nitrogen mustards

cyclophosphamide

major med under nitrogen mustards

cyclophosphamide

therapeutic use

• Broad spectrum chemotherapy agent used by itself or with other agents to treat:

Leukemias

Multiple myeloma

Lymphomas

Solid tumors (adenocarcinomas) of head, ovary, breast

Lung cancer

adverse effects

• Hair loss (alopecia)

• Severe gastrointestinal effects: nausea and vomiting (especially at high doses)

• Bone marrow suppression: leukopenia (low WBC count) is most common

• Kidney toxicity manifested frequently by hemorrhagic cystitis

• Electrolyte imbalance: hyperkalemia, hyponatremia most common

interventions

• Monitor for alopecia and the client’s reaction to it.

• Premedicate or time administration of antiemetic when dosing with alkylating agents.

• Monitor CBC before, during, and after treatment.

• Observe and report character of wound drainage if present (infected wound might not contain pus due to leukopenia).

• Protect client from people who have infections.

• Monitor temperature and manifestations of infection (elevated temperature may be a late sign in leukopenia).

• Encourage frequent fluid intake; supplement with IV fluids. • Monitor I&O.

• Administer mesna, a chemoprotective agent, with each dose of cyclophosphamide.

• Monitor electrolyte levels and findings that indicate imbalance.

• Monitor cardiac rhythm if hyperkalemia is present.

administration

• Available for oral or IV administration.

• Give oral dose without food for best absorption, or with food if severe nausea and vomiting occur.

client instructions

• Tell client early about alopecia so they can obtain a wig, hat, or scarf if desired.

• Inform client that hair will grow back following cyclophosphamide treatment.

• Report nausea, vomiting to provider or hospital staff.

• Report fever, sore throat, easy bruising, and 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).

• Void before dose is given and increase fluid intake as able.

• Report hematuria (blood in urine) or pain with voiding to provider.

• Report weakness, palpitations, muscle twitching to provider.

• Use reliable method of birth control during chemotherapy.

• Immediately report to provider if pregnancy is likely.

contraindications

• Pregnancy risk category D, lactation

• Live virus vaccinations

• Fluid volume deficits • Severe infections, especially viruses such as chickenpox or herpes zoster

precautions

• History of radiation or other chemotherapy

• Liver or kidney impairment

• Recent corticosteroid use

• Bone marrow malignancy • History of hyperuricemia and gout

• Present leukopenia or thrombocytopenia

interactions

• Doxorubicin may increase risk for cardiac toxicity.

• With succinylcholine, neuromuscular blocking can be prolonged.