Cancer Drug Study

7/31/2019 Cancer Drug Study

1/14

Drug Name Action Indication Contraindication Side Effects Nursing

ResponsibilitiesCytarabine

Ara-C

Cytosar

Drug

Classification

Antimetabolite

Antineoplastic

Inhibits DNA

polymerase;

cell cycle phase

specific-S phase

(stage of DNA

synthesis) also

blocks

progression ofcells from G1 to

S.

- Induction and

maintenance of

remission in AML

(higher response rate in

children than in adults)

- Treatment of acute

lymphocytic leukemia

in adults and children;treatment of chronic

myelocytic leukemia

and erythroleukemia

- Intrathecal use:

Treatment of

meningeal leukemia

- Liposomal: Treatment

of lymphomatous

meningitis

- In combination

therapy: Treatment of

non-hodgkins

lymphoma in children

- Unlabeled uses:

Hodgkins lymphoma,

bone marrow

transplantation

- Contraindicated with

allergy to cytarabine,

active meningeal

infection (liposomal).

- Use cautiously with

hematopoietic

depression secondary to

radiation orchemotherapy; hepatic

impairment, pregnancy,

lactation, premature

infants

- CNS: Neuritis,

neural toxicity

- Dermatologic:Fever, rash,

urticarial,

freckling, skin

ulceration, pruritus,

conjunctivitis,alopecia.

- GI: Anorexia,

nausea, vomiting,

diarrhea, oral and

anal inflammation

or ulceration;

esophageal

ulcerations,

esophagitis,

abdominal pain,

hepatic impairment

(jaundice), acute

pancreatitis

- GU: Renal

impairment, urine

retention

- Hematologic:Bone marrow

depression,

hyperuricemia,

leukopenia,

thrombocytopenia,

anemia

- Local:Thromboplebitis,

cellulitis at

injection site- Other:Cytarabine

syndrome (fever

myalgia, bone pain,

occasional chest

pain,

maculopapular

rash, conjunctivitis,

malaise, which is

sometimes

responsive to

corticosteroids),

fever, rash,arachnoiditis

(liposomal

preparation)

- Evaluate

hematopoietic

status before and

frequently during

therapy.

- Use Elliotts B

solution for diluent

similar to CSF, forintrathecal use.

Administer with

4hr after

withdrawal from

vial; contains no

preservatives. Do

not use in-line

filters; inject

directly into CSF.

- Use caution to

avoid skin contact

with liposomal

form; use liposoma

form within 4hr of

withdrawing from

vial

- Make sure

antiermetics are

ordered before each

dose.

- Give comfort

measures for anal

inflammation,

headache, other

pain associated

with cytarabine

syndrome.


2/14


ResponsibilitiesFluorouracil

5-FU

Drug

Classification

Antimetabolite

Antineoplastic

Inhibits

thymidylate

synthetase,

leading to

inhibition of

DNA synthesis

and cell death.

- Parenteral: Palliative

management of

carcinoma of the colon,

rectum, breast,

stomach, pancreas in

selected patients

considered incurable by

surgery or other means- Topical treatment of

superficial basal cell

carcinoma

- Orphan drug uses: In

combination with

interferon alfa 2-a

recombinant for

esophageal and

advanced colorectal

carcinoma; with

leucovorin for colon or

rectum metastatic

adenocarcinnoma

- Unlabeled use:

Topical treatment of

condylomata acuminata


allergy to 5-FU; poor

nutritional status; serious

infection; lactation.


hematopoietic

depression secondary to

radiation orchemotherapy; impaired

liver function;

pregnancy.

