IMMUNE SYSTEM (CANCER)

drama-erykah badu

methotrexate (antimetabolite, folic acid analog)

can cause bone marrow suppression as the blood cell-forming cells of the bone marrow are killed along with the cancer cells that are targeted. effects leukocytes, erythrocytes, and platelets. can show neutropenia, which requires isolation precautions, limiting the number of invasive procedures, keeping designated client care equipment in the client’s room, and notifying the provider if the client gets a fever.

mercaptopurine (antimetabolite, purine analog)

can cause nausea and vomiting due to stimulation of the CTZ in the brain. emesis can occur prior to chemo in anticipation of this med, during chemo, and for some meds, several days after chemo. antiemetics are more effectives when given prior to the beginning of emesis. maintenance of adequate nutritional and fluid intake may be hard, and IV fluids may be necessary.

cytarabine (antimetabolite, pyrimidine analog)

watch the nadir (time following chemo when blood cell counts (leukocytes and platelets) are at their lowest level) closely. this helps caregivers know when monitoring the client for signs of a low platelet or leukocyte count is vital and when these blood counts may start rising again.

cyclophosphamide (alkylating agent, nitrogen mustard)

can lead to alopecia, which is temporary, but can have a significant effect on the client’s self esteem. when working with a client on this med, talk to them before starting therapy about ways to manage this change in self-image, such as wearing a wig or a scarf.

carmustine (alkylating agent, nitrosurea)

can affect cells that have a high growth fraction, such as the cells of a fetus. this can lead to fetal malformations and death in babies. the risk of fetal damage is highest during then first trimester; clients who are of child bearing age should be instructed to use a reliable method of birth control to prevent pregnancy.

cisplatin (platinum compound)

has really bad ADRs on the kidneys that can be minimized by hydrating the client with one to two liters of IV fluid before treatment, and by continuing hydration for 24 hours as necessary following treatment. obtain baseline serum creatinine, urinary creatinine clearance, and BUN, and monitor weekly for 2 weeks. monitor client’s urine output before and after each treatment and notify provider immediately for an output less than the hourly amount prearranged with the provider.

doxorubicin (antitumor antibiotic, anthracycline)

can lead to superinfections such as thrush. when caring for an immunosuppressed client on this med, evaluate their mouth for s/s of thrush (inflammation and white patches on oral mucosa and tongue that cannot be removed). early recognition of the development of thrush will allow for early treatment. ensure client with thrush is receiving adequate nutrition and hydration as the severity of the oral and throat pain can make clients avoid eating and drinking.

vincristine (anti mitotic, vinca alkaloid)

can lead to constipation, especially in children, as it decreases GI motility. can also cause paralytic ileus and/or upper colon impactions to occur as well. parents of children on this drug should keep a record of their child’s BMs, as well as their consistency and frequency. child should increase fiber and fluids.

paclitaxel (mitotic inhibitor, taxanes)

check neutrophils before administering this medication and ensure they are not too low as giving this med to a client who is already severely immunocompromised can reduce the neutrophil count even further. notify provider if neutrophils are too low.

topotecan (topoisomerase inhibitors)

can cause bone marrow suppression, thrombocytopenia in particular. this can lead to spontaneous bleeding via trauma and in the GI tract. avoid the use of needles when possible; use smallest gauge possible when giving parenteral meds. use caution when taking blood pressure to prevent bruising, monitor for nose bleeds, and test stool samples for occult blood. a change in mental status can indicate a cerebral bleed. avoid NSAIDs. platelet transfusion or oprelvekin can be beneficial.

tamoxifen (estrogen receptor blockers)

activates the estrogen receptors in the uterus, increasing the client’s risk for endometrial cancer. clients who are premenopausal should observe for abnormal bleeding and spotting that may indicate endometrial hyperplasia. dx and treatment must be prompt. post-menopausal woman who no longer have periods should report any type of uterine bleeding immediately.

anastrozole (aromatase inhibitors)

check to see if the client has a family history of osteoporosis. if so, and they are not taking a med to prevent osteoporosis, clarify the client’s medication therapy with the provider and ensure the provider is aware of this.

trastuzumab (monoclonal antibodies)

can cause heart failure due to its effect on the ventricles of the heart. s/s depend on which ventricle is affected. frequent nighttime urination can occur secondary to the reabsorption of the fluid from the lower parts of the body that occurs when the body is in a supine position. s/s of HF should be reported immediately to the provider.

interferon alfa 2-A /2-B(interferons)

ensure the pharmacy has sent up the correct med before administration, as the two meds are not interchangeable. look alike meds include alfacon-1, beta 1a, and beta 1b, which are not interchangeable either. do med check 3 times.

imatinib (antieoplastic meds)

monitor for fluid retention in clients on this med, which manifests as fluid collecting in and around the lungs as pulmonary edema and effusion along with ascites. each of these can make oxygen exchange difficult, so notify provider of pulse ox readings that are below the expected reference range. keeping client in high-fowler’s can help.