NAME: Ellaine Jhane T.

Domede BSN1V

PALLIATIVE CARE
MY DRUG STUDY
DEXAMETHASONE 4mg 1 tab BID
Trade Names: Decadron, Dexasone, Diodex, Hexadrol, Maxidex
Other Names: dexamethasone sodium phosphate, dexamethasone acetate

CLASS: corticosteroid (more precisely a glucocorticosteroid)

INDICATION

• As an anti-inflammatory medication. Dexamethasone relieves inflammation in various parts of the

body. It is used specifically to decrease swelling (edema), associated with tumors of the spine and
brain, and to treat eye inflammation.
• To treat or prevent allergic reactions.
• As treatment of certain kinds of autoimmune diseases, skin conditions, asthma and other lung
conditions.
• As treatment for a variety of cancers, such as leukemia, lymphoma, and multiple myeloma.
• To treat nausea and vomiting associated with some chemotherapy drugs.
• Used to stimulate appetite in cancer patients with severe appetite problems.
• Also used to replace steroids in conditions of adrenal insufficiency (low production of needed steroids
produced by the adrenal glands).

MECHANISM OF ACTION

Dexamethasone is a glucocorticoid agonist. Unbound dexamethasone crosses cell membranes and

binds with high affinity to specific cytoplasmic glucocorticoid receptors. This complex binds to DNA
elements (glucocorticoid response elements) which results in a modification of transcription and, hence,
protein synthesis in order to achieve inhibition of leukocyte infiltration (accumulation of WBC or cell in
excess of the normal) at the site of inflammation, interference in the function of mediators of
inflammatory response, suppression of humoral immune responses, and reduction in edema or scar tissue.
The anti-inflammatory actions of dexamethasone are thought to involve phospholipase A2 inhibitory
proteins, lipocortin, which control the biosynthesis of potent mediators of inflammation such as
prostaglandins and leukotrienes.

The following side effects are common (occurring in greater than 30%) for patients taking
dexamethasone:

• Increased appetite
• Irritability
• Difficulty sleeping (insomnia)
• Swelling in your ankles and feet (fluid retention)
• Heartburn
• Muscle weakness
• Impaired wound healing
 • Increased blood sugar levels. (Persons with Diabetes may need to have blood sugar levels
monitored more closely and possible adjustments to diabetes medications).

NURSING RESPONSIBILITY

➢ Observe for signs of adverse reactions.

➢ Monitor blood pressure 2-3 times daily.
➢ Test for glycosuria daily. If urine is positive for sugar, check each urine.
➢ Observe gastric aspirates and stools for bleeding.
➢ Observe closely for signs of infection.

OMEPRAZOLE 40 mg BID before meals

CLASS: proton pump inhibitors (PPI) that block the production of acid by the stomach.
INDICATION
Proton pump inhibitors are used for the treatment of conditions such as ulcers, gastroesophageal
reflux disease (GERD) and the Zollinger-Ellison syndrome, which are all caused by stomach acid.
Omeprazole is indicated for the treatment of duodenal ulcers, benign gastric ulcers,
gastroesophageal reflux disease (GERD), heartburn and other symptoms associated with
GERD, erosive esophagitis, and long-term treatment of pathological hypersecretory conditions
like Zollinger-Ellison syndrome, multiple endocrine adenomas, and systemic mastocytosis.
MECHANISM OF ACTION:
Omeprazole, like other proton-pump inhibitors, blocks the enzyme in the wall of the stomach that
produces acid. By blocking the enzyme, the production of acid is decreased, and this allows the stomach
and esophagus to heal.
Omeprazole is a proton pump inhibitor that suppresses gastric acid secretion by specific inhibition of the
H+/K+-ATPase in the gastric parietal cell. By acting specifically on the proton pump, omeprazole blocks
the final step in acid production, thus reducing gastric acidity.
SIDE EFFECT: diarrhea, nausea, vomiting, headaches, rash and dizziness.
NURSING CONSIDERATION:

➢ Give medication before meals, preferably in the morning for once-daily dosing. If necessary, also
give an antacid, as prescribed.
If needed, open capsule and sprinkle the granules on applesauce or yogurt or mix with water or
acidic fruit juice, such as apple or cranberry juice. Give immediately.
➢ Tell patient to take drug before eating (before breakfast) and to swallow capsules whole. Tell the
patient to drink a glass of cool water.
➢ If patient takes the oral suspension, tell them to empty the package into a small cup containing 2
tablespoons of water (no other beverage should be used), stir the mixture well, drink it
immediately, refill the cup with water, and drink again.
➢ Encourage patient to avoid alcohol, aspirin products, ibuprofen, and foods that may increase
gastric secretions during therapy.
➢ Tell patient to notify all doctors about prescription drug use.
➢ Advise patient to notify doctor immediately if they have abdominal pain or diarrhea.
 KCL 1 tab BID while on cisplatin (POTASSIUM CHLORIDE)

