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24 Cards in this Set

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Teniposide (VM-26, Vumon)
An epipodophyllotoxin
Dose/Route: IV 70-180mg/m2
daily x 3 Q 3-6 weeks
Treats: leukemia, induction for refractory ALL
Side FX: Severe myelosuppression. mucositis, mild neurotoxicity, decreased BP
Nursing considerations:
- give over 60 mins, check BP, use non-PVC bags and tubing
- Irritant, extravasation precautions
- may precipitate with heparin
- premed with benadryl
Etoposide (VP-16, Vepesid)
An epipodophyllotoxin
Dose/Route: IV or PO
Treats: leukemia, lymphomas, neuroblastoma, sarcomas, brain tumors
Side FX: myelosuppression, secondary leukemia, hypersensitivity, hypotension
Nursing considerations:
- give over 60 minutes, check BP, monitor for crystallization, premed with benadryl
- refrigerate PO capsules, do not refrigerate IV solution
Vinblastine (Velban)
A Vinca alkaloid
Dose/Route: IV 30mg/m2 weekly
Used to treat: Leukemia, Hodgkin's lymphoma, non-small cell lung cancer
Side FX: myelosuppression, esp. neutropenia, vesicant, mild to moderate neurotoxicity
Nursing considerations:
- extravasation precautions
- use stool softeners
- neurotoxic with high doses
- need thorough neuro exam
Vincristine (Oncovin)
A Vinca alkaloid
Dose/Route: IV 1-1.5 mg (2mg max)
weekly for 3-6 doses
Treats: Leukemias, lymphomas, most solid tumors including brain tumors,
Wilm’s tumor, neuroblastoma
Side FX: peripheral neurotoxicity, vesicant, SIADH
Nursing considerations:
-extravasation precautions
-use stool softeners
-fatal if given intrathecally
-need thorough neuro exam
-peripheral neurotoxicity is cumulative
-assess for constipation – increase fluids, increase fiber in diet,
promote exercise
Carboplatin (Paraplatin)
Alkylating agent
Dose/Route: IV 300-560mg/m2
Single dose or daily x 2 Q 28 days
Treats: Brain tumors, germcell tumors, neuroblastoma, sarcomas, hepatoblastoma
Side FX: myelosuppression esp. thrombocytopenia
Nursing considerations:
- premed with benadryl and steroids
- give over 15 minutes or longer
Cisplatin (Platinol)
Alkylating agent
Dose/Route: IV 50-200mg/m2 Daily x 1-5 days every 21-28 days
Max: 200mg/m2/course
Treats: germ cell tumors, brain tumors, osteosarcoma. neuroblastoma, hepatoblastoma
Side FX: neurotoxic
Nursing considerations:
- hydrate well, monitor serum creatinine
- audiogram, may need magnesium supplement, very emetogenic
Cyclophosphamide (Cytoxan)
Alkylating agent
Dose/Route: IV: varies, 1-40mg/kg daily x 1-4 days q 21-28 days, PO - uncommon in pediatrics
Treats: lymphoma, leukemia, sarcomas, rhabdomyosarcoma, brain tumors
Side FX: myelosuppression esp. neutropenia
Nursing considerations:
- hydrate well, give mesna to prevent hemorrhagic cystitis, check urine for blood, empty bladder frequently
Procarbazine
Alkylating agent
Dose/Route: IV 1600-3000 mg/m2 daily x 3-5 days Q 21-28 days
Max: 9gm/m2/course
Treats: brain tumors
Side FX: myelosuppression esp. thrombocytopenia
Nursing considerations: decreased BP or CNS symptoms can occur with cheese, wine, bananas, yogurt, barbiturates, phenothiazines, phenytoin, narcotics & alcohol
Ifosfamide (IFOS, IFEX)
Alkylating agent
Dose/Route: IV 1600-3000 mg/m2 daily x 3-5 days Q 21-28 days
Max: 9gm/m2/course
Treats: sarcomas, relapsed Wilm's tumor
Side FX: nephorotoxicity, hemorrhagic cystitis, myelosuppression
Nursing considserations:
- give over 30-120 minutes, give with Mesna, hydrate well
- Fanconi's syndrome common with increased dose
- check magnesium, KCL and phos.
