MEDICATION
ORDER
Generic:
Methotrexate
Route: PO
Brand: Rheumatrex
Frequency: Once
weekly.
DOSE AND RANGE
(APA citation)
Ordered: 7.5 mg
once weekly, PO.
Safe Range: 5mg20mg
Time(s): any time
Maximum: Do not
exceed 20-30
mg/m^2.
(Vallerand, 2022).
CLASSIFICATION
MECHANISM OF ACTION
(APA Citation)
It is an
antimetabolites. Used
for
immunosuppression
and killing of
malignant cells from
replicating (Vallerand,
2022). It works by
inhibiting DNA
synthesis by
interering with folic
acid metabolism
(Vallerand, 2022).
PT SPECIFIC
REASON FOR
MEDICATION
Rheumatrex is
often
prescribed for
treating
rheumatoid
arthritis and
severe
psoriasis.
COMMON/LETHAL
SIDE EFFECTS
(APA Citation)
Lethal side
effects include
eruthema
multiforme,
stevens-johson
syndrome, toxic
epidermal
necrolysis, GI
perforation,
hepatotoxicity,
aplastic
anemia,
seizures,
interstitial
pneumonitis,
hypersensitive
reactions
(Vallerand,
2022).
Additionally,
other common
side effects are
anorexia,
diarrhea,
nausea,
stomatitis,
vomiting,
nephrophty,
anemia,
leukopenia,
thrombocytope
nia (Vallerand,
2022).
NURSING CONSIDERATIONS
Assessment/Monitoring:
Should monitor vital signs
frequently during
administration of the drug.
Careful monitor for bone
marrow depression and use
precautions when platelete
count is low. Assess for
rashes frequently during
therapy. Effectiveness of
therapy is determine by
improvement in
hematopoietic values in
leukemia or decrased size
and spread of maglinant
cells.
Administration/ IV
compatibility: Can be given
IV, IT or PO
Teaching: Educate the
patient to follow the order
when taking the medication.
Also, instruct the patient to
notify provider promptly if
they experience any signs of
infection and rahses.
Generic: cytarabine
Brand: Cytosar-U,
DepoCyt
Route: IV push
Frequency: every 2
weeks
Time(s): 5 days
Ordered: 200
mg/m^2/day for 5
days every 2 wk as a
single agent, IV.
Safe Range: 5-75
mg/m^2Maximum: n/a
Inhibits DNA
polymerase which
distrubts DNA
synthesis and
ultimately causes
death of malignant
cells from rapidly
recpilicating
(Vallerand, 2022).
(Vallerand, 2022).
Generic:
mercaptopurine
Route: PO
Ordered: 50mg daily
PO.
Frequency: daily
Brand: purinethol
Time(s): Administer
once with meals.
Safe Range: 1.5-2.5
mg/dg/day as single
dose.
Maximum: 0.75-1.5
mg/kg/day PO is
usual maximal dose
range (PDR, n.d.).
Causing death of
malignant cells and
immunosuppression
by distrupting DNA
and RNA synthesis
(Vallerand, 2022).
Cytosar-U is
prescribed for
remission
induction in
nonlymphocytic
leukemia.
DepoCyt is
used to reduce
symptoms of
acute
nonlymphcytic
leukemia.
To treat acute
lymphocytic
leukemia.
Letheal side
effects include
pulmonary
edema,
hepatotoxicity,
chemical
arachnoiditis
(Vallerand,
2022). Other
common side
effects are
nausea,
vomiting,
anemia,
leukopenia,
throbocyotopen
ia (Vallenarand,
2022).
Assessment/Monitoring:
monitor for bone marrow
depression and assess for
bleeding. Take daily weights
and keep data of I&O.
Nutritional assessment
necessary. Monitor renal
and hepatic functions.
Lethal side
effects:
hepatotoxicity,
machrophage
activation
syndrome,
hepatoslenic Tcell lymphoma,
secondary
amliganancy
(Vallerand,
2022).
Commone side
effects: anemai,
leukopenia,
thrombocytope
nia
(Vallenarnad,
2022).
Assessment/Monitoring
Administration/ IV
compatibility: IV, SC, IT
Teaching: Instruct patient to
avoid crowed area and any
contact with people who are
sick. Educate patient to
report any unusual bleeding
and monitor their oral
mucosa and gum for
bleeding or ulcerations.
Administration/ IV
compatibility
Teaching
Generic: leuprolide
Brand: Lupron,
Lupron Depot
Route IM
Ordered: 7.5 mg
once monthly for up
to 6 months
Frequency:
monthly.
Safe Range: 7.5-45
mg.
Time(s): once up to
6 months.
Maximum: 45 mg.
(Vallerand, 2022),
Decreases
testosterone levels by
acting as a synthetic
analogue of
luteinizing hormonereleasing hormone
which ultimately
reduces pain/lesions
induced by
endometriosis
(Vallerand, 2022).
To treat
endometriosis.
Lethal side
effects: MI,
heptatotoxicity,
GI bleeding,
seuizures,
stroke,
pulmonary
elmbolism
(Vallerand,
2022).
Common side
effect: hot
flashes
(Vallerand,
2022).
