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Cancer Medication
Medical-Surgical Nursing (Lincoln Technical Institute)
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Maryann Akwensivie
Cancer Medications
Pegfilgrastim (Neulasta)
Medication class: Colony-stimulating factors
Pharmacological action: Glycoprotein that binds to and stimulates neutrophils to divide and
differentiate. also activates mature neutrophils. Binding to a polyethylene glycol molecule
prolongs its effects.
Therapeutic use: Decreased incidence of infection in patients who are neutropenic from
chemotherapy.
Adverse effects: Adult Respiratory Distress Syndrome (ARDS), splenic rupture,
glomerulonephritis, sickle cell crisis, leukocytosis, medullary bone pain, anaphylaxis, capillary
leak syndrome.
Contraindications: Hypersensitivity to filgrastim Escherichia -coli-derived proteins.
Interactions: Simultaneous use with antineoplastics may have adverse effects on rapidly
proliferating neutrophils, avoid use for 24hrs. before and 24hrs. following chemotherapy.
Lithium may potentiate the release of neutrophils; concurrent use should be undertaken
cautiously.
Medications doses for adult Patients: 6mg per chemotherapy cycle.
Nursing interventions and client education: Assess bone pain throughout therapy. Assess for
fever, lung infiltration, and respiratory distress. Monitor for hypotension and edema. Do not
reuse needle, syringe, or drug product. Do not administer solutions that are discolored. Do not
shake. Apply to non-irritated skin on the abdomen or back of arm. Obtain complete health
history including allergies, drug history, and drug interactions. Make sure the patient is receiving
the right medications for the right reason. Tell patient to report to a HCP any signs of allergic
reaction (SOB, hives, rash, pruritus, laryngeal edema). Teach importance of compliance with
therapy and regular monitoring blood count, Teach correct disposal of needle, syringe and drug
product.
Administer with or without food? Can be administered with or without food.
Can the med be crushed? NO
List Physical assessment to be completed before administration: Assess patient for bone pain,
fever, long infiltration, respiration, distress, monitor for capillary leak syndrome, hypotension,
hypoalbuminemia, edema, hemoconcentration.
List Assessment questions the nurse will ask the patient before administration: Ask if patient
feels any pain, bone pain, fever, or respiration distress.
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List specific instructions related to what time e medication should be administered: Medication
can be administered anytime.
List labs the nurse would assess before administration: CBC, platelet count, hematocrit, WBC,
and platelet, LDH, alkaline phosphatase, and uric acid.
Epoetin Alfa (Procrit)
Medication class: Erythropoiesis stimulating agents (ESA)
Pharmacological action: Stimulates erythropoiesis (production of red blood cells)
Therapeutic use: Maintains and may elevate RBC’s, decreasing the n need for transfusions.
Adverse effects: Seizures, headache, stroke, MI, HF, thromboembolic events, transient rashes,
restored fertility, resumption fertility, resumption of menses. Increased mortality and increased
tumor growth.
Contraindications: Hypersensitivity to albumin or mammalian cell-derived products,
Uncontrolled hypertension, patient with erythropoietin levels, patients with cancer receiving
hormonal agents, biologic products, or radiotherapy, unless also receiving concomitant
myelosuppressive chemotherapy, patients receiving chemotherapy when anticipated outcome of
cure, patient undergoing cardiac or vascular surgery, neutropenia in newborns.
Interactions: May increase requirements heparin anticoagulation during hemodialysis.
Medications doses for adult Patients: IV 50-100 units/kg 3 times weekly
Nursing interventions and client education: Monitor electrolytes and hematocrit levels. Discuss
reading the mediation guide prior to therapy. Ways to prevent self-injury, driving and activities
requiring alertness should be avoided. Notify doctor if signs of blood clots, chest pain, SOB, or
edema. Advise patient to read med guideline before initiate treatment and sign acknowledgement
agreement before each course of therapy. Explain how iron increase production of red blood
cells, instruct patient about risk of injuries from seizures, avoid driving and activities that require
alertness. Inform patient about decrease of overall survival and decrease of time of tumor
progression. Notify HPC if any blood clot signs. Patients with dialysis done at home, determine
effectively and safety.
Administer with or without food? Can be given with or without food.
