Drug Name and

Classification
Vincristine (Antineoplastic)

Dosage
Standard Dose:

Mechanism of
Action
Binds to tubulin
dimers, inhibiting
assembly of
microtubule
structures.
Disruption of the
microtubules arrests
mitosis in
metaphase. The
vinca alkaloids
therefore affect all
rapidly dividing cell
types including
cancer cells, but also
intestinal epithelium
and bone marrow

Indication and
Contraindication
Indication :
Treating certain
types of cancer (eg,
leukemia, Hodgkin
disease, nonHodgkin
lymphomas,
rhabdomyosarcoma,
neuroblastoma,
Wilms' tumor).
Contraindication:
you are allergic to
any ingredient in

1.4 mg/m2 IV over

vincristine

one minute, once.

you have a certain

The drug is

disease of the

generally

nervous system

administered once

(Charcot-Marie

a week

Tooth syndrome)

Side effects

Nursing Responsibility

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 of vincristine.
One of the first symptoms
of peripheral neuropathy
is foot drop

Monitor 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

Drug Name and

Classification
Vinblastine
(Antineoplastic)

Dosage:
3.7-18
mg/sq.meter/day IV q710d

Mechanism of action
Vinblastine is a vinca
alkaloid and a chemical
analogue of vincristine.
It binds tubulin, thereby
inhibiting the assembly
of microtubules.
Vinblastine treatment
causes M phase
specific cell
cycle arrest by
disrupting microtubule
assembly and proper
formation of the mitotic
spindle and
the kinetochore, each
of which are necessary
for the separation of
chromosomes during
anaphase of mitosis.

Indication and
Contraindication
Indication:
Vinblastine is a component
of a number
of chemotherapy regimens,
including ABVD for Hodgki
n lymphoma. It is also used
to
treathistiocytosis according
to the established protocols
of the Histiocytosis
Association.

Side effects
Blurred or double
vision
constipation
difficulty in walking
drooping eyelids
headache
jaw pain
joint pain
lower back or side pain
numbness or tingling in

Contraindication

fingers and toes

you are allergic to any

toes

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

pain in fingers and

Nursing
Responsibility
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.

Drug name and

Classification

Mechanism of
Action

Indication and
Contraindication

Side effects

Nursing
responsibilities

Doxorubucin(Ant
hracyclines
and Anthracenedio
nes)

Intercalates with
DNA, directly
affecting transcri
ption and
translation.Forms
a tripartite
complex with
topoisomerase II
and DNA
and prevents religation of
double-stranded
breaks made by
topoisomerase II
which leads to
apoptosis. Also
generates
freeradicals by
formation of
semiquinone
radical
intermediates
from
quinone groups
that react with O2
to produce
superoxide anion
radicals
(increased radical
production in
combinationwith
iron)

Indication:
Multiple myeloma,
ovarian cancer, AIDSrelated Kaposi sarcoma,
malignantlymphomas (in
combination with
cyclophosphamide
and vinca alkaloids),
adjuvant
and metastaticcarcinoma
of the breast, and other
human solid tumors

Skin
Reversible
Alopecia,Hyperpimentation of
nailbeds and dermalcreases
GI:
Acute Nausea andVomiting,
Mucositis,Ulceration and
necrosisof the colon which
maylead to bleeding
Vascular:
Phlebosclerosis, FacialFlushing
Local:Severe
cellulitis,vesication,
tissuenecrosisHematogic
:Secondary acutemyeloid
leukemia
Hypersensitvity:Fever, chills,
uticaria

Instruct patient
toreport difficulty
of breathing,
weight gain, pain
orburning
sensationat
injection
site,unusual
bleedingor
bruising

Contraindication: Marked
Myelosuppression, previous
treatmentwith cumulativedoses
of
doxorubicin,daunorubicin,ida
rubicin, and/or other
anthracyclinesand
anthracenes

Assist in obtaining
a wig for patient
before hair loss
occurs
Encourage
smallfrequent
feedings for
Nausea and
Vomiting

Drug name and

Classification

Mechanism of Action

Indication and
Contraindication

Side effects

Nursing
responsibilities

Etoposide
( Topoisomerase
inhibitor)

