibiotic class Excretion: Varies by antibiotic class Contraindications: Varies by antibiotic class. Adverse Effects: GI upset, CNS effects, risk of superinfections, photosensitivity, specific class-related adverse reactions. Interactions: Varies by antibiotic class. Nursing Considerations Nursing Assessment: Assess for the mentioned cautions and contraindications (e.g., drug allergies, CNS depression, CV disorders, etc.) to prevent any untoward complications. Perform a thorough physical assessment (other medications taken, CNS, skin, respirations, and laboratory tests like renal functions tests and complete blood count or CBC) to establish baseline data before drug therapy begins, to determine effectiveness of therapy, and to evaluate for the occurrence of any adverse effects associated with drug therapy. Perform culture and sensitivity tests at the site of infection to ensure appropriate use of the drug. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 19 of 54  Medel Notes HES 005 Conduct orientation and reflex assessment, as well as auditory testing to evaluate any CNS effects of the drug (aminoglycosides). Nursing Diagnoses: Acute pain related to GI or CNS drug effects. Deficient fluid volume and imbalanced nutrition: less than body requirements related to diarrhea. Disturbed sensory perception (auditory) related to CNS drug effects. Risk for infection related to bone marrow suppression (aminoglycosides) and repeated injections (cephalosporins). Implementation with Rationale: Check culture and sensitivity reports to ensure that this is the drug of choice for this patient. Ensure that the patient receives the full course of antibiotics as prescribed, divided around the clock to increase effectiveness and decrease the risk for the development of resistant strains of bacteria. Monitor the infection site and presenting signs and symptoms throughout the course of drug therapy because failure of these manifestations to resolve may indicate the need to reculture the site. Provide safety measures to protect the patient if CNS effects (e.g., confusion, disorientation, numbness) occur. Educate the client on drug therapy to promote understanding and compliance. Provide the following patient teaching: safety precautions (e.g., changing positions, avoiding hazardous tasks, etc.), drinking lots of fluids, and maintaining nutrition even though nausea and vomiting may occur, report difficulty breathing, severe headache, fever, diarrhea, and signs of infection. Evaluation: Monitor patient response to therapy (decrease in signs and symptoms of infection). Monitor for adverse effects (e.g., orientation and affect, hearing changes, bone marrow suppression, renal toxicity, hepatic dysfunction, etc). CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 20 of 54  Medel Notes HES 005 Evaluate patient understanding of drug therapy by asking the patient to name the drug, its indication, and adverse effects to watch for. Monitor patient compliance with drug therapy. Antiviral Agents Learning Objectives 1. Discuss: Problems with treating viral infections and the use of antivirals across the lifespan. 2. Describe: Characteristics and clinical presentations of common viral infections. 3. Explain: Therapeutic actions, indications, pharmacokinetics, contraindications, common adverse reactions, and drug–drug interactions of antivirals. 4. Compare: Prototype drugs for each type of antiviral with others in the same group. 5. Outline: Nursing considerations for patients receiving each class of antiviral agent. Introduction to Antiviral Agents Antiviral drugs are used to treat infections caused by viruses. Unlike bacteria, viruses replicate within host cells, making treatment more challenging. Antiviral Drugs: Generic and Brand Names Influenza A and Respiratory Viruses Drugs Amantadine (Symmetrel) Oseltamivir (Tamiflu) Ribavirin (Rebetron, Virazole) Rimantadine (Flumadine) Zanamivir (Relenza) Herpes and Cytomegalovirus (CMV) Drugs Acyclovir (Zovirax) CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 21 of 54  Medel Notes HES 005 Cidofovir (Vistide) Famciclovir (Famvir) Foscarnet (Foscavir) Ganciclovir (Cytovene) Valacyclovir (Valtrex) Valganciclovir (Valcyte) Agents for HIV and AIDS Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs) Delavirdine (Rescriptor) Efavirenz (Sustiva) Etravirine (Intelence) Nevirapine (Viramune) Rilpivirine (Edurant) Nucleoside Reverse Transcriptase Inhibitors (NRTIs) Abacavir (Ziagen) Didanosine (Videx) Emtricitabine (Emtriva) Lamivudine (Epivir) Stavudine (Zerit XR) Tenofovir (Viread) Zidovudine (AZT, Retrovir, Aztec) Protease Inhibitors Atazanavir (Reyataz) Darunavir (Prezista) Fosamprenavir (Lexiva) Indinavir (Crixivan) Lopinavir (Kaletra) Nelfinavir (Viracept) Ritonavir (Norvir) Saquinavir (Fortovase) CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 22 of 54  Medel Notes HES 005 Tipranavir (Aptivus) Fusion Inhibitors Enfuvirtide (Fuzeon) CCR5 Coreceptor Antagonists Maraviroc (Selzentry) Integrase Inhibitors Raltegravir (Isentress) Anti-Hepatitis B Agents Adefovir (Hepsera) Entecavir (Baraclude) Telbivudine (Tyzeka) Anti-Hepatitis C Agents Boceprevir (Victrelis) Telaprevir (Incivek) Locally Active Antiviral Agents Docosanol (Abreva) Ganciclovir (Vitrasert) Imiquimod (Aldara) Penciclovir (Denavir) Trifluridine (Viroptic) Disease Spotlight: Viral Diseases Characteristics: Viruses are composed of DNA or RNA inside a protein coat and must enter a host cell to replicate. Challenge: Because viruses replicate inside host cells, it is difficult to target them without damaging the host cell. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 23 of 54  Medel Notes HES 005 Response: Some antiviral therapies are effective, including those for influenza A, herpes, CMV, HIV, hepatitis B and C, and viruses causing warts and eye infections. Agents for Influenza A and Respiratory Viruses Therapeutic Action These agents are believed to prevent the shedding of the viral protein coat and entry of the virus into the cell, preventing replication and causing viral death. Indications Treatment of respiratory flu in healthcare workers and high-risk individuals. Oseltamivir is effective for H1N1 and avian flu. Lifespan Considerations Children: Sensitive to antivirals; smaller doses are used. Adults: Education on not using antibiotics for viral infections. Pregnant Women: Generally avoided unless benefits outweigh risks. Older Adults: More susceptible to adverse effects, especially with hepatic and renal dysfunction. Pharmacokinetics Route: Oral Onset: Slow Peak: 6 hours Half-life: 25.4 hours Excretion: Kidney (urine) Contraindications and Cautions Renal Impairment: Alters metabolism and excretion. Pregnancy and Lactation: Use with caution. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 24 of 54  Medel Notes HES 005 Adverse Effects CNS: Light-headedness, dizziness, insomnia. CV: Orthostatic hypotension. GU: Urinary retention. Interactions Increased effects with anticholinergics and reduced effectiveness with antacids, acetaminophen, aspirin. Nursing Considerations 1. Assessment: Check for contraindications, perform thorough physical assessment. 2. Diagnoses: Acute pain, disturbed sensory perception. 3. Implementation: Administer promptly, ensure hydration, educate patients. 4. Evaluation: Monitor response, adverse effects, patient understanding, and compliance. Agents for Herpes and Cytomegaloviruses (CMV) Therapeutic Action Inhibit viral DNA replication by forming shorter, non-effective DNA chains. Indications Treatment of infections caused by herpes simplex, herpes zoster, and CMV. Pharmacokinetics Route: Oral, IV, Topical Onset: Varies (oral), Immediate (IV) Peak: 1-2 hours (oral), 1 hour (IV) CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 25 of 54  Medel Notes HES 005 Half-life: 2.5-5 hours Excretion: Kidney (urine) Contraindications and Cautions Allergy: Prevent hypersensitivity reactions. Renal Impairment: Alter drug excretion. Pregnancy and Lactation: Avoid due to potential adverse effects. CNS Disorders: Can cause severe CNS effects. Adverse Effects CNS: Headache, depression, neuropathy. GI: Nausea, vomiting. GU: Renal dysfunction. Local: Rash, inflammation. Interactions Increased renal toxicity with aminoglycosides, increased drowsiness with zidovudine. Nursing Considerations 1. Assessment: Check for contraindications, perform thorough physical assessment. 2. Diagnoses: Acute pain, disturbed sensory perception. 3. Implementation: Administer promptly, ensure hydration, educate patients, wear gloves for topical application. 4. Evaluation: Monitor response, adverse effects, patient understanding, and compliance. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 26 of 54  Medel Notes HES 005 Agents for HIV and AIDS (Antiretroviral Drugs) Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs) Therapeutic Action Bind directly to HIV reverse transcriptase, blocking RNA- and DNA- dependent DNA polymerase activities, preventing viral replication. Indications Treatment of AIDS or ARC with decreased helper T cells. Pharmacokinetics Route: Oral Onset: Rapid Peak: 4 hours Half-life: 25-45 hours Excretion: Kidney (urine) Contraindications and Cautions Pregnancy: Limited use unless benefits outweigh risks. Children: Safety not established. Adverse Effects CNS: Dizziness, blurred vision, headache. GI: Dry mouth, constipation, nausea. Interactions Avoid with certain antiarrhythmics, antibiotics, and sedatives. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 27 of 54  Medel Notes HES 005 Nucleoside Reverse Transcriptase Inhibitors (NRTIs) Therapeutic Action Compete with natural nucleosides, preventing DNA chain extension and viral replication. Indications Combination therapy for HIV; lamivudine for chronic hepatitis B; zidovudine for preventing maternal transmission of HIV. Pharmacokinetics Route: Oral, IV Onset: Varies (oral), Rapid (IV) Peak: 30-90 min (oral), End of infusion (IV) Half-life: 30-60 min Excretion: Kidney (urine) Contraindications and Cautions Pregnancy: Limited use, except for zidovudine. Hepatic and Renal Dysfunction: Use with caution. Bone Marrow Suppression: Can be aggravated. Adverse Effects Hypersensitivity: Serious reactions with abacavir. GI: Nausea, diarrhea. Hematologic: Bone marrow suppression. Interactions Avoid alcohol with abacavir, certain antibiotics and antifungals with didanosine, and cyclosporine with zidovudine. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 28 of 54  Medel Notes HES 005 Protease Inhibitors Therapeutic Action Block protease activity within HIV, rendering the virus non-infective. Indications Combination therapy for HIV. Pharmacokinetics Route: Oral Onset: Varies Peak: 1.5-4 hours Half-life: 7.7 hours Excretion: Kidney (urine) Contraindications and Cautions Pregnancy and Lactation: Use with caution. Hepatic Dysfunction: Increased toxicity. Diabetes: Darunavir can cause hyperglycemia. Adverse Effects GI: Nausea, vomiting. Skin: Rashes, Steven Johnson syndrome. Interactions Avoid with certain drugs (e.g., rifampin, triazolam) due to severe toxic effects. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 29 of 54  Medel Notes HES 005 Fusion Inhibitors Therapeutic Action Prevent fusion of the virus with the human cell membrane, stopping entry of HIV-1 into the cell. Indications Combination therapy for HIV-1. Pharmacokinetics Route: Subcutaneous Onset: Slow Peak: 4-8 hours Half-life: 3.2-4.4 hours Excretion: Recycled in tissues Contraindications and Cautions Pregnancy and Lactation: Avoid due to potential risks. Hypersensitivity: Known allergy. Adverse Effects CNS: Insomnia, depression. GI: Nausea, diarrhea. Respiratory: Pneumonia. Local: Injection-site reactions. CCR5 Coreceptor Antagonist Therapeutic Action CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 30 of 54  Medel Notes HES 005 Block receptor sites on cell membranes to prevent HIV entry. Indications Combination therapy for HIV. Pharmacokinetics Route: Oral Onset: Slow Peak: 0.5-4 hours Half-life: 14-28 hours Excretion: Kidney (urine), colon (feces) Contraindications and Cautions Pregnancy and Lactation: Avoid due to potential risks. Renal Impairment: Increased toxicity risk. Children: Safety not established. Adverse Effects CNS: Dizziness, changes in consciousness. Hepatic: Severe hepatotoxicity. Interactions Avoid with certain drugs (e.g., ketoconazole, rifampin) due to increased toxicity or decreased effectiveness. Integrase Inhibitors Therapeutic Action Inhibit integrase, preventing HIV-1 replication. Indications Use in patients with treatment-resistant HIV. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 31 of 54  Medel Notes HES 005 Pharmacokinetics Route: Oral Onset: Rapid Peak: 3 hours Half-life: 9 hours Excretion: Kidney (urine), colon (feces) Contraindications and Cautions Pregnancy and Lactation: Avoid due to potential risks. Rhabdomyolysis Risk: Use with caution. Adverse Effects CNS: Headache, dizziness. Musculoskeletal: Rhabdomyolysis, myopathy. Interactions Avoid with rifampin and St. John’s wort due to reduced effectiveness. Nursing Considerations for Antiretroviral Drugs Assessment 1. Check for contraindications, perform thorough physical assessment. 2. Evaluate hepatic and renal function, CBC with differential. Diagnoses 1. Acute pain, disturbed sensory perception, imbalanced nutrition. Implementation 1. Administer as prescribed, ensure hydration, educate patients. 2. Monitor for severe rashes, provide safety precautions for CNS effects. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 32 of 54  Medel Notes HES 005 Evaluation 1. Monitor therapy response, adverse effects, patient understanding, and compliance. Anti-Hepatitis B and C Agents Therapeutic Action Inhibit reverse transcriptase in hepatitis B virus, leading to blocked viral replication. Indications Treatment of chronic hepatitis B and C. Pharmacokinetics Route: Oral Onset: Rapid Peak: 0.6-4 hours Half-life: 7.5 hours Excretion: Kidney (urine) Contraindications and Cautions Allergy: Prevent hypersensitivity reactions. Renal and Liver Impairment: Increased risk of toxicity. Pregnancy: Use with caution. Adverse Effects CNS: Headache, dizziness. GI: Diarrhea, elevated liver enzymes. GU: Lactic acidosis, renal impairment. Interactions Increased risk of renal toxicity with nephrotoxic drugs. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 33 of 54  Medel Notes HES 005 Nursing Considerations 1. Assessment: Check for contraindications, perform thorough physical assessment. 2. Diagnoses: Acute pain, imbalanced nutrition. 3. Implementation: Monitor renal and hepatic function, educate patients on continuous drug use. 4. Evaluation: Monitor therapy response, adverse effects, patient understanding, and compliance. Antifungal Agents Learning Objectives 1. Describe: Characteristics of fungi and fungal infections. 2. Discuss: Therapeutic actions, indications, pharmacokinetics, contraindications, administration, adverse reactions, and drug interactions of systemic and topical antifungals. 