Drug Name and ClassificationMechanism of ActionIndication and ContraindicationSide effectsNursing Responsibility

Vincristine (Anti-neoplastic)

Binds to tubulin dimers, inhibiting assembly of microtubule structures. Disruptionof the microtubules arrests mitosis in metaphase. The vinca alkaloids therefore affect all rapidly dividing cell types including cancer cells, but also intestinal epithelium andbone marrowIndication :Treating certain types of cancer (eg, leukemia, Hodgkin disease, non-Hodgkin lymphomas, rhabdomyosarcoma, neuroblastoma, Wilms' tumor).

Contraindication:you are allergic to any ingredient in vincristineyou have a certain disease of the nervous system (Charcot-Marie Tooth syndrome)

The main side-effects of vincristine are:peripheral neuropathy,hyponatremia,constipation hair loss.Peripheral neuropathy can be severe, and hence a reason to avoid, reduce, or stop the use ofvincristine. One of the first symptoms of peripheral neuropathy isfoot dropMonitor Vital Signs

Assess the client for any contraindication

Instruct the client to prevent going to public places like malls to prevent having an infection.

Instruct the client or advise to wear wigs before chemotherapy because the client would have temporary hair loss

Dosage Standard Dose: 1.4 mg/m2 IV over one minute, once. The drug is generally administered once a week

Drug Name and ClassificationMechanism of action Indication and ContraindicationSide effectsNursing Responsibility

Vinblastine (Antineoplastic)

Vinblastine is avinca alkaloidand a chemical analogue ofvincristine. It bindstubulin, thereby inhibiting the assembly of microtubules. Vinblastine treatment causes M phase specificcell cyclearrest by disrupting microtubule assembly and proper formation of themitotic spindleand thekinetochore, each of which are necessary for the separation of chromosomes during anaphaseof mitosis.Indication:Vinblastine is a component of a number ofchemotherapy regimens, includingABVDforHodgkin lymphoma. It is also used to treathistiocytosisaccording to the established protocols of the Histiocytosis Association.

Contraindication

you are allergic to any ingredient in vinblastineyou have a low white blood cell count that is not caused by the disease being treatedyou have a bacterial infection, chickenpox, or herpes zoster

Blurred or double visionconstipationdifficulty in walkingdrooping eyelidsheadachejaw painjoint painlower back or side painnumbness or tingling in fingers and toespain in fingers and toes

Assess vital signs

Assess the clients reaction before and after treatment

Instruct the client to prevent going to public places like malls to prevent having an infection.

Dosage:3.7-18 mg/sq.meter/day IV q7-10d

Drug name and Classification Mechanism of ActionIndication and ContraindicationSide effectsNursing responsibilities

Doxorubucin(Anthracyclines andAnthracenediones)Intercalates with DNA, directly affectingtranscription and translation.Forms a tripartite complex with topoisomerase II and DNA andprevents re-ligation of double-stranded breaks made by topoisomerase II which leads to apoptosis.Also generates freeradicals by formation of semiquinone radical intermediates from quinonegroups that react with O2to produce superoxide anion radicals (increasedradical production in combinationwith iron)

Indication: Multiple myeloma, ovarian cancer, AIDS-related Kaposi sarcoma, malignantlymphomas (in combination with cyclophosphamide andvinca alkaloids), adjuvant andmetastaticcarcinoma of the breast, and other human solid tumors

Contraindication: Marked Myelosuppression,previous treatmentwith cumulativedoses ofdoxorubicin,daunorubicin,idarubicin, and/orother anthracyclinesand anthracenes

SkinReversible Alopecia,Hyperpimentationofnailbeds and dermalcreasesGI:Acute Nausea andVomiting, Mucositis,Ulceration and necrosisof the colon which maylead to bleedingVascular:Phlebosclerosis,FacialFlushingLocal:Severe cellulitis,vesication, tissuenecrosisHematogic:Secondary acutemyeloid leukemia Hypersensitvity:Fever, chills, uticariaInstruct patient toreport difficulty ofbreathing, weight gain, pain orburning sensationat injection site,unusual bleedingor bruising

