Neurological Agents and Chemotherapy Flashcards
fluoxetine (Prozac) MOA
blocks reuptake of serotonin to produce CNS excitation
fluoxetine (Prozac) class
SSRI
fluoxetine (Prozac) indications
- major depression
- bipolar disorder
- panic disorder
- OCD
4 weeks to reach steady state
fluoxetine (Prozac) AEs
- weight gain
- nausea
- suicidal thoughts
- sexual dysfunction
fluoxetine (Prozac) nursing considerations
- serotonin syndrome (begins within 2-72 hrs); concurrent use with MAOIs increase risk
- confusion, agitation, disorientations, anxiety, AMS
- spontaneous resolution when med stopped
venlafaxine (Effexor XR) MOA
blocks reuptake of serotonin and norepinephrine
venlafaxine (Effexor XR) class
SNRI
venlafaxine (Effexor XR) indications
- GAD
- major depression
- social anxiety disorder
- panic disorders
venlafaxine (Effexor XR) AEs
- N/V
- HA
- nervousness
- anorexia
venlafaxine (Effexor XR) nursing considerations
- taper over two weeks to avoid withdrawal
- serotonin syndrome
imipramine (Tofranil) MOA
block reuptake of serotonin and norepinephrine
imipramine (Tofranil) indications
- depression
- bipolar disorder
- fibromyalgia syndrome
imipramine (Tofranil) AEs
- sedation
- orthostatic HOTN
- anticholinergic effects
- cardiac toxicity
- sudden death
imipramine (Tofranil) nursing considerations
- lethal dose = 8x therapeutic dose
- treatment for OD = gastric lavage, activated charcoal
- give suicidal pts 1-week supply = min. OD
imipramine (Tofranil) class
tricyclic antidepressant
phenelzine (Nardil) MOA
block monoamine oxidase, inc. NE, dopamine, serotonin, and tyramine
phenelzine (Nardil) class
monoamine oxidase inhibitors (MAOIs)
phenelzine (Nardil) indications
- depression
- bulimia nervosa
- panic disorder
- PTSD
- OCD
phenelzine (Nardil) AEs
- orthostatic HOTN
- many drug interactions
- HTN crisis when tyramine-rich foods consumed
bupropion (Wellbutrin) MOA
blocks dopamine and/or NE reuptake (effects seen in 1-3 weeks)
bupropion (Wellbutrin) class
atypical antidepressants
bupropion (Wellbutrin) indications
- major depression
- prevention of SAD
- unlabeled ADHD
- smoking cessation?
bupropion (Wellbutrin) AEs
- agitation, HA, dry mouth, constipation, weight loss, GI upset, dizziness, tremor, insomnia, blurred vision, seizures
- no sexual dysfunction
alprazolam (Xanax) MOA
inc inhibitory effects of GABA
alprazolam (Xanax) class
anxiolytics
alprazolam (Xanax) indications
- GAD
- panic disorder
alprazolam (Xanax) AEs
- sedation
- lightheadedness
- ataxia
- decreased cognitive function
alprazolam (Xanax) nursing considerations
- increase CNS depression with other CNS depressants
- retrograde amnesia
- short-term use only - can lead to dependence
- contraindicated w/ OSA
lithium (Lithobid) MOA
unknown - may block serotonin receptor binding, alter glutamate uptake/release
lithium (Lithobid) class
mood stabilizer
lithium (Lithobid) indications
- DOC for manic episodes
- prophylaxis for mania/depression
lithium (Lithobid) AEs
- GI upset
- muscle weakness
- fine hand tremors
- polyuria
- lethargy
- slurred speech
lithium (Lithobid) nursing considerations
- keep levels < 1.5mEq/L
- therapeutic range = 0.8-1mEq/L
- draw levels in AM 12 hrs after evening dose
- initiation = levels q2-3 days
- established dosing = levels q3-6 months
- hemodialysis for levels > 2.5mEq/L
- monitor kidney, thyroid, and sodium levels
- improvement in 5-7 days, full benefits in 2-3 wks
- adequate hydration
phenytoin (Dilantin) MOA
decreases sodium into cell
phenytoin (Dilantin) class
antiepileptic drugs (AEDs)