Parenteral- CNS: Lethargy,

malaise, weakness,

euphoria, acute

cerebellar

syndrome,

photophobia,

lacrimanation,decreased vision,

nystagmus,

diplopia

- CV: Myocardial

ischemia, angina

- Dermatologic:Alopecia,

dermatitis,

maculopapular

rash,

photosensitivity,

nail changes

including nail loss,

dry skin, fissures

- GI: Anorexia,

nausea, vomiting,

diarrhea, cramps,

enteritis, duodenal

ulcer, duodenitis,

gastritis, glossitis,

stomatitis,

pharyngitis,

esophagopharyngiti

s

- Hematologic:

Leukopenia,

thrombocytopenia, elevations in

alkaline

phosphatase, serum

transaminase,

serum bilirubin,

lactate

dehydrogenase

- Other: Fever,

epistaxis

Topical

- Hematologic:Leukocytosis,

thrombocytopenia,toxic granulation ,

eosinophilia

- Local: Local

pain, pruritus,

hyperpigmentation,

irritation,

inflammation and

burning at the site

of application,

allergic contact

dermatitis,

scarring, soreness,

- Evaluate

hematologic status

before beginning

therapy and before

each dose.

- Discontinue drug

therapy at any sign

of toxicity(stomatitis,

esphagopharyngitis

, rapidly falling

WBC count,

intractable

vomiting, diarrhea,

GI ulceration and

bleeding,

thrombocytopenia,

haemorrhage);

consult with

physician.

- Arrange for

biopsies of skin

lesions to rule out

frank neoplasm

before beginning

topical therapy and

in all patients who

do not respond to

topical theray.

- Avoid occulusive

dressings with

topical application;

the incidence of

inflammatory

reactions inadjacent skin areas

is increased with

these dressings.

Use porous gauze

dressings for

cosmetic reasons.


3/14


4/14


ResponsibilitiesMercaptopurine

6-MP,

Purinethol

Drug

Classification

Antimetabolite

Antineoplastic

Tumor-

inhibiting

properties,

probably due to

interference

with purine

nucleotide

synthesis andhence with

RNA and DNA

synthesis,

leading to cell

death; cell-

cycle specific.

- Remission induction,

remission

consolidation, and

maintenance therapy

of acute leukemia (

lymphocytic,

myelogenous)


allergy mercaptopurine,

prior resistance to

mercaptopurine (cross-

resistance with

thioguanine is frequent),

hematopoietic

depression, pregnancy,lactation


impaired renal fuction

(slower elimination and

greater accumulation;

reduce dosage).

- GI: Hepato

toxicity; oral

lesions (resembling

thrush); nausea;

vomiting; anorexia,

pancreatitis

- Hematologic:

Bone marrowdepression,

immunosuppressio

n, hyperuricemia as

consequence of

atineoplastic effect

and cell lysis.

- Other: Drug

fever, cancer,

chromosomal

aberrations, rash,

hyperpigmentation

- Evaluate

hematopoietic

status before and

frequently during

therapy

- Round dose to

nearest 25mg

(tablets are scored)- Ensure that the

patient is well

hydrated before and

during therapy to

minimize adverse

effects of

hyperuricemia

- Caution the

patient bout the risk

of the serious fetal

harm while taking

this drug; advice

patient to use

barrier

contraceptives

- Administer as a

single daily dose.


5/14


ResponsibilitiesMethotrexate

Mexate

Drug

Classification

Antimetabolite

Antineoplastic

Inhibits

dihydrofolic

acid reductase,

leading to

inhibition of

DNA synthesisand inhibition

of cellular

replication;

selectively

affects the most

rapidly dividing

cells (neoplastic

and psoriatic

cells).

- Treatment of

gestational

choriocarcinoma,

chorioadenoma

destruens,

hydatidiform mole- Treatment and

prophylaxis of

meningeal leukemia,

mycosis fungoides

- Symptomatic

controlof severe,

recalcitrant disabling

psoriasis

- Management of

severe, active,

classical, or definite

rheumatoid arthritis

- High-dose regimenfollowed by

leucovorin rescue for

adjuvant therapy of

nonmetastatic

osteosarcoma (orphan

drug designation)

- Unlabeled uses: To

reduce corticosteroid

requirements in

patients with severe

corticosteroid-

dependent asthma; as a

maintenance regimen

for Wegenersagranulomatosis,

dermatomyositis,

relapsing-remitting

MS, myositis,

ulcerative colitis,

refractory Crohns

disease, uveitis, SLE,

psoriatic arthritis.


