Brand: Frindovyx
Class: Antineoplastic and immunosuppressant; alkylating agent (nitrogen mustard)
Indications: Lymphomas, leukemias, multiple myeloma, breast and ovarian cancer, pediatric minimal change nephrotic syndrome
Action: Liver-activated metabolites cross-link DNA, stopping cell division
Adverse Effects: Myelosuppression, hemorrhagic cystitis, heart and lung toxicity, hyponatremia, secondary cancers, infertility, fetal harm
Contraindications: Hypersensitivity (including other alkylators), urinary outflow obstruction
Interactions: Protease inhibitors, metronidazole, succinylcholine (prolonged apnea), warfarin
Monitoring: CBC, urinalysis
Nursing Considerations: Hazardous drug: chemo PPE per USP 800; push fluids and have the patient void often; check urine for blood
Patient Teaching: Drink plenty and void often; report pink urine, fever or sore throat; use birth control
Its metabolite acrolein collects in the bladder, so the defense is water in, urine out, and mesna when ordered.
Card 2
doxorubicin
Answer
Brand: None
Class: Antineoplastic; anthracycline
Indications: Adjuvant breast cancer, leukemias, lymphomas, sarcomas and other solid tumors
Action: Intercalates into DNA and inhibits topoisomerase II
Adverse Effects: Boxed: cardiomyopathy, secondary malignancies, extravasation and tissue necrosis, severe myelosuppression
Contraindications: Severe myocardial insufficiency, MI within 4 to 6 weeks, severe myelosuppression, severe hepatic impairment
Interactions: Trastuzumab (heart failure, avoid), paclitaxel (give doxorubicin first), CYP3A4, CYP2D6 and P-gp inhibitors or inducers (avoid)
Monitoring: Ejection fraction before and during treatment; CBC
Nursing Considerations: Hazardous drug: chemo PPE per USP 800; vesicant, confirm blood return; if infiltrated: stop, aspirate, no flush, ice, elevate, consider dexrazoxane
Patient Teaching: Red urine for 1 to 2 days is expected; report shortness of breath, swelling or fever
The red drug: red solution, red urine for a day or two, and a red-flag cumulative dose for the heart.
Card 3
cisplatin
Answer
Brand: None (Platinol discontinued)
Class: Antineoplastic; platinum compound
Indications: Advanced testicular, ovarian and bladder cancer
Action: Forms platinum cross-links in DNA, blocking replication
Adverse Effects: Boxed: nephrotoxicity, peripheral neuropathy, nausea and vomiting, myelosuppression; ototoxicity, low Mg, K, Ca, Na, anaphylaxis
Contraindications: Severe hypersensitivity to cisplatin
Interactions: Other nephrotoxic drugs such as aminoglycosides, other ototoxic drugs
Monitoring: Kidney function, electrolytes including magnesium, CBC, hearing
Nursing Considerations: Hazardous drug: chemo PPE per USP 800; hydrate before, during and after; premedicate for nausea; safety practice: double-check cisplatin vs carboplatin (look-alike names)
Patient Teaching: Report ringing in the ears, hearing loss, numbness or tingling; nausea can be delayed, keep taking antiemetics
Cisplatin hits the kidneys, ears, nerves and gut, so hydrate hard, give antiemetics and replace magnesium.
Card 4
vincristine
Answer
Brand: None (Oncovin and Marqibo discontinued)
Class: Antineoplastic; vinca alkaloid
Indications: Acute leukemia; with other drugs for lymphomas, rhabdomyosarcoma, neuroblastoma, Wilms tumor
Action: Binds tubulin and blocks microtubules, arresting cells in metaphase
Adverse Effects: Boxed: IV use only, fatal by other routes; extravasation; neuropathy, constipation and paralytic ileus, SIADH
Contraindications: Demyelinating form of Charcot-Marie-Tooth syndrome
Interactions: Strong CYP3A inhibitors such as itraconazole and strong inducers (avoid); lowers phenytoin levels
Monitoring: Neuro exam and bowel function before each dose; CBC
Nursing Considerations: Hazardous drug: chemo PPE per USP 800; vesicant, confirm blood return; safety practice: keep apart from intrathecal drugs; start a bowel regimen
Patient Teaching: Report constipation, belly pain, numbness, tingling or trouble walking
Intrathecal vincristine is almost always fatal; the label requires dilution in a labeled IV container, and safety practice (ISMP) is a minibag, never a syringe.
