Antineoplastic Drugs (Pharmacology)

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C|ass|f|cat|on]Drug
Name
1rade
Name]8rand
Name
8enef|ts
4/ky/otinq 4qents
nlLrogen musLard
(mechloreLhamlne
hydrochlorlde)
MusLargen ÞarL of comblnaLlon Lherapy of Podgkln's dlsease and
mallgnanL lymphomadsŦ used palllaLlvely lnť
8ronchogenlc carclnoma LeukemlasŦ AdmlnlsLered lnLo
cavlLles (peural perlLoneal) Lo prevenL reaccumulaLlon of
mallgnanL lnfuslonsŦ
chlorambucll Leukeran ManagemenL of chronlc lymphocyLlc leukemlaţ mallgnanL
lymphomaţ and Podgkln's dlsease (alone and ln
comblnaLlon wlLh oLher agenLs)Ŧ
cyclophosphamlde CyLoxan lnLerferes wlLh unA repllcaLlon and 8nA LranscrlpLlonţ
ulLlmaLely dlsrupLlng proLeln synLhesls (cellŴcycle phaseŴ
nonspeclflc)Ŧ1PL8AÞLu1lC LllLC1Sť deaLh of rapldly
repllcaLlng cellsţ parLlcularly mallgnanL onesŦ Also has
lmmunosuppressanL acLlon ln smaller dosesŦ
esLramusLlne LmcyL chemoLherapy agenL used Lo LreaL prosLaLe cancerŦ lL ls a
derlvaLlve of esLrogen (speclflcallyţ esLradlol) wlLh
a nlLrogen musLardŴcarbamaLe esLer moleLy LhaL makes lL
a alkylaLlng anLlneoplasLlc agenL slmllar
Lo mechloreLhamlneţ wlLh esLrogenŴlnduced speclflclLyŦ
lfosfamlde lfex lL ls glven as a LreaLmenL for a varleLy of cancersţ
lncludlngť 1esLlcular cancerţ 8reasL cancerţ
Lymphoma(noJqkloƌs ooJ NooŴnoJqkloƌs)ţ SofL Llssue
sarcomaţ CsLeogenlc sarcoma (8one cancer)ţ Lung
cancerţ Cervlcal cancerţ Cvarlan cancerŦ
melphalan Alkeran lL ls used Lo LreaL mulLlple myeloma and ovarlan cancerţ
and occaslonally mallgnanL melanomaŦ
uracll musLard uracll MusLard lL ls used ln lymphaLlc mallgnancles such as nonŴ
Podgklnƌs lymphomaŦ
-itrosoureos
carmusLlne 8lCnuţ 8Cnuţ
Clladel
lL ls used ln Lhe LreaLmenL of several Lypes of braln
cancer (lncludlng gllomaţ glloblasLoma
mulLlformeţ medulloblasLoma and asLrocyLoma)ţ mulLlple
myeloma and lymphoma (Podgklnƌs and nonŴPodgkln)Ŧ
8Cnu ls someLlmes used ln con[uncLlon wlLh alkyl
guanlne Lransferase (AC1) lnhlblLorsţ such
as C
6
ŴbenzylguanlneŦ 1he AC1ŴlnhlblLors lncrease Lhe
efflcacy of 8Cnu by lnhlblLlng Lhe ulrecL 8eversal
paLhway of unA repalrţ whlch wlll prevenL formaLlon of
Lhe lnLersLrand crossllnk beLween Lhe n
1
of guanlne and
Lhe n
3
of cyLoslneŦ
carmusLlne wlLh
pollfeprosan 20
lmplanL
Clladel Wafer lL ls used ln Lhe LreaLmenL of several Lypes of braln
cancer (lncludlng gllomaţ glloblasLoma
mulLlformeţ medulloblasLoma and asLrocyLoma)ţ mulLlple
myeloma and lymphoma (Podgklnƌs and nonŴPodgkln)Ŧ
8Cnu ls someLlmes used ln con[uncLlon wlLh alkyl
guanlne Lransferase (AC1) lnhlblLorsţ such as C
6
Ŵ
benzylguanlneŦ 1he AC1ŴlnhlblLors lncrease Lhe efflcacy
of 8Cnu by lnhlblLlng Lhe ulrecL 8eversal paLhway of
unA repalrţ whlch wlll prevenL formaLlon of
Lhe lnLersLrand crossllnk beLween Lhe n
1
of guanlne and
Lhe n
3
of cyLoslneŦ
lomusLlne Ceenuţ CCnu 8raln LumoursŤ 8eslsLanL or relapsed Podgklnƌs
dlseaseŤ Lung cancerŤ MallgnanL melanoma
sLrepLozocln Zanosar SLrepLozoLoclnlne ls approved by Lhe uŦSŦ lood and urug
AdmlnlsLraLlon (luA) for LreaLlng meLasLaLlc cancer of
Lhe pancreaLlc lsleL cellsŦ
4/ky/otinqŴLike 4qents
alLreLamlne Pexalen
lL ls used Lo LreaL refracLory ovarlan cancerŦ
lL ls noL consldered a flrsLŴllne LreaLmenLţ

buL lL can be
useful as salvage LherapyŦ

lL also has Lhe advanLage of
belng less Loxlc Lhan oLher drugs used for LreaLlng
refracLory ovarlan cancerŦ
carboplaLln ÞaraplaLln A chemoLherapy drug used agalnsL some forms
of cancer (malnly ovarlan carclnomaţ lungţ head and neck
cancers)Ŧ
clsplaLln ÞlaLlnol lL ls used Lo LreaL varlous Lypes of cancersţ
lncludlng sarcomasţ some carclnomas (eŦgŦ small cell lung
cancerţ and ovarlan cancer)ţ lymphomasţ and germ cell
LumorsŦ
dacarbazlne u1lC used ln Lhe LreaLmenL of varlous cancersţ among
Lhem mallgnanL melanomaţ Podgkln
lymphomaţ sarcomaţ and lsleL cell carclnoma of Lhe
pancreasŦ
oxallplaLln LloxaLln A coordlnaLlon complex LhaL ls used ln
cancer chemoLherapyŦ
plpobroman vercyLe


