pyrimidine analogs (antimetabolites)

cytarabine

therapeutic use of cytarabine

• both acute myelocytic and acute lymphomcytic leukemia

• non-hodgkin lymphoma

• meningitis caused by leukemia

• maintains remission

adverse effects

• GI effects: N/V, stomatitis

• bone marrow supression

• arachnoidits - N/V, headache, fever when given intrathecal

interventions

• monitor CBC, Hgb, Hct before, during, after

• monitor pt weight, fever, GI effects

• premedicate with antiemetic

• colony-stimulating meds: fligrastim - prevent neutropenia

• avoid bruising

• administer dexamethoasone (glucocorticoid) - antiemetic used with intrathecal cytarabine

administration of cytarabine

• SUBQ, IV, or intrathecal use

• SUBQ: given every 1 - 4 wks

• intrathecal use: given daily for 4 consecutive days or 1 dose every 4 days

• decrease dosage in renal impairment

main medication under pyrimidine analogs

cytarabine

client instructions

• take antiemetic

• small frequent meals

• report severe N/V, fever, sore throat, easy bruising, unusual fatigue

• scrupulous handwashing, restrict ill visitors

• soft toothbrush, electric razor

• explain dexamethasone - reduces N/V

• contraception during treatment

contraindications

• pregnancy risk category: positive evidence of fetal risk

• myelosuppression - bone marrow decreases: cause hematologic toxicity, worsen suppression

• meningeal infection: worsen infection, cause fatal neurotoxicity

precautions

• gout

• neurological disorders

• renal or hepatic dysfunction

• myelosupression

• older adults

interactions with cytarabine

• ↓ digoxin absorption

• after 3 treatment DO NOT give immunization with live viruses

• aminoglycoside antibiotics ↓ effectiveness against klebsiella pneumoniae