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Name of Student: Monica Carla C. Mamuric Name of Client: Herman Lee Age: 66 y/o  Sex: Male Civil Status: M Bed: B4 Medical Diagnosis: Laryngeal subglottic carcinoma s/p laryngectomyDrug Name: Carboplatin 

Drug Order:Drug classification antineoplastic agent; alkylating agent functionDrug Action: Carboplatin is a platinum compound that is a chemotherapeutic agent. It produces interstrand DNA cross-

linkages, thus interfering with DNA, RNA, and protein synthesis. Carboplatin is cell-cycle nonspecific, i.e., effective throughout

the entire cell life cycle.

Indications for patient:

  Combination therapy for laryngeal cancer

Contraindications:History of severe reactions to carboplatin or other platinum compounds, severe bone marrow depression; significant bleeding;

impaired renal function; pregnancy and lactation.

Adverse effects: Body as a Whole: Hypersensitivity reactions, ototoxicity

GI: Mild to moderate nausea and vomiting, anorexia, hypogeusia, dysgeusia, mucositis, diarrhea, constipation, elevated liver

enzymes.

Hematologic: Thrombocytopenia, leukopenia, neutropenia, anemia.Metabolic: Mild hyponatremia, hypomagnesemia, hypocalcemia, and hypokalemia.

CNS: Peripheral neuropathy.

Skin: Rash, alopecia.

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Special Senses: Tinnitus.

Urogenital: Nephrotoxicity.

Interactions:

Drug: AMINOGLYCOSIDES, loop diuretics may increase the risk of ototoxicity and nephrotoxicity. May decrease phenytoin

levels.Nursing Responsibilities:Administration:

PREPARE IV Infusion: Do not use needles or IV setscontaining aluminum. Immediately before use,reconstitute with either sterile water for injection or D5Wor NS as follows:50-mg vial plus 5 mL diluent; 150-mg vial plus 15mL

diluent; 450-mg vial plus 45 mL diluent. All dilutions yield10 mg/mL. May be further diluted to 0.5 mg/mL withD5W or NS. ADMINISTER IV Infusion: Give IV solution over 15 min orlonger, depending on total amount of solution and patienttolerance. Lengthening duration of administration maydecrease nausea and vomiting.INCOMPATIBILITIES Solution/additive: Sodium

bicarbonate,fluorouracil,mesna. Y-site: Amphotericin Bcholesteryl complex.

  Premedication with a parenteral antiemetic 1/2 hbefore and on a scheduled basis thereafter is

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normally used.

  Do not repeat doses until the neutrophil count is atleast 2000/mm3 and platelet count at least 100,00/mm3.

  Protect from light. Reconstituted solutions are stable for 8 h at room temperature; discard solutions 8 h after dilution.

Nursing responsibilities: Monitor closely during first 15 min of infusion, since allergic reactions have occurred within minutes of carboplatin

administration.

 Lab tests: Baseline and periodic CBC with differential, platelet count, Hgb and Hct. Monitor periodically kidney functionwith creatinine clearance tests and serum electrolytes, may cause increased serum bilirubin, alk phosphatase, AST

 Monitor results of peripheral blood counts. Median nadir occurs at day 21. Leukopenia, neutropenia, andthrombocytopenia are dose related and may produce dose-limiting toxicity.

 

Monitor for peripheral neuropathy (e.g., paresthesias), ototoxicity, and visual disturbances. Monitor for signs of anaphylaxis (rash, urticaria, pruritus, facial swelling, wheezing, hypotension)

 Monitor serum electrolyte studies, because carboplatin has been associated with decreases in sodium, potassium,calcium, and magnesium. Special precautions may be warranted for patients on diuretic therapy.

