Fluorouracil
Antimetabolite; HIGH ALERT
Why is pt receiving this? Used alone or in combo w/ other modalities in treatment of colorectal
cancer, breast cancer, stomach cancer and pancreatic cancer. Inhibits DNA/RNA synthesis of
cells by preventing thymidine production (cell cycle S phase specific)
Dose Topical or IV depending on cancer. IV: 370 mg/m2 preceeded by leucovorin or 425 mg/m^2
preceeded by lecuovorin daily for 5 days. May be repeated q 4-5 weeks. Direct IV or Intermittent
infusion
Intermittent: May be diluted w/ D5W or NS, use plastic tubing. [up to 50 mg/mL], over 2-8 hr
SE acute cerebellar dysfunction, diarrhea, n/v, stomatitis, alopecia, rash, phototoxicity, sterility,
anemia, leukopenia, thrombocytopenia, thrombophlebitis
Med Admin concerns Excretion is respiratory and urine. Used w/ irinotecan may produce
unacceptable toxicity. Addative bone marrow depression, may decrease antibody response to live
virus vaccines. Monitor vs, mucous membranes, n/v , bowel function, IV site for inflammation or
infiltration, Is and OS and nutritional intake, cerebellar dysfunction (weakness, ataxia, dizziness)
throughout therapy . GI s/sx on 4th day, generally last 2-3 days
Pt teaching points Notify for symptoms of fever, chill, sore throat, signs of infection, jaundice,
joint or flank pain. Rinse mouth with clear water after eating/drinking to avoid floosing to
minimize stomatitis. Discuss possibility of alopecia. Photosensitivity protection. Routine follow
methotrexate
Antimetabolite; HIGH ALERT
Why is pt receiving this? Alone or w/ other modalities in treatment of breast, head, neck, lung,
renal, ovary, bladder, testicle, leukemia, non-Hodgkins Lymphoma. Inhibits DNA synthesis and
cell reproduction (cell cycle S phase specific) by interfering with folic acid metabolism.
Dose Varies based on type of cancer. Can be given PO, IM, IV, IT
SE dizziness, drowsiness, HA, seizures, blurred vision, PULMONARY FIBROSIS, hepatotoxicity,
anorexia, n/v, diarrhea, stomatitis, vomiting, acute renal failure, SJS, TENS, neuropathy anemia,
leukopenia, thrombocytopenia
Med Admin concerns Increased hematologic toxicity w/ NSAIDS, oral hypoglycemic agents,
phenytoin, tetracylines, probenecid, PPI. Addative bone marrow depression, addative
hepatotoxicity. may decrease antibody response to live virus vaccines, addative neurologic rxns
w/ acyclovir. Monitor vs, mucous membranes, n/v , bowel function, IV site for inflammation or
infiltration, Is and OS and nutritional intake, cerebellar dysfunction (weakness, ataxia, dizziness)
throughout therapy Watch for s/sx of pulmonary toxicity (dry, nonproductive cough), rash
Pt teaching points Notify for symptoms of rash, fever, chill, sore throat, signs of infection,
jaundice, joint or flank pain. Rinse mouth with clear water after eating/drinking to avoid floosing
to minimize stomatitis. Discuss possibility of alopecia. Inspect oral mucosa for
ulceration/erythema. Don’t receive vaccines. Photosensitivty protection. Possible teratogen.
leucovorin calcium
Folic acid analogues
Why is pt receiving this? Administered 24 hr after methotrexate to block toxic effects of high
doses. Reversal of toxic effects of folic acid antagonist allowing cell synthesis.
Dosage PO, IM, IV; normal elimination. 10 mg/m2 q 6 hr (1st dose IV/IM then change PO) until
methotrexate level is under 5X10-8. Doses should be determined based on blood level.
SE Thrombocytosis, Allergic rxns, convulsions
Med administration concerns may decrease anticonvulsant effect of barbiturates, phenytoin, or
primidone. Addative CNS depression. PCP in HIV patients. Increase therapeutic effects and
toxicity of florouracil. Assess for n/v, development of allergic rxns. Assess degree of weakness
and fatigue (megabloblastic anemia). Monitor urine pH q 6 hr, ph should be maintaine >7 to
decrease nephrotoxic effects.
Pt education Explain purpose. Insturct pt to drink at least 3 L of fluid each day during leucovorin
resuce. Encourage pt to eat diet high in folic acid (meat, bran, dried beans, green/leafy
vegetables)
mechlorethamine (Mustargen)
Alkylating agents
Why is pt receiving this? Part of combo therapy of Hodgkin’s disease, and malignant
lymphomas. Used palliatively in bronchogenic carcinoma, leukemias. Inhibits DNA/RNA
synthesis by cross linking strands (Cell cycle phase non specific)
Dosage 0.4 mg/kg as single dose or divided dose over 2-4 days. Part of MOPP regimen for
Hodgkin’s lymphoma: 6 mg/m^2, days 1 and 8 of 28 day cycle. Can be given Itracavitary,
intrapericardial. 1 mg/mL over 3-5 min
SE n/v (w/in 1-3 hr), anorexia, wakness, alopecia, anemia, leukopenia, thrombocytopenia,
herpes zoster, neuro/ototoxicity, breast/ovary cancer, neroblastoma, retinoblastoma,
Hodgkins/non hodgkin’s lymphoma
Med admin concerns Assess vs, injection site for rxns, monitor Is/Os, appetite, nutritional stauts.
