Drug (Brand) Class/Action
Folic Acid
(Vitamin B)
antianemics,
vitamin/stimulates
the production of
RBC, WBC &
platelets
ADVERSE/se:
Dose
no life threatening, or most 1 mg/day. Initial
frequent.
dose then 0.5
mg/day maintenance
O= 30-60 min
P = 1 hr
D = UKN
Nursing considerations: outcome-reticulocytosis 2-5 days after beginning
therapy. Resolution of symptoms of Megaloblastic anemia.
Drug (Brand) Class/Action
ADVERSE/se:
Dose
hydroxyurea antineoplastics/interferes anorexia, N&V,
PO 60-80 mg/kg as
a single dose q 3
(Hydrea)
with DNA synthesis
diarrhea, leukopenia
days or 20-30
(cellcyle S specific)
Therapeutic effect: death
mg/kg/day as a
single dose.
of rapidly replicating cells,
O= 7 days particularly malignant
2 mg/day (sickle
P = 10 days ones. ↓d frequency of
cell)
D = 21 days painful crises and ↓d
need for transfusions in
sickle cell anemia.
Nursing considerations: assess for signs of infection/anemia/bleeding. Avoid IM
injections/Monitor I/O. Labs: CBC. Hold Hydroxyura if Neurtrophils < 2,000
cells/mm3, platelet is <80,000, hgl < 9g/dl. Monitor BUN, creatinine, uric acid and
liver function tests. LEUKEMIA: encourage fluid intake of 2000-3000 ml/day.
Drug (Brand) Class/Action
Ibuprophen
(Motrin, Advil )
O
P
D
anti-pyretic
0.5-2.5 hr 2-4 hr 6-8 hr
analgesic
30 min
1-2 hr 4-6 hr
inflammation
7 days
1-2 wk UKN
ADVERSE/se:
antipyretic,
GI BLEEDING,
antirheumatics, HEPATITIS,
nonoppioid
EXPOLIATIVE
analgesics,
DERMATITIS, TOX
NSAID/inhibits EPIDERMAL
prostaglandin
NECROLYSIS,
synthesis. Therp. ALLERGIC REACTION,
eff: ↓d pain and ANAPHYLAXIS, N&V,
inflammation.
constipation, dyspepsia,
Reduction of
headache.
fever
Dose
PO 400-800 mg 3-4
times daily (3600
max)
take w/full glass
water. remain
upright 15-30 min.
Nursing considerations: Patients who have asthma, aspirin-induced allergy, and nasal
polyps are at ↑d risk for developing hypersensitivity reactions. Assess for rhinitis, asthma,
and urticaria.
Drug (Brand) Class/Action
Enoxaparin
(Lovenox)
O= UKN
P = 3-5hr
D = 12 hr
ADVERSE/se:
BLEEDING, anemia,
anticoagulant/pr thrombocytopenia (can occur up
evention of
to several weeks after
thrombus
discontinuation of therapy).
formation
Heparin-induced
thrombocytopenia. may develop
on 8th day. may ↓ platelet count
to 5,000/mm3
Dose
VTE prophylaxis
in patients
undergoing knee
replacement
surgery-SQ-30
mg q 12 hr
starting 12-24 hr
po stop for 7-10
days
Nursing considerations: No lab est or antidote. Davis Drug says Protamine
Sulfate is antidote. Long term use can contribute to osteoporosis.
Drug (Brand) Class/Action
Heparin
O= 20-60 min
P = 2 hr
D = 8-12 hr
anticoagulant/
PROPHYLAXIS,
prevents new
clots.
ADVERSE/se:
Dose
BLEEDING, anemia,
Small 30-40 ml 3-4 x day
thrombocytopenia (can occur is Prophylactic
up to several weeks after
Medium 40-80 mL is for
discontinuation of therapy). High Risk prophylactic
Therapeutic – MG/KG
IV SQ
Protamine sulfate Heparin-induced
Antidote
is
the
antidote
thrombocytopenia.
may
Protamin
STOPS DIC4 Hr Shelf Life
develop on 8th day. may
Sulfate
Production of
reduce platelet count to
Platelets
5,000/mm3 HIT or HAT
Nursing considerations: Administer deep into SQ tissue. Alternate sites abdominal wall
above the iliac crest. 45° or 90° angle into a skin fold, hold skin fold throughout injection.