3. Compare: Prototype drugs for systemic and topical antifungals with other drugs in each class. 4. Discuss: Impact of antifungals across different age groups. 5. Outline: Nursing considerations for patients on systemic or topical antifungals. Overview Antifungals: Treat mycosis, infections caused by fungi. Fungi: Different from bacteria; have chitin and polysaccharide cell walls, resistant to antibiotics. Increased Infections: Common in immunocompromised patients (e.g., AIDS, organ transplant recipients). Types: Systemic and topical antifungals. Common Antifungal Drugs CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 34 of 54  Medel Notes HES 005 Systemic Antifungals Azole Antifungals Examples: Fluconazole (Diflucan), Itraconazole (Sporanox), Ketoconazole (Nizoral), Terbinafine (Lamisil), Voriconazole (VFend) Echinocandin Antifungals Examples: Anidulafungin (Eraxis), Caspofungin (Cancidas), Micafungin (Mycamine) Other Systemic Antifungals Examples: Amphotericin B (Abelcet), Flucytosine (Ancobon), Griseofulvin, Nystatin (Mycostatin) Topical Antifungals Azole Topical Antifungals Examples: Butoconazole (Gynazole), Clotrimazole (Lotrimin), Ketoconazole (Extina), Miconazole (Monistat) Other Topical Antifungals Examples: Ciclopirox (Loprox), Gentian Violet, Naftifine (Naftin), Tolnaftate (Tinactin), Undecylenic Acid (Cruex) Azole Antifungals Action: Bind to sterols causing cell death or interfering with cell replication. Uses: Treat candidiasis, cryptococcal meningitis, systemic mycoses, aspergillosis. Pharmacokinetics: Route: Oral, IV CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 35 of 54  Medel Notes HES 005 Onset: Slow (oral), Rapid (IV) Peak: 1-2 hours (oral), 1 hour (IV) Duration: 2-4 days Half-life: 30 hours Excretion: Kidney Contraindications: Hepatic Dysfunction: Can cause liver toxicity. Endocrine/Fertility Issues: Ketoconazole affects testosterone and cortisol. Pregnancy/Lactation: Unknown effects. Side Effects: GI: Liver toxicity. Reproductive: Severe effects on fetus/nursing babies. Interactions: Increased serum levels: Cyclosporine, digoxin, oral hypoglycemics. Serious cardiac effects: Statins, triazolam. Echinocandin Antifungals Action: Inhibit glucan synthesis, preventing fungal cell wall formation. Uses: Treat candidemia, invasive aspergillosis, prophylaxis in stem cell transplant patients. Pharmacokinetics: Route: IV Onset: Rapid Half-life: Anidulafungin (40-50 hours), Caspofungin (9-50 hours), Micafungin (14-17 hours) Excretion: Kidney, colon CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 36 of 54  Medel Notes HES 005 Contraindications: Hepatic Impairment: Use with caution. Pregnancy/Lactation: Caspofungin is embryotoxic; micafungin should be used if benefits outweigh risks. Side Effects: GI: Hepatic toxicity. Immunological: Bone marrow depression. Hypersensitivity: Especially with micafungin. Interactions: Caspofungin: Contraindicated with cyclosporine. Other Systemic Antifungals Action: Cause fungal cell death (fungicidal) or prevent reproduction (fungistatic). Uses: Treat progressive, potentially fatal infections. Pharmacokinetics: Route: IV, PO Onset: Rapid (IV), N/A (PO) Half-life: Amphotericin B (24 hours, then 15 days), Griseofulvin (24 hours) Excretion: Kidney Contraindications: Amphotericin B: Caution in pregnancy, contraindicated in lactation. Flucytosine: Caution in renal impairment. Nystatin: Avoid in pregnancy and lactation. Side Effects: CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 37 of 54  Medel Notes HES 005 CNS: Headache, CNS changes (Griseofulvin). GI: Nausea, vomiting, hepatic and renal failure. Local: Injection site pain, phlebitis. Interactions: Amphotericin B: Increased risk of renal toxicity with nephrotoxic antibiotics. Nursing Considerations for Systemic Antifungals Assessment: 1. Check for contraindications and perform thorough physical assessment. 2. Obtain culture of infected area to determine type and responsiveness. 3. Evaluate renal and hepatic function tests, CBC. Diagnoses: 1. Acute pain related to drug effects. 2. Disturbed sensory perception. Implementation: 1. Administer full course of antifungals as prescribed. 2. Monitor IV sites for phlebitis or infiltration. 3. Provide safety measures for CNS effects. 4. Provide small, frequent meals if GI upset is severe. 5. Educate patient on drug therapy, report adverse effects. Evaluation: 1. Monitor patient response and adverse effects. 2. Evaluate patient understanding and compliance. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 38 of 54  Medel Notes HES 005 Topical Antifungals Action: Alter cell permeability, causing prevention of replication and fungal death. Uses: Treat local mycoses, including tinea infections. Pharmacokinetics: Not absorbed systemically; pharmacokinetics unknown. Contraindications: Allergy: Prevent hypersensitivity. Specific drugs: Econazole (local burning), Gentian Violet (toxic, stains skin), Naftifine (not for longer than 4 weeks), Sulconazole (not for longer than 6 weeks). Side Effects: Local: Irritation, burning, rash, swelling. GI: Nausea, vomiting, hepatic dysfunction (suppository/troche). GU: Urinary frequency, burning, change in sexual activity (vaginal use). Nursing Considerations for Topical Antifungals Assessment: 1. Check for contraindications and perform thorough physical assessment. 