C|ass|f|cat|on]Drug

Name
1rade
Name]8rand
Name
8enef|ts
4/ky/otinq 4qents
nlLrogen musLard
(mechloreLhamlne
hydrochlorlde)
MusLargen arL of comblnaLlon Lherapy of Podgkln's dlsease and
mallgnanL lymphomads used palllaLlvely ln
8ronchogenlc carclnoma Leukemlas AdmlnlsLered lnLo
cavlLles (peural perlLoneal) Lo prevenL reaccumulaLlon of
mallgnanL lnfuslons
chlorambucll Leukeran ManagemenL of chronlc lymphocyLlc leukemla mallgnanL
lymphoma and Podgkln's dlsease (alone and ln
comblnaLlon wlLh oLher agenLs)
cyclophosphamlde CyLoxan lnLerferes wlLh unA repllcaLlon and 8nA LranscrlpLlon
ulLlmaLely dlsrupLlng proLeln synLhesls (cellcycle phase
nonspeclflc)1PL8ALu1lC LllLC1S deaLh of rapldly
repllcaLlng cells parLlcularly mallgnanL ones Also has
lmmunosuppressanL acLlon ln smaller doses
esLramusLlne LmcyL chemoLherapy agenL used Lo LreaL prosLaLe cancer lL ls a
derlvaLlve of esLrogen (speclflcally esLradlol) wlLh
a nlLrogen musLardcarbamaLe esLer moleLy LhaL makes lL
a alkylaLlng anLlneoplasLlc agenL slmllar
Lo mechloreLhamlne wlLh esLrogenlnduced speclflclLy
lfosfamlde lfex lL ls glven as a LreaLmenL for a varleLy of cancers
lncludlng 1esLlcular cancer 8reasL cancer
Lymphoma(noJqklos ooJ NoonoJqklos) SofL Llssue
sarcoma CsLeogenlc sarcoma (8one cancer) Lung
cancer Cervlcal cancer Cvarlan cancer
melphalan Alkeran lL ls used Lo LreaL mulLlple myeloma and ovarlan cancer
and occaslonally mallgnanL melanoma
uracll musLard uracll MusLard lL ls used ln lymphaLlc mallgnancles such as non
Podgklns lymphoma
-itrosoureos
carmusLlne 8lCnu 8Cnu
Clladel
lL ls used ln Lhe LreaLmenL of several Lypes of braln
cancer (lncludlng glloma glloblasLoma
mulLlforme medulloblasLoma and asLrocyLoma) mulLlple
myeloma and lymphoma (Podgklns and nonPodgkln)
8Cnu ls someLlmes used ln con[uncLlon wlLh alkyl
guanlne Lransferase (AC1) lnhlblLors such
as C
6
benzylguanlne 1he AC1lnhlblLors lncrease Lhe
efflcacy of 8Cnu by lnhlblLlng Lhe ulrecL 8eversal
paLhway of unA repalr whlch wlll prevenL formaLlon of
Lhe lnLersLrand crossllnk beLween Lhe n
1
of guanlne and
Lhe n
3
of cyLoslne
carmusLlne wlLh
pollfeprosan 20
lmplanL
Clladel Wafer lL ls used ln Lhe LreaLmenL of several Lypes of braln
cancer (lncludlng glloma glloblasLoma
mulLlforme medulloblasLoma and asLrocyLoma) mulLlple
myeloma and lymphoma (Podgklns and nonPodgkln)
8Cnu ls someLlmes used ln con[uncLlon wlLh alkyl
guanlne Lransferase (AC1) lnhlblLors such as C
6

benzylguanlne 1he AC1lnhlblLors lncrease Lhe efflcacy

of 8Cnu by lnhlblLlng Lhe ulrecL 8eversal paLhway of
unA repalr whlch wlll prevenL formaLlon of
Lhe lnLersLrand crossllnk beLween Lhe n
1
of guanlne and
Lhe n
3
of cyLoslne
lomusLlne Ceenu CCnu 8raln Lumours 8eslsLanL or relapsed Podgklns
dlsease Lung cancer MallgnanL melanoma
sLrepLozocln Zanosar SLrepLozoLoclnlne ls approved by Lhe uS lood and urug
AdmlnlsLraLlon (luA) for LreaLlng meLasLaLlc cancer of
Lhe pancreaLlc lsleL cells
4/ky/otinqLike 4qents
alLreLamlne Pexalen
lL ls used Lo LreaL refracLory ovarlan cancer
lL ls noL consldered a flrsLllne LreaLmenL

buL lL can be
useful as salvage Lherapy

lL also has Lhe advanLage of
belng less Loxlc Lhan oLher drugs used for LreaLlng
refracLory ovarlan cancer
carboplaLln araplaLln A chemoLherapy drug used agalnsL some forms
of cancer (malnly ovarlan carclnoma lung head and neck
cancers)
clsplaLln laLlnol lL ls used Lo LreaL varlous Lypes of cancers
lncludlng sarcomas some carclnomas (eg small cell lung
cancer and ovarlan cancer) lymphomas and germ cell
Lumors
dacarbazlne u1lC used ln Lhe LreaLmenL of varlous cancers among
Lhem mallgnanL melanoma Podgkln
lymphoma sarcoma and lsleL cell carclnoma of Lhe
pancreas
oxallplaLln LloxaLln A coordlnaLlon complex LhaL ls used ln
cancer chemoLherapy
plpobroman vercyLe


