Pharmacology Oncology
Contraindications of Doxorubicin
-Pregnancy/lactation risk-teratogenic -existing bone marrow suppression -Cardiac disorders -obstructive jaundice -previously completed tx with doxorubicin or daunorubien
Meraptoprine Contraindications/precautions
-Pregnancy/lactation risk-teratogenic -presence of infections
Which chemotherapy medication is KIND to bone marrow and does not cause Infection and bleeding risks?
vincristine
Contraindications of Vincristine
-Pregnancy/lactation-teratogenic -Intestinal illeus -Liver radiation -Charcot-Marie-tooth syndrome
Meraptoprine Client education
-Report GI symptoms to provider -Take prescribed antiemetic as needed -Report fever, sore throat, easy bruising, unusual fatigue to provider -use scrupulous hand washing techniques -wash fresh fruits and vegetables -institute frequent oral cares in prevent stomatitis -use a soft toothbrush and electric razor to prevent bleeding/ take measures to prevent bruising. -Report abdominal pain or discomfort, jaundice and decreased appetite -Use reliable method of birth control
Carmustine Client education
-Report fever, sore throat, easy bruising unusual fatigue to provider -Report cough, SOB, or fever to provider -Report immediately IV site pain, redness and swelling to staff
Client Education while on Cisplatin
-Report fever, sore throat, easy bruising, unusual fatigue -Report N/V to staff -Report hearing loss, vertigo, or tinnitus -Saline rinse before and after meals -Increase fluid intake for the next 3 days -teach how to manage fatigue
Topotecan Client Education
-Report nausea, constipation or vomiting and abdominal pain, anorexia or difficulty eating. -Report fever, sore throat, easy bruising, unusual fatigue -Use scrupulous hand washing techniques, restrict visitors who are ill -Wash fruits and vegetable well and cook foods properly -Institute frequent oral care to prevent stomatitis -use a soft toothbrush and electric razor to prevent bleeding-prevent bruising -inform client that alopecia may occur
Carmustine Complications
-Severe GI effects: Nausea, vomiting -Bone marrow suppression -Decreased lung function- pulmonary fibrosis -hypotension, tachycardia -myleosuppression, hepatotoxicity, renal failure
You are about to administer cisplatin to a client who has ovarian cancer. Before beginning the infusion, you should take which of the following actions? (Select all that apply.)
-infuse 1-2 L of IV fluid -administer an antiemetic -evaluate the client's hearing -determine the client's weight
Trastuzumab complications
-infusion reaction, neutropenia, heart failure, febrile neutropenia, cardiac toxicity. -myelosuppression -fever, headache, backache, flu-like symptoms, heart failure, dysrhythmias, N/V//D -URI, anemia, nasalphargitis, pharyngitis, rhinitis, asthenia, N/V, shivering, fatigue, infectious disease, neutropenia, thrombocytopenia
Paclitaxel MOA
Inhibits the normal dynamic reorganization of the microtubules network during interphase and mitosis.
Paclitaxel
Kaposi's sarcoma
A female client with carcinoma of the breast is admitted to the hospital for treatment with IV administered doxorubicin. The client tells the nurse that she has been told by her friends that she is going to lose her hair. What is the MOST appropriate nursing response?
"Hair loss may occur, and it will grow back, but it may have a different color or texture."
When preparing to administer tamoxifen to a patient with breast cancer, the nurse is most concerned by which patient report?
"I have been experiencing really heavy menstrual cycles recently"
Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The client asks the nurse if her family member with bladder cancer can also take this medication. The nurse MOST appropriately responds by making which statement?
"This medication can be taken to prevent and treat clients with breast cancer."
A client is about to start taking ritonavir to treat HIV-1 infection. Which of the following instructions should you include when talking with the client about taking this drug? (Select all that apply.)