CLASS: POTASSIUM (Electrolytes and Replacement Solutions)

INDICATION: For use as an electrolyte replenisher and in the treatment of hypokalemia.
PHARMACODYNAMIC: The potassium ion is in the principle intracellular cation of most body
tissues. Potassium ions participate in a number of essential physiological processes including the
maintenance of intracellular tonicity, the transmission of nerve impulses, the contraction of cardiac,
skeletal and smooth muscle, and the maintenance of normal renal function. The intracellular
concentration of potassium is approximately 150 to 160 mEq per liter. The normal adult plasma
concentration is 3.5 to 5 mEq per liter. An active ion transport system maintains this gradient across the
plasma membrane. Potassium is a normal dietary constituent and under steady-state conditions the
amount of potassium absorbed from the gastrointestinal tract is equal to the amount excreted in the urine.
The usual dietary intake of potassium is 50 to 100 mEq per day. Potassium depletion will occur whenever
the rate of potassium loss through renal excretion and/or loss from the gastrointestinal tract exceeds the
rate of potassium intake. Such depletion usually develops as a consequence of therapy with diuretics,
primarily or secondary hyperaldosteronism, diabetic ketoacidosis, or inadequate replacement of potassium
in patients on prolonged parenteral nutrition. Depletion can develop rapidly with severe diarrhea,
especially if associated with vomiting. Potassium depletion due to these causes is usually accompanied by
concomitant loss of chloride and is manifested by hypokalemia and metabolic alkalosis. Potassium
depletion may produce weakness, fatigue, disturbances of cardiac rhythm (primarily ectopic beats),
prominent U-waves in the electrocardiogram, and, in advanced cases, flaccid paralysis and/or impaired
ability to concentrate urine. If potassium depletion associated with metabolic alkalosis cannot be managed
by correcting the fundamental cause of the deficiency, e.g., where the patient requires long-term diuretic
therapy, supplemental potassium in the form of high potassium food or potassium chloride may be able to
restore normal potassium levels. In rare circumstances (e.g., patients with renal tubular acidosis)
potassium depletion may be associated with metabolic acidosis and hyperchloremia.
MECHANISM OF ACTION: Supplemental potassium in the form of high potassium food or
potassium chloride may be able to restore normal potassium levels.
SIDE EFFECT:
nausea, vomiting, abdominal pain, post infusion phlebitis, paresthesia of the extremities, mental
confusion, weakness or heaviness of limbs, flaccid paralysis, ECG changes, hypotension, arrhythmias,
heart block, possible cardiac arrest, respiratory paralysis.

Nursing Considerations

• use cautiously in patients with cardiac disease and in those with renal impairment
• Give oral potassium supplements with extreme caution because different forms deliver varying
amounts of potassium. Never switch products without a doctor’s order.
• make sure powders are completely dissolved before administering
• Know that enteric-coated tablets are not recommended because of increased potential for GI
bleeding and small bowel ulcerations.
• Know that drug is often used orally with potassium-wasting diuretics to maintain potassium levels.
• Be aware that sugar free liquid is available; use if tablet or capsule passage is likely to be delayed,
such as GI obstruction. Have patients sip slowly to minimize GI irritation.
 CISPLATIN 50 g in PNSS 1L

CLASS: Cisplatin is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This medication

is classified as an "alkylating agent.

INDICATION:
Treatment of advanced bladder cancer, metastatic ovarian cancer, and metastatic testicular cancer.
Testicular, ovarian, bladder, head and neck, esophageal, small and non-small cell lung, breast, cervical,
stomach and prostate cancers. Also to treat Hodgkin's and non-Hodgkin's lymphomas, neuroblastoma,
sarcomas, multiple myeloma, melanoma, and mesothelioma.

PHARMACODYNAMICS:
Cisplatin is an antineoplastic in the class of alkylating agents and is used to treat various forms of cancer.
Alkylating agents are so named because of their ability to add alkyl groups to many electronegative
groups under conditions present in cells. They stop tumor growth by cross-linking guanine bases in DNA
double-helix strands - directly attacking DNA. This makes the strands unable to uncoil and separate. As
this is necessary in DNA replication, the cells can no longer divide. In addition, these drugs add methyl or
other alkyl groups onto molecules where they do not belong which in turn inhibits their correct utilization
by base pairing and causes a miscoding of DNA. Alkylating agents are cell cycle-nonspecific. Alkylating
agents work by three different mechanisms all of which achieve the same end result - disruption of DNA
function and cell death.

