Antiinflammatory drugs

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Antiinflammatory drugs

  1. 1. Drugs affecting the immune system Chapters 43,44,45,46
  2. 2. NSAIDs <ul><li>Large and chemically diverse group of drugs with the following properties: </li></ul><ul><ul><li>Analgesic </li></ul></ul><ul><ul><li>Anti-inflammatory </li></ul></ul><ul><ul><li>Antipyretic </li></ul></ul><ul><ul><li>Antirheumatic </li></ul></ul>
  3. 3. NSAIDs: Indications <ul><li>Analgesia (mild to moderate) </li></ul><ul><li>Antigout effects </li></ul><ul><li>Anti-inflammatory effects </li></ul><ul><li>Antipyretic effects </li></ul><ul><li>Relief of vascular headaches </li></ul><ul><li>Platelet inhibition (ASA) </li></ul><ul><li>Various bone, joint, and muscle pain </li></ul><ul><li>Osteoarthritis </li></ul><ul><li>Rheumatoid arthritis </li></ul><ul><li>Dysmenorrhea </li></ul>
  4. 4. NSAIDs: Mechanism of Action <ul><li>Analgesia—treatment of headaches, mild to moderate pain, and inflammation </li></ul><ul><li>Antipyretic: reduce fever </li></ul><ul><li>Inhibit prostaglandin E 2 within the area of the brain that controls temperature </li></ul><ul><li>Salicylates also have antiplatelet activity </li></ul><ul><ul><li>Inhibit platelet aggregation </li></ul></ul>
  5. 5. Figure 43-1 Arachidonic acid pathway.
  6. 6. NSAIDS: Mechanism of action <ul><li>Inflammation: response to tissue injury and infection </li></ul><ul><li>Cardinal signs of inflammation </li></ul><ul><li>Chemical Mediators </li></ul><ul><ul><li>Prostaglandins </li></ul></ul><ul><ul><ul><li>Vasodilation, relaxation of smooth muscles, increased capillary permeability & sensitization of nerve cells to pain </li></ul></ul></ul><ul><ul><li>Cyclooxygenase (COX) </li></ul></ul><ul><ul><ul><li>COX-1 & COX-2 </li></ul></ul></ul><ul><ul><ul><li>Enzyme responsible for conversion of arachidonic acid into prostaglandins </li></ul></ul></ul><ul><li>-Leukotrienes </li></ul>
  7. 7. Chemical Categories of NSAIDs <ul><li>Seven structurally related groups </li></ul><ul><li>Acetic acids </li></ul><ul><li>Carboxylic acids (salicylates) </li></ul><ul><ul><li>Acetylated and nonacetylated </li></ul></ul><ul><li>Propionic acids </li></ul><ul><li>COX-2 inhibitors </li></ul><ul><li>Fenamic acids </li></ul><ul><li>Napthylalkanones (nonacidic) </li></ul><ul><li>Oxicams </li></ul>
  8. 8. NSAIDs: Acetic Acid <ul><li>diclofenac sodium, Voltaren </li></ul><ul><li>Indomethacin, indocin </li></ul><ul><li>Sulindac, Clinoril </li></ul><ul><li>tolmetin </li></ul>
  9. 9. NSAIDs: Carboxylic Acids <ul><li>Acetylated </li></ul><ul><li>acetylsalicytic acid </li></ul><ul><li>diflunisal , Dolobid </li></ul><ul><li>Nonacetylated </li></ul><ul><li>Ketorolac, Toradol </li></ul><ul><li>sodium salicylate </li></ul>
  10. 10. NSAIDs: Propionic Acids <ul><li>Flurbiprofen, Ansaid </li></ul><ul><li>Ibuprofen, (Advil, Motrin) </li></ul><ul><li>Ketoprofen(Orudis) </li></ul><ul><li>Naproxen( Aleve, Anaprox, Naprosyn ) </li></ul>
  11. 11. NSAIDs: Other Agents <ul><li>COX-2 inhibitors </li></ul><ul><li>Celebrex </li></ul><ul><li>Vioxx (removed in 2004) </li></ul>
  12. 12. NSAIDs: Other Agents (cont’d) <ul><li>Oxicams </li></ul><ul><li>Meloxicam, Mobic </li></ul><ul><li>piroxicam </li></ul><ul><li>Fenamic acids </li></ul><ul><li>mefenamic acid </li></ul><ul><li>Nonacidic compounds </li></ul><ul><li>nabumetone </li></ul>
