platinum compounds

cisplatin

major med under platinum compounds

cisplatin

therapeutic use

• Use in combination with other chemotherapy agents to treat metastatic testicular or ovarian cancer

• Use off-label to treat head and neck cancers or carcinoma of the bladder or uterine lining.

adverse effects

• Severe nausea/vomiting occurs about 1 hr after infusion of cisplatin begins.

• Bone marrow suppression related to size of dose (all cells): Nadir for thrombocytes and leukocytes reached between days 18 and 23 following cisplatin treatment

• Kidney toxicity and ototoxicity

• Peripheral neuropathy

• Anaphylactic reaction soon after IV infusion begins from allergy to platinum

interventions

• Premedicate with prescribed antiemetic 30 min before beginning infusion.

• Monitor CBC (platelets, erythrocytes, leukocytes, Hgb, and Hct) before each treatment and at weekly intervals following treatments as prescribed.

• Monitor temperature frequently during treatment.

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

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

• Avoid bruising if thrombocytopenia is present.

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

• Monitor for nephrotoxicity and ototoxicity.

Perform baseline audiometric testing and repeat before each dose of cisplatin.

Perform baseline kidney function tests and repeat before each dose of cisplatin.

Ensure adequate hydration before, during, after cisplatin administration.

Monitor weight and notify provider of sudden increases.

Expect dosage decrease at signs of kidney toxicity or ototoxicity.

• Monitor for manifestations of peripheral neuropathy in extremities.

• Monitor carefully for findings that indicate allergy.

• Have epinephrine ready for administration if anaphylaxis occurs

administration

• Only available for IV use.

• Base dose on client’s weight.

• Do not use any equipment containing aluminum when administering platinum compounds.

• Wear gloves and take care when preparing solution; flush area with water if solution touches skin.

client instructions

• Report nausea, vomiting to staff.

• Take prescribed antiemetics as needed for several days following cisplatin treatment.

• Critical time for low platelet and WBC counts is 18 to 23 days after each cisplatin IV treatment.

• 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 flank pain, decreased urination, weight gain, itching skin, nausea/ vomiting, loss of appetite, dry mucous membranes to provider. • Report hearing loss, vertigo, or tinnitus to provider.

• Report numbness, tingling, and decreased sensation in hands or feet to provider.

• Immediately report rash, swelling of airway, or shortness of breath to staff.

contraindications

• Pregnancy Risk category D

• Allergy to platinum-containing substances

• Severely impaired kidney function

• Hearing loss • Severe bone marrow suppression

• History of gout or renal stones

• Client also taking loop diuretics

• Raynaud’s syndrome

precautions

• Previous chemotherapy or radiation therapy with other medications that affect kidneys or hearing

• Peripheral neuropathy

• High uric acid or electrolyte imbalance

• Mild to moderate kidney impairment

• Liver impairment

• History of circulatory disorders

interactions

• Other nephrotoxic medications, such as amphotericin B, increase risk for nephrotoxicity: separate administration by 1 to 2 weeks if possible.

• Other ototoxic medications, such as furosemide, increase risk for irreversible hearing loss.