Vaccine Schedule & Folic Acid Analogs PDF

1. Vaccine schedule for birth through 6 years, 7-18, & adult/older adult *birth-6 yrs: hep A & B. rotavirus (RV). diphtheria, tetanus, and acellular pertussis (DTaP). Haemophilus influenza type b (Hib). inactivated polio virus vaccine (IPV). measles, mumps, and rubella (MMR). varicella or chic...

1. Vaccine schedule for birth through 6 years, 7-18, & adult/older adult *birth-6 yrs: hep A & B. rotavirus (RV). diphtheria, tetanus, and acellular pertussis (DTaP). Haemophilus influenza type b (Hib). inactivated polio virus vaccine (IPV). measles, mumps, and rubella (MMR). varicella or chickenpox vaccine. All children at least 6 months should take the flu vaccine each year *7-18 yrs: booster dose of diphtheria, tetanus, and acellular pertussis (TDaP) between ages 11-12 after completing the earlier series of DTaP vaccines. 3 doses of the vaccine for human papillomavirus (HPV) recommended for ages 11-12. Children who have not received the vaccine that prevents infectious meningitis, the meningococcal conjugate (MCV-4) should receive the vaccine between 11-18 y/o. Some children may receive the MCV-4 vaccine as early as 2 y/o if their immune systems have been compromised and at great risk for infection. Children should continue to receive a yearly flu vaccine. If a child did not get a recommended vaccine or series at an earlier age they can get them at this time *adult/older adult: flu vaccine yearly. Tetanus and diphtheria (TD) every 10 yrs. Adults over 65 should receive the pneumococcal vaccine but may also be required for younger adults who are at risk like those who smoke. Vaccines for Hep A or B, measles, mumps, and rubella, and varicella, or chickenpox may be necessary for certain adults. Herpes zoster or shingles vaccine is recommended for adults older than 50 y/o 3. Know Folic Acid Analog: methotrexate *drug class: antineoplastic *Methotrexate (also called Trexall) treats rheumatoid arthritis and the inflammatory skin disorder-psoriasis, when other treatments have been ineffective. Both of these disorders have an autoimmune component and smaller doses of methotrexate treats them compared to the larger doses that treat cancer. *folic acid analogs block folic acid synthesis by first inhibiting the enzyme, dihydrofolate reductase, that is responsible for the ultimate activation of folic acid. Since the s-phase of cell formation is responsible for DNA synthesis, the folic acid analogs kill cancer cells by distrupting DNA synthesis during this phase. *adverse reactions: severe bone marrow suppression w/ decreased thromocytes which are platelets and decreases leukocytes or white blood cells and erythrocytes which are red blood cells. Liver damage, GI ulceration, and pulmonary damage which can result in pulmonary fibrosis may also occur *interventions: important to monitor bone marrow depression which means evaluating a complete blood count (CBC) including platelets, erythrocytes, leukocytes, hemoglobin and hematocrit, before, during, and after therapy. Monitor for fever frequently during treatment since the client is at risk for infection if the leukocyte count drops and neutropenia develops. Monitor for bleeding from common sites such as the gums. If platelet count drops and thrombocytopenia develops use measures to avoid bruising such as applying prolonged pressure to puncture sites of using small guage needles if injections are necessary. Monitor for oral and GI ulcerations that can cause bleeding and discomfort. Liver function tests should be monitored while observing for jaundice, and monitor for respiratory distress and decreased oxygenation due to the possibility of pulmonary fibrosis and damage. *administration: oral, IM, IV, and preservative-free intrathecal form. For high-dose cancer therapy administer Leucovorin, a reduced form of folic acid along with methotrexate as an antidote for the severe bone marrow depression. Give oral doses with or without food but methotrexate is incompatible with multiple other drugs in solution so administer using a dedicated IV line. *client instructions: report fever, sore throat, easy bruising, and unusual fatigue. Wash hand frequently and limit visitors who are sick to lower the risk for infection. Wash fresh fruits and veggies and properly cook their foods. Good oral care will help prevent stomatitis, a yeast superinfection in the mouth. Use a soft toothbrush to prevent bleeding