DRUG STUDY

Name of Patient: Juvy Rodriguez Age: 43 years old

Chief Complaint: Molar Pregnancy
Initial Diagnosis: Molar Pregnancy with Previous Molar Pregnancy in 2008

Generic Name Dosage and

Classification Indication Contraindication Side Effects Nursing Responsibilities
(Brand Name) Frequency
Dexametason 20mg IV 30 Orticosteroid  Hypercalcemia Contraindicated in: CNS: vertigo, Assessment:
e minutes prior Glucocorticoid associated with  Infection headaches,  History for systemic
chemotherap Hormone cancer especially euphoria, administration: Active infections,
y  Thromboocyto tuberculosis, insomnia, mood renal or hepatic disease,
penic purpura, fungal infections swings, hypothyroidism, ulcerative colitis,
erythroblasropenia amebiasis, depression diverticulus, active or latent peptic
 Ulcerative vaccinia and CV: Hypertension ulcer, inflammatory bowe disease,
colitis, acute varicella, and Endo: Secondary thromboembolic disorders,
exacerbation of antibiotic adrenocortical Hypertension, CHF,osteoporosis,
multiple sclerosis, resistant and pituitary seizure disorders, diabetes
and palliation in infections unresponsivenes mellitus, lactation.
some leukemias  Allergy to any s Interevention:
and lymphomas component of  Do not give drug to nursng
 Anti-emetic for preparation used. GU: Amennorhea,
mothers; drug is secreted in breat
cisplastin-induced irregular menses
milk.
vomiting Use cautiously in: Hema: Fluid and
electrolyte  Increase dosage when patient
 Renal or is subject to stress.
hepatic disease disturbances
MS: Muscle  Taper doses when
 Hypothyroidis discontinuing high-dose or long-
m weakness
Other: impaired term therapy.
 Ulcerative  Do not give live virus vaccines
colitis with wound healing,
petechiae, with immunosuppressive doses of
impending costicosteroids.\
perforation ecchymosis,
increased  Report unusual weight gain,
 Diverticulus swelling of the extremities, muscle
sweating, thin
 Active or weakness, black or tarry stools,
and fragile skin,
latent peptic ulcer ever, prolonged sore throat, colds
acne,
 Thromboemb immunosupressio or other infections, worsening o the
olic disorders n and masking of disorder.
 Hypertension signs of infection
, CHF
 Seizure
 disorders
 Diabetes
mellitus

Generic
Name Dosage and
Classification Indication Contraindication Side Effects Nursing Responsibilities
(Brand Frequency
Name)
Leucovorin 15mg IM Folic acid  “Leucovorin  Contraindic  Hypersen Assessment:
Calcium every 12 hours derivative rescue” – after ated with allergy sitivity:  History: Allergy to leucovorin on
(Folinic Acid) for 4 doses high dose to leucovorin on Allergic previous exposure, pericous anemia
beginning 24 methotrexate previous reaction or other megaloblastic anemias,
hours from therapy for various exposure,  Local: lactation, pregnancy.
giving cancers. pernicious Pain,  Physical: Skin lesions, color; R,
methotrexate  To decrease anemia, or other discomfort at adventious sounds; CBC, Hgb, Hct,
bolus toxicity of megaloblastic injection site. serum folate levels, serum
methotrexate anemias in methotrexate levels.
caused by which vitamin Interventions:
decreased B12 is deficient.  Begin leucovorin rescue within 24
elimination or for  Use hours of methotrexate
inadvertent cautiously with administration. Arrange for fluid
overdose of folic pregnancy and loading and urine alkalinization
acid antagonists lactation. during this procedure to decrease
(methotrexate, methotrexate toxicity
trimethoprim, or  Give drugs orally unless intolerance
pyrimethamine) to oral route develops due to nausea
ad vomiting from chemotherapy or
clinical conditions. Switch to oral
drugs when feasible. Doses >25mg
should be divided or given IV.
 Monitor patient for hypersensitivity
reactions, especially if drug has
been used previously. Keep
supportive equipment and
emergency drugs readily available in
case of serious allergic response.
Nursing Consideration:
 IV route is preferred in patients with
GI toxicity when doses exceed 25
mg.
 Drug may mask diagnosis of
pernicious anemia.
 Follow leucovorin rescue schedule
and protocol closely.
 Don’t give leucovorin with systemic
methotrexate.
  Do not confuse leucovorin (folinic
acid) with folic acid.
 Do not give leucovorin intrathecally.