MECHANISM OF ACTION: Alkylating agents work by three different mechanisms: 1) attachment of

alkyl groups to DNA bases, resulting in the DNA being fragmented by repair enzymes in their attempts to
replace the alkylated bases, preventing DNA synthesis and RNA transcription from the affected DNA, 2)
DNA damage via the formation of cross-links (bonds between atoms in the DNA) which prevents DNA
from being separated for synthesis or transcription, and 3) the induction of mispairing of the nucleotides
leading to mutations.
The following side effects are common (occurring in greater than 30%) for patients taking
Cisplatin:

• Nausea and vomiting. Nausea may last up to 1 week after therapy. Anti-nausea medication is
given before the infusion, and a prescription is also given for use after.
• Low blood counts. Your white and red blood cells and platelets may temporarily decrease. This
can put you at increased risk for infection, anemia, and/or bleeding. Nadir: Meaning low point, is
the point in time between chemotherapy cycles in which you experience low blood counts.
o Nadir: 18-23 days. Recovery: 39 days
• Kidney toxicity. Effects on kidney function are dose related, observed 10-20 days after therapy,
and are generally reversible.
• Ototoxicity hearing loss, ringing in the ears.
• Blood test abnormalities (low magnesium, low calcium, low potassium)

These are less common side effects (occurring in 10-29%) for patients receiving Cisplatin:
 • Peripheral neuropathy: Although less common, a serious side effect of decreased sensation and
paresthesia (numbness and tingling of the extremities) may be noted. Sensory loss, numbness and
tingling, and difficulty in walking may last for at least as long as therapy is continued. These side
effects may become progressively more severe with continued treatment, and your doctor may
decide to decrease your dose. Neurologic effects may be irreversible.
• Loss of appetite
• Taste changes, metallic taste
• Increases in blood tests measuring liver function. These return to normal once treatment is
discontinued. (see liver problems).
• Hair loss may cause hair loss; however, this side effect is uncommon.

NURSING RESPONSIBILITIES

• Before starting cisplatin treatment, make sure you tell your doctor about any other medications
you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not
take aspirin, products containing aspirin unless your doctor specifically permits this.
• Cisplatin may be inadvisable if you have a history of severe allergic reaction to cisplatin,
carboplatin, other platinum-containing formulations or mannitol.
• Do not receive any kind of immunization or vaccination without your doctor's approval while
taking cisplatin.
• Your fertility, meaning your ability to conceive or father a child, may be affected by cisplatin.
Please discuss this issue with your health care provider.

NURSING EDUCATION

• To reduce nausea, take anti-nausea medications as prescribed by your doctor, eat small amounts
of food frequently.
• Try dry cereal, toast, or crackers, especially in the morning, to help curb nausea.
• Maintaining a good fluid intake is very important to help to avoid kidney damage. Drink at least
two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
• You may be at risk of infection so try to avoid crowds or people with colds, and report fever or
any other signs of infection immediately to your health care provider.
• Wash your hands often.
• To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1
teaspoon of baking soda mixed with 8 ounces of water.
• Use an electric razor and a soft toothbrush to minimize bleeding.
• In general, drinking alcoholic beverages should be kept to a minimum or avoided completely.
You should discuss this with your doctor.
• Avoid sun exposure. Wear SPF 30 (or higher) sunblock and protective clothing.
• Get plenty of rest.
• Maintain good nutrition.
• If you experience symptoms or side effects, be sure to discuss them with your health care team.
They can prescribe medications and/or offer other suggestions that are effective in managing such
problems.
 5-FU 1500 mg + PNSS 1L to run for 14 hours (FLUORORACIL)
CLASS: Fluorouracil is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug.
Fluorouracil is classified as an "antimetabolite."
INDICATION: Colon and rectal cancer, Gastrointestinal cancers including: anal, esophageal, pancreas
and gastric (stomach), Head and neck cancer, Unknown primary (squamous cell), Neuroendocrine
tumors, Thymic cancers, Cervical cancer, Bladder cancer, Hepatobiliary cancers, Topical use (cream or
solution) in basal cell cancer of the skin and actinic keratoses.
PHARMACODYNAMIC: Fluorouracil is an antineoplastic anti-metabolite. Anti-metabolites
masquerade as purine or pyrimidine - which become the building blocks of DNA. They prevent
these substances from becoming incorporated into DNA during the "S" phase (DNA
SYNTHESIS OCCURS, ALSO REPLICATED AND TRANSCRIBED) of the cell cycle, stopping
normal development and division. Fluorouracil blocks an enzyme which converts the cytosine
nucleotide into the deoxy derivative ( decrease oxygen in the molecule) . In addition, DNA
synthesis is further inhibited because Fluorouracil blocks the incorporation of the thymidine
nucleotide (building block of DNA and a pyrimidine bases) into the DNA strand.
MECHANISM OF ACTION: Main mechanism of fluorouracil is thought to be the binding of the
deoxyribonucleotide (single unit of DNA) and the folate cofactor, N5–10-
methylenetetrahydrofolate (co factor in several biochemical reactions) to thymidylate synthase
(TS) (provides the sole de novo source of thymidylate for DNA synthesis.) to form a covalently bound
ternary complex. This results in the inhibition of the formation of thymidylate from uracil
(nucleobases in the RNA) which leads to the inhibition of DNA and RNA synthesis and cell
death. Fluorouracil can also be incorporated into RNA in place of uridine triphosphate (UTP),
producing a fraudulent RNA and interfering with RNA processing and protein synthesis.
SIDE EFFECTS