Monitor for bone marrow depression. Monitor for s/sx of gout. Solution should be prepared in
biologic cabinet. Wear gloves, gown, mask. Discard all contaminated equipment. DRUG IS
HIGHLY TOXIC
Notify for symptoms of rash, fever, chill, sore throat, signs of infection, jaundice, joint or flank
pain. Rinse mouth with clear water after eating/drinking to avoid floosing to minimize
stomatitis. Discuss possibility of alopecia. Inspect oral mucosa for ulceration/erythema. Don’t
receive vaccines. Photosensitivty protection. Possible teratogen.
cyclophosphamide (Cytoxan)
Alkylating agents HIGH ALERT
Why is pt receiving this? leukemias, breast/ovarian cancer, neuroblastoma, retinoblastoma,
hodgkins and non hodgkins lymphoma
Dose Many regimens used; PO: 1-5 mg/kg/day; IV: 40-50 mg/kg in divided doses over 2-5 days
or 10-15 mg/kg q 7-10 days or 3-5 mg/kg twice weekly or 1.5-3 mg/kg/day Dilute w/ D5W,
D5/NS, ½ NS [2 mg/mL] @ very slow rate
SE n/v, anorexias, diarrhea, DARKENING OF SKIN/NAILS , facial flushing, HA, increased sweating,
swollen lips, rash, alopecia, cardio/nephrotoxic at high doses,
Med admin concerns CAN cross BBB. Increased toxicity w/ rifampin or phenobarbital; incr bone
marrow depression w/ thiazide diuretics, may decrease serum digoxin levels, may potentiate
effects of warfarin, decreased antibody response to live vaccines. Assess BP, pulse, RR, temp
frequently. MONITOR UO frequently, MONITOR for bone marrow depression, Encourage pt to
drin 2000-3000 mL/day to promote uric acid excretion. Assess for signs of HF.
Pt education Take dose early in morning, need to drink plenty of fluids. Notify for symptoms of
rash, fever, chill, sore throat, signs of infection, jaundice, joint or flank pain. Rinse mouth with
clear water after eating/drinking to avoid floosing to minimize stomatitis. Discuss alopecia.
cisplatin (Platinol)
HIGH ALERT alkylator like agent
Why is pt receiving this? bladder, ovarian, and testicular cancer. Cell cycle phase nonspecific
disruptor of DNA synthesis
Dosage IV; depends on type of cancer
SE REVERSEIBLE POST. LEUKOENCEPHALOPATHY, SEIZURES, ototoxicity, tinnitus, n/v,
nephrotoxicity, sterility, alopecia, hypocalcemia, hypokalemia, hypomagnesemia, leukopenia,
thrombocytopenia, anemia Phlebitis, hyperuricemia
Med administration concerns Monitor for all above mentioned as well as RPLS (HA, seizure,
lethargy, confusion, blindness w/ or w/out hypertension.
Pt education pts report pain at IV site immediately, adverse s/sx, numbness or tingling, unusual
swelling or joint pain, discuss need for contraception even though may cause infertility
doxorubicin (Adriamycin)
Anthracyclines; Antibiotic antitumor agent; HIGH ALERT
Why is pt receiving this? acute leukemia, Wilm’s tumor (rare, pediatric kindey cancer), soft
tissue and bone cancer, Hodgkin’s, breast cancer; S phase specific, binds directly w/ DNA to
impair replication
Dosage Only given IV, but many regimens. 60-75 mg/m2 daily, repeat q 21 days or 25-30 mg/m2
daily for 2-3 days, repeat q 3-4 wk or 20mg/m^2/week. Total cumulative dose should not exceed
550 mg/m^2 w/out cardiac monitoring.