Card 5
tamoxifen
Answer
Brand: Soltamox (Nolvadex discontinued)
Class: Antineoplastic hormonal agent; selective estrogen receptor modulator (SERM)
Indications: Metastatic breast cancer (women and men), adjuvant breast cancer, DCIS, risk reduction in high-risk women
Action: Competes with estrogen for receptors in breast tissue
Adverse Effects: Boxed (DCIS and risk reduction): uterine malignancies, stroke, pulmonary embolism; DVT, hot flashes, cataracts
Contraindications: Hypersensitivity; for DCIS or risk reduction: warfarin use, history of DVT or PE
Interactions: Warfarin (raises INR), rifampin (lowers levels), anastrozole and letrozole (do not combine)
Nursing Considerations: Hazardous drug: gloves, do not crush; ask about clot history; assess for leg swelling and dyspnea
Patient Teaching: Report abnormal vaginal bleeding, pelvic pain, leg swelling or chest pain; use nonhormonal birth control
Tamoxifen blocks estrogen in the breast but acts like estrogen in the uterus and blood, hence endometrial cancer and clots.
Card 6
anastrozole
Answer
Brand: Arimidex
Class: Antineoplastic hormonal agent; nonsteroidal aromatase inhibitor
Indications: Hormone receptor-positive breast cancer in postmenopausal women (adjuvant, advanced, after tamoxifen)
Action: Blocks aromatase, cutting conversion of androgens to estrogen
Adverse Effects: Bone loss and fractures, joint pain, hot flashes, high cholesterol, ischemic heart events in women with heart disease
Contraindications: Hypersensitivity to anastrozole
Interactions: Tamoxifen (do not combine), estrogen-containing products (reduce effect)
Nursing Considerations: Confirm postmenopausal status; plan bone density testing; ask about joint pain and adherence; hazardous drug: handle per policy
Patient Teaching: Take daily even when you feel well; get calcium, vitamin D and weight-bearing exercise as advised; report chest pain
Aromatase inhibitors are for postmenopausal women, when fat-tissue aromatase is the main source of estrogen.
Card 7
imatinib
Answer
Brand: Gleevec, Imkeldi
Class: Antineoplastic; tyrosine kinase inhibitor
Indications: Philadelphia chromosome-positive CML and ALL, KIT-positive GIST, hypereosinophilic syndrome, other rare cancers
Action: Inhibits the BCR-ABL tyrosine kinase, plus KIT and PDGF receptor kinases
Adverse Effects: Fluid retention and edema, cytopenias, heart failure, hepatotoxicity, GI bleeding or perforation, severe skin reactions
Contraindications: None listed in the label
Interactions: Strong CYP3A4 inducers (avoid) and inhibitors; raises CYP3A4 substrates; use heparin rather than warfarin
Monitoring: CBC, liver function and weight
Nursing Considerations: Hazardous drug: gloves, do not crush; give with a meal and a large glass of water; weigh regularly, check for edema
Patient Teaching: Report rapid weight gain, swelling, shortness of breath, yellow skin or black stools
Imatinib was the first drug built to hit one cancer-driving enzyme, the BCR-ABL kinase made by the Philadelphia chromosome.