• Diarrhea
• Nausea and possible occasional vomiting
• Mouth sores
• Poor appetite
• Watery eyes, sensitivity to light (photophobia)
• Taste changes, metallic taste in mouth during infusion
• Discoloration along vein through which the medication is given
• Low blood counts Your white and red blood cells and platelets may temporarily decrease.
This can put you at increased risk for infection, anemia and/or bleeding.

NURSING RESPONSIBILITY

• Before starting Fluorouracil treatment, make sure you tell your doctor about any other
medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies,
etc.). Do not take aspirin or products containing aspirin unless your doctor specifically permits
this.
• Do not receive any kind of immunization or vaccination without your doctor's approval while
taking Fluorouracil. Inform your health care professional if you are pregnant or may be pregnant
prior to starting this treatment. Pregnancy category D (Fluorouracil may be hazardous to the fetus.
Women who are pregnant or become pregnant must be advised of the potential hazard to the
fetus).
 • For both men and women: Use contraceptives, and do not conceive a child (get pregnant) while
taking Fluorouracil. Barrier methods of contraception, such as condoms, are recommended.
• Do not breast feed while taking Fluorouracil.

NURSING EDUCATION

• Use of ice chips in the mouth 10-15 minutes before and after IV injections of Fluorouracil may
reduce the incidence and severity of mouth sores.
• To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1
teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
• Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
• You may be at risk of infection so try to avoid crowds or people with colds and/or not feeling
well, and report fever or any other signs of infection immediately to your health care provider.
• Follow regimen of anti-diarrhea medication as prescribed by your health care professional.
• Eat foods that may help reduce diarrhea
• Avoid sun exposure. Wear SPF 30 (or higher) sunblock and protective clothing.
• In general, drinking alcoholic beverages should be kept to a minimum or avoided completely.
You should discuss this with your doctor.
• Get plenty of rest.
• Maintain good nutrition.
• Remain as active as you are able. Gentle exercise is encouraged, such as a daily walk.
• If you experience symptoms or side effects, be sure to discuss them with your health care team.
They can prescribe medications and/or offer other suggestions that are effective in managing such
problems.
• Prevention of hand-foot syndrome. You may need to modify normal activities of daily living to
reduce friction and heat exposure to hands and feet, for about a week after treatment. (for more
information see
• Keep palms of hands and soles of feet moist using emollients.
• You may experience drowsiness or dizziness; avoid driving or engaging in tasks that require
alertness until your response to the drug is known.

ONDANSETRON
CLASS: antiemetic and selective 5-HT3 receptor antagonist
INDICATION:
For the prevention of nausea and vomiting associated with emetogenic cancer chemotherapy,
postoperation, and radiation. Also used for the treatment of postoperative nausea and vomiting.
PHARMACODYNAMIC: Ondansetron is a highly specific and selective serotonin 5-
HT3 receptor antagonist, not shown to have activity at other known serotonin receptors and with
low affinity for dopamine receptors. The serontonin 5-HT3 receptors are located on the nerve
terminals of the vagus in the periphery, and centrally in the chemoreceptor trigger zone of the
area postrema. The temporal relationship between the emetogenic action of emetogenic drugs
and the release of serotonin, as well as the efficacy of antiemetic agents suggest that
chemotherapeutic agents release serotonin from the enterochromaffin cells of the small
intestine by causing degenerative changes in the GI tract. The serotonin then stimulates the
vagal and splanchnic nerve receptors that project to the medullary vomiting center, as well as
 the 5-HT3 receptors in the area postrema, thus initiating the vomiting reflex, causing nausea and
vomiting.
MECHANISM OF ACTION:
Ondansetron is a selective serotonin 5-HTreceptor antagonist. The antiemetic activity of the
drug is brought about through the inhibition of 5-HT3 receptors present both centrally (medullary
chemoreceptor zone) and peripherally (GI tract). This inhibition of 5-HT3 receptors in turn inhibits
the visceral afferent stimulation of the vomiting center, likely indirectly at the level of the area
postrema, as well as through direct inhibition of serotonin activity within the area postrema
(medullary structure in the brain that controls vomiting) and the chemoreceptor trigger zone
(medulla oblongata).
SIDE EFFECTS