LhloLepa 1hloplex used Lo LreaL cancerŦ
4/ky/ 5u/fonotes
busulfan Myleran lLs maln uses are ln bone marrow LransplanLaLlonţ
especlally ln chronlc myelogenous leukemla (CML)ţ
where lL ls used as a condlLlonlng drugŦ lLs mechanlsm of
acLlon Lhrough alkylaLlon produces guanlneŴ
adenlne lnLrasLrand crossllnksŦ 1hls occurs Lhrough
an Sn2 reacLlon ln whlch Lhe
relaLlvely nucleophlllc guanlne n7 aLLacks Lhe carbon
ad[acenL Lo Lhe mesylaLe leavlng groupŦ 1hls klnd of
damage cannoL be repalred by cellular machlnery and
Lhus Lhe cell undergoes apopLosls lLs maln uses are
ln bone marrow LransplanLaLlonţ especlally ln chronlc
myelogenous leukemla (CML)ţ where lL ls used as a
condlLlonlng drugŦ lLs mechanlsm of acLlon
Lhrough alkylaLlon produces guanlneŴadenlne lnLrasLrand
crossllnksŦ 1hls occurs Lhrough an Sn2 reacLlon ln whlch
Lhe relaLlvely nucleophlllc guanlne n7 aLLacks Lhe carbon
ad[acenL Lo Lhe mesylaLe leavlng groupŦ 1hls klnd of
damage cannoL be repalred by cellular machlnery and
Lhus Lhe cell undergoes apopLoslsŦ
4ntimetobo/ites
follc acld anLagonlsL A meLaŴanalysls publlshed ln 2010 falled Lo flnd a
sLaLlsLlcally slgnlflcanL cancer rlsk due Lo follc acld
LreaLmenLsŦ
meLhoLrexaLe M1xţ
ameLhopLerlnţ
lolexţ MexaLe
used for chemoLherapy elLher alone or ln comblnaLlon
wlLh oLher agenLsŦ lL ls effecLlve for Lhe LreaLmenL of a
number of cancers lncludlngť breasLţ head and
neckţ leukemlaţ lymphomaţ lungţ osLeosarcomaţ bladderţ
and LrophoblasLlc neoplasmsŦ
pemeLrexed dlsodlum AllmLa MallgnanL pleural mesoLhelloma ln comblnaLlon w/
clsplaLlnţ locally advanced or meLasLaLlc nonŴsmall
cell lung cancer afLer prlor chemoLherapyŦ
Pyrimidine 4no/oques
azaclLldlne vldaza 1reaLmenL of myelodysplasLlc syndrome subLypesť
8efracLory anemla or refracLory anemla w/ rlnged
slderoblasLs (lf accompanled
by neuLropenla orLhrombocyLopenla or requlrlng
Lransfuslons)ţ refracLory anemla w/ excess blasLsţ
refracLory anemla w/ excess blasLs ln LransformaLlon Ǝ
chronlc myelomonocyLlc leukemlaŦ
capeclLablne xeloda CrallyŴadmlnlsLered chemoLherapeuLlc agenL used ln Lhe
LreaLmenL of meLasLaLlcbreasL and colorecLal cancersŦ
CapeclLablne ls a prodrugţ LhaL ls enzymaLlcally
converLed Lo 3Ŵfluorouracll ln Lhe Lumorţ where lL
lnhlblLs unA synLhesls and slows growLh of Lumor LlssueŦ
cyLarablne PCl CyLosarŴuţ A8AŴC ChemoLherapy agenL used malnly ln Lhe LreaLmenL
of cancers of whlLe blood cells such as acuLe myelold
leukemla (AML) and nonŴPodgkln lymphomaŦ lL ls also
known as AraŴC (Arablnofuranosyl CyLldlne)Ŧ lL desLroys
cancer cells by lnLerferlng wlLh unA synLheslsŦ
floxurldlne luu8 1he drug ls mosL ofLen used ln Lhe LreaLmenL of
colorecLal cancerŦ lloxurldlne works because lL ls broken
down by Lhe body lnLo lLs acLlve formţ whlch ls Lhe same
as a meLabollLe of 3ŴlluorouracllŦ
fluorouracll 3Ŵluţ Adrucll 1he chemoLherapy agenL 3Ŵlu (fluorouracll)ţ whlch has
been ln use agalnsL cancer for abouL 40 yearsţ acLs ln
several waysţ buL prlnclpally as aLhymldylaLe synLhase
lnhlblLorŦ lnLerrupLlng Lhe acLlon of Lhls enzyme blocks
synLhesls of Lhe pyrlmldlne Lhymldlneţ whlch ls a
nucleoslde requlred for unA repllcaLlonŦ 1hymldylaLe
synLhase meLhylaLes deoxyurldlne monophosphaLe
(duMÞ) lnLo Lhymldlne monophosphaLe (d1MÞ)Ŧ
AdmlnlsLraLlon of 3Ŵlu causes a scarclLy ln d1MÞţ so
rapldly dlvldlng cancerous cells undergo cell deaLh
vla Lhymlneless deaLhŦ
gemclLablne PCl Cemzar Chemlcally gemclLablne ls a nucleoslde analog ln whlch
Lhe hydrogen aLoms on Lhe 2ƌ carbon
of deoxycyLldlne are replaced by fluorlne aLomsŦ
CemclLablne ls used ln varlous carclnomasť nonŴsmall
cell lung cancerţ pancreaLlc cancerţ bladder
cancer and breasL cancerŦ lL ls belng lnvesLlgaLed for use
ln esophageal cancerţ and ls used experlmenLally
ln lymphomas and varlous oLher Lumor LypesŦ
CemclLablne represenLs an advance ln pancreaLlc cancer
care
Ŧ
lL ls also noL as deblllLaLlng as some oLher forms of
chemoLherapyŦ
procarbazlne PCl MaLulane urug for Lhe LreaLmenL of Podgklnƌs lymphoma and
cerLaln braln cancers (such as ClloblasLoma mulLlforme)Ŧ
lL ls a member of a group of medlclnes called alkylaLlng
agenLsŦ lL galned luA Approved ln !uly 1969Ŧ 1he drug ls
meLabollzed and acLlvaLed ln Lhe llverŦ lL also
lnhlblLs MAC Lhus lncreaslng Lhe effecLs
of sympaLhomlmeLlcsţ 1CAsţ and LyramlneŦ
nelarablne Arranon ls lndlcaLed for Lhe LreaLmenL of paLlenLs wlLh 1Ŵcell
acuLe lymphoblasLlc leukemla and 1Ŵcell
lymphoblasLlc lymphoma whose dlsease has noL
responded Lo or has relapsed followlng LreaLmenL wlLh aL
leasL Lwo chemoLherapy reglmensŦ
Purine 4no/oques
cladrlblne LeusLaLln used Lo LreaL halry cell leukemla (PCLţ leukemlc
reLlculoendoLhellosls) and mulLlple scleroslsŦ lLs chemlcal
name ls 2Ŵchlorodeoxyadenoslne (2CuA)Ŧ
clofarablne Clolar
fludarablne lludara lludarablne ls hlghly effecLlve ln Lhe LreaLmenL of chronlc
lymphocyLlc leukemlaţ produclng hlgher response raLes
Lhan alkylaLlng agenLs such aschlorambucll aloneŦ
lludarablne lnhlblLs unA synLhesls by lnLerferlng
wlLh rlbonucleoLlde reducLase and unA polymeraseŦ
6ŴmercapLopurlne 6ŴMÞţ ÞurlneLhol lL ls used Lo LreaL leukemlaţ pedlaLrlc nonŴPodgklnƌs
lymphomaţ polycyLhemla veraţ psorlaLlc arLhrlLlsţ and
lnflammaLory bowel dlsease (such as Crohnƌs
dlsease and ulceraLlve collLls)Ŧ
Lhloguanlne Lanvls lLs prlnclpal use ls ln acuLe leukaemlas and chronlc
myelold leukaemlaŦ lL has been lnvesLlgaLed for use ln
LreaLmenL of psorlaslsŦ
ibonuc/eotide
eductose lnhibitors

hydroxyurea Pydrea 1reaLmenL for sysLemlc masLocyLoslsŦ Cne mechanlsm of
acLlon ls LhoughL Lo be based on lLs reducLlon of
producLlon of deoxyrlbonucleoLldes vla lnhlblLlon of Lhe
enzyme rlbonucleoLlde reducLase by scavenglng Lyrosyl
free radlcals as Lhey are lnvolved ln Lhe reducLlon nuÞsŦ
1rlmeLrexaLe
glucuronaLe
neuLrexln lL has been used wlLh leucovorln ln
LreaLlng pneumocysLls pneumonlaŦ lL has been
lnvesLlgaLed for use ln LreaLlng lelomyosarcomaŦ lL ls a
meLhoLrexaLe (M1x) analog LhaL ls acLlve agalnsL
LransporLŴdeflclenL M1xŴreslsLanL Lumor cells LhaL
overcome Lhe acqulred and naLural reslsLance Lo
meLhoLrexaLeŦ CLher uses lnclude skln lymphomaŦ
2Ŵdeoxycoformycln ÞenLosLaLlnţ
nlpenLţ uCl
lL ls classlfled as a purlne analogueţ whlch ls a Lype
of anLlmeLabollLeŦ lL mlmlcs
Lhe nucleoslde adenoslne and Lhus lnhlblLs Lhe
enzyme adenoslne deamlnaseţ lnLerferlng wlLh Lhe cellƌs
ablllLy Lo process unAŦ

Cancer cells generally dlvlde more
ofLen Lhan healLhy cellsŤ unA ls hlghly lnvolved ln cell
dlvlslon (mlLosls) and drugs whlch LargeL unAŴrelaLed
processes are Lherefore more Loxlc Lo cancer cells Lhan
healLhy cellsŦ ÞenLosLaLln ls used Lo LreaL halry cell
leukemlaŦ lL ls glven by lnLravenous lnfuslon once every
Lwo weeks for Lhree Lo slx monLhsŦ
£ntyme lnhibitors
penLosLaLln nlpenL lL ls classlfled as a purlne analogţ whlch ls a Lype
of anLlmeLabollLeŦ lL mlmlcs
Lhe nucleoslde adenoslne and Lhus lnhlblLs Lhe
enzyme adenoslne deamlnaseţ lnLerferlng wlLh Lhe cellƌs
ablllLy Lo process unAŦ

