PHARMACOLOGY OF NURSING
Hematology, STIs, Urology, Oncology
HEMATOLOGY MEDICATIONS:
Generic: Heparin
Class: anticoagulants
Pharm Class: antithrombotics
Action: binds to antithrombin; inactivates clotting factors XII, Xa; half life 60-90 min;
prevent extension of thrombus; prevent development of new thrombus
Indications: VTE prophylaxis
Contraindications: uncontrolled bleeding; heparin-induced thrombocytopenia; severe
thrombocytopenia; open wounds; Use extreme caution in- uncontrolled HTN, bleeding
DOs, GI bleed/ulcers, stroke, hx of thrombocytopenia r/t heparin, recent CNS or eye
surgery
Adverse Reactions: Bleeding, Heparin- induced thrombocytopenia; anemia
Antidote: Protamine sulfate is antidote-monitor for hypotension & bradycardia if
administered
Nursing Considerations: SubQ, Intermittent, or Continuous IV admin; dosing wt
based; Admin IV using pump; Monitor PLT/ aPTT count every 2-3 days during therapy-
may cause mild thrombocytopenia (appears on 4th day) but usually resolves with
continued therapy. Heparin-induced thrombocytopenia necessitates discontinuing
medication. Monitor Hbg, Hct. NORMAL PTT= 30-40 second 1.5-2.5x the control. Teach
pt’s soft toothbrush, electric razors, no NSAIDs, herbal medications
Generic: enoxaparin
Trade: Lovenox
Class: anticoagulants
Pharm Class: antithrombotics, low molecular weight heparins
Action: Inhibits factor Xa; Prevent extension of thrombus; Prevent development of new
thrombus
Indications: VTE prophylaxis ; Tx of DVT/ PE with warfarin
Contraindications: Active, major bleeding; use caution in HTN, GI bleeding/ ulcers ^^
all same as heparin
Adverse Reactions: bleeding, anemia
Nursing Considerations: Protamine sulfate is antidote & monitor for hypotension, and
bradycardia if admin; Monitor CBC, PLT, stools for occult blood periodically; Can be
administered SubQ once daily or 2x/day. Educate pt on proper administration, care, and
,disposal. Notify of unusual rash, bleeding, bruising, dizziness, fever, swelling, difficulty
breathing; Inject into anterolateral and left and right posterolateral abd wall.
Generic: Aspirin
Trade: Bayer
Class: Antiplatelet agents, Antipyretics, Nonopioid analgesics
Pharm Class: Salicylates, NSAIDs
Action: Produce analgesia and reduce inflammation. Decreases platelet aggregation
Indications: Inflammatory DOs- RA, Osteoarthritis; Mild to moderate pain; Fever;
Prophylaxis of TIA/ MIs; unlabeled- adjuvant tx for kawasaki disease
Contraindications: bleeding DOs; thrombocytopenia; OB; Pede. Use caution in- Hx of
GI bleed or ulcer, chronic alcohol use/abuse, severe hepatic/ or renal disease
Adverse Reactions: DRESS, GI bleeding, hypersensitivity reactions; dyspepsia,
epigastric distress, nausea
Nursing Considerations: Monitor for rash, facial swelling, lymphadenopathy d/c in
noted; Assess for pain, Assess CBC H&H; Monitor kidney and LFTs. Monitor for toxicity/
overdose and notify asap- new onset of headache, tinnitus, hyperventilation, agitation,
mental confusion, lethargy, diarrhea, sweating; Take with full glass of water and remain
upright for 15-30 minutes after admin; Avoid drinking alcohol, and do not take with other
NSAIDs
Generic: warfarin
Trade: coumadin
Class: anticoagulants
Pharm Class: coumarins
Action: Vitamin K antagonist inhibits synthesis of vitamin K- dependent clotting factors
II, VII, IX, X & Vitamin K proteins C and S; Has slow onset, 12-24 hr after first dose;
Antithrombotic effect occurs 2-7 days after first dose
Indications: Prophylaxis and treatment of VTE, PE, A-fib without embolization;
Management of MI- decreases risk of death, subsequent MI, future thromboembolic
events
Contraindications: Uncontrolled bleeding; open wounds; active ulcer disease; recent
brain, eye, or spinal cord injury or surgery; severe kidney or liver disease; uncontrolled
HTN; pregnancy
Adverse Reactions: Calciphylaxis, bleeding
Nursing Considerations: Administer once a day at same time each day; Requires
routine monitoring of PT with goal of 1.5-2 times normal; INR with goal of 2.0-3.0;
Requires admin with heparin during drug initiation until desired anticoagulation
achieved; Monitor for food-drug, and drug-drug reactions (St. johns wort, NSAIDs,
acetaminophen, licorice, arnica, ginkgo, ginger); Assess pt for bleeding; Administer
, vitamin K (antidote), fresh-frozen plasma, or prothrombin complex concentrate as
ordered for overdose or to reverse effects; Requires periprocedural bridging
Generic: filgrastim
Trade: Neupogen
Ther Class: colony-stimulating factors
Action: A glycoprotein, filgrastim binds to and stimulates immature neutrophils to divide
and differentiate
Indications: Prevention of febrile neutropenia and infection in pt’s receiving bone
marrow-depressing antineoplastics for the tx of nonmyeloid malignancies
Contraindications: Hypersensitivity to filgrastim or E. coli-derived proteins
Adverse Reactions: Splenic rupture, acute myeloid leukemia, myelodysplastic
syndrome, ARDS, hypersens reactions; medullary bone pain
Nursing Considerations: Given SubQ or IV; Monitor bone pain; Monitor for allergic
reaction. After chemo, obtain CBC with diff- include measure of blast cells and PLT
count before chemotherapy and twice weekly to avoid leukocytosis.
