ANTI-CANCER DRUGS CYCLOPHOSPHAMIDE Drug class: Alkylating drug Trade names: Cytoxan, Procytox, Endoxan, Neosar Pregnancy Category:

D Dosage: PO: initially: 1-5 mg/kg over 2-5 d; maint: 1-5 mg/kg/d IV: initially: 40-50 mg/kg in divided doses 2-5 d; max:100 mg/d;

maint: 10-15 mg/kg every 7-10 d

PO/IV: initially: 1-5 mg/kg in divided doses or 50-150 mg/m2 If bone marrow depression occurs, dose adjustment is necessary Contraindications: Hypersensitivity, severe bone marrow depression. Caution: Pregnancy, liver or kidney disease Therapeutic Effects/uses: Breast, lung, ovarian cancers; Hodgkins disease; leukemias; lymphomas. An immunosuppressant agent Mode of action: Inhibition of protein synthesis through interference with DNA replication by alkylation of DNA Side Effects : vomiting, diarrhea, weight loss, hematuria, alopecia, impotence, sterility, ovarian fibrosis, headache, dizziness, dermatitis Adverse Reactions: Hemorrhagic cystitis, secondary neoplasm, bone marrow depression

Life-threatening: leukopenia, thrombocytopenia, cardiotoxicity (very high doses),

hepatotoxicity (lon term) Assessment: Assess CBC, differential, and platelet count weekly. Drug may be withheld if RBC, WBC or platelet counts drop below predetermined levels

Conduct thorough PA; document findings Assess results of pulmonary function tests, chest radiographs, and renal and liver function studies during therapy Assess temp.; fever may be an early sign of infection Monitor for adequate intake and output

Nursing interventions: Monitor blood counts and lab. values Handle drug with care during preparation and administration; avoid direct skin, eye and mucus membrane contact with anticancer drugs. Follow protocols. Monitor IV site frequently for irritation and phebitis Administer antiemetic 30-60 mins. before giving drug Hydrate client with IV and/or oral fluids before chemotherapy is administered Monitor blood, urea, nitrogen (BUN), and creatinine prior to administration Assess for s/sx of hematuria, urinary frequency, or dysuria. Teach client to empty bladder every 2-3 hrs. fluids to 2-3 L/day to reduce the risk of hemorrhagic cystitis, urate deposition, or calculus formation Monitor fluid intake and output and nutritional intake Maintain strict medical asepsis during dressing changes and invasive procedures

FLUOROURACIL, 5-FLUOROURACIL, 5-FU Drug class: antiembolite Trade names: Adrucil, 5-FU, Efudex (topical) Pregnancy category: D Dosage: IV: 12 mg/kg/d x 4 d; max: 800 mg/d; repeat with 6 mg/kg on days

6,8,10 and 12 or as indicated

Maintenance dose: 10-15 mg/kg/wk as single dose; max: 1g/wk Topical: 1-2% sol/cream bid to head/neck lesions; 5% to other body areas Therapeutic effects: cancer of breast, cervix, colon, liver, ovary, pancreas, stomach, and rectum.. given in combination with levamisole after surgical resection in clients with Dukes stage C colon cancer Mode of action: Prevention of thymidine synthetase production, thereby inhibiting DNA and RNA synthesis; not phase specific Side effects: stomatitis, nausea, vomiting, diarrhea, alopecia, rash,

photosensitivity. Diarrhea may be severe Adverse reactions: bone marrow depression

Life-threatening: thrombocytopenia, myelosuppression, hemorrhage, renal failure

Assessment: Assess CBC, differential, and platelet count weekly. Drug may be withheld if RBC, WBC or platelet counts drop below predetermined levels Conduct thorough PA; document findings Assess renal function studies before and during drug therapy Assess temp.; fever may be an early sign of infection

Nursing interventions: Monitor blood counts and lab. values Handle drug with care during preparation and administration; avoid direct skin, eye and mucus membrane contact with anticancer drugs. Follow protocols. Monitor IV site frequently. Extravasation produces severe pain. If this ocuurs, apply ice pack and notify health care provider Administer antiemetic 30-60 mins. before drug to prevent vomiting Assess for hyperpigmentation along the vein in which 5-FU was administered Offer client food and fluids that may nausea (e.g., cola, crackers, ginger ale0

Plan small, frequent meals Maintain strict medical asepsis during dressing changes and invasive procedures Support good oral hygiene; brush teeth with soft toothbrush and use waxed dental floss Encourage mouth rinses every 2 hrs. with normal saline Monitor fluid intake and output and nutritional intake. GI effects are common on the fourth day of treatment

THIOTEPA (THIOPLEX) Thiotepa is a cancer (antineoplastic) medication. Thiotepa interferes with the growth of cancer cells and slows their growth and spread in the body.Thiotepa is used in the treatment of cancers of the breast, ovary, bladder, and others. SIDE EFFECTS OF THIOTEPA (THIOPLEX):

an allergic reaction (including difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); decreased bone marrow function and blood problems (extreme fatigue; easy bruising or bleeding; black, bloody or tarry stools; or fever, chills, or signs of infection); tissue or vein reactions near the site of administration; liver damage (abdominal pain, yellowing of the skin or eyes); severe nausea, vomiting, or loss of appetite; fever, chills, or other signs of infection; or painful or difficult urination. Other, less serious side effects may be more likely to occur. Continue taking thiotepa and talk to your doctor if you experience:

fatigue or weakness; mild to moderate nausea, vomiting, or loss of appetite; redness or inflammation of the eyes; dizziness, headache, or blurred vision; temporary hair loss; a loss of skin coloration; or decreased menstruation in women and decreased sperm production in men.