LhloLepa 1hloplex used Lo LreaL cancer
4/ky/ 5u/fonotes
busulfan Myleran lLs maln uses are ln bone marrow LransplanLaLlon
especlally ln chronlc myelogenous leukemla (CML)
where lL ls used as a condlLlonlng drug lLs mechanlsm of
acLlon Lhrough alkylaLlon produces guanlne
adenlne lnLrasLrand crossllnks 1hls occurs Lhrough
an Sn2 reacLlon ln whlch Lhe
relaLlvely nucleophlllc guanlne n7 aLLacks Lhe carbon
ad[acenL Lo Lhe mesylaLe leavlng group 1hls klnd of
damage cannoL be repalred by cellular machlnery and
Lhus Lhe cell undergoes apopLosls lLs maln uses are
ln bone marrow LransplanLaLlon especlally ln chronlc
myelogenous leukemla (CML) where lL ls used as a
condlLlonlng drug lLs mechanlsm of acLlon
Lhrough alkylaLlon produces guanlneadenlne lnLrasLrand
crossllnks 1hls occurs Lhrough an Sn2 reacLlon ln whlch
Lhe relaLlvely nucleophlllc guanlne n7 aLLacks Lhe carbon
ad[acenL Lo Lhe mesylaLe leavlng group 1hls klnd of
damage cannoL be repalred by cellular machlnery and
Lhus Lhe cell undergoes apopLosls
4ntimetobo/ites
follc acld anLagonlsL A meLaanalysls publlshed ln 2010 falled Lo flnd a
sLaLlsLlcally slgnlflcanL cancer rlsk due Lo follc acld
LreaLmenLs
meLhoLrexaLe M1x
ameLhopLerln
lolex MexaLe
used for chemoLherapy elLher alone or ln comblnaLlon
wlLh oLher agenLs lL ls effecLlve for Lhe LreaLmenL of a
number of cancers lncludlng breasL head and
neck leukemla lymphoma lung osLeosarcoma bladder
and LrophoblasLlc neoplasms
pemeLrexed dlsodlum AllmLa MallgnanL pleural mesoLhelloma ln comblnaLlon w/
clsplaLln locally advanced or meLasLaLlc nonsmall
cell lung cancer afLer prlor chemoLherapy
Pyrimidine 4no/oques
azaclLldlne vldaza 1reaLmenL of myelodysplasLlc syndrome subLypes
8efracLory anemla or refracLory anemla w/ rlnged
slderoblasLs (lf accompanled
by neuLropenla orLhrombocyLopenla or requlrlng
Lransfuslons) refracLory anemla w/ excess blasLs
refracLory anemla w/ excess blasLs ln LransformaLlon
chronlc myelomonocyLlc leukemla
capeclLablne xeloda CrallyadmlnlsLered chemoLherapeuLlc agenL used ln Lhe
LreaLmenL of meLasLaLlcbreasL and colorecLal cancers
CapeclLablne ls a prodrug LhaL ls enzymaLlcally
converLed Lo 3fluorouracll ln Lhe Lumor where lL
lnhlblLs unA synLhesls and slows growLh of Lumor Llssue
cyLarablne PCl CyLosaru A8AC ChemoLherapy agenL used malnly ln Lhe LreaLmenL
of cancers of whlLe blood cells such as acuLe myelold
leukemla (AML) and nonPodgkln lymphoma lL ls also
known as AraC (Arablnofuranosyl CyLldlne) lL desLroys
cancer cells by lnLerferlng wlLh unA synLhesls
floxurldlne luu8 1he drug ls mosL ofLen used ln Lhe LreaLmenL of
colorecLal cancer lloxurldlne works because lL ls broken
down by Lhe body lnLo lLs acLlve form whlch ls Lhe same
as a meLabollLe of 3lluorouracll
fluorouracll 3lu Adrucll 1he chemoLherapy agenL 3lu (fluorouracll) whlch has
been ln use agalnsL cancer for abouL 40 years acLs ln
several ways buL prlnclpally as aLhymldylaLe synLhase
lnhlblLor lnLerrupLlng Lhe acLlon of Lhls enzyme blocks
synLhesls of Lhe pyrlmldlne Lhymldlne whlch ls a
nucleoslde requlred for unA repllcaLlon 1hymldylaLe
synLhase meLhylaLes deoxyurldlne monophosphaLe
(duM) lnLo Lhymldlne monophosphaLe (d1M)
AdmlnlsLraLlon of 3lu causes a scarclLy ln d1M so
rapldly dlvldlng cancerous cells undergo cell deaLh
vla Lhymlneless deaLh
gemclLablne PCl Cemzar Chemlcally gemclLablne ls a nucleoslde analog ln whlch
Lhe hydrogen aLoms on Lhe 2 carbon
of deoxycyLldlne are replaced by fluorlne aLoms
CemclLablne ls used ln varlous carclnomas nonsmall
cell lung cancer pancreaLlc cancer bladder
cancer and breasL cancer lL ls belng lnvesLlgaLed for use
ln esophageal cancer and ls used experlmenLally
ln lymphomas and varlous oLher Lumor Lypes
CemclLablne represenLs an advance ln pancreaLlc cancer
care

lL ls also noL as deblllLaLlng as some oLher forms of
chemoLherapy
procarbazlne PCl MaLulane urug for Lhe LreaLmenL of Podgklns lymphoma and
cerLaln braln cancers (such as ClloblasLoma mulLlforme)
lL ls a member of a group of medlclnes called alkylaLlng
agenLs lL galned luA Approved ln !uly 1969 1he drug ls
meLabollzed and acLlvaLed ln Lhe llver lL also
lnhlblLs MAC Lhus lncreaslng Lhe effecLs
of sympaLhomlmeLlcs 1CAs and Lyramlne
nelarablne Arranon ls lndlcaLed for Lhe LreaLmenL of paLlenLs wlLh 1cell
acuLe lymphoblasLlc leukemla and 1cell
lymphoblasLlc lymphoma whose dlsease has noL
responded Lo or has relapsed followlng LreaLmenL wlLh aL
leasL Lwo chemoLherapy reglmens
Purine 4no/oques
cladrlblne LeusLaLln used Lo LreaL halry cell leukemla (PCL leukemlc
reLlculoendoLhellosls) and mulLlple sclerosls lLs chemlcal
name ls 2chlorodeoxyadenoslne (2CuA)
clofarablne Clolar
fludarablne lludara lludarablne ls hlghly effecLlve ln Lhe LreaLmenL of chronlc
lymphocyLlc leukemla produclng hlgher response raLes
Lhan alkylaLlng agenLs such aschlorambucll alone
lludarablne lnhlblLs unA synLhesls by lnLerferlng
wlLh rlbonucleoLlde reducLase and unA polymerase
6mercapLopurlne 6M urlneLhol lL ls used Lo LreaL leukemla pedlaLrlc nonPodgklns
lymphoma polycyLhemla vera psorlaLlc arLhrlLls and
lnflammaLory bowel dlsease (such as Crohns
dlsease and ulceraLlve collLls)
Lhloguanlne Lanvls lLs prlnclpal use ls ln acuLe leukaemlas and chronlc
myelold leukaemla lL has been lnvesLlgaLed for use ln
LreaLmenL of psorlasls
ibonuc/eotide
eductose lnhibitors

hydroxyurea Pydrea 1reaLmenL for sysLemlc masLocyLosls Cne mechanlsm of
acLlon ls LhoughL Lo be based on lLs reducLlon of
producLlon of deoxyrlbonucleoLldes vla lnhlblLlon of Lhe
enzyme rlbonucleoLlde reducLase by scavenglng Lyrosyl
free radlcals as Lhey are lnvolved ln Lhe reducLlon nus
1rlmeLrexaLe
glucuronaLe
neuLrexln lL has been used wlLh leucovorln ln
LreaLlng pneumocysLls pneumonla lL has been
lnvesLlgaLed for use ln LreaLlng lelomyosarcoma lL ls a
meLhoLrexaLe (M1x) analog LhaL ls acLlve agalnsL
LransporLdeflclenL M1xreslsLanL Lumor cells LhaL
overcome Lhe acqulred and naLural reslsLance Lo
meLhoLrexaLe CLher uses lnclude skln lymphoma
2deoxycoformycln enLosLaLln
nlpenL uCl
lL ls classlfled as a purlne analogue whlch ls a Lype
of anLlmeLabollLe lL mlmlcs
Lhe nucleoslde adenoslne and Lhus lnhlblLs Lhe
enzyme adenoslne deamlnase lnLerferlng wlLh Lhe cells
ablllLy Lo process unA

