Pharmacology III Exam 2 Study Set

Which medication will the nurse question when it is prescribed for a client with acute pancreatitis? 1. Ranitidine 2. Cimetidine 3. Meperidine 4. Promethazine

3. Meperidine Meperidine should be avoided because accumulation of its metabolites can cause central nervous system irritability and even tonic-clonic seizures (grand mal seizures). Ranitidine is useful in reducing gastric acid stimulation of pancreatic enzymes. Cimetidine is useful in reducing gastric acid stimulation of pancreatic enzymes. Promethazine is useful as an antiemetic for clients with pancreatitis.

Which clinical finding would indicate to the nurse that an infant is experiencing life-threatening zidovudine toxicity? 1. Fatigue and lethargy 2. Increased urine output 3. Progressive weight loss 4. Bruises on the limbs and trunk

4. Bruises on the limbs and trunk

Why would lactulose be prescribed for a client with a history of cirrhosis of the liver? 1. The desire to drink alcohol is decreased. 2. Diarrhea is controlled and prevented. 3. Elevated ammonia levels are lowered. 4. Abdominal distension secondary to ascites is decreased

3. Elevated ammonia levels are lowered. Lactulose is an ammonia detoxicant. It decreases serum ammonia concentration by preventing reabsorption of ammonia. Lactulose has been used to lower blood ammonia content in clients with portal hypertension and hepatic encephalopathy secondary to chronic liver disease. Lactulose has no effect on the craving for alcohol or reduction of ascites or abdominal distension. Lactulose is also used as a hyperosmotic laxative; therefore it will not relieve diarrhea.

The nurse determines that an infant receiving zidovudine is exhibiting signs of life-threatening toxicity. Which clinical finding would support this conclusion? 1. Weight loss 2. Extreme lethargy 3. Bruises over the body 4. Increased urine output

3. Bruises over the body

A client with acquired immunodeficiency syndrome (AIDS) is on a treatment protocol that includes a protease inhibitor. When assessing the client's response to this medication, which common side effect would the nurse expect? 1. Diarrhea 2. Hypoglycemia 3. Paresthesias of the extremities 4. Seeing yellow halos around lights

1. Diarrhea Diarrhea, nausea, and vomiting are common side effects; clients should take these medications with a meal or light snack. These medications may cause hyperglycemia, not hypoglycemia. Circumoral (perioral), not peripheral, paresthesias may occur with protease inhibitors; peripheral paresthesias may occur with nucleoside reverse transcriptase inhibitors. Seeing yellow halos around lights does not occur with protease inhibitors; it may occur with digoxin toxicity.

A client who has been diagnosed with breast cancer is to receive chemotherapy with both cisplatin and vincristine. The client asks the nurse why both medications must be given together. The nurse should explain to the client that the combination of 2 chemotherapeutic medications is used for which reason? 1. Increase the destruction of tumor cells. 2. Prevent the destruction of normal cells. 3. Decrease the risk of the alopecia and stomatitis. 4. Increase the likelihood of erythrocyte and leukocyte recovery.

1. Increase the destruction of tumor cells. Cisplatin is an alkylatinglike medication, and vincristine is a vinca alkaloid. Alkylating medications are cell-cycle nonspecific. Vinca alkaloids are cell-cycle specific and act on the M phase. Single-agent medication therapy seldom is used. Combinations of medications are used to increase the destruction of tumor cells.

The nurse is being treated for a needlestick injury. Which instruction would the nurse be given to decrease the risk of seroconversion while taking combination antiretroviral therapy (cART)? 1. "Take both medications on a daily basis." 2. "Continue medication for 3 months." 3. "Start medication within 24 to 36 hours." 4. "Refrain from further contact with client."

3. "Start medication within 24 to 36 hours." The nurse will be instructed to initiate cART within 24 to 36 hours of exposure to decrease the risk of seroconversion. The treatment is a 3-medication, not 2-medication, regimen. Treatment needs to be taken for 28 days, not 3 months. Once treatment is initiated, the nurse does not need to avoid contact with the client.

