im
What are the 6 rules of IV extravasation?
Check for blood return prior to administering chemo
• Assess patient for pain, burning
• Stop drug immediately if signs of infiltration are noted
• aspiration of drug (5mL blood) prior to removal
• Elevate extremity
• Warm compress / Cold compress
This antitumor antibiotic causes pulmonary toxicity
Bleomycin
This glucocorticoid suppresses the t-cell activation (so basically no inflammatory response happens) and is given to patients who need an organ transplant.
Prednisone
This drug is the pro type of colony-stimulating factors (CSF). It stimulates production, maturation, and activation of neutrophils within bone marrow.
Use – 1) preventing infections in neutropenic patients r/t cancer
Use - 2) mobilizing stem cells from BM to peripheral blood. Most pts have fewer days with fever, infection and antimicrobial drug therapy with drug. Cautious use in people with renal and hepatic impairment. Older pts may develop infections.
Filgrastim
1. A patient receiving high-dose cyclophosphamide reports new dysuria and pink-tinged urine. Which nursing action is PRIORITY?
A. Administer leucovorin
B. Increase rate of IV hydration
C. Administer mesna as prescribed
D. Restrict oral fluid intake
Correct Answer: C
Rationale: Mesna binds toxic acrolein metabolites to prevent hemorrhagic cystitis, the major risk of high-dose cyclophosphamide. Hydration is important, but mesna is the immediate protective agent.
This alkylating agent disrupts DNA replication regardless of where the cell is in its cycle. It is taken concurrently with mesna to help mitigate hemorrhagic cystitis. It is considered broad spectrum.
Cyclophosphamide
This mitotic inhibitor interferes with DNA replication in the MITOSIS phase only. It is considered a vinca alkaloid (yes, like the flower) and has a common s/e of peripheral neuropathy. We will NEVER administer this intrathecally.
Vincristine
Monoclonal antibody (“-mabs”) that is directed against CD20 on surface of B-cell. Treats rheumatoid arthritis, non-Hodgkin lymphoma (cancer of B-lymphocytes), auto immune disorders, and cancers of WBC.
We check baseline immunoglobulins prior to start and administer Tylenol for infusion reactions. There is risk for allergic reactions.
Rituximab
This category of drug can be given SQ. It can cause drowsiness, fatigue, flulike symptoms, and bone pain, In children splenomegaly.
Must be monitor labs every 2 weeks and if someone is on this drug long term, it’ll start in the hospital and then they will start taking it at home.
Colony stimulating factors (CSF)
2. A client beginning cisplatin therapy asks why they are receiving mannitol with IV fluids. The nurse's response is based on preventing which toxicity?
A. Cardiotoxicity
B. Nephrotoxicity
C. Pulmonary fibrosis
D. Bone marrow suppression
Correct Answer: B
Rationale: Cisplatin causes dose-limiting nephrotoxicity; aggressive hydration + diuretics help protect the kidneys.
This platinum compound interrupts DNA regardless of where it is in the cycle. It’s used for testicular, ovarian, and bladder cancer. It can cause nephrotoxicity, so adequate hydration and diuretic is needed. Can cause peripheral neuropathy.
Cisplatin
Which hormonal therapy drug blocks estrogen receptors on cells?
Tamoxifen
Monoclonal antibody that is directed against TNF (an alpha blocking agent that alerts t lymphocytes to go kill cells). Reduces the activity of abnormal Bcells. Used to treat RA, crohn’s disease, ulcerative colitis, psoriatic arthritis.
we monitor for leukopenia and anaphylaxis
Remicade
This drug is a CSF that is used for aplastic anemia, chronic hepatitis C. It is an oral drug & its platelet count increases every 1-2 weeks.
Eltrombopag
3. A patient receiving methotrexate develops a rising creatinine and alkaline urine pH 8.3. Which action should the nurse anticipate?
A. Slow the infusion rate
B. Administer leucovorin
C. Prepare sodium bicarbonate
D. Notify provider for neutropenia risk
Correct Answer: B
Rationale: Leucovorin rescue is required when high-dose methotrexate causes renal injury and impaired drug clearance.
This antimetabolites interferes with the body’s ability to use its own nutrients, so it disrupts DNA synthesis by starving the cells to death. This is one of your more common cancer drugs and can cause stomatitis. High doses of it can also injure kidneys.
We administer leucovorin after this med so we can rescue the healthy cells from starving to death!
Methotrexate
Which hormonal therapy drug blocks androgen (precursor to testosterone) receptors on cells?
Leuprolide
Our most common used organ transplant anti-rejection agent. Inhibits normal immune responses to prevent organ rejection in renal, hepatic, or cardiac transplants. Can be given IV or oral. Monitor for decreased urine output!
MUST monitor the drugs troph levels evert 4-7days.
Cyclosporine
avoid styrofoam, grapefruit juice. Monitor drug levels and gingival hyperplasia, hepatotoxicity, nephrotoxicity, hypertension
This drug stimulates kidneys to make more erythropoiesis to help cancer patients with chemo associated Anemia. It can be given IV or SQ (IV preferred). Do not give if known hypersensitivity to drug and may cause HTN if it increases the Hgb too fast.
Epoetin alfa
4. A patient receiving doxorubicin reports new shortness of breath and severe fatigue. Which diagnostic test is MOST urgent?
A. BMP
B. EKG
C. Echocardiogram
D. Chest x-ray
Correct Answer: C
Rationale: Doxorubicin causes cardiotoxicity; LVEF must be evaluated via echocardiogram.
This anti tumor antibiotic is only used to treat cancer, NOT infections despite having antibiotic in the name. These 2 drugs can cause cardiotoxicity, therefor we have to perform ECHO prior to administration.
Daunorubicin & doxorubicin
Your “-icins“
This is a syndrome that is considered an oncologic EMERGENCY. More common in yogurt patients with leukemia and lymphoma.
Our interventions are to provide vigorous IV hydration, ECG monitoring, and prescribe allopurinol, rate oxidase, and sevelamer. Dialysis might be performed in serious cases.
Tumor lysis syndrome
What are hematopoietic drugs and why are they given?
They increase blood cell lines because of bone marrow suppression. Promote synthesis of various types of major blood components by promoting the growth & function of precursor cells in bone marrow.
Used to decrease the duration of chemotherapy induced, anemia, neutropenia, and thrombocytopenia. They also enable higher doses of chemotherapy to be given.
Why are interferons given?
they interfere with viral replication and cancer cells.
•Viral infections - Genital warts, hepatitis
• Cancer - Chronic myelogenous leukemia, follicular lymphoma, hairy-cell leukemia, Kaposi’s sarcoma, malignant melanoma
• Autoimmune disorders - Multiple sclerosis (MS)
14. A patient receiving infliximab reports chills, fever, and flushing during infusion. Which action is MOST appropriate?
A. Increase infusion rate
B. Stop the infusion and treat reaction
C. Continue administration and monitor
D. Premedicate with aspirin
Correct Answer: B
Rationale: Infliximab may cause cytokine release syndrome or anaphylaxis; infusion must be stopped immediately.