Card 8
filgrastim
Answer
Brand: Neupogen, Zarxio, Nivestym, Releuko
Class: Hematopoietic agent; granulocyte colony-stimulating factor (G-CSF)
Indications: Febrile neutropenia prevention with myelosuppressive chemo, AML, marrow transplant, stem cell mobilization, chronic neutropenia
Action: Stimulates production, maturation and function of neutrophils
Adverse Effects: Bone pain, splenic rupture, ARDS, serious allergic reactions, sickle cell crisis, glomerulonephritis, capillary leak
Contraindications: History of serious allergic reaction to filgrastim or pegfilgrastim
Interactions: Chemotherapy (not within 24 hours before or after), radiation
Monitoring: CBC with differential
Nursing Considerations: Refrigerate, do not shake; treat bone pain as ordered; assess for left upper abdominal or shoulder pain and dyspnea
Patient Teaching: Report belly or shoulder pain, trouble breathing or fever at once
Bone pain after filgrastim means the marrow is busy; left upper abdominal or shoulder pain could be the spleen.
Card 9
epoetin alfa
Answer
Brand: Epogen, Procrit, Retacrit
Class: Erythropoiesis-stimulating agent (ESA)
Indications: Anemia from CKD, zidovudine in HIV or myelosuppressive chemo; fewer transfusions in elective noncardiac surgery
Action: Stimulates red blood cell production in the bone marrow
Adverse Effects: Boxed: ESAs increase risk of death, MI, stroke, VTE, vascular access thrombosis, tumor progression or recurrence; hypertension, seizures
Contraindications: Uncontrolled hypertension, pure red cell aplasia after an ESA, serious allergy
Interactions: None major; iron is often needed for response
Monitoring: Hemoglobin, blood pressure, iron studies
Nursing Considerations: Hold for uncontrolled hypertension; check iron status before and during; do not shake; lowest dose that avoids transfusion
Patient Teaching: Report headache, chest pain, leg swelling or seizures; keep BP checks and lab visits
Epoetin replaces the kidney hormone that drives red cell production, but pushing hemoglobin too high raises clot and death risk.
Card 10
oxycodone
Answer
Brand: Roxicodone, OxyContin, Xtampza ER
Class: Opioid analgesic (Schedule II); full mu-opioid agonist
Indications: Pain severe enough to require an opioid when alternatives are inadequate
Action: Binds mu-opioid receptors in the brain and spinal cord
Adverse Effects: Boxed: addiction, abuse and misuse; respiratory depression; accidental ingestion; NOWS; CYP3A4 interaction; benzodiazepine co-use; constipation
Contraindications: Significant respiratory depression, acute or severe asthma without monitoring, GI obstruction or paralytic ileus
Interactions: Benzodiazepines, alcohol and CNS depressants, CYP3A4 inhibitors and inducers, MAOIs, serotonergic drugs
Antidote: Naloxone
Nursing Considerations: Assess sedation and respiratory rate before and after doses; never crush ER forms; bowel regimen; fall precautions
Patient Teaching: No alcohol or sleep aids; keep naloxone at home and the drug locked away
Opioid boxed warnings share the same core dangers: addiction, breathing, children, benzodiazepines and newborn withdrawal.
Card 11
tramadol
Answer
Brand: ConZip
Class: Opioid analgesic (Schedule IV)
Indications: Pain severe enough to require an opioid, alternatives inadequate
Action: Mu agonist (mainly via M1 metabolite) plus weak serotonin and norepinephrine reuptake inhibition
Adverse Effects: Boxed: addiction, respiratory depression, accidental ingestion, NOWS, benzodiazepines, ultra-rapid metabolism in children, CYP interactions; seizures, serotonin syndrome
Contraindications: Under 12, under 18 after tonsillectomy or adenoidectomy, respiratory depression, GI obstruction, MAOIs within 14 days
Interactions: Serotonergic drugs such as SSRIs, SNRIs, TCAs, triptans; CNS depressants; CYP2D6 and CYP3A4 drugs
Antidote: Naloxone (may raise seizure risk)
Nursing Considerations: Ask about seizure history and serotonergic drugs; assess respiration and sedation; watch for low sodium and glucose
Patient Teaching: Report agitation, fever, sweating or tremor; no alcohol; keep naloxone on hand
Tramadol adds SNRI-like action to a weak opioid, so seizures and serotonin syndrome join the usual opioid risks.