- expect periodic blood glucose testing -watch for and report jaundice -increase weight-bearing activity -expect periodic cholesterol testing
Therapeutic use of Vincristine
-Acute Leukemia -Lymphoma -Breast and lung cancer -Soft tissue sarcomas -Wilms tumor & neuroblastoma in children
Paclitaxel Medication Administration
-Available for IV use in two forms. Taxol and Abraxanel -must be administered in glass containers with inline filters
Interferon Medication administration
-Available for SQ, IM and IV use -verify doses, usually prescribed in million units (mu)
Trastuzumab MOA
-Binds to HER2 receptor cells, reduce the growth of cancer cells and cause cancer cells to die. Targets Breast cancer cells, prevents cell growth, causes cell death.
Meraptoprine Interventions
-CBC with diff and platelet count -Liver function tests -Monitor for GI symptoms- decrease dose. Administer antiemetic -Monitor Weight and I&O's -Monitor CBC, thrombocyte counts, HGD, HCT before, during and after therapy -Monitor for infection during treatment -Monitor levels of bilirubin and liver transamhase for elevations.
Contraindications of cyclophosphamide
-Pregnancy/lactation risk-teratogenic -Live virus vaccinations -fluid volume deficits -severe infections, esp viruses such as chicken pox or herpes zoster.
Paclitaxel contraindications
-Pregnancy/lactation risk-teratogenic -Thrombocytopenia
Meraptoprine complications
-GI symptoms: N/V/D, intestinal ulceration -Bone marrow suppression -Liver toxicity -Hepatoxocity -Immune suppression -Skin rash
Trastuzumab Client education
-Immediately report rash, SOB, wheezing to staff and chest pain -report chills, flu-like symptoms that occurring during an infusion. -Report SOB, edema of extremities, palpitations to provider -report persistent H/A, insomnia, dizziness, numbness and tingling of extremities -report signs of cardiomeyopathy- dizziness, fatigue, loss of appetite, chest pain, abnormal rhythm, fast heart rate, or murmur. Bloating or fluid in abdomen. Cough, SOB, swelling in extremities and weight gain.
Paclitaxel Client Education
-Inform client that frequent monitoring will be done -Report palpitations or chest pain -Report parenthesis and decreased sensation or strength in hands and feet -report fever, sore throat, easy bruising and unusual fatigue -institute frequent oral care to prevent stomatitis -use a soft toothbrush and electric razor to prevent bleeding -take measures to prevent bruising -immediately report swelling of mouth, throat, neck, rash, itching and difficulty breathing
Carmustine Contraindications
-Pregnancy/lactation risk-teratogenic -History of impaired lung function -Recent infection or exposure to herpes or chickenpox. -Severe bone marrow suppression or preexisting infection -Pt with impaired pulmonary function
Paclitaxel nursing interventions
-monitor VS frequently -monitor clients with preexisting cardiac disease -check deep tendon reflexes -monitor for decreased strength or movement of hands and feet -monitor CBC with diff and thrombocyte count before treatment and weekly intervals. -monitor temperature frequently during treatment -monitor for bleeding from common sites -Avoid bruising if thrombocytopenia occurs -Use measures to apply prolonged pressure to puncture sites
Anastrozole nursing interventions
-monitor for muscle pain and weakness -if provider approves, advise client to take acetaminophen for discomfort. -monitor for and report GI symptoms -prescribe antiemetic if nausea is a persistent problem -monitor clients weight and ensure that fluid intake is sufficient. -monitor bon density through periodic screenings -women at high risk for fractures may be prescribed a biophosphonate drug, such as aledronate (fosamax) -administer fluids, antiemetics, and analgesics as prescribed -monitor fluid status, bleeding and CBC
Carmustine Nursing Interventions
-monitor lung functions, LFT's, Kidney functions —premeditate or time administration of antiemetic when dosing with alkylating agents -monitor CBC with differential and thrombocyte count before each treatment and weekly intervals. -monitor temperature during treatment -monitor for bleeding from common sites -monitor s/s of lung infection-listen to breath sounds (PFT) -administer corticosteroids if pulmonary functions -avoid starting IV in veins near joints of hand and AC space -monitor for thrombophlebitis or infiltrate
Trastuzumab Medication Administration
-only available to IV use over 4 hours —infuse weekly at a dosage based on clients weight —do not mix dose with dextrose solutions -first dose 50 cc/hr -alone or in conjunction with Paclitaxel -give by central lines
Trastuzumab Contraindications
-pregnancy risk-teratogenic -concurrent radiation or administration with anthracycline anti cancer antibiotics, such as doxorubicin
You should give the client which of the following instructions about chemotherapy with doxorubicin? (Select all that apply.)