pregnancy, lactation,

alcoholism, chronic liver

disease, immune

deficiencies, blood

dyscrasias,hypersensitivity to

methotrexate


renal disease, infection,

peptic ulcer, ulcerative

colitis, debility

- CNS: Headache,

drowsiness, blurred

vision, aphasia,

hemiparesis,

paresis, seizures,

fatigue, malaise,dizziness

- Dermatologic:Erythematous

rashes, pruritus,

urticarial,

photosensitivity,

depigmentation,

alopecia,

ecchymosis,

teangietasia. Acne,

furunculosis

- GI: Ulcerative

stomatitis,gingivitis,

pharyngitis,

anorexia, nausea,

vomiting, diarrhea,

hematemesis,

melena, GI

ulceration and

bleeding, enteritis,

hepatic toxicity

- GU: Renal

failure, effects on

fertility (defective

oogenesis,

defectivespermatogenesis,

transient

oligospermia,

menstrual

dysfunction,

infertility, abortion,

fetal defects)

- Hematologic:

Severe bone

marrow

depression,increased

susceptibility toinfection

- Hypersensitivity:

Anaphylaxis

sudden death

- Respiratory:

Interstitial

pneumonitis,chronic interstitial

obstructive

pulmonary disease

- Other: Chills and

fever, metabolic

- Arrange for tests

to evaluate CBC,

urinalysis, renal

and liver function

tests, and chest x-

ray before therapy,during therapy, and

for several weeks

after therapy;

severe toxicity

could occur.

- Ensure that

patient is not

pregnant before

administering this

drug; counsel

patient about the

severe risks of fetal

abnormalitiesassociated with this

drug.

- Reconstitute

powder for

intrathecal use with

preservative-free

sterile sodium

chloride injection;

intended for one

dose only; discard

remainder. The

solution for

injection contains

benzyl alcohol andshould not be given

intrathecally.

- Arrange for an

antiemetic if nausea

and vomiting are

severe.

- Arrange for

adequate hydration

during therapy to

reduce the risk of

hyperuricemia.

- Do not administer

any othermedications

containing alcohol


6/14

changes (diabetes,

osteoporosis),

cancer


7/14


ResponsibilitiesThioguanine

TG

6-Thioguanine

Drug

Classification

Antimetabolite

Antineoplastic

Tumor-

inhibiting

properties,

probably due to

interference

with a numberof steps in the

synthesis and

use of purine

nucleotides,

which are

normally

incorporated

into DNA and

RNA.

- Remission induction,

remission

consolidation, and

maintenance therapy

of acute

nonlymphocyticleukemias-usually

used in combination

therapy


allergy to thioguanine,

prior to resistance to

thioguanine or

mercaptopurine ,

hematopoietic,depression, pregnancy

(potential, mutagen and

teratogen, lactation)


impaired renal fuction

- GI: Hepato

toxicity, nausea;

vomiting; anorexia,

stomatitis

- Hematologic:

Bone marrowsuppression,

immunosuppressio

n, hyperuricemia

due to rapid lysis

of malignant cells

- Other: Fever

weakness, cancer,

chromosomal

aberrations

- Evaluate

hematopoietic

status before and

frequently during

therapy

- Administer as asingle daily dose


8/14


ResponsibilitiesFludarabine

Phosphate

Fludara

Drug

Classification

Antimetabolite

Antineoplastic

Inhibits DNA

polymerase

alpha,

ribonucleotidereductase and

DNA primase,

which inhibits

DNA synthesis

and prevents

cell replication.