Card 12
ibuprofen
Answer
Brand: Advil, Motrin IB, Caldolor (IV)
Class: Analgesic, anti-inflammatory and antipyretic; nonselective NSAID
Indications: Rheumatoid arthritis and osteoarthritis, mild to moderate pain, primary dysmenorrhea, fever (OTC)
Action: Inhibits COX-1 and COX-2, reducing prostaglandin synthesis
Adverse Effects: Boxed: CV thrombotic events; GI bleeding, ulceration and perforation; kidney injury, hypertension, heart failure
Contraindications: Hypersensitivity, asthma or hives after aspirin or other NSAIDs, setting of CABG surgery
Interactions: Anticoagulants and SSRIs (bleeding), low-dose aspirin (blunted effect), ACE inhibitors, ARBs, diuretics, lithium
Nursing Considerations: Give with food; ask about GI bleeding, kidney disease and heart failure; check BP; avoid at about 30 weeks of pregnancy and later
Patient Teaching: Lowest dose for the shortest time; report black stools, chest pain, swelling or less urine
NSAIDs block the prostaglandins that protect the stomach lining and keep kidney blood flow up.
Card 13
celecoxib
Answer
Brand: Celebrex
Class: Analgesic and anti-inflammatory; COX-2 selective NSAID
Indications: Osteoarthritis, rheumatoid and juvenile arthritis, ankylosing spondylitis, acute pain, primary dysmenorrhea
Action: Selectively inhibits COX-2, reducing prostaglandin synthesis
Adverse Effects: Boxed: serious cardiovascular and GI events; kidney injury, hypertension, edema, liver injury, DRESS
Contraindications: Sulfonamide allergy, aspirin or NSAID-induced asthma or hives, setting of CABG surgery
Interactions: CYP2C9 inhibitors such as fluconazole (raise levels), warfarin and SSRIs (bleeding), ACE inhibitors, ARBs, lithium
Nursing Considerations: Ask about sulfa allergy and cardiac history; check BP and edema; lower dose in poor CYP2C9 metabolizers
Patient Teaching: It does not replace low-dose aspirin for heart protection; report chest pain, black stools, rash or swelling
COX-2 selectivity spares the stomach somewhat but not the heart or kidneys.
Card 14
gabapentin
Answer
Brand: Neurontin, Gralise
Class: Antiseizure drug and neuropathic pain agent; gabapentinoid
Indications: Postherpetic neuralgia, adjunct for partial-onset seizures (Gralise: postherpetic neuralgia only)
Action: Binds the alpha-2-delta subunit of voltage-gated calcium channels
Adverse Effects: Dizziness, somnolence, ataxia, respiratory depression with opioids or lung disease, DRESS, angioedema, suicidal thoughts
Contraindications: Hypersensitivity to gabapentin
Interactions: Opioids and other CNS depressants (respiratory depression), aluminum or magnesium antacids (give gabapentin 2 h after)
Nursing Considerations: Assess sedation and breathing with opioids; renal dose adjustment; fall precautions; taper over at least 1 week
Patient Teaching: Do not stop suddenly; no driving until you know the effect; report rash, mood changes or trouble breathing
Gabapentin looks like GABA but does not act on GABA receptors; it binds calcium channels.
Card 15
cyclobenzaprine
Answer
Brand: Amrix (Flexeril discontinued)
Class: Skeletal muscle relaxant; centrally acting, tricyclic-related
Indications: Short-term relief of muscle spasm from acute painful musculoskeletal conditions
Action: Acts in the brainstem to reduce tonic motor activity; does not act on muscle directly
Adverse Effects: Drowsiness, dry mouth, dizziness, arrhythmias, serotonin syndrome, urinary retention, confusion in older adults
Contraindications: MAOIs within 14 days, recent MI, arrhythmias, heart block, heart failure, hyperthyroidism
Interactions: MAOIs, SSRIs, SNRIs, tramadol, bupropion (serotonin syndrome), alcohol and CNS depressants, anticholinergics
Nursing Considerations: Use only 2 to 3 weeks; not for spasticity from brain or cord disease; fall precautions; check for urinary retention
Patient Teaching: Avoid alcohol and driving until you know the effect; sugarless candy for dry mouth
Cyclobenzaprine is built like a tricyclic antidepressant, so expect sedation and anticholinergic effects.
