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[q] Erythropoietin

[a] Epoetin alfa, Darbepoetin alfa – incrrease production of red blood cells.

[q] Erythropoietin Complications

[a] Hypertension due to to elevations in hematocrit, Risk for a thrombotic event (MI/Stroke/PE/DVT)

[q] Erythropoietin Nurse Notes

[a] Monitor Hgb levels and blood pressure, Donot give for high Hb, Do not agitate the vial of medication (single dose), Ensure a normal iron level

[q] Leukopoietic growth factors

[a] Filgrastim, Pegfilgrastim – stimulate the bone marrow to increase production of neutrophils.

[q] Leukopoietic growth factors adverse effect

[a] Bone pain, Leukocytosis (Monitor CBC), Splenomegaly and rupture (Evaluate reports of left upper quadrant abdominal pain or shoulder tip pain)

[q] Oprelvekin

[a] Increases the production of platelets. Decreases thrombocytopenia and the need for platelet transfusions.

[q] Oprelvekin Adverse Effects

[a] Fluid retention (peripheral edema, dyspnea on exertion), Cardiac dysrhythmias, eye problems

[q] Oprelvekin expected outcome

[a] platelet count greater than 50,000/mm3.

[q] Methotrexate

[a] Kill cancer cells

[q] Methotrexate side effect

[a] Bone marrow suppression, GI discomfort, Mucositis, Reproductive toxicity, Renal damage (hyperuricemia)

[q] Methotrexate side effect Management

[a] Monitor WBC, absolute neutrophil count, platelet count, Hgb, and Hct, bleeding, frequent oral hygiene using soft toothbrushes and avoid alcohol mouthwashes, Monitor kidney function, BUN, creatinine, and I&O, adequate fluid intake, Administer allopurinol if uric acid level is elevated.

[q] Cytarabine

[a] Inhibit cancer cell growth

[q] Cytarabine Side Effect

[a] Bone marrow suppression,Liver disease (Monitor liver enzymes. Monitor for indications of jaundice), May reduce digoxin level (Monitor digoxin level and ECG), Neurotoxicity (nystagmus), Pulmonary edema, Arachnoiditis (nausea, headache,fever – spinal cord membraine inflamation)

[q] Mercaptopurine- Chemo

[a] Bone marrow suppression,Liver disease (Monitor liver enzymes. Monitor for indications of jaundice), Mucositis, Reproductive toxicity,

[q] Methotrexate special note

[a] Administer with leucovorin rescue to reduce toxicity to healthy cells. Take the medication on an empty stomach. Protect the skin from sunlight. Female clients to use birth control during and for 6 months after completing treatment. Salicylates, other NSAIDs, sulfonamides,penicillin, and tetracyclines may cause methotrexate toxicity. Avoid folic acid supplements or vitamins containing folic acid (decreases absorption)

[q] Doxorubicin (Chemo med) Side Effect

[a] Bone marrow suppression, GI manifestations, extravasations, Alopecia, Acute cardiac toxicity, Cardiomyopathy, heart failure (Monitor ECG and echocardiogram) Red coloration to urine and sweat (not harmful)

[q] Vincristine

[a] Used in combination with other chemo drugs

[q] Vincristine Adverse Effects

[a] Peripheral neuropathy (weakness, paresthesia), extravasations of vesicants (Use a central line for infusion), Alopecia, Vincristine may reduce effects of digoxin and phenytoin.

[q] Paclitaxel

[a] Chemo drug – stop cell division

[q] Paclitaxel Side Effect

[a] Bone marrow suppression, Cardiac (Bradycardia, heart block, MI), Alopecia

[q] Cyclophosphamide

[a] Chemo drug – Kills rapid growing cells

[q] Cyclophosphamide Adverse effects

[a] Bone marrow suppression, GI discomfort, Acute hemorrhagic cystitis, Alopecia

[q] Acute hemorrhagic cystitis Nurse Notes

[a] Increase fluids (3 L daily), Monitor for blood in urine, Mesna -uroprotectant agent-may be given

[q] Carmustine

[a] Chemo drug

[q] Carmustine Adverse Effect

[a] Pulmonary fibrosis (monitor lung function) , Bone marrow suppression, GI discomfort, Liver and kidney toxicity

[q] Cisplatin

[a] Chemo drug

[q] Cisplatin Adverse Effects

[a] Bone marrow suppression, GI discomfort, Renal toxicity, Hearing loss (Monitor for tinnitus)

[q] Asparaginase

[a] Kills cancer – leukemia

[q] Asparaginase Adverse Effects

[a] Hypersensitivity reaction (Test dose, Premedicate, Monitor for wheezing and/or rash), CNS effects, Liver and pancreas toxicity, Renal Toxicity, GI discomfort, Decreased effect of antidiabetic medication

[q] Hydroxyurea

[a] Chemo drug – Bone marrow depression

[q] Tamoxifen

[a] Breast cancer treatment

[q] Tamoxifen Adverse Effect

[a] Endometrial cancer (Monitor for abnormal bleeding, gynecological exam and PAP smear), Hypercalcemia, Nausea and vomiting, Pulmonary embolus, Hot flushes, Vaginal discharge or bleeding

[q] Anastrozole

[a] Stops growth of breast cancer

[q] Anastrozole Side Effect

[a] Muscle and joint pain, headache,Nausea,Vaginal bleeding,Increased risk for osteoporosis (Advise clients to take calcium and vitamin D supplements and perform weight-bearing exercises), Hot flushes

[q] Trastuzumab

[a] Targets breast cancer cells

[q] Trastuzumab Adverse Effects

[a] Cardiac toxicity, tachycardia,heart failure (Obtain baseline ECG and monitor for heart failure), Hypersensitivity reaction (Have resuscitation equipment), Nausea and vomiting

[q] Interferon alfa-2b

[a] Increases immune response and decreases production of cancer cells.

[q] Interferon Adverse Effect

[a] Flulike symptoms, Bone marrow suppression, alopecia, cardiotoxicity, and neurotoxicity (with prolonged therapy), Depression, anxiety, insomnia,altered mental states

[q] Interferon Nurse Note

[a] Store the medication in the refrigerator and do not freeze. Administer at room temperature. Do not shake vial. Monitor for flu symptoms, give acetaminophen. Advise clients to practice good oral hygiene. Monitor CBC, platelets, and electrolytes, fluid status

[q] Cetuximab, Rituximab, Bevacizumab, Imatinib

[a] Antibody that stops cancer cell growth and increases cell death

[q] Cetuximab Side Effect

[a] Infusion reaction, rash,hypotension, wheezing (premedicate), PE, Skin toxicity, rash (use sun screen)

[q] Imatinib Side Effect

[a] GI discomfort (antiemetic, with food), Flulike symptoms,Edema,Hypokalemia,Neutropenia, anemia

[q] Rituximab Side Effect

[a] Infusion reaction, rash, hypotension, wheezing, Flulike symptoms, Tumor lysis syndrome

[q] Bevacizumab Side Effect

[a] Thromboembolism, Alopecia, Hemorrhage (GI, vaginal, nasal, intracranial, or pulmonary), Gastric perforation, Hypertension. Contraindicated in clients who have a low WBC, nephrotic syndrome, recent surgery or dental work, or hypertensive crisis.

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