Antineoplastic drugs Flashcards

1
Q

Busulfan ( BUSLFEX) - V

A

How does it work?
- It interferes DNA crosslinking. In high doses, it affects all lines of hematopoiesis. It uses in combination with radiotherapy for its myeloablative effects.

What is(are) the side effects?
- seizure - treated with Ativan (anticonvulsant)
- no longer N & V if IV
- pancytopenia and prolong WBC recovery

Nursing Implications?
- need in-line FILTER infusion set. with 1.2 microns or smaller pore size
- ensure patients receiving concomitant ANTICONSULVANT therapy. monitor CLOSELY for visual changes and involuntary movements. may require padded side rails.
- monitor S+S of INFECTION. restrict contact with visitors with colds, infection (bacterial and viral)

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2
Q

Cyclophosphamide (CYTOXAN, PROCYTOX) - NV

A

How dose it work?
- It induces genetic changes and inhibits RNA transcription required for DNA replication.

What is(are) the side effects?
- HEMORRHAGIC CYSTITIS (active metabolites that are secreted in urine damage the bladder epithelium, contributing to chronic inflammation and possible severe bleeding)
- occasionally pulmonary fibrosis and interstitial pneumonitis
- N & V
- decrease WBC

Nursing Implications?
- 24-hour HYPERHYDRATION to decrease bladder toxicity
- measure U/O (> = 400ML/4 HOURS) q4hr during and 48 hours post last dose
- initiate DIURETIC therapy if U/O insufficiency, eg. Lasix
- educate to void frequently that helps reduce the amount of drug in the bladder at any given time, even at night
- educate patients to alert staff for any signs of hematuria
- DAILY hemastix (URINE DIP STICK) in q morning to test for microscopic blood
- RBC and platelet replacement may be indicated. for severe cases, electrocautery/cryosurgery/CBI (+- formaldehyde).
- monitor for tachycardia, dyspnea, non-productive cough, hypoxemia, ventilation/perfusion dysfunction
- monitor for fluid overload: edema, wt gain, water intoxication
- monitor for S+S of infection
- maintain adequate nutrition

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3
Q

Cytarabine (ARA-C, CYTOSAR) - NV

A

How dose it work?
It damages DNA mainly in the S phase of cell cycle

What is(are) the side effects?
- CNS TOXICITY with standard high dose (3g/m2) treatment:
Cerebellar dysfunction: ataxia, dysarthria, nystagmus, slurred speech
**Cerebellar toxicity resolves within 5-10 days once medication stops.
- conjunctivitis
- myelosuppression
- N & V
- mild stomatitis
- flu-like symptoms: fever, chill, arthralgia, skin rash (palmar/plantar erythroderma)

Nursing Implications?
- monitor for changes in fine motor coordination. obtain SIGNATURE prior to administration of pre-medications
- prophylactic use of ophthalmic corticosteroids: 2gtts into each eye q4hr before 1st dose and until 48hrs post last dose
- monitor for S+S of infection
- maintain adequate nutrition
- maintain oral hygiene
- monitor hepatic function

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4
Q

Daunorubicin (CERUBIDINE) - V

A

How dose it work?
A clear red solution prevents DNA base pairing thus preventing RNA and DNA transcription causing cell death. Non cell cycle specific.

What is(are) the side effects?
- CARDIAC TOXICITY: fixed max. lifetime dose of 550mg/m2 (normal cardiac output)
- N &V
- enhance radiation injury to tissues
- myelosuppression

Nursing Implications?
- MUGA scan (RVGs) prior to treatment
- monitor for cardiac dysfunction (may be several months following therapy)
- HIGHLY EMETIGENIC
- monitor for tissue injury
- monitor for delayed signs of extravasation (days to weeks)
- inform patient of red color in urine
- maintain adequate nutrition
- monitor for S+S of infection

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5
Q

Etoposide (VP-16, VEPESID) - NV

A

How dose it work?
It causes single-strand breaks in DNA. Late S-phase and G-phase specific.

What is(are) the side effects?
- transient HYPOTENTION with rapid infusions/high doses
- stomatitis in patients treated with radiation to the head and neck
- myelosuppression

Nursing Implications?
- via DEHP FREE TUBING with 0.22 micron FILTER

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6
Q

Hydroxyurea (Hydrea) - O

A

How dose it work?
It inhibits ribonucleotide reductase, then depletes essential DNA precursors.
It directly damages DNA
S-phase specific
It is used to control counts
**maybe combine with other cytotoxic therapies/radiation (synergistic actions)

What is(are) the side effects?
- myelosuppression
- HYPERURICEMIA

Nursing Implications?
- monitor for S+S of infection
- administer allopurinol / hyperhydration for urinary acidity

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7
Q

Melphalan (ALKERAN) - V

A

How dose it work?
It causes some immunosuppression in resting phase.
It is used in combination with other cytotoxic agents in autologous transplants
Non-cell cycle specific

What is(are) the side effects?
- profoundly myelosuppressive with high dose
- N & V
- GI TOXICITY: mucositis, esophagitis, diarrhea with high dose therapy

Nursing Implications?
- monitor for S+S of infection
- maintain adequate nutrition
- monitor for GI toxicity

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8
Q

Methotrexate (MTX, AMETHOPTERIN) - NV

A

How dose it work?
It completes for binding sites that are normally required for cellular reactions to occur, hence inhibits DNA, RNA and protein.
S phase specific
GVHD PROPHYLAXIS on Day +1, +3, +6, +11

What is(are) the side effects?
- stomatitis
- acute hepatic dysfunction with high dose, reversible
- myelosuppression

Nursing Implications?
- monitor for mucositis
- administer mouthwashes, local analgesics, IV analgesics, eg. PCA/CIVI morphine
- provide ice packs to the throat and cheeks
- encourage the sucking of ice chips before, during and after administration
- review lab tests for hepatic dysfunction
- assess BILIRUBIN, CREATININE CLEARANCE, FLUID COLLECTION (ASCITES), STOMATITIS PRIOR TO EACH DOSE
- MUST BE 24HRS post bone marrow infusion PRIOR TO ADMINISTRATION

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9
Q

Vincristine (Oncovin) - V

A

How dose it work?
It binds to the microtubular proteins of the mitotic spindle, leading to crystallization of the microtubule and mitotic arrest or cell death. Cell cycle phase specific.
IV only (FATAL if given intrathecally)

What is(are) the side effects?
- hyperuricemia
- SIADH (syndrome of inappropriate antidiuretic hormone secretion)
- peripheral neuropathy (reversible if d/c’d at onset)
/depression of the Achilles reflex (earliest)
/loss of other deep tendon reflexes, peripheral paresthesia, pain and tingling (after 3 or more weekly doses)
/wrist and foot drop, ataxia, slapping gait, difficulty in walking (prolonged/ high doses)
- GI neuropathy: constipation, abd. pain, urinary retention, paralytic ileus

Nursing Implications?
- monitor for urinary acidity. administer allopurinol/hyperhydration
- fluid restriction for patients with SIADH
- assess for peripheral neuropathy
- assess for GI neuropathy
- hold if patients c/o constipation and assess with Dr.

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10
Q

Cyclophosphamide (CYTOXAN, PROCYTOX) - NV

A

How dose it work?

What is(are) the side effects?

Nursing Implications?

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