  13. 13. NSAIDs: Salicylates <ul><li>salicylates (aspirin) </li></ul><ul><li>More potent effect on platelet aggregation and thermal regulatory centre in the brain </li></ul><ul><ul><li>Analgesic </li></ul></ul><ul><ul><li>Antipyretic </li></ul></ul><ul><ul><li>Anti-inflammatory </li></ul></ul><ul><li>Antithrombotic effect: used in the treatment of MI and other thromboembolic disorders </li></ul>
  14. 14. NSAIDs: Antigout Agents <ul><li>Gout: condition that results from inappropriate uric acid metabolism </li></ul><ul><ul><li>Underexcretion of uric acid </li></ul></ul><ul><ul><li>Overproduction of uric acid </li></ul></ul><ul><li>Uric acid crystals are deposited in tissues and joints, resulting in pain </li></ul>
  15. 15. NSAIDs: Antigout Agents (cont’d) <ul><li>allopurinol </li></ul><ul><ul><li>Used to reduce production of uric acid </li></ul></ul><ul><li>colchicine </li></ul><ul><ul><li>Reduces inflammatory response to the deposits of urate crystals </li></ul></ul><ul><li>probenecid, sulfinpyrazone </li></ul><ul><ul><li>Increase excretion of uric acid in the urine </li></ul></ul>
  16. 16. NSAIDs: Side Effects <ul><li>Gastrointestinal </li></ul><ul><li>Dyspepsia, heartburn, epigastric distress, nausea </li></ul><ul><ul><li>GI bleeding* </li></ul></ul><ul><ul><li>Mucosal lesions* (erosions or ulcerations) </li></ul></ul><ul><li>*misoprostol (Cytotec) can be used to reduce these dangerous effects </li></ul><ul><li>Renal </li></ul><ul><li>Reductions in creatinine clearance </li></ul><ul><li>Acute tubular necrosis with renal failure </li></ul>
  17. 17. NSAIDs Salicylate Toxicity <ul><li>Adults: tinnitus and hearing loss </li></ul><ul><li>Children: hyperventilation and CNS effects </li></ul><ul><li>Effects arise when serum levels exceed 300 mcg/mL </li></ul><ul><li>Metabolic acidosis and respiratory alkalosis may be present </li></ul>
  18. 18. NSAIDs: Nursing Implications <ul><li>Before beginning therapy, assess for conditions that may be contraindications to therapy, especially: </li></ul><ul><ul><li>GI lesions or peptic ulcer disease </li></ul></ul><ul><ul><li>Bleeding disorders </li></ul></ul><ul><li>Assess also for conditions that require cautious use </li></ul><ul><li>Perform laboratory studies as indicated (cardiac, renal, liver studies, CBC, platelet count) </li></ul>
  19. 19. Nursing Implications <ul><li>Perform a medication history to assess for potential drug interactions. </li></ul><ul><li>Several serious drug interactions exist </li></ul><ul><ul><li>Alcohol </li></ul></ul><ul><ul><li>Heparin </li></ul></ul><ul><ul><li>Phenytoin </li></ul></ul><ul><ul><li>Oral anticoagulants </li></ul></ul><ul><ul><li>Steroids </li></ul></ul><ul><ul><li>Sulfonamides </li></ul></ul>
  20. 20. Nursing Implications (cont’d) <ul><li>Salicylates are NOT to be given to children under age 12 because of the risk of Reye’s syndrome </li></ul><ul><li>Because these agents generally cause GI distress, they are often better tolerated if taken with food, milk, or an antacid to avoid irritation </li></ul><ul><li>Explain to clients that therapeutic effects may not be seen for 3 to 4 weeks </li></ul>
  21. 21. Nursing Implications (cont’d) <ul><li>Educate clients about the various side effects of NSAIDs, and to notify their physician if these effects become severe or if bleeding or GI pain occurs </li></ul><ul><li>Clients should watch closely for the occurrence of any unusual bleeding, such as in the stool </li></ul><ul><li>Enteric-coated tablets should not be crushed or chewed </li></ul>
  22. 22. Nursing Implications (cont’d) <ul><li>Monitor for therapeutic effects, which vary according to the condition being treated </li></ul><ul><ul><li>Decrease in swelling, pain, stiffness, and tenderness of a joint or muscle area </li></ul></ul>