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Name of Student: Monica Carla C. Mamuric Name of Client: Herman Lee Age: 66 y/o  Sex: Male Civil Status: M Bed: B4 Medical Diagnosis: Laryngeal subglottic carcinoma s/p laryngectomyDrug Name: Diphenhydramine 

Trade name: Allerdry, Banophen, Genahist, Benadryl, Diphen, Diphenhist, NytolDrug Order: 500 mg/ampDrug classification: Ethanolamine; antihistamine, anticholinergic, antitussive, antiemetic  Drug action: Antagonizes the effects of histamine at H1-receptor sites; does not bind to or inactivate histamine; SignificantCNS depressant and anticholinergic properties.Indications for patient:

  Decrease hypersensitivity to chemotherapeutic agents  Symptomatic relief of fever and pain 

Contraindications:  Hypersensitivity   Acute attacks of asthma  Lactation  Known alcohol intolerance (some liquid product

Adverse effects:□  CNS: drowsiness, dizziness, headache, paradoxical excitation (increased in children).□  EENT: blurred vision, tinnitus.□

 

CV: hypotension, palpitations□  GI: anorexia, dry mouth, constipation, diarrhea.□  GU: dysuria, frequency, urinary retention.□  Derm: photosensitivity.

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□  Local: pain at IM site.Nursing Responsibilities:

  Cough Suppressant: Assess frequency and nature of cough, lung sounds, and amount and type of sputumproduced. Unless contraindicated, maintain fluid intake of 1500 –2000 ml daily to decrease viscosity of bronchialsecretions.

 

Pruritus: Assess degree of itching, skin rash, and inflammation.  Prevention and Treatment of Anaphylaxis: Assess for urticaria and for patency of airway.  Allergic Rhinitis: Assess degree of nasal stuffiness, rhinorrhea, and sneezing.  Monitor BP, especially in elderly (increased risk of hypotension)

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Name of Student: Monica Carla C. Mamuric Name of Client: Herman Lee Age: 66 y/o  Sex: Male Civil Status: M Bed: B4 Medical Diagnosis: Laryngeal subglottic carcinoma s/p laryngectomy, recurrent liver metastasesDocetaxel

FUNC. CLASS: Anti-neoplasticCHEM CLASS: Antimicrotubulestool; Renal clearance is relatively low at about 10%USE: Breast, Non-small cell lung, Prostate, Gastric Cancer, Suamous cell carcinoma of the head and neckOff-label uses: Ovarian, Pancreatic, Head and Neck, Esophagus, Sarcoma, Uterine, BladderIndication for Patient:

  Head and Neck Cancer (Laryngeal cancer)Contraindications: Hypersensitivity; Hyper-

sensitivity to polysorbate 80; Known alcohol intolerance; Neutrophil count <1500/mm3; Liver impairment (serum bilirubin>upper limit of normal, ALT and/or AST >1.5 times upper limit of normal, with alkaline phosphatase >2.5 times upper limitof normal); pregnancy, lactation

ROUTE OF ADMIN: Intravenous infusion ONLY, over 60 minutesPRETREATMENT GUIDELINES: CBC and baseline liver fcn; DO NOT ADMIN if total bilirubin >=ULN or AST/ALT >1.5times ULN, and alkaline phosphate >2.5 times ULNSIDE EFFECTS: Irritant, potential vesicant, fatigue, myelosuppresion, hypersensitivity reaction, fluid retentionsyndrome, rash, nail changes, alopecia, mucositis, peripheral neuropathy, hyperlacrimation 2o to ductal stenosis, whichcan be treated with stent placement. Pt needs referral to OpthaSTORAGE: Unreconstituted vials: unopened vials require protection from bright l ight; may be stored at room temp orrefrigerated

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MIXING INSTRUCTIONS: Allow refrigerated vials to stand at least 5 minutes at room temperature before reconstitution,Vials are available as 80-mg or 20-mg concentrate as single dose blister packs with diluents; do not reuse single dosevials. Once diluent added to concentrate, resulting concentration is 10 mg/ml-must be further diluted. Gently invertrepeatedly. Do not shake initial diluted solution. Withdraw ordered dose and further dilute in appropriate volume of 5%dextrose or 0.9%NaCl to final concentration of 0.3-0.74 mg/ml. Thoroughly mix by manual rotation.