Cancer cells generally dlvlde more
ofLen Lhan healLhy cells unA ls hlghly lnvolved ln cell
dlvlslon (mlLosls) and drugs whlch LargeL unArelaLed
processes are Lherefore more Loxlc Lo cancer cells Lhan
healLhy cells enLosLaLln ls used Lo LreaL halry cell
leukemla lL ls glven by lnLravenous lnfuslon once every
Lwo weeks for Lhree Lo slx monLhs
ntyme lnhibitors
penLosLaLln nlpenL lL ls classlfled as a purlne analog whlch ls a Lype
of anLlmeLabollLe lL mlmlcs
Lhe nucleoslde adenoslne and Lhus lnhlblLs Lhe
enzyme adenoslne deamlnase lnLerferlng wlLh Lhe cells
ablllLy Lo process unA

Cancer cells generally dlvlde more
ofLen Lhan healLhy cells unA ls hlghly lnvolved ln cell
dlvlslon (mlLosls) and drugs whlch LargeL unArelaLed
processes are Lherefore more Loxlc Lo cancer cells Lhan
healLhy cells enLosLaLln ls used Lo LreaL halry cell
leukemla lL ls glven by lnLravenous lnfuslon once every
Lwo weeks for Lhree Lo slx monLhs
Mitotic lnhibitors
vlnca alkalolds used ln Lhe LreaLmenL of cancer 1hey are a class of cell
cyclespeclflc cyLoLoxlc drugs whlch work by lnhlblLlng
Lhe ablllLy of cancer cells Lo dlvlde acLlng upon Lubulln
Lhey prevenL lL from formlng lnLo mlcroLubules a
necessary componenL for cellular dlvlslon vlnca alkalolds
are now produced synLheLlcally and used as drugs ln
cancer Lherapy and as lmmunosuppresslve drugs
vlnblasLlne sulfaLe velban used ln Lhe LreaLmenL of cancer 1hey are a class of cell
cyclespeclflc cyLoLoxlc drugs whlch work by lnhlblLlng
Lhe ablllLy of cancer cells Lo dlvlde acLlng upon Lubulln
Lhey prevenL lL from formlng lnLo mlcroLubules a
necessary componenL for cellular dlvlslon
vlncrlsLlne sulfaLe Cncovln vlncrlsLlne ls dellvered vla lnLravenous lnfuslon for use ln
varlous Lypes of chemoLherapy reglmens lLs maln uses
are ln nonPodgklns lymphoma as parL of Lhe
chemoLherapy reglmen CPC Podgklns lymphoma as
parL of MC CC 8LACC or Lhe less
popular SLanford v chemoLherapy reglmen lnacuLe
lymphoblasLlc leukemla and ln LreaLmenL
for nephroblasLoma
vlncrlsLlne (llposomal) Marqlbo ln comblnaLlon Lherapy reglmen for acuLe leukemla
Podgkln's dlsease oLher lymphomas lncludlng 8urklLL's
lymphoma
vlnorelblne navelblne vlnorelblne ls approved for Lhe LreaLmenL of non small
cell lung cancer and MeLasLaLlc breasL cancer lL ls also
acLlve ln rhabdomyosarcoma
4ntimicrotubu/es or
1oxones

doceLaxel 1axoLere lL ls used malnly for Lhe LreaLmenL of breasL ovarlan
prosLaLe and nonsmall cell lung cancer
pacllLaxel 1axol used Lo LreaL paLlenLs wlLh lung ovarlan breasL cancer
head and neck cancer and advanced forms of kaposls
sarcoma acllLaxel ls also used for Lhe prevenLlon
of resLenosls
4ntitumor 4ntibiotics
bleomycln sulfaLe 8lenoxane 1he drug ls used ln Lhe LreaLmenL of Podgklns
lymphoma (as a componenL of
Lhe A8vu reglmen) squamous cell carclnomas
and LesLlcular cancer as well as ln Lhe LreaLmenL
of planLar warLs and as a means of effecLlng pleurodesls
dacLlnomycln AcLlnomycln u
Cosmegen
AcLlnomycln u ls prlmarlly used as an lnvesLlgaLlve Lool ln
cell blology Lo lnhlblL LranscrlpLlon lL does Lhls by
blndlng unA aL Lhe LranscrlpLlon lnlLlaLlon complex and
prevenLlng elongaLlon by 8nA polymerase 8ecause lL
can blnd unA duplexes lL can also lnLerfere wlLh unA
repllcaLlon alLhough oLher chemlcals such
as hydroxyurea are beLLer sulLed for use ln Lhe laboraLory
as lnhlblLors of unA synLhesls
daunorublcln PCl Cerubldlne lL slows or sLops Lhe growLh of cancer cells ln Lhe body
1reaLmenL ls usually performed LogeLher wlLh oLher
chemoLherapy drugs (such as cyLarablne) and lLs
admlnlsLraLlon depends on Lhe Lype of Lumor and Lhe
degree of response
daunorublcln
(llposomal)
uaunoxome a chemoLherapy drug LhaL ls luA approved Lo
LreaL AluS relaLed kaposls sarcoma lL ls also commonly
used Lo LreaL speclflc Lypes ofleukaemla and nonPodgkln
lymphoma Llposomal daunorublcln ls lnLravenously
admlnlsLered
doxorublcln Adrlamycln 8ubex uoxorublcln lnLeracLs wlLh unA by lnLercalaLlon and
lnhlblLlon of macromolecular blosynLhesls 1hls lnhlblLs
Lhe progresslon of Lhe enzyme Lopolsomerase ll whlch
relaxes supercolls ln unA for LranscrlpLlon uoxorublcln
sLablllzes Lhe Lopolsomerase ll complex afLer lL has
broken Lhe unA chaln for repllcaLlon prevenLlng Lhe
unA double hellx from belng resealed and Lhereby
sLopplng Lhe process of repllcaLlon
doxorublcln PCl
(llposomal)
uoxll Caelyx
MyoceL
lL was developed Lo LreaL kaposls sarcoma an AluS
relaLed cancer LhaL causes leslons Lo grow under Lhe skln
ln Lhe llnlng of Lhe mouLh nose and LhroaL or ln oLher
organs 1he polyeLhylene glycol coaLlng resulLs ln
preferenLlal concenLraLlon of uoxll ln Lhe skln
eplrublcln Lllence Lplrublcln ls prlmarlly used agalnsL breasL and ovarlan
cancer gasLrlc cancer lung cancer and lymphomas
ldarublcln ldamycln A flrsL llne LreaLmenL of acuLe myelold leukemla
mlLomycln MuLamycln MlLomycln C ls a poLenL unA crossllnker A slngle
crossllnk per genome has shown Lo be effecLlve ln kllllng
bacLerla 1hls ls accompllshed by reducLlve acLlvaLlon
followed by Lwo nalkylaLlons
mlLoxanLrone novanLrone lL ls used ln Lhe LreaLmenL of cerLaln Lypes of cancer
mosLly meLasLaLlc breasL cancer acuLe myelold leukemla
and nonPodgklns lymphoma lL was also shown Lo
lmprove Lhe survlval of chlldren sufferlng from flrsL
relapse of acuLe lymphoblasLlc leukaemla
pllcamycln MlLhracln llcamycln has been used ln Lhe LreaLmenL of LesLlcular
cancer