- Chronic lymphocytic

leukemia (CLL);

unresponsive B-cell

CLL or no progressduring treatment with

atleast one standard

regimen that contains

an alkalating drug

- Unlabeled uses: Non-

Hodgkins, lymphoma,

relapsing and

secondary AML, acute

lymphoblastic anemia


allergy to fludarabine or

any component,

lactation, pregnancy,severe bone marrow

depression.


renal impairment

- CNS: Weakness,

paresthesia,

headache, visual

disturbance,hearing loss, sleep

disorder,

depression, CNS

toxicity

- CV: Edema,

angina

- Dermatologic:Rash, pruritus,

seborrhea

- GI: Diarrhea,

anorexia, nausea,

vomiting,

stomatitis,esophagopharyngiti

s, GI bleeding,

mucositis

- GU: Dysuria,

urinary infection,

hematuria, renal

failure

- Hematologic:Bone marroe

toxicity,

autoimmune

haemolytic anemia

- Respiratory:Cough, pneumonia,

dyspnea, sinusitis,

URI, epistaxis,

bronchitis, hypoxia

-Other: Fever,

chills, fatigue,

infection, pain,

malaise,

diaphoresis,

haemorrhage,

myalgia, arthralgia,

osteoporosis, tumor

lysis syndrome

- Evaluate

hematopoietic

status before and

frequently duringtherapy

- Caution patient to

avoid pregnancy

while taking this

drug.

.


9/14


ResponsibilitiesPentostatin

Nipent

Drug

Classification

Antineoplastic

Antibiotic

A potent

transition state

inhibitor of

adenosine

deaminase

(ADA), thegreatest activity

of which is

found in cells of

the lymphoid

system. T-cells

have higher

ADA activity

than B-cells,

and T-cell

malignancies

have higher

activity than B-

cellmalignancies.

The

cytotoxicity that

results from

prevention of

catabolism of

adenosine or

deoxyadenosine

is thought to be

due to elevated

intracellular

levels of dATP,

which can block

DNA synthesisthrough

inhibition of

ribonucleotide

reductase.

Intracellular

activation

results in

incorporation

into DNA as a

false purine

base. An

additional

cytotoxic effectis related to its

incorporation

into RNA.

Cytotoxicity is

cell cycle

phase-specific

(S-phase).

- Treatment for adults

with alpha interferon

refractory hairy cell

leukemia, chronic

lymphocytic leukemia,

cutaneous T-celllymphoma, peripheral

T-cell lymphoma


allergy to fludarabine or

any component,

lactation, pregnancy,

severe bone marrow

depression.- Use cautiously with

renal impairment

- CNS: Weakness,

paresthesia,

headache, visual

disturbance,

hearing loss, sleep

disorder,depression, CNS

toxicity

- CV: Edema,

angina

- Dermatologic:Rash, pruritus,

seborrhea

- GI: Diarrhea,

anorexia, nausea,

vomiting,

stomatitis,

esophagopharyngiti

s, GI bleeding,mucositis

- GU: Dysuria,

urinary infection,

hematuria, renal

failure

- Hematologic:Bone marroe

toxicity,

autoimmune

haemolytic anemia

- Respiratory:Cough, pneumonia,

dyspnea, sinusitis,

URI, epistaxis,bronchitis, hypoxia

-Other: Fever,

chills, fatigue,

infection, pain,

malaise,

diaphoresis,

haemorrhage,

myalgia, arthralgia,

osteoporosis, tumor

lysis syndrome

- Evaluate

hematopoietic

status before and

frequently during

therapy

- Caution patient toav oid pregnancy

while taking this

drug.

.


10/14


ResponsibilitiesVinorelbine

Tartrate

Navelbine

Drug

Classification

Antineoplastic

Mitotic

Inhibitor

Affects cell

energy

production

required for

mitosis; has

antimioticeffect, prevents

the formation of

microtubules

and leads to cell

death; cell cycle

specific.

- First-line treatment

Of ambulatory patients

with unresectable

advanced non-small-

cell lung cancer

- Treatment of stageIV non-small-cell lung

cancer alone or with

cisplastin

- Treatment of stage

III non-small-cell lung

cancer with cisplastin

- Unlabeled uses:

Breast cancer, ovarian

cancer, Hodgkins

lymphoma, desmoid

tumors and fibro

mitosis, advanced

Kaposis sarcoma


allergy to vinca

alkaloids, pretreatment

granulocyte counts of

1,000 cells/mm3 or less,

pregnancy, lactation- Use cautiously with

liver disease.

