Critical Care | Oncology Medications

MedicationIndicationsSide EffectsAdverse EffectsNursing InterventionsContraindications
Adrenergic Agonists
- EpinephrineCardiac arrest, anaphylaxis, asthma attacksPalpitations, tachycardia, anxietyHypertension, arrhythmiasMonitor vital signs, especially heart rate and rhythm; monitor for chest painNarrow-angle glaucoma, shock (other than anaphylactic)
- Norepinephrine (Levophed)Shock, hypotensionPalpitations, anxietyTissue necrosis (if extravasation), arrhythmiasMonitor blood pressure, ensure the IV site is patentHypotension due to blood volume deficit
Benzodiazepines
- Diazepam (Valium)Anxiety, seizures, muscle spasmsDrowsiness, dizzinessRespiratory depression, dependencyMonitor respiratory rate, avoid alcohol with useMyasthenia gravis, acute narrow-angle glaucoma, severe respiratory insufficiency, sleep apnea
MedicationIndicationsSide EffectsAdverse EffectsNursing InterventionsContraindications
Antiarrhythmics
- AmiodaroneVentricular and supraventricular tachyarrhythmiasNausea, dizzinessPulmonary fibrosis, hepatic injuryMonitor for respiratory issues, EKG changes; periodic ophthalmic examsSevere sinus node dysfunction, second- or third-degree heart block
- LidocaineVentricular arrhythmias, local anesthesiaDrowsiness, tremorsSeizures, respiratory arrestMonitor EKG, CNS changesSevere heart block, Stokes-Adams syndrome
Antidotes
- Naloxone (Narcan)Opioid overdoseTremors, hyperventilationOpioid withdrawal symptomsMonitor respiratory status, might require repeated dosingPatients known to be hypersensitive to naloxone or any of its other ingredients
- FlumazenilBenzodiazepine overdoseNausea, vomitingSeizuresMonitor CNS changes, respiratory statusSeizure patients receiving benzodiazepine treatment, tricyclic antidepressant overdose
Vasoactive Agents
- DopamineShock, heart failureTachycardia, anxietyArrhythmias, tissue necrosisTitrate based on hemodynamic response, monitor blood pressure and heart ratePheochromocytoma, uncorrected tachyarrhythmias
- VasopressinDiabetes insipidus, GI bleeding, septic shockAbdominal pain, tremorWater intoxication, anginaMonitor fluid status and electrolytes, blood pressureHypersensitivity to vasopressin or its components
Other Agents
- Sodium BicarbonateMetabolic acidosis, certain drug overdosesHypernatremia, metabolic alkalosisHypokalemiaMonitor electrolytes, especially potassium and sodium levelsMetabolic or respiratory alkalosis, hypocalcemia
MedicationIndicationsSide EffectsAdverse EffectsNursing InterventionsContraindications
Anticoagulants
- HeparinDVT prophylaxis, pulmonary embolism, ACSBleeding, thrombocytopeniaHeparin-induced thrombocytopenia (HIT)Monitor aPTT, watch for signs of bleedingUncontrolled bleeding, thrombocytopenia, heparin-induced thrombocytopenia history
- Warfarin (Coumadin)Atrial fibrillation, DVT treatment and preventionBleeding, headacheSevere bleeding, necrosisMonitor INR, educate about consistent vitamin K intakePregnancy, uncontrolled hypertension
Bronchodilators
- AlbuterolAsthma, COPDTremors, palpitationsTachycardia, hypokalemiaMonitor heart rate, potassium levels, and respiratory statusTachycardia due to cardiac conditions
Sedatives
- Propofol (Diprivan)Sedation in ICU, anesthesia inductionHypotension, respiratory depressionPropofol infusion syndrome (rare)Monitor blood pressure, respiratory rate; use with a dedicated IV line due to risk of contaminationSoy or egg allergy, in children for sedation in ICU
Nitrates
- NitroglycerinAngina, heart failure, hypertensive emergenciesFlushing, headacheHypotension, reflex tachycardiaMonitor blood pressure and heart rate, use gloves when applying patchesUse with PDE inhibitors like sildenafil (Viagra)
Antiseizure
- Phenytoin (Dilantin)Seizure disorders, status epilepticusNystagmus, drowsinessGingival hyperplasia, Steven-Johnson syndromeMonitor serum drug levels, monitor for rashBradycardia, heart block, hypersensitivity
Antipsychotics
- Haloperidol (Haldol)Schizophrenia, acute psychosis, agitationExtrapyramidal symptoms, drowsinessTardive dyskinesia, QT prolongationMonitor EKG for QT prolongation, monitor for extrapyramidal symptoms
Oncology Medications
Medication (Generic Name)IndicationsCommon Side EffectsAdverse EffectsNursing Considerations
TrastuzumabHER2-Positive Breast CancerCardiotoxicity, infusion reactionsHeart failure, pulmonary toxicity, neutropeniaMonitor cardiac function (e.g., LVEF); assess for signs of infusion reactions.