ageLs dlsease of bone and rarely Lhe
managemenL of hypercalcemla llcamycln has been
LesLed ln chronlc myelold leukemla llcamycln ls
currenLly used ln mulLlple areas of research lncludlng
cancer cell apopLosls and as a meLasLasls lnhlblLor
valrublcln valsLar used Lo LreaL bladder cancer valrublcln ls a
semlsynLheLlc analog of Lhe anLhracycllne doxorublcln
and ls admlnlsLered by lnfuslon dlrecLly lnLo Lhe bladder
1orqeted 1heropies
loolJs
bexaroLene 1argreLln are lndlcaLed for Lhe LreaLmenL of cuLaneous
manlfesLaLlons of cuLaneous 1cell lymphoma ln paLlenLs
who are refracLory Lo aL leasL one prlor sysLemlc Lherapy
Lhalldomlde 1halomld lor Lhe LreaLmenL of LryLhema nodosum leprosum (1ype
2) and mulLlple myeloma
lenalldomlde
(derlvaLlve of
Lhalldomlde)
8evllmld used ln comblnaLlon w/ dexameLhasone for Lhe
LreaLmenL of mulLlple myeloma paLlenLs who have
recelved aL leasL 1 prlor Lherapy
ormones ormono/
4ntoqonists ond
ntymes
oJtoqos
LesLolacLone 1eslac


progesLerone CesLerol 30


notmoool ooqoolss
ooJ ozyms

amlnogluLeLhlmlde CyLadren ls lndlcaLed for Lhe suppresslon of adrenal funcLlon ln
selecLed paLlenLs wlLh Cushlngs syndrome Mornlng
levels of plasma corLlsol ln paLlenLs wlLh adrenal
carclnoma and ecLoplc AC1Pproduclng Lumors were
reduced on Lhe average Lo abouL one half of Lhe
preLreaLmenL levels and ln paLlenLs wlLh adrenal
hyperplasla Lo abouL Lwo Lhlrds of Lhe preLreaLmenL
levels durlng 13 monLhs of Lherapy wlLh CyLadren
anasLrozole Arlmldex 1reaLmenL of advanced breasL cancer ln posLmenopausal
women Ad[uvanL LreaLmenL of posLmenopausal women
w/ hormone recepLor +ve early lnvaslve breasL cancer
ln early breasL cancer ln hormone recepLor +ve
posLmenopausal women who have recelved 23 yr of
ad[uvanL Lamoxlfen
blcaluLamlde Casodex Advanced prosLaLe cancer ln comblnaLlon w/ LP8P
analogue Lherapy or surglcal casLraLlon
exemesLrane Aromasln Ad[uvanL LreaLmenL of posLmenopausal women w/
esLrogenrecepLor +ve or unknown early breasL cancer
conLralaLeral breasL cancer 1sLllne LreaLmenL hormone
recepLor +ve advanced breasL cell cancer (A8C) 2nd/3rd
llne LreaLmenL of A8C progressed dlsease followlng anLl
esLrogen Lherapy alone or mulLlple hormonal Lheraples ln
women w/ naLural/lnduced posLmenopausal sLaLus
fluLamlde Lulexln 1reaLmenL of paLlenLs w/ advanced prosLaLe cancer ln
whlch suppresslon of LesLosLerone effecLs ls lndlcaLed
lnlLlal LreaLmenL ln comblnaLlon wlLh LP8P analogue or
ln con[uncLlon w/ orchlecLomy (LoLal blocklng of
androgens) as well as paLlenLs who are already belng
LreaLed w/ LP8P analogue or Lhose who have
undergone surglcal removal of LesLes LreaLmenL of
paLlenLs who dld noL respond Lo oLher forms of
endocrlne LreaLmenL or for whom oLher endocrlne
LreaLmenL ls noL well LoleraLed buL a necesslLy
fulvesLranL laslodex 1reaLmenL of posLmenopausal women w/ esLrogen
recepLor +ve locally advanced or meLasLaLlc breasL
cancer for dlsease relapse on or afLer ad[uvanL
anLlesLrogen Lherapy or dlsease progresslon on Lherapy
w/ an anLlesLrogen
goserelln aceLaLe Zoladex ManagemenL of prosLaLe breasL cancer ln
premenopausal perlmenopausal women sulLable for
hormonal manlpulaLlonendomeLrlosls endomeLrlal
Lhlnnlng ln con[uncLlon w/ le Lherapy ln hemaLologlcal
lmprovemenL of anemlc paLlenLs w/ uLerlne flbrolds pre
op asslsLed reproducLlon
hlsLrelln aceLaLe
lmplanL
vanLas ls lndlcaLed ln Lhe palllaLlve LreaLmenL of
advanced prosLaLe cancer
leLrozole lemara 1sLllne LreaLmenL ln posLmenopausal women w/
hormonedependenL advanced breasL cancer Advanced
breasL cancer ln women w/ naLural or arLlflclally lnduced
posLmenopausal sLaLus who have prevlously been
LreaLed w/ anLlesLrogens reop Lherapy ln
posLmenopausal women w/ locallzed hormone recepLor
+ve breasL cancer Lo allow subsequenL breasLconservlng
surgery exLended ad[uvanL LreaLmenL of early breasL
cancer ln posLmenopausal women who have recelved
prlor sLandard ad[uvanL Lamoxlfen Lherapy
leuprollde aceLaLe Lupron


megesLrol aceLaLe Megace


mlLoLane Lysodren lndlcaLed ln Lhe LreaLmenL of lnoperable adrenal corLlcal
carclnoma of boLh funcLlonal and nonfuncLlonal Lypes
nlluLamlde nllandron lndlcaLed for use ln comblnaLlon wlLh surglcal casLraLlon
for Lhe LreaLmenL of meLasLaLlc prosLaLe cancer (SLage
u2) lor maxlmum beneflL nlLAnu8Cn LreaLmenL musL
begln on Lhe same day as or on Lhe day afLer surglcal
casLraLlon
polyesLradlol
phosphaLe
LsLradurln


raloxlfene
hydrochlorlde
LvlsLa lndlcaLed for Lhe reducLlon ln rlsk of lnvaslve breasL
cancer ln posLmenopausal women aL hlgh rlsk of lnvaslve
breasL cancer
Lamoxlfen clLraLe
(nonsLeroldal
anLlesLrogen
nolvadex lor Lhe LreaLmenL of breasL cancer or lnovulaLory
lnferLlllLy
Lorlmlfene laresLon ls lndlcaLed for Lhe LreaLmenL of meLasLaLlc breasL
cancer ln posLmenopausal women wlLh esLrogen
recepLor poslLlve or unknown Lumors
,lsclloooos
ozyms

Lasparaglnase Llspar ls lndlcaLed as a componenL of a mulLlagenL
chemoLherapeuLlc reglmen for Lhe LreaLmenL of paLlenLs
wlLh acuLe lymphoblasLlc leukemla (ALL)
pegaspargase Cncaspar ls lndlcaLed as a componenL of a mulLlagenL
chemoLherapeuLlc reglmen for Lhe flrsL llne LreaLmenL of
paLlenLs wlLh ALL and hypersenslLlvlLy Lo Lasparaglnase
io/oqico/ 1heropies
yoklos
lnLerferonalpha2a
recomblnanL
8oferonA rllnA ls lndlcaLed for Lhe LreaLmenL of chronlc hepaLlLls C and
halry cell leukemla ln paLlenLs 18 years of age or older ln
addlLlon lL ls lndlcaLed for chronlc phase hlladelphla
chromosome (h) poslLlve chronlc myelogenous
leukemla (CML) paLlenLs who are mlnlmally preLreaLed
(wlLhln 1 year of dlagnosls)
lnLerferonalpha2b
recomblnanL
lnLronA llnalpha
2



lnLerleukln2 lL2


aldesleukln roleukln lor Lhe LreaLmenL of MeLasLaLlc melanoma MeLasLaLlc
renal cell carclnoma
Monoc/ono/
4ntibodies

