Nursing pharmacology

Hematology/Oncology/Immunity/Infectious diseases

Hematology

Small pills = antiplatelets (aspirin, Medium pills = anticoagulants, (warfarin, Large pills =thrombolytics, clot
clopidogrel) heparin) busters = alteplase
Stops clot from growing and others from
Prevents aggregation forming Breaks clots
Think of antiplatelets, think of Heparin Warfarin All end in “-ase”
“AntiClogging” (A + C) Prevention of clots Slow, onset in ~5 days
Biggest risk for massive bleed
Prevent the formation of clots Works “Hella fast” – needles should not be given
to these patients
Used often after percutaneous IV or Subcut
coronary intervention Only given through peripheral
“Bleeding too high, IV
patient will die”
Contraindications = Active
“Bleeding too low, bleeding, uncontrolled HTN
clots will grow” (180/110), Recent surgery w/in
2 weeks, Aneurysm, Accident,
AV malformation
Assess Hgb – if <7, you go to Assess PTT N: 46- Assess INR N: 2-3 Assess bleeding
heaven 70

Assess platelets (N: 150-400) – if
<150, its kinda iffy. If <50, its risky
Toxicity is indicated by tinnitus and Frequent blood tests Excessive bleeding
tachycardia required
Antidote is activated charcoal (A + Antidote = Antidote = vit. K Stop infusion and control
C) protamine sulfate (through liver and bleeding
leafy greens)
Oncology
- Chemotherapy “Bad to the bone” – other than vincristine, all chemo drugs cause bone
marrow suppression – monitor for anemia, leukopenia (fever >38 is not great),
thrombocytopenia. All chemo drugs slow/stop the growth of all fast-growing cells: hair,
skin, bone marrow (deadliest)
o Doxorubicin
 Slow or stop growth of tumors
 Bone marrow suppression leads to low RBCs and CBC = anemia
o RBCs N: 4.5-6 mill
 Leads to thrombocytopenia (<100 000)
o N: 150-400 K
 Leads to leukopenia (<4000)
o Fever is a priority (>38 degrees, “38 is not great”)
o Apply neutropenic precautions to the client

,  Private room
 Strict handwashing
 Avoid exposure to sick people and crowds
 Avoid fresh fruits and veggies, avoid flowers
 All equipment used must be disinfected
 Teach patients to use electric razors, use stool softeners, avoid falls –
avoid possibility of bleeding or injuring bones
 Decreased insulin sensitivity = hyperglycemia – monitor blood glucose
 Nausea is a common side effect – stop chemo, flush, and give ondansetron
(Zofran)
o Cisplatin (“PISSplatin”)
 ! Renal toxicity! – Monitor I/O,
 Dangerous labs = Creatinine >1.3, BUN >20, UO <30ml/hr
 Hydration is key – hope for good BP, good skin turgor, good cap
refills, good UO
 Give antiemetics prophylactically
 Give saline rinse before and after meals
 Increase fluid intake for the next few days
 Teach patient how to manage their fatigue
o Cyclophosphamide (“the bones have died”)
 Treats by stopping protein synthesis
 BONE MARROW SUPPRESSION – anemia, thrombocytopenia,
leukopenia
*Cyclobenzaprine “cycloBACKaprine” – muscle relaxant for the back
*Cyclosporine “cyclosSPARIN” “organs cycle” – spares organs from rejection after transplant
o Vincristine “very cool Christian”
 Stops cell divisions during mitosis
 THE ONLY CHEMO DRUG THAT ISN’T BAD TO THE BONE – no
anemia, leukopenia, thrombocytopenia
 Won’t weaken the immune system and bleeding
 Causes neuropathy in hands and feet “They nailed His hands and feet”
o Tamoxifen “TamHOTxifen” (for expected hot flashes)– for breast/endometrial
cancer
 Blocks estrogen receptors in the breasts, inhibiting estrogen dependent
cancers
 Report heavy periods!!
 Big risk for clot (any drug that blocks estrogen ends up in a clot, like birth
control)
 Avoid giving to Hx of DVT/PE


- New cells stimulators – all focus on producing WBCs to fight off cancer cells
o Oprelvekin
 particularly for thrombocytopenia
 Side effects – fluid retention, a-fib, anaphylaxis

, o Filgrastim and Pegfilgrastim
 Stimulate neutrophil production
 No effect on hemoglobin
o Interferon – interferes with cancer
 Stimulate immune system
 Gives flu-like symptoms – fever, muscle aches, chills
 Apply warm compress before giving, Give at night
- Radiation
o Usually combined with chemotherapy
o Given outside the body, can be hard on the skin
 Don’t give anything that irritates skin – lotion, skin, makeup, perfume,
deodorant, tape, no shaving, no cloths on the skin
- Brachytherapy
o Given inside the body, placed directly on the tumor for 24-72 hrs
o Typically used with endometrial and cervical cancers use this most
o Nursing interventions
 Limit time (30 minutes/shift) and distance (6ft) with the patient
 No pregnant people, No one <18yrs
 Private room and washroom, door always closed
 Use lead apron when in direct contact with the patient, otherwise use
special badge
 Teach patient not to get up with implants and no touching if they fall out

Immunity
- Immunosuppressants
o Stops the body from attacking itself, and transplanted organs
o Bone marrow suppression – leukopenia and thrombocytopenia
o Hydroxychloroquine – “Selena is a queen”
 Used to treat lupus – body attacks skin and joints
 Decreases inflammation and fatigue
 Taken for several months for therapeutic level
 Major adversity
 Retinal damage, vision problems – teach to have eye appointments
q6-12 months
 *No need for a medical alert bracelet*
o Cyclosporine/Azathioprine – “organs cycle,” “cycloSPARIN”
 Inhibits organ rejection after transplant, Life-long
 Can be given for rheumatoid arthiritis and IBS
 Adversity
 Bone marrow suppression – leukopenia and thrombocytopenia
 Gingival hyperplasia – no need to report, expected
 Teach to use contraception
 No grapefruit juice
 Avoid crowds
 Regular bloodwork