1. Dactinomycin

2. the -rubicins

3. mechlorethamine (mustargen)

4. Vincristine

* Can cause extravasation

* Know emergency treatment before giving vesicants IV

Long -Term Consequences

* Possible infertility

* IRF secondary tumors

1. Cyclophosphamide (Cytoxan)

2. Mechlorethamine (Mustargen)

3. Cisplatin (Platinol)

4. Carboplatin (paraplatin)

Side Effects of Alykylating Agents

1. Bone Marrow Suppression

2. Hemorrhagic cystitis

3. Ototxic - will never recover

4. Pulmonary toxicity - need to discontinue drugs - will look like copd

5. Neurotoxic - peripheral neuropathy, pain

1. Methotrexate (Folex, Mexate)

2. Gemcitabine (Gemzar)

3. -bine

4. Fluoruracil (5FU)

1. Bone Marrow Toxicity

2. Hepatotoxic - liver failure is normal reason these drugs are discontinued)

3. Pregnancy Category X - must avoid pregnancy for 6 mo following last dose

4. Photosensitivity

1. Doxorubicin (Adriamycin)

2. - rubicin

3. Bleomycin (Blenoxane)

1. Cardiotoxic (irreversible HF)

2. Decreases Digoxin levels

1. Tamoxifen (Nolvadex)

2. Steroids

Note: It's all about estrogen (they look like they are going through menopause)

Nausea/Vomiting

IRF endometrial cancer

thromboemolitic disease

IRF blood clots

Hot flashes, fluid retention, vaginal discharge

1. Vincristine (Oncovin)

2. Docetazel (Taxotere)

3. Paclitaxel (Taxol)

4. Etoposide (VePesid)

1. Nervous system toxicity (numbness and tingling in limbs)

a. muscular weakness, loss of reflexes

b. paralytic ileus, constipation

2. Cardiotoxic

3. Acute bronchospasm: must be at bedside for first few administrations

4. Suicide ideation

5. Nephrotoxicity

Stimulate or assist client's immune system to rid itself of cancer cells

Less toxic

Interferons, interleukins, monoclonal antibodies

1. Sub Q administration 3X/week

2. Slow and controlled elevation of RBC (Max Hgb 36%)

3. Dangerous spike in BP - hard to treat; B-Blocker doesn't automatically help

4. Thrombolytic events

Accelerate neutrophil production and activation

Sub Q injection

Filgastim = HTN, St depression/MI, bone pain before neutrophils inrease

Start 24 hrs after chemo

Sargramostim (GM - CSF) (Leukine)

Granulocyte and Macrophage stimulation

IV administation and infused over 2 hrs

Respiratory Distress during administration
*Restlessness

* Dyspnea

* Tachycardia

Supraventricular Tachycardia

Use with caution with HF

1. Sub Q injection once daily 24 hrs after chemo

2. Takes 5 - 10 days for effects

3. Watch fluid retention

4. Withhold: 12 hrs b/f and after radiation therapy