Iocclos
CuadrlvalenL human
paplllomavlrus (1ypes
6 11 16 18)
recomblnanL vacclne
Cardasll revenLlon of cervlcal vulvar vag cancer premallgnanL
genlLal leslons (cervlcal vulvar vag) Pv lnfecLlon
cervlcal adenocarclnoma lo slo (AlS) exLernal genlLal
warLs (ooJylomo ocomlooo) causally relaLed Lo Pv
Lypes 6 11 16 18 ln glrls women 926 yr
Puman paplllomavlrus
vacclne AS04
ad[uvanLabsorbed
Cervarlx

ln females from 1023 yr for Lhe prevenLlon of perslsLenL
lnfecLlon premallgnanL cervlcal leslons cervlcal cancer
caused by Pv Lypes 16 18

nurslng 8esponslblllLles
ALkLA1ING DkUGS CCLCnCSnAMIDL (C1CkAN)
ASSLSSMLn1
O Assess compleLe blood counL (C8C) dlfferenLlal and plaLeleL counL weekly ChemoLherapy may
be held lf red cell whlLe cell or plaLeleL counLs drop below predeLermlned levels
O ConducL Lhorough physlcal assessmenL documenL flndlngs
O Assess resulLs of pulmonary funcLlon LesLs chesL radlographs and renal and llver funcLlon
sLudles durlng Lherapy
O Assess LemperaLure fever may be an early slgn of lnfecLlon
O MonlLor for adequaLe lnLake and ouLpuL
nu8SlnC ulACnCSLS
O 8lsk for lnfecLlon relaLed Lo bone marrow depresslon
O 8lsk for lmbalanced nuLrlLlon less Lhan body requlremenLs relaLed Lo Cl slde effecLs of
chemoLherapy
O 8lsk for lmpalred urlnary ellmlnaLlon relaLed Lo hemorrhaglc cysLlLls caused by chemoLherapy
O 8lsk for abnormal bleedlng relaLed Lo effecLs of chemoLherapy on Lhe llnlng of Lhe bladder
and/or bone marrow depresslon
O ueflclenL knowledge (paLlenL/famlly/careglvers) relaLed Lo chemoLherapeuLlc proLocol
O 8lsk for sexual dysfuncLlon relaLed Lo lnLerference wlLh normal mensLrual cycle (ln females) or
lack of sperm producLlon (ln males)
O ulsLurbed body lmage relaLed Lo halr Lhlnnlng and/or loss
LAnnlnC
O CllenL wlll have whlLe cell red cell and plaLeleL counLs ln Lhe deslred range
O CllenL wlll remaln free from lnfecLlon
O CllenL wlll malnLaln nuLrlLlonal sLaLus (adequaLe fluld lnLake and ouLpuL sufflclenL calorlc lnLake
sLable welghL)
O CllenL wlll malnLaln adequaLe urlnary ouLpuL
O CllenL wlll remaln free of sympLoms of hemorrhaglc cysLlLls
O CllenL/famlly/careglver wlll demonsLraLe undersLandlng of chemoLherapeuLlc proLocol (eg
dose admlnlsLraLlon slde effecLs adverse reacLlons)
nu8SlnC ln1L8vLn1lCnS
O MonlLor blood counLs and laboraLory values
O Pandle drug wlLh care durlng preparaLlon and admlnlsLraLlon avold dlrecL skln eye and mucus
membrane conLacL wlLh anLlcancer drugs lollow proLocols
O MonlLor lv slLe frequenLly for lrrlLaLlon and phleblLls
O AdmlnlsLer anLlemeLlc 30 Lo 60 mlnuLes before glvlng drug
O PydraLe cllenL wlLh wlLh lv and/or oral flulds before chemoLherapy ls admlnlsLered
O MonlLor blood urea nlLrogen (8un) and creaLlnlne prlor Lo admlnlsLraLlon
O Assess for slgns and sympLoms of hemaLurla urlnary frequency or dysurla 1each cllenL Lo
empLy bladder every 23 hours
O lncrease flulds Lo 2 Lo 3 L/day Lo reduce rlsk of hemorrhaglc cysLlLls uraLe deposlLlon or calculus
formaLlon
O MonlLor fluld lnLake and ouLpuL and nuLrlLlonal lnLake
O MalnLaln sLrlcL medlcal asepsls durlng dresslng changes and lnvaslve procedures
O CllenL Leachlng
4 Ceneral
Lmphaslze proLecLlve precauLlons as necessary (eg handwashlng personal
hyglene)
1each cllenL Lo Lake cyclophosphamlde early ln Lhe day Lo prevenL accumulaLlon
of drug ln Lhe bladder durlng Lhe nlghL
8emlnd cllenL Lo consulL wlLh a healLh care provlder before admlnlsLraLlon of
any vacclnes
Advlse cllenL LhaL cyclophosphamlde ls excreLed ln breasL mllk 1esLlcular
aLrophy and reverslble ollgospermla/azoospermla may occur ln males
1each lmporLance of uslng blrLh conLrol measures as approprlaLe ulscuss
spermbanklng wlLh male cllenLs as approprlaLe
1each cllenL LhaL pregnancy should be avolded for 34 monLhs afLer compleLlng
anLlneoplasLlc Lherapy ln mosL slLuaLlons Some sources recommend LhaL boLh
men and women avold concepLlon for 2 years afLer compleLlon of LreaLmenL
Advlse cllenL noL Lo vlslL anyone who has a resplraLory lnfecLlon A decreased
W8C counL puLs cllenL aL hlgh rlsk for acqulrlng an lnfecLlon
lnsLrucL cllenL Lo prompLly reporL slgns of lnfecLlon (eg elevaLed LemperaLure
fever chllls sore LhroaL frequency and/or burnlng on urlnaLlon
redness/swelllng/paln near a wound) bleedlng (eg bleedlng gums peLechlae
brulses hemaLurla blood ln Lhe sLool) and anemla (eg lncreased faLlgue
dyspnea orLhosLaLlc hypoLenslon)
4 Slde LffecLs
lnsLrucL cllenL abouL good oral hyglene wlLh a sofL LooLhbrush for sLomaLlLls
have cllenL use a sofL LooLhbrush when plaLeleL counL ls 30000/mm
3