Can the med be crushed? NO
List Physical assessment to be completed before administration: BP, monitor symptoms of
anemia (fatigue, dyspnea, pallor). Monitor dialysis shunts (thrill and bruit) and status of artificial
kidney during hemodialysis, monitor impaired circulation for patients with underlying vascular
disease.
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List Assessment questions the nurse will ask the patient before administration? Any feeling of
dizziness, fatigue, dyspnea, pallor.
List specific instructions related to what time e medication should be administered:
Administering epoetin should be taught proper dosage, administration techniques and disposal.
List labs the nurse would assess before administration: WBC, platelets, serum ferritin,
transferrin, and iron levels. Hematocrit, CBC with differential, and platelet count, renal functions
studies and electrolytes, BUN, creatinine, Hemoglobin weekly.
Oprelvekin (Neumega)
Medication class: Thrombopoietin receptor agonists and thrombopoiesis stimulators
Pharmacological action: Stimulates production of megakaryocytes and platelets count.
Therapeutic use: Stimulates production of megakaryocytes and platelets transfusions following
myelosuppressive chemotherapy in patients at risk for thrombocytopenia.
Adverse effects: Hives, itching, swollen, blisters, peeling skin, wheezing, tightness in chest or
throat. Weakness of one side if the body, SOB, chest pain, flushing, big weigh gain, swelling in
the arms or legs, dizziness, fever, headache, unexplained bruising or bleeding, confusion.
Contraindications: Acute bronchospasm, angioedema, urticaria, Hypersensitivity to Neumega.
Interactions: carfilzomib, ifosfamide. Fluid retentions, arrhythmias, papilledema, renal
impairment
Medications doses for adult Patients: 50mcg/kg subcutaneously once a day starting 6 to 24 hours
after chemotherapy completion.
Nursing interventions and client education: Advise patient to seek medical attention if any
symptom of allergy reaction occur, advise patient that mild to moderate peripheral edema and
SOB on exertion can occur within the first week and may continue for the duration of treatment.
Advise patient with preexisting pleural or other effusions or a history of congestive heart failure
to contact HCP if dyspnea worsens, as well as if symptoms attributable to atrial arrhythmia
occur.
Administer with or without food? Can be administered with or without food
Can the med be crushed? No
List Physical assessment to be completed before administration: Assess heart rate, heart sounds,
monitor respiratory function, assess for dizziness, gait, balance, and functional activities.
peripheral edema, muscle, or bone pain, monitor subcutaneous site for pain, swelling, and
irritation.
List Assessment questions the nurse will ask the patient before administration: Any chest pain,
dizziness during activities, tolerance for activities and fatigue levels.
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List specific instructions related to what time the medication should be administered: Take
medication as instructed.
List labs the nurse would assess before administration: CBC, platelet count.
Cytotoxic Medications
Vincristine Sulfate (Oncovin)
Medication class: Antineoplastics
Pharmacological action: Binds to a protein of cellular microtubules, where it interferes with
microtubule assembly. Cell replication is stopped as a result.
Therapeutic use: Death of rapidly replicating cells, particularly malignant cells.
Adverse effects: SOB, chest pain, constipation, nausea, abdominal pain, diarrhea, anorexia,
transient increased in liver enzymes, vomiting, alopecia, hyponatremia, anemia neutropenia,
irritation at IV site, myalgia, pain in tumor containing tissue.
Contraindications: Hypersensitivity, active infection, decreased bone marrow, lactation,
pregnancy.
Interactions: Increased bone marrow depression with other anticoplastics or radiation therapy.
Concurrent use of cisplatin increased risk and severity of bone marrow depression. Concurrent
use with mitomycin or chest radiation increased risk of pulmonary reactions.
Medications doses for adult Patients: IV 30mg/m2 once weekly.
Nursing interventions and client education: Notify a HCP if fever, sore throat, signs of infection,
bleeding gum, bruising petechiae blood in stool, urine, emesis, increased fatigue, dyspnea, or
orthostatic hypotension occurs. Avoid crowds and person with known infections. Avoid alcohol
and medications containing aspirin or NSAIDs. Instruct patient to inspect oral mucosa for
bleeding. Advise patient about the teratogenic effect. Emphasize the need for periodic lab tests to
monitor for side effects.
