A nurse is preparing to administer topotecan IV for a client who has metastatic ovarian cancer.
Which of the following medications should the nurse expect to administer to control the adverse effects of topotecan?

Choice A rationale

Ocular erythema, or redness of the eye, is not a typical adverse effect associated with spironolactone. Spironolactone is a potassium-sparing diuretic that primarily acts on the renal tubules to inhibit aldosterone, affecting electrolyte balance and fluid excretion, not directly impacting ocular tissues or causing inflammatory responses in the eye.

Choice B rationale

Diarrhea is not a common or expected adverse effect of spironolactone. While gastrointestinal disturbances can occur with many medications, spironolactone is more commonly associated with effects related to its diuretic and anti-androgenic properties, such as electrolyte imbalances (hyperkalemia) or endocrine-related symptoms, rather than increased bowel motility.

Choice C rationale

Muscle weakness can occur as an adverse effect of spironolactone, particularly due to its potential to cause hyperkalemia. Spironolactone's mechanism of action involves conserving potassium, and elevated serum potassium levels (normal range 3.5-5.0 mEq/L) can impair the excitability of muscle cells, leading to symptoms like muscle weakness, fatigue, and in severe cases, cardiac dysrhythmias.

Choice D rationale

Depression is not a recognized or common adverse effect of spironolactone. Spironolactone's primary pharmacological actions are on the kidney and endocrine system, and it is not known to directly affect neurotransmitter systems in the brain in a way that would commonly induce depressive symptoms. Psychotropic effects are not typically associated with this medication.

Choice A rationale

Disulfiram is an aldehyde dehydrogenase inhibitor used in the treatment of chronic alcoholism, causing an unpleasant reaction when alcohol is consumed. It has no pharmacological antagonism to opioids and would not be effective in reversing the effects of hydromorphone toxicity.

Choice B rationale

Epinephrine is a potent vasoconstrictor and bronchodilator, primarily used in anaphylaxis and cardiac arrest. While it stimulates adrenergic receptors, it does not counteract the central nervous system depression caused by opioid toxicity and is not a specific antidote for hydromorphone.

Choice C rationale

Naloxone is an opioid antagonist that competitively binds to opioid receptors, displacing opioid agonists like hydromorphone. This action rapidly reverses the central nervous system and respiratory depression characteristic of opioid toxicity, restoring ventilation and consciousness.

Choice D rationale

Flumazenil is a benzodiazepine receptor antagonist, used to reverse the effects of benzodiazepine overdose. It has no affinity for opioid receptors and therefore would be ineffective in treating hydromorphone toxicity, which is mediated by opioid receptor activation.