Cancer Drug Study

Drug Name Cytarabine Ara-C Cytosar

Drug Classification Antimetabolite Antineoplastic

Action

Indication

Contraindication

Side Effects

Nursing Responsibilities

Inhibits DNA polymerase; cell cycle phase specific-S phase (stage of DNA synthesis) also blocks progression of cells 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-hodgkin’s 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 or chemotherapy; 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 Elliott’s B solution for diluent, similar to CSF, for intrathecal 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 liposomal 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.

Drug Name Fluorouracil 5-FU

Drug Classification Antimetabolite Antineoplastic

Action

Indication

Contraindication

Side Effects

Nursing Responsibilities

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

- Contraindicated with allergy to 5-FU; poor nutritional status; serious infection; lactation. - Use cautiously with hematopoietic depression secondary to radiation or chemotherapy; 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 in adjacent skin areas is increased with these dressings. Use porous gauze dressings for cosmetic reasons.

tenderness, suppuration, scalling and swelling

Drug Name

Action

Indication

Contraindication

Side Effects

Nursing Responsibilities

Mercaptopurine

Tumorinhibiting properties, probably due to interference with purine nucleotide synthesis and hence with RNA and DNA synthesis, leading to cell death; cellcycle specific.

- Remission induction, remission consolidation, and maintenance therapy of acute leukemia ( lymphocytic, myelogenous)

- Contraindicated with allergy mercaptopurine, prior resistance to mercaptopurine (crossresistance with thioguanine is frequent), hematopoietic depression, pregnancy, lactation - Use cautiously with impaired renal fuction (slower elimination and greater accumulation; reduce dosage).

- GI: Hepato toxicity; oral lesions (resembling thrush); nausea; vomiting; anorexia, pancreatitis - Hematologic: Bone marrow depression, 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.

6-MP, Purinethol

Drug Classification Antimetabolite Antineoplastic

Drug Name Methotrexate

Mexate

Drug Classification Antimetabolite Antineoplastic

Action

Indication

Contraindication

Side Effects

Nursing Responsibilities

Inhibits dihydrofolic acid reductase, leading to inhibition of DNA synthesis and 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 regimen followed by leucovorin rescue for adjuvant therapy of nonmetastatic osteosarcoma (orphan drug designation) - Unlabeled uses: To reduce corticosteroid requirements in patients with severe corticosteroiddependent asthma; as a maintenance regimen for Wegener’s agranulomatosis, dermatomyositis, relapsing-remitting MS, myositis, ulcerative colitis, refractory Crohn’s disease, uveitis, SLE, psoriatic arthritis.

- Contraindicated with pregnancy, lactation, alcoholism, chronic liver disease, immune deficiencies, blood dyscrasias, hypersensitivity to methotrexate - Use cautiously with 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, defective spermatogenesis, transient oligospermia, menstrual dysfunction, infertility, abortion, fetal defects) - Hematologic: Severe bone marrow depression, increased susceptibility to infection - 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 xray 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 abnormalities associated 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 and should 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 other medications containing alcohol

changes (diabetes, osteoporosis), cancer

Drug Name Thioguanine

TG 6-Thioguanine

Drug Classification Antimetabolite Antineoplastic

Action

Indication

Tumorinhibiting properties, probably due to interference with a number of 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 nonlymphocytic leukemias-usually used in combination therapy

Contraindication - Contraindicated with allergy to thioguanine, prior to resistance to thioguanine or mercaptopurine , hematopoietic, depression, pregnancy (potential, mutagen and teratogen, lactation) - Use cautiously with impaired renal fuction

Side Effects - GI: Hepato toxicity, nausea; vomiting; anorexia, stomatitis - Hematologic: Bone marrow suppression, immunosuppressio n, hyperuricemia due to rapid lysis of malignant cells - Other: Fever weakness, cancer, chromosomal aberrations

Nursing Responsibilities - Evaluate hematopoietic status before and frequently during therapy - Administer as a single daily dose

Drug Name Fludarabine Phosphate

Fludara

Drug Classification Antimetabolite Antineoplastic

Action

Indication

Contraindication

Side Effects

Nursing Responsibilities

Inhibits DNA polymerase alpha, ribonucleotide reductase and DNA primase, which inhibits DNA synthesis and prevents cell replication.

- Chronic lymphocytic leukemia (CLL); unresponsive B-cell CLL or no progress during treatment with atleast one standard regimen that contains an alkalating drug - Unlabeled uses: NonHodgkins, lymphoma, relapsing and secondary AML, acute lymphoblastic anemia

- Contraindicated with 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 to avoid pregnancy while taking this drug. .

Drug Name Pentostatin Nipent

Drug Classification Antineoplastic Antibiotic

Action

Indication

Contraindication

Side Effects

Nursing Responsibilities

A potent transition state inhibitor of adenosine deaminase (ADA), the greatest 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 Bcell malignancies. 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 synthesis through inhibition of ribonucleotide reductase. Intracellular activation results in incorporation into DNA as a false purine base. An additional cytotoxic effect is 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-cell lymphoma, peripheral T-cell lymphoma

- Contraindicated with 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 to av oid pregnancy while taking this drug. .

Drug Name Vinorelbine Tartrate Navelbine

Drug Classification Antineoplastic Mitotic Inhibitor

Action

Indication

Contraindication

Side Effects

Affects cell energy production required for mitosis; has antimiotic effect, prevents the formation of microtubules and leads to cell death; cell cycle specific.

