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Name of Drug Dactinomycin Brand name: Cosmegen The dosage for the drug is calculated in micrograms (mcg).

The dose intensity per 2-week cycle for adults or children should not exceed 15 mcg/kg/day or 400-600 mcg/m2/day intravenously for five days.

Classification of drug Anti-neoplastic

Indications and contraindication Wilms' tumor, rhabdomyosarcoma, metastatic and nonmetastatic choriocarcinoma, Ewing's sarcoma, sarcoma botryoides, in combination therapy. Nonseminomatous testicular carcinoma Potentiation of effects of radiation therapy Contraindications/cautions

Side effects/ adverse effects Miscellaneous: Sepsis (including neutropenic sepsis) with fatal outcome, infection, malaise, fatigue, lethargy, fever, myalgia, proctitis, hypocalcemia and growth retardation. Oral: cheilitis, dysphagia, esophagitis, ulcerative stomatitis, pharyngitis. Lung: pneumonitis. Gastrointestinal: anorexia, nausea, vomiting, abdominal pain, diarrhea, gastrointestinal ulceration. Nausea and vomiting, which occur early during the first few hours after administration, may be alleviated by the administration of antiemetics. Hepatic: liver toxicity including liver function test abnormalities, ascites, hepatomegaly, hepatitis, hepatic failure with reports of death, hepatic veno-occlusive disease which may be associated with intravascular clotting disorder and multi-organ failure Hematologic: anemia, even to the point of aplastic anemia, agranulocytosis, leukopenia, thrombocytopenia, pancytopenia, reticulocytopenia, neutropenia, febrile neutropenia. Platelet and white cell counts should be performed frequently to detect severe hematopoietic depression. If either count

Nurses responsibilities

Contraindications: allergy to dactinomycin; chickenpox, herpes zoster (severe, generalized disease and death could result); pregnancy; lactation. Use cautiously with bone marrow suppression, radiation therapy.

Do not give IM or SC; severe local reaction and tissue necrosis occur; IV use only. Monitor injection site for extravasation, burning, or stinging. Discontinue infusion immediately, apply cold compresses to the area, and restart in another vein. Local infiltration with injectable corticosteroid and flushing with saline may lessen reaction. Monitor response, including CBC, often at start of therapy; adverse effects may require a decrease in dose or discontinuation of the drug; consult physician. Adverse effects may not occur immediately, may be maximal 1---2 wk after therapy.

markedly decreases, the drug should be withheld to allow marrow recovery. This often takes up to three weeks. Dermatologic: alopecia, skin eruptions, acne, erythema multiforme, flare-up of erythema or increased pigmentation of previously irradiated skin. Toxic Epidermal Necrolysis (TEN) and Stevens Johnson Syndrome (SJS) have been observed from postmarketing experience. Soft tissues: Dactinomycin is extremely corrosive. If extravasation occurs during intravenous use, severe damage to soft tissues will occur. In at least one instance, this has led to contracture of the arms. Epidermolysis, erythema, and edema, at times severe, have been reported with regional limb perfusion. Laboratory Tests: Many abnormalities of renal, hepatic, and bone marrow function have been reported in patients with neoplastic diseases receiving COSMEGEN. Renal, hepatic, and bone marrow functions should be assessed frequently.

Name of Drug Ifosfamide Available Forms: Powder for injection--1, 3 g Adult Administer IV at a dose of 1.2 mg/m2 per day for 5 consecutive d. Treatment is repeated every 3 wk or after recovery from hematologic toxicity. Pediatric Safety and efficacy not established. Geriatric or Renal or Hepatic Impaired Data not available on appropriate dosage. Reduced dosage is advisable.

Classification of drug

Alkylating agent Nitrogen mustard Antineoplastic

Indications and contraindication Indications

Side effects/ adverse effects

Nurses responsibilities Assessment History: Allergy to ifosfamide, hematopoietic depression, impaired hepatic or renal function, pregnancy, lactation Physical: Reflexes, affect; skin lesions, hair; urinary output, renal function; renal and hepatic function tests, CBC, Hct

In combination with other approved neoplastic agents for third-line chemotherapy of germ cell testicular cancer; should be used with an agent for hemorrhagic cystitis Unlabeled uses: possible effectiveness in the treatment of lung, breast, ovarian, pancreatic and gastric cancer, sarcomas, acute leukemias, malignant lymphomas Orphan drug uses: third-line chemotherapy in the treatment of germ cell testicular cancer, bone sarcomas, softtissue sarcomas

CNS: Somnolence, confusion, hallucinations, coma, depressive psychosis, dizziness, seizures GI: Anorexia, nausea, vomiting, diarrhea, stomatitis Hematologic: Leukopenia, thromboc ytopenia, anemia (rare), increased serum uric acid levels GU: Hemorrhagic cystitis, bladder fibrosis, hematuria to potentially fatal hemorrhagic cystitis, increased urine uric acid levels, gonadal suppression Dermatologic: Alopecia, darkening of skin and fingernails Other: Immunosuppression, secondary neoplasia

Implementation Take drug with food, have small frequent meals. drink at least 10---12 glassses of fluid each day Report unusual bleeding or bruising, fever, chills, sore throat, cough, shortness of breath, blood in the urine, painful urination, unusual lumps or masses, flank, stomach or joint pain, sores in mouth or on lips, yellow discoloration of skin or eyes.

Arrange for blood tests to evaluate hematopoietic function

Contraindications/cautions

before beginning therapy and weekly during therapy. Arrange for extensive hydration consisting of at least 2 L of oral or IV fluid per day to prevent bladder toxicity. Arrange to administer a protector, such as mesna, to prevent hemorrhagic cystitis. Counsel male patients not to father a child during or immediately after therapy; infant cardiac and limb abnormalities have occurred. Counsel female patients not to become pregnant while on this drug; severe birth defects have occurred.

Allergy to ifosfamide, hematopoietic depression, impaired hepatic or renal function, pregnancy, lactation.