• Headache
• Fatigue
• Constipation
• Diarrhea
• Dizziness
• Rash
• Hiccups
• Flushing

Serious side effects can occur. If you have any of these side effects, call your doctor right away:

• Temporary blurred vision or loss of vision

• Severe rash, hives, or a rash that causes blisters and peeling
• Yellowing of skin or eyes or dark-colored urine
• Seizure
• Chest pain
• Loss of consciousness
• Swelling of face, lips, tongue, or other parts of the body
• Difficulty breathing, swallowing, or talking

NURSING RESPONSIBILITY
• Instruct patient to report bothersome side effects such as severe or prolonged headache,
weakness, fatigue, or GI problems (diarrhea, constipation, abdominal pain, dry mouth).

MANNITOL 8/ post
• CLASS: Classes: Diuretics, Osmotic Agents (inhibits reabsorption of water and sodium)
INIDICATION:
Used for the promotion of diuresis before irreversible renal failure becomes established, the reduction of
intracranial pressure, the treatment of cerebral edema, and the promotion of urinary excretion of toxic
substances.

MECHANISM OF ACTION:
Mannitol is an osmotic diuretic that is metabolically inert in humans and occurs naturally, as a sugar or
sugar alcohol, in fruits and vegetables. Mannitol elevates blood plasma osmolality, resulting in enhanced
flow of water from tissues, including the brain and cerebrospinal fluid, into interstitial fluid and plasma.
As a result, cerebral edema, elevated intracranial pressure, and cerebrospinal fluid volume and pressure
may be reduced. As a diurectic mannitol induces diuresis because it is not reabsorbed in the renal tubule,
thereby increasing the osmolality of the glomerular filtrate, facilitating excretion of water, and inhibiting
the renal tubular reabsorption of sodium, chloride, and other solutes. Mannitol promotes the urinary
excretion of toxic materials and protects against nephrotoxicity by preventing the concentration of toxic
substances in the tubular fluid. As an Antiglaucoma agent mannitol levates blood plasma osmolarity,
resulting in enhanced flow of water from the eye into plasma and a consequent reduction in intraocular
pressure. As a renal function diagnostic aid mannitol is freely filtered by the glomeruli with less than 10%
tubular reabsorption. Therefore, its urinary excretion rate may serve as a measurement of glomerular
filtration rate (GFR).

SIDE EFFECTS: CNS: Headache, tremor, convulsions, dizziness, transient muscle

rigidity. CV: Edema, CHF, angina-like pain, hypotension, hypertension, thrombophlebitis. Eye: Blurred
vision. GI: Dry mouth, nausea, vomiting. Urogenital: Marked diuresis, urinary retention, nephrosis,
uricosuria. Metabolic: Fluid and electrolyte imbalance, especially hyponatremia; dehydration,
acidosis. Other: With extravasation (local edema, skin necrosis; chills, fever, allergic reactions).

NURSING RESPONSIBILITY

Assessment & Drug Effects

• Take care to avoid extravasation. Observe injection site for signs of inflammation or edema.
• Lab tests: Monitor closely serum and urine electrolytes and kidney function during therapy.
• Measure I&O accurately and record to achieve proper fluid balance.
• Monitor vital signs closely. Report significant changes in BP and signs of CHF.
• Monitor for possible indications of fluid and electrolyte imbalance (e.g., thirst, muscle cramps or
weakness, paresthesias, and signs of CHF).
• Be alert to the possibility that a rebound increase in ICP sometimes occurs about 12 h after drug
administration. Patient may complain of headache or confusion.
• Take accurate daily weight.

Patient & Family Education

• Report any of the following: Thirst, muscle cramps or weakness, paresthesia, dyspnea, or
headache.
• Family members should immediately report any evidence of confusion.
• Do not breast feed while using this drug

FOR CANCER: Mannitol can also be used to open the blood-brain barrier, which allows anticancer
medicines to enter the brain and treat brain tumors.