-report vaginal itching -expect red-tinged tears -use contraception -expect regrowth after hair loss
Trastuzumab Nursing Interventions
-stay with patient the first 15-20 minutes on first administration -stop infusion if symptoms develop -prepare to treat with epinephrine or other drugs -monitor for flu like symptoms and monitor temperature -monitor cardiac status at baseline and frequently during course of treatment -monitor and report CNS symptoms to provider -monitor for GI symptoms -treat N/V during infusion with antiemetics -have resuscitation equipment near by.
Meraptoprine interactions
-use with allopurinol for gout, which may cause toxicity -May increase or decrease effects of warfarin
What is the MOA of vincristine?
-vinca alkaloid -binds to tubulin and inhibits microtubule formation -disrupts mitosis
A client who has been diagnosed with breast cancer is to receive chemotherapy with both cisplatin and vincristine. The client asks the nurse why both medications must be given together. The nurse should explain to the client that the combination of 2 chemotherapeutic medications is used for which reason?
Increase the destruction of tumor cells.
The nurse is caring for a client with ovarian cancer taking doxorubicin, which assessment finding should the nurse report to the health care provider? Select all that apply. 1) Partial thromboplastin time 55. 2) Platelet count of 48,000 3) Red blood cell count 5 x 10^6 4) Temperature of 100.7 (38.2ºC) 5) White blood cells 3,600.
2) Platelet count of 48,000 4) Temperature of 100.7 (38.2ºC) 5) White blood cells 3,600.
A client is about to start therapy with topotecan to treat metastatic ovarian cancer. To minimize neutropenia, an adverse effect of topotecan, you should administer filgrastim at which of the following times?
24 hr after the topotecan infusion
The nurse provides care for a client who is prescribed doxorubicin for the treatment of cancer. The client is experiencing nausea and vomiting. Which is the priority assessment by the nurse?
Hydration
The nurse provides care for a client who is prescribed interferon for the treatment of cancer. Which assessment data requires immediate healthcare provider notification?
Hypertension
How is vincristine administered?
IV (vesicant)
The nurse is assigned to care for a client with metastatic breast cancer who is taking tamoxifen citrate. The nurse plans to monitor for which changes in laboratory values for this client? 1. Increase in lipase level 2. Increase in blood glucose level 3. Increase in serum calcium level 4. Increase in serum potassium level 5. Decrease in low-density lipoprotein levels
3. Increase in serum calcium level 5. Decrease in low-density lipoprotein levels
The nurse provides care for a post-menopausal client who is diagnosed with ductal carcinoma in situ (DCIS), a non-invasive breast cancer. The client is presently taking anastrozole. Which client statement does the nurse report to the health care provider (HCP) based on the current data? Select all that apply. 1) "I have not had a menstrual flow for 6 months" 2) "I sometimes have trouble sleeping at night." 3) "I have gained two pounds since I started taking this medication three months ago." 4) "I have noticed an increase in vaginal discharge and some spotting" 5) "I am having severe nausea with food and oral liquids."
4) "I have noticed an increase in vaginal discharge and some spotting" 5) "I am having severe nausea with food and oral liquids."
Carmustine Medication Administration
IV and topical -wafer implanted into brain tissue following brain cancer tumor removal. -Pre-med with steroids/ antiemetics
Topotecan Medication Administration
IV use only Metabolized in liver-excreted by kidney
The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide. The nurse should tell the client to take which action?