Card 16
allopurinol
Answer
Brand: Zyloprim, Aloprim (IV)
Class: Antigout agent; xanthine oxidase inhibitor
Indications: Gout, hyperuricemia from cancer therapy, recurrent calcium oxalate stones; not for asymptomatic hyperuricemia
Action: Blocks xanthine oxidase, reducing uric acid production
Adverse Effects: Rash that can progress to SJS, TEN or DRESS, gout flares when starting, hepatotoxicity, marrow suppression
Contraindications: Hypersensitivity to allopurinol
Interactions: Azathioprine and mercaptopurine (cut their dose), ampicillin and amoxicillin (rash), thiazides, warfarin
Nursing Considerations: Stop at the first sign of rash and notify the provider; HLA-B*58:01 raises SJS risk; give flare prophylaxis as ordered
Patient Teaching: Drink enough fluid to make about 2 liters of urine a day; keep taking it during a flare
Allopurinol stops uric acid from being made; it does nothing for an attack already underway.
Card 17
colchicine
Answer
Brand: Colcrys, Mitigare, Gloperba
Class: Antigout agent; anti-inflammatory alkaloid (microtubule inhibitor)
Indications: Prevention and treatment of gout flares, familial Mediterranean fever
Action: Disrupts microtubules, reducing neutrophil migration and inflammasome activation
Adverse Effects: Diarrhea, nausea and vomiting, myelosuppression, myopathy and rhabdomyolysis, neuropathy, fatal overdose
Contraindications: Kidney or liver impairment with a P-gp or strong CYP3A4 inhibitor
Interactions: Clarithromycin, ketoconazole, ritonavir, cyclosporine, verapamil, diltiazem, grapefruit juice; statins and fibrates
Nursing Considerations: Review all drugs for CYP3A4 and P-gp inhibitors; adjust for kidney or liver disease; hazardous drug (reproductive)
Patient Teaching: Avoid grapefruit; call for muscle pain or weakness; keep away from children, overdose can be fatal
Colchicine has a narrow margin: GI upset is often the first sign of toxicity.
Card 18
oxybutynin
Answer
Brand: Oxytrol, Oxytrol for Women (OTC)
Class: Urinary antispasmodic; antimuscarinic
Indications: Overactive bladder with urge incontinence, urgency and frequency; neurogenic bladder
Action: Blocks muscarinic receptors on bladder smooth muscle, reducing involuntary contractions
Adverse Effects: Dry mouth, constipation, blurred vision, drowsiness, confusion, heat prostration, urinary retention, angioedema
Contraindications: Urinary or gastric retention, severe GI hypomotility, uncontrolled narrow-angle glaucoma
Interactions: Other anticholinergics, strong CYP3A4 inhibitors such as ketoconazole, alcohol
Nursing Considerations: Check for urinary retention; assess cognition in older adults; avoid high heat; rotate patch sites
Patient Teaching: Sugarless gum for dry mouth; avoid overheating; report trouble urinating or swelling of face or tongue
Antimuscarinic effects: can't see, can't pee, can't spit, can't poop, and in older adults, can't think.