  23. 23. Case Study: NSAIDS <ul><li>Mrs Jones is 78 years old and has been discharged from hospital following an open reduction internal fixation of her Right tib/fibula. </li></ul><ul><li>She has a remote history of GI bleed in her 60’s </li></ul><ul><li>Her orthopedic surgeon prescribes : </li></ul><ul><li>Cytotec, </li></ul><ul><li>ASA 81 mg </li></ul><ul><li>Celebrex </li></ul>
  24. 24. Your discharge instructions will be: <ul><li>ASA : </li></ul><ul><li>Celebrex: </li></ul><ul><li>Cytotec : </li></ul>
  25. 25. Client teaching about NSAIDS: <ul><li>Take with food/milk </li></ul><ul><li>Check stools for blood </li></ul><ul><li>Report stomach pain </li></ul><ul><li>Report to other health care providers (ie dentist) </li></ul>
  26. 26. Immune System <ul><li>Defends the body against invading pathogens, foreign antigens, and its own cells that become cancerous </li></ul><ul><li>Can also sometimes attack itself, causing “autoimmune diseases” or immune-mediated diseases </li></ul><ul><li>Participates in analphylaxis & tissue/organ rejection </li></ul>
  27. 27. Immunosuppressants <ul><li>Agents that decrease or prevent an immune response, thus suppressing the immune system </li></ul><ul><li>Used to prevent or treat rejection of transplanted organs </li></ul>
  28. 28. Immunosuppressants (cont’d) <ul><li>All suppress certain T-lymphocyte cells lines, preventing their involvement in the immune response </li></ul><ul><li>Result: a pharmacologically immunocompromised state </li></ul><ul><li>Mechanisms of action vary according to agent </li></ul>
  29. 29. Immunosuppressants (cont’d) <ul><ul><li>Corticosteroids </li></ul></ul><ul><ul><li>azathioprine </li></ul></ul><ul><ul><li>muromonab-CD3 </li></ul></ul><ul><ul><li>daclizumab </li></ul></ul><ul><ul><li>sirolimus </li></ul></ul><ul><ul><li>cyclophosphamide </li></ul></ul><ul><ul><li>cyclosporine </li></ul></ul><ul><ul><li>tacrolimus </li></ul></ul><ul><ul><li>basiliximab </li></ul></ul><ul><ul><li>glatiramer acetate </li></ul></ul>
  30. 30. Immunosuppressants (cont’d) <ul><li>Indications vary from agent to agent </li></ul><ul><li>Primarily indicated for the prevention of organ rejection </li></ul><ul><li>Some also used for immunological diseases such as rheumatoid arthritis and multiple sclerosis </li></ul>
  31. 31. Immunosuppressants (cont’d) <ul><li>azathioprine </li></ul><ul><ul><li>Used as an adjunct medication to prevent rejection of kidney transplants </li></ul></ul><ul><ul><li>Also used in the treatment of rheumatoid arthritis </li></ul></ul>
  32. 32. Immunosuppressants (cont’d) <ul><li>cyclosporine </li></ul><ul><ul><li>Primary agent used in the prevention of kidney, liver, heart, and bone marrow transplant rejection </li></ul></ul><ul><ul><li>May be used for other autoimmune disorders </li></ul></ul><ul><li>tacrolimus </li></ul><ul><ul><li>Used for the prevention of liver and kidney transplant rejection </li></ul></ul>
  33. 33. Immunosuppressants (cont’d) <ul><li>glatiramer acetate </li></ul><ul><ul><li>The only immunosuppressant agent used for the treatment of multiple sclerosis (MS) </li></ul></ul><ul><ul><li>Used to reduce the frequency of MS relapses (exacerbations) in relapsing-remitting multiple sclerosis (RRMS) </li></ul></ul>
  34. 34. Immunosuppressants (cont’d) <ul><li>Side effects vary according to agents, and may be devastating </li></ul><ul><li>**All immunosuppressed clients have a heightened susceptibility to opportunistic infections** </li></ul>