Generic
Name Dosage and
Classification Indication Contraindication Side Effects Nursing Responsibilities
(Brand Frequency
Name)
Methotrexate 148mg IV Therapeutic: Treatment of Contraindicated in: CNS: dizziness,  Monitor BP, pulse
bolus Antineoplastic; trophoblastic  Hypersensi drowsiness, &respiratory rate periodically
Antirhuematics; neoplasms tivity headaches, malaise, during administration. Report
Immunosuppressants (gestational  Pregnancy fatigue significant changes.
. choriocarcinom, and Lactation Resp: interstitial  Monitor for abdominal pain,
chorioadenoma  Alcoholism pneumonitis diarrhea, or stomatitis. Report
Pharmacologic: destruens,  Chronic GI: hepatotoxicity, occurrence, therapy may need to
Antimetabolites. hydatidiform Liver Disease nausea, ulcerative be discontinues.
mole)  Immune stomatitis, vomiting  Monitor bone marrow
deficiencies GU: infertility depression. Assess for bleeding
High-dose regimen Derm: erythematous (bleeding gums, bruising,
 Blood
followed by rashes, alopecia, petechiae, guaiac stools, urine
dyscrasiaa
leucovorin Hema: severe bone and emesis) and avoid IM
rescue for marrow depression, injections & taking rectal
Use cautiously in:
adjuvant therapy increased temperature idf platelet count is
 Renal
of nonmetastatic susceptibility to low. Apply pressure to
impairment
osteosarcoma. infection venipuncture site for 10 minutes.
 Peptic Misc: nephropathy
ulcer Assess for signs of infection
chills, fever, soft during neutropenia. Anemia may
 Ulcerative tissue necrosis occur. Monitor for increased
colitis Hypersensitivity: fatigue, dypsnea, & orthostatic
 Active Anaphylaxis, sudden hypotension.
infections death  Monitor intake and outpt ratio
 Decreased
& daily weights. Report significant
bone marrow
changes in totals.
reserve
 Monitor for symptoms of
pulmonary toxicity, which may
manifest early as a dry, non-
productive cough.
 Monitor for symptoms of gout
(increased uric acid, joint pain,
edema). Encourage patient to
drink at least 2L of fluids each
day.
 Assess nutritional status.
Administering antiemetic prior to
and periodically during therapy
and adjusting diet as tolerated
 may help maintain fluid &
electrolyte balance and nutritional
status.
 Lab Test Consideration:
Monitr CBC & differential pain to
and frequently during therapy.
Notify physician of any sudden
drop of values.
 Monitor renal (BUN &
creatinine) & hepatic function
(AST, ALT, biliburin & LDH) prior
to & routinely during therapy.
Urine pH should be monitored
prior to high-dose methotrexate
therapy & every 6 ours during
leucovorin rescue. Urin pH should
be kept above 7.00 to prevent
renal damage.
 May cause increased serum
uric acid concentrations,
especially during initial treatment
of leukaemia & lymphoma.
 Toxicity & Overdose: Monitor
Serum methotrexate level every
12 to 24 hours during high-dose
therapy until levels are less than
5x10M. with hgh-dose therapy,
patient must receive leucovorin
rescue within 24 to 48 hours to
prevent fatal toxicity. In cases pf
massive overdose, hydration &
urinary alkalization may be
required to prevent renal tubule
damage. Monitor fluids &
electrolytes.

Generic
Name Dosage and
Classification Indication Contraindication Side Effects Nursing Responsibilities
(Brand Frequency
Name)
Sodium 625mg i tab Electrolyte  Treatment of Contraindicated in: Hema: Systemic Assessment:
Bicarbonate TID for 10 Systemic metabolic  Allergy to alkalosis  History: Allergy to components
days alkalinizer acidosis, with components of (headache, of preparation, Low serum chloride,
Urinary measures to preparation nausea, irritability, Metabolic and respiratory alkalosis,
alkalinizer control the cause  Low serum weakness, tetany, hypocalcemia, Impaired renal
Antacid of acidosis chloride confusion, function, CHF, Edematous or
 Treatment of  Metabolic and hypokalemia sodium retaining states, Oliguria or
certain drug respiratory secondary to anuria, Potassium depletion,
 intoxication, alkalosis; intracellular Pregnancy
haemolytic hypocalcemia sihfting of Interevention:
reactions that potassium,  Have patients chew oral tablets
require Use cautiously in: hypernatremia thoroughly before swallowing and
alkalinization of  Impaired renal follow then with a full glass of water.
urine function  Do not give oral sodium
 Prevention of  CHF bicarbonate within 1-2 hours of other
methotrexate  Edematous or drugs to reduce risk of drug
nephrotoxicity by sodium retaining interaction
alkalinization of states  Report irritability, headache,
urine  Oliguria or tremors, confusion, swelling of the
 Minimization anuria extremities, DOB, black or tarry
of uric acid  Potassium stools.
crystalluria depletion
 Pregnancy
 Lactation

Generic
Name Dosage and
Classification Indication Contraindication Side Effects Nursing Responsibilities
(Brand Frequency
Name)
Vincristine 1.68mg slow Mitotic inhibitor  Acute Contraindicated in: CNS: Ataxia, cranial Assessment:
IV for 30 Antineoplastic leukaemia  Allergy to nerve  History: Allergy to vincristine,
minutes.  Hodgkin’s vincristine manifestation, leukopenia, acute infections,
disease  Leukopeni neuritic pain, neuromuscular disease, diabetes
 Non-Hodgkin’s a muscle wasting insipidus, hepatic dysfunction,
lymphoma  Acute GI: Constipation pregnancy, lactation
 Rhabdomyosarc infection Hema: Leukopenia Interevention:
oma  Pregnancy Other: Weight loss,  Ensure patient is not pregnant
 Neuroblastoma  Lactation loss of hair, death before administering.
with serious  Tell patient to avoid grapefruit
 Wilm’s tumor  Demyelina
overdose juice while being treated with this
ting Charcot-
Marie-Tooth drug.
Syndrome  Do not administer IM or SQ due
to sever local reaction and tissue
Use cautiously in: necrosis.
 Neuromus  Do not give intrathecally, drug if
cular disease fatal if given IT.
 Diabetes  WOF irritation and infiltration;
insipidus extravasation causes tissue
 Hepatic damage and necrosis. If it occurs,
dysfunction discontinue injection immediately
and give remainder of dose in
another vein.
 Monitor urine output and serum
sodium; if SIADH occurs, consult
with physician and arrange for fluid
restriction and perhaps a potent
diuretic.