2. Obtain culture of infected area. Diagnoses: 1. Acute pain related to local drug effects. Implementation: 1. Administer full course of antifungals as prescribed. 2. Instruct patient on correct administration method. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 39 of 54  Medel Notes HES 005 3. Advise patient to stop drug if severe rash or local irritation occurs. 4. Educate patient on drug therapy. Evaluation: 1. Monitor patient response and adverse effects. 2. Evaluate patient understanding and compliance. Antiprotozoal Agents Learning Objectives 1. Outline the life cycle of the protozoan that causes malaria. 2. Describe therapeutic actions, indications, pharmacokinetics, contraindications, administration, adverse reactions, and drug interactions of antimalarial drugs. 3. Describe other common protozoal infections, including causes and clinical presentations. 4. Compare and contrast antimalarials with other drugs used to treat protozoal infections. 5. Outline nursing considerations for patients receiving antiprotozoal agents across the lifespan. Overview Antiprotozoals: Treat protozoan infections. Protozoans: Single-celled organisms with multiple life stages, often including a human parasitic phase. Common Infections: More prevalent in tropical areas but can occur in crowded, unsanitary conditions. Common Antiprotozoal Drugs Antimalarials Chloroquine (Aralen) Mefloquine (Lariam) Primaquine CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 40 of 54  Medel Notes HES 005 Pyrimethamine (Daraprim) Quinine (Qualaquin) Other Antiprotozoals Atovaquone (Mepron) Metronidazole (Flagyl) Nitazoxanide (Alinia) Pentamidine (Pentam 300) Tinidazole (Tindamax) Disease Spotlight: Protozoal Diseases Malaria Cause: Plasmodium species (P. falciparum, P. vivax, P. malariae, P. ovale). Transmission: Bite of female Anopheles mosquito. Symptoms: Cyclic fever, chills, anemia, jaundice. Amebiasis Cause: Entamoeba histolytica. Transmission: Fecal-oral route. Symptoms: Diarrhea, abdominal pain, can invade extraintestinal tissues. Leishmaniasis Cause: Protozoa from sand flies. Symptoms: Skin, mucous membrane, and visceral lesions. Trypanosomiasis Cause: Trypanosoma species. Types: African sleeping sickness (T. brucei, tsetse fly), Chagas’ disease (T. cruzi, housefly). Symptoms: Lethargy, sleep disturbances, severe cardiomyopathy. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 41 of 54  Medel Notes HES 005 Trichomoniasis Cause: Trichomonas vaginalis. Transmission: Sexual intercourse. Symptoms: Vaginitis, itching, burning, discharge. Giardiasis Cause: Giardia lamblia. Transmission: Contaminated water or food. Symptoms: Diarrhea, epigastric pain, weight loss, malnutrition. Antimalarials Therapeutic Action Action: Enter red blood cells, change metabolic pathways to prevent reproduction. Chloroquine: Toxic to parasites, inhibits DNA synthesis. Indications Uses: Treatment and prevention of malaria, extraintestinal amoebiasis (chloroquine), toxoplasmosis (pyrimethamine). Pharmacokinetics Route: Oral Onset: Varies Peak: 1-2 hours Duration: 1 week Half-life: 70-120 hours Metabolism: Liver Excretion: Kidney (urine) Contraindications Allergy: Prevent hypersensitivity. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 42 of 54  Medel Notes HES 005 Liver Disease/Alcoholism: Risk of toxicity. Pregnancy: Birth defects. Retinal Disease: Risk of vision damage. Psoriasis/Porphyria: Risk of skin damage. Adverse Effects CNS: Headache, dizziness. Immunological: Fever, shaking, chills. GI: Nausea, vomiting, hepatic dysfunction. Dermatological: Rash, pruritus, hair loss. Eyes/Ears: Visual changes, ototoxicity. Cinchonism: Nausea, vomiting, tinnitus, vertigo (high levels of quinine/primaquine). Interactions Quinine Derivatives: Increased cardiac toxicity and convulsions. Anti-folate Drugs: Increased bone marrow suppression with pyrimethamine. Nursing Considerations for Antimalarials 1. Assessment: Evaluate for allergies, hepatic/renal impairment, pregnancy, visual disturbances. 2. Physical Exam: Reflexes, muscle strength, skin color, temperature. 3. Ophthalmic/Auditory Exams: Baseline and periodic checks. 4. Liver Function Tests: Monitor for toxicity. 5. Blood Culture: Identify Plasmodium species. Nursing Diagnoses 1. Acute pain related to GI, CNS, skin effects. 2. Disturbed sensory perception related to CNS effects. 3. Risk for injury related to CNS changes. Implementation CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 43 of 54  Medel Notes HES 005 1. Administer complete drug course. 2. Monitor hepatic function and vision. 3. Provide comfort and safety measures. 