- CNS: Numbness,

paresthesias (less

common than with

other vinca

alkaloids);

headache,weakness,

dizziness

- Dermatologic:Topical epilation

(loss of hair),

vesiculation of the

skin

- GI: Nausea,

vomiting,

stomatitis,

pharyngitis,

vesiculation of the

mouth, ileus,diarrhea,

constipation,

anorexia,

abdominal pain,

increased liver

enzyme

Hematologic:Granulocytopenia,

leukopenia

- Local: Local

cellulitis, phlebitis,

sloughing with

extravasation

Other: Myalgia,arthralgia

- Ensure that the

patient is not

pregnant before

use; advise patient

with to use barrier

contraceptives.- Consult with

physician if

antiemetic is

needed for severe

nausea and

vomiting


11/14


ResponsibilitiesVincrictine

Sulfate

Oncovin

Drug

Classification

Antineoplastic

Mitotic

Inhibitor

Mitotic

inhibitor:

Arrests mitotic

division at the

stage of

metaphase;exact

mechanism of

action unknown

- Acute leukemia

- Hodgkins

lymphoma, non-

hodgkins lymphoma,

rhabdomyosarcoma,

neuroblastoma,Wilms tumor as part

of combination

therapy


allergy to vincristine,

leukopenia, acute

infection, pregnancy,

lactation, demyelinating

form of Charcot-marietooth syndrome.


neuromuscular disease,

diabetes insipidus ,

heptic impairment.

- CNS: Ataxia,

cranial nerve

manifestations;

foot drop,

headache, seizures,

bladderneuropathy,

paresthesias,

sensory

impairment,

neuritic pain,

muscle wasting,

SIADH, optic

atrophy, transient

cortical blindness,

ptosis, diplopia,

photophobia

- GI: Constipation,

oral ulcerations,abdominal cramps,

diarrhea, vomiting,

intestinal necrosis -

GU: Acute uric

acid nephropathy,

polyuria, dysuria

- Hematologic:Lekopenia

- Local: Local

irritation, cellulitis

if extravasation

occurs

-Other: Weight

loss, loss of hairfever, death with

serious overdose

- Enssure that the

patient is not

pregnant before

Administering;

using barrier

contraceptives isadvised

- Tell patient to

avoid grapefruit

juice while being

treated with this

drug

- Arrange for wig

or suitable head

covering if hair loss

occurs; ensure thatpatients head is

covered in

extremes oftemperature.

- Monitor urine

output and serum

sodium; if SIADH

occurs with

physician, and

arrange for fluid

restriction and

perhaps a potent

diuretic.


12/14


ResponsibilitiesVincrictine

Sulfate

Oncovin

Drug

Classification

Antineoplastic

Mitotic

Inhibitor

Mitotic

inhibitor:

Arrests mitotic

division at the

stage of

metaphase;exact

mechanism of

action unknown

- Acute leukemia

- Hodgkins

lymphoma, non-

hodgkins lymphoma,

rhabdomyosarcoma,

neuroblastoma,Wilms tumor as part

of combination

therapy


allergy to vincristine,

leukopenia, acute

infection, pregnancy,

lactation, demyelinating

form of Charcot-marietooth syndrome.


neuromuscular disease,

diabetes insipidus ,

heptic impairment.

- CNS: Ataxia,

cranial nerve

manifestations;

foot drop,

headache, seizures,

bladderneuropathy,

paresthesias,

sensory

impairment,

neuritic pain,

muscle wasting,

SIADH, optic

atrophy, transient

cortical blindness,

ptosis, diplopia,

photophobia

- GI: Constipation,

oral ulcerations,abdominal cramps,

diarrhea, vomiting,

intestinal necrosis -

GU: Acute uric

acid nephropathy,

polyuria, dysuria


- Local: Local

irritation, cellulitis

if extravasation

occurs

-Other: Weight

loss, loss of hairfever, death with

serious overdose

- Ensure that the

patient is not

pregnant before

Administering;

using barrier

contraceptives isadvised

- Tell patient to

avoid grapefruit

juice while being

treated with this

drug

- Arrange for wig

or suitable head

covering if hair loss

occurs; ensure thatpatients head is

covered in

extremes oftemperature.