gums, use an electric razor instead of one with a blade, and take measures to prevent bruising. Due to risk for liver damage, advise client to avoid drinking alcohol and to report yellowing of the skin and eyes immediately. Report ulcerations and pain in the mouth as well as blood in their vomit or stool due to risk for oral ulcerations and GI bleeding. Report any difficult breathing or SOB. Use contraception (men and women) for a designated period of time as folic acid analogs having teratogenic effects may cause harm to a fetus. Avoid breastfeeding, possibility of fertility issues. *contraindications: pregnancy, liver insufficiency or hepatitis and renal insufficiency, peptic ulcer disease or ulceratice colitis due to risk for GI ulceration and bleeding. Active bacterial or viral infections *interactions: taking methotrexate and digoxin at the same time could see a reduction in digoxin levels. Concurrent use of methotrexate and NSAIDs, salicylates and sulfonamides may cause methotrexate toxicity. Alcohol use increases the risk for hepatoxicity and taking folic acid supplements also changes the clients response to methotrexate. Provider should approve any use of vitamin or mineral supplements. 4. Understand “Nadir” definition *means the time following chemotherapy when blood cell counts especially the leukocytes and platelets reach their lowest level or the expected low point in bone marrow suppression for a specific drug. Nadir helps caregivers know when monitoring the client for signs of a low platelet or leukocyte is vital and when these blood counts may be expected to rise again 5. Why cancer meds cause nausea & vomiting (patho) *many drugs used for cancer chemotherapy cause n/v due to stimulation of the chemorecptor trigger zone or CTZ in the brain. Emesis can occur prior to chemotherapy in anticipation of the drug, during chemotherapy and for some anticancer drugs several days after chemotherapy. N/V may last for several days. 6. Nitrogen mustards and alopecia *nitrogen mustard drugs can be used alone or w/ other regimens to treat a variety of cancers such as lymphomas, leukemias, hodgkin’s disease, neuroblastomas, and ovarian or breast cancers *Drug/Class: Cyclophosphamide, alkylating agent *nitrogen mustard drugs causes alopecia, monitor for patients reaction. Temporary but can have a significant effect on a clients self-esteem. Talk to the client before starting therapy about ways to manage this change in self-image. Encourage a conversation about how the client feels about this dody image and support them as they go through it. Hair will grow back following cyclophosohamide treatment. *note: alkylating anticancer drugs form an abnormal cross-link bind w/ the DNA bases and the defective bond damages to the cells and kills it. Prevent normal cell function. Nitrogen mustard drugs are cell cycle phase non-secific meaning they can kill growing cells at any time during their cycle. The most effective cancer regimens consist of pairing a cell cycle phase non-specific drug w/ one that is cell cycle phase specific in order to kill the greatest number of cancer cells 7. Anthracyclines: Doxorubicin classification & side effects/client instructions *classification: anthracycline *side effects: severe bone marrow suppression most commonly of leukocytes. cell suppression (10-14 days after the dose), thrombocytopenia and anemia. Reversible but distressing SE: alopecia and red urine and tears (lasts for 1-2 days after infusion). Cardiac toxicity (can occur immediately), irreversible cardiac symptoms occur months or years after treatment is completed. Hepatic or liver toxicity is also a risk. Severe tissue damage due to the anticancer antibiotics are vesicants (an iv drug that causes tissue damage if extravasation or leakage occurs) *client instructions: Client getting doxorubicin should be told the critical time for a decrease in white blood counts is 10-14 days after each IV treatment. Use previous instructions to prevent client injury from bone marrow suppression. Advise the client that complete hair loss will occur and urine will be red for up to 2 days after each treatment. Tell client about the necessity of tests for cardiac function and should be advised to report a rapid heartbeat, palpitations, SOB, or chest pain following treatment. Because of the risk for liver damage, the client should be instructed to report to the provider persistent anorexia, vomiting, abdominal pain, itchy skin, dark urine, and jaundice. During IV infusions instruct the client to report immediately to a staff member IV site pain, redness, or swelling. Advise female clients of childbearing age to avoid pregnancy during chemtherapy and instruct the client to report immediately to the provider if pregnancy occurs. 