4. Educate patient on drug therapy and compliance. Evaluation 1. Monitor therapy response. 2. Monitor for adverse effects. 3. Evaluate patient understanding and compliance. Other Antiprotozoal Agents Therapeutic Action Action: Inhibit DNA synthesis, interfere with cell reproduction. Indications Uses: Treat infections caused by susceptible protozoa. Pharmacokinetics Route: Oral, IV Onset: Varies (oral), Rapid (IV) Peak: 1-2 hours Duration: N/A Half-life: 6-8 hours Metabolism: Liver Excretion: Kidney (urine), colon (feces) Contraindications Allergy: Prevent hypersensitivity. Pregnancy: Risk of fetal abnormalities. CNS Disease: Possible exacerbation. Hepatic Disease: Risk of exacerbation. Candidiasis: Risk of superinfection. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 44 of 54  Medel Notes HES 005 Lactation: Severe adverse effects to infant. Adverse Effects CNS: Headache, dizziness, ataxia. GI: Nausea, vomiting, diarrhea, liver function changes. Superinfections: Risk of secondary infections. Interactions Alcohol: Severe adverse effects with tinidazole, metronidazole. Oral Anticoagulants: Increased bleeding. Disulfiram: Psychotic reactions. Nursing Considerations for Other Antiprotozoals 1. Assessment: Evaluate for allergies, hepatic/renal impairment, pregnancy. 2. Physical Exam: Reflexes, muscle strength, skin/mucous membrane color, temperature. 3. Liver Function Tests: Monitor for toxicity. 4. Cultures: Identify protozoal species. Nursing Diagnoses 1. Acute pain related to GI and CNS effects. 2. Imbalanced nutrition related to GI effects. 3. Disturbed sensory perception related to CNS effects. Implementation 1. Administer complete drug course. 2. Monitor hepatic function. 3. Provide comfort and safety measures. 4. Educate patient on drug therapy and compliance. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 45 of 54  Medel Notes HES 005 Evaluation 1. Monitor therapy response. 2. Monitor for adverse effects. 3. Evaluate patient understanding and compliance. Anthelmintic Agents Learning Objectives 1. List the common worms that cause disease in humans. 2. Describe the therapeutic actions, indications, pharmacokinetics, contraindications, adverse reactions, and drug interactions of anthelmintics. 3. Discuss the use of anthelmintics across the lifespan. 4. Compare and contrast the prototype drug mebendazole with other anthelmintics. 5. Outline nursing considerations and important teaching points for patients receiving anthelmintics. Overview Anthelmintics are drugs used to treat infections caused by worms (helminths). These infections are most common in tropical areas but can also occur in any crowded and unsanitary conditions. Common Anthelmintic Drugs Albendazole (Albenza) Ivermectin (Stromectol) Mebendazole (Vermox) Praziquantel (Biltricide) Pyrantel (Antiminth) Disease Spotlight: Helminthic Infections Infection Types: GI tract or tissue infections caused by worm infestations. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 46 of 54  Medel Notes HES 005 Common Worms: Nematodes (roundworms) and platyhelminths (flatworms). Therapeutic Action Anthelmintics act on metabolic pathways in the worms that are either absent or significantly different in humans, effectively killing the worms without harming the host. Indications Albendazole: Treats pork tapeworm lesions, dog tapeworm cystic disease. Ivermectin: Treats threadworm disease and river blindness. Mebendazole: Treats pinworms, roundworms, whipworms, hookworms. Praziquantel: Treats various flukes (schistosomes). Pyrantel: Treats pinworms and roundworms. Use Across Lifespan Children Culture: Important to identify the worm before starting treatment. Drug Choice: Albendazole, ivermectin, and praziquantel are avoided due to higher toxicity; mebendazole is preferred. GI Effects: Monitor nutritional status and hydration. Adults Reluctance: May be hesitant to discuss worm infestations and treatment. Pregnancy/Lactation: Use only if benefits outweigh risks. Communicate potential risks clearly. Older Adults Susceptibility: More prone to GI and CNS effects, especially with hepatic/renal dysfunction. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 47 of 54  Medel Notes HES 005 Pharmacokinetics Route: Oral Onset: Slow Peak: 2-4 hours Half-life: 2.5-9 hours Metabolism: Liver Excretion: Colon (feces) Contraindications and Cautions Allergy: Prevent hypersensitivity reactions. Lactation: Drug can enter breast milk. Renal/Hepatic Disease: Interfere with drug metabolism/excretion. Severe Diarrhea/Malnourishment: Can alter drug effects. Children Under 2: Pyrantel safety not established. Adverse Effects GI: Abdominal discomfort, diarrhea, pain. CNS: Headache, dizziness. Immunologic: Fever, chills, rash, pruritus, hair loss. Albendazole: Severe bone marrow depression, renal failure. Drug Interactions Albendazole: Increased toxicity with dexamethasone, praziquantel, cimetidine. Nursing Considerations Nursing Assessment 1. Cautions/Contraindications: Check for allergies, hepatorenal dysfunction, pregnancy, lactation. 