Increase fluid intake to 2000 to 3000 mL daily.
What category class is cyclophosphamide?
Alkylating agent
Carmustine MOA
Alkylating anti cancer drugs form an abnormal cross-linked band with the DNA bases, and this defective bond damages the cell and kills it. They can kill growing cells at any time during their cycle.
Carmustine (BiCNU, Gliadel)
An alkylating agent (nitrosourea) Treats brain tumors, lymphomas, treat multiple myeloma, emlanoma, hepatoma, and GI adenocarcinoma
Drug class of Doxorubicin
Anthracycline
Interferon Hesi key points
Apply warm compress before giving injections to reduce risk of pain at site. -Administer med late in the day so flu like symptoms occur during sleep
Paclitaxel Therapeutic use
Approved for use after failure of first-line or subsequent therapy in metastatic ovarian cancer and metastatic breast cancer.
Cytarabine medication administration
Available for SQ, IV and intrathecal use
Tamoxifen Medication administration
Available for oral administration Administer one to two times daily
Medication administration of cyclophosphamide
Available for oral or IV administration Give oral dose without food for best absorption, or with food if severe nausea and vomiting occur.
Topotecan MOA
Bind DNA along with Topoisomerase I. Topoisomerase I relaxes coiled up DNA and then allows DNA to recoil normally, which must occur before replication takes place
Paclitaxel Complications
Black box warning: risk for anaphylaxis, dyspnea, hypotension, tachycardia, wheezing and chest pain. -Bradycardia -peripheral neuropathy -bone marrow suppression -loss of DTR, arthroelgia, diffuse myalgia -myelosuppression-severe neutropenia.
Therapeutic use of Doxorubicin
Broad-spectrum cytotoxic antibiotic, prescribed for solid tumors of the lung, breast, ovary, and bladder, and for various leukemias and lymphomas.
You are assessing a client who is receiving imatinib to treat chronic myeloid leukemia. Which of the following findings might indicate an adverse reaction to this drug?
Crackles at lung bases
What is the MOA of cyclophosphamide?
Cross links DNA Stops protein sysnthesis Guanine N7 position Requires bioactivation by liver
Cisplatin MOA
Cross-links DNA
When talking with the client about chemotherapy with doxorubicin, you explain the need for periodic diagnostic tests. The result of which of the following diagnostic tests or procedures requires monitoring?
ECG
The nurse is monitoring a client with leukemia who is receiving doxorubicin by IV infusion. The nurse should monitor for which finding that would indicated doxorubicin toxicity?
Electrocardiogram (ECG) changes
Tamoxifen Kaplan key point
Endometrial cancer- report heavy periods or excessive bleeding.
Tamoxifen
Estrogen receptor positive breast cancer
Delavirdine
HIV-1 infection
Your administering cyclophosphamide and mesna to a client. Mesna, a chemoprotective agent, helps prevent which adverse reaction to cyclophosphamide?
Hemorrhagic cystitis
Complications of cyclophosphamide
Hemorrhagic cystitis Bone marrow suppression Kidney toxicity electrolyte imbalance- hyperkalemia, hyponatremia (most common)
Interferon contraindications
Known allergy Pregnancy and lactation inflammation of the colon or pancreas suicidal ideation Use with caution in cardiac disease, myelosuppression, and with central nervous system dysfunction
Meraptoprine MOA
Metabolite of azathioprine- immunosuppressants agent -Inhibit purine synthesis
Cyclophosphamide
Multiple myeloma
Anastrozole drug class
Non-steroidal Aromatase inhibitor
Medication Administration of Cisplatin
Only available for IV use -based on client's weight -give antiemetics before administration
Meraptoprine Medication Administration
PO -Give dose once daily with or without food -based dose on client's weight, adjust for renal
Paclitaxel Drug class
Plant alkaloid
Flutamide
Prostate cancer
mercaptoprine category/class
Purine Antagonist, Antimetabolite, S- phase specific
During IV administration of doxorubicin, the infusion site becomes swollen, red, and painful. Which of the following actions should you take?
