Neurological Agents and Chemotherapy Flashcards
(136 cards)
1
Q
fluoxetine (Prozac) MOA
A
blocks reuptake of serotonin to produce CNS excitation
2
Q
fluoxetine (Prozac) class
A
SSRI
3
Q
fluoxetine (Prozac) indications
A
- major depression
- bipolar disorder
- panic disorder
- OCD
4 weeks to reach steady state
4
Q
fluoxetine (Prozac) AEs
A
- weight gain
- nausea
- suicidal thoughts
- sexual dysfunction
5
Q
fluoxetine (Prozac) nursing considerations
A
- serotonin syndrome (begins within 2-72 hrs); concurrent use with MAOIs increase risk
- confusion, agitation, disorientations, anxiety, AMS
- spontaneous resolution when med stopped
6
Q
venlafaxine (Effexor XR) MOA
A
blocks reuptake of serotonin and norepinephrine
7
Q
venlafaxine (Effexor XR) class
A
SNRI
8
Q
venlafaxine (Effexor XR) indications
A
- GAD
- major depression
- social anxiety disorder
- panic disorders
9
Q
venlafaxine (Effexor XR) AEs
A
- N/V
- HA
- nervousness
- anorexia
10
Q
venlafaxine (Effexor XR) nursing considerations
A
- taper over two weeks to avoid withdrawal
- serotonin syndrome
11
Q
imipramine (Tofranil) MOA
A
block reuptake of serotonin and norepinephrine
12
Q
imipramine (Tofranil) indications
A
- depression
- bipolar disorder
- fibromyalgia syndrome
13
Q
imipramine (Tofranil) AEs
A
- sedation
- orthostatic HOTN
- anticholinergic effects
- cardiac toxicity
- sudden death
14
Q
imipramine (Tofranil) nursing considerations
A
- lethal dose = 8x therapeutic dose
- treatment for OD = gastric lavage, activated charcoal
- give suicidal pts 1-week supply = min. OD
15
Q
imipramine (Tofranil) class
A
tricyclic antidepressant
16
Q
phenelzine (Nardil) MOA
A
block monoamine oxidase, inc. NE, dopamine, serotonin, and tyramine
17
Q
phenelzine (Nardil) class
A
monoamine oxidase inhibitors (MAOIs)
18
Q
phenelzine (Nardil) indications
A
- depression
- bulimia nervosa
- panic disorder
- PTSD
- OCD
19
Q
phenelzine (Nardil) AEs
A
- orthostatic HOTN
- many drug interactions
- HTN crisis when tyramine-rich foods consumed
20
Q
bupropion (Wellbutrin) MOA
A
blocks dopamine and/or NE reuptake (effects seen in 1-3 weeks)
21
Q
bupropion (Wellbutrin) class
A
atypical antidepressants
22
Q
bupropion (Wellbutrin) indications
A
- major depression
- prevention of SAD
- unlabeled ADHD
- smoking cessation?
23
Q
bupropion (Wellbutrin) AEs
A
- agitation, HA, dry mouth, constipation, weight loss, GI upset, dizziness, tremor, insomnia, blurred vision, seizures
- no sexual dysfunction
24
Q
alprazolam (Xanax) MOA
A
inc inhibitory effects of GABA
25
alprazolam (Xanax) class
anxiolytics
26
alprazolam (Xanax) indications
- GAD
- panic disorder
27
alprazolam (Xanax) AEs
- sedation
- lightheadedness
- ataxia
- decreased cognitive function
28
alprazolam (Xanax) nursing considerations
- increase CNS depression with other CNS depressants
- retrograde amnesia
- short-term use only - can lead to dependence
- contraindicated w/ OSA
29
lithium (Lithobid) MOA
unknown - may block serotonin receptor binding, alter glutamate uptake/release
30
lithium (Lithobid) class
mood stabilizer
31
lithium (Lithobid) indications
- DOC for manic episodes
- prophylaxis for mania/depression
32
lithium (Lithobid) AEs
- GI upset
- muscle weakness
- fine hand tremors
- polyuria
- lethargy
- slurred speech
33
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
34
phenytoin (Dilantin) MOA
decreases sodium into cell
35
phenytoin (Dilantin) class
antiepileptic drugs (AEDs)
36
phenytoin (Dilantin) indications