Card 19
tamsulosin
Answer
Brand: None (Flomax discontinued)
Class: BPH agent; selective alpha-1A adrenergic blocker
Indications: Signs and symptoms of benign prostatic hyperplasia (not for hypertension)
Action: Blocks alpha-1A receptors in prostate and bladder neck smooth muscle
Adverse Effects: Orthostatic hypotension and syncope, dizziness, abnormal ejaculation, priapism, intraoperative floppy iris syndrome
Contraindications: Hypersensitivity to tamsulosin
Interactions: Strong CYP3A4 inhibitors such as ketoconazole (avoid), other alpha blockers, PDE5 inhibitors, cimetidine
Nursing Considerations: Check orthostatic BP after the first dose or a restart; ask about cataract surgery plans
Patient Teaching: Take 30 min after the same meal daily; do not crush or open capsules; rise slowly; tell your eye surgeon you take it
Tamsulosin targets prostate alpha-1A receptors, so it relaxes the outlet with less BP drop than older alpha blockers.
Card 20
finasteride
Answer
Brand: Proscar, Propecia
Class: BPH and hair loss agent; 5-alpha-reductase inhibitor
Indications: Symptomatic BPH (Proscar, alone or with doxazosin), male pattern hair loss (Propecia)
Action: Blocks type II 5-alpha-reductase, lowering conversion of testosterone to DHT
Adverse Effects: Decreased libido, erectile and ejaculation problems, breast enlargement or tenderness, depression, high-grade prostate cancer
Contraindications: Pregnancy (can harm a male fetus), hypersensitivity
Interactions: None clinically significant
Nursing Considerations: Hazardous drug: anyone who is or may be pregnant must not handle crushed or broken tablets; takes about 6 months to judge effect
Patient Teaching: Results take months; tell anyone ordering a PSA test that you take it; report breast lumps, nipple discharge or low mood
Finasteride halves PSA, so a PSA on finasteride is doubled before comparing it with normal values.
Card 21
sildenafil
Answer
Brand: Viagra, Revatio
Class: ED and pulmonary hypertension agent; phosphodiesterase-5 (PDE5) inhibitor
Indications: Erectile dysfunction (Viagra), pulmonary arterial hypertension (Revatio)
Action: Inhibits PDE5, raising cGMP and relaxing smooth muscle in penile and pulmonary vessels
Adverse Effects: Headache, flushing, hypotension, priapism, sudden vision loss (NAION), sudden hearing loss, nasal congestion
Contraindications: Nitrates in any form, guanylate cyclase stimulators such as riociguat, hypersensitivity
Interactions: Nitrates (severe hypotension), alpha blockers, ritonavir and other strong CYP3A4 inhibitors
Nursing Considerations: Ask about nitrates, including PRN nitroglycerin, before giving; ask chest pain patients about recent PDE5 inhibitor use
Patient Teaching: Never combine with nitrates or poppers; seek care for an erection over 4 hours or sudden vision or hearing loss
Nitrates and PDE5 inhibitors both raise cGMP, and together they can drop BP to fatal levels.
Card 22
medroxyprogesterone
Answer
Brand: Depo-Provera CI, depo-subQ provera 104, Provera
Class: Contraceptive and hormone agent; progestin
Indications: Contraception (injection); abnormal uterine bleeding, secondary amenorrhea, endometrial hyperplasia prevention (tablets)
Action: Inhibits gonadotropin secretion, preventing ovulation and thinning the endometrium
Adverse Effects: Boxed: injection, bone density loss; tablets with estrogen, CV disorders, breast cancer, dementia; irregular bleeding, weight gain, meningioma
Contraindications: Thromboembolic or cerebrovascular disease, breast cancer, significant liver disease, undiagnosed bleeding
Interactions: CYP3A4 inducers (may lower effectiveness)
Nursing Considerations: Rule out pregnancy before the first injection; Depo-Provera CI is deep IM every 13 weeks; hazardous drug (reproductive)
Patient Teaching: Calcium, vitamin D, weight-bearing exercise; fertility may take months to return; no STI protection
Bone loss is why the label discourages the injection beyond 2 years unless other methods are inadequate.