Administer with or without food – Can be administered with or without food
Can the med be crushed? No
List Physical assessment to be completed before administration: Pulse, respiratory rate,
temperature. Monitor for acute infusion-related reactions consisting of flushing, shortness of
breath, facial swelling, headache, chills, chest pain, back pain, chest or throat tightness, fever,
tachycardia, pruritus, rash, cyanosis, syncope, bronchospasm, asthma, apnea, and hypotension.
Observe for signs of anaphylaxis. Monitor for bone marrow depression. Assess for bleeding
gums, bruising petechiae, guaiac stools, urine, and emesis). Monitor intake and output. Monitor
for gout.
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List Assessment questions the nurse will ask the patient before administration: Ask pt if they
have back or any other pain, and nausea. Any bleeding or any redness or irritation on previous
site of radiation therapy.
List labs the nurse would assess before administration: CBC, and differential, BUN, creatinine,
AST, ALT, LDH, serum bilirubin.
Doxorubicin (Adriamycin)
Medication class: Antineoplastics, Anthracyclines
Pharmacological action: Inhibits DNA and RNA synthesis by forming a complex with DNA
action is cell-cycle S-phase-specific. Also has immunosuppressive properties. Encapsulation in a
liposome increases uptake by tumors, prolongs action, and may decrease some toxicity. Or
radiation therapy.
Therapeutic use: Death of rapidly replication cells, particularly malignant ones.
Adverse effects: Weakness cardiomyopathy, nausea, diarrhea, increase alkaline phosphatase,
moniliasis, oral malignancy, stomatitis, vomiting, hand-foot Sythrombocytopenia, injection site
reaction, anaphylactoid allergy reactions, acute infusion-related reactions, acute infusion-related
reactions, fever.
Contraindications: Hypersensitivity, lactation, fetal harm may occur.
Interactions: Increase bone marrow depression with other antineoplastics or radiation therapy,
may increase skin reactions at previous radiation therapy sites. Hematologic toxicity is increased
by concurrent use of cyclosporine, risk of coma and seizures is also increased. Incidence and
severity of neutropenia and thrombocytopenia are increased by concurrent progesterone.
Phenobarbital may increase clearance and increase effects of doxorubicin. Doxorubicim may
decrease metabolism and increase effects of phenytoin. May increase risk of hemorrhagic cystitis
from cyclophosphamide or hepatitis from mercaptopurine. Cardiac toxicity may be increased by
radiation therapy or cyclophosphamide. May decrease antibody response to live-virus vaccines
and increase risk of adverse reactions.
Medications doses for adult Patients: Ovarian cancer – IV: 50mg/m2 every 4 weeks until disease
progression or unacceptable toxicity.
Nursing interventions and client education: Notify a HCP if fever, sore throat, signs of infection,
bleeding gum, bruising petechiae blood in stool, urine, emesis, increased fatigue, dyspnea, or
orthostatic hypotension occurs. Avoid crowds and person with known infections. Avoid alcohol
and medications containing aspirin or NSAIDs. Instruct patient to inspect oral mucosa for
bleeding. Advise patient about the teratogenic effect. Emphasize the need for periodic lab tests to
monitor for side effects.
Administer with or without food – Can be administered with or without food.
Can the med be crushed? - No
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List Physical assessment to be completed before administration: BP, pulse, respiratory rate,
temperature. Monitor for acute infusion-related reactions consisting of flushing, shortness of
breath, facial swelling, headache, chills, chest pain, back pain, chest or throat tightness, fever,
tachycardia, pruritus, rash, cyanosis, syncope, bronchospasm, asthma, apnea, and hypotension.
Observe for signs of anaphylaxis. Monitor for bone marrow depression. Assess gum bleeding.
Monitor intake and output. Assess left ventricular cardiac function, assess injection site for
redness. Irritation or inflammation. Assess oral mucosa for development of stomatitis. Monitor
for skin toxicity.
List Assessment questions the nurse will ask the patient before administration: Ask Patient if any
back or any other pain, and nausea. Any bleeding or any redness or irritation on previous site of
radiation therapy.
List labs the nurse would assess before administration: CBC, and differential, BUN, creatinine,
AST, ALT, LDH, serum bille
Cyclophosphamide (Cytoxan)
Medication class: Immunosuppressants, alkylating agents
Pharmacological action: Interferes with DNA replication and RNA transcription, ultimately
disrupting protein synthesis.
