Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Mitotane Cyproheptadine

2-16 g per day in divided doses PO

4 mg 2-3 times a day PO

Antineoplastic

Antihistamine; serotonin antagonist

Inhibits activity of adrenal cortex; used to treat inoperable adrenocortical carcinomas and Cushing's syndrome

Inhibits the release of ACTH from pituitary gland; drug is considered last resort and often causes no improvement.

Other Drugs: Aminoglutethimide inhibits cholesterol synthesis, and metyrapone partially Inhibits adrenal cortex steroid synthesis. These drugs may be used in conjunction with surgery or radiation if the tumor is not completely resectable or if complete remission is not expected.

Independent

An important goal is to limit the risk of infection for the patient. Note, document, and report any signs of skin or pulmonary infection. Restrict visitors with upper respiratory infections. Unless contraindicated after surgery, encourage the patient to cough and deep-breathe, turn in bed at least every 2 hours, and use good oral hygiene. Focus on helping the patient deal with changes

260 Cystic Fibrosis in body image, sexuality, and self-esteem. Let the patient know that many of the body changes are reversible with treatment; this information allows the patient to focus on setting goals. Include the patient's partner in all education. Patient and family teaching occurs throughout the patient's hospitalization and after discharge. Provide information about patient care and activity restrictions. Explanation of all diagnostic tests and their findings, as well as the treatment plan, are important. The patient and family often require time to consider treatment options. As time progresses, the patient and family need information about the disease process and lifelong management with medication and diet changes.

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