Romans 8 38 39 For I am persuaded

Romans 8: 38 -39 For I am persuaded, that neither death, nor life, nor angels, nor principalities, nor powers, nor things present, nor things to come, Nor height, nor depth, nor any other creature, shall be able to separate us from the love of God, which is in Christ Jesus our Lord.

Electrolytes: Potassium Hyperkalemia: excessive serum potassium; serum potassium level over 5. 5 m. Eq/L • Potassium supplements • ACE inhibitors • Renal failure • Excessive loss from cells • Potassium-sparing diuretics • • • Burns Trauma Metabolic acidosis Hyperaldosteronism Infections

Electrolytes: Potassium (cont’d) Hypokalemia: deficiency of potassium; serum potassium level less than 3. 5 m. Eq/L Excessive potassium loss (rather than poor dietary intake) • Loop and thiazide Alkalosis diuretics Corticosteroids • Vomiting Crash diets • Malabsorption Diarrhea • Large amounts of Ketoacidosis licorice consumption

Electrolytes: Potassium Adverse effects • Oral preparations – Diarrhea, nausea, vomiting, GI bleeding, ulceration • IV administration – Pain at injection site – Phlebitis

Electrolytes: Potassium • Hyperkalemia – Muscle weakness, paresthesia, paralysis, cardiac rhythm irregularities (leading to possible ventricular fibrillation and cardiac arrest) • Treatment of severe hyperkalemia – IV sodium bicarbonate, calcium salts, dextrose with insulin – Sodium polystyrene sulfonate (Kayexalate) or hemodialysis to remove excess potassium

Nursing Implications • Parenteral infusions of potassium must be monitored closely – Rate should not exceed 20 m. Eq/hour – NEVER give as an IV bolus or undiluted – 10 m. Eq/50 m. L of solution over an hour • Oral forms of potassium – Must be diluted in water or fruit juice to minimize GI distress or irritation – Monitor for complaints of nausea, vomiting, GI pain, or GI bleeding

What should you always check? • K+ level!

Dialysis Medications

Dialysis meds Phosphate binders • Pts with ESRD have elevated Phosphorus levels and low Calcium levels. • Inhibit the absorption of phosphorus in the GI tract. With meals! • Calcium Acetate (Phos. Lo) • Calcium carbonate (Caltrate, Tums) • Sevalamer (Renagel)-calcium FREE

Vitamin D “Sunshine vitamin” • Normally calcitriol is produced by the kidneys and helps increase calcium and decrease parathyroid hormone.

Epoetin alpha (Epogen) • Increases RBC production • Need nl iron levels • Tx of anemia associated with ESRD • Evaluate effectiveness: H&H

Drugs to hold before dialysis • Vasoactive agents • Anti-HTN (if SBP < 110) • Vasodilators • Narcotics • Sedatives • Antiarrhythmics • Antimicrobials

Chemotherapy • Pharmacologic treatment of cancer • Antineoplastic drugs • Divided into two groups based on where in the cellular life cycle they work – Cell cycle–nonspecific (CCNS) – Cell cycle–specific (CCS) • Some drugs have characteristics of both

Chemotherapy • Drugs have a narrow therapeutic index • Combination of drugs is usually more effective than single-drug therapy • Drug resistance • Nearly all drugs cause adverse effects • Dose-limiting adverse effects

Chemotherapy • Harmful to all rapidly growing cells • Hair follicles • GI tract cells • Bone marrow cells

Memory Booster • Bone Marrow Suppression • Alopecia • Retching: N/V • Fear and anxiety • Stomatitis

Chemotherapy Terms • Dose-limiting adverse effects – GI tract and bone marrow • Alopecia • Emetic potential • Myelosuppression – Bone marrow suppression (BMS) – Bone marrow depression (BMD) • Extravasation

Antimetabolites • Folate (folic acid) antagonists – methotrexate (MTX), others • Purine antagonists – fludarabine (F-AMP) – mercaptopurine (6 -MP) – thioguanine (6 -TG) • Pyrimidine antagonists – fluorouracil (5 -FU) – cytarabine (ARA-C), others

Antimetabolites • Folic acid antagonism – Interferes with the use of folic acid – As a result, DNA is not produced, and the cell dies

Antimetabolites • Purine antagonism – Interrupts metabolic pathways of purine nucleotides – Results in interruption of DNA and RNA synthesis

Antimetabolites • Pyrimidine antagonism – Interrupts metabolic pathways of pyrimidine bases – Results in interruption of DNA and RNA synthesis

Antimetabolites: Indications • Used in combination with other drugs to treat various types of cancer, such as solid tumors and some hematologic cancers – Acute and chronic lymphocytic leukemias – Leukemias (several types) – Colon, rectal, breast, stomach, lung, pancreatic cancers

Antimetabolites: Methotrexate • Immunosuppressive and antiinflammatory activity • Also used for rheumatoid arthritis and psoriasis • Leucovorin “rescue” – Leucovorin given with folic acid antagonists to protect healthy cells and reduce bone marrow suppression

Leucovorin “rescue” Methotrexate • Leucovorin given to protect healthy cells and reduce bone marrow suppression

Antimetabolites: Adverse Effects • Hair loss, nausea and vomiting, myelosuppression • Many other severe adverse effects

Alkylating Drugs: Examples • cisplatin (Platinol) • cyclophosphamide (Cytoxan) • mechlorethamine (Mustine, nitrogen mustard) • carmustine (Bi. CNU)

Cytotoxic Antibiotics • Natural substances produced by the mold Streptomyces • Synthetic substances also used • Used to treat cancer; too toxic to treat infections

Cytotoxic Antibiotics: Adverse Effects (cont’d) • Cardiomyopathy is associated with large amounts of doxorubicin

Hormonal Drugs • Used to treat a variety of neoplasms in men and women • Hormonal therapy used to – Oppose effects of hormones – Block the body’s sex hormone receptors • Used most commonly as adjuvant and palliative therapy – But may be a drug of first choice for some cancers

Hormonal Drugs for Female. Specific Neoplasms q. Selective estrogen receptor modulators – Tamoxifen (Nolvadex) • Progestins – megestrol (Megace)

Hormonal Drugs for Male. Specific Neoplasms • Antiandrogens – bicalutamide, flutamide, nilutamide • Antineoplastic hormone – estramustine

Extravasation • Leaking of an antineoplastic drug into surrounding tissues during IV administration • Can result in permanent damage to nerves, tendons, muscles; loss of limbs • Skin grafting or amputation may be necessary • Prevention is essential • Continuous monitoring of the IV site is essential

Handling Antineoplastic Drugs

Handling Antineoplastic Drugs • During care of a patient receiving these drugs, special precautions may be implemented, depending on facility policies – Double flushing of bodily fluids in the commode – Special hampers for disposal of all objects that contact the patient’s bodily fluids – Personal protective equipment: WEAR GLOVES

Adrenal Agent Quiz 1. List the #1 SE of discontinuing adrenal agents abruptly. 2. State how Prednisone should be taken in relationship with meals. 3. What is the maximum concentration of potassium that can be administered in an IV? 4. When is the best time to take adrenal agents? 5. Glucocorticoids are given to help or control what kind of process?