Cancer cells generally dlvlde more
ofLen Lhan healLhy cellsŤ unA ls hlghly lnvolved ln cell
dlvlslon (mlLosls) and drugs whlch LargeL unAŴrelaLed
processes are Lherefore more Loxlc Lo cancer cells Lhan
healLhy cellsŦ ÞenLosLaLln ls used Lo LreaL halry cell
leukemlaŦ lL ls glven by lnLravenous lnfuslon once every
Lwo weeks for Lhree Lo slx monLhsŦ
Mitotic lnhibitors
vlnca alkalolds used ln Lhe LreaLmenL of cancerŦ 1hey are a class of cellŴ
cycleŴspeclflc cyLoLoxlc drugs whlch work by lnhlblLlng
Lhe ablllLy of cancer cells Lo dlvldeť acLlng upon Lubullnţ
Lhey prevenL lL from formlng lnLo mlcroLubulesţ a
necessary componenL for cellular dlvlslonŦ vlnca alkalolds
are now produced synLheLlcally and used as drugs ln
cancer Lherapy and as lmmunosuppresslve drugsŦ
vlnblasLlne sulfaLe velban used ln Lhe LreaLmenL of cancerŦ 1hey are a class of cellŴ
cycleŴspeclflc cyLoLoxlc drugs whlch work by lnhlblLlng
Lhe ablllLy of cancer cells Lo dlvldeť acLlng upon Lubullnţ
Lhey prevenL lL from formlng lnLo mlcroLubulesţ a
necessary componenL for cellular dlvlslonŦ
vlncrlsLlne sulfaLe Cncovln vlncrlsLlne ls dellvered vla lnLravenous lnfuslon for use ln
varlous Lypes of chemoLherapy reglmensŦ lLs maln uses
are ln nonŴPodgklnƌs lymphoma as parL of Lhe
chemoLherapy reglmen CPCÞţ Podgklnƌs lymphoma as
parL of MCÞÞţ CCÞÞţ 8LACCÞÞţ or Lhe less
popular SLanford v chemoLherapy reglmenţ lnacuLe
lymphoblasLlc leukemlaţ and ln LreaLmenL
for nephroblasLomaŦ
vlncrlsLlne (llposomal) Marqlbo ln comblnaLlon Lherapy reglmen for acuLe leukemla Ǝ
Podgkln's dlsease Ǝ oLher lymphomas lncludlng 8urklLL's
lymphomaŦ
vlnorelblne navelblne vlnorelblne ls approved for Lhe LreaLmenL of non small
cell lung cancer and MeLasLaLlc breasL cancerŦ lL ls also
acLlve ln rhabdomyosarcomaŦ
4ntimicrotubu/es or
1oxones

doceLaxel 1axoLere lL ls used malnly for Lhe LreaLmenL of breasLţ ovarlanţ
prosLaLeţ and nonŴsmall cell lung cancerŦ
pacllLaxel 1axol used Lo LreaL paLlenLs wlLh lungţ ovarlanţ breasL cancerţ
head and neck cancerţ and advanced forms of kaposlƌs
sarcomaŦ ÞacllLaxel ls also used for Lhe prevenLlon
of resLenoslsŦ
4ntitumor 4ntibiotics
bleomycln sulfaLe 8lenoxane 1he drug ls used ln Lhe LreaLmenL of Podgklnƌs
lymphoma (as a componenL of
Lhe A8vu reglmen)ţ squamous cell carclnomasţ
and LesLlcular cancerţ as well as ln Lhe LreaLmenL
of planLar warLs and as a means of effecLlng pleurodeslsŦ
dacLlnomycln AcLlnomycln uţ
Cosmegen
AcLlnomycln u ls prlmarlly used as an lnvesLlgaLlve Lool ln
cell blology Lo lnhlblL LranscrlpLlonŦ lL does Lhls by
blndlng unA aL Lhe LranscrlpLlon lnlLlaLlon complex and
prevenLlng elongaLlon by 8nA polymeraseŦ 8ecause lL
can blnd unA duplexesţ lL can also lnLerfere wlLh unA
repllcaLlonţ alLhough oLher chemlcals such
as hydroxyurea are beLLer sulLed for use ln Lhe laboraLory
as lnhlblLors of unA synLheslsŦ
daunorublcln PCl Cerubldlne lL slows or sLops Lhe growLh of cancer cells ln Lhe bodyŦ
1reaLmenL ls usually performed LogeLher wlLh oLher
chemoLherapy drugs (such as cyLarablne)ţ and lLs
admlnlsLraLlon depends on Lhe Lype of Lumor and Lhe
degree of responseŦ
daunorublcln
(llposomal)
uaunoxome a chemoLherapy drug LhaL ls luA approved Lo
LreaL AluS relaLed kaposlƌs sarcomaŦ lL ls also commonly
used Lo LreaL speclflc Lypes ofleukaemla and nonŴPodgkln
lymphomaŦ Llposomal daunorublcln ls lnLravenously
admlnlsLeredŦ
doxorublcln Adrlamyclnţ 8ubex uoxorublcln lnLeracLs wlLh unA by lnLercalaLlon and
lnhlblLlon of macromolecular blosynLheslsŦ 1hls lnhlblLs
Lhe progresslon of Lhe enzyme Lopolsomerase llţ whlch
relaxes supercolls ln unA for LranscrlpLlonŦ uoxorublcln
sLablllzes Lhe Lopolsomerase ll complex afLer lL has
broken Lhe unA chaln for repllcaLlonţ prevenLlng Lhe
unA double hellx from belng resealed and Lhereby
sLopplng Lhe process of repllcaLlonŦ
doxorublcln PCl
(llposomal)
uoxllţ Caelyxţ
MyoceL
lL was developed Lo LreaL kaposlƌs sarcomaţ an AluSŴ
relaLed cancer LhaL causes leslons Lo grow under Lhe sklnţ
ln Lhe llnlng of Lhe mouLhţ nose and LhroaLţ or ln oLher
organsŦ 1he polyeLhylene glycol coaLlng resulLs ln
preferenLlal concenLraLlon of uoxll ln Lhe sklnŦ
eplrublcln Lllence Lplrublcln ls prlmarlly used agalnsL breasL and ovarlan
cancerţ gasLrlc cancerţ lung cancerţ and lymphomasŦ
ldarublcln ldamycln A flrsL llne LreaLmenL of acuLe myelold leukemla
mlLomycln MuLamycln MlLomycln C ls a poLenL unA crossllnkerŦ A slngle
crossllnk per genome has shown Lo be effecLlve ln kllllng
bacLerlaŦ 1hls ls accompllshed by reducLlve acLlvaLlon
followed by Lwo nŴalkylaLlonsŦ
mlLoxanLrone novanLrone lL ls used ln Lhe LreaLmenL of cerLaln Lypes of cancerţ
mosLly meLasLaLlc breasL cancerţ acuLe myelold leukemlaţ
and nonŴPodgklnƌs lymphomaŦ lL was also shown Lo
lmprove Lhe survlval of chlldren sufferlng from flrsL
relapse of acuLe lymphoblasLlc leukaemlaŦ
pllcamycln MlLhracln Þllcamycln has been used ln Lhe LreaLmenL of LesLlcular
cancerţ