Stop the IV infusion
Meraptoprine therapeutic use
Treats acute lymphocytic and acute myelogenous leukemia in adults and children -may cause temporary remission in chronic Granulocytes leukemia.
Carmustine therapeutic use:
Use alone or with other agents to treat the following types of cancer: Primary and metastatic brain tumors, lymphomas, multiple myeloma, melanoma, hepatoma, gastrointestinal adenocarcinoma.
You are caring for a client who is pregnant and is HIV-positive. Which of the following drugs helps prevent the transfer of HIV to the fetus?
Zidovudine (Retrovir)
You should instruct a client who is taking tamoxifen to treat breast cancer to watch for and report which of the following serious adverse effects of this drug?
abnormal menstrual bleeding
Cytarabine
acute myelocytic leukemia
Enfuvirtide
advanced or resistant HIV disease
drug class of cisplatin
alkylating agent
A client is about to start taking mercaptopurine to treat acute lymphocytic leukemia. You should instruct the client to watch for and report which of the following indications of an adverse effect of this drug?
bruising
A client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication?
calcium level
While administering trastuzumab IV to a client who has breast cancer, you should ensure that you have which of the following drug available to treat an adverse reaction to this drug?
epinephrine
You should monitor this client for which of the following indications of an adverse reaction to cyclophosphamide?
fever
Carmustine
gastrointestinal adenocarcinoma
Anemia
low RBC count -Normal value- 4.5-6 million
Leukopenia
low WBC count -Normal: 5,000-10,000 <4,000= leukopenia
Thrombocytopenia
low platelet count -normal platelet count 150-400,000 -<100,000= thrombocytopenia
Trastuzumab therapeutic use
metastatic breast cancer with specific type with human epidermal growth factor receptor 2 (HER2)
Trastuzumab (Herceptin) class
monoclonal antibody
A client with ovarian cancer is being treated with vincristine. The nurse monitors the client, knowing that which manifestation indicates an adverse effect specific to this medication?
peripheral neuropathy
Cytarabine MOA
pyrimidine analog, inhibits DNA polymerase
Anastrozole Client Education
-If provider approves, take acetaminophen for muscle pain -Report GI symptoms to provider -Increase intake of calcium and vitamin D -Take precautions to prevent falls in bone density is low -Increase weight-bearing exercise if possible -Do not smoke
A primary health care provider prescribes cisplatin and vincristine to a client with bladder cancer. The nurse should explain to the client that 2 medications are administered together for which reason?
To increase the therapeutic response.
Topotecan drug class
Topoisomerase I inhibitor Antineoplastic
Tamoxifen HESI key point
Treats breast cancer
Topotecan Therapeutic Use
Treats cancers that other anti cancer drugs have failed to treat: -Metastatic ovarian cancer -Small cell lung cancer -acute lymphoblastic leukemia (all)
Topotecan Nursing Interventions
-Medicate client with antiemetic, as needed, on treatment days -monitor for GI symptoms -monitor CBC before each treatment and then periodically as prescribed -monitor temperature frequently: watch for s/s of infection -Monitor for bleeding from common sites (gums and GI tract) -Avoid bruising if thrombocytopenia is present -Administer platelet and RBC transfusions -monitor for alopecia
Therapeutic use of Cisplatin
-Metastatic testicular cancer -ovarian cancer
Topotecan complications
-Moderate GI symptoms: N/V, constipation or diarrhea, abdominal pain -Bone marrow suppression -H/A, fever, alopecia -thrombocytopenia, neutropenia, myelosuppression -flu like symptoms
Anastorzole MOA
Stops growth of breast cancer cells by blocking estrogen production
Nursing Interventions of Cisplatin
-Monitor Intake and Output -Pre-medicate with antiemetic 30 min before infusion -Monitor CBC before each treatment and weekly after. -Monitor temperature frequently during treatment -Monitor for bleeding from common sites -Avoid bruising -Aggressive hydration before and after infusion
Interactions of cyclophosphamide
-Doxorubicin (Adriamycin) may increase risk for cardiac toxicity -with succinylcholine, neuromuscular blocking can be prolonged
Tamoxifen complication
-Endometrial cancer! -increased Clot risk- venous thromboembolism (VTE) Hot flashes- expected -N/V
Cytarabine complications
-GI effect- N/V, stomatitis -Bone marrow suppression (all types of cells) occurs at predictable times following treatment with cytarabine. -Intrathecal form: arachnoiditis, causing nausea, vomiting, H/A and fever.