Etoposide forms a
ternary complex
with DNA and
the topoisomerase
II enzyme (which aids in
DNA unwinding),
prevents re-ligation of the
DNA strands, and by
doing so causes DNA
strands to break.
[3]
Cancer cells rely on
this enzyme more than
healthy cells, since they
divide more rapidly.
Therefore, this causes
errors in DNA
synthesis and
promotes apoptosis of
the cancer cell

Indication
Treating lung cancer

low blood pressure

hair loss
pain and or burning at
the IV site
constipation or diarrhea
metallic food taste
Bone
marrow suppression,
leading to:
decreased white blood
cell counts (leading to
increased susceptibility
to infections)low red
blood cell counts
(anemia)
low platelet counts
(leading to easy bruising
and bleeding)

Monitor Vital signs

and testicular tumors in

patients who have not
responded to other
treatment. It is used in
combination with other
cancer medications

Contraindication

Assist in obtaininga
wig for patient
before hair loss
occurs
Encourage
smallfrequent
feedings for Nausea
and Vomiting

Drug name and

Classification

Mechanism of Action

Indication and
Contraindication

Side effects

Nursing
responsibilities

Tamoxilen(Antago
nist of estrogen
receptor)

is a prodrug, having
relatively little affinity for its
target protein, the estrogen
receptor. It is metabolized in
the liver by thecytochrome
P450 isoform CYP2D6 and CY
P3A4 into active metabolites
such as 4-hydroxytamoxifen
(afimoxifene) and Ndesmethyl-4hydroxytamoxifen
(endoxifen)] which have 30100 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 cancer
McCune-Albright
syndrome
Infertility
Gynecomastia
Bipolar 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
periods
decrease in
the amount of
urine
feeling of
warmth
menstrual
changes
noisy, rattling
breathing
redness of the
face, neck,
arms and
occasionally,
upper chest
skin changes
stopping 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 Action

Indication and
Contraindication

Side effects

Nursing
responsibilities

Cysplatin

Inhibits DNA
synthesis by
producing crosslinking of parent DNA
strands (cell-cyclenonspecific)

Indications
Alone 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,
THROMBOCYTOPENI
A, 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 Action

Indication and
Contraindication

Side effects

Nursing
responsibilities

Nitrogen mustard

Nitrogen mustards
(NMs) form cyclic
aminium ions
(aziridinium rings) 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 crosslinks (ICLs) as it was
shown in the early
1960s

Indication:
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 antinausea medication
before receiving drug.
Hair loss
Mouth sores
Darkening of veins
used for infusion
Redness, 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 Action

Indication and
Contraindication

Side effects

Nursing
responsibilities

Busulfan

Busulfan is an
alkylsulfonate. It's
an alkylating agent that
forms DNADNA intrastrand
crosslinks between
the DNA bases guanine
and adenine and
between guanine andgu
anine.[3] This occurs
through an SN2 reaction
in which the
relatively nucleophilic gu
anine N7 attacks the
carbon adjacent to
the mesylate leaving
group. DNA
crosslinkingprevents DN
A replication. Because
the intrastrand DNA
crosslinks cannot be
repaired by cellular
machinery, the cell
undergoes apoptosis.

Indication:
Busulfan is used in pediatrics
and adults in combination
with cyclophosphamide or flud
arabine/clofarabine as a
conditioning agent prior
to bone marrow
transplantation, especially
in chronic myelogenous
leukemia (CML) and
other leukemias, lymphomas,
andmyeloproliferative
disorders.

Skin
Reversible
Alopecia,Hyperpimenta
tion of nailbeds and
dermalcreases
GI:
Acute Nausea
andVomiting,
Mucositis,Ulceration
and necrosisof the
colon which maylead to
bleeding
Vascular:
Phlebosclerosis, FacialF
lushing
Local:Severe
cellulitis,vesication,
tissuenecrosisHematog
ic
:Secondary
acutemyeloid leukemia
Hypersensitvity:Fever,
chills, uticaria

Instruct patient
toreport difficulty
of breathing,
weight gain, pain
orburning
sensationat
injection
site,unusual
bleedingor
bruising

Contraindication:

you have a low white blood

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

Assist in obtaining
a wig for patient
before hair loss
occurs
Encourage
smallfrequent
feedings for
Nausea and
Vomiting

Drug name and

Classification

Mechanism of Action

Indication and
Contraindication

Side effects

Nursing
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.

