purine analogs

mercaptopurine

major med under purine analogs

mercaptopurine

therapeutic use

• Treats acute lymphocytic and acute myelogenous leukemia in adults and children

• May cause temporary remission in chronic granulocytic leukemia

adverse effect

• Gastrointestinal manifestations: nausea, vomiting, diarrhea, intestinal ulceration

• Bone marrow suppression (all types of cells) occurs at predictable times following treatment with purine analogs.

• Liver toxicity (usually mild)

interventions

• Monitor for gastrointestinal effects, which may indicate need for a decrease in dose. Administer antiemetic as needed.

• Monitor client’s weight and I&O.

• Monitor CBC, thrombocyte counts, Hgb, Hct before, during, and after therapy.

• Monitor for infection during treatment.

• Colony-stimulating medications, such as filgrastim, may be prescribed.

• Monitor for bleeding from common sites, such as gums, and gastrointestinal tract (watch for melena—blood in stool).

• Institute measures to avoid bruising, such as applying prolonged pressure to puncture sites and using small-gauge needles if injection is necessary.

• Monitor levels of bilirubin and liver transaminase for elevations.

administration

• Mercaptopurine is only available orally.

• Give dose once daily with or without food.

• Base dose on client’s weight.

client instructions

• Report gastrointestinal symptoms to provider.

• Take prescribed antiemetic, as needed.

• Report fever, sore throat, easy bruising, unusual fatigue to provider.

• Use scrupulous handwashing techniques; restrict visitors who are ill.

• Wash fresh fruits and vegetables well and cook foods properly.

• Institute frequent oral care to prevent stomatitis (yeast superinfection in mouth).

• Use a soft toothbrush and electric razor to prevent bleeding; take measures to prevent bruising.

• Report abdominal pain or discomfort, jaundice, decreased appetite.

• Use a reliable method of birth control during chemotherapy.

• Immediately report to provider if pregnancy is likely.

contraindications

• Pregnancy risk category D, lactation

• Presence of infections

precautions

Liver or kidney impairment

interactions

• Use with allopurinol for gout, which may cause mercaptopurine toxicity (reduce dose of mercaptopurine).

• May increase or decrease effects of warfarin.