Assist in obtaining a wig for patient before hair loss occurs

Encourage smallfrequent feedings for Nausea and Vomiting

Drug name and Classification Mechanism of ActionIndication and ContraindicationSide effectsNursing responsibilities

Etoposide ( Topoisomerase inhibitor)

Etoposide forms a ternary complex withDNAand thetopoisomerase IIenzyme (which aids in DNA unwinding), prevents re-ligation of the DNA strands, and by doing so causes DNA strands to break.[3]Cancercells rely on this enzyme more than healthy cells, since they divide more rapidly. Therefore, this causes errors inDNA synthesisand promotesapoptosisof the cancer cellIndicationTreating lung cancer and testicular tumors in patients who have not responded to other treatment. It is used in combination with other cancer medications

Contraindication

low blood pressurehair losspain and or burning at the IV siteconstipationordiarrheametallic food tasteBone marrowsuppression, leading to:decreasedwhite blood cellcounts (leading to increased susceptibility toinfections)lowred blood cellcounts (anemia)lowplateletcounts (leading to easy bruising and bleeding)

Monitor Vital signs

Assist in obtaininga wig for patient before hair loss occurs

Encourage smallfrequent feedings for Nausea and Vomiting

Drug name and Classification Mechanism of ActionIndication and ContraindicationSide effectsNursing responsibilities

Tamoxilen(Antagonist of estrogen receptor)is aprodrug, having relatively little affinity for its target protein, the estrogen receptor. It is metabolized in the liver by thecytochrome P450isoformCYP2D6andCYP3A4into active metabolites such as 4-hydroxytamoxifen (afimoxifene) and N-desmethyl-4-hydroxytamoxifen (endoxifen)]which have 30-100 times more affinity with the estrogen receptor than tamoxifen itself. These active metabolites compete with estrogen in the body for binding to the estrogen receptor.Indication:Breast cancerMcCune-Albright syndromeInfertilityGynecomastiaBipolar Disorder

Contraindication:Pregnancy

a history of stroke or blood clot;

liver disease;high cholesterol or triglycerides (a type of fat in the blood);

a history of cataracts

if you are receiving chemotherapy or radiation.

Absent, missed, or irregular periodsdecrease in the amount of urinefeeling of warmthmenstrual changesnoisy, rattling breathingredness of the face, neck, arms and occasionally, upper chestskin changesstopping of menstrual bleeding

Monitor Vital signs

Assist in obtaining a wig for patient before hair loss occurs

Encourage smallfrequent feedings for Nausea and Vomiting

Instruct the client that absent or missed periods are a side effect of the drug

Drug name and Classification Mechanism of ActionIndication and ContraindicationSide effectsNursing responsibilities

CysplatinInhibits DNA synthesis by producing cross-linking of parent DNA strands (cell-cycle- nonspecific)IndicationsAlone or in combination (with other antineoplastics, surgery, or radiation) in the management of: Metastatic testicular and ovarian carcinoma; Advanced bladder cancer; Head and neck cancer; Cervical cancer; Lung cancer; Other tumors. Contraindicated in: Hypersensitivity; Pregnancy or lactation.Use Cautiously in: Hearing loss; Renal impairment (dosage reduction recommended); Congestive heart failure; Electrolyte abnormalities; Active infections; Bone marrow depression; Chronic debilitating illnesses; Patients with childbearing potential.

CNS: SEIZURES, malaise, weakness. EENT: ototoxicity, tinnitus. GI: severe nausea, vomiting, diarrhea, hepatotoxicity. GU: nephrotoxicity, sterility. Derm: alopecia. F and E: hypocalcemia, hypokalemia, hypomagnesemia. Hemat: LEUKOPENIA, THROMBOCYTOPENIA, anemia. Local: phlebitis at IV site. Metab: hyperuricemia. Neuro: peripheral neuropathy. Misc: anaphylactoid reactions.Severe and protracted nausea and vomiting usually occur 14 hr after a dose; vomiting may last for 24 hr. Parenteral antiemetic agents should be administered 3045 min before therapy and routinely around the clock for the next 24 hr