Card 23
levonorgestrel-ethinyl estradiol
Answer
Brand: Seasonique, Altavera, Aviane, Levora, Portia
Class: Hormonal contraceptive; combined oral contraceptive (COC)
Indications: Prevention of pregnancy
Action: Suppresses ovulation; also thickens cervical mucus and thins the endometrium
Adverse Effects: Boxed: cigarette smoking and serious cardiovascular events (contraindicated over 35 and smoking); VTE, stroke, MI, hypertension
Contraindications: High risk of arterial or venous clots, breast cancer, liver tumors or severe liver disease, undiagnosed uterine bleeding
Interactions: Rifampin, carbamazepine, phenytoin, St. John's wort (backup needed); ombitasvir-paritaprevir-ritonavir (contraindicated)
Nursing Considerations: Ask about smoking, migraine with aura and clot history; check BP; hazardous drug: handle per policy
Patient Teaching: Same time daily, follow missed-pill instructions; report leg or chest pain, sudden headache or vision change
Smoking plus estrogen plus age over 35 is the classic setup for clots, stroke and MI on the pill.
Card 24
oxytocin
Answer
Brand: Pitocin
Class: Oxytocic; posterior pituitary hormone
Indications: Labor induction or augmentation for medical reasons, third stage of labor, postpartum bleeding, incomplete or inevitable abortion
Action: Binds uterine oxytocin receptors, increasing frequency and force of contractions
Adverse Effects: Boxed: not for elective induction of labor; uterine hyperstimulation or rupture, fetal distress, water intoxication
Contraindications: Cephalopelvic disproportion, unfavorable fetal position, fetal distress with delivery not imminent, hypertonic uterus
Interactions: Vasopressors with caudal block anesthesia (severe hypertension)
Nursing Considerations: High-alert: infusion pump, continuous fetal and contraction monitoring; stop for hyperstimulation or fetal distress; I&O; hazardous drug (reproductive, third trimester)
Patient Teaching: Report constant or very painful contractions, headache or confusion
Oxytocin has an intrinsic antidiuretic effect, which is how long infusions cause water intoxication.
Card 25
testosterone
Answer
Brand: Depo-Testosterone, AndroGel, Xyosted
Class: Androgen (Schedule III)
Indications: Male hypogonadism, primary or hypogonadotropic (not established for age-related low testosterone)
Action: Replaces endogenous testosterone
Adverse Effects: Boxed (gels): secondary exposure, virilization of children; polycythemia, raised BP, VTE, worsening BPH, edema, sleep apnea
Contraindications: Male breast cancer, known or suspected prostate cancer, pregnancy
Interactions: Insulin and other diabetes drugs (lower glucose), warfarin (raises INR)
Monitoring: Hematocrit and PSA per label schedule
Nursing Considerations: Check BP and hematocrit; assess for leg swelling and sleep apnea; hazardous drug (reproductive): pregnant staff avoid contact
Patient Teaching: Apply gel to shoulders or upper arms, wash hands, cover the site; keep children and women from touching it
Gel can rub off onto children and partners, which is why gel labels carry a boxed warning.
Card 26
buprenorphine-naloxone
Answer
Brand: Suboxone, Zubsolv
Class: Opioid use disorder agent (Schedule III); partial mu agonist plus opioid antagonist
Indications: Opioid dependence, with counseling and psychosocial support
Action: Buprenorphine partially activates mu receptors and blocks other opioids; naloxone causes withdrawal if injected
Adverse Effects: Precipitated withdrawal, respiratory depression with benzodiazepines or alcohol, hepatitis, dental problems, constipation
Contraindications: Hypersensitivity to buprenorphine or naloxone
Interactions: Benzodiazepines, alcohol and CNS depressants, CYP3A4 inhibitors and inducers, serotonergic drugs
Antidote: Naloxone (may need higher or repeated doses)
Nursing Considerations: Start only with objective signs of moderate withdrawal; dissolve under the tongue; check liver tests; assess sedation
Patient Teaching: Do not chew, swallow or cut; rinse with water, wait 1 h to brush teeth; keep naloxone at home
Buprenorphine binds mu receptors tighter than full agonists, so starting too soon precipitates withdrawal.