A client with ovarian cancer is being treated with vincristine. The nurse monitors the client, knowing that which manifestation indicates an adverse effect specific to this medication? 1. Diarrhea 2. Hair loss 3. Chest pain 4. Peripheral neuropathy

4. Peripheral neuropathy An adverse effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all antineoplastic medications. Chest pain is unrelated to this medication.

A client with acquired immunodeficiency syndrome (AIDS) is prescribed epoetin. Which step would the nurse include during the administration of this medication? 1. Administer the medication via the Z-track technique. 2. Shake the vial before withdrawing the solution. 3. Obtain the client's pulse rate before administration. 4. Use a syringe that has a 1-inch (2.5-cm), 25-gauge needle.

4. Use a string that has a 1-inch (2.5-cm), 25-gauge needle. Epoetin is administered via the subcutaneous or intravenous route; a 1-inch (2.5-cm), 25-gauge needle is appropriate for either method of administration. The client's vital signs, particularly the blood pressure, need to be monitored only routinely to determine the effectiveness of the medication. Epoetin is not administered via the intramuscular route, so the Z-track technique is not used. Shaking the vial denatures the glycoprotein, making the medication biologically inactive and therefore ineffective.

Lorazepam (Ativan)

***Controlled Substance Schedule IV*** Functional Class: Sedative, hypnotic, antianxiety Chemical Class: Benzodiazepine, short acting Action: Potentiates the actions of GABA, especially in the limbic system and the reticular formation Uses: Anxiety, irritability with psychiatric or organic disorders, preoperatively; insomnia; adjunct for endoscopic procedures, status epilepticus, insomnia Side Effects: ECG changes, tachycardia, apnea, cardiac arrest (IV, rapid) Nursing Considerations: Assess for a decrease in anxiety; Assess for s/s of physical dependence and withdrawal (headache, n/v, muscle pain, weakness, tremors, seizures after long-term and excessive use); Use only if clearly needed in pregnancy; neonatal withdrawal syndrome may occur; do not breastfeed unless benefits outweigh the risk Black Box Warning: Teach patient to avoid alcohol and other psychotropic medications, opioids unless directed by prescriber; to notify prescriber immediately of trouble breathing, dizziness, coma, or if no response

Oxazepam (Serax)

***Controlled Substance Schedule IV*** Functional Class: Sedative/hypnotic; antianxiety Chemical Class: Benzodiazepine, short acting Action: Potentiates the actions of GABA, especially in the limbic system and the reticular formation Uses: Anxiety; alcohol withdrawal Side Effects: ECG changes, tachycardia, drug-induced hepatitis Nursing Considerations: Assess Mental status, mood, sensorium, affect, sleeping pattern, drowsiness, dizziness, sedation, suicidal thoughts/behaviors; Assess for physical dependency and withdrawal symptoms (Headache, n/v, muscle pain, weakness, tremors, seizures (long-term use); Assess for pregnancy before use and do not use in pregnancy; do not breastfeed Black Box Warning: Respiratory depression (Not to be used in preexisting respiratory depression; use cautiously in severe pulmonary disease; monitor respirations)

A client with human immunodeficiency virus (HIV) infection is diagnosed with tuberculosis. Before starting antitubercular pharmacotherapy, which essential test results will the nurse review? 1. Liver function studies 2. Pulmonary function studies 3. Electrocardiogram and echocardiogram 4. White blood cell counts and sedimentation rate

1. Liver function studies Antitubercular medications, such as isoniazid (INH) and rifampin (RIF), are hepatotoxic; liver function should be assessed before initiation of pharmacological therapy. Pulmonary function studies, electrocardiogram, and echocardiogram might be done; the results of these tests are not crucial for the nurse to review before administering antitubercular medications. White blood cell counts and sedimentation will not provide information relative to starting antitubercular therapy or to its side effects.