Encourage patient to drink 20003000 ml/day to promote excretion of uric acid

Monitor blood pressure, pulse, respiratory rate, and temperature frequently during administration. Report significant changes. Monitor for signs of anaphylaxis (facial edema, wheezing, dizziness, fainting, tachycardia, hypotension). Discontinue medication immediately and report symptoms

Assist in obtaining a wig for patient before hair loss occurs

Drug name and Classification Mechanism of ActionIndication and ContraindicationSide effectsNursing responsibilities

Nitrogen mustardNitrogen mustards (NMs) form cyclic aminium ions (aziridiniumrings) by intramolecular displacement of the chloride by the amine nitrogen. This aziridinium group then alkylates DNA once it is attacked by the N-7 nucleophilic center on the guanine base. A second attack after the displacement of the second chlorine forms the second alkylation step that results in the formation of interstrand cross-links (ICLs) as it was shown in the early 1960sIndication:As part of combination regimens in treatment of Hodgkin's disease, non-Hodgkin's lymphoma.As palliative chemotherapy in lung and breast cancers.As a lotion to skin lesions of mycosis fungoides (cutaneous T-cell lymphoma)Contraindication

Nausea and vomiting. Usually occurs within first 3 hours after drug administration. You will be given anti-nausea medication before receiving drug.Hair lossMouth soresDarkening of veins used for infusionRedness, dryness, irritation with topical use

Monitor blood pressure, pulse, respiratory rate, and temperature frequently during administration. Report significant changes

Assist in obtaining a wig for patient before hair loss occurs

Assist in obtaining a wig for patient before hair loss occurs

Assist the client in performing mouth care

Drug name and Classification Mechanism of ActionIndication and ContraindicationSide effectsNursing responsibilities

Busulfan

Busulfan is an alkylsulfonate. It's analkylating agentthat forms DNA-DNAintrastrand crosslinksbetween theDNAbasesguanineandadenineand betweenguanineandguanine.[3]This occurs through anSN2reaction in which the relativelynucleophilicguanine N7 attacks the carbon adjacent to themesylateleaving group.DNA crosslinkingpreventsDNA replication. Because the intrastrand DNA crosslinks cannot be repaired by cellular machinery, the cell undergoesapoptosis.Indication:Busulfan is used in pediatrics and adults in combination withcyclophosphamideorfludarabine/clofarabineas a conditioning agent prior tobone marrow transplantation, especially inchronic myelogenous leukemia(CML) and otherleukemias,lymphomas, andmyeloproliferative disorders.

Contraindication:

you have a low white blood cell count that is not caused by the disease being treatedyou have a bacterial infection, chickenpox, or herpes zoster

SkinReversible Alopecia,Hyperpimentationofnailbeds and dermalcreasesGI:Acute Nausea andVomiting, Mucositis,Ulceration and necrosisof the colon which maylead to bleedingVascular:Phlebosclerosis,FacialFlushingLocal:Severe cellulitis,vesication, tissuenecrosisHematogic:Secondary acutemyeloid leukemia Hypersensitvity:Fever, chills, uticariaInstruct patient toreport difficulty ofbreathing, weight gain, pain orburning sensationat injection site,unusual bleedingor bruising

Assist in obtaining a wig for patient before hair loss occurs

Encourage smallfrequent feedings for Nausea and Vomiting

Drug name and Classification Mechanism of ActionIndication and ContraindicationSide effectsNursing responsibilities

Decarbazine Treating certain cancers (eg, advanced skin cancer) and Hodgkin disease.Dacarbazine is an antineoplastic agent. It is not known exactly how dacarbazine works. It may block the growth of cancer cells.Indications:Hodgskins lymphoma, Skincancer.