2. Physical Exam: Baseline data, other medications, reflexes, muscle strength, skin condition. 3. Liver Function Tests: Determine appropriateness and monitor toxicity. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 48 of 54  Medel Notes HES 005 4. Stool Culture: Identify infecting worm. 5. Abdominal Assessment: Monitor for changes related to infection. Nursing Diagnoses 1. Acute pain related to GI, CNS, skin effects. 2. Imbalanced nutrition: less than body requirements due to GI effects. Implementation with Rationale 1. Culture and Sensitivity Tests: Ensure proper drug use. 2. Complete Drug Course: Ensure full effectiveness. 3. Monitor Liver Function: Detect early signs of toxicity. 4. Provide Comfort and Safety Measures: Prevent injury from CNS effects. 5. Patient Education: Promote understanding and compliance. Evaluation 1. Response to Therapy: Resolution of helminth infestation. 2. Monitor Adverse Effects: Check for orientation changes, nutritional status, skin condition, liver function, abdominal discomfort. 3. Evaluate Understanding: Ensure patient can name the drug, indication, and adverse effects. 4. Compliance: Ensure patient follows therapy regimen. Antineoplastic Agents Learning Objectives 1. Understand the nature of cancer and its impact on the body. 2. Learn the therapeutic actions, uses, pharmacokinetics, side effects, and interactions of different antineoplastic agents. 3. Discuss the use of these drugs for different age groups. 4. Compare the prototype drugs within each class of antineoplastic agents. 5. Know the nursing considerations and patient teaching points for antineoplastic agents. Disease Spotlight: Cancer CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 49 of 54  Medel Notes HES 005 Nature of Cancer: Uncontrolled cell growth due to genetic mutations, leading to tumor formation and potential metastasis. Types of Cancer: o Solid Tumors: Carcinomas (originate in epithelial cells) and Sarcomas (originate in connective tissues). o Hematological Malignancies: Cancers that affect blood, bone marrow, and lymph nodes. Cancer Treatment Goals: Decrease the size of the tumor and allow the immune system to combat it. Overview Antineoplastic agents are drugs used in chemotherapy to kill cancer cells. These drugs can also affect normal cells. They work by targeting cell survival mechanisms or boosting the immune system to fight cancer cells. Common Antineoplastic Drugs Alkylating Agents Examples: Cyclophosphamide (Cytoxan), Cisplatin (Platinol-AQ), Carboplatin (Paraplatin) Therapeutic Action: React chemically with portions of RNA, DNA, or other cellular proteins to produce cytotoxic effects, most potent when binding with cellular DNA. Uses and Indications: Slow-growing cancers such as lymphomas, leukemias, myelomas, ovarian, testicular, breast, and pancreatic cancers. Pharmacokinetics: o Route: Oral and IV o Onset: Varies (oral), rapid (IV) o Half-life: 60-90 minutes o Metabolism: Liver o Excretion: Kidney (urine) Contraindications: Pregnancy, lactation, allergies, bone marrow suppression, renal or hepatic dysfunction. Side Effects: Nausea, vomiting, diarrhea, mucous membrane deterioration, bone marrow suppression, renal toxicity, alopecia. Antimetabolites Examples: Methotrexate (Rheumatrex), Fluorouracil (Adrucil), Capecitabine (Xeloda) Therapeutic Action: Inhibit DNA production in cells that depend on certain natural metabolites, replacing these needed metabolites to prevent normal cellular function. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 50 of 54  Medel Notes HES 005 Uses and Indications: Various leukemias, some GI cancers, and basal cell cancers. Pharmacokinetics: o Route: Oral and IV o Onset: Varies (oral), rapid (IV) o Half-life: 2-4 hours o Excretion: Kidney (urine) Contraindications: Pregnancy, lactation, allergies, bone marrow suppression, renal or hepatic dysfunction, GI ulceration. Side Effects: Headache, drowsiness, dizziness, pulmonary toxicity, bone marrow suppression, nausea, vomiting, renal toxicity. Antineoplastic Antibiotics Examples: Doxorubicin (Adriamycin), Bleomycin (Blenoxane), Mitomycin (Mutamycin) Therapeutic Action: Interfere with cellular DNA synthesis by inserting themselves between base pairs in the DNA chain, causing a mutant DNA molecule leading to cell death. Uses and Indications: Various types of rapidly-dividing cancers. Pharmacokinetics: o Route: IV o Onset: Rapid o Half-life: Varies (multiple phases) o Metabolism: Liver o Excretion: Kidney (urine), liver (bile), colon (feces) Contraindications: Pregnancy, lactation, allergies, bone marrow suppression, renal or hepatic dysfunction, GI ulceration, pulmonary/cardiac problems. Side Effects: Headache, drowsiness, dizziness, pulmonary toxicity, bone marrow suppression, nausea, vomiting, renal toxicity, alopecia. Mitotic Inhibitors Examples: Vincristine (Oncovin), Paclitaxel (Taxol), Docetaxel (Taxotere) Therapeutic Action: Interfere with the ability of the cell to divide by blocking or