Interferon Therapeutic Use
-Hairy cell leukemia -Chronic myelogenous leukemia -Malignant myeloma -Kaposi's sarcoma
Precautions of cyclophospamide
-History of radiation or other chemotherapy -liver or kidney impairment -recent corticosteroid use -bone marrow malignancy -history of hyperuricemia and gout -present leukopenia or thrombocytopenia
Interferon Client instructions
-If approved by provider, premeditated with acetaminophen if flu-like symptoms occur -Report CNS symptoms to provider -Avoid hazardous activities, such as driving until effects known -instruct client to notify provider for easy bruising, bleeding, fatigue -report abdominal pain, weight loss, loss of appetite, and persistent diarrhea
Anastrozole Medication Administration
-Available for oral administration only. -Give once daily on an empty stomach, 1 hour before or 2 hours after meals for best absorption. -Take at the same time each day.
Medication administration of Doxorubicin
-Available in IV form (Adriamycin) and in lyophilized liposome form (Doxil) for IV infusion -Prescribed dose by body size and type of cancer -war gloves and take care when preparing solution -slow IV rate for red streak along vein or flushing
Interactions with Doxorubicin
-Barbiturates may decrease effect -Drugs that prolong QT interval on ECG may increase risk of cardiac effects -Streptozocin (zanosar, a nitrogen mustard anticancer agent, prolonged half-life of doxorubicin
Nursing interventions for cyclophosphamide
-Big risk for infection and bleeding -Administer with Mesna -Premedicate or time administration of antiemetic when dosing with alkylating agents. -Monitor CDC before, during and after treatment -Protect client from people with infections -Monitor temperature and for signs of infection -Encourage frequent fluid intake (Monitor I&O) -Monitor electrolytes -Monitor cardiac rhythm
What nursing intervention would you address with a patient on vincristine?
-Check deep tendon reflexes periodically (esp Achilles reflex) -Monitor IV site for infiltration -Monitor for decreased strength or movement in hands and feet. -Monitor for constipation (give stool softeners)
Client education with Doxorubicin
-Critical time for WBC counts is 10-14 days after each IV treatment -report fever, sore throat, easy bruising, unusual fatigue -report black, hairy tongue, pain in mouth, diarrhea, and vaginal itching or discharge in females -comply with tests for cardiac functions -report rapid heartbeat, palpitations, SOB, chest pain. -report persistent anorexia, vomiting, abdominal pain, itching skin, dark urine, jaundice. -Urine will be red for up to 2 days after treatment
Cytarabine Nursing Interventions
-Monitor client's weight and report GI effects -Premedicate with an antiemetic prior to administration -Monitor CBC, Hgb, HCT during and after treatment -Monitor for bleeding (Gums, GI tract) -Use measures to avoid bruising -Administer dexamethasone with intrathecal form. (antiemetic) -Do not give immunizations with live viruses during therapy for 3 months after taking this drug.
tamoxifen nursing interventions
-Monitor for GI effects -Monitor for hot flashes -Monitor for visual disturbances -Assist with endometrial biopsies as needed -Monitor for leg pain, sudden chest pain or shortness of breath, or signs of stroke.