Contraindications:PregnancyAllergic to any ingredient of decarbazineHave shingles of chicken pox. Facial flushing, numbness, or tingling; loss of appetite; metallic taste in mouth; muscle pain or weakness; nausea; temporary hair loss; vomiting.Monitor blood pressure, pulse, respiratory rate, and temperature frequently during administration. Report significant changes

Assist in obtaining a wig for patient before hair loss occurs

Assist in obtaining a wig for patient before hair loss occurs

Assist the client in performing mouth care

Offer great looking foods to provide appetite

Drug name and Classification Mechanism of ActionIndication and ContraindicationSide effectsNursing responsibilities

ThiotepaThiotepa is a cell cycle nonspecific alkylating agent related to nitrogen mustard. Its radiomimetic action is believed to occur through the release of ethylenimine radicals, which disrupt the bonds of DNA. TEPA possesses cytotoxic activityIndication:Bladder cancer, palliative therapy of breast and ovarian carcinoma.

Contraindication:History of hypersensitivity reaction, hepatic disease, renal disease, or bone marrow toxicity. Administer reduced doses if therapy is necessary in these patients.CNSConfusion and somnolence at high doses used for bone marrow transplantation. With intrathecal use lower extremity weakness or pain, spinal cord demyelination, transient paresthesias.DermatologicRash, hives, bronze hyperpigmentation after bone marrow transplantation.GILow potential for nausea and vomiting, anorexia, mucositis, intestinal ulceration, lower abdominal pain with intravesical use.GenitourinaryChemical and hemorrhagic cystitis, hematuria with intravesical use, amenorrhea, interference with spermatogenesis.

Orient the client to person, place and time

Assess and monitor vital signs

Provide moisturizer ot lotion to skin

Provide anti-emetics before therapy and offer good looking foods

Instruct client that absence of menstruation is normal side effect.

Drug name and Classification Mechanism of ActionIndication and ContraindicationSide effectsNursing responsibilities

Prednisone(Corticosteroids)Prednisone is a corticosteroid. It prevents the release of substances in the body that cause inflammation. It also suppresses the immune system.Prednisone is used as an anti-inflammatory or an immunosuppressant medication.

Indication:- Replacement therapy in adrenal cortical insufficiencyHypercalcemia associated with cancerShort-term management of various inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (eg, SLE)Contraindication:Contraindicated with infections, especially tuberculosis, fungal infections, amebiasis, vaccinia and varicella, and antibiotic-resistant infections; lactation.

Vertigo, headache, paresthesias, insomnia, convulsions, psychosis, cataracts, increased intraocular pressure, glaucoma (long-term therapy)Hypotension, shock, hypertension and CHF secondary to fluid retention, thromboembolism, thrombophlebitis, fat embolism, cardiac arrhythmiasNa+ and fluid retention, hypokalemia, hypocalcemiaAmenorrhea- Administer once-a-day doses before 9 AM to mimic normal peak corticosteroid blood levels.Increase dosage when patient is subject to stress.Taper doses when discontinuing high-dose or long-term therapy.Do not give live virus vaccines with immunosuppressive doses of corticosteroids.

Drug name and Classification Mechanism of ActionIndication and ContraindicationSide effectsNursing responsibilities

MethotrexateInhibits folic acid reductase, leading to inhibition of DNA synthesis and inhibition of cellular replication; selectively affects the most rapidly dividing cells (neoplastic and psoriatic cells)Indication:Burkitt's lymphoma- Acute lymphoblastic leukaemia- Choriocarcinoma- Mycosis fungoides- Psoriasis- Rheumatoid arthritis- Crohn's disease- Osteosarcoma- Breast cancer- Advanced lymphosarcoma

Contraindication:Pregnancy- Lactation- Alcoholism- Chronic liver disease- Immune deficiencies- Blood dyscrasias- HypersensitivityCNS: Headache, drowsiness, blurred vision, aphasia, hemiparesis, paresis, seizures, fatigue, malaise, dizzinessDermatologic: Erythematous rashes, pruritus, urticaria, photosensitivity, depigmentation, alopecia, ecchymosis, telangiectasia, acne, furunculosisGI: Ulcerative stomatitis, gingivitis, pharyngitis, anorexia, nausea, vomiting, diarrhea, hematemesis, melena, GI ulceration, bleeding, enteritis, hepatic toxicityGU: Renal failure, effects on fertility

Before- Observe 15 rights in drug administration.- Assess for contraindications of the drug.- Arrange for tests to evaluate CBC, urinalysis, renal and liver function tests,

During- Arrange for tests to evaluate CBC, urinalysis, renal and liver function tests, and chest X-ray during therapy.- Do not administer any other

After- Arrange for tests to evaluate CBC, urinalysis, renal and liver function tests, and chest X-ray several weeks after therapy.- Instruct to report black tarry stools, fever, chills, sore throat, unusual bleeding or bruising, cough or shortness of breath, darkened or bloody urine, abdominal, flank or joint pain, jaundice symptoms, mouth sores.