ÞageLƌs dlsease of boneţ andţ rarelyţ Lhe
managemenL of hypercalcemlaŦ Þllcamycln has been
LesLed ln chronlc myelold leukemlaŦ Þllcamycln ls
currenLly used ln mulLlple areas of researchţ lncludlng
cancer cell apopLosls and as a meLasLasls lnhlblLorŦ
valrublcln valsLar used Lo LreaL bladder cancerŦ valrublcln ls a
semlsynLheLlc analog of Lhe anLhracycllne doxorublclnţ
and ls admlnlsLered by lnfuslon dlrecLly lnLo Lhe bladderŦ
1orqeted 1heropies
loolJs
bexaroLene 1argreLln are lndlcaLed for Lhe LreaLmenL of cuLaneous
manlfesLaLlons of cuLaneous 1Ŵcell lymphoma ln paLlenLs
who are refracLory Lo aL leasL one prlor sysLemlc LherapyŦ
Lhalldomlde 1halomld lor Lhe LreaLmenL of LryLhema nodosum leprosum (1ype
2) and mulLlple myelomaŦ
lenalldomlde
(derlvaLlve of
Lhalldomlde)
8evllmld used ln comblnaLlon w/ dexameLhasone for Lhe
LreaLmenL of mulLlple myeloma paLlenLs who have
recelved aL leasL 1 prlor LherapyŦ
ormonesţ ormono/
4ntoqonistsţ ond
£ntymes
oJtoqos
LesLolacLone 1eslac


progesLerone CesLerol 30


notmoool ooqoolss
ooJ íozyms

amlnogluLeLhlmlde CyLadren ls lndlcaLed for Lhe suppresslon of adrenal funcLlon ln
selecLed paLlenLs wlLh Cushlngƌs syndromeŦ Mornlng
levels of plasma corLlsol ln paLlenLs wlLh adrenal
carclnoma and ecLoplc AC1PŴproduclng Lumors were
reduced on Lhe average Lo abouL one half of Lhe
preLreaLmenL levelsţ and ln paLlenLs wlLh adrenal
hyperplasla Lo abouL Lwo Lhlrds of Lhe preLreaLmenL
levelsţ durlng 1Ŵ3 monLhs of Lherapy wlLh CyLadrenŦ
anasLrozole Arlmldex 1reaLmenL of advanced breasL cancer ln posLmenopausal
womenŦ Ad[uvanL LreaLmenL of posLmenopausal women
w/ hormone recepLor +ve early lnvaslve breasL cancer Ǝ
ln early breasL cancer ln hormone recepLor +ve
posLmenopausal women who have recelved 2Ŵ3 yr of
ad[uvanL LamoxlfenŦ
blcaluLamlde Casodex Advanced prosLaLe cancer ln comblnaLlon w/ LP8P
analogue Lherapy or surglcal casLraLlonŦ
exemesLrane Aromasln Ad[uvanL LreaLmenL of posLmenopausal women w/
esLrogenŴrecepLor +ve or unknown early breasL cancer Ǝ
conLralaLeral breasL cancerŦ 1sLŴllne LreaLmenL hormoneŴ
recepLor +ve advanced breasL cell cancer (A8C)ţ 2nd/3rdŴ
llne LreaLmenL of A8C progressed dlsease followlng anLlŴ
esLrogen Lherapy alone or mulLlple hormonal Lheraples ln
women w/ naLural/lnduced posLmenopausal sLaLusŦ
fluLamlde Lulexln 1reaLmenL of paLlenLs w/ advanced prosLaLe cancer ln
whlch suppresslon of LesLosLerone effecLs ls lndlcaLedŤ
lnlLlal LreaLmenL ln comblnaLlon wlLh LPŴ8P analogue or
ln con[uncLlon w/ orchlecLomy (LoLal blocklng of
androgens)ţ as well as paLlenLs who are already belng
LreaLed w/ LPŴ8P analogue or Lhose who have
undergone surglcal removal of LesLesŤ LreaLmenL of
paLlenLs who dld noL respond Lo oLher forms of
endocrlne LreaLmenL or for whom oLher endocrlne
LreaLmenL ls noL well LoleraLed buL a necesslLyŦ
fulvesLranL laslodex 1reaLmenL of posLmenopausal women w/ esLrogen
recepLor +veţ locally advanced or meLasLaLlc breasL
cancer for dlsease relapse on or afLer ad[uvanL
anLlesLrogen Lherapy or dlsease progresslon on Lherapy
w/ an anLlesLrogenŦ
goserelln aceLaLe Zoladex ManagemenL of prosLaLe Ǝ breasL cancer ln
premenopausal Ǝ perlmenopausal women sulLable for
hormonal manlpulaLlonŤendomeLrloslsŤ endomeLrlal
LhlnnlngŤ ln con[uncLlon w/ le Lherapy ln hemaLologlcal
lmprovemenL of anemlc paLlenLs w/ uLerlne flbrolds preŴ
opŤ asslsLed reproducLlonŦ
hlsLrelln aceLaLe
lmplanL
vanLas ls lndlcaLed ln Lhe palllaLlve LreaLmenL of
advanced prosLaLe cancerŦ
leLrozole lemara 1sLŴllne LreaLmenL ln posLmenopausal women w/
hormoneŴdependenL advanced breasL cancerŦ Advanced
breasL cancer ln women w/ naLural or arLlflclally lnduced
posLmenopausal sLaLusţ who have prevlously been
LreaLed w/ anLlesLrogensŦ ÞreŴop Lherapy ln
posLmenopausal women w/ locallzed hormone recepLor
+ve breasL cancerţ Lo allow subsequenL breasLŴconservlng
surgeryţ exLended ad[uvanL LreaLmenL of early breasL
cancer ln posLmenopausal women who have recelved
prlor sLandard ad[uvanL Lamoxlfen LherapyŦ
leuprollde aceLaLe Lupron


megesLrol aceLaLe Megace


mlLoLane Lysodren lndlcaLed ln Lhe LreaLmenL of lnoperable adrenal corLlcal
carclnoma of boLh funcLlonal and nonfuncLlonal LypesŦ
nlluLamlde nllandron lndlcaLed for use ln comblnaLlon wlLh surglcal casLraLlon
for Lhe LreaLmenL of meLasLaLlc prosLaLe cancer (SLage
u2)Ŧ lor maxlmum beneflLţ nlLAnu8Cn LreaLmenL musL
begln on Lhe same day as or on Lhe day afLer surglcal
casLraLlonŦ
polyesLradlol
phosphaLe
LsLradurln


raloxlfene
hydrochlorlde
LvlsLa lndlcaLed for Lhe reducLlon ln rlsk of lnvaslve breasL
cancer ln posLmenopausal women aL hlgh rlsk of lnvaslve
breasL cancer
Lamoxlfen clLraLe
(nonŴsLeroldal
anLlesLrogen
nolvadex lor Lhe LreaLmenL of breasL cancer or lnovulaLory
lnferLlllLyŦ
Lorlmlfene laresLon ls lndlcaLed for Lhe LreaLmenL of meLasLaLlc breasL
cancer ln posLmenopausal women wlLh esLrogenŴ
recepLor poslLlve or unknown LumorsŦ
,lsclloooos
íozyms

LŴasparaglnase Llspar ls lndlcaLed as a componenL of a mulLlŴagenL
chemoLherapeuLlc reglmen for Lhe LreaLmenL of paLlenLs
wlLh acuLe lymphoblasLlc leukemla (ALL)Ŧ
pegaspargase Cncaspar ls lndlcaLed as a componenL of a mulLlŴagenL
chemoLherapeuLlc reglmen for Lhe flrsL llne LreaLmenL of
paLlenLs wlLh ALL and hypersenslLlvlLy Lo LŴasparaglnaseŦ
io/oqico/ 1heropies
yoklos
lnLerferonŴalphaŴ2aţ
recomblnanL
8oferonŴAţ rllnŴA ls lndlcaLed for Lhe LreaLmenL of chronlc hepaLlLls C and
halry cell leukemla ln paLlenLs 18 years of age or olderŦ ln
addlLlonţ lL ls lndlcaLed for chronlc phaseţ Þhlladelphla
chromosome (Þh) poslLlve chronlc myelogenous
leukemla (CML) paLlenLs who are mlnlmally preLreaLed
(wlLhln 1 year of dlagnosls)Ŧ
lnLerferonŴalphaŴ2bţ
recomblnanL
lnLronŴAţ llnŴalpha
2



lnLerleuklnŴ2 lLŴ2


aldesleukln Þroleukln lor Lhe LreaLmenL of MeLasLaLlc melanomaŤ MeLasLaLlc
renal cell carclnoma
Monoc/ono/
4ntibodies

