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Cyclophosphamide - Cytoxan
- Class - Alkylating Agent
- Category - C
- Use - wide variety of cancers
- Action - forms bonds or links with DNA and changes the DNA shape preventing nucleic acid from completeting normal cell divition.
- Alerts - nader 6-10 days
- Side Effects - blood cells particularly sensitive to alkylating agents such as immunosupression, hemorrhagic cycstitis b/c sits in bladder and becomes concentrated and toxic to the bladder, bone marrow toxicity > thrombocytopenia, nausea/vomiting, anorexia, diarrhea, alopecia.
- Interactions - may give MESNA for OD to help excrete drug from bladder.
- Nursing/Patient teaching - nurse should increase fluids to flush kidneys. WBC > 3000, platelets > 100,000, ANC > 1000. Teach patient side effects.
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Methotrexate - Folex, Mexate
- Class - Antimetabolite
- Category - X
- Action - interrupts protein metabolism of cancer cells, but can also interfere with metabolism of cells that form baby cell-cycle specific.
- Alerts - avoid skin exposure, inhalation, dilute prior to IV admin.
- Side Effects - bone marrow toxicity, hemorrhage, bruising, nausea/vomiting, anorexia, GI ulceration in serious intestinal bleeding, PULMONARY TOXICITY INTERACTIONS.
- Interactions - for OD Leucovorin (folinic acid) to rescue normal cells.
- Nursing/Patient teaching - teach to avoid pregnancy 4-6 months after therapy is ended, avoid citric acid and foods high in purine (organ means, beans, peas), rinse mouth with NS every 2hrs.
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Doxorubicin - Adriamycin
- Class - Anti-tumor, antibiotic
- Category - D
- Use - broad-spectrum antibiotic for solid tumors of lung, breast, ovary, bladder, leukemias, lymphomas.
- Action - distorts DNA structure preventing synthesis
- Alerts - avoid inhalation and skin exposure
- Side Effects - CARDIOTOXICITY, dysrhythmias, irreversible heart failure, profound blood cell count lower.
- Interactions -
- Nursing/Patient teaching - vesicant - will cause serious tissue damage if extravates. Will do cardio assessments. If contact with skin, wash thoroughly with soap and water. Teach patient that they will be monitored for years for immediate or latent cardiotoxicity. Turns urine red/brown.
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Vincristine - Oncovin
- Class - Vinca alkaloid
- Category - D
- Use - Hodgkin's and non-Hodgkin's, leukemias, Kaposi's sarcoma, bladder and breast cancers.
- Action - cell-cycle specific prevents cancer cells from completing mitosis (M-phase)
- Alerts -
- Side Effects - ALLERGY (b/c plant), mental depression, nephrotoxicity
- Interactions -
- Nursing/Patient teaching - causes minimal immunosuppression.
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Tamoxifen - Nolvadex
- Class - Anti-estrogen
- Category - D
- Use - estrogen dependent cancers (breast)
- Action - non-cytoxic
- Alerts - can be given PO, don't crush or chew
- Contraindications - warfarin use, thrombus history
- Side Effects - no alopecia, like menopause for other SE b/c stops estrogen: hot flashes, fluid retention, vaginal discharge.
- Interactions -
- Nursing/Patient teaching - can cause initial tumor flare but is expected event.
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