Therapeutic use: Death of rapidly replicated cells, p-particularly malignant ones. Also has
immunosuppressant action in smaller doses.
Adverse effects: Pulmonary fibrosis, myocardial fibrosis, hypotension, anorexia, nausea,
vomiting, hematuria, alopecia, gonadal suppression, syndrome of inappropriate antidiuretic
hormone. Thrombocytopenia, anemia, hyperuricemia, secondary neoplasm.
Contraindications: Hypersensitivity, lactating, pregnancy.
Interactions: Phenobarbital or rifampin may increase toxicity of cyclophosphamide, concurrent
allopurinol or thiazide diuretics may exaggerate bone marrow depression, may prolong
neuromuscular blockade from succinylcholine. Cardiotoxicity may be additive with other
cardiotoxic agents. cytarabine, daunorubicin, doxorubicin. May increase serum digoxin levels.
Additive bone marrow depression with other antineoplastics or radiation therapy. May potentiate
the effects of warfarin, may decrease antibody response to live-virus vaccines and increase risk
of adverse reactions.
Medications doses for adult Patients: PO- 1-5mg/kg/day
Nursing interventions and client education: Instruct patient to take dose early morning, adequate
fluid intake for 72hrs. after therapy, void frequently to decrease bladder irritation. Report
hematuria immediately. Use gloves when handling capsules. Notify PHC for fever, sore throat,
or signs of infection. Lower back or side pain, difficult urination, sores in the mouth or lips,
yellow discoloration of skin or eyes, bleeding gum, bruising, petechiae, blood in urine, stool, or
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emesis, unusual swelling if ankles or legs, joint pain, weigh gain, or confusion occur. Possibility
to hair loss, medication may cause sterility and menstrual irregularities. Instruct patient that this
drug is teratogenic.
Administer with or without food – With food or after meals.
Can the med be crushed? No.
List Physical assessment to be completed before administration: Monitor BP, pulse, respiratory
rate, temperature, urinary output, and frequency, monitor bone marrow depression, assess for
bleeding gums, bruising, petechiae guaiac stools, urine and emesis, assess nausea, vomiting,
appetite, weigh weekly, assess cardiac and respiratory.
List Assessment questions the nurse will ask the patient before administration: Ask patient about
pain level and any allergy.
List specific instructions related to what time e medication should be administered: Take
medication early in the morning and take with food or after meal. Do not overdose.
List labs the nurse would assess before administration: CBC, with differential and platelets,
count. Monitor BUN, creatinine, urine acid, ALT, AST, LDH, serum bilirubin, Urinalysis, test for
candida, mumps, trichophyton, PPD, Pap smear.
Amifostine (Ethyol)
Medication class: Cytoprotective agents.
Pharmacological action: Converted by alkaline phosphatase in tissue to a free thiol compound
that binds and detoxifies damaging metabolites of cisplatin and reactive oxygen species
generated by radiation.
Adverse effects: Dizziness, somnolence, blurred vision, diplopia, sneezing, hypotension, hiccups,
nausea, vomiting, erythema multiforme, exfoliative dermatitis, necrolysis, toxoderma, flushing,
hypocalcemia, chills, injection site reactions.
Contraindications: Hypersensitivity to aminothiol compounds; hypotension or dehydration,
lactation, avoid breastfeeding, concurrent antineoplastic therapy for other tumors.
Interactions: Concurrent use of antihypertensives risk of hypotension.
Medications doses for adult Patients: IV – 910 mg/m2 once daily
Nursing interventions and client education: Explain patient the purpose of amifostine infusion,
and inform that meds may cause hypotension, nausea, vomiting, flushing, chills, dizziness,
somnolence, hiccups, and sneezing, tell patient to report to a HCP any skin reaction, or signs or
symptoms of anaphylaxis or DRESS occurs.
Administer with or without food – Without food
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Can the med be crushed? No
List Physical assessment to be completed before administration: Assess for BP, Place patient in
Trendelenburg position, if necessary, in case of hypotension. Assess fluid status, correct
dehydration. Assess for nausea and vomit and administer prophylactic antiemetic before and
during therapy. Observe patient for signs and symptoms of anaphylaxis. Monitor for skin
reactions, assess for dry mouth, and mouth sores.