Complications of Doxorubicin
-Nausea and vomiting (common) -Severe bone marrow supression -Thromocytopenia and anemia -Alopecia (complete hair loss) -Hyperglycemia -Cardiac and hepatotoxicity
Nursing interventions of Doxorubicin
-No fresh flowers or fresh fruits -avoid crowds and sick people -Monitor for fever-Neutropenic precautions -Monitor CBC with diff and other blood counts before tx and weekly intervals. -Fever >100.3/38ºC- High priority -Monitor for bleeding if thrombocytopenia occurs -Monitor for presence of red urine, alopecia -Monitor for dysrhythmias and assess VS -Monitor baseline LFT -Avoid starting IV near joints -Monitor for thrombophlebitis or infiltration
Contraindications of cisplatin
-Pre-existing cardiac/pulmonary problems (lack of hydration and risk of kidney toxicity) -Dose reductions of the drug are necessary for patients with renal insufficiency -Pregnancy risk-teratogenic -Severe bone marrow suppression -History of gout or renal stones -Patients taking loop diuretics -Raynaud's syndrome
Topotecan Contraindications
-Pregnancy/lactation risk- teratogenic -severe bone marrow depression -severe thrombocytopenia Neutrophil count <1500 cells/mm3 or current infection
Client education of Vincristine
-Report paresthesias and decreased sensation or strength of hands or feet. -Immediately report pain, swelling or pallor/redness of IV site. -Inform client that alopecia can occur -Report constipation, hard stools, or decrease in bowel movements to provider.
Complications of Cisplatin
-Severe Nausea and vomiting -Bone marrow suppression -Renal toxicity -Ototoxicity
Anastorzole Therapeutic Use
-Similar to tamoxifen -Treats early or advanced ER (estrogen receptor) positive breast cancer in postmenopausal women only.
Cytarabine client education
-Take antiemetic as prescribed -eat small, frequent meals -Notify provider of severe/prolonged N/V -Report fever, sore throat, easy bruising and unusual fatigue -Frequent oral care, prevent stomatitis -Use a soft tooth brush and electric razor to prevent bleeding -Report N/V and headache
Client education for cyclophosphamide
-Tell client early about alopecia so they can obtain a with, hat or scarf if desired. -Inform client that hair will grow back following treatment -Report n/v to provider -Report fever, sore throat, easy bruising, unusual fatigue -Frequent handwashing, restrict visitors that are ill -Wash fresh fruits and vegetables well and cook foods properly. -Frequent oral care to prevent stomatitis -Increase fluid intake before tx and void before dose. -Report weakness, palpitations, muscle twitching -use reliable birth control, notify HCP if pregnancy possible
Tamoxifen interactions
-Warfarin -Bromocriptine -SSRIs
Therapeutic Use of Cytarabine
-acute myelogcytic and acute lymphocytic leukemias -non-hodgkin's lymphoma
Anastrozole interactions
-anthracylines-monitor for cardiomyopathy increase risk of cardiac effects
Interferon complication
-flu like symptoms- interFLUon- fever, fatigue, muscle aches, chills, weakness -CNS symptoms- dizziness, insomnia, depression, tremor, headache. -Bone marrow suppression (all cell types) usually mild & self limiting -GI symptoms- abdominal pain, anorexia, weight loss, diarrhea
Tamoxifen patient education
-have yearly gynecological exams -seek medical attention for any chest pain, shortness of breath, or swelling of the leg or calf -report persistent N/V to provider -report blurred vision or decreased visual acuity. -Have regular ophthalmic exams -report abdominal menstrual bleeding to provider.
What is the antidote for vincristine?
-hyaluronidase (local SQ) -apply heat to site
Interferon Nursing interventions
-medicate with acetaminophen if prescribed -monitor for flu-like symptoms -monitor for and report CNS symptoms -monitor CBC before treatment begins and periodically -monitor and report persistent GI symptoms -assure client is well-hydrated for treatment (especially with GI symptoms.