Iocclos
CuadrlvalenL human
paplllomavlrus (1ypes
6ţ 11ţ 16ţ 18)
recomblnanL vacclne
Cardasll ÞrevenLlon of cervlcalţ vulvar Ǝ vag cancerŤ premallgnanL
genlLal leslons (cervlcalţ vulvar Ǝ vag)ţ PÞv lnfecLlonţ
cervlcal adenocarclnoma lo slo (AlS) Ǝ exLernal genlLal
warLs (ooJylomo ocomlooo) causally relaLed Lo PÞv
Lypes 6ţ 11ţ 16 Ǝ 18 ln glrls Ǝ women 9Ŵ26 yrŦ
Puman paplllomavlrus
vacclneţ AS04
ad[uvanLŴabsorbed
Cervarlx

ln females from 10Ŵ23 yrţ for Lhe prevenLlon of perslsLenL
lnfecLlonţ premallgnanL cervlcal leslons Ǝ cervlcal cancer
caused by PÞv Lypes 16 Ǝ 18Ŧ

nurslng 8esponslblllLlesť
ALk¥LA1ING DkUGSť C¥CLCÞnCSÞnAMIDL (C¥1CkAN)
ASSLSSMLn1
O Assess compleLe blood counL (C8C)ţ dlfferenLlalţ and plaLeleL counL weeklyŦ ChemoLherapy may
be held lf red cellţ whlLe cellţ or plaLeleL counLs drop below predeLermlned levelsŦ
O ConducL Lhorough physlcal assessmenLŤ documenL flndlngsŦ
O Assess resulLs of pulmonary funcLlon LesLsţ chesL radlographsţ and renal and llver funcLlon
sLudles durlng LherapyŦ
O Assess LemperaLureŤ fever may be an early slgn of lnfecLlonŦ
O MonlLor for adequaLe lnLake and ouLpuLŦ
nu8SlnC ulACnCSLS
O 8lsk for lnfecLlon relaLed Lo bone marrow depresslon
O 8lsk for lmbalanced nuLrlLlonť less Lhan body requlremenLs relaLed Lo Cl slde effecLs of
chemoLherapy
O 8lsk for lmpalred urlnary ellmlnaLlon relaLed Lo hemorrhaglc cysLlLls caused by chemoLherapy
O 8lsk for abnormal bleedlng relaLed Lo effecLs of chemoLherapy on Lhe llnlng of Lhe bladder
and/or bone marrow depresslon
O ueflclenL knowledge (paLlenL/famlly/careglvers) relaLed Lo chemoLherapeuLlc proLocol
O 8lsk for sexual dysfuncLlon relaLed Lo lnLerference wlLh normal mensLrual cycle (ln females) or
lack of sperm producLlon (ln males)
O ulsLurbed body lmage relaLed Lo halr Lhlnnlng and/or loss
ÞLAnnlnC
O CllenL wlll have whlLe cellţ red cellţ and plaLeleL counLs ln Lhe deslred rangeŦ
O CllenL wlll remaln free from lnfecLlonŦ
O CllenL wlll malnLaln nuLrlLlonal sLaLus (adequaLe fluld lnLake and ouLpuLţ sufflclenL calorlc lnLakeţ
sLable welghL)Ŧ
O CllenL wlll malnLaln adequaLe urlnary ouLpuLŦ
O CllenL wlll remaln free of sympLoms of hemorrhaglc cysLlLlsŦ
O CllenL/famlly/careglver wlll demonsLraLe undersLandlng of chemoLherapeuLlc proLocol (eŦgŦţ
doseţ admlnlsLraLlonţ slde effecLsţ adverse reacLlons)
nu8SlnC ln1L8vLn1lCnS
O MonlLor blood counLs and laboraLory valuesŦ
O Pandle drug wlLh care durlng preparaLlon and admlnlsLraLlonŤ avold dlrecL sklnţ eyeţ and mucus
membrane conLacL wlLh anLlcancer drugsŦ lollow proLocolsŦ
O MonlLor lv slLe frequenLly for lrrlLaLlon and phleblLlsŦ
O AdmlnlsLer anLlemeLlc 30 Lo 60 mlnuLes before glvlng drugŦ
O PydraLe cllenL wlLh wlLh lv and/or oral flulds before chemoLherapy ls admlnlsLeredŦ
O MonlLor bloodţ ureaţ nlLrogen (8un)ţ and creaLlnlne prlor Lo admlnlsLraLlonŦ
O Assess for slgns and sympLoms of hemaLurlaţ urlnary frequencyţ or dysurlaŦ 1each cllenL Lo
empLy bladder every 2Ŵ3 hoursŦ
O lncrease flulds Lo 2 Lo 3 L/day Lo reduce rlsk of hemorrhaglc cysLlLlsţ uraLe deposlLlonţ or calculus
formaLlonŦ
O MonlLor fluld lnLake and ouLpuL and nuLrlLlonal lnLakeŦ
O MalnLaln sLrlcL medlcal asepsls durlng dresslng changes and lnvaslve proceduresŦ
O CllenL Leachlngť
4 Ceneral
Lmphaslze proLecLlve precauLlons as necessary (eŦgŦţ handwashlngţ personal
hyglene)Ŧ
1each cllenL Lo Lake cyclophosphamlde early ln Lhe day Lo prevenL accumulaLlon
of drug ln Lhe bladder durlng Lhe nlghLŦ
8emlnd cllenL Lo consulL wlLh a healLh care provlder before admlnlsLraLlon of
any vacclnesŦ
Advlse cllenL LhaL cyclophosphamlde ls excreLed ln breasL mllkŦ 1esLlcular
aLrophy and reverslble ollgospermla/azoospermla may occur ln malesŦ
1each lmporLance of uslng blrLh conLrol measures as approprlaLeŦ ulscuss
spermŴbanklng wlLh male cllenLs as approprlaLeŦ
1each cllenL LhaL pregnancy should be avolded for 3Ŵ4 monLhs afLer compleLlng
anLlneoplasLlc Lherapy ln mosL slLuaLlonsŦ Some sources recommend LhaL boLh
men and women avold concepLlon for 2 years afLer compleLlon of LreaLmenLŦ
Advlse cllenL noL Lo vlslL anyone who has a resplraLory lnfecLlonŦ A decreased
W8C counL puLs cllenL aL hlgh rlsk for acqulrlng an lnfecLlonŦ
lnsLrucL cllenL Lo prompLly reporL slgns of lnfecLlon (eŦgŦţ elevaLed LemperaLureţ
feverţ chlllsţ sore LhroaLţ frequencyţ and/or burnlng on urlnaLlonţ
redness/swelllng/paln near a wound)Ť bleedlng (eŦgŦţ bleedlng gumsţ peLechlaeţ
brulsesţ hemaLurlaţ blood ln Lhe sLool)Ť and anemla (eŦgŦţ lncreased faLlgueţ
dyspneaţ orLhosLaLlc hypoLenslon)Ŧ
4 Slde LffecLs
lnsLrucL cllenL abouL good oral hyglene wlLh a sofL LooLhbrush for sLomaLlLlsŤ
have cllenL use a sofL LooLhbrush when plaLeleL counL ls Ƽ30ţ000/mm
3
Ŧ
8emlnd premenopausal females LhaL Lhey may experlence amenorrheaţ
mensLrual lrregularlLlesţ or sLerlllLyŤ lnsLrucL male cllenLs LhaL Lhey may
experlence lmpoLenceŦ
Advlse cllenL of posslble halr lossŤ recommend a wlgţ halrpleceţ scarfţ or LurbanŦ
Assess for use of alLernaLlve/complemenLary Lherapy LhaL may lnLeracL wlLh
chemoLherapy agenLŦ
4 uleL
Advlse cllenL Lo follow a dleL low ln purlnes (eŦgŦţ organ meaLsţ beansţ peas) Lo
alkallze urlneŦ
Advlse cllenL Lo avold clLrlc acldŦ
Cffer cllenL food and flulds LhaL may decrease nausea (eŦgŦţ colaţ crackersţ
glnger ale)Ŧ
Þlan smallţ frequenL mealsŦ
O CulLural ConslderaLlons
ln some nonŴWesLern culLural groupsţ healLh care declslons are made by
consensusţ and Lhe famlly plays a key role ln fllLerlng Lhe lnformaLlon glven Lo a
cllenLŦ lssues relaLed Lo lnformed consenL and full dlsclosure of medlcal
lnformaLlon may cause dlsLress ln culLural groups who place Lhe needs of Lhe
famlly above Lhe needs of Lhe lndlvldualŦ lnLeracLlons should be modlfled based
on famlly sLrucLureţ rellglous values and bellefsţ Llme orlenLaLlonţ culLural healLh
pracLlcesţ and verbal and nonverbal communlcaLlonŦ
PyperplgmenLaLlon of Lhe Longue and oral mucosa afLer admlnlsLraLlon has
been reporLed ln Afrlcan AmerlcansŦ lncldence raLe of hlghŴgrade neuLropenla
may be hlgher ln Aslan paLlenLsŦ
LvALuA1lCn
CllenL was free of lnfecLlonŦ
CllenL malnLalned LargeL welghLŦ
CllenL malnLalned nuLrlLlonal sLaLusŦ
CllenL dld noL develop hemorrhaglc cysLlLlsŦ
CllenL/famlly/careglver educaLlon needs were meLŦ
CuesLlons relaLed Lo sexuallLy were answeredŦ