Important Information I Should Know About Thiotepa (Thioplex) Thiotepa should only be administered under the supervision of a qualified healthcare provider experienced in the use of cancer chemotherapeutic agents. Serious side effects have been reported with the use of thiotepa including: allergic reactions (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); severe heart damage with prolonged use; decreased bone marrow function and blood problems (extreme fatigue; easy bruising or bleeding; black, bloody or tarry stools; fever or chills; or signs of infection); severe nausea, vomiting,diarrhea, and loss of appetite; and others.

Methotrexate
Classification/Action : Antimetabolite,Antineoplastic,Antipsoriatic,Antirheumatic Mechanism of Action: Inhibits dihydrofolic acid reductase, leading to inhinbition of dividing cells. Indication: Treatment of gestational choriocarcinoma, chorioadenoma destruens, DNA

synthesis and inhibition of cellular replication; selectively affects the most rapidly

hytidiformmoles. Symptomatic control of severe,recalcitrant disabling psoriasis. Contraindication: Contraindicated with pregnancy, lactation, alcoholism, chronic liver disease, immune deficiencies,blood dyscrasias, hypersensitivity to methotrexate. Adverse effect: CNS: drowsiness, headache, dizziness, blurred vision, aphasia, hemiparesis, paresis, seizures, fatigue, malaise. GI: Ulterative stomatitis, gingivitis, pharyngitis, anorexia, nausea, vomiting, diarrhea, hematemesis, melana, GI ulceration and bleeding, enteritis, hepatic toxicity.

GU:

Renal Failure, effects on fertility (defective oogenesis, defective spermatogenesis, transient oligospermia, menstrual dysfunction, infertility, abortion, fetal defects) Hematologic: Severe bone marrow depression, increased susceptibility to infection. Hypersensitivity : Anaphylaxis, sudden death Respiratory: Interstitial pneumonitis, chronic interstitial obstructive pulmonary disease Other: Chills andfever, metabolic changes (diabetes,osteoporosis), cancer. Nursing responsibilities: Arrange for tests to evaluate CBC, urinalysis, renal and liver function tests ,and X-ray before therapy, during therapy and several weeks after therapy; severe toxicity could occur. Ensure patient is notpregnant beforeadministering drug. Reduce dosage ordiscontinue of renalfailure occurs. Arrange leucovorin or levoleucovorin readily available as antidote for methotrexate overdose or when large doses are used. Tell the patient to avoid NSAIDs and alcohol; serious side effects may occur.
AZACITIDINE-VIDAZA

CLINICAL

PHARMACOLOGY

Mechanism of Action VIDAZA is a pyrimidine nucleoside analog of cytidine. VIDAZA is believed to exert its antineoplastic effects by causing hypomethylation of DNA and direct cytotoxicity on abnormal hematopoietic cells in the bone marrow. The concentration of azacitidine required for maximum inhibition of DNA methylation in vitro does not cause major suppression of DNA synthesis. Hypomethylation may restore normal function to genes that are critical for differentiation and proliferation. The cytotoxic effects of azacitidine cause the death of rapidly dividing cells, including cancer cells that are no longer responsive to normal growth control mechanisms. Non-proliferating cells are relatively insensitive to azacitidine. 1. INDICATIONS 1.1 Myelodysplastic AND USAGE Syndromes (MDS)

VIDAZA is indicated for treatment of patients with the following FrenchAmerican-British (FAB) myelodysplastic syndrome subtypes: refractory anemia (RA) or refractory anemia with ringed sideroblasts (if accompanied by neutropenia or thrombocytopenia or requiring transfusions), refractory anemia with excess blasts (RAEB), refractory anemia with excess blasts in transformation (RAEB-T), and chronic myelomonocytic leukemia (CMMoL).

2. DOSAGE AND ADMINISTRATION 2.1 First Treatment Cycle The recommended starting dose for the first treatment cycle, for all patients regardless of baseline hematology laboratory values, is 75 mg/m2 subcutaneously or intravenously, daily for 7 days. Patients should be premedicated for nausea and vomiting. 2.2 Subsequent Treatment Cycles Cycles should be repeated every 4 weeks. The dose may be increased to 100 mg/m2 if no beneficial effect is seen after 2 treatment cycles and if no toxicity other than nausea and vomiting has occurred. It is recommended that patients be treated for a minimum of 4 to 6 cycles. However, complete or partial response may require additional treatment cycles. Treatment may be continued as long as the patient continues to benefit. 4. CONTRAINDICATIONS 4.1 Advanced Malignant Hepatic Tumors Mannitol VIDAZA is contraindicated in patients with advanced malignant hepatic tumors 4.2 Hypersensitivity to or mannitol. Azacitidine or VIDAZA is contraindicated in patients with a known hypersensitivity to azacitidine