Do not aspirate or massage. Rotate sites frequently. Do not administer IM because of
danger of hematoma formation Assess for signs of bleeding and hemorrhage (bleeding
gums; nosebleed; unusual bruising; black, tarry stools; hematuria; fall in hematocrit or
blood pressure; guaiac-positive stools). Notify physician if these occur. aPTT, platelet
count every 2-3 days throughout therapy
Drug (Brand) Class/Action
ADVERSE/se:
Dose
colony-stimulating
medullary bone pain
IV, SQ 5 mcg/kg/day
factors/stimulates
avoid use for 24 hrs
immature Neurtrophils
before and after
to divide and
chemotherapy.
differentiate. ↓d
incidence of infection in
chemo pt. improve
progenitor cells for BMT
Nursing considerations: monitor HR, BP, RR, bone pain. LAB CBC. After bone
filgrastim
(Neupogen)
O=
P=
D=
marrow transplant, the daily dose is titrated by the neutrophil response. When the ANC is
>1000/mm3 for 3 consecutive days, the dose should be ↓d by 5 mcg/kg/day. If the ANC
remains >1000/mm 3 for 3 or more consecutive days, filgrastim is discontinued. If the
ANC ↓s to <1000/mm3, filgrastim should be resumed at 5 mcg/kg/day.
Drug (Brand) Class/Action
ADVERSE/se:
Dose
SQ IV: 50-100
epoetin
antianemics/stimula SEIZURES, hypertension
units/kg 3 times
(Epogen)
tes erythropoiesis
weekly initially,
IV
RBC
then adjust dose
O= 7-10
based on
days
hematocrit.
P = 2 month
D = 2 wk
Nursing considerations: May ↑ the requirement for heparin anticoagulation during
hemodialysis. Monitor BP, anemia, dialysis shunts. Labs: May cause ↑ in WBCs and
platelets. May ↓ bleeding times. Serum ferritin, transferrin, and iron levels should also be
monitored to assess need for concurrent iron therapy. Transferrin saturation should be at
least 20% and ferritin should be at least 100 ng/ml. Institute seizure precautions in
patients who experience greater than a 4-point ↑ in hematocrit in a 2-wk period or exhibit
any change in neurologic status. Risk of seizures is greatest during the first 90 days of
therapy
Drug (Brand) Class/Action
Warfarin
(Coumadin)
ADVERSE/se:
Dose
PO IV (Adults): 2.5-10
anticoagulant/
BLEEDING
Prevention of
the antidote is vitamin K mg/day for 2-4 days;
thromboembolic
(phytonadione,
then adjust daily dose by
events. Helps inhibit AquaMEPHYTON).
results of prothrombin
When taken with other time or international
blood clots.
O= 36-72 hr
Prophylaxis take
meds, they go first
normalized ratio (INR).
P = 5-7 days
home
drug.
hard
to
and
warfarin
Initiate therapy with
D = 2-5 days PT
control
accumulates
in
blood.
lower doses in geriatric
> 13 or INR > 3.0
LONG
Term
or debilitated patients.
means you are
taking too long to
form a clot
Nursing considerations: Before administering, evaluate recent INR or PT results and
have second practitioner independently check original order. Assess patient for signs of
bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; tarry, black
stools; hematuria; fall in hematocrit or blood pressure; guaiac-positive stools, urine, or
nasogastric aspirate). Withholding 1 or more doses of medication is usually sufficient if
INR is excessively elevated or if minor bleeding occurs. If overdose occurs the antidote is
vitamin K (phytonadione, AquaMEPHYTON). no Grapefruit juice
Drug (Brand) Class/Action
predniSONE
(Sterapred)
antiasthmatic,
corticosteroids
ADVERSE/se:
PEPTIC ULCERATION,
THROMBOEMBOLISM,
osteoporosis, muscle wasting, N&V,
hypertension, ↓d wound healing,
ecchymoses, fragility , hirsutism,
Petechiae, adrenal suppression,
anorexia, depression, euphoria,
cushingoid appearance.
Dose
most uses PO 5-60
mg/day
w/meals, Capsules
should be
swallowed who≤
do not crush,
break, or chew.
O= UKN
P = UKN
D = 1.25-1.5
days
Nursing considerations: monitor I/O, wt, edema, rales/Dyspnea, cerebral edema, Lab:
lytes, glucose, May cause hyperglycemia, especially in persons with diabetes. May
cause hypokalemia. Patients on prolonged therapy should routinely have CBC, serum
electrolytes, and serum and urine glucose evaluated. May ↓ WBCs. May cause
hyperglycemia, especially in persons with diabetes. May ↓ serum potassium and calcium
and ↑ serum sodium concentrations.
Guaiac-test stools. Promptly report presence of guaiac-positive stools.
May ↑ serum cholesterol and lipid values. May ↓ uptake of thyroid 123I or 131I.
Drug (Brand) Class/Action
ADVERSE/se:
dexamethasone antiasthmatic, PEPTIC ULCERATION,
(Decadron)
corticosteroid/su THROMBOEMBOLISM,
osteoporosis, muscle wasting,
ppress
N&V, hypertension, ↓d wound
inflammation
Dose
PO,IM,IV mg/daily
dependent upon
therapy
Capsules should
healing, ecchymoses, fragility , be swallowed
hirsutism, Petechiae, adrenal
O= UKN
who≤ do not
suppression, anorexia,
crush, break, or
P = 1-3 hr
depression, euphoria,
chew.