Prep: sould be prepared in biologic cabinet w/ gloves, gown and mask. Mix in 100-250 mL NS, infuse over
30-60 min
SE GI, alopecia, RED URINE, DARKENING of soles, palms or nails; leukopenia, stomatitis,
esophagitis
Med Admin concerns TO MONITOR: URIC ACID LEVELS, CBC, I&Os, signs of bleeding,
bruising, EKG (Cardiotoxicity) May extravasate PAINLESSLY
Pt educaton pts Report adverse s/sx immediately, check for ulceration/stomatitis in mouth,
notify for irregular heartbeat, SOB, swelling of lower extremities, discuss alopecia, May cause
urine to appear dark for 1-2 days, (family)Take protections in handling bodily fluids for at least
5 days; doxorubicin may increase risk of developing 2ndary cancers, may have teratogenic
effects, importance of follow up w/ provider
vincristine (Oncovin)
Mitotic inhibitor HIGH ALERT
Why is pt receiving this? Used in combo to treat Hodgkin’s diseases, leukemias, neuroblastoma,
malignant lymphomas, Rhabdomyoscarcoma, Wilm’s tumor and others FASTER DIVIDING ;
Binds to proteins of mitotic spindle causing metaphase arrest
Dose Many doses used. IV: 10-30 mcg/kg (.4-1.4 mg/m2); may repeat weekly
Undiluted @ [1mg/mL]; Administer direct IV push over 1 min through NS or D5W
SE agitation, insomnia, mental depression, mental status changes, n/v, abd cramps, anorexia,
constipation, ileus, stomatitis, gonadal supresson, nocturia/oliguria/retention, alopecia, SIADH,
leukopenia, thrombocytopenia, anemia, ascending periph neuropathy
Med admin concerns Assess all mentioned above, w/ concern paid to neurologic status
(parastehsia, deep tendon reflex, weakness, cranial nerve palsies, autonomic dysfunction;
symptoms may persist for MONTHS). Decreased urine output may indicate SIADH. Monitor for
gout. May decrease response to live virus vaccines
Pt teaching points Report symptoms of neurotoxicity, notify s/sx, discuss alopecia, may have
teratogenic effects. Importance of follow up
megestrol (Megace)
progestin
Why is pt receiving this? used like progesterone. Treatment of anorexia, weight loss. Used in
prostate cancer to suppress androgens Also w/ palliative treatment of breast and endometrial
cancer. Action: believed to be pituitary inhibition
Dosage PO: varies based on use
SE THROMBOEMOLISM , edema, Gi irritation, asymptomatic adrenal suppression,
thrombophlebitis
Med administration concerns Assess for swelling pain or tenderness in legs. Report these signs
as they may indicate DVT. Monitor anorexia. No significant drug/drug interactions.
Pt teaching points Take exactly as directed, report any abnormal vaginal bleeding or s/sx of
thromboembolism/thrombophlebitis, discuss alopecia. May have teratogenic effects
tamoxifen
Anti-estrogen
Why is pt receiving this? Estrogen receptor cancers, esp breast cancer and breast cancer
prevention, competes w/ estrogen receptor in tissue, decreases DNA synthesis
Dose PO 10-20 mg twice a day; doses of 20 mg may be taken once daily
SE PREGNANCY CATEGORY D, may cause menopausal symptoms, vaginal bleeding, STROKE,
THROMBOEMBOLISM, UTERINE MALGINANCIES, hypercalcemia, leukopenia, thrombocytopenia
Med admin concerns Full effect may take MONTHS ; H2 antagonists may dampen effects, SSRI’s
completely negate effect, may increase effect of warfarin, Assess for increase in tumor/bone
pain.
Pt education Take as directed, skin lesions may temporarily increase in size, number and may
lead to erythema. Report bone pain. Monitor weight weekly. May cause hot flashes. May induce
ovulation and has known teratogen effects.
Letrozole (Femara)
Aromatase inhibitor
Why is pt receiving this? First or second line treatment of postmenopausal women with
hormone receptor positive or unknown advanced breast cancer. Adjuvant treatment w/
hormone receptor positive early breast cancer. Inhibits aromatase, which is partially responsible
for conversion of precursors to estrogen. Used after 5 years of Tamoxifen, or if aggressive
Dosage PO: 2.5 mg daily
SE: anxiety, depression, dizziness, fatigue, HA, vertigo, coughing, dyspnea, chest pain, edema,
nausea, abd pain ,anorexia, diarrhea, dyspepsia, vomiting, alopecia, hot flashes, increased
perspiration, msk pain, hypercholesterolemia, weight gain.
Med admin concerns No significant drug interactions. Assess for pain and side effects.
Pt education Take as directed. May casue dizziness/fatigue (initial fall precautions until rxn
known), potential for adverse rxns. May cause fetal harm, use adequate contraception.
trastuzmab (Herceptin)
Monoclonal antibodies HIGH ALERT
Why is pt receiving this? First line treatment of metastatic breast cancer that displays human
epidermal growth factor receptor 2 (HER2), adjuvant treatment of HER2 node positive or node
negative breast cancer. Treatment of HER2 gastric or gastroesophageal adenocarcinoma in pts
who have not received prior treatment for metastatic disease.
Dose IV, different regiments. Concentration 21 mg/mL. Infuse 4 mg/kg loading dose over 90 min
and the weekly 2 mg/kg dose over 30 min or 6 mg/kg over 90 min every 3 wk if loading dose
well tolerated.
SE interstitial pneumonitis, pulmonary edema, PULMONARY FIBROSIS, arrhythmias, HF,
hypotension, tachycardia, abd pain, anorexia, diarreah, n/v, rash, edema, anemia, leukopenia,
HYPERSENSITIVITY RXNS
Med admin concerns Assess for infusion rxns, s/sx of HF, pulmonary hypersensititvity rxns
Pt education Alert for new onset or worsening SOB, coughin, swelling of LE, palpiations, weight
gain, may cause teratogenic effects