Antineoplastics

Question 1

Cisplatin

Answer 1

purpose: tx of advanced bladder cancer, adjunct therapy in metastatic testicular & ovarian cancer

SE: seizures, peripheral neuropathy, cardiac abnormalities, ototoxicity, blurred vision, stomatitis, N, V, renal tubular damage, thrombocytopenia, leukopenia, sterility, alopecia, hyopmagnesemia, hypocalcemia, hypokalemia, hypophosphatemia, fibrosis

Nurs con: -use cytoxic handling procedures

• give anti-emetic 30-60 min before tx
• monitor temp every 4 hours
• increase fluid intake to 2-3L/day
• rinse mouth 3-4 times/day for stomatitis
• avoid vaccinations during therapy

Question 2

Cyclophosphamide

Answer 2

purpose: tx of cancer

SE: headache, dizziness, cardiotoxicity, SIADH, stomatitis, N, V, hepatoxicity, hemorrhagic crisis, renal tubular necrosis, sterility, leukopenia, Alopecia, hyperuricemia, pulmonary fibrosis

Nurs con: -Use cytotoxic handling procedures

• avoid evening dosing
• give antiemetic 30-60 minutes before tx
• PO: take on an empty stomach
• monitor temp for every 4 hours
• increase fluid intake to 2-3 L/day
• rinse mouth 3-4 times/day for stomatitis
• avoid aspirin, ibuprofen
• avoid vaccinations during therapy

Question 3

Methotrexate

Answer 3

purpose: treatment of cancer, psoriasis, rheumatoid arthritis & mycosis fungoides

SE: N, V, D, anorexia, alopecia, rash, ulcerative stomatitis, dizziness, headache, renal abnormalities, hepatotoxicity, thrombocytopenia

Nurs con: PO, IM, IV: onset 4-7 days, peak 7-14 days, duration 21 days

• avoid crowds & people with known infections
• do not take ASA or other NSAIDs, which may cause GI bleeding
• monitor for pulmonary toxicity, which may manifest early as a dry, nonproductive cough
• do not take with proton pump inhibitors
• increase fluid intake to 10-12 glasses/day

Question 4

Tamoxifen

Answer 4

purpose: management of advanced breast cancer not responsive to other therapy in estrogen-receptor positive patients

SE: N, V, hot flashes, headache, rash, vaginal discharge, vision abnormalities, irregular menses, fluid retention, depression, mood disturbances, chest pain

Nurs con: -peak 4-7 hours

• to decrease GI upset, take after antacid, after evening meal, before bedtime or take antiemetic 30-60 minutes ahead
• vaginal bleeding, pruritus, hot flashes are reversible after stopping med
• contact provider if decreased visual acuity, which may be irreversible
• tumor flare (increase in tumor size & increased bone pain may occur, but will decrease rapidly; may take analgesics for pain)