PRODUCT STABILITY: Reconstituted solution is good for 8 hour at room temperature or refrigerated.COMPATABILITY WITH OTHER DRUGS/IV FLUIDS: Compat with 5%dextrose or 0.9%NaClDRUG INTERXNS: Radiosensitizing effect; CYP3A4 inhibitors such as ketoconazole, erythromycin, cyclosporine,terfeneradine, nifedipine can inhibit docetaxel metabolism; CYP3A4 inducers such as phenytoin, carbamazepine,Phenobarbital, and St. John’s Wort may decrease serum level of docetaxel. Infuse docetaxel prior to platinum compoundsto decrease toxicity.NSG/SPECIAL CONSIDERATIONS:Pts should receive steroid premedication to decrease the incidence and severity of hypersensitivity reactions and fluid

retention; Use only glass, polypropylene bottles, or polypropylene bags for drug admin; Administer slowly with rapidly flowing IV due to vesicant potential;Flush peripheral line before removal to reduce potential for leakage of drug into the skin;Teach patient fatigue prevention strategies

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Name of Student: Monica Carla C. Mamuric Name of Client: Herman Lee Age: 66 y/o  Sex: Male Civil Status: M Bed: B4 Medical Diagnosis: Laryngeal subglottic carcinoma s/p laryngectomy, recurrent liver metastasesDrug Name: 5-fluorouracil Trade Name: Adrucil, Efudex, Fluoroplex, 5-FU

Drug Order: Drug classification:Drug action: Inhibits the formation of thymidine, which is necessary for DNA Synthesis; causes abnormal RNA synthesis; Acts synergistically with methotrexate; Cell cycle phase specifi c for the S phase.Indications for patient:

  Head and neck cancerContraindications: allergy, pregnancy, lactationAdverse effects:

Myelosuppression may be dose limiting, but less common withcontinuous infusion.• Mucositis is most common DLT with continuous infusions. Symptoms of erythema, soreness, and ulceration may beginwithin 5 –8 days of therapy. Sucking on ice chips as tolerated may decrease PO stomatitis, esopharyngitis• Diarrhea can be severe, even life- threatening, especially when 5-FU is given in higher doses with leucovorin.Nausea, vomiting, and anorexia occur less frequently, butare more common when 5-FU is given simultaneously withradiation to the abdomen.• Skin and nail bed changes occur, especially with continuous infusion. Partial nail loss can occur as well as banding.Palmarplantar erythrodysesthesias can be severe, necessitating dose reduction and treatment delays. Hyperpigmentation

and photosensitivity are common. Patients are cautioned to protect themselves from the sun.• Excessive lacrimation due to tear duct stenosis and blurred vision occur in about 25% of patients. • Headache, cerebellar ataxia, nystagmus, and confusion occur with higher doses.• Administering 5-FU based on the patient’s circadian rhythm may lessen toxicity in general. 

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• Alopecia is dose dependent. • Ataxia occurs in elderly patients. Other CNS changes include headache, drowsiness, and blurred visionDrug-drug: irinotecan, bone marrow depressants- dec antibody response to live-virus vaccines Y-Site Compatibility: allopurinol, amifostine, aztreonam, bleomycin, cefepime, cisplatin, cyclophosphamide, doxorubicin,doxorubicin liposome, etoposide, fludarabine, furosemide, gemcitabine, granisetron, heparin, hydrocortisone, leucovorin,

linezolid, mannitol, melphalan, methotrexate, metoclopramide, mitomycin, paclitaxel, pemetrexed, piperacillin/tazobactam,potassium chloride, propofol, sargramostim, teniposide, thiotepa, vinblastine, vincristine, vitamin B complex with C. Y-Site Incompatibility: aldesleukin, amphotericin B cholesteryl sulfate complex droperidol, filgrastim, lansoprazole,topotecan, vinorelbine.Additive Compatibility: bleomycin, cyclophosphamide, D5/LR, etoposide, floxuridine, ifosfamide, methotrexate,mitoxantrone, vincristine.Additive Incompatibility: carboplatin, cisplatin, cytarabine, diazepam, doxorubicin, epirubicin, fentanyl, leucovorin,metoclopramide, morphine.