- Monitor urine

output and serum

sodium; if SIADH

occurs with

physician, and

arrange for fluid

restriction and

perhaps a potent

diuretic.


13/14


ResponsibilitiesVinblastine

sulfate

Velban

Drug

Classification

Antineoplastic

Mitotic

Inhibitor

Affects cell

energy

production

required for

mitosis, has

antimitoticeffect and

causes

abnormal

mitotic figures

- Palliative treatment

for lymphocytic

lymphoma, histiocytic

lymphoma,generalized, hodgkins

lymphoma (stage IIIand IV), mycosis

funcoides, advanced

testicular carcinoma,

Kaposis sarcoma,

letterer-Siwe disease.

- Treatment of

choriocarcinoma,

breast cancer

unresponsive to other

therapies.

- Hodgkins

lymphoma (advanced)

alone or incombination therapies

- Advanced testicular

germinal-cell cancers

alone or in

combination therapy.


allergy to vinblastine,

leukopenia, acute

infection, pregnancy ,

lactation.

- Use cautiously withliver disease.

- CNS: Numbness,

paresthesias,

peripheral neuritis,

mental depression,

loss of deep

tendon reflexes,headache, seizures,

malaise, weakness,

dizziness

- Dermatologic:Topical epilation

(loss of hair),

vesiculation of the

skin

- GI: Nausea,

vomiting,

pharyngitis,

vesiculation of the

mouth, ileus,diarrhea,

constipation,

anorexia,

abdominal pain,

rectal bleeding,

hemorrhagic

enterocolitis

- GU: Aspermia


- Local: Local

cellulitis, phlebitis,

sloughing if

extravasationoccurs

-Other: Pain in

tumor site

- Ensure that the

patient is not

pregnant before

administering;

advise patients to

use contraceptivemeasures

- Consult with

physician if

antiemetic is

needed for severe

nausea and

vomiting.

- Check CBC

before each dose.


14/14


ResponsibilitiesEtoposide

(VP-16)

Etopophos

Toposar

VePesid

Drug

Classification

Antineoplastic

Mitotic

Inhibitor

G2-specific cell

toxic: Lyses

cells entering

mitosis; inhibits

cells from

enteringprophase;

inhibits DNA

synthesis,

leading to cell

death

- Palliative treatment

for lymphocytic

lymphoma, histiocytic

lymphoma,generalized, hodgkins

lymphoma (stage IIIand IV), mycosis

funcoides, advanced

testicular carcinoma,

Kaposis sarcoma,

letterer-Siwe disease.

- Treatment of

choriocarcinoma,

breast cancer

unresponsive to other

therapies.

- Hodgkins

lymphoma (advanced)

alone or incombination therapies

- Advanced testicular

germinal-cell cancers

alone or in

combination therapy.


allergy to etoposide,

teniposide, Cremophor

El; pregnancy, lactation.


marrow suspensiontransplants.

- CNS:Somnolence,

fatigue,peripheral

neuropathy

- CV: Hypotension

(after rapid IVadministration)

- Dermatologic:

Alopecia

- GI: Nausea,

vomiting,anorexia,

diarrhea, stomatitis,

after taste, liver

toxicity

- Hematologic:Myelotoxicity

- Hypersensitivity:Chills, fever,

tachycardia,anaphylactic-like

reaction, broncho

spasm and

dyspenea

-Other:Carcinogenesis

- Ensure that the

patient is not

pregnant before

administering;

advise patients to

use contraceptivemeasures

- Consult with

physician if

antiemetic is

needed for severe

nausea and

vomiting.

- Check CBC

before each dose.

Cancer Drug Study

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