  35. 35. Nursing Implications <ul><li>Thorough assessment should be performed before administering these agents </li></ul><ul><ul><li>Renal, liver, and cardiovascular function </li></ul></ul><ul><ul><li>Respiratory assessment </li></ul></ul><ul><ul><li>Baseline vital signs </li></ul></ul><ul><ul><li>Baseline laboratory studies, including hemoglobin, hematocrit, WBC, and platelet counts </li></ul></ul>
  36. 36. Nursing Implications (cont’d) <ul><li>Assess for contraindications, drug allergies </li></ul><ul><li>Monitor WBC counts throughout therapy; if the count drops below 3.0 x 10 9 /L the drug should be discontinued, but only after contacting the physician </li></ul>
  37. 37. Nursing Implications (cont’d) <ul><li>Oral immunosuppressants should be taken with food to minimize GI upset </li></ul><ul><li>Oral forms are used when possible to decrease the risk of infection that may occur with parenteral injections </li></ul><ul><li>Oral antifungal agents are usually given with these agents to treat oral candidiasis that may occur </li></ul><ul><li>Observe the oral cavity often for white patches on the tongue, mucous membranes, and oral pharynx </li></ul>
  38. 38. Nursing Implications (cont’d) <ul><li>Follow guidelines for parenteral administration carefully </li></ul><ul><li>Clients need to be told that lifelong therapy with immunosuppressants is indicated with organ transplantation </li></ul>
  39. 39. Nursing Implications (cont’d) <ul><li>Clients taking immunosuppressants should be encouraged to take measures to reduce the risk of infection </li></ul><ul><ul><li>Avoiding crowds </li></ul></ul><ul><ul><li>Avoiding people with colds or other infections </li></ul></ul><ul><li>Clients should be told to report any fever, sore throat, chills, joint pain, fatigue, or other signs of a severe infection immediately </li></ul>
  40. 40. Immunity <ul><li>Immune response </li></ul><ul><ul><li>Antigens </li></ul></ul><ul><ul><li>Antibodies </li></ul></ul><ul><li>Active immunization </li></ul><ul><li>Passive immunization </li></ul>
  41. 41. Table 45-1 Active versus passive immunity
  42. 42. Immunizing Biologicals <ul><li>Biological antimicrobial agents </li></ul><ul><ul><li>Also called biologicals </li></ul></ul><ul><ul><li>Antitoxins </li></ul></ul><ul><ul><li>Serum </li></ul></ul><ul><ul><li>Toxoids </li></ul></ul><ul><ul><li>Vaccines </li></ul></ul><ul><ul><li>Used to prevent, treat, or cure infectious diseases </li></ul></ul>
  43. 43. Toxoids <ul><li>Antigenic (foreign) preparations or bacterial exotoxins </li></ul><ul><li>Detoxified with chemicals or heat </li></ul><ul><li>Cannot revert back to a toxic form </li></ul><ul><li>Stimulate one’s immune system to produce a specific antibody </li></ul><ul><li>The production of these antibodies protect against future exposures to the antigen </li></ul><ul><li>Ex. Tetanus </li></ul>
  44. 44. Vaccines <ul><li>Suspensions of live, attenuated (weakened) or killed (inactivated) micro-organisms </li></ul><ul><li>The weakened form prevents the person from contracting the disease </li></ul>
  45. 45. Vaccines (cont’d) <ul><li>Also stimulate the production of antigens against a specific antibody </li></ul><ul><li>Vaccinations with live bacteria or virus provide lifelong immunity </li></ul><ul><li>Vaccinations with killed bacteria or virus provide partial immunity, and booster shots are needed periodically </li></ul>
