Category
Alkylating Agents
(Nitrogen mustard
derivatives and
platinum
compounds)
Antimetabolites
Antitumor
antibiotics
Medication Names Mechanism of
Action
Cyclophosphamide Damage DNA
Carboplatin
Cisplatin
Leukemia,
Hodgkin’s, Breast,
Brain, Ovarian
Fluorouracil
Methotrexate
Hydroxyurea
Gemcitabine
Interferes with DNA
synthesis
Doxorubicin
Modifies DNA
function
Leukemia, Breast,
Colon, Testicular
Breast, Lung,
Ovarian, Leukemia
Common Side Effects
Nursing Care
Myelosuppression, nausea,
vomiting, hepatotoxicity,
hemorrhagic cystitis,
stomatitis, alopecia, gonadal
suppression, ototoxicity,
nephrotoxicity, peripheral
neuropathy, may cause
secondary malignancies of
leukemia and bladder
(cyclophosphamide)
Nausea, vomiting, diarrhea,
myelosuppression, stomatitis,
renal and hepatic toxicity,
photosensitivity,
pneumonitis,
hyperpigmentation of veins,
increase in mucous
production, alopecia,
Erythrodysesthesia (handfoot syndrome)
Myelosuppression, nausea,
vomiting, alopecia,
Erythrodysesthesia,
Cardiac toxicity, Pulmonary
toxicity, urine may turn red
(not hematuria), dyspnea,
edema
Mesna to reduce hemorrhagic
cystitis risk, Amifostine to help
reduce risk of renal toxicity,
increase fluids, monitor urine
Assessments, Amifostine to
protect against renal failure
Dexrazoxane to help reduce
risk of cardiac toxicity
Plant alkaloids
(Mitotic inhibitors)
Docetaxol
Vincristine
Inhibits cellular
replication
Breast, Lung,
Leukemia
Nitrosoureas
Carmustine
Crosses blood brain
barrier
Brain
Nausea & vomiting,
constipation/(vincristine)
diarrhea, neuropathies
(vincristine), stomatitis,
alopecia, paralytic ileus,
SIADH, anemia,
thrombocytopenia,
leukopenia, anaphylaxis
(Docetaxol), hepatic
(vincristine)
Hepatoxicity, renal failure,
anemia, leukopenia,
thrombocytopenia, nausea,
vomiting, alopecia,
pulmonary fibrosis
Give first dose slowly over a
long period of time to prevent
anaphylaxis
Mesna for renal failure,
monitor respiratory status
Hemopoietic Growth Factors
Medication Name
Epoetin alfa, Darbepoetin alfa
Action
Stimulates RBC production
Side Effects/Assessment
Hypertension, hyperviscosity do not give
is hemoglobin >12 (clot/stroke risk)
Filgrastim, Pegfilgrastim
WBC stimulation, starts to work when
WBC count drops
Given sub. Q, may cause bone pain due to
rapid action, give acetaminophen for pain
Oprelvekin
Platelet stimulation
Not really used due to black box warning
of anaphylaxis
Drugs used in conjunction with chemotherapy
Medication
Name
Dronabinol
Mechanism of Action
Common Side Effects
Nursing Care
Appetite stimulant, active ingredient
in marijuana
antiemetic
High abuse potential, last resort
Metoclopramide
Domperidone
Antiemetic
Prochlorperazine
Palonodteron
Rolapitant
Chlorpromazine
Ondansetron
Famotidine
Antiemetics
Diphenhydramine
Antihistamine, CNS depressant
Drowsiness, dry mouth, ataxia,
dizziness
Abnormal heart rhythm,
weakness, fatigue, dizziness, GI
issues, hiccups, loss of appetite,
rash, resp complications
Restlessness, anxiety,
hallucinations, drowsiness,
sedation, extrapyramidal
symptoms
Extrapyramidal symptoms, dry
eyes, blurred vision, hypotension,
constipation, dry mouth, urine
retention, photosensitivity
Headache, drowsiness, weakness,
constipation, diarrhea, Abd pain,
dry mouth, extrapyramidal
symptoms
drowsiness
Lorazepam
Antianxiety
Vertigo, drowsiness, lethargy
Meperidine
Antianxiety
Megestrol
Anorexia
Dexrazoxane
Cardiac protectant
Confusion, sedation,
hypotension, resp. depression
Asymptomatic adrenal
suppression, thromboembolism
Myelosuppression and secondary
malignancies
Aprepitant
Antiemetic
Use with other antiemetics
Monitor for extrapyramidal
symptoms, give diphenhydramine
if present
Watch for CNS depression and
hypotension
Rolapitant has a duration of 7 days
Check liver studies
Assess for hypotension, urticaria,
airway
Assess anxiety, CNS depression
Antidote flumazenil
Assess CNS depression
Antidote naloxone
Assess weight, appetite and for
DVT
Cardiac assessments
Mesna
Hemorrhagic cystitis protectant
Palifermin
Oral mucositis protectant
Trastuzumab
HER2 breast cancer
Bortezomib
MM, aptosis
Hydrocortisone,
Corticosteroids
Methylprednisone,
Dexamethasone
Anastrozole,
Aromatase inhibitors
Letrozole
Raloxifene
Selective Estrogen Receptor
Modulator (SREM)
Tamoxifen
Antiestrogens
Bicalutamide
Antiandrogen
Procarbazine
Hydroxyurea
Used for leukemia
Flu like symptoms, anorexia,
N/V/D
Proteinuria, increased pancreatic
enzymes
Pneumonitis, pulmonary edema,
anorexia, nausea, vomiting,
diarrhea, anaphylaxis, flu like
symptoms, heart failure
Nausea, vomiting, neuropathy,
orthostatic hypotension,
neutropenia, congestive heart
failure, fatigue, tumor lysis
syndrome
Hypokalemia, hyperglycemia,
increased infection risk, nausea,
vomiting, delayed healing
Headache, weakness, nausea,
back pain, hot flashes
Thrombosis and PE
Nausea, vomiting, hot flashes,
endometrial cancer
Nausea, vomiting, hot flashes,
breast enlargement
Nausea, vomiting, seizures,
confusion, cough, pleural
effusion
Myelosuppression, impaired
renal function, secondary
malignancies
Urinary assessments
Oral assessments, urine assessment
Monitor for heart failure,
respiratory status, get baseline
echo before starting
Monitor blood pressure,
myelosuppression, liver failure
Give before chemo to decrease
adverse reactions
Third line treatment for estrogen
blocking
Second line treatment for estrogen
blocking
First line estrogen block
Chemoprevention
Blocks testosterone
In short:
Cyclophosphamide- can cause hemorrhagic cystitis (give mesna), stomatitis (mouth ulcers), secondary malignancies of leukemia or
bladder
Fluorouracil- can cause Erythrodysesthesia (hand-foot syndrome), increases mucous production
Methotrexate- can cause renal failure, mesna can help
Hydroxyurea- can help leukostasis, give with fluids
Doxorubicin- can cause cardiac toxicity (baseline echo with EF), Erythrodysesthesia, red urine
Docetaxol- can cause anaphylaxis at any time