- partial and tonic-clonic seizures
- post-neuro sx
- off-label = antiarrythmic and severe preeclampsia
37
phenytoin (Dilantin) AEs
- nystagmus, ataxia, dysarthria, slurred speech, mental confusion, tremor, HA, insomnia, hirsutism, gingival hyperplasia, increase glucose level, teratogenic effects, purple glover syndrome
38
phenytoin (Dilantin) nursing considerations
- therapeutic range = 10-20mcg/mL (toxicity > 20)
- dose adjustments: levels q5-7 days, taper off discontinuation
- take with food
- vesicant
39
oxcarbazapine (Oxtellar XR, Trileptal) MOA
decrease sodium into cell
40
oxcarbazapine (Oxtellar XR, Trileptal) class
AEDs
41
oxcarbazapine (Oxtellar XR, Trileptal) indications
partial seizures
42
oxcarbazapine (Oxtellar XR, Trileptal) AEs
- dizziness, drowsiness, double vision, nystagmus, HA, ataxia, hyponatremia, hypothyroidism, SJS, hypersensitivity
43
oxcarbazapine (Oxtellar XR, Trileptal) nursing considerations
- take w/o regard to food
- XR tabs = swallow whole
- decreased effectiveness of OCs
44
baclofen (Lioresal) MOA
mimics GABA, no direct effect on muscle strength
45
baclofen (Lioresal) indications
- MS
- spinal cord injuries
46
baclofen (Lioresal) AEs
- drowsiness, dizziness, weakness, fatigue
- abrupt withdrawal = visual hallucinations, paranoid ideations, seizures (TAPER OFF SLOWLY)
47
baclofen (Lioresal) nursing considerations
- monitor neuro status, UOP
- OD = taper off slowly
48
dantrolene (Dantrium) MOA
decreased calcium release to decrease muscle contractions
49
dantrolene (Dantrium) indications
- MS
- cerebral palsy
- spinal cord injuries
- malignant hyperthermia
50
dantrolene (Dantrium) nursing considerations
- monitor LFTs for heptatotoxicity
51
cyclobenzaprine (Flexeril/Amrix) MOA
structurally like TCAs, acts on brainstem to reduce tonic somatic muscle activity
52
cyclobenzaprine (Flexeril/Amrix) indications
localized muscle spasms/pain
53
cyclobenzaprine (Flexeril/Amrix) AEs
- drowsiness, dizziness, fatigue, dry mouth, blurred vision, photophobia, urinary retention, constipation, dysrhythmias
54
cyclobenzaprine (Flexeril/Amrix) nursing considerations
- drowsiness and dizziness most prevalent during early treatment
- caution against operating heavy machinery
55
granulocyte colony stimulating factors (G-CSF) MOA
stimulate bone marrow growth of neutrophils
56
granulocyte colony stimulating factors (G-CSF) indications
neutropenia prophylaxis for myelosuppressive therapy
57
granulocyte colony stimulating factors (G-CSF) AEs
- bone pain
- pyrexia
- pain, cough, dyspnea
58
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
59
cyclophosphamide (Cytoxan) MOA
nitrogen mustard, inhibit DNA/RNA synthesis
60
cyclophosphamide (Cytoxan) class
alkylating agents
61
cyclophosphamide (Cytoxan) indications
lymphomas, HR-breast cancers
62
cyclophosphamide (Cytoxan) AEs
- alopecia
- CINV (severe)
- myelosuppression
- mucositis
- hemorrhagic cysts
63
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
64
cisplatin (Platinol) MOA
alkylating agent, inhibits DNA/RNA synthesis
65
cisplatin (Platinol) class
platinum compounds
66
cisplatin (Platinol) indications
- head, neck, testicular, lung, breat, GYN cancers
67
cisplatin (Platinol) AEs
- CINV
- myelosuppression
- nephrotoxicity
- ototoxicity
68
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
69
doxorubicin (Adriamycin) MOA
blocks enzyme topoisomerase 2 - breaks DNA strands
70
doxorubicin (Adriamycin) class
antitumor abx