  46. 46. Active Immunization <ul><li>The body is exposed to a relatively harmless form of an antigen </li></ul><ul><li>The immune system is stimulated, and “remembers” this antigen if subsequent exposures occur </li></ul><ul><li>The immunizations do not cause a full-blown infection </li></ul>
  47. 47. Examples of Active Immunizing Agents <ul><li>BCG vaccine (tuberculosis) </li></ul><ul><li>Diphtheria,tetanus, and pertussis toxoids, several forms </li></ul><ul><li>Cholera vaccine </li></ul><ul><li>Haemophilus influenzae type b conjugate vaccine </li></ul><ul><li>Hepatitis A and B virus vaccines </li></ul><ul><li>Measles, mumps, and rubella virus vaccine, live—several forms </li></ul><ul><li>Poliovirus vaccine, several forms </li></ul>
  48. 48. Examples of Active Immunizing Agents (cont’d) <ul><li>Rabies virus vaccine </li></ul><ul><li>Smallpox virus vaccine </li></ul><ul><li>Tetanus toxoid </li></ul><ul><li>Varicella virus vaccine (chicken pox) </li></ul><ul><li>Yellow fever virus vaccine </li></ul>
  49. 49. Indications <ul><li>Active immunization </li></ul><ul><ul><li>Prevents infection caused by bacterial toxins or viruses </li></ul></ul><ul><ul><li>Provides long-lasting or permanent immunity </li></ul></ul><ul><ul><li>“ Herd immunity” </li></ul></ul>
  50. 50. Passive Immunization <ul><li>Serum or concentrated immune globulins from humans or animals are injected into a person </li></ul><ul><li>The substances needed to fight off invading micro-organisms are given directly to a person </li></ul><ul><li>The immune system is bypassed </li></ul><ul><li>Short-lived compared with active immunization, but works faster </li></ul>
  51. 51. Passive Immunization (cont’d) <ul><li>Naturally acquired passive immunity </li></ul><ul><ul><li>From mother to fetus through the placenta </li></ul></ul><ul><ul><li>From mother to infant through breast milk </li></ul></ul><ul><li>Artificially acquired passive immunity </li></ul><ul><ul><li>Acquired from an external source, such as injection of antibodies or immunoglobulins </li></ul></ul>
  52. 52. Examples of Passive Immunizing Agents <ul><li>Antivenins </li></ul><ul><li>Diphtheria antitoxin </li></ul><ul><li>Hepatitis B immune globulin </li></ul><ul><li>Immune globulin, various forms </li></ul><ul><li>Rabies immune globulin (human) </li></ul><ul><li>Rh 0 (D) immune globulin (RhoGAM) </li></ul><ul><li>Tetanus immune globulin </li></ul><ul><li>Varicella zoster immune globulin (chicken pox/shingles) </li></ul>
  53. 53. Indications (cont’d) <ul><li>Passive immunization </li></ul><ul><ul><li>Antitoxins, antivenins, immune globulins </li></ul></ul><ul><ul><li>Minimizes effects of poisoning by the venoms of spiders and certain snakes </li></ul></ul><ul><ul><li>Provides quick immunity before a person’s own immune system has a chance to make antibodies (such as in cases of exposure to hepatitis B or rabies viruses) </li></ul></ul>
  54. 54. Indications (cont’d) <ul><li>National Advisory Committee on Immunization recommendations for adult and pediatric immunizations (Canada) </li></ul><ul><ul><li>Provide specific dosages and intervals for immunizations </li></ul></ul>
  55. 55. Mechanism of action:vaccines <ul><li>Anitgens: foreign substances </li></ul><ul><li>Anitbodies: immunoglobulins </li></ul><ul><li>Once the vaccine is administered the body produces immunoglobulins: IgG, IgA, IgE, IgD, IgM to attack and kill the foreign invader </li></ul><ul><li>Anitbody titre : the amount of immunoglobulin in the body that must be present to protect the body against the pathogen </li></ul><ul><li>Booster shot: given when antibody titre reveals low levels </li></ul>