A female client with a diagnosis of breast cancer is taking cyclophosphamide. The client calls the health care clinic and tells the nurse that the medication is upsetting her stomach. Which instruction should the nurse provide to the client? 1. Take the medication with food. 2. Avoid drinking fluids while taking the medication. 3. Try to take the medication with a small amount of orange juice. 4. Continue to take the medication on an empty stomach, and lie down after taking the medication.

1. Take the medication with food. Hemorrhagic cystitis is a toxic effect that can occur with the use of this medication. The medication should be taken on an empty stomach, but if the client complains of gastrointestinal (GI) upset, it can be taken with food. The client who is taking cyclophosphamide needs to be instructed to drink copious amounts of fluids during the administration of this medication. Orange juice probably would cause and increase the GI upset. Option 4 will not assist in relieving the discomfort experienced by the client.

A client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? 1. Glucose level 2. Calcium level 3. Potassium level 4. Prothrombin time

2. Calcium Level Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium level should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain.

The nurse administers lactulose to a client with cirrhosis of the liver. Which laboratory test change leads the nurse to determine that the lactulose is effective? 1. Decreased amylase 2. Decreased ammonia 3. Increased potassium 4. Increased hemoglobin

2. Decreased ammonia Lactulose destroys intestinal flora that break down protein and, in the process, give off ammonia. In clients with cirrhosis, ammonia is inadequately detoxified by the liver and can build to toxic levels. Amylase levels are associated with pancreatic problems. Increased potassium levels are associated with kidney failure. Hemoglobin is increased when the body needs more oxygen-carrying capacity, such as in smokers, or in high altitudes.

A client with cirrhosis of the liver has been taking chlorothiazide. The provider adds spironolactone to the client's medication regimen to prevent which condition? 1. Hyponatremia 2. Hypokalemia 3. Ascites 4. Peripheral neuropathy

2. Hypokalemia Spironolactone is a potassium-sparing diuretic often used in conjunction with thiazide diuretics. The provider was prompted to add spironolactone to the chlorothiazide to prevent potassium loss. It stimulates sodium excretion so will not prevent hyponatremia. Spironolactone is a relatively weak diuretic that will not have a significant effect on ascites. Peripheral neuropathy is not a concern in this scenario and spironolactone would not have an effect on it if it was a concern.

The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide. The nurse should tell the client to take which action? 1. Take the medication with food. 2. Increase fluid intake to 2000 to 3000 mL daily. 3. Decrease sodium intake while taking the medication. 4. Increase potassium intake while taking the medication.

2. Increase fluid intake to 2000 to 3000 mL daily. Hemorrhagic cystitis is an adverse effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be told to increase potassium intake. The client would not be instructed to alter sodium intake.

Which stage of the human immunodeficiency virus (HIV) would a client with a CD4+ T cell count of 325 cells/mm 3 be classified? 1. Stage 1 2. Stage 2 3. Stage 3 4. Stage 4

2. Stage 2 Stage 2 describes a client with a CD4+ T cell count between 200 and 499 cells/mm 3. Stage 1 describes a client with a CD4+ T cell count of greater than 500 cells/mm 3. Stage 3 describes a client with a CD4+ T cell count of less than 200 cells/mm 3. Stage 4 describes a client with a confirmed HIV infection but no information regarding CD4+ T cell counts is available.

A child infected with human immunodeficiency virus (HIV) is admitted with Pneumocystis jiroveci pneumonia and receives trimethoprim/sulfamethoxazole. Which common side effects would the nurse anticipate? Select all that apply. One, some, or all responses may be correct. 1. Jaundice 2. Vomiting 3. Headache 4. Crystalluria 5. Photosensitivity

2. Vomiting 4. Crystalluria 5. Photosensitivity Nausea and vomiting may occur as a result of gastrointestinal irritation. Crystalluriamay occur with this medication, especially in the presence of restricted fluid intake secondary to nausea and vomiting. Skin reactions such as photosensitivity are also common. Hepatic side effects such as jaundice may occur but are not common. Central nervous system side effects such as headache are rare adverse reactions.