8emlnd premenopausal females LhaL Lhey may experlence amenorrhea
mensLrual lrregularlLles or sLerlllLy lnsLrucL male cllenLs LhaL Lhey may
experlence lmpoLence
Advlse cllenL of posslble halr loss recommend a wlg halrplece scarf or Lurban
Assess for use of alLernaLlve/complemenLary Lherapy LhaL may lnLeracL wlLh
chemoLherapy agenL
4 uleL
Advlse cllenL Lo follow a dleL low ln purlnes (eg organ meaLs beans peas) Lo
alkallze urlne
Advlse cllenL Lo avold clLrlc acld
Cffer cllenL food and flulds LhaL may decrease nausea (eg cola crackers
glnger ale)
lan small frequenL meals
O CulLural ConslderaLlons
ln some nonWesLern culLural groups healLh care declslons are made by
consensus and Lhe famlly plays a key role ln fllLerlng Lhe lnformaLlon glven Lo a
cllenL lssues relaLed Lo lnformed consenL and full dlsclosure of medlcal
lnformaLlon may cause dlsLress ln culLural groups who place Lhe needs of Lhe
famlly above Lhe needs of Lhe lndlvldual lnLeracLlons should be modlfled based
on famlly sLrucLure rellglous values and bellefs Llme orlenLaLlon culLural healLh
pracLlces and verbal and nonverbal communlcaLlon
PyperplgmenLaLlon of Lhe Longue and oral mucosa afLer admlnlsLraLlon has
been reporLed ln Afrlcan Amerlcans lncldence raLe of hlghgrade neuLropenla
may be hlgher ln Aslan paLlenLs
LvALuA1lCn
CllenL was free of lnfecLlon
CllenL malnLalned LargeL welghL
CllenL malnLalned nuLrlLlonal sLaLus
CllenL dld noL develop hemorrhaglc cysLlLls
CllenL/famlly/careglver educaLlon needs were meL
CuesLlons relaLed Lo sexuallLy were answered

AN1IML1A8CLI1LS ILUCkCUkACIL (SIU ADkUCIL)
ASSLSSMLn1
Assess compleLe blood counL (C8C) dlfferenLlal and plaLeleL counL weekly ChemoLherapy may
be held lf red cell whlLe cell or plaLeleL counLs drop below predeLermlned levels
ConducL Lhorough physlcal assessmenL documenL flndlngs
Assess renal funcLlons sLudles before and durlng drug Lherapy
Assess LemperaLure fever may be an early slgn of lnfecLlon
nu8SlnC ulACnCSLS
8lsk for lnfecLlon relaLed Lo bone marrow depresslon
8lsk for lmbalanced nuLrlLlon less Lhan body requlremenLs relaLed Lo Cl slde effecLs of
chemoLherapy
8lsk for acuLe paln (mucoslLls/sLomaLlLls) relaLed Lo Cl slde effecLs of chemoLherapy
8lsk for lmpalred perlanal skln lnLegrlLy relaLed Lo dlarrhea caused by chemoLherapy
ueflclenL knowledge (cllenL/famlly) relaLed Lo chemoLherapeuLlc proLocol
LAnnlnC
CllenL blood counLs wlll remaln ln Lhe deslred range
CllenL wlll malnLaln nuLrlLlonal sLaLus (adequaLe fluld lnLake and ouLpuL adequaLe calorlc lnLake
sLable welghL)
CllenL wlll have adequaLe paln conLrol
CllenL wlll llmlL exposure Lo sunllghL
CllenL/famlly/careglver wlll demonsLraLe undersLandlng of chemoLherapeuLlc proLocol (dose
admlnlsLraLlon slde effecLs and adverse reacLlons)
nu8SlnC ln1L8vLn1lCnS
MonlLor blood counLs and laboraLory values
Pandle drug wlLh care durlng preparaLlon and admlnlsLraLlon avold dlrecL skln conLacL wlLh
anLlcancer drugs lollow proLocols
MonlLor lv slLe frequenLly LxLravasaLlon produces severe paln lf Lhls occurs apply lce pack and
noLlfy healLh care provlder
AdmlnlsLer anLlemeLlc 3060 mlnuLes before drug Lo prevenL vomlLlng
Assess for hyperplgmenLaLlon along Lhe veln ln whlch 3lu was admlnlsLered
Cffer cllenL food and flulds LhaL may decrease nausea (eg cola crackers glnger ale)
lan small frequenL meals
MalnLaln sLrlcL medlcal asepsls durlng dresslng changes and lnvaslve procedures
SupporL good oral hyglene brush LeeLh wlLh sofL LooLhbrush and use waxed denLal floss
Lncourage mouLh rlnses every 2 hours wlLh normal sallne
MonlLor fluld lnLake and ouLpuL and nuLrlLlonal lnLake Cl effecLs are common on Lhe fourLh day
of LreaLmenL
CllenL Leachlng
4 Ceneral
Lmphaslze proLecLlve precauLlons as necessary (eg handwashlng personal
hyglene)
1each cllenL Lo examlne mouLh dally and reporL slgns of sLomaLlLls (soreness
ulceraLlons whlLe paLches ln mouLh) Cral hyglene several Llmes a day ls
essenLlal lf sLomaLlLls occurs rlnse mouLh wlLh baklng soda or normal sallne
use a sofL LooLhbrush
lnsLrucL cllenL Lo Lake paln medlcaLlon as prescrlbed Lo relleve mouLh paln
relaLed Lo mucoslLls/sLomaLlLls
Advlse cllenL Lo Lake yearround phoLosenslLlvlLy precauLlons use sunscreen
when ouLdoors
Advlse cllenL noL Lo vlslL anyone who has a resplraLlory lnfecLlon A decreased
whlLe blood cell (W8C) counL puLs cllenL aL rlsk for acqulrlng an lnfecLlon
1each lmporLance of uslng blrLh conLrol measures as approprlaLe ulscuss
spermbanklng wlLh male cllenLs as approprlaLe
1each cllenL LhaL pregnancy should be avolded for 34 monLhs afLer compleLlng
anLlneoplasLlc Lherapy ln mosL slLuaLlons Some sources recommend LhaL boLh
men and women avold concepLlon for 2 years afLer compleLlon of LreaLmenL
lnsLrucL cllenL Lo prompLly reporL slgns of lnfecLlon (eg fever sore LhroaL
chllls urlnary frequency burnlng on urlnaLlon redness swelllng or paln near a
wound) bleedlng (eg bleedlng gums peLechlae brulses hemaLurla blood ln
Lhe sLool) or slgns of anemla (eg lncreased faLlgue dyspnea orLhosLaLlc
hypoLenslon)
4 Slde LffecLs
lnsLrucL cllenL abouL good oral hyglene wlLh a sofL LooLhbrush for
mucoslLls/sLomaLlLls have cllenL use a sofL LooLhbrush when plaLeleL counL ls
30000/mm
3

