Drug/Class Mechanism Indication Contraindication Adverse Effect Nursing

ification of Action Responsibilities

Prednisone It prevents Assessment
60 mg/m2 the release Replaceme Hypersensit Insomnia
every of nt therapy ivity,
month for 5 substances in adrenal Nervousness History: Infec
cortical serious tions; renal
days in the body
insufficien infections increased or liver
that cause cy (except appetite disease,
Corticoster inflammatio tuberculous hypothyroidis
oid n. It Hypercalc meningitis) indigestion m, ulcerative
decreases emia colitis with
inflammatio associated Varicella dizziness/lighthea impending
n by with dedness perforation,
suppression cancer Systemic diverticulitis,
of migration fungal headache, inflammatory
Hematolog infections. bowel
of
ic disease, CHF,
polymorpho hypopigmentation
disorders: hypertension,
nuclear Thromboc thromboemb
ytopenia diabetes mellitus
leukocytes olic
and reversal purpura, disorders,
erythrobla glucose seizure
of increased intolerance
stopenia disorders,
capillary
diabetes
permeability. hyperglycemia
Ulcerative mellitus;
Prednisone colitis, hepatic
also acute arthralgia disease;
suppresses exacerbati
the immune ons of MS cataracts Physical: Wei
system by and ght,
reducing palliation glaucoma Temperature,
in some reflexes and
activity and
leukemia epistaxis grip strength,
vol of the and affect and
lymphatic
system. lymphoma hypertension orientation,
s Pulse rate,
pancreatitis BP,
peripheral
pituitary-adrenal perfusion,
axis suppression prominence
of superficial
seizures veins,
Respiratory
rates,
adventitious
sounds,
serum
electrolytes,
blood
glucose.

Interventions

Administer
once-a-day
doses before
9AM to mimic
normal peak
corticosteroid
blood levels.

Increase
dosage when
patient is
subject to
stress.
 WARNING:
Taper doses
when
discontinuing
high-dose or
long-term
therapy to
avoid adrenal
insufficiency.

Do not give
live virus
vaccines with
immunosupp
ressive doses
of
corticosteroid

Teaching points

Do not stop
taking the
drug without
consulting
your health
care
provider;
take once-
daily doses
at about 9
AM.

Avoid
 exposure to
infections.

Report
unusual
weight gain,
swelling of
the
extremities,
muscle
weakness,
black or tarry
stools, fever,
prolonged
sore throat,
colds or
other
infections,
worsening of
the disorder
for which the
drug is being
taken

Teaching points

Do not stop
taking the
drug without
consulting
your health
 care
provider;
take once-
daily doses
at about 9
AM.

Avoid
exposure to
infections.