Assessment/Monitoring:
Periodic ECG monitor
required and assess for QT
interveral prolongation.
Assess pain before and
frequently during the
therapy. Monitor
testostronte and electrolytes
before beginning the
theraphy.
Administration/ IV
compatibility: IM, SC, no IV.
Teaching: Let the patient
know that the medication
may cause hot flashes.
Educate patient about forms
of contraceptions other than
oral contraceptives as the
therapy can reduce the
effectiveness of oral
contraceptives.
Generic: flutamide
Route: PO
Brand: Eulexin
Frequency: every 8
hr
Time(s): 3 times a
day/
Ordered: 250 mg PO
every 8 hr daily.
Safe Range: 2
capsues a day.
Maximum: 750 mg.
Adntrogen
(testosterone)
antagonizers, which
reduces growth of
prostate carcinoma
(Vallerand, 2022).
Prostate cancer
treatment.
Lethal side
effects are
hepatotoxicity
and other
common side
effects are
gynecomastia,
diarrhea,
nausea,
vomiting,
erectile
dysfunction,
loss of libido,
and hot flashes
(Vallerand,
Assessment/Monitoring:
monitor for development of
diarrhea, nausea, vomiting
to make adjustment in
dosage. Monitor patient’s
lab results especially AST,
ALT , bilirubine and serum
creatinine (Vallerand, 2022).
Administration/ IV
compatibility: PO no IV.
Teaching: notify immediately
if patient is experiencing
Generic: tamoxifen
Route: PO
Ordered: 20 mg
once daily PO.
Frequency: daily.
Brand: Nolvadex
Time(s): once with
meals (food or
fluids).
Safe Range: 20 mg
daily for 5 years
(Cunha, 2021).
Maximum: n/a.
Generic:
anastrozole
Route: PO
Ordered: 1 mg once
daily, PO.
Frequency: daily
Safe Range: 10-60
mg.
Brand: Arimidex
Time(s): Once
Maximum: up to 60
mg in a single dose
(Cunha, 2021).
Interferes estrange
binding sites which
reduces DNA
synthesis which
ultimately releases
therapeutic effects of
suppressing tumor
growth and
preventing breast
cancer in high-risk
patients (Vallearand,
2022).
Breat cancer
treatment.
Inhibits the
aromatase and
disrupts concersion
of precursors to
estrogen (Vallerand,
2022).
Delaying breast
cancer
progression.
2022).
darkening of urine, itching,
and loss of appetite,
nausea, vomiting (Vallerand,
2022). Warn the patient
about common side effect of
hot flashes and how it does
not have any significant
impact on health.
Lethal side
effects are
thromboemboli
sm, uterine
malignancies,
stroke, and
other common
side effects are
nausea, hot
flashes
(Vallerand,
2022).
Assessment/Monitoring:
Monitor pain in bone or
tumor.
Lethal side
effect: MI,
angioedema,
urticaria,
anaphylaxis,
and other
common side
effects are
nausea, back
pain,
headache,
weakness, hot
flashes, and
pain (Vallerand,
2022).
Assessment/Monitoring:
Assess for pain and other
side effects frequently
throughout the therapy.
Administration/ IV
compatibility: PO, no IV
Teaching: notify for pain or
swelling of legs, SOB,
weakness, confusion,
weight gain, and menstrual
irregularities (Vallerand,
2022),
Administration/ IV
compatibility: PO.
Teaching: Notify provider
immediately observing any
allergic reactions, liver
problems, yellowing of skin
or eyes (Vallearand, 2022).
Generic:
trastuzumab
Route: IV
Frequency: every 3
weeks.
Ordered: 8 mg/kg IV
initially then 6 mg.kg
every 3 weeks until
disease
progressiones.
Brand: Herceptin
Time(s): once, 90
minutes
Safe Range: 6
mg/kg- 8mg/kg
Maximum8mg/kg
(Vallearand, 2022).
Bind to HER2 sites in
breat cancer tissue
and prevents growth
of cells, this results in
delaying progress of
breat, gastric or
gastroesphoageal
cancer (Vallerand,
2022).
Treat
oesophageal
cancer.
Lethal side
effects:
arrhythmias,
HF, interstitial
pneumonitis,
pulmonary
edema,
pulmonary
fibrosis,
hypersensitive
reactions,
infections, and
other common
side effects are
abdominal pain,
anorexia,
diarrhea,
nausea,
vomiting, back
pain, chills,
fever, pain
(Vallerand,
2022).
Assessment/Monitoring:
Assess for side effects, s/s
of HF, and pulmonary
hypersensitivity reactions.
Need negative preganacy
before starting the therapy.
(Vallerand, 2022).
Administration/ IV
compatibility: IV
Teaching: Notiful provider
onset or worsening of SOB,
cough, swelling of legs and
face, and significant weight
gain (vallerand, 2022).
Reference:
Vallerand, A. (2022). Davis’s Drug Guide for Nurses, 17th edition. Davis Compnay.
PDR. (n.d.). mercaptopurine- Drug Summary. Prescribers’ Digital Reference.
Cunha, J. (2021). Nolvadex. RxList.
Cunha, J. (2021). Arimidex. Rxlist.
Cunha, J. (2021). Herceptin. Rxlist.