The nurse evaluates that teaching for the oral pancreatic enzymes pancrelipase is understood when the client identifies which time for medication scheduling? 1. At bedtime 2. With meals 3. One hour before meals 4. On arising each morning

2. With meals The pancreatic enzymes (amylase, trypsin, and lipase) must be present when food is ingested for digestion to take place. At bedtime the food eaten for dinner has passed beyond the duodenum, so at bedtime the enzyme is given too late to aid digestion. Taking pancrelipase 1 hour before meals or on arising each morning will have no chyme in the duodenum on which the enzyme can act.

Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The client asks the nurse if her family member with bladder cancer can also take this medication. The nurse most appropriately responds by making which statement? 1. "This medication can be used only to treat breast cancer." 2. "Yes, your family member can take this medication for bladder cancer as well." 3. "This medication can be taken to prevent and treat clients with breast cancer." 4. "This medication can be taken by anyone with cancer as long as their health care provider approves it."

3. "This medication can be taken to prevent and treat clients with breast cancer." Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy and for preventing breast cancer in those that are at high risk.

Which nursing intervention would prevent stimulation of the pancreas in a client with acute pancreatitis? 1. Maintain the gastric pH at a level of less than 3.5. 2. Encourage the resumption of activities of daily living. 3. Administer the histamine H 2-receptor antagonist as prescribed. 4. Ensure that the nasogastric tube remains in the fundus of the stomach.

3. Administer the histamine H 2-receptor antagonist as prescribed. The histamine H 2-receptor antagonist medication inhibits histamine at H 2-receptor sites in parietal cells, thus decreasing gastric secretion and preventing pancreatic stimulation. A lower pH will stimulate pancreatic secretion, which contains bicarbonate ions that neutralize the acid. The client should rest to decrease stimulation of the pancreas. The tube should be positioned nearer the pylorus for the removal of gastric contents.

Which laboratory values are most important for the nurse to monitor in the client who takes zidovudine? 1. Cardiac enzymes 2. Serum electrolytes 3. Complete blood counts (CBCs) 4. Urinalysis

3. Complete blood counts (CBCs)

A client with cirrhosis of the liver develops ascites, and the health care provider prescribes spironolactone. The nurse will monitor the client for which adverse medication effect? 1. Bruising 2. Tachycardia 3. Hyperkalemia 4. Hypoglycemia

3. Hyperkalemia Spironolactone is a potassium-sparing diuretic that is used to treat clients with ascites; therefore the nurse would monitor the client for signs and symptoms of hyperkalemia. Bruising and purpura are associated with cirrhosis, not with the administration of spironolactone. Spironolactone does not cause tachycardia. Spironolactone does not cause hypoglycemia.

The nurse is assigned to care for a client with metastatic breast cancer who is taking tamoxifen citrate. The nurse plans to monitor for which changes in laboratory values for this client? Select all that apply. 1. Increase in lipase level 2. Increase in blood glucose level 3. Increase in serum calcium level 4. Increase in serum potassium level 5. Decrease in low-density lipoprotein levels

3. Increase in serum calcium level 5. Decrease in low-density lipoprotein levels Tamoxifen citrate is an antiestrogen and antineoplastic medication. It may increase the calcium level and lower the low-density lipoprotein levels. Before the initiation of therapy, the complete blood count (CBC), platelet count, and serum calcium levels should be determined. These blood levels should continue to be monitored periodically during therapy. The nurse should monitor for signs of hypercalcemia while the client is taking this medication. These signs include increased urine volume, excessive thirst, nausea, vomiting, constipation, decreased muscle tone, and deep bone or flank pain. Options 1, 2, and 4 are not associated with this medication.

A primary health care provider prescribes cisplatin and vincristine to a client with bladder cancer. The nurse should explain to the client that 2 medications are administered together for which reason? 1. To prevent alopecia 2. To decrease the destruction of cells 3. To increase the therapeutic response 4. To prevent gastrointestinal side effects

3. To increase the therapeutic response Cisplatin is an alkylating type of medication, and vincristine is a vinca (plant) alkaloid. Alkylating medications are cell-cycle nonspecific. Vinca alkaloids are cell-cycle specific and act on the M phase. Combinations of medications are used to enhance tumoricidal effects and increase the therapeutic response. Alopecia and gastrointestinal disturbances are side and adverse effects of chemotherapy.

The nurse is educating a client on combination antiretroviral (cART) in the management of human immunodeficiency virus (HIV). Which statement by the client indicates the need for further teaching? 1. "I must take all doses of the medications as scheduled." 2. "I will notify the health care provider of any fever." 3. "All three medications must be taken to prevent medication resistance." 4. "These antiretroviral medications will cure my HIV infection."

4. "These antiretroviral medications will cure my HIV infection." The use of cART inhibits viral replication but does not kill the virus. Clients will be instructed to take all scheduled doses, notify the health care provider of any fever, and take all three medications in the regimen to prevent resistance and worsening infection.

Which action is likely to reduce the pancreatic and gastric secretions of a client with pancreatitis? 1. Encourage clear liquids. 2. Obtain a prescription for morphine. 3. Assist the client into a semi-Fowler position. 4. Administer prescribed anticholinergic medication.

4. Administer prescribed anticholinergic medication. Anticholinergic medications block the neural impulses that stimulate pancreatic and gastric secretions. Oral fluids stimulate pancreatic secretion. Morphine sulfate is an analgesic and does not decrease gastric secretions. The semi-Fowler position decreases pressure against the diaphragm to help relieve discomfort, but it does not decrease pancreatic secretions.

A client is admitted to the hospital with a diagnosis of acute pancreatitis. The health care provider's prescriptions include nothing by mouth and total parenteral nutrition (TPN). The nurse explains that the TPN therapy provides which benefit? 1. Is the easiest method for administering needed nutrition 2. Is the safest method for meeting the client's nutritional requirements 3. Will satisfy the client's hunger without the discomfort associated with eating 4. Will meet the client's nutritional needs without causing the discomfort precipitated by eating

4. Will meet the client's nutritional needs without causing the discomfort precipitated by eating Providing nutrients by the intravenous route eliminates pancreatic stimulation, reducing the pain experienced with pancreatitis. TPN is used to meet the client's needs, not the nurse's needs. TPN creates many safety risks for the client. Hunger can be experienced with TPN therapy.

Cyclophosphamide (Cytoxan)

Action: Alkylates DNA; is responsible for cross-linking DNA strands; activity is not cell-cycle phase specific Uses: Leukemia, cancer of female reproductive tract, breast cancer, multiple myeloma Contraindications: Pregnancy, hypersensitivity, prostatic hypertrophy, bladder neck obstruction Life-threatening side effects: Cardiotoxicity in high doses, myocardial fibrosis, hypotension, hemorrhagic cystitis, thrombocytopenia, leukopenia, myelosuppression, secondary neoplasms, pulmonary fibrosis, interstitial pneumonia Nursing considerations: Assess for hemorrhagic cystitis (BUN, serum uric acid, I&O ratio, report if urine output <30 mL/hr, increase fluid intake to 3L/day); Assess for bone marrow suppression (CBC w/ diff, platelet count (Notify provider if WBC if <2500 or if platelet count is <7500); Assess for hematuria, guaiac, bruising or petechiae, mucosa q8hr); Assess for pulmonary fibrosis and interstitial pneumonia (pulmonary function tests, CXR); Assess for hepatotoxicity (bilirubin, AST, ALT, LDH, jaundice, dark urine, clay-colored stools, itchy skin, fever, diarrhea, abdominal pain, diarrhea)

Efavirenz (Sustiva)

Action: Binds directly to reverse transcriptase and blocks RNA, DNA polymerase, thus causing disruption of the enzyme's site Uses: HIV Contraindications: Pregnancy, hypersensitivity, moderate/severe hepatic disease Life-threatening side effects: Suicidal thoughts/behaviors, hepatotoxicity, S-J, toxic epidermal necrolysis, exfoliative dermatitis, immune reconstitution syndrome, QT prolongation Nursing considerations: Do not give with benzodiazepines, ergots, midazolam, triazolam, pimozide; assess for suicidal thoughts/behaviors; assess for serious skin reactions; Assess for signs of toxicity (Severe N/V, maculopapular rash); Hepatotoxicity (Hold if LFTs (3.5-5) are moderately elevated in those with liver disease)

Atazanavir

Action: Inhibits HIV protease, which prevents maturation of the infectious virus Uses: HIV Contraindications: Hypersensitivity Life-threatening side effects: Hepatotoxicity, S-J, DRESS, lactic acidosis, hyperbillirubinemia (pregnancy, females, obesity), immune reconstitution syndrome Nursing considerations: Assess ALT, AST, bilirubin; Assess for lactic acidosis; Assess for serious rash

Tamoxifen

Functional Class: Antineoplastic Chemical Class: Anti Estrogen Hormone Action: Inhibits cell division by binding to cytoplasmic estrogen receptors; resembles normal cell complex but inhibits DNA synthesis and estrogen response of target tissue Uses: Advanced breast carcinoma not responsive to other therapy in estrogen-receptor-positive patients (usually postmenopausal), prevention of breast cancer, after breast surger/radiation for ductal carcinoma Side Effects: Anemia, neutropenia, thrombocytopenia, New primary malignancy, leukemia, MDS/AML Nursing Considerations: Fetal harm may be caused if used in pregnant women

Fluorouracil (5-FU)

Functional Class: Antineoplastic, antimetabolite Chemical Class: Pyrimidine analog Action: Inhibits DNA, RNA synthesis; interferes with cell replication by competitively inhibiting thymidylate production, specific for S phase of cell cycle Uses: Cancer of breast, colon, rectum, stomach, and pancreas Side Effects: Hemorrhage, thrombocytopenia, leukopenia, myelosuppression, anemia, agranulocytosis, anaphylaxis, alopecia, hand-foot syndrome Nursing Considerations: Assess for bleeding, infection, and toxicity (hemorrhage, severe vomiting, severe diarrhea, stomatitis, WBC<100,000) Black Box Warning: Use only with an experienced clinician in specialized care setting for cancer chemotherapy

Vincristine (Oncovin)

Functional Class: Antineoplastic- Misc. Chemical Class: Vinca alkaloid Action: Inhibits mitotic activity, arrests cell cycle at metaphase; inhibits RNA synthesis, blocks cellular use of glutamic acid needed for purine synthesis; vesicant Uses: Lymphomas, neuroblastoma, Hodgkin's disease, acute lymphoblastic and other leukemias, rhabdomyosarcoma, Wilms' tumor, non-Hodgkin's lymphoma, malignant glioma, soft-tissue sarcoma Side Effects: Seizures, paralytic ileus, hepatotoxicity, renal tubular obstruction, thrombocytopenia, leukopenia, myelosuppression, anema, Tumor Lysis Syndrome (TLS) Nursing Considerations: Assess for bronchospasm and Tumor Lysis Syndrome (Hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia) Black Box Warnings: Extravasation (Pain, swelling, poor blood return; if extravasation occurs, local injection of hyaluronidase and moderate heat to area may help disperse product)

Zidovudine (Retrovir, AZT)

Functional Class: Antiretroviral Chemical Class: Nucleoside reverse Transcriptase Inhibitor (NRTI) Action: Inhibits replication of HIV-1 virus by incorporating into cellular DNA by viral reverse transcriptase, thereby terminating the cellular DNA chain Uses: Used in combination with at least 2 other antiretrovirals for HIV-1 infection Side Effects: Seizures, Hepatomegaly, Granulocytopenia anemia, lactic acidosis Nursing Considerations: Assess for HIV and symptoms of HIV and the patient's baseline, register pregnant patients at the Antiretroviral Pregnancy Registry (1-800-258-4263); do not breastfeed, is excreted in breast milk Black Box Warnings: Bone marrow suppression (Blood counts q2wk; watch for decreasing granulocytes, hgb; if low, therapy may have to be discontinued and restarted after hematologic recovery; blood transfusions may be required; viral load, CD4 counts, LFTs, plasma, HIV RNA, Serum creatinine/BUN at baseline and throughout treatment