Cytarabine (ARA-C, cytosar)
Antimetabolite
Dose/Route: IV, SQ, IT
100-200mg/ms Q 12 hours x 5-7 days or 1000-3000mg/m2 q 12 hours x 4-8 doses
Treats: leukemia, lymphoma, CNS leukemia
Side FX: myelosuppression
Nursing considerations:
- use preservative-free normal saline with IT administration
- give steroid eye drops with high doses
Fluorouracil (5-Fluorouracil, 5-FU)
Antimetabolite
Dose/Route: IV 500mg/m2 1-5 days
200-400mg/m2 daily as C1
Treats: carcinomas, hepatic tumor, head and neck tumors
Side FX: myelosuppression esp. with bolus doses
Nursing considerations:
- photosensitivity precautions
- pyridoxine can be used to treat palmar=plantar erythema
Mercaptopurine (6-MP, purinethol)
Antimetabolite
Dose/Route: PO 20-100mg/m2 daily
Treats: leukemia
Side FX Myelosuppression
Nursing considerations:
- reduce dose by 75% when given concurrently with allopurinol
- take entire dose at the same time on an empty stomach, preferably at bedtime
Idarubicin (Idamycin)
Antitumor antibiotic
Dose/Route: IV 10-15mg/m2 daily or weeky x 3
Treats: ALL, lymphomas
Sied FX: myelosuppression esp. neutropenia, mucositis, vesicant. cardiomyopathy, radiation recall, local hives
Nursing considerations:
- analog of daunorubicin, extravasation precautions,
- obtain baseline cardiac studies (ECHO, EKG, MUGA)
- monitor cumulative dose, protect from light
- more than 3 times more potent than doxorubicin
Doxorubicin (adriamycin)
Antitumor antibiotic
Dose/Route: IV Cumulative life time dose is 450mg/m2 (may be lower in kids)
Treats: leukemias, lymphomas, most solid tumors
Side FX: myelosuppression, vesicant, facial flushing, red or pink urine, radiation recall, cardiotoxicity
Nursing considerations:
- extravasation precaution
- obtain baseline cardiac studies (ECHO, EKG, MUGA)
- monitor cumulative dose
- dexrazoxone - cardiac protective drug may be given
Daunorubicin (Cerubidine, daunomycin)
Antitumor antibiotic
Dose/Route: IV: 30-45mg/m2 Daily x 3 or weekly. Cumulative lifetime dose is 550 U/m2 - may be lower in kids
Treats: ALL, lymphomas
Side FX: myelosuppression, cardiotoxicity, radiation recall
Nursing considerations:
- extravasation precautions
- obtain baseline cardiac studies (ECHO, EKG, MUGA)
- monitor cumulative dose
Dactinomycin (Cosmegen, actinomycin-D)
Antitumor Antibiotic
Dose/Route: IV 400-500mcg/m2/day
(Max dose is 0.5 mg) Daily x 5 days, Q 3-6 weeks, mag 2.5mg/m2/course
Treats: Wilm's Tumor, sarcomas
Side FX: severe myelosuppression, radiation recall, vesicant, veno-occlusive disease
Nursing considerations:
- extravasation precautions
- dosage may be written as mg or mcg
- protect from light, do not filter
Bleomycin (Blenoxane, BLEO)
Antitumor Antibiotic
Dose/Route: IV, IM, SQ - 10-20 units weekly - Cumulative lifetime dose 400 units
Treats: lymphoma, germ cell tumors, sclerosing agent for pleural effusions
Side FX: fever, hypersensitivity, rare anaphylaxis, chronic rash
Nursing considerations:
- disclose prior use before anesthesia
- obtain baseline pulmonary studies
- decrease dose when also getting radiation
Thioguanine (6-TG, 6-thioguinine)
Antimetabolite
Dose/ROute: PO 40-200 mg/m2 daily X 5-7 days
Treats: leukemia
Side FX: myelosuppression esp. neutropenia
Nursing considerations:
- take entire dose at the same time on an empty stomach, preferably at bedtime
Methotrexate (MTX)
ANtimetabolite
Dose/Route: IV. PO. IT, IVP 25-1200mg/m2. IT dose based on age
Treats: leukemia, lymphoma, ostesarcoma
Nursing considerations:
- Alkalinize urine - prevent crystallization in kidneys
- leucovorin rescue with moderate to high doses
- avoid folate in vitamins
- photosensitivity precautions
- provide oral care
Aparaginase erwinia (L-asparaginase. Elspar)
Misc Agent
Dose/Route: IV or IM
Treats: ALL. lymphomas
Side FX: Hypersensitivity. anaphlyaxis, pancreatitis, malais, hepatotoxicity, CNS ischemic attack
Nursing considerations:
- IM has decreased risk for anaphylaxis
- be prepared for emergency, watch for 30 mins
- educate on thrombophlebitis and bleeding
PEG asparginase (Oncaspar)
Misc Agent
Dose/Route: IV or IM
Treats: ALL. lymphomas
Side FX: Hypersensitivity. anaphlyaxis, pancreatitis, malais, hepatotoxicity, CNS ischemic attack
Nursing considerations:
- IM has decreased risk for anaphylaxis
- be prepared for emergency, watch for 30 mins
- educate on thrombophlebitis and bleeding
- PEG asparaginase has long half-life - late reactions can occur
Topotecan (hycentin)
Camptothecins
Dose/Route: IV 0.6-1.5mg/M2 daily x5 days Q 3 weeks
Treats: neuroblastoma, rhabdomyosarcoma
Side FX: myelosuppression esp. neutropenia, mucositis, increased LFTs
Nursing considerations:
- may have fever with treatment
Prednisone
Hormonal agent
Dose/Route: PO, IV
Treats: leukemia, lymphoma
Side FX: Immunosuppression, mood swings, hyperglycemia, Na+ and fluid retention, long term - Cushings
Nursing considerations:
- may mask fever or infections
- do not stop abruptly
- educate on decreased Na+ diet
- take with food
- perineal burning with rapid infusion
- do not give at night for patients with sleep disturbances
Dexamethasone (decadron)
Hormonal agent
Dose/Route: PO, IV
Treats: leukemia, lymphoma, brain tumors
Side FX: Immunosuppression, mood swings, hyperglycemia, Na+ and fluid retention, long term - Cushings
Nursing considerations:
- may mask fever or infections
- do not stop abruptly
- educate on decreased Na+ diet
- take with food
- perineal burning with rapid infusion
- do not give at night for patients with sleep disturbances