CllenL should rlnse mouLh every 2 hours wlLh normal sallne and avold use of
commerclal mouLhwashes LhaL conLaln alcohol
8emlnd premenopausal females LhaL Lhey may experlence amenorrhea
mensLrual lrregularlLles or sLerlllLy lnsLrucL male cllenLs LhaL Lhey may
experlence lmpoLence
Advlse cllenL of posslble halr loss recommend a wlg halrplece scarf or Lurban
Assess for use of alLernaLlve/complemenLary Lherapy LhaL may lnLeracL wlLh
chemoLherapy agenL
4 uleL
Lncourage small frequenL meals
Lncourage use of cool bland foods
Cffer lce chlps or lce pops Lo help relleve mouLh paln
CulLural ConslderaLlons
ln some nonWesLern culLural groups healLh care declslons are made by
consensus and Lhe famlly plays a key role ln fllLerlng Lhe lnformaLlon glven Lo a
cllenL lssues relaLed Lo lnformed consenL and full dlsclosure of medlcal
lnformaLlon may cause dlsLress ln culLural groups who place Lhe needs of Lhe
famlly above Lhe needs of Lhe lndlvldual lnLeracLlons should be modlfled based
on famlly sLrucLure rellglous values and bellefs Llme orlenLaLlon culLural healLh
pracLlces and verbal and nonverbal communlcaLlon
An lncreased lncldence of hyperplgmenLaLlon has been reporLed ln darksklnned
people PyperplgmenLaLlon may be seen on Lhe skln nalls halr and oral
mucosa 1hls usually dlsappears over Llme
LvALuA1lCn
CllenL was free of lnfecLlon
Cral mucosa was free of eryLhema and swelllng
aln was conLrolled
Skln lnLegrlLy remalned lnLacL
CllenL/famlly/careglver educaLlon needs were meL
CuesLlons relaLed Lo sexuallLy were answered