altering the M phase of the cell cycle. Uses and Indications: Various tumors and leukemias. Pharmacokinetics: o Route: IV o Onset: Varies o Half-life: Varies (multiple phases) o Metabolism: Liver o Excretion: Kidney (urine), colon (feces) CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 51 of 54  Medel Notes HES 005 Contraindications: Pregnancy, lactation, allergies, bone marrow suppression, renal or hepatic dysfunction, GI ulceration. Side Effects: Headache, dizziness, pulmonary toxicity, bone marrow suppression, nausea, vomiting, renal toxicity, risk of extravasation. Hormones and Hormone Modulators Examples: Tamoxifen (Soltamox), Anastrozole (Arimidex), Leuprolide (Lupron) Therapeutic Action: Block or interfere with hormone receptor sites to prevent cancer growth and cause cell death. Uses and Indications: Breast cancer in postmenopausal women, prostatic cancers sensitive to hormone manipulation. Pharmacokinetics: o Route: Oral o Onset: Varies o Half-life: 7-14 days o Metabolism: Liver o Excretion: Colon (feces) Contraindications: Pregnancy, lactation, allergies, hypercalcemia, bone marrow suppression, renal or hepatic dysfunction. Side Effects: Menopause-like symptoms, bone marrow suppression, hepatic toxicity, hypercalcemia. Cancer Cell-Specific Agents Examples: Imatinib (Gleevec), Erlotinib (Tarceva), Bortezomib (Velcade) Therapeutic Action: Target specific cancer cell enzymes or receptors, sparing healthy cells. o Protein Tyrosine Kinase Inhibitors: Inhibit enzymes for tumor cell growth. o Epidermal Growth Factor Inhibitors: Target receptors more abundant on cancer cells. o Proteasome Inhibitors: Inhibit proteasome for cell homeostasis and protein production. Uses and Indications: Chronic myelocytic leukemia, multiple myeloma. Pharmacokinetics: o Route: Oral o Onset: Slow o Half-life: 18-40 hours o Metabolism: Liver o Excretion: Colon (feces) Contraindications: Pregnancy (Category D), lactation, hepatic dysfunction, prolonged QT intervals, allergies. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 52 of 54  Medel Notes HES 005 Side Effects: GI upset, muscle cramps, heart failure, fluid retention, skin rash, interstitial lung disease, bone marrow depression. Use Across the Lifespan Children Considerations: Follow protocols, monitor dosages, nutritional needs, hydration, and bone marrow activity. Provide support for body image issues and isolation risks. Therapy: Emphasize combination therapy. Adults Considerations: Address body image changes, support systems, and education on risks. Contraindicated in pregnant and nursing women. Use barrier contraceptives and educate on risks. Older Adults Considerations: More prone to GI and CNS adverse effects, especially with hepatic and renal dysfunction. Focus on infection and injury protection. Pharmacokinetics Route: Oral and IV Onset: Varies, rapid for IV Half-life: Depends on the drug, liver metabolism, and renal excretion Contraindications and Cautions Common Contraindications: Pregnancy, lactation, known allergies, bone marrow suppression, renal or hepatic dysfunction, GI ulcerations, pre-existing pulmonary or cardiac problems. Adverse Effects Common Adverse Effects: Nausea, vomiting, anorexia, diarrhea, mucous membrane deterioration, hepatic and renal toxicity, bone marrow suppression, alopecia, CNS effects (headache, dizziness), pulmonary toxicity. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 53 of 54  Medel Notes HES 005 Drug Interactions Common Interactions: Drugs with potential hepatic or renal toxicity, oral anticoagulants, drugs metabolized in the liver. Herbs like echinacea, ginkgo, saw palmetto, and St. John’s wort can interact negatively. Nursing Considerations Nursing Assessment 1. Assess for cautions and contraindications (allergies, hepatic/renal impairment, bone marrow suppression, pregnancy). 2. Perform thorough physical assessment and establish baseline data. 3. Monitor CBC, liver and renal function tests, and patient’s nutritional status. Nursing Diagnoses 1. Acute pain related to GI, CNS, and skin effects. 2. Disturbed body image due to alopecia, skin effects, and impaired fertility. 3. Anxiety related to diagnosis. 4. Risk for infection due to bone marrow suppression. Implementation with Rationale 1. Arrange blood tests to monitor bone marrow function. 2. Administer medication according to protocol. 3. Ensure hydration to prevent renal toxicity. 4. Protect from infection and limit invasive procedures. 5. Provide small, frequent meals and dietary consultations. 6. Plan for rest periods and offer head coverings for alopecia. Evaluation 1. Monitor patient’s response to therapy. 2. Monitor for adverse effects. 3. Evaluate patient’s understanding of drug therapy. 4. Ensure patient compliance with the therapy regimen. CONFIDENTIALITY AND COPYRIGHT NOTICE These notes are the property of Mr. Medel. Unauthorized use, sharing, or reproduction is prohibited. For permission, contact Mr. Medel. © 2024 Mr. Medel. All rights reserved. Page 54 of 54