Nursing Responsibilities:   Monitor VS    Assess for bleeding, vomiting, consistency of stools    Assess IV sites for inflammation or infiltration    Assess skin for palmar-plantar erythrodysthesia (tingling of hands and feet followed by pain erythema and

swelling   Monitor I and O. Adjust diet.   May cause decreased plasma albumin 

 

 Administration precautions: may be given a variety of ways: IV as a continuous infusion, IV push, arterialinfusion, intracavitary, or intraperitoneally. 

  Store at room temperature and protect from light.

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Name of Student: Monica Carla C. Mamuric Drug Name: Dexamethasone (DexPak)Drug classification: Long-acting corticosteroidsDrug action: anti-inflammatory, suppress adrenal functionIndications for patient:

 

 Adjunctive mgt of nausea and vomiting from chemotherapy   Mgt of cerebral edema 

   Anti-inflammatory 

  Prevent resp distress syndrome in the newborn

   Airway edema prior to extubation Contraindications:

   Active untreated infection 

  Lactation

 

Known alcohol, bisuflite or tartrazine hypersensitivity or intolerance 

   Admin of live virus vaccines Use cautiously in:

  Chronic treatment

  Hypothyroidism

  Cirrhosis

  Children

 

Stress  Pregnancy

  NeonatesAdverse effects: 

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CNS: Depression, Euphoria, Headache, Inc ICP, personality changes, psychoses, restlessness| EENT: Cataracts, Incintraocular pressure CV: HypertensionGI: Peptic ulceration, anorexia, nausea, vomiting| Derm: acne, dec wound healing, fragility, ecchymoses, fragility,hirsutism, petechiae Endo: Adrenal suppression, hyperglycemia| F&E: Fluid retention, hypokalemia, hypokalemicalkalosis| Hemat: Thromboembolism, thrombophlebitis| Metab: Weight gain| MS: Muscle wasting, osteoporosis, aseptic

necrosis of joints, muscle pain| Misc: Cushingoid appearance, inc susceptibility to infectionDrug-Drug interactions: Hypokalemia with thiazide and loop diuretics or amphotericin B, inc risk of digoxin toxicity |Increq for insulin or oral hypoglycemic agent |Phenytoin, Phenobarbital and rifampin inc metabolism,|Hormonalcontraceptives dec metabolism|Inc GI effects with NSAIDS|dec antibody response and inc risk of adverse rxns from livevirus vaccines inc conc of cyclosporine and tacrolimus|inc risk of tendon rupture from fluoroquinolones|antacids decabsorption|dec isoniazid levels and effectiveness|

Nursing Responsibilities:

 

 Assess involved systems    Assess for adrenal insufficiency (hypotension, weight loss, weakness, anusea, vomiting, anorecia, lethary,

confusion, restlessness) 

  Monitor I/O and daily weight; observe for peripheral edema, wt gain, rales/crackles, dyspnea 

  Children should have periodic evaluations of growth 

   Assess for LOC and headache 

  Monitor serum electrolytes and glucose 

  Lab test;may increase hyperglycemia, hyoppkalemia, may increase sodium conc Direct IV: Diluent: May be given undiluted | Conc: 4-10 mg/ml | Rate: Administer over 1-4 min if dose is <10mg|Intermittent infusion: Diluent: High-dose therapy should be added to D5W or 0.9NaCl, solution clear and colorless tolight yellow | Storage: Use diluted solution w/in 24 hr|Conc: Up to 10mg/ml|Rate: Infuse over 15-30 minSyringe compatibility: granisitron, metoclopramide, palonosetron, ranitidine, sufentanil