List Assessment questions the nurse will ask the patient before administration: Ask patient if they
experience nausea.
List labs the nurse would assess before administration: Monitor serum calcium concentration.
Cisplatin (Platinol)
Medication class: Anthracyclines
Pharmacological action: Inhibits DNA and RNA synthesis by forming a complex with DNA
action is cell-cycle S-phase-specific
Therapeutic use: Death of rapidly replication cells, particularly malignant ones.
Adverse effects: Reversible Posterior Leukoencephalopathy Syndrome (RPLS), Weakness,
malaise, ototoxicity, tinnitus, nephrotoxicity, phlebitis, anaphylactoid reactions.
Contraindications: Hypersensitivity, lactation.
Interactions: Risk of nephrotoxicity and ototoxicity with other nephrotoxic and ototoxicity drugs
(aminoglycosides, loop diuretics) increased risk of hypokalemia and hypomagnesemia with loop
diuretics and amphotericin B. May decrease phenytoin levels. Increase bone marrow depression
with other antineoplastic or radiation therapy, may decrease antibody response in live-virus
vaccines and increase adverse
Medications doses for adult Patients: IV- 20mg/m2 daily for 5 days.
Nursing interventions and client education: Instruct patient to report pain at injection site, fever,
chills, cough, hoarseness, lower back pain, or difficult urination. Blood in stools, or orthostatic
hypotension, numbness or tingling, unusual swelling, or joint pain. If planning contraception
report to the HCP.
Administer with or without food? Can be administered with or without food
Can the med be crushed? No
List Physical assessment to be completed before administration: Assess vitals, I&O, encourage
drinks 2-3L/day. Assess IV site for irritation.
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List Assessment questions the nurse will ask the patient before administration: Ask if having
pain, tingling, fever, encourage drinks before and during treatment, ask to monitor urine sample
before treatment.
List labs the nurse would assess before administration: CBC, with differential, platelets, BUN,
creatinine, CCr, serum bilirubin.
Mesna (Mesnex)
Medication class: Cytoprotectants.
Pharmacological action: Binds to the toxic metabolites of ifosfamide in the kidneys.
Therapeutic use: Presents hemorrhagic cystitis from ifostamide
Adverse effects: Dizziness, drowsiness, headache, anorexia, diarrhea, nausea, unpleasant taste,
vomiting, flushing, injection site reaction, flu like symptoms.
Contraindications: Hypersensitivity to mesna or other thiol, (rubber) compounds.
Interactions: None
Medications doses for adult Patients: Give a dose of mesna equal to 20% of the ifosfamide dose
at the same time as ifosfamide and 4 to 8 hours after. Available IV 100mg/mL
Nursing interventions and client education: Notify patient about unpleasant taste may occur
during administration, notify HCP if nausea, vomiting, or diarrhea persists or is severe.
Abdominal pain, sweating, hunger, weakness, dizziness, tachycardia, anxiety occurs. Notify HCP
if planning pregnancy.
Administer with or without food – Administer without or without food.
Can the med be crushed? No
List Physical assessment to be completed before administration: Monitor for development of
hemorrhagic cystitis in patients receiving ifosfamide.
List Assessment questions the nurse will ask the patient before administration: Ask patient if they
have any bleeding or any pain and any allergy
List specific instructions related to what time the medication should be administered: Take at
prescribed time. Do not overdose.
List labs the nurse would assess before administration: Cause false positive results when testing
urinary ketones.
2. Stomatitis
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Nursing Diagnosis: Impaired oral mucous membrane related to side effects of chemotherapeutic
drugs as evidence by painful lesions in the oral mucosa.
Goal: Patients mucous membranes will be free from harmful plaque to prevent secondary
infection. Patient will demonstrate proper oral hygiene.
Interventions:
1. Assess patients mouth discomfort. Discontinue flossing if it causes pain. Increases
sensitivity to pain is a result of thinning of oral mucosal lining.
2. Provide systemic or topical analgesics. This will provide comfort and relieve pain.
3. Encourage patient to rinse mouth with saline solution every 2 hours. This will reduce
further damage and may promote comfort.
4. Educate patient on to provide proper mouth care. Mouth care prevents formation of
oral plaques and bacteria.
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