8. Gonadotropin-releasing hormone agonists (GnRH) leuprolide- indication, expected pharmacological action *drug: Leuprolide; class= GnRH *indication: Treats advanced prostate cancer (most common cancer among males in the US). The GnRH agonists are for palliative treatment of prostate cancer meaning these drugs control pain and can slow the progression of the cancer but are not expected to cure it. This is alternative to surgical castration or orchiectomy which provides palliation for advanced prostate cancer. Other non-cancer uses for certain GnRH agonists include treatment for endometriosis and uterine fibroid non-malignant tumors in females. *expected action: cells of the prostate gland are dependent on testosterone to support growth and maintain the health of tissue. Acts as the pituitary gland to cause the release of luteinizing hormone (LH), ultimately stimulates testosterone production by the testes. Regular administration of the drug form of GnRH increases production of testosterone for a short time and then drastically decreases its production. The reason testosterone production stops is because giving the drug at regular intervals desensitizes pituitary receptors to the effects of hormone gonadotrophin-releasing hormone. Prostate gland tissue shrinks as testosterone production ceases including both cancerous and normal cells. *note: given subq (small dose once daily) or IM (large dose once a month or every 3 months), lupron depot (IM once every 4 months) 9. Estrogen receptor blockers- tamoxifen *estrogen receptor blockers treat estrogen receptor positive metastatic breast cancer as well as prevent the occurance of breast cancer in high risk women *TAMOXIFEN (soltamox) drug class: selective estrogen receptor blocker *activates estrogen receptors to maintain bone density and to increase the amount of HDL or good cholesterol both benefits of taking these drugs *note: is given to block the estrogenic receptors located in the breast tissue causing a decrease in estrogen-dependent cancers. Activates the estrogen receptors in the uterus increasing the clients risk for endometrial cancer. Premenopausal clients should observe for abnormal bleeding and spotting that indicates endometrial hyperplasia  selective estrogen receptor activation also causes two adverse effects in tamoxifen: increase in endometrial proliferation (cancer) and blood clotting *adverse reactions: n/v, hot flashes, blurred vision, increased risk for uterine cancer because of endometrial hyperplasia (overgrowth of the tissue that lines the uterus), increased risk for thrombophlebitis and thromboembolism (may cause embolism and stroke in some clients) *client instructions: instruct them to report to the provider persistent n/v, severe hot flashes, and blurred vision or decreased visual activity. Advise client to have regular ophthalmic examinations while taking and report abnormal menstrual bleeding which could be a sign of endometrial hyperplasia or cancer. Instruct client to report leg pain or swelling. Seek IMMEDIATE help if sudden chest pain, SOB, weakness on one side of the body occurs *contraindications: contraindicated in clients who are on anticoagulant therapy or have a hx of thrombocytopenia or endometrial hyperplasia, use caution with clients who have visual disturbances such as cataracts, bone marrow suppression, hypercalcemia, high blood cholesterol, or ductal carcinoma in situ of the breast *interactions: estrogens may decrease effectiveness of concurrently administered tamoxifen, blood levels are decreased by bromocriptine, may increase the anticoagulant effect of warfarm when taken concurrently, taking other anticancer drugs may increase the risk for thromboembolism w/ tamoxifen *note: interventions- monitor for GI effects, hot flashes visual disturbances. Assist as necessary w/ endometrial biopsies that can determine if the endometrial cancer has developed. Monitor client for leg pain, sudden chest pain or SOB, weakness on one side of body that can manifest thrombophletbitis, thromboembolism or stroke, monitor bone density and cholesterol levels