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Syringe incompatibility: doxapram, glycopyrrolate, pantoprazole Y-site compatibility: acyclovir, allopurinol, amifostine, amikacin, amphotericin B cholesteryl, amsacrine,aztreonam, bivalirudin, cefepime, cisatracurium, cisplatin, cladribine, cyclophosphamide, cytarabine,dexmedetomidine,docetaxel, doxorubicin,doxorubicin liposome, etoposide phosphate, famotidine, fentanyl, filgrastim, fluconazole,fludarabine, foscarnet, gallium

nitrate, gatifloxacin, gemcitabine, granisetron, heparin,hydromorphone, lansoprazole, levofloxacin,linezolid, lorazepam, melphalan, meperidine,meropenem, methadone,milrinone,morphine, ondansetron, oxaliplatin, paclitaxel, pemetrexed, piperacillin/tazobactam, potassium, propofol, remifentanil,sargramostim, sodium bicarbonate, sufentanil, tacrolimus, teniposide, theophylline, thiotepa, vinorelbine, vitamin Bcomplex with C, zidovudine Y-Site Incompatibility: ciprofloxacin, fenoldopam, idarubicin, midazolam, topotecanAdditive compatibility: aminophylline, vleomycin, cimetidine, floxacillin, furosemide, granisetron, lidocaine, meropenem,nafcillin, palonosetron, ranitidine

Additive incompatibility: daunorubicin, metaraminol, vancomycin 

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Name of Student: Monica Carla C. Mamuric Drug Name: Metoclopramide Trade Name: Apo-Metoclop, Maxolon, Metozolv, ODT, Nu-Metoclopramide,Octamide PFS, ReglanDrug Order:Drug classification: Anti-emetic, dopaminergic blocker, GI stimulant

Drug action: Stimulates motility of upper GI tract without stimulating gastric, biliary, or pancreatic secretions; appear tosensitize tissues to action of acetylcholine; relaxes pyloric sphincter, which, when combined with effects of motility,accelerates gastric emptying and intestinal transit; increases lower esophageal sphincter pressure; has sedativeproperties; induces release of prolactinIndications for patient:

  Symptomatic gastroesophageal reflux   Parenteral: prevention of n/v assoc. w/ emetogenic cancer chemotherapy 

Contraindications:

 

 Allergy   Mech. Obstruction or perforation   Gi hemorrhage   Pheochromocytoma 

Adverse effects:

CNS: Restlessness, drowsiness, fatigue, lassitude, extrapyramidal reaction

CV: transient hypertensionGI: nausea, diarrhea

Desired Action:  The client will be able to prevent or relieve emesis.

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Nursing Responsibilities:  Use cautiously w/ previously detected breast cancer, lactation, pregnancy, fluid overload, renal impairment  Do not mix chloramphenicol, sodium bicarbonate, cisplatin and erythromycin  Drug to drug: dec. absorption of digoxin; inc. tocxicity and immunosuppressive effects woth cyclosporine;

inc.neuromuscular blocking effects w/ succinylcholine 

Monitor BP carefully during IV administration; VS 

Monitor for extrapyramidal reactions   Arrange for alteration in insulin dose and timing  Have phentolamine readily available in case of hypertensive crisis (for pheochromocytoma)  Instruct pt not to use alcohol, sleep remedies and sedatives - serious sedation

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Name of Student: Monica Carla C. Mamuric Name of Client: Herman Lee Age: 66 y/o  Sex: Male Civil Status: M Bed: B4 Medical Diagnosis: Laryngeal subglottic carcinoma s/p laryngectomy, recurrent liver metastasesDrug: OndansetronDosage: Route: Frequency:

Drug Classification: gastrointestinal agent; antiemetic; serotonin 5-HT3-receptor antagonistPharmacologic action of drug: Selective serotonin (5-HT3) receptor antagonist. Serotonin receptors are located centrally in the

chemoreceptor trigger zone (CTZ) and peripherally on the vagal nerve terminals. Serotonin is released from the wall of the small

intestine and stimulates the vagal efferents through the serotonin receptors and initiates the vomiting reflex.