D = 2.75 days
cushingoid appearance.
Nursing considerations: monitor I/O, wt, edema, rales/Dyspnea, cerebral edema, Lab:
lytes, glucose, May cause hyperglycemia, especially in persons with diabetes. May
cause hypokalemia. Patients on prolonged therapy should routinely have CBC, serum
electrolytes, and serum and urine glucose evaluated. May ↓ WBCs. May cause
hyperglycemia, especially in persons with diabetes. May ↓ serum potassium and calcium
and ↑ serum sodium concentrations.
Guaiac-test stools. Promptly report presence of guaiac-positive stools.
May ↑ serum cholesterol and lipid values. May ↓ uptake of thyroid 123I or 131I.
Drug (Brand) Class/Action
ADVERSE/se:
Dose
Renal Allograft
azathioprine immuneSERUM SICKNESS,
Rejection Prevention
(muran )
suppressant/antagoi leucopenia, anemia,
PO IV 3-5 mg/kg/day
zes purine
thrombocytopenia,
initially; maint. dose 1metabolism –inhibit pancytopenia, chills,
3 mg/kg/day.
DNA/RNA
fever, anorexia,
RA PO: 1 mg/kg/day
PO
synthesis.
hepatotoxicity, N&V
for 6-8 wk, ↑ by 0.5
O= 6-8 wk
mg/kg/day q 4 wk until
P = 12 wk
response
D = UKN
Nursing considerations: assess for infection, I/O, wt, ↓ urine output- toxicity.
Leukocyte count of < 3000 or platelet count of <100,000/mm 3 may necessitate a
reduction in dosage or temporary discontinuation.
↑
Drug (Brand) Class/Action
ADVERSE/se:
Dose
cyclophopha antineoplastics, PULMONARY
PO 1-5 mg/kg/day
High Alert: Fatalities have
mide
immuneFIBROSIS,
occurred with chemotherapeutic
(Cytoxan)
suppressants/
MYOCARDIAL
interferes with
FIBROSIS,
agents. Before administering,
clarify all ambiguous orders;
DNA
HEMORRHAGIC
double check single, daily, and
CYSTITIS,
O= 7 days
LEUKOPENIA, N&V, course-of-therapy dose limits;
P = 7-15 days
anorexia, Hematuria, have second practitioner
D = 21 days
independently double check
alopecia,
thrombocytopenia original order, calculations and
infusion pump settings.
Nursing considerations: Monitor blood pressure, pulse, respiratory rate, and
temperature frequently during administration. Report significant changes.
Monitor I/O. To ↓ the risk of hemorrhagic cystitis, fluid intake should be at least 3000
ml/day for adults and 1000-2000 ml/day for children. May be administered with mesna.
Monitor for bone marrow depression. Assess for bleeding (bleeding gums, bruising,
petechiae, guaiac stools, urine, and emesis) and avoid IM injections and taking rectal
temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min.
Drug (Brand) Class/Action
ADVERSE/se:
Dose
Assess for signs of infection during neutropenia. Anemia may occur. Monitor for ↑
fatigue, dyspnea, and orthostatic hypotension. Assess nausea, vomiting, and appetite.
Weigh weekly. Antiemetics may be given 30 min before administration of medication to
minimize GI effects. Anorexia and weight loss can be minimized by feeding frequent light
meals. Encourage patient to drink 2000-3000 ml/day to promote excretion of uric acid.
Alkalinization of the urine may be used to help prevent uric acid nephropathy. Assess
cardiac and respiratory status for dyspnea, rales/crackles, weight gain, edema.
Pulmonary toxicity may occur after prolonged therapy. Cardiotoxicity may occur early in
therapy and is characterized by symptoms of CHF. Lab Test Considerations:
Monitor CBC with differential and platelet count before and periodically during therapy.
The nadir of leukopenia occurs in 7-12 days (recovery in 17-21 days). Leukocytes should
be maintained at 2500-4000/mm3. May also cause thrombocytopenia (nadir 10-15 days),
and rarely causes anemia. Monitor BUN, creatinine, and uric acid before and
frequently during therapy to detect nephrotoxicity. Monitor ALT, AST, LDH, and serum
bilirubin before and frequently during therapy to detect hepatotoxicity. Urinalysis
should be evaluated before initiating therapy and frequently during therapy to detect
hematuria or change in specific gravity indicative of SIADH.
cyclophophamide (Cytoxan) continued.
Drug (Brand) Class/Action
ADVERSE/se:
Dose
Arginine
amino acid supplementation/antisickling properties enhancing the
(L-Arginine) availability of nitric oxide (vasodilator) resulting in decreased
pulmonary artery pressure. Arginine is synergistic with hydroxyurea
and can be useful as combination therapy for managing pulmonary
hypertension.
Nursing considerations:
used in patient w/sickle cell disease