  56. 56. Side Effects <ul><li>Range from mild and transient to very serious or life threatening </li></ul><ul><li>Minor effects </li></ul><ul><ul><li>Fever, minor rash, soreness at injection site, itching </li></ul></ul><ul><li>Severe effects </li></ul><ul><ul><li>Fever >38° C, encephalitis, convulsions, anaphylactic reaction, dyspnea, others </li></ul></ul>
  57. 57. Immunization schedule
  58. 58. Side Effects (cont’d) <ul><li>Minor reactions </li></ul><ul><ul><li>Treated with acetaminophen and rest </li></ul></ul><ul><li>Serious or unusual reactions </li></ul><ul><ul><li>Serum sickness </li></ul></ul><ul><ul><li>Report serious or unusual reactions to the Canadian Adverse Events Following Immunization Surveillance System </li></ul></ul>
  59. 59. Nursing Implications <ul><li>Assess client’s health history, medication history, allergies, pregnancy status </li></ul><ul><li>Assess previous reactions and responses to immunizations </li></ul><ul><li>Assess for contraindications, including immunosuppression </li></ul>
  60. 60. Nursing Implications (cont’d) <ul><li>Before giving any agent, recheck the specific protocols for administration and schedules for administration </li></ul><ul><li>Follow manufacturer’s guidelines for drug storage, administration, routes, and site of administration </li></ul>
  61. 61. Nursing Implications (cont’d) <ul><li>If discomfort occurs at the injection site, apply warm compresses and give acetaminophen </li></ul><ul><li>Do not give acetylsalicylate acid to children </li></ul><ul><li>Monitor for therapeutic responses and adverse reactions </li></ul>
  62. 62. Cancer <ul><li>Cellular transformation </li></ul><ul><li>Uncontrolled and rapid cellular growth </li></ul><ul><li>Invasion into surrounding tissue </li></ul><ul><li>Metastasis to other tissues or organs </li></ul>
  63. 63. Cancer (cont’d) <ul><li>Cancerous cells do not have: </li></ul><ul><ul><li>Growth control mechanisms </li></ul></ul><ul><ul><li>Positive physiological function </li></ul></ul><ul><li>Cancer cells either: </li></ul><ul><ul><li>Grow and invade adjacent tissues </li></ul></ul><ul><ul><li>Break away from original tumour mass and travel by means of blood or lymphatic system to distant sites </li></ul></ul>
  64. 64. Cancer (cont’d) <ul><li>Metastasis </li></ul><ul><ul><li>Uncontrolled cell growth </li></ul></ul><ul><li>Neoplasm </li></ul><ul><ul><li>Mass of new cells; tumour </li></ul></ul><ul><li>Tumour </li></ul><ul><ul><li>Benign </li></ul></ul><ul><ul><li>Malignant (cancer) </li></ul></ul>
  65. 65. Table 46-2 Tumour classification based on specific tissue of origin
  66. 66. Etiology of Cancer <ul><li>Age- and sex-related differences </li></ul><ul><li>Genetic factors </li></ul><ul><li>Ethnic factors </li></ul><ul><li>Oncogenic factors (viruses) </li></ul><ul><li>Occupational and environmental carcinogens </li></ul><ul><li>Radiation </li></ul><ul><li>Immunological factors </li></ul>
  67. 67. Chemotherapy <ul><li>Pharmacological treatment of cancer </li></ul><ul><li>Antineoplastic agents </li></ul><ul><li>Divided into two groups based on where in the cellular life cycle they work </li></ul><ul><ul><li>Cell cycle nonspecific (CCNS) </li></ul></ul><ul><ul><li>Cell cycle specific (CCS) </li></ul></ul>
  68. 68. Chemotherapy (cont’d) <ul><li>Drugs have a narrow therapeutic index </li></ul><ul><li>Combination of agents is usually more effective than single-agent therapy </li></ul><ul><li>Nearly all agents cause side effects and adverse effects </li></ul><ul><li>Dose-limiting side effects </li></ul>