phenytoin (Dilantin) indications
- partial and tonic-clonic seizures
- post-neuro sx
- off-label = antiarrythmic and severe preeclampsia
phenytoin (Dilantin) AEs
- nystagmus, ataxia, dysarthria, slurred speech, mental confusion, tremor, HA, insomnia, hirsutism, gingival hyperplasia, increase glucose level, teratogenic effects, purple glover syndrome
phenytoin (Dilantin) nursing considerations
- therapeutic range = 10-20mcg/mL (toxicity > 20)
- dose adjustments: levels q5-7 days, taper off discontinuation
- take with food
- vesicant
oxcarbazapine (Oxtellar XR, Trileptal) MOA
decrease sodium into cell
oxcarbazapine (Oxtellar XR, Trileptal) class
AEDs
oxcarbazapine (Oxtellar XR, Trileptal) indications
partial seizures
oxcarbazapine (Oxtellar XR, Trileptal) AEs
- dizziness, drowsiness, double vision, nystagmus, HA, ataxia, hyponatremia, hypothyroidism, SJS, hypersensitivity
oxcarbazapine (Oxtellar XR, Trileptal) nursing considerations
- take w/o regard to food
- XR tabs = swallow whole
- decreased effectiveness of OCs
baclofen (Lioresal) MOA
mimics GABA, no direct effect on muscle strength
baclofen (Lioresal) indications
- MS
- spinal cord injuries
baclofen (Lioresal) AEs
- drowsiness, dizziness, weakness, fatigue
- abrupt withdrawal = visual hallucinations, paranoid ideations, seizures (TAPER OFF SLOWLY)
baclofen (Lioresal) nursing considerations
- monitor neuro status, UOP
- OD = taper off slowly
dantrolene (Dantrium) MOA
decreased calcium release to decrease muscle contractions
dantrolene (Dantrium) indications
- MS
- cerebral palsy
- spinal cord injuries
- malignant hyperthermia
dantrolene (Dantrium) nursing considerations
- monitor LFTs for heptatotoxicity
cyclobenzaprine (Flexeril/Amrix) MOA
structurally like TCAs, acts on brainstem to reduce tonic somatic muscle activity
cyclobenzaprine (Flexeril/Amrix) indications
localized muscle spasms/pain
cyclobenzaprine (Flexeril/Amrix) AEs
- drowsiness, dizziness, fatigue, dry mouth, blurred vision, photophobia, urinary retention, constipation, dysrhythmias
cyclobenzaprine (Flexeril/Amrix) nursing considerations
- drowsiness and dizziness most prevalent during early treatment
- caution against operating heavy machinery
granulocyte colony stimulating factors (G-CSF) MOA
stimulate bone marrow growth of neutrophils
granulocyte colony stimulating factors (G-CSF) indications
neutropenia prophylaxis for myelosuppressive therapy
granulocyte colony stimulating factors (G-CSF) AEs
- bone pain
- pyrexia
- pain, cough, dyspnea
granulocyte colony stimulating factors (G-CSF) nursing considerations
- do not admin within 24hr of chemotherapy
- short acting = Filgrastim (Neupogen) daily SQ admin 3-5 days
- long acting = Peg-filgrastim (Neulasta) injector or on-body injector
cyclophosphamide (Cytoxan) MOA
nitrogen mustard, inhibit DNA/RNA synthesis
cyclophosphamide (Cytoxan) class
alkylating agents
cyclophosphamide (Cytoxan) indications
lymphomas, HR-breast cancers
cyclophosphamide (Cytoxan) AEs
- alopecia
- CINV (severe)
- myelosuppression
- mucositis
- hemorrhagic cysts
cyclophosphamide (Cytoxan) nursing considerations
- PO = give in AM w/ food
- increase PO fluids, IV hydration/Mesna as ordered
- monitor labs
- supportive care as ordered - growth factors
- I/O
cisplatin (Platinol) MOA
alkylating agent, inhibits DNA/RNA synthesis
cisplatin (Platinol) class
platinum compounds
cisplatin (Platinol) indications
- head, neck, testicular, lung, breat, GYN cancers
cisplatin (Platinol) AEs
- CINV
- myelosuppression
- nephrotoxicity
- ototoxicity