AN1IML1A8CLI1LSť ILUCkCUkACIL (SŴIUţ ADkUCIL)
ASSLSSMLn1
Assess compleLe blood counL (C8C)ţ dlfferenLlalţ and plaLeleL counL weeklyŦ ChemoLherapy may
be held lf red cellţ whlLe cellţ or plaLeleL counLs drop below predeLermlned levelsŦ
ConducL Lhorough physlcal assessmenLŤ documenL flndlngsŦ
Assess renal funcLlons sLudles before and durlng drug LherapyŦ
Assess LemperaLureŤ fever may be an early slgn of lnfecLlonŦ
nu8SlnC ulACnCSLS
8lsk for lnfecLlon relaLed Lo bone marrow depresslon
8lsk for lmbalanced nuLrlLlonť less Lhan body requlremenLs relaLed Lo Cl slde effecLs of
chemoLherapy
8lsk for acuLe paln (mucoslLls/sLomaLlLls) relaLed Lo Cl slde effecLs of chemoLherapy
8lsk for lmpalred perlanal skln lnLegrlLy relaLed Lo dlarrhea caused by chemoLherapy
ueflclenL knowledge (cllenL/famlly) relaLed Lo chemoLherapeuLlc proLocol
ÞLAnnlnC
CllenL blood counLs wlll remaln ln Lhe deslred rangeŦ
CllenL wlll malnLaln nuLrlLlonal sLaLus (adequaLe fluld lnLake and ouLpuLţ adequaLe calorlc lnLakeţ
sLable welghL)Ŧ
CllenL wlll have adequaLe paln conLrolŦ
CllenL wlll llmlL exposure Lo sunllghLŦ
CllenL/famlly/careglver wlll demonsLraLe undersLandlng of chemoLherapeuLlc proLocol (doseţ
admlnlsLraLlonţ slde effecLs and adverse reacLlons)Ŧ
nu8SlnC ln1L8vLn1lCnS
MonlLor blood counLs and laboraLory valuesŦ
Pandle drug wlLh care durlng preparaLlon and admlnlsLraLlonŤ avold dlrecL skln conLacL wlLh
anLlcancer drugsŦ lollow proLocolsŦ
MonlLor lv slLe frequenLlyŦ LxLravasaLlon produces severe palnŦ lf Lhls occursţ apply lce pack and
noLlfy healLh care provlderŦ
AdmlnlsLer anLlemeLlc 30Ŵ60 mlnuLes before drug Lo prevenL vomlLlngŦ
Assess for hyperplgmenLaLlon along Lhe veln ln whlch 3Ŵlu was admlnlsLeredŦ
Cffer cllenL food and flulds LhaL may decrease nausea (eŦgŦţ colaţ crackersţ glnger ale)Ŧ
Þlan smallţ frequenL mealsŦ
MalnLaln sLrlcL medlcal asepsls durlng dresslng changes and lnvaslve proceduresŦ
SupporL good oral hygleneŤ brush LeeLh wlLh sofL LooLhbrush and use waxed denLal flossŦ
Lncourage mouLh rlnses every 2 hours wlLh normal sallneŦ
MonlLor fluld lnLake and ouLpuL and nuLrlLlonal lnLakeŦ Cl effecLs are common on Lhe fourLh day
of LreaLmenLŦ
CllenL Leachlngť
4 Ceneral
Lmphaslze proLecLlve precauLlons as necessary (eŦgŦţ handwashlngţ personal
hyglene)Ŧ
1each cllenL Lo examlne mouLh dally and reporL slgns of sLomaLlLls (sorenessţ
ulceraLlonsţ whlLe paLches ln mouLh)Ŧ Cral hyglene several Llmes a day ls
essenLlalŦ lf sLomaLlLls occursţ rlnse mouLh wlLh baklng soda or normal sallneŦ
use a sofL LooLhbrushŦ
lnsLrucL cllenL Lo Lake paln medlcaLlon as prescrlbed Lo relleve mouLh paln
relaLed Lo mucoslLls/sLomaLlLlsŦ
Advlse cllenL Lo Lake yearŴround phoLosenslLlvlLy precauLlonsŦ use sunscreen
when ouLdoorsŦ
Advlse cllenL noL Lo vlslL anyone who has a resplraLlory lnfecLlonŦ A decreased
whlLe blood cell (W8C) counL puLs cllenL aL rlsk for acqulrlng an lnfecLlonŦ
1each lmporLance of uslng blrLh conLrol measures as approprlaLeŦ ulscuss
spermŴbanklng wlLh male cllenLs as approprlaLeŦ
1each cllenL LhaL pregnancy should be avolded for 3Ŵ4 monLhs afLer compleLlng
anLlneoplasLlc Lherapy ln mosL slLuaLlonsŦ Some sources recommend LhaL boLh
men and women avold concepLlon for 2 years afLer compleLlon of LreaLmenLŦ
lnsLrucL cllenL Lo prompLly reporL slgns of lnfecLlon (eŦgŦţ feverţ sore LhroaLţ
chlllsţ urlnary frequencyŤ burnlng on urlnaLlonŤ rednessţ swelllngţ or paln near a
wound)Ť bleedlng (eŦgŦţ bleedlng gumsţ peLechlaeţ brulsesţ hemaLurlaţ blood ln
Lhe sLool)Ť or slgns of anemla (eŦgŦţ lncreased faLlgueţ dyspneaţ orLhosLaLlc
hypoLenslon)Ŧ
4 Slde LffecLs
lnsLrucL cllenL abouL good oral hyglene wlLh a sofL LooLhbrush for
mucoslLls/sLomaLlLlsŤ have cllenL use a sofL LooLhbrush when plaLeleL counL ls
Ƽ30ţ000/mm
3
Ŧ
CllenL should rlnse mouLh every 2 hours wlLh normal sallne and avold use of
commerclal mouLhwashes LhaL conLaln alcoholŦ
8emlnd premenopausal females LhaL Lhey may experlence amenorrheaţ
mensLrual lrregularlLlesţ or sLerlllLyŦ lnsLrucL male cllenLs LhaL Lhey may
experlence lmpoLenceŦ
Advlse cllenL of posslble halr lossŤ recommend a wlgţ halrpleceţ scarfţ or LurbanŦ
Assess for use of alLernaLlve/complemenLary Lherapy LhaL may lnLeracL wlLh
chemoLherapy agenLŦ
4 uleL
Lncourage small frequenL mealsŦ
Lncourage use of coolţ bland foodsŦ
Cffer lce chlpsţ or lce pops Lo help relleve mouLh palnŦ
CulLural ConslderaLlons
ln some nonŴWesLern culLural groupsţ healLh care declslons are made by
consensusţ and Lhe famlly plays a key role ln fllLerlng Lhe lnformaLlon glven Lo a
cllenLŦ lssues relaLed Lo lnformed consenL and full dlsclosure of medlcal
lnformaLlon may cause dlsLress ln culLural groups who place Lhe needs of Lhe
famlly above Lhe needs of Lhe lndlvldualŦ lnLeracLlons should be modlfled based
on famlly sLrucLureţ rellglous values and bellefsţ Llme orlenLaLlonţ culLural healLh
pracLlcesţ and verbal and nonverbal communlcaLlonŦ
An lncreased lncldence of hyperplgmenLaLlon has been reporLed ln darkŴsklnned
peopleŦ PyperplgmenLaLlon may be seen on Lhe sklnţ nallsţ halrţ and oral
mucosaŦ 1hls usually dlsappears over LlmeŦ
LvALuA1lCn
CllenL was free of lnfecLlonŦ
Cral mucosa was free of eryLhema and swelllngŦ
Þaln was conLrolledŦ
Skln lnLegrlLy remalned lnLacLŦ
CllenL/famlly/careglver educaLlon needs were meLŦ
CuesLlons relaLed Lo sexuallLy were answeredŦ