Report
unusual
weight gain,
swelling of
the
extremities,
muscle
weakness,
black or tarry
stools, fever,
prolonged
sore throat,
colds or
other
infections,
worsening of
the disorder
for which the
drug is being
taken.
Drug/Classifi mechanism of Action Indication Contraindicati Adverse Effect Nursing
cation on Responsibiliti
es
Vincristine Vincristine is classified Used primarily Known Hair loss Baseline
1.5 mg/m2 as an antimicrotubule in the hypersen Low white data is
Every month agent or vinca alkaloid. treatment of sitivity to blood cell obtained
(max 2mg) Vincristine produces its acute vinca Low red before
anti-cancer effects by leukemia, alkaloids blood cell starting
Antineoplasti causing abnormalities in usually as a or Low platelet vincristin
Nausea and
c microtubule formation in component of mannitol. e and
The vomiting
agent/antimi cells. Microtubules are various with each
Mouth sores
totic components of cells that chemotherape demyelin subseque
Diarrhea
provide structural utic regimens. ating Taste nt clinic
framework that enables form of changes visits so
cells to divide and grow. Charcot- Numbness or that the
The abnormal Marie- tingling of appropria
microtubule formation Tooth- feet or hands te drug
caused by vincristine syndrom Loss of dose can
inhibits cellular e should appetite be
replication and not be Abdominal determin
ultimately causes given cramps ed to
cellular death. vincristin Constipation maximize
e. tumor
Pharmacology: The Patients response
precise mechanism of receiving with the
action of vincristine radiation fewest
sulfate remains under therapy side
investigation. Vincristine through effects.
appears to affect cell ports Nursing
mitosis by interfering that interventi
with micro tubular include ons are
proteins and causing an the liver. directed
arrest of cell division at
during the metaphase. It symptom
is cell cycle phase- manage
specific. ment.
Pharmacokinetics: Dis Patient-
tribution: After IV family
administration, educatio
vincristine is rapidly n centers
distributed to body on
tissues. Vincristine is relating
extensively protein informing
bound (75%) and is of the
reported to be potential
concentrated in blood and
platelets. Vincristine symptom
does not penetrate the s of
central nervous system neurotoxi
to any significant city, with
degree. an
emphasis
on safety
precautio
ns.
Drug/Classificat Mechanism Indication Contraindicati Adverse Effect Nursing
ion of Action on Responsibilities
Intrathecal Decreases ALL Patients Decreased Assessment
Methotrexate Dihydrofolate (Acute with bowel
12mg/m2 reductase- Lympho liver/chro movement
Every 3 months mediated blastic nic liver Nausea and History: Allergy
(max 15mg) production of Leukemi disease Vomiting to methotrexate,
tetrahydrofola a) Patients Anorexia hematopoietic
with Mucositis depression,
Antineoplastic/ te, causes
Rashes severe hepatic
Immunosuppre decrease DNA known
Dizziness or renal disease,
ssant/ synthesis. hypersen infection, peptic
Malaise
Antimetabolite It also prevent sitivity to Alopecia ulcer, ulcerative
leukemia cells the drug Renal failure colitis, debility,
entering the pneuminitis psoriasis
CSF.
Physical: Weight;
Temperature;
 skin lesions,
color; hair;
vision, speech,
orientation,
reflexes,
sensation;
Respiration,
adventitious
sounds; mucous
membranes,
liver evaluation,
abdominal
examination;
CBC, differential;
LFTs, renal
function tests;
urinalysis, blood
and urine
glucose, glucose
tolerance test,
chest X-ray.

Interventions

BLACK BOX
WARNING:
Arrange for tests
to evaluate CBC,
urinalysis, renal
and liver
 function tests,
chest X-ray
before therapy,
during therapy,
and for several
weeks after
therapy.

WARNING:
Reduce dosage
or discontinue if
renal failure
occurs.

Reconstitute
powder for
intrathecal use
with
preservative-
free sterile
sodium chloride
injection;
intended for one
dose only;
discard
remainder.

WARNING:
Arrange to have
leucovorin
readily available
as antidote for
overdose or
when large
doses are used.
 In general, doses
of leucovorin
(calcium
leucovorin)
should be equal
or higher than
doses of
methotrexate
and should be
given within the
first hour.
Arrange for an
antiemetic if
nausea and
vomiting are
severe.

Arrange for
adequate
hydration during
therapy to
reduce the risk
of
hyperuricemia.

Do not
administer any
other
medications
containing
alcohol.

Teaching points
 Prepare a
calendar of
treatment days.

Avoid alcohol;
serious side
effects may
occur.

Arrange for
frequent, regular
medical follow-
up visits,
including blood
tests to follow
the drug's
effects.

You may
experience
these side
effects: Nausea,
vomiting
(request
medication; eat
frequent small
meals);
numbness,
tingling,
dizziness,
drowsiness,
blurred vision,
difficulty
speaking (drug
effects; seek
 dosage
adjustment;
avoid driving or
operating
dangerous
machinery);
mouth sores
(frequent mouth
care is needed);
infertility; loss of
hair (obtain a
wig or other
suitable head
covering; keep
the head
covered at
extremes of
temperature);
rash, sensitivity
to sun and
ultraviolet light
(avoid sun; use a
sunscreen and
protective
clothing).

Report black,
tarry stools;
fever; chills; sore
throat; unusual
bleeding or
bruising; cough
or shortness of
breath;
darkened or
bloody urine;
abdominal,
flank, or joint
pain; yellow
color to the skin
or eyes; mouth
sores.