Neoplasia - CH. 38

Question 1

Cyclophosphamide

Answer 1

Action- alters DNA structure to prevent replication; cell cycle nonspecific

Side effects: bone marrow suppression can be life threatening; occurs 9-14 days after administration; thrombocytopenia, n/v/d,

Side effects: bone marrow suppression can be life threatening; occurs 9-14 days after administration; thrombocytopenia, n/v/d, hemorrhagic cystitis, reversible alopecia, stomatitis

Nursing: *maintain high po fluid intake 2-3L/day ́Contra: kidney disorder, BPH, leukopenia, TCP

Labs- increased uric acid levels, CBC

Question 2

Methotrexate

Answer 2

Action- interrupts S-phase of cell cycle (replication phase) ́Uses- ca, UC, SLE, RA

Adverse effects: n/v, severe myelosuppression, hepatotoxicity, *ulcerative stomatitis, mucositis & diarrhea require halting therapy; reproductive toxicity, alopecia, phototoxicity

Nursing: monitor for GI bleed, kidney function; pregnancy X ́Drug: folic acid; NSAIDs, pcn, tetracycline cause toxicity; PPIs

Labs: increased uric acid levels, BUN, creatinine, CBC

Overdose: *Leucovorin (folinic acid)- for severe bone marrow suppression; usually given with the chemo= leucovorin rescue

Question 3

Doxorubicin

Answer 3

́Action- stops synthesis of RNA & DNA; cell phase nonspecific

Adverse effects: *severe cardiotoxicity; CHF; nausea, vomiting, reversible hair loss, red urine & sweat, severe myelosuppression, stomatitis, *severe necrosis with extravasation, *secondary malignancy of leukemia 1-3 years after treatment

Nursing- vesicant- IV extravasation; monitor EKG, assess for CHF ́Contra-indications- cardiac disease, thrombocytopenia

Drug- - cardiac meds cause cardiac toxicity

Labs- increased uric acid, CBC

Overdose- transfuse platelets; Neupogen, Epogen

Question 4

Vincristine

Answer 4

Action- kills cells in M-phase of cell cycle

Use- treatment of lymphomas, leukemias, Kaposi’s sarcoma, Wilm’s tumor, bladder & breast cancers

Nursing: *vesicant- IV extravasation—stop infusion, apply heat & inject hyaluronidase; neuropathy, alopecia

Adverse effects: Neurotoxicity, *numbness & tingling to limbs, muscle weakness, pain

Contraindications: men & women of child-bearing age, active infection

Drug- decreases effect of digoxinLabs: increased uric acid levels

BBW- extravasation

Overdose: *Leucovorin

Question 5

Tamoxifen

Answer 5

Action: stops growth of estrogen-dependent cancer; preferred drug for treating metastatic breast cancer
́approved for prophylaxis of breast cancer & high-risk patients

Adverse effects: n/v, hot flashes, weight gain, edema, thrombus, *Initial “tumor flare”– idiosyncratic increase in tumor size; Increased risk endometrial cancer, thromboembolism, CVA, P/E, DVT

Nursing: take with food/fluids to prevent GI upset, do not crush or chew, do not take antacids within 1-2 hours after

Contraindications: endometrial hyperplasia, history of
thromboembolism

Drug-drug interactions: decreases effect of estrogen, increases effect of warfarin

Labs: Hypercalcemia