EtoposideVarious cancers including lung, testicularNausea, vomiting, hair lossBone marrow suppression, secondary leukemiaMonitor CBC; educate on potential long-term effects.
MedicationIndicationsSide EffectsAdverse EffectsNursing ConsiderationsContraindications
DoxorubicinVarious cancers, including breast, lung, and blood cancersNausea, vomiting, hair loss, cardiotoxicityCardiomyopathy, bone marrow suppressionMonitor cardiac function, administer through a central line, assess for signs of infectionSevere heart disease
PaclitaxelOvarian, breast, lung, and other cancersNeuropathy, hypersensitivity reactions, hair lossBone marrow suppression, severe allergic reactionsPre-medicate with steroids and antihistamines, monitor for hypersensitivitySevere hypersensitivity/allergy
MethotrexateVarious cancers, including leukemia and non-Hodgkin lymphomaNausea, mouth sores, hepatotoxicity, bone marrow suppressionRenal dysfunction, severe mucositisAdminister with leucovorin rescue, monitor renal function, encourage hydrationImpaired renal function, pregnancy
CisplatinVarious cancers, including testicular, ovarian, and lung cancerNausea, vomiting, kidney toxicity, peripheral neuropathyNephrotoxicity, hearing loss, electrolyte imbalancesHydrate adequately, monitor renal function, assess hearingImpaired renal function, hearing loss
CyclophosphamideMultiple cancer types, including lymphomas and breast cancerNausea, vomiting, alopecia, hemorrhagic cystitisBone marrow suppression, bladder toxicityEncourage hydration, administer with MESNA to prevent cystitis, monitor CBCSevere bone marrow dysfunction
5-Fluorouracil (5-FU)Colorectal, breast, and other cancersDiarrhea, mucositis, hand-foot syndromeBone marrow suppression, severe gastrointestinal toxicityMonitor for signs of gastrointestinal toxicity, educate on hand-foot syndromeBone marrow dysfunction, pregnancy
ImatinibChronic myeloid leukemia (CML), gastrointestinal stromal tumors (GIST)Edema, muscle cramps, rash, myelosuppressionHepatotoxicity, fluid retention, cardiotoxicityMonitor CBC, liver function, educate on fluid intakeSevere liver disease
RituximabNon-Hodgkin lymphoma, chronic lymphocytic leukemia (CLL)Infusion reactions, feverSerious infections, cardiotoxicityPre-medicate with corticosteroids and antihistamines, monitor for reactionsSevere infections
TamoxifenHormone receptor-positive breast cancerHot flashes, mood swingsRisk of endometrial cancer, thromboembolismMonitor for signs of endometrial cancer, educate on thromboembolic risksHistory of blood clots, endometrial cancer
BevacizumabColorectal, lung, and other cancersHypertension, bleedingGI perforation, impaired wound healingMonitor blood pressure, assess for bleeding, educate on wound careSevere hypertension, bleeding disorders

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