Pancrelipase (Creon, Pancreaze)

Functional Class: Digestant Chemical Class: Pancreatic enzyme Action: Pancreatic enzyme needed for the breakdown of substances released from the pancreas Uses: Exocrine pancreatic secretion insufficiency, cystic fibrosis, steatorrhea, pancreatic enzyme deficiency Side Effects: No life-threatening side effects :) Nursing Considerations: Use only if clearly needed in pregnancy; do not breastfeed

Lactulose

Functional Class: Laxative; ammonia detoxicant (hyperosmotic) Chemical Class: Lactose synthetic derivative Action: Prevents absorption of ammonia in colon by acidifying stool; increases water, softens stool Uses: Chronic constipation, portal-systemic encephalopathy (PSE) in patients with hepatic disease Side Effects: No life-threatening side effects :) Nursing Considerations: Assess hepatic encephalopathy (Blood ammonia level (15-45 mcg/dL or 35-65 umol/L is normal range); may decrease ammonia level by 25-50%; clearing of confusion, lethargy, restlessness, irritability if portal-systemic encephalopathy; monitor sodium in higher doses); Discontinue if patient begins have cramping, rectal bleeding, and/or N/V

Spironolactone

Functional Class: Potassium-sparing diuretic Chemical Class: Aldosterone antagonist Action: Competes with aldosterone at receptor sites in distal tubule, thereby resulting in the excretion of sodium chloride and water and the retention of potassium and phosphate Uses: Edema of HF, hypertension, diuretic-induced hypokalemia, primary hyperaldosteronism, edema of nephrotic syndrome, cirrhosis of liver with ascites Side Effects: Hyperkalemia, bleeding, hepatocellular toxicity, agranulocytosis Nursing Considerations: Assess for hypokalemia and hyperkalemia and hydration; Use only if benefits outweigh fetal risk; fetal harm has occurred; do not breastfeed Black Box Warning: Secondary malignancy (Assess periodically)

Doxorubicin (Adriamycin)

Functional Class:Antineoplastic, antibiotic Chemical Class: Anthracycline glycoside Action: Inhibits DNA synthesis primarily; replication is decreased by binding to DNA, which causes strand splitting; active throughout entire cell cycle; a vesicant Uses: Bladder, breast, lung, ovarian, stomach, thyroid cancer; Hodgkin's/Non-Hodgkin's disease; Acute hemoplastic leukemia; myeloblastic leukemia; neuroblastomas; soft tissue/bone sarcomas Side Effects: Irreversible cardiomyopathy, acute left ventricular failure, hepatotoxicity, thrombocytopenia, leukopenia, anemia, necrosis at injection site, radiation recall, anaphylaxis, secondary malignancy Nursing Considerations: Assess renal studies (BUN, serum uric acid, urine CCr, electrolytes before and during therapy); Report fall in urine <30mL/hr; Fever might indicate beginning infection; Assess hepatic studies before and during therapy (Bilirubin, AST, ALT, alkphos as needed or monthly; check for jaundice of skin and sclera, dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea) Black Box Warnings: Bone marrow depression (CBC, differential, platelet count weekly; withhold or reduce dose of product if WBC is <1,500 or platelet count is <50,000; notify prescriber of these results); Dysrhythmias (ECG; watch for ST-T wave changes, low QRS and T, possible dysrhythmias (sinus tachycardia, heart block, PVCs), ejection fraction before treatment, signs of irreversible cardiomyopathy, can occur up to 6 months after treatment begins); Secondary Malignancy (Assess for AML and MDS, which may occur); Extravasation (Local irritation, pain, burning at injection site; a vesicant; if extravasation occurs, stop durg, restart at another site, apply ice, elevate extremity to reduce swelling; if resolution does not occur, surgical debridement may be required)