ANTINEOPLASTIC AGENTS

ANTINEOPLASTICS
Alkylating Agents

WHAT I NEED TO KNOW AS A BRAND NEW NURSE

*Bone marrow suppression (neutropenia, anemia, thrombocytopenia) is the primary dose-limiting
adverse effect.
Common examples:
*Adverse effects include Alopecia, severe GI complaints, anorexia, Stevens-Johnson syndrome,
Nitrogen Mustards
neurotoxicity, nephrotoxicity, ototoxicity, hypersensitivity reactions, hemorrhagic cystitis,
Chlorambucil (Leukeran)
anaphylaxis.
Cyclophosphamide (Cytoxan,
Neosar) Bendamustine (Treanda) *Monitor I&O and increase fluids to decrease renal irritation.
*Monitor blood counts.
Nitrosoureas
Carmustine (BiCNU, Gliadel)

Miscellaneous Alkylating
Agents
Oxaliplatin (Eloxatin)
Cisplatin (Platinol)
Carboplatin (Paraplatin)

Antimetabolites
Common examples:
Methotrexate (Rheumatrex,
Trexall)
Flouracil (5-FU, Adrucil, Carac,
Efudex)

*Adverse effects include GI complaints, stomatitis, bone marrow suppression, alopecia,

hepatotoxicity, neurotoxicity, hypersensitivity reactions, anaphylaxis.
*Highly toxic to rapidly dividing normal tissues.
*Monitor blood counts.
*Monitor I&O, encourage fluids and keep well hydrated (at least 2000ml/day).
*With Methotrexate administration, Leucovorin is given to decrease the toxic effects of Methotrexate
(Leucovorin Rescue Therapy). Leucovorin can be fatal for the patient receiving Methotrexate if not
given in the right dose at the right time.

Antitumor Antibiotics
Common examples:
Bleomycin (Blenoxane)
Doxorubicin (Adriamycin, Rubex)

Hormones and Hormone

Antagonists
Common examples:
Hormones
Dexamethasone (Decadron)
Medroxyprogesterone (Provera,
Depo-Provera)
Megestrol (Megace)
Prednisone (Deltasone)
Testosterone (Andro, Histerone)
Hormone Antagonists
Leuprolide (Eligard, Lupron,
Viadur)
Raloxifene (Evista)
Tamoxifen (Nolvadex)
Anastrozole (Arimidex)

*Bone marrow suppression (neutropenia, anemia, thrombocytopenia) is the primary dose-limiting

adverse effect.
*Most are vesicants except Bleomycin, monitor IV site closely.
*Cardiotoxicity associated with many of the agents in this class.
*Adverse effects include severe GI complaints, stomatitis, alopecia, pulmonary and cardiac toxicities,
hypersensitivity reactions, anaphylaxis.
*Monitor blood counts.
*Monitor I&O, encourage fluids and keep well hydrated (at least 2000ml/day).
* EKG indicated prior to therapy and at regular intervals.

*These agents are not cytotoxic and produce few severe adverse effects.
*Adverse effects are related to the type of hormone or hormone antagonist used and include Weight
gain, insomnia, nervousness, hot flashes, GI complaints, thrombophlebitis, osteoporosis,
hepatotoxicity, sexual dysfunction, anaphlylaxis

Plant Alkaloids
Common examples:
Vincristine (Oncovin)
Vinblastine (Velban)
Paclitaxel (Taxol)

Biologic Response
Modifiers BRMs
(Immunostimulants)
Interferon alfa-2 (Roferon-A,
Intron A)
Epoetin-alfa (PRocrit)
Aldesleukin (Proleukin)

*Adverse effects include bone marrow suppression, numbness and tingling, ataxia, severe GI
complaints, alopecia, anorexia, stomatitis, nephrotoxicity, pulmonary and cardiac toxicities, joint and
bone pain, hypersensitivity reactions, anaphylaxis.
*Neurotoxicity is associated with plant alkaloids, including decrease in muscle strength, loss of deep
tendon reflexes, motor instability, numbness, tingling. May be irreversible.
*Monitor blood counts.
*Monitor I&O, encourage fluids and keep well hydrated (at least 2000ml/day).
*Adverse effects include flu-like symptoms, malaise, fatigue, asthenia, GI complaints, hypotension,
tachycardia, thrombocytopenia, oliguria, anuria, hepatotoxicity, suicide ideation, cardiac arrest.
*Monitor blood counts. Imperative to monitor H & H with Procrit therapy, target hemoglobin should
not exceed 12g/dl with Procrit therapy.
*Monitor I&O, encourage fluids and keep well hydrated (at least 2000ml/day).
*Monitor ALT and AST.