AN1I1UMCk AN1I8IC1ICSť DCkCkU8ICIN (ADkIAM¥CIN)
ASSLSSMLn1
Assess compleLe blood counL (C8C)ţ dlfferenLlalţ and plaLeleL counL weeklyŦ urug may be
wlLhheld lf red blood cellţ whlLe blood cell (W8C)ţ or plaLeleL counLs drop below predeLermlned
levelsŦ
ConducL Lhorough physlcal assessmenL and documenL flndlngsŦ
Assess LemperaLureŤ fever may be an early slgn of lnfecLlonŦ
Assess plans for pregnancy (lf approprlaLe)Ŧ
nu8SlnC ulACnCSLS
8lsk for lnfecLlon relaLed Lo bone marrow depresslon
8lsk for alLeraLlon ln cardlac ouLpuL relaLed Lo cardloLoxlc effecLs of chemoLherapy
8lsk for lmpalred skln lnLegrlLy relaLed Lo veslcanL properLles of chemoLherapy
ueflclenL knowledge relaLed Lo anLlneoplasLlc Lherapy
ÞLAnnlnC
CllenL wlll malnLaln blood cell values ln Lhe deslred rangeŦ
CllenL wlll be free of cardlac dysfuncLlonŦ
CllenL's skln lnLegrlLy wlll remaln lnLacLŦ
CllenL/famlly/careglver wlll demonsLraLe undersLandlng of Lhe chemoLherapy reglmenţ lncludlng
slde effecLsŦ
Assess cllenL/famlly/careglver knowledgeţ relaLed Lo chemoLherapeuLlc proLocolŦ
nu8SlnC ln1L8vLn1lCnS
MonlLor blood counLs and laboraLory valuesŦ
Assess cardlac sLaLusŦ
Pandle drug wlLh care durlng preparaLlonsŤ avold dlrecL skln conLacL wlLh drugŦ
MonlLor lv slLe frequenLlyŦ uoxorublcln ls a severe veslcanL whose effecLs are noL lmmedlaLely
apparenLŦ Clve drug Lhrough a large boreţ qulckly runnlng lv lnfuslonŦ
1lssue necrosls may occur 3Ŵ4 weeks afLer lnfllLraLlon lnLo LlssueŦ LxLravasaLlon produces severe
palnŦ lf Lhls occursţ apply lce pack and noLlfy Lhe healLh care provlderŦ
AdmlnlsLer anLlemeLlc 30Ŵ60 mlnuLes before chemoLherapyŦ
MonlLor for changes ln urlne color (plnk Lo red)Ŧ 1he drug ls red and ls excreLed ln Lhe urlneŦ
Cffer cllenL food and flulds LhaL may decrease nausea (eŦgŦţ colaţ crackersţ glnger ale)Ŧ
Þlan smallţ frequenL mealsŦ
AdmlnlsLer prophylacLlc anLlbloLlcs Lo prevenL lnfecLlonŦ
Cffer analgeslcs for paln as prescrlbedŦ
MalnLaln sLrlcL medlcal asepsls durlng dresslng changes and lnvaslve procedures
SupporL good oral hygleneŦ use sofL LooLhbrushŦ use waxed denLal flossŦ
MonlLor fluld lnLake and ouLpuL and nuLrlLlonal lnLakeŦ
CllenL (lamlly Member/Careglver) 1eachlngť
4 Ceneral
Lmphaslze proLecLlve precauLlons as necessary (eŦgŦţ handwashlngţ personal
hyglene)Ŧ
1each cllenL Lhe slgns and sympLoms of cardlac dysfuncLlon (shorLness of
breaLhţ palplLaLlonsţ edema ln exLremlLles) and Lo reporL Lhese Lo healLh care
provlderŦ
1each cllenL LhaL compleLe alopecla occurs wlLh doses ƽ30mg/m
2
Ŧ 1each LhaL
halr wlll begln Lo regrow wlLhln several monLhs afLer Lherapy ls compleLedŦ
Advlse cllenL noL Lo vlslL anyone who has a resplraLory lnfecLlonŦ A decreased
W8C counL puLs cllenL aL hlgh rlsk for acqulrlng an lnfecLlonŦ
1each lmporLance of uslng blrLh conLrol measures as approprlaLeŦ ulscuss
spermŴbanklng wlLh male cllenLs as approprlaLeŦ
1each cllenL LhaL pregnancy should be avolded for 3Ŵ4 monLhs afLer compleLlng
anLlneoplasLlc Lherapy ln mosL slLuaLlonsŦ Some sources recommend LhaL boLh
men and women avold concepLlon for 2 years afLer compleLlon of LreaLmenLŦ
lnsLrucL cllenL Lo prompLly reporL slgns of lnfecLlon (eŦgŦţ feverţ sore LhroaL)ţ
bleedlng (eŦgŦţ bleedlng gumsţ peLechlaeţ brulsesţ hemaLurlaţ blood ln Lhe sLool)ţ
and anemla (eŦgŦţ lncreased faLlgueţ dyspneaţ orLhosLaLlc hypoLenslon)Ŧ
4 Slde LffecLs
Assess for nausea/vomlLlng and admlnlsLer anLlemeLlcs as prescrlbedŦ
1each lmporLance of blrLh conLrol measuresŦ ulscuss sperm banklng lf
approprlaLeŦ
8emlnd premenopausal females LhaL Lhey may experlence amenorrheaţ
mensLrual lrregularlLlesţ or sLerlllLyŤ lnsLrucL male cllenLs LhaL Lhey may
experlence lmpoLenceŦ
Advlse cllenL of posslble halr lossŤ recommend a wlgţ halrpleceţ scarfţ or LurbanŦ
Assess for use of alLernaLlve/complemenLary Lherapy LhaL may lnLeracL wlLh
chemoLherapy agenLŦ
4 uleL
Lncourage smallţ frequenL mealsŦ
Lncourage eaLlng bland foodsŦ
Avold foods wlLh exLreme LemperaLuresŦ
CulLural ConslderaLlons
ln some nonŴWesLern culLural groupsţ healLh care declslons are made by
consensusţ and Lhe famlly plays a key role ln fllLerlng Lhe lnformaLlon glven Lo a
cllenLŦ lssues relaLed Lo lnformed consenL and full dlsclosure of medlcal
lnformaLlon may cause dlsLress ln culLural groups who place Lhe needs of Lhe
famlly above Lhe needs of Lhe lndlvldualŦ lnLeracLlons should be modlfled based
on famlly sLrucLureţ rellglous values and bellefsţ Llme orlenLaLlonţ culLural healLh
pracLlcesţ and verbal and nonverbal communlcaLlonŦ
PyperplgmenLaLlon of Lhe Longue and oral mucosa has been seen afLer Lhe
admlnlsLraLlon of doxorublcln ln Afrlcan AmerlcansŦ lncldence raLe of hlghŴgrade
neuLropenla may be hlgher ln Aslan paLlenLsŦ
LvALuA1lCn
CllenL was free of lnfecLlonŦ
Cardlac funcLlon was malnLalnedŦ
CllenL and famlly educaLlon needs were meLŦ
Slde effecLs of Lherapy were conLrolledŦ
CllenL/famlly/careglver educaLlon needs were meLŦ
MI1C1IC INnI8I1CkS]ÞLAN1 (VINCA) ALkALCIDSť VINCkIS1INL (CNCCVIN)
ASSLSSMLn1
Assess basellne condlLlon of paLlenL before and durlng chemoLherapy LreaLmenLŦ
Assess compleLe blood counL (C8C)ţ dlfferenLlalţ and plaLeleL counL weeklyŦ
MonlLor blllrubln levelsŦ uose may be reduced lf blllrubln levels are ƽ1Ŧ3mg/dlŦ
ConducL Lhorough physlcal assessmenL and documenL flndlngsŦ 8e especlally aware of evldence
of neuroLoxlclLyţ because Lhls ls a doseŴllmlLlng LoxlclLyŦ