cisplatin (Platinol) nursing considerations
- nephrotoxicity = increase PO fluids, IV hydration as ordered (10-20 days after tx, dose-related)
- ototoxicity = baseline hearing test, monitor for changes (Cranial nerve VIII assessment)
- monitor labs
- I/O
- supportive care as ordered - growth factors
doxorubicin (Adriamycin) MOA
blocks enzyme topoisomerase 2 - breaks DNA strands
doxorubicin (Adriamycin) class
antitumor abx
doxorubicin (Adriamycin) indications
breast, ovarian, testicular, lymphomas, sarcomas of the soft tissue and bone, Hodgkin and non-Hodgkin lymphomas
doxorubicin (Adriamycin) AEs
- CINV
- myelosuppression
- alopecia
- bright red discoloration of bodily fluids
doxorubicin (Adriamycin) nursing considerations
- cardiotoxicity acute/delayed = ECHO q3months (lifetime dose limits)
- vesicant = treat with dexrazoxane (Zinecard) - pt IV or central line
methotrexate MOA
inhibits folic acid conversion for synthesis of DNA (S-phase specific)
methotrexate indications
- rheumatoid arthritis
- psoriasis
- Crohn’s disease
- many cancers
methotrexate AEs
- mucositis
- gastric ulcers
- GI perforation
methotrexate nursing considerations
- monitor labs
- fluid intake 2-3 L/day
- avoid salicylates, NSAIDs, penicillin, tetracyclines
- monitor levels 24hrs post treatment
- Leucovorin resuce
vincristine (Oncovin) MOA
blocks mitosis during M-phase - disrupts microtubule assembly
vincristine (Oncovin) indications
- NHL
- HL
- ALL
- Wilms’ tumor
- breast CA
- rhabdomyosarcoma
vincristine (Oncovin) AEs
- peripheral neuropathy
- alopecia
- constipation
vincristine (Oncovin) nursing considerations
- vesicant
- always in a mini bag, NO IV push (this is fatal!)
tamoxifen (Saltimox/Nolvadex) MOA
block estrogen receptors on cells
tamoxifen (Saltimox/Nolvadex) indications
breast cancer
tamoxifen (Saltimox/Nolvadex) AEs
- hot flashes
- fluid retention
- N/V
- menstrual irregularities
tamoxifen (Saltimox/Nolvadex) nursing considerations
- treatment and prophylaxis
- small inc in DVT and endometrial CA incidence
- pre and post-menopausal
anastrozole (Arimidex) MOA
inhibits aromatase; dec production of estrogen
anastrozole (Arimidex) indications
breast cancer
anastrozole (Arimidex) AEs
- hot flashes
- menopausal symptoms
- musculoskeletal pain
- HA
- vaginal dryness
- N/V
anastrozole (Arimidex) nursing considerations
- post-menopausal
leuprolide (Eligard) MOA
suppresses testicular androgen production (testosterone); goal is chemical castration
leuprolide (Eligard) indications
- prostate CA
- endometriosis
leuprolide (Eligard) AEs
- hot flashes
- erectile dysfunction
- gynecomastia
- DM
- MI, stroke, early bone pain
leuprolide (Eligard) nursing considerations
- increased incidence of osteoporosis (dec w/ concurrent use of bisphosphonates)
degarelix (Firmagon) MOA
dec release of LH and FSH in pituitary
degarelix (Firmagon) indications
prostate CA
degarelix (Firmagon) AEs
- hot flashes
- erectile dysfunction
- gynecomastia
degarelix (Firmagon) nursing considerations
- inc incidence of osteoporosis (dec w/ concurrent use of bisphosphates)
trastuzumab (Herceptin) MOA
binds to HER2 receptor
trastuzumab (Herceptin) indications
- HER2+ breast CA
- HER2+ gastric CA
trastuzumab (Herceptin) AEs
- flu-like symptoms (fever, chills, pain)
- hypersensitvity rxns
- cardiotoxicity (LV dysfunction, CHF)
trastuzumab (Herceptin) nursing considerations
- neoadjuvant and adjuvant tx - total of 1 year
cetuximab (Erbitux) MOA
blocks EGFR on cell membrane
cetuximab (Erbitux) indications
- colorectal CA
- head and neck CA
