Cell Cycle Specific
Agent which can cause hypotension during rapid administration, hypersensitivity and potentially anaphylaxis, myelosuppression, and secondary malignancies
What is etoposide?
Given for leukemias, lymphomas, and solid tumors
Education a patient receiving irinotecan receive about common toxicities/side effects?
I-RUN-TO-THE-CAN
Irinotecan causes diarrhea, report loose stools, different supportive meds given depending on how long it's been since the irinotecan dose was given, monitor I&Os, etc.
Famous for hypersensitivity/anaphylactic reactions, pancreatitis, hyperglycemia, and coagulopathies
What is peg-asparaginase* (& Erwinia chrysanthemi)?
*In December, moving to a product called calasparaginase, longer shelf life, same side effects
A patient receiving rituximab develops a fever- what is your first action?
What is STOP the infusion?
Next: in true NCLEX fashion, take a set of vitals, call the attending, administer appropriate supportive care, take your own pulse...
Finding which is elevated in tumor lysis syndrome and can be treated with either rasburicase and/or allopurinol
What is uric acid (>8 mg/dL)?
Tips: TLS most common in rapidly dividing tumors such as leukemias and Burkitt's lymphomas, neuroblastoma. Monitor fluid status/urien output/weight to assess kidney function!
Toxicities include mucositis, photosensitivity, liver enzyme elevation, kidney damage, N&V, and myelosuppression. Urinary alkalinization prevents kidney damage.
What is methotrexate?
Maintain urine pH greater than 7- when we go to q 4 hour urine pH testing, results lower than 7 need to be retested with the NEXT void!!!
Expected supportive care for a patient receiving high-dose cytarabine?
C"EYE"TARABINE- steroid eye drops to prevent chemical conjunctivitis
Also: higher doses cause more N&V, IT doses cause immediate N&V!, myelosuppression, fevers (infection vs. drug toxicity)
Agent which may cause high-frequency hearing loss, nephrotoxicity with electrolyte wasting, nausea and vomiting, and myelosuppression
What is cisplatin?
Which agents are not administered until 24 hours after chemotherapy is completed and help prevent chemo-induced neutropenia?
Filgrastim (GCSF)
Tips: Who is giving the injection? Where is it coming from? When is their clinic appointment?
Two drugs which increase the risk for hyperglycemia
What are corticosteroids and peg-asparaginase?
Whomp, whomp acute lymphoblastic leukemics.
Medication which can cause pulmonary fibrosis, hyperpigmentation of fingernails, hypersensitivity/anaphylaxis, fever. Long term, PFTs are monitored and patients should avoid high concentrations of oxygen and scuba diving.
What is bleomycin?
Education for a patient receiving vincristine
Constipation!
Also: peripheral neuropathy (what might that look like in a baby?), foot/wrist drop, SIADH (this was on my CPHON exam!)
Important for nursing: FATAL if given IT, Vesicant
Class of drugs that causes the most fertility late effects
What are alkylating agents?
Example: cyclophosphamide
Drug class known for causing cardiotoxicity- expect periodic ECHO/EKG monitoring throughout treatment
What are anthracyclines?
Examples: doxorubicin, daunorubicin, idarubicin
Mitoxantrone is a topoisomerase inhibitor- but also cardiotoxic!
Your newly diagnosed APL patient with a platelet count of 100 has had a nosebleed for 20 minutes and is oozing from procedure sites. What could be causing this and what labs do you expect?
Disseminated intravascular coagulation (DIC)
Check CBC, PT, PTT, Fibrinogen, D-Dimer- TREAT malignancy! correct deficiencies, replace lost blood volume
Not a direct side effect of chemo, but good to know! APL patients are most at risk for this issue.
Medication with hypersensitivity/anaphylaxis potential, dyspnea, and cough (requires multiple pre-medications); can also cause peripheral neuropathy, pain and myelosuppression. Used more often in adults.
What is paclitaxel?
Tips: We don't routinely pre-medicate etoposide, so if this shows up on the test, that may help you distinguish! Etoposide also is not known for peripheral neuropathy.
Monitoring considerations for patients receiving dinutuximab
Vital signs, BID weights, urine output, labs (albumin, potassium), pain score
Avoid cold temperatures during administration of this agent
What is oxaliplatin?
Cold exacerbates neuropathies.
A monoclonal antibody given as a 28 day infusion in leukemia which can cause cytokine release syndrome, neurotoxicity, fever, headache, and tremor
What is blinatumomab?
Cardiotoxicities may be prevented in some regimens with administration of this drug
What is dexrazoxane?
This oral medication given in leukemia may require dose reductions due to myelosuppression.
What is mercaptopurine?
Extra fact: Genetic testing is now done to identify patients with inherited deficiency of the enzyme thiopurine methyltransferase (TPMT) which leads to increased myelosuppression.
Weight gain of more than 5%, elevated bilirubin, and hepatomegaly with right-upper-quadrant pain are the most common presenting symptoms of this syndrome which impairs portal vein flow in the liver and is treated with defibrotide
What is sinusoidal obstructive syndrome (SOS)?
Agent which can cause QT interval changes, electrolyte abnormalities, rash, and differentiation syndrome
What is arsenic trioxide?
Occurs in 90% of patients receiving CAR-T cells, but can occur in other biotherapy treatments. Causes high fever, headache, nausea, myalgia, respiratory compromise... may progress to renal insufficiency, capillary leak, coagulopathy
What is cytokine release syndrome?
A patient with low urine output and increased weight with no signs of edema may have which toxicity? Bonus if you can name a potential drug that causes this!
What is SIADH?
Drugs: Vincristine, cyclophosphamide, ifosfamide, and cisplatin. Also caused by trauma, infection, surgery, and tumors