Anastrozole Complications
-muscle pain, weakness (Asthenia) Joint pain, H/A -GI symptoms: nausea, vomiting, diarrhea, or constipation, anorexia -Osteoporosis and risk for fractures. -Vaginal bleeding, hot flashes
Interferon interactions
-other anticancer drugs & zidovudine (Retrovir) may increased bone marrow suppression -may increase theophylline blood levels -may increase toxicity of doxorubicin -when given with vinblastine, may increase neurotoxicity.
Tamoxifen Contraindications/Precautions
-pregnancy/lactation risk- teratogenic -anticoagulant therapy -History of thrombocytopenia -preexisting endometrial hyperplasia -History of DVT or PE
Anastrozole contraindications/precautions
-pregnancy/lactation risk- teratogenic —premenopausal women, children -Postmenopausal estrogen therapy -Severe liver disease -use cautiously with mild to moderate liver disease
A female client with a diagnosis of breast cancer is taking cyclophosphamide. The client calls the health care clinic and tells the nurse that the medication is upsetting her stomach. Which instruction should the nurse provide to the client?
Take the medication with food.
The nurse provides education to a client who is an elementary school teacher and diagnosed with breast cancer. The client is scheduled to begin an extensive chemotherapy regime of doxorubicin within the next month. Which health promotion instruction should the nurse provide to this client? Select all that apply. 1) "It is important to keep all scheduled appointments with your doctor" 2) "You should consult with your doctor prior to obtaining any vaccines" 3) "Your medication increases your risk of infection so it is important to wash your hands frequently" 4) "A vegan or vegetarian diet is best to decrease your risk for complications associated with your prescribed medication" 5) "Due to your risk for infection is best that you take a leave of absence from your job while receiving chemotherapy treatments"
1) "It is important to keep all scheduled appointments with your doctor" 2) "You should consult with your doctor prior to obtaining any vaccines" 3) "Your medication increases your risk of infection so it is important to wash your hands frequently"
A client with testicular cancer is receiving cisplatin. The nurse assesses for which finding as a toxic effect of this medication?
Tinnitus
Chemotherapy side effects
Increased risk of bleeding and infection. -immunosuppression Use electric razors, do not strain with pooping (stool softeners), No falls. -Avoid big crowd and ill visitors -No fresh flowers or fresh fruits -good hand washing and oral cares -Monitor for signs and symptoms of infection
Interferon MOA
Inhibits viral replication (translation or transcription) -stimulate the body's immune system -interferes with cancer cells and viral infections- Increasing immune response.
Interferon alfa-2a category/class
Interferon Immunotherapy
What is a common complication of Vincristine?
Peripheral neuropathy
Tamoxifen (therapeutic use)
Preferred drug for treating metastatic breast cancer. Effective against breast tumor cells that require estrogen for their growth, which are known as estrogen receptor (ER) positive cells. It is the only antineoplastic that is approved for prophylaxis of breast cancer, for high-risk patients who are at risk of developing the disease. In addition, it is approved as adjunctive therapy in women following mastectomy to decrease the potential for cancer in the opposite breast.
Tamoxifen MOA
SERM - Selective Estrogen Receptor Modulators - block estrogen in breast tissue but can act as estrogen agonists elsewhere. Used when tumor is estrogen-receptor positive.
Tamoxifen category class
Selective estrogen receptor modulator (SERM)
What is the therapeutic use of cyclophosphamide?
Used alone, or in combination with other drugs, against a wide variety of cancers, including Hodgkin's disease, lymphoma, multiple myeloma, breast cancer, and ovarian cancer. Immunosuppression for the prophylaxis of organ transplant rejection and to treat severe rheumatoid arthritis and systemic lupus erythematosus ( SLE).
The nurse caring for a client receiving vincristine is monitoring the client for toxicity. The nurse interprets that the client is experiencing a toxic effect of this medication on the basis of which assessment finding?
Weakness and sensory loss in the legs