71
doxorubicin (Adriamycin) indications
breast, ovarian, testicular, lymphomas, sarcomas of the soft tissue and bone, Hodgkin and non-Hodgkin lymphomas
72
doxorubicin (Adriamycin) AEs
- CINV
- myelosuppression
- alopecia
- bright red discoloration of bodily fluids
73
doxorubicin (Adriamycin) nursing considerations
- cardiotoxicity acute/delayed = ECHO q3months (lifetime dose limits)
- vesicant = treat with dexrazoxane (Zinecard) - pt IV or central line
74
methotrexate MOA
inhibits folic acid conversion for synthesis of DNA (S-phase specific)
75
methotrexate indications
- rheumatoid arthritis
- psoriasis
- Crohn's disease
- many cancers
76
methotrexate AEs
- mucositis
- gastric ulcers
- GI perforation
77
methotrexate nursing considerations
- monitor labs
- fluid intake 2-3 L/day
- avoid salicylates, NSAIDs, penicillin, tetracyclines
- monitor levels 24hrs post treatment
- Leucovorin resuce
78
vincristine (Oncovin) MOA
blocks mitosis during M-phase - disrupts microtubule assembly
79
vincristine (Oncovin) indications
- NHL
- HL
- ALL
- Wilms' tumor
- breast CA
- rhabdomyosarcoma
80
vincristine (Oncovin) AEs
- peripheral neuropathy
- alopecia
- constipation
81
vincristine (Oncovin) nursing considerations
- vesicant
- always in a mini bag, NO IV push (this is fatal!)
82
tamoxifen (Saltimox/Nolvadex) MOA
block estrogen receptors on cells
83
tamoxifen (Saltimox/Nolvadex) indications
breast cancer
84
tamoxifen (Saltimox/Nolvadex) AEs
- hot flashes
- fluid retention
- N/V
- menstrual irregularities
85
tamoxifen (Saltimox/Nolvadex) nursing considerations
- treatment and prophylaxis
- small inc in DVT and endometrial CA incidence
- pre and post-menopausal
86
anastrozole (Arimidex) MOA
inhibits aromatase; dec production of estrogen
87
anastrozole (Arimidex) indications
breast cancer
88
anastrozole (Arimidex) AEs
- hot flashes
- menopausal symptoms
- musculoskeletal pain
- HA
- vaginal dryness
- N/V
89
anastrozole (Arimidex) nursing considerations
- post-menopausal
90
leuprolide (Eligard) MOA
suppresses testicular androgen production (testosterone); goal is chemical castration
91
leuprolide (Eligard) indications
- prostate CA
- endometriosis
92
leuprolide (Eligard) AEs
- hot flashes
- erectile dysfunction
- gynecomastia
- DM
- MI, stroke, early bone pain
93
leuprolide (Eligard) nursing considerations
- increased incidence of osteoporosis (dec w/ concurrent use of bisphosphonates)
94
degarelix (Firmagon) MOA
dec release of LH and FSH in pituitary
95
degarelix (Firmagon) indications
prostate CA
96
degarelix (Firmagon) AEs
- hot flashes
- erectile dysfunction
- gynecomastia
97
degarelix (Firmagon) nursing considerations
- inc incidence of osteoporosis (dec w/ concurrent use of bisphosphates)
98
trastuzumab (Herceptin) MOA
binds to HER2 receptor
99
trastuzumab (Herceptin) indications
- HER2+ breast CA
- HER2+ gastric CA
100
trastuzumab (Herceptin) AEs
- flu-like symptoms (fever, chills, pain)
- hypersensitvity rxns
- cardiotoxicity (LV dysfunction, CHF)
101
trastuzumab (Herceptin) nursing considerations
- neoadjuvant and adjuvant tx - total of 1 year
102
cetuximab (Erbitux) MOA
blocks EGFR on cell membrane
103
cetuximab (Erbitux) indications
- colorectal CA
- head and neck CA
104
cetuximab (Erbitux) AEs
- acneiform rash
- decreased magnesium
- diarrhea
- stomatitis
- inc LFTs
105
cetuximab (Erbitux) nursing considerations
- rash is NOT acne (limit sun exposure)
- infusion rxn = airway obstruction, LOC, MI, shock, CP arrest
106
rituximab (Rituxan) MOA
recruits immune response through binding of CD20 antigen on surface of B cells
107
rituximab (Rituxan) indications
B-cell NHL, B-cell CLL, rheumatoid arthritis
108
rituximab (Rituxan) AEs
- mucocutaneous reactions
- flu-like symptoms
109
rituximab (Rituxan) nursing considerations
- infusion rxns
- Tumor Lysis Syndrome ONCOLOGIC EMERGENCY! (12-24 hrs post infusion, may require dialysis)
110
bevacizumab (Avastin) MOA
binds to VEGF in extracellular space, inhibits cell membrane binding on vascular endothelial cells
111
bevacizumab (Avastin) indications
- metastatic colorectal CA
- nonsquamous NSCLC
- metastatic renal cell CA
- glioblastoma
- GYN CA
112
bevacizumab (Avastin) AEs
- GI perforation
- hemorrhage
- proteinuria
- dry skin
- HA
113
bevacizumab (Avastin) nursing considerations
- HTN -> hypertensive crisis
- delayed wound healing
114
imatinib mesylate (Gleevec) MOA
inhibits BCR-ABL tyrosine kinase activity d/t presence of Philadelphia Chromosome
115
imatinib mesylate (Gleevec) indications
chronic myeloid leukemia (CML)
116
imatinib mesylate (Gleevec) AEs
- GI upset
- HA
- fatigue
- pyrexia
- musculoskeletal pain
- hepatotoxicity
- neutropenia and thrombocytopenia
- fluid retention
117
vemurafenib (Zelboraf) MOA
inhibits kinase BRAF V600E activity
118
vemurafenib (Zelboraf) indications
metastatic melanoma
119
vemurafenib (Zelboraf) AEs
- hepatotoxicity
- SJS/TEN
- QT prolongation
- GI upset
- arthralgia
- alopecia
120
vemurafenib (Zelboraf) nursing considerations
- severe hypersensitivity rxns common
- secondary malignancies common
121
bortezomib (Velcade) MOA
inhibits activity of proteasomes producing buildup of waste proteins in the cell -> apoptosis
122
bortezomib (Velcade) indications
- multiple myeloma
- mantle cell lymphoma
123
bortezomib (Velcade) AEs
- GI upset
- weakness
- anorexia
- peripheral neuropathy
- pyrexia
- cytopenias
124
bortezomib (Velcade) nursing considerations
- monitor labs
- avoid St. John's wort
125
nivolumab (Opdivo) MOA
programmed cell death receptor-1 (PD-1) blocking MoAB/checkpoint inhibitor
126
nivolumab (Opdivo) indications
- unresectable and metastatic melanoma
- metastatic NSCLC
- renal cell carcinoma
- HL, head and neck, urothelial
127
nivolumab (Opdivo) AEs
- fatigue, malaise
- peripheral neuropathy
- GI toxicities
- elevated LFTs
- increased creatinine
- electrolyte imbalances
- pancytopenia
- uppers RTIs
- cough, febrile rxn
128
nivolumab (Opdivo) nursing considerations
monitor for immune-related adverse effects (hepatitis, nephritis, colitis, pneumonitis, etc)
129
denosumab (Xgeva, Prolia) MOA
RANK ligand inhibitor
130
denosumab (Xgeva, Prolia) indications
- prevention of skeletal events in pts with bone mets, MM, and osteoporosis
131
denosumab (Xgeva, Prolia) AEs
- fatigue, muscle weakness
- nausea
- hypophosphatemia
- hypocalcemia
- joint pain
- HA, cough, SOB, diarrhea
132
denosumab (Xgeva, Prolia) nursing considerations
- osteonecrosis of the jaw
- monitor labs
- calcium supplementation daily
133
zoledronate (Zometa) MOA
inhibits osteoclast function
134
zoledronate (Zometa) indications
prevention of skeletal events, hypercalcemia of malignancy
135
zoledronate (Zometa) AEs
- fatigue, muscle weakness
- nausea
- hypophosphatemia
- hypocalcemia
- joint pain, HA, cough, SOB, diarrhea
136
zoledronate (Zometa) nursing considerations
- osteonecrosis of the jaw
- monitor labs
- calcium supplementation daily