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

Contraindications:
Pregnancy
Allergic to any
ingredient of
decarbazine
Have shingles of
chicken pox.

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 Action

Indication and
Contraindication

Side effects

Nursing
responsibilities

Thiotepa

Thiotepa is a cell cycle

Indication:
Bladder cancer,

CNS
Confusion and
somnolence at high
doses used for bone
marrow
transplantation. With
intrathecal use lower
extremity weakness
or pain, spinal cord
demyelination,
transient
paresthesias.
Dermatologic
Rash, hives, bronze
hyperpigmentation
after bone marrow
transplantation.
GI
Low potential for
nausea and
vomiting, anorexia,
mucositis, intestinal
ulceration, lower
abdominal pain with
intravesical use.
Genitourinary
Chemical and
hemorrhagic cystitis,
hematuria with
intravesical use,
amenorrhea,
interference with
spermatogenesis.

Orient the client to

person, place and
time

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
activity

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.

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 Action

Indication and
Contraindication

Side effects

Nursing
responsibilities

Prednisone(Corticoste
roids)

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 insufficiency
Hypercalcemia
associated with
cancer
Short-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
arrhythmias
Na+ and fluid
retention,
hypokalemia,
hypocalcemia
Amenorrhea

- Administer once-aday doses before 9

AM to mimic normal
peak corticosteroid
blood levels.
Increase dosage
when patient is
subject to stress.
Taper doses when
discontinuing highdose or long-term
therapy.
Do not give live
virus vaccines with
immunosuppressive
doses of
corticosteroids.

Drug name and

Classification

Mechanism of Action

Indication and
Contraindication

Side effects

Nursing
responsibilities

Methotrexate

Inhibits 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

CNS: Headache,
drowsiness, blurred
vision, aphasia,
hemiparesis, paresis,
seizures, fatigue,
malaise, dizziness
Dermatologic:
Erythematous
rashes, pruritus,
urticaria,
photosensitivity,
depigmentation,
alopecia,
ecchymosis,
telangiectasia, acne,
furunculosis
GI: Ulcerative
stomatitis, gingivitis,
pharyngitis,
anorexia, nausea,
vomiting, diarrhea,
hematemesis,
melena, GI
ulceration, bleeding,
enteritis, hepatic
toxicity
GU: 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,

Contraindication:
Pregnancy
- Lactation
- Alcoholism
- Chronic liver
disease
- Immune
deficiencies
- Blood dyscrasias
- Hypersensitivity

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 Action

Indication and
Contraindication

Side effects

Nursing
responsibilities

Fluoracil

Drug name and

Classification

Fluorouracil 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
properly

Mechanism of
Action

Indication:
Cancer
Breast cancer
Hodgkins lymphoma
Contraindication:
Leucopenia,
thrombocytopenia,
advanced liver
insufficiency,
pregnancy.

Indication and
Contraindication

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 gums
Nausea and vomiting

Side effects

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.

Nursing
responsibilities

Cytarabine

Ara-C contains a 2hydroxyl that is

trans
to the 3-hydroxyl of
thesugar. The 2hydroxyl hinders
rotation of the base
around the
nucleoside bond
and interfereswith
base pairing. Ara-C
is enters cells
through a
nucleoside
transporter (hENT1,
highlyexpressed in
patients with AML
and MLL) and then
is converted to its
active form (5monophosphate
ribonucleotide [AraCMP]) by
deoxycytidine
kinase (exhibits
polymorphicexpress
ion among patients

Indication:
The most important
antimetabolite used to treat
AML
(acute myelogenousleukemi
a). Also can treat ALL (acute
lymphoblastic leukemia),
CML (chronic
myelogenousleukemia),
acute promyelocytic
leukemia, and high-grade
lymphomas
Contraindication:
Pregnancy
thrombocytopenia,
advanced liver insufficiency

Myelosuppression
(leukopenia,
thrombocytopenia,
and anemia),GI
disturbances,
stomatitis,
conjunctivitis,
reversible hepatic
enzyme elevations,
noncardiogenic pulm
onary 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 Action

Indication and
Contraindication

Side effects

Nursing
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
cancer
Hodgkins lymphoma
Lung cancer
Skin cancer

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
Bruising 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.

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