  69. 69. Chemotherapy (cont’d) <ul><li>Harmful to all rapidly growing cells </li></ul><ul><ul><li>Harmful cancer cells </li></ul></ul><ul><ul><li>Healthy, normal human cells </li></ul></ul><ul><ul><ul><li>Hair follicles </li></ul></ul></ul><ul><ul><ul><li>GI cells </li></ul></ul></ul><ul><ul><ul><li>Bone marrow cells </li></ul></ul></ul>
  70. 70. Chemotherapy: Contraindications <ul><li>Few given the fatal outcome of cancer </li></ul><ul><li>Low wbc </li></ul><ul><li>Infectious process </li></ul>
  71. 71. Extravasation <ul><li>Leaking of an antineoplastic drug into surrounding tissues during IV administration </li></ul><ul><li>Can result in permanent damage to nerves, tendons, muscles, loss of limbs </li></ul><ul><li>Skin grafting or amputations may be necessary </li></ul><ul><li>Prevention is essential, Continuous monitoring of the IV site is essential </li></ul>
  72. 72. Extravasation (cont’d) <ul><li>If suspected, stop the IV infusion immediately but do not remove the IV tube </li></ul><ul><li>If possible, aspirate remaining drug or blood from the tube </li></ul><ul><li>Follow instructions for giving the appropriate antidote (if one exists) through the existing IV tube, then remove the catheter </li></ul><ul><li>Some antidotes are not given through the IV catheter </li></ul>
  73. 73. Extravasation (cont’d) <ul><li>Cover area with sterile, occlusive dressing </li></ul><ul><li>Apply warm or cold compresses, depending on the extravasated agent </li></ul><ul><li>Elevate the limb </li></ul>
  74. 74. Nursing Implications <ul><li>Assess baseline blood counts before giving any antineoplastic agents </li></ul><ul><li>Follow specific administration guidelines for each antineoplastic agent </li></ul><ul><li>Remember that all rapidly dividing cells (both normal and cancer cells) are affected </li></ul><ul><ul><li>Mucous membranes </li></ul></ul><ul><ul><li>Hair follicles </li></ul></ul><ul><ul><li>Bone marrow component </li></ul></ul>
  75. 75. Nursing Implications (cont’d) <ul><li>Monitor for complications </li></ul><ul><ul><li>GI mucous membranes: stomatitis, altered bowel function with high risk for poor appetite, nausea, vomiting, diarrhea, and inflammation and possible ulcerations of GI mucosa </li></ul></ul>
  76. 76. Nursing Implications (cont’d) <ul><li>Monitor for complications </li></ul><ul><ul><li>Hair follicles: loss of hair (alopecia) </li></ul></ul><ul><ul><li>Bone marrow components: dangerously low (life-threatening) blood cell counts </li></ul></ul>
  77. 77. Nursing Implications (cont’d) <ul><li>Implement measures to monitor for and prevent infection in clients with neutropenia </li></ul><ul><li>Implement measures to monitor for and prevent bleeding in clients with thrombocytopenia and anemia </li></ul><ul><li>Keep in mind that anemia may result in severe fatigue </li></ul>
  78. 78. Nursing Implications (cont’d) <ul><li>Monitor for stomatitis (oral inflammation and ulcerations) and implement measures to reduce the effects if it occurs </li></ul><ul><li>Anticipate nausea and vomiting and implement measures to reduce these effects </li></ul><ul><li>Women of childbearing age will need to use a nondrug form of contraception during therapy </li></ul>
  79. 79. Nursing Implications (cont’d) <ul><li>In addition to physical measures, keep in mind the need for emotional support during this time for both the client and family </li></ul><ul><li>Monitor for therapeutic responses to antineoplastic therapies and the many possible side/adverse effects </li></ul>

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