Drug name and Classification Mechanism of ActionIndication and ContraindicationSide effectsNursing responsibilities

FluoracilFluorouracil is part of a group of chemotherapy drugs known as the anti metabolites. Anti metabolites are similar to normal body molecules but they have a slightly different structure. These differences mean that anti metabolites stop cells working properlyIndication:Cancer Breast cancerHodgkins lymphoma

Contraindication:Leucopenia, thrombocytopenia, advanced liver insufficiency, pregnancy.Increased risk of getting an infection from a drop in white blood cells - it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery Tiredness and breathlessness due to a drop in red blood cells (anaemia) - you may need a blood transfusion Bleeding of gumsNausea and vomiting

Assess mucous membranes, number and consistency of stools, and frequency of vomiting. Assess for signs of infection (fever, chills, sore throat, cough, hoarseness, pain in lower back or side, difficult or painful urination). Assess for bleeding (bleeding gums; bruising; petechiae; and guaiac test stools, urine, and emesis). Avoid IM injections and taking rectal temperatures. Apply pressure to venipuncture sites for 10 min.

Drug name and Classification Mechanism of ActionIndication and ContraindicationSide effectsNursing responsibilities

CytarabineAra-C contains a 2-hydroxyl that istransto the 3-hydroxyl of thesugar.The 2-hydroxyl hinders rotation of the base around the nucleoside bond and interfereswith base pairing.Ara-C is enterscells through a nucleoside transporter (hENT1, highlyexpressed in patients with AML and MLL) andthen is converted to its active form (5-monophosphate ribonucleotide [Ara-CMP]) by deoxycytidine kinase(exhibits polymorphicexpression among patients

Indication:The most important antimetabolite used to treat AML (acutemyelogenousleukemia).Also can treat ALL (acute lymphoblastic leukemia), CML (chronic myelogenousleukemia), acute promyelocytic leukemia, and high-grade lymphomas

Contraindication:Pregnancythrombocytopenia, advanced liver insufficiencyMyelosuppression (leukopenia, thrombocytopenia, and anemia),GI disturbances, stomatitis, conjunctivitis, reversible hepatic enzyme elevations, noncardiogenicpulmonary edema, and dermatitis.Monitor Vital signs

Assist in obtaining a wig for patient before hair loss occurs

Encourage smallfrequent feedings for Nausea and Vomiting

Instruct the client that absent or missed periods are a side effect of the drug

Drug name and Classification Mechanism of ActionIndication and ContraindicationSide effectsNursing responsibilities

Mercaptopurine It is an immunosuppresive drug.6-MP ribonucleotide inhibits purine nucleotide synthesis and metabolism. This alters the synthesis and function of RNA and DNA. Mercaptopurine interferes with nucleotide interconversion and glycoprotein synthesis.Indication:Several types of cancerHodgkins lymphomaLung cancerSkin cancer

Contraindication:PURINETHOL should not be used in patients who have a hypersensitivity to mercaptopurine or any component of the formulation.

Increased risk of getting an infection from a drop in white blood cells - it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery.Tiredness and breathlessness due to a drop in red blood cells (anaemia) - you may need a blood transfusionBruising more easily due to a drop in platelets - you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechiae) Assess mucous membranes, number and consistency of stools, and frequency of vomiting. Assess for signs of infection (fever, chills, sore throat, cough, hoarseness, pain in lower back or side, difficult or painful urination). Assess for bleeding (bleeding gums; bruising; petechiae; and guaiac test stools, urine, and emesis). Avoid IM injections and taking rectal temperatures. Apply pressure to venipuncture sites for 10 min.