AN1I1UMCk AN1I8IC1ICS DCkCkU8ICIN (ADkIAMCIN)
ASSLSSMLn1
Assess compleLe blood counL (C8C) dlfferenLlal and plaLeleL counL weekly urug may be
wlLhheld lf red blood cell whlLe blood cell (W8C) or plaLeleL counLs drop below predeLermlned
levels
ConducL Lhorough physlcal assessmenL and documenL flndlngs
Assess LemperaLure fever may be an early slgn of lnfecLlon
Assess plans for pregnancy (lf approprlaLe)
nu8SlnC ulACnCSLS
8lsk for lnfecLlon relaLed Lo bone marrow depresslon
8lsk for alLeraLlon ln cardlac ouLpuL relaLed Lo cardloLoxlc effecLs of chemoLherapy
8lsk for lmpalred skln lnLegrlLy relaLed Lo veslcanL properLles of chemoLherapy
ueflclenL knowledge relaLed Lo anLlneoplasLlc Lherapy
LAnnlnC
CllenL wlll malnLaln blood cell values ln Lhe deslred range
CllenL wlll be free of cardlac dysfuncLlon
CllenL's skln lnLegrlLy wlll remaln lnLacL
CllenL/famlly/careglver wlll demonsLraLe undersLandlng of Lhe chemoLherapy reglmen lncludlng
slde effecLs
Assess cllenL/famlly/careglver knowledge relaLed Lo chemoLherapeuLlc proLocol
nu8SlnC ln1L8vLn1lCnS
MonlLor blood counLs and laboraLory values
Assess cardlac sLaLus
Pandle drug wlLh care durlng preparaLlons avold dlrecL skln conLacL wlLh drug
MonlLor lv slLe frequenLly uoxorublcln ls a severe veslcanL whose effecLs are noL lmmedlaLely
apparenL Clve drug Lhrough a large bore qulckly runnlng lv lnfuslon
1lssue necrosls may occur 34 weeks afLer lnfllLraLlon lnLo Llssue LxLravasaLlon produces severe
paln lf Lhls occurs apply lce pack and noLlfy Lhe healLh care provlder
AdmlnlsLer anLlemeLlc 3060 mlnuLes before chemoLherapy
MonlLor for changes ln urlne color (plnk Lo red) 1he drug ls red and ls excreLed ln Lhe urlne
Cffer cllenL food and flulds LhaL may decrease nausea (eg cola crackers glnger ale)
lan small frequenL meals
AdmlnlsLer prophylacLlc anLlbloLlcs Lo prevenL lnfecLlon
Cffer analgeslcs for paln as prescrlbed
MalnLaln sLrlcL medlcal asepsls durlng dresslng changes and lnvaslve procedures
SupporL good oral hyglene use sofL LooLhbrush use waxed denLal floss
MonlLor fluld lnLake and ouLpuL and nuLrlLlonal lnLake
CllenL (lamlly Member/Careglver) 1eachlng
4 Ceneral
Lmphaslze proLecLlve precauLlons as necessary (eg handwashlng personal
hyglene)
1each cllenL Lhe slgns and sympLoms of cardlac dysfuncLlon (shorLness of
breaLh palplLaLlons edema ln exLremlLles) and Lo reporL Lhese Lo healLh care
provlder
1each cllenL LhaL compleLe alopecla occurs wlLh doses 30mg/m
2
1each LhaL
halr wlll begln Lo regrow wlLhln several monLhs afLer Lherapy ls compleLed
Advlse cllenL noL Lo vlslL anyone who has a resplraLory lnfecLlon A decreased
W8C counL puLs cllenL aL hlgh rlsk for acqulrlng an lnfecLlon
1each lmporLance of uslng blrLh conLrol measures as approprlaLe ulscuss
spermbanklng wlLh male cllenLs as approprlaLe
1each cllenL LhaL pregnancy should be avolded for 34 monLhs afLer compleLlng
anLlneoplasLlc Lherapy ln mosL slLuaLlons Some sources recommend LhaL boLh
men and women avold concepLlon for 2 years afLer compleLlon of LreaLmenL
lnsLrucL cllenL Lo prompLly reporL slgns of lnfecLlon (eg fever sore LhroaL)
bleedlng (eg bleedlng gums peLechlae brulses hemaLurla blood ln Lhe sLool)
and anemla (eg lncreased faLlgue dyspnea orLhosLaLlc hypoLenslon)
4 Slde LffecLs
Assess for nausea/vomlLlng and admlnlsLer anLlemeLlcs as prescrlbed
1each lmporLance of blrLh conLrol measures ulscuss sperm banklng lf
approprlaLe
8emlnd premenopausal females LhaL Lhey may experlence amenorrhea
mensLrual lrregularlLles or sLerlllLy lnsLrucL male cllenLs LhaL Lhey may
experlence lmpoLence
Advlse cllenL of posslble halr loss recommend a wlg halrplece scarf or Lurban
Assess for use of alLernaLlve/complemenLary Lherapy LhaL may lnLeracL wlLh
chemoLherapy agenL
4 uleL
Lncourage small frequenL meals
Lncourage eaLlng bland foods
Avold foods wlLh exLreme LemperaLures
CulLural ConslderaLlons
ln some nonWesLern culLural groups healLh care declslons are made by
consensus and Lhe famlly plays a key role ln fllLerlng Lhe lnformaLlon glven Lo a
cllenL lssues relaLed Lo lnformed consenL and full dlsclosure of medlcal
lnformaLlon may cause dlsLress ln culLural groups who place Lhe needs of Lhe
famlly above Lhe needs of Lhe lndlvldual lnLeracLlons should be modlfled based
on famlly sLrucLure rellglous values and bellefs Llme orlenLaLlon culLural healLh
pracLlces and verbal and nonverbal communlcaLlon
PyperplgmenLaLlon of Lhe Longue and oral mucosa has been seen afLer Lhe
admlnlsLraLlon of doxorublcln ln Afrlcan Amerlcans lncldence raLe of hlghgrade
neuLropenla may be hlgher ln Aslan paLlenLs
LvALuA1lCn
CllenL was free of lnfecLlon
Cardlac funcLlon was malnLalned
CllenL and famlly educaLlon needs were meL
Slde effecLs of Lherapy were conLrolled
CllenL/famlly/careglver educaLlon needs were meL
MI1C1IC INnI8I1CkS]LAN1 (VINCA) ALkALCIDS VINCkIS1INL (CNCCVIN)
ASSLSSMLn1
Assess basellne condlLlon of paLlenL before and durlng chemoLherapy LreaLmenL
Assess compleLe blood counL (C8C) dlfferenLlal and plaLeleL counL weekly
MonlLor blllrubln levels uose may be reduced lf blllrubln levels are 13mg/dl
ConducL Lhorough physlcal assessmenL and documenL flndlngs 8e especlally aware of evldence
of neuroLoxlclLy because Lhls ls a dosellmlLlng LoxlclLy
Assess for slgns of perlpheral neuropaLhy (numbness or Llngllng ln flngers or Loes) loss of deep
Lendon reflexes fooL drop slapplng galL dlfflculLy walklng
MonlLor bowel funcLlon AuLonomlc neuropaLhy may lead Lo consLlpaLlon and paralyLlc lleus
1he use of vlncrlsLlne (Cncovln) and narcoLlc analgeslcs may lncrease Lhe rlsk of consLlpaLlon
Assess LemperaLure fever may be an early slgn of lnfecLlon
MonlLor for acuLe bronchospasm
Assess plans for pregnancy (lf approprlaLe)
LvaluaLe paLlenL/famlly/careglver knowledge of drug Lherapy
nu8SlnC ulACnCSLS
8lsk for lnfecLlon relaLed Lo bone marrow depresslon
8lsk for consLlpaLlon relaLed Lo neuropaLhlc slde effecLs of chemoLherapy
8lsk for ln[ury relaLed Lo neuropaLhlc slde effecLs of chemoLherapy
ueflclenL knowledge relaLed Lo anLlneoplasLlc Lherapy
LAnnlnC
CllenL wlll malnLaln blood cell values ln Lhe deslred range
CllenL wlll malnLaln adequaLe bowel funcLlon
CllenL wlll be free of neuropaLhlc dysfuncLlon
CllenL/famlly/careglver wlll demonsLraLe undersLandlng of chemoLherapeuLlc reglmen lncludlng
Lhe slde effecLs
nu8SlnC ln1L8vLn1lCnS
MonlLor blood counLs and laboraLory values
Assess bowel funcLlon
AdmlnlsLer sLool sofLener or laxaLlve as prescrlbed
MonlLor for slgns of perlpheral neuropaLhy (numbness and/or Llngllng ln hands and/or feeL)
sensory loss loss of deep Lendon reflexes paresLhesla fooL drop wrlsL drop aLaxla)
Assess lv slLe carefully vlncrlsLlne (Cncovln) ls a severe veslcanL whose effecLs are noL
lmmedlaLely apparenL Clve drug Lhrough a large bore qulckly runnlng lv lnfuslon over 1
mlnuLe
1lssue necrosls may occur 34 weeks afLer lnfllLraLlon lnLo Llssue LxLravasaLlon produces severe
paln lf exLravasaLlon occurs sLop lnfuslon lmmedlaLely noLlfy healLh care provlder Apply heaL
lnLermlLLenLly every 2 hours for 24 hours Clve hyaluronldase lnLo Lhe lnfllLraLed area per
physlclan order
AdmlnlsLer anLlemeLlc 3060 mlnuLes before chemoLherapy as prescrlbed
MonlLor fluld lnLake and ouLpuL and nuLrlLlonal lnLake
MalnLaln sLrlcL medlcal asepsls durlng dresslng changes and lnvaslve procedures
CllenL (lamlly Member/Careglver) 1eachlng
4 Ceneral
Lmphaslze proLecLlve precauLlons as necessary (eg handwashlng personal
hyglene) as necessary
1each cllenL Lhe slgns and sympLoms of neuroLoxlclLy (numbness and/or Llngllng
ln hands and/or feeL sensory loss loss of deep Lendon reflexes paresLhesla
fooL drop wrlsL drop aLaxla) lnablllLy Lo buLLon cloLhes or Lo close zlppers may
be an early slgn of perlpheral neuropaLhy
1each paLlenL slgns of sLocklng/glove" syndrome (numbness/Llngllng of hands
and feeL) 1hls may lasL as long as a year or may never compleLely resolve
1each cllenL LhaL compleLe alopecla may occur 1each LhaL halr may wlll begln Lo
regrow wlLhln several monLhs afLer Lherapy ls compleLed
Advlse cllenL noL Lo vlslL anyone who has a resplraLory lnfecLlon A decreased
W8C counL puLs cllenL aL hlgh rlsk for acqulrlng an lnfecLlon
1each lmporLance of uslng blrLh conLrol measures as approprlaLe ulscuss
spermbanklng wlLh male cllenLs as approprlaLe
1each cllenL LhaL pregnancy should be avolded for 34 monLhs afLer compleLlng
anLlneoplasLlc Lherapy ln mosL slLuaLlons Some sources recommend LhaL boLh
men and women avold concepLlon for 2 years afLer compleLlon of LreaLmenL
lnsLrucL cllenL Lo prompLly reporL slgns of lnfecLlon (eg fever sore LhroaL)
bleedlng (eg bleedlng gums peLechlae brulses hemaLurla blood ln Lhe sLool)
and anemla (eg lncreased faLlgue dyspnea orLhosLaLlc hypoLenslon)
4 Slde LffecLs
1each paLlenL Lhe slgns of perlpheral neuropaLhy
1each paLlenL Lo reporL consLlpaLlon and abdomlnal paln
Assess for nausea vomlLlng admlnlsLer anLlemeLlcs as prescrlbed
Advlse paLlenL of posslble halr loss recommend a wlg halrplece scarf or
Lurban
1each lmporLance of blrLh conLrol measures ulscuss sperm banklng lf
approprlaLe
8emlnd premenopausal females LhaL Lhey may experlence amenorrhea
mensLrual lrregularlLles or sLerlllLy lnsLrucL male cllenLs LhaL Lhey may
experlence lmpoLence
Assess for use of alLernaLlve/complemenLary Lherapy LhaL may lnLeracL wlLh
chemoLherapy agenL
4 uleL
Lncourage bulky hlghflber foods adequaLe fluld lnLake and moderaLe exerclse
Lo reduce Lhe rlsk of consLlpaLlon
CulLural ConslderaLlons
ln some nonWesLern culLural groups healLh care declslons are made by
consensus and Lhe famlly plays a key role ln fllLerlng Lhe lnformaLlon glven Lo a
cllenL lssues relaLed Lo lnformed consenL and full dlsclosure of medlcal
lnformaLlon may cause dlsLress ln culLural groups who place Lhe needs of Lhe
famlly above Lhe needs of Lhe lndlvldual lnLeracLlons should be modlfled based
on famlly sLrucLure rellglous values and bellefs Llme orlenLaLlon culLural healLh
pracLlces and verbal and nonverbal communlcaLlon
Aslans may be aL lncreased rlsk for hyponaLremla and syndrome of
lnapproprlