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cyclophosphamide
class: alkylating drug
prototype
- Cytoxan
- Breast lung, ovarian cancer; Hodgkins disease; leukemias; lymphomas. An immunosuppressant agent.
- MOA: inhibition of protein synthesis through inferference with DNA replication by alkylation of DNA.
- Contra: hypersensitivety, sever bone marrow depression
- Caution: Pregnancy, liver or kidney disease
- SE: N&V diarrhea, weight loss, hematuia, alopecia, impotence, sterility, ovarian fibrosis, headache dizziness, dermatitis.
- AR: Hemorragic cystitis, secondary neoplasm, bonemarrow depression.
- Interactions: Decreases digoxin level. Increases drug action of barbituates, chloramphenicol half-life.
- Toxicity if given with corticosteroids, phenytoin, or sulfamides.
- Use cautiously with garlic, ginko, echinacea, ginseng, St. John's wort, Kava Kava, grape seed.
- Suppresses positive reaction to uric acid, purified protein derivative, mumps, May cause false positive Candida pap smear.
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5-fluorouracil
Antimetabolite
Prototype
- 5-FU
- Cancer of breast, cervix, colon, liver, ovary, pancreas, stomach, and rectum. Given in combination with levamisole after surgical resection in clients with Duke's stage C colon cancer.
- MOA: prevention of thymidine symthetase production, thereby inhibiting DNA and RNA synthesis. Not phase specific.
- Contra: Hypersensitivity, pregnancy, severe infection, myelo-suppression, marginal nutritional status. Reduce dose in clients with impaired hepatic or renal function or malnutrition.
- SE: Stomatitis, N&V&D, alopecia, rash, photosensitivity, Diarrhea may be sever.
- AR:bome marrow depression. Life threatening: thrombocytopenia, myelosuppression, hemorrhage, renal failure.
- Interactions: bone marrow depressants increase chances of toxicity. Avoid live virus vaccines. May decrease albumin, increase excretion of 5-HIAA in urine. Use cautiously with genseng, St. John's Wort, gingko biloba. Topical pepermint oil and eucalyptus oil may increase absorption of topical 5-FU
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vincristin
Class: Mitotic inhibitor/plant alkaloid
prototype
- OncovinAcute leukemia, hodgkin's desease, non-hodgkin's lymphoma, neuroblastoma, rhabdomyosacroma, Ewing's sarcoma, Wilms tumor, multiple myeloma, chronic leukemia, thyroid cancer, brain tumors.
- MOA: affects cells in the M phase of the cell cycle and inhibits mitosis.
- Contra: Fatal if given intrathecally. Don't give to patients receiving radiation therapy through ports into the liver. Hypersensitivity. Don't give to patients with charcot-Marie-Tooth syndrome.
- Caution: Pregnancy, liver or kidney disease, neromuscular disease, infection.
- SE: peripheral neuropathy, loss of deep tenon reflexes, phlebitis, constapation, cramps, nausea, vomiting, muscle weakness, reversible alopecia.
- AR: sensory loss, hypotension, visual disterbances, ptosis, ileus, SIADH, hyponatremia, hyperuricemia, severe local reaction with extravasation, fever. Intestinal necrosis, seizures, coma, acute bronchospasm, bone marrow depression.
- Interactions: Given 12-14 hrs prior to L-asparaginase to minimize toxixity. Increased risk of bronchospasams with mitomycin. decreases digoxin effects-monitor levels. mix only with normal saline or glucose in H2O - keep pH range at 3.5-5.5. May cause hyponatremia, hyperuricemia, anemia, leukopenia, thrombocytopenia.
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erythropoietin
Biologic response modifier
prototype
- ProcritTo treat anemia secondary to CRF or AZT treatment of HIV infections. Use in clients with anemia secondary to cancer chemotherapy.
- MOA: increased production of RBCs triggered by hypoxia or anemia.
- Contra: Unccontrolled hypertension, hypersensitivity to mamalian cell-derivedproducts or human albumin.
- Caution: pregnancy, lactation, porphyia;safety in children not known; increased mortality and/or tumor progression, serious cardiovascular and thromboembolic events if target hemoglobin of 12g/dl exceeded.
- SE: sense of well-being, hypertension, arthralgias, nausea, edema, fatigue, injection site reaction, rash, diarrhea, SOB
- AR: seizures, hyperkalemia, CVA, MI
- Interactions: increase hematocrit, decrease plasma volume
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filgrastim
Granulocyte colony-stimulating factor (G-CSF)
prototype
- NeupogenTo decrease incidence of infection in clients receiving myelosuppressive chemotherapeutic agents, including clients with AML undergoing induction or consolidation therapy, and clients undergoing bone marrow transplant; adjunct to chemotherapy for both solid tumor and hematologic malignancies; and for mobilization of progenitor stem cells used in autologous transplant; also for treatment of clients with severe, chronic neutropenia.
- MOA: increases production of neutrophils and enhances their phagocytosis.
- Contra: hypersensitivity to Escherichia coli-derived proteins. 24 hrs before or after cytotoxic chemotherapy.
- Caution: pregnancy, lactation, safety in children is not known.
- SE: N&V, skelatal pain, alopecia, diarrhea, fever, skin rash, anorexia, headache, cough, chest pain, sore throat, constipation
- AR:Neutropenia, dyspnea, splenomegaly, psoriasis, hematuria. Thrombocytopenia, MI, adult respiratory distress syndrome in clients with sepsis, splenic rupture.
- Interactions: increase in lactic acid, LDH, alkaline phoshatase transient increase in neutrophils.
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