Therapeutic Effects: Prevents nausea and vomiting associated with cancer chemotherapy and anesthesia.

Indications:

Prevention of nausea and vomiting associated with initial and repeated courses of cancer chemotherapy, Contraindications: 

Hypersensitivity to ondansetron.Adverse Effects:

CNS: Dizziness and light-headedness, headache, sedation.

GI: Diarrhea, constipation, dry mouth, transient increases in liver aminotransferases and bilirubin.

Body as a Whole: Hypersensitivity reactions.

Interactions:

Drug: Rifampin may decrease ondansetron levels.

Administration:PREPARE Direct: May be given undiluted. IV Infusion: Dilute a single does in 50 mL of D5W or NS. May be further diluted inselected IV solution.

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 ADMINISTER Direct: Give over at least 30 sec, 2 –5 min preferred. IV Infusion: Give over 15 min. When three separate doses areadministered, infuse each over 15 min.INCOMPATIBILITIES Solution/additive: Meropenem. Y-site: Acyclovir, allopurinol, aminophylline, amphotericin B, ampicillin,ampicillin/sulbactam, amsacrine, cefepime, cefoperazone, fluorouracil, furosemide, ganciclovir, lorazepam, meropenem,methylprednisolone, piperacillin, sargramostim, sodium bicarbonate, TPN.Nursing responsibilities:

 

Monitor fluid and electrolyte status. Diarrhea, which may cause fluid and electrolyte imbalance, is a potential adverse effect ofthe drug.

  Monitor cardiovascular status, especially in patients with a history of coronary artery disease. Rare cases of tachycardia andangina have been reported.

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Name of Student: Monica Carla C. Mamuric Name of Client: Herman Lee Age: 66 y/o  Sex: Male Civil Status: M Bed: B4 Medical Diagnosis: Laryngeal subglottic carcinoma s/p laryngectomy, recurrent liver metastasesDrug Name: Ranitidine Trade Name: Zantac, Zantac 75Drug Order: 

Drug classification: antiulcer agents; histamine H2 antagonistsDrug action: Inhibits the action of histamine at the H2-recep-tor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion.Indications for patient:

 

Prevent nausea and vomiting  Prophylaxis of hyperacidity from chemotherapeutic drugs

Contraindications:   Allergy 

 

 Alcohol intolerance  

phenylketonuriaUse cautiously: renal impairment , acute porphyria, geriatric, alcholic, lactation, pregnancy

Adverse effects:

CNS: confusion, dizziness, drowsiness, hallucinations, headache. CV: ARRHYTHMIAS. GI: consti-pation, diarrhea, nausea. GU:decreased sperm count Endo: gynecomastia. Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, anemia, neutropenia,thrombocytopenia. Local: pain at IM site. Misc: hypersensivity reactions, vasculitis.Drug-drug:

decreased absorption of atazanavir, delavirdine, ketoconazole, and itraconazole. Administration: IV, IM (Adults): 50 mg q 6 –8 hr. Continuous IV infusion—6.25 mg/hr. Gastric hypersecretory conditions—1mg/kg/hr; may be increased by 0.5 mg/kg/hr (not to exceed 2.5 mg/kg/hr). 0.5 mg/kg/dose once daily.Nursing Responsibilities: 

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 Assess for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. 

Geri: Assess geriatric and debilitated patients routinely for confusion. Report promptly. 

Lab Test Considerations: Monitor CBC with differential periodically during therapy.  Antagonize effects of pentagastrin and histamine during gastric acid secretion testing. Avoid administration for 24 hr

before the test.  May cause false-negative results in skin tests using allergenic extracts. Histamine H2 antag-onists should be

discontinued 24 hr before the test. 

May cause increase in serum creatinine.  False positive results for urine protei

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