- First-line treatment Of ambulatory patients with unresectable advanced non-smallcell lung cancer - Treatment of stage IV 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 Kaposi’s sarcoma

- Contraindicated with 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

Nursing Responsibilities - 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

Drug Name Vincrictine Sulfate Oncovin

Drug Classification Antineoplastic Mitotic Inhibitor

Action

Indication

Contraindication

Side Effects

Nursing Responsibilities

Mitotic inhibitor: Arrests mitotic division at the stage of metaphase; exact mechanism of action unknown

- Acute leukemia - Hodgkin’s lymphoma, nonhodgkin’s lymphoma, rhabdomyosarcoma, neuroblastoma, Wilm’s tumor as part of combination therapy

- Contraindicated with allergy to vincristine, leukopenia, acute infection, pregnancy, lactation, demyelinating form of Charcot-marie tooth syndrome. - Use cautiously with neuromuscular disease, diabetes insipidus , heptic impairment.

- CNS: Ataxia, cranial nerve manifestations; foot drop, headache, seizures, bladder neuropathy, 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 hair fever, death with serious overdose

- Enssure that the patient is not pregnant before Administering; using barrier contraceptives is advised - Tell patient to avoid grapefruit juice while being treated with this drug - Arrange for wig or suitable head covering if hair loss occurs; ensure that patient’s head is covered in extremes of temperature. - Monitor urine output and serum sodium; if SIADH occurs with physician, and arrange for fluid restriction and perhaps a potent diuretic.

Drug Name Vincrictine Sulfate Oncovin

Drug Classification Antineoplastic Mitotic Inhibitor

Action

Indication

Contraindication

Side Effects

Nursing Responsibilities

Mitotic inhibitor: Arrests mitotic division at the stage of metaphase; exact mechanism of action unknown

- Acute leukemia - Hodgkin’s lymphoma, nonhodgkin’s lymphoma, rhabdomyosarcoma, neuroblastoma, Wilm’s tumor as part of combination therapy

- Contraindicated with allergy to vincristine, leukopenia, acute infection, pregnancy, lactation, demyelinating form of Charcot-marie tooth syndrome. - Use cautiously with neuromuscular disease, diabetes insipidus , heptic impairment.

- CNS: Ataxia, cranial nerve manifestations; foot drop, headache, seizures, bladder neuropathy, 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 hair fever, death with serious overdose

- Ensure that the patient is not pregnant before Administering; using barrier contraceptives is advised - Tell patient to avoid grapefruit juice while being treated with this drug - Arrange for wig or suitable head covering if hair loss occurs; ensure that patient’s head is covered in extremes of temperature. - Monitor urine output and serum sodium; if SIADH occurs with physician, and arrange for fluid restriction and perhaps a potent diuretic.

Drug Name Vinblastine sulfate Velban

Drug Classification Antineoplastic Mitotic Inhibitor

Action Affects cell energy production required for mitosis, has antimitotic effect and causes abnormal mitotic figures

Indication - Palliative treatment for lymphocytic lymphoma, histiocytic lymphoma, generalized, hodgkin’s lymphoma (stage III and IV), mycosis funcoides, advanced testicular carcinoma, Kaposi’s sarcoma, letterer-Siwe disease. - Treatment of choriocarcinoma, breast cancer unresponsive to other therapies. - Hodgkin’s lymphoma (advanced) alone or in combination therapies - Advanced testicular germinal-cell cancers alone or in combination therapy.

Contraindication - Contraindicated with allergy to vinblastine, leukopenia, acute infection, pregnancy , lactation. - Use cautiously with liver disease.

Side Effects - 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 - Hematologic: Lekopenia - Local: Local cellulitis, phlebitis, sloughing if extravasation occurs -Other: Pain in tumor site

Nursing Responsibilities - Ensure that the patient is not pregnant before administering; advise patients to use contraceptive measures - Consult with physician if antiemetic is needed for severe nausea and vomiting. - Check CBC before each dose.

Drug Name Etoposide (VP-16) Etopophos Toposar VePesid

Drug Classification Antineoplastic Mitotic Inhibitor

Action

Indication

Contraindication

Side Effects

G2-specific cell toxic: Lyses cells entering mitosis; inhibits cells from entering prophase; inhibits DNA synthesis, leading to cell death

- Palliative treatment for lymphocytic lymphoma, histiocytic lymphoma, generalized, hodgkin’s lymphoma (stage III and IV), mycosis funcoides, advanced testicular carcinoma, Kaposi’s sarcoma, letterer-Siwe disease. - Treatment of choriocarcinoma, breast cancer unresponsive to other therapies. - Hodgkin’s lymphoma (advanced) alone or in combination therapies - Advanced testicular germinal-cell cancers alone or in combination therapy.

- Contraindicated with allergy to etoposide, teniposide, Cremophor El; pregnancy, lactation. - Use cautiously with marrow suspension transplants.

- CNS: Somnolence, fatigue,peripheral neuropathy - CV: Hypotension (after rapid IV administration) - 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

Nursing Responsibilities - Ensure that the patient is not pregnant before administering; advise patients to use contraceptive measures - Consult with physician if antiemetic is needed for severe nausea and vomiting. - Check CBC before each dose.