Generic: epoeitin alfa
Trade: Epogen
Class: antianemics
Pharm Class: hormones; erythropoiesis stimulating agents (ESA)
Action: Stimulates erythropoiesis (RBC production)- decreasing need for transfusions
Indications: anemia associated with CKD; Anemia secondary to zidovudine (AZT)
therapy in HIV; Anemia from chemo with nonmyeloid malignancies; Reduced need for
PRBC transfusion therapy in pt’s undergoing elective, noncardiac, nonvascular surgery
Contraindications: Hypersens to albumin; Uncontrolled HTN; Erythropoietin levels
>200; Pt’s with CA receiving hormonal agents, biologics, radiation- or when chemo
expected to cure; Pts requiring correction of anemia with PRBCs; Cardiac or vascular
surgery; OB; Lactation; PEDI
Adverse Reactions: HF, MI, Stroke, Thromboembolic events, Erythema multiforme,
SJS, TEN, Seizures, ↑ mortality, ↑ tumor growth (with HGB >12); HTN
Nursing Considerations: Admin IV, or SubQ, SE rare- can cause HTN; If anemia is
corrected too quickly, sharp increase in HCT causes headache, seizures, or thrombosis.
Hematology, STIs, Urology, Oncology
HEMATOLOGY MEDICATIONS:
Generic: Heparin
Class: anticoagulants
Pharm Class: antithrombotics
Action: binds to antithrombin; inactivates clotting factors XII, Xa; half life 60-90 min;
prevent extension of thrombus; prevent development of new thrombus
Indications: VTE prophylaxis
Contraindications: uncontrolled bleeding; heparin-induced thrombocytopenia; severe
thrombocytopenia; open wounds; Use extreme caution in- uncontrolled HTN, bleeding
DOs, GI bleed/ulcers, stroke, hx of thrombocytopenia r/t heparin, recent CNS or eye
surgery
Adverse Reactions: Bleeding, Heparin- induced thrombocytopenia; anemia
Antidote: Protamine sulfate is antidote-monitor for hypotension & bradycardia if
administered
Nursing Considerations: SubQ, Intermittent, or Continuous IV admin; dosing wt
based; Admin IV using pump; Monitor PLT/ aPTT count every 2-3 days during therapy-
may cause mild thrombocytopenia (appears on 4th day) but usually resolves with
continued therapy. Heparin-induced thrombocytopenia necessitates discontinuing
medication. Monitor Hbg, Hct. NORMAL PTT= 30-40 second 1.5-2.5x the control. Teach
pt’s soft toothbrush, electric razors, no NSAIDs, herbal medications
Generic: enoxaparin
Trade: Lovenox
Class: anticoagulants
Pharm Class: antithrombotics, low molecular weight heparins
Action: Inhibits factor Xa; Prevent extension of thrombus; Prevent development of new
thrombus
Indications: VTE prophylaxis ; Tx of DVT/ PE with warfarin
Contraindications: Active, major bleeding; use caution in HTN, GI bleeding/ ulcers ^^
all same as heparin
Adverse Reactions: bleeding, anemia
Nursing Considerations: Protamine sulfate is antidote & monitor for hypotension, and
bradycardia if admin; Monitor CBC, PLT, stools for occult blood periodically; Can be
administered SubQ once daily or 2x/day. Educate pt on proper administration, care, and
,disposal. Notify of unusual rash, bleeding, bruising, dizziness, fever, swelling, difficulty
breathing; Inject into anterolateral and left and right posterolateral abd wall.
Generic: Aspirin
Trade: Bayer
Class: Antiplatelet agents, Antipyretics, Nonopioid analgesics
Pharm Class: Salicylates, NSAIDs
Action: Produce analgesia and reduce inflammation. Decreases platelet aggregation
Indications: Inflammatory DOs- RA, Osteoarthritis; Mild to moderate pain; Fever;
Prophylaxis of TIA/ MIs; unlabeled- adjuvant tx for kawasaki disease
Contraindications: bleeding DOs; thrombocytopenia; OB; Pede. Use caution in- Hx of
GI bleed or ulcer, chronic alcohol use/abuse, severe hepatic/ or renal disease
Adverse Reactions: DRESS, GI bleeding, hypersensitivity reactions; dyspepsia,
epigastric distress, nausea
Nursing Considerations: Monitor for rash, facial swelling, lymphadenopathy d/c in
noted; Assess for pain, Assess CBC H&H; Monitor kidney and LFTs. Monitor for toxicity/
overdose and notify asap- new onset of headache, tinnitus, hyperventilation, agitation,
mental confusion, lethargy, diarrhea, sweating; Take with full glass of water and remain
upright for 15-30 minutes after admin; Avoid drinking alcohol, and do not take with other
NSAIDs
Generic: warfarin
Trade: coumadin
Class: anticoagulants
Pharm Class: coumarins
Action: Vitamin K antagonist inhibits synthesis of vitamin K- dependent clotting factors
II, VII, IX, X & Vitamin K proteins C and S; Has slow onset, 12-24 hr after first dose;
Antithrombotic effect occurs 2-7 days after first dose
Indications: Prophylaxis and treatment of VTE, PE, A-fib without embolization;
Management of MI- decreases risk of death, subsequent MI, future thromboembolic
events
Contraindications: Uncontrolled bleeding; open wounds; active ulcer disease; recent
brain, eye, or spinal cord injury or surgery; severe kidney or liver disease; uncontrolled
HTN; pregnancy
Adverse Reactions: Calciphylaxis, bleeding
Nursing Considerations: Administer once a day at same time each day; Requires
routine monitoring of PT with goal of 1.5-2 times normal; INR with goal of 2.0-3.0;
Requires admin with heparin during drug initiation until desired anticoagulation
achieved; Monitor for food-drug, and drug-drug reactions (St. johns wort, NSAIDs,
acetaminophen, licorice, arnica, ginkgo, ginger); Assess pt for bleeding; Administer
, vitamin K (antidote), fresh-frozen plasma, or prothrombin complex concentrate as
ordered for overdose or to reverse effects; Requires periprocedural bridging
Generic: filgrastim
Trade: Neupogen
Ther Class: colony-stimulating factors
Action: A glycoprotein, filgrastim binds to and stimulates immature neutrophils to divide
and differentiate
Indications: Prevention of febrile neutropenia and infection in pt’s receiving bone
marrow-depressing antineoplastics for the tx of nonmyeloid malignancies
Contraindications: Hypersensitivity to filgrastim or E. coli-derived proteins
Adverse Reactions: Splenic rupture, acute myeloid leukemia, myelodysplastic
syndrome, ARDS, hypersens reactions; medullary bone pain
Nursing Considerations: Given SubQ or IV; Monitor bone pain; Monitor for allergic
reaction. After chemo, obtain CBC with diff- include measure of blast cells and PLT
count before chemotherapy and twice weekly to avoid leukocytosis.
Generic: epoeitin alfa
Trade: Epogen
Class: antianemics
Pharm Class: hormones; erythropoiesis stimulating agents (ESA)
Action: Stimulates erythropoiesis (RBC production)- decreasing need for transfusions
Indications: anemia associated with CKD; Anemia secondary to zidovudine (AZT)
therapy in HIV; Anemia from chemo with nonmyeloid malignancies; Reduced need for
PRBC transfusion therapy in pt’s undergoing elective, noncardiac, nonvascular surgery
Contraindications: Hypersens to albumin; Uncontrolled HTN; Erythropoietin levels
>200; Pt’s with CA receiving hormonal agents, biologics, radiation- or when chemo
expected to cure; Pts requiring correction of anemia with PRBCs; Cardiac or vascular
surgery; OB; Lactation; PEDI
Adverse Reactions: HF, MI, Stroke, Thromboembolic events, Erythema multiforme,
SJS, TEN, Seizures, ↑ mortality, ↑ tumor growth (with HGB >12); HTN
Nursing Considerations: Admin IV, or SubQ, SE rare- can cause HTN; If anemia is
corrected too quickly, sharp increase in HCT causes headache, seizures, or thrombosis.