Assess for slgns of perlpheral neuropaLhy (numbness or Llngllng ln flngers or Loes)ţ loss of deep
Lendon reflexesţ fooL dropţ slapplng galLţ dlfflculLy walklngŦ
MonlLor bowel funcLlonŦ AuLonomlc neuropaLhy may lead Lo consLlpaLlon and paralyLlc lleusŦ
1he use of vlncrlsLlne (Cncovln) and narcoLlc analgeslcs may lncrease Lhe rlsk of consLlpaLlonŦ
Assess LemperaLureŤ fever may be an early slgn of lnfecLlonŦ
MonlLor for acuLe bronchospasmŦ
Assess plans for pregnancy (lf approprlaLe)Ŧ
LvaluaLe paLlenL/famlly/careglver knowledge of drug LherapyŦ
nu8SlnC ulACnCSLS
8lsk for lnfecLlon relaLed Lo bone marrow depresslon
8lsk for consLlpaLlon relaLed Lo neuropaLhlc slde effecLs of chemoLherapy
8lsk for ln[ury relaLed Lo neuropaLhlc slde effecLs of chemoLherapy
ueflclenL knowledge relaLed Lo anLlneoplasLlc Lherapy
ÞLAnnlnC
CllenL wlll malnLaln blood cell values ln Lhe deslred rangeŦ
CllenL wlll malnLaln adequaLe bowel funcLlonŦ
CllenL wlll be free of neuropaLhlc dysfuncLlonŦ
CllenL/famlly/careglver wlll demonsLraLe undersLandlng of chemoLherapeuLlc reglmen lncludlng
Lhe slde effecLsŦ
nu8SlnC ln1L8vLn1lCnS
MonlLor blood counLs and laboraLory valuesŦ
Assess bowel funcLlonŦ
AdmlnlsLer sLool sofLener or laxaLlve as prescrlbedŦ
MonlLor for slgns of perlpheral neuropaLhy (numbness and/or Llngllng ln hands and/or feeL)ţ
sensory lossţ loss of deep Lendon reflexesţ paresLheslaţ fooL dropţ wrlsL dropţ aLaxla)Ŧ
Assess lv slLe carefullyŦ vlncrlsLlne (Cncovln) ls a severe veslcanL whose effecLs are noL
lmmedlaLely apparenLŦ Clve drug Lhrough a large boreţ qulckly runnlng lv lnfuslon over 1
mlnuLeŦ
1lssue necrosls may occur 3Ŵ4 weeks afLer lnfllLraLlon lnLo LlssueŦ LxLravasaLlon produces severe
palnŦ lf exLravasaLlon occursţ sLop lnfuslon lmmedlaLelyŦ noLlfy healLh care provlderŦ Apply heaL
lnLermlLLenLly every 2 hours for 24 hoursŦ Clve hyaluronldase lnLo Lhe lnfllLraLed areaţ per
physlclan orderŦ
AdmlnlsLer anLlemeLlc 30Ŵ60 mlnuLes before chemoLherapyţ as prescrlbedŦ
MonlLor fluld lnLake and ouLpuL and nuLrlLlonal lnLakeŦ
MalnLaln sLrlcL medlcal asepsls durlng dresslng changes and lnvaslve proceduresŦ
CllenL (lamlly Member/Careglver) 1eachlngť
4 Ceneral
Lmphaslze proLecLlve precauLlons as necessary (eŦgŦţ handwashlngţ personal
hyglene) as necessaryŦ
1each cllenL Lhe slgns and sympLoms of neuroLoxlclLy (numbness and/or Llngllng
ln hands and/or feeLţ sensory lossţ loss of deep Lendon reflexesţ paresLheslaţ
fooL dropţ wrlsL dropţ aLaxla)Ŧ lnablllLy Lo buLLon cloLhes or Lo close zlppers may
be an early slgn of perlpheral neuropaLhyŦ
1each paLlenL slgns of ºsLocklng/glove" syndrome (numbness/Llngllng of hands
and feeL)Ŧ 1hls may lasL as long as a year or may never compleLely resolveŦ
1each cllenL LhaL compleLe alopecla may occurŦ 1each LhaL halr may wlll begln Lo
regrow wlLhln several monLhs afLer Lherapy ls compleLedŦ
Advlse cllenL noL Lo vlslL anyone who has a resplraLory lnfecLlonŦ A decreased
W8C counL puLs cllenL aL hlgh rlsk for acqulrlng an lnfecLlonŦ
1each lmporLance of uslng blrLh conLrol measures as approprlaLeŦ ulscuss
spermŴbanklng wlLh male cllenLs as approprlaLeŦ
1each cllenL LhaL pregnancy should be avolded for 3Ŵ4 monLhs afLer compleLlng
anLlneoplasLlc Lherapy ln mosL slLuaLlonsŦ Some sources recommend LhaL boLh
men and women avold concepLlon for 2 years afLer compleLlon of LreaLmenLŦ
lnsLrucL cllenL Lo prompLly reporL slgns of lnfecLlon (eŦgŦţ feverţ sore LhroaL)ţ
bleedlng (eŦgŦţ bleedlng gumsţ peLechlaeţ brulsesţ hemaLurlaţ blood ln Lhe sLool)ţ
and anemla (eŦgŦţ lncreased faLlgueţ dyspneaţ orLhosLaLlc hypoLenslon)Ŧ
4 Slde LffecLs
1each paLlenL Lhe slgns of perlpheral neuropaLhyŦ
1each paLlenL Lo reporL consLlpaLlon and abdomlnal palnŦ
Assess for nauseaţ vomlLlngŤ admlnlsLer anLlemeLlcs as prescrlbedŦ
Advlse paLlenL of posslble halr lossŤ recommend a wlgţ halrpleceţ scarfţ or
LurbanŦ
1each lmporLance of blrLh conLrol measuresŦ ulscuss sperm banklng lf
approprlaLeŦ
8emlnd premenopausal females LhaL Lhey may experlence amenorrheaţ
mensLrual lrregularlLlesţ or sLerlllLyŤ lnsLrucL male cllenLs LhaL Lhey may
experlence lmpoLenceŦ
Assess for use of alLernaLlve/complemenLary Lherapy LhaL may lnLeracL wlLh
chemoLherapy agenLŦ
4 uleL
Lncourage bulky hlghŴflber foodsţ adequaLe fluld lnLakeţ and moderaLe exerclse
Lo reduce Lhe rlsk of consLlpaLlonŦ
CulLural ConslderaLlons
ln some nonŴWesLern culLural groupsţ healLh care declslons are made by
consensusţ and Lhe famlly plays a key role ln fllLerlng Lhe lnformaLlon glven Lo a
cllenLŦ lssues relaLed Lo lnformed consenL and full dlsclosure of medlcal
lnformaLlon may cause dlsLress ln culLural groups who place Lhe needs of Lhe
famlly above Lhe needs of Lhe lndlvldualŦ lnLeracLlons should be modlfled based
on famlly sLrucLureţ rellglous values and bellefsţ Llme orlenLaLlonţ culLural healLh
pracLlcesţ and verbal and nonverbal communlcaLlonŦ
Aslans may be aL lncreased rlsk for hyponaLremla and syndrome of
lnapproprlaLe anLldlureLlc hormone secreLlon (SlAuP)Ŧ
LvALuA1lCn
CllenL was free of lnfecLlonŦ
8owel funcLlon was malnLalnedŦ
Þerlpheral neuropaLhy dld noL occurŦ
Slde effecLs of Lherapy were conLrolledŦ
LxLravasaLlon and Llssue necrosls dld noL occurŦ
CllenL/famlly/careglver educaLlon needs were meLŦ




SubmlLLed Loť
ZanlLa Clenda AŦ Þlagaţ 8ŦnŦ
SubmlLLed byť
?na lempla AŦ Þaez 8Sn 2Ŵu

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