cetuximab (Erbitux) AEs
- acneiform rash
- decreased magnesium
- diarrhea
- stomatitis
- inc LFTs
cetuximab (Erbitux) nursing considerations
- rash is NOT acne (limit sun exposure)
- infusion rxn = airway obstruction, LOC, MI, shock, CP arrest
rituximab (Rituxan) MOA
recruits immune response through binding of CD20 antigen on surface of B cells
rituximab (Rituxan) indications
B-cell NHL, B-cell CLL, rheumatoid arthritis
rituximab (Rituxan) AEs
- mucocutaneous reactions
- flu-like symptoms
rituximab (Rituxan) nursing considerations
- infusion rxns
- Tumor Lysis Syndrome ONCOLOGIC EMERGENCY! (12-24 hrs post infusion, may require dialysis)
bevacizumab (Avastin) MOA
binds to VEGF in extracellular space, inhibits cell membrane binding on vascular endothelial cells
bevacizumab (Avastin) indications
- metastatic colorectal CA
- nonsquamous NSCLC
- metastatic renal cell CA
- glioblastoma
- GYN CA
bevacizumab (Avastin) AEs
- GI perforation
- hemorrhage
- proteinuria
- dry skin
- HA
bevacizumab (Avastin) nursing considerations
- HTN -> hypertensive crisis
- delayed wound healing
imatinib mesylate (Gleevec) MOA
inhibits BCR-ABL tyrosine kinase activity d/t presence of Philadelphia Chromosome
imatinib mesylate (Gleevec) indications
chronic myeloid leukemia (CML)
imatinib mesylate (Gleevec) AEs
- GI upset
- HA
- fatigue
- pyrexia
- musculoskeletal pain
- hepatotoxicity
- neutropenia and thrombocytopenia
- fluid retention
vemurafenib (Zelboraf) MOA
inhibits kinase BRAF V600E activity
vemurafenib (Zelboraf) indications
metastatic melanoma
vemurafenib (Zelboraf) AEs
- hepatotoxicity
- SJS/TEN
- QT prolongation
- GI upset
- arthralgia
- alopecia
vemurafenib (Zelboraf) nursing considerations
- severe hypersensitivity rxns common
- secondary malignancies common
bortezomib (Velcade) MOA
inhibits activity of proteasomes producing buildup of waste proteins in the cell -> apoptosis
bortezomib (Velcade) indications
- multiple myeloma
- mantle cell lymphoma
bortezomib (Velcade) AEs
- GI upset
- weakness
- anorexia
- peripheral neuropathy
- pyrexia
- cytopenias
bortezomib (Velcade) nursing considerations
- monitor labs
- avoid St. John’s wort
nivolumab (Opdivo) MOA
programmed cell death receptor-1 (PD-1) blocking MoAB/checkpoint inhibitor
nivolumab (Opdivo) indications
- unresectable and metastatic melanoma
- metastatic NSCLC
- renal cell carcinoma
- HL, head and neck, urothelial
nivolumab (Opdivo) AEs
- fatigue, malaise
- peripheral neuropathy
- GI toxicities
- elevated LFTs
- increased creatinine
- electrolyte imbalances
- pancytopenia
- uppers RTIs
- cough, febrile rxn
nivolumab (Opdivo) nursing considerations
monitor for immune-related adverse effects (hepatitis, nephritis, colitis, pneumonitis, etc)
denosumab (Xgeva, Prolia) MOA
RANK ligand inhibitor
denosumab (Xgeva, Prolia) indications
- prevention of skeletal events in pts with bone mets, MM, and osteoporosis
denosumab (Xgeva, Prolia) AEs
- fatigue, muscle weakness
- nausea
- hypophosphatemia
- hypocalcemia
- joint pain
- HA, cough, SOB, diarrhea
denosumab (Xgeva, Prolia) nursing considerations
- osteonecrosis of the jaw
- monitor labs
- calcium supplementation daily
zoledronate (Zometa) MOA
inhibits osteoclast function
zoledronate (Zometa) indications
prevention of skeletal events, hypercalcemia of malignancy
zoledronate (Zometa) AEs
- fatigue, muscle weakness
- nausea
- hypophosphatemia
- hypocalcemia
- joint pain, HA, cough, SOB, diarrhea
zoledronate (Zometa) nursing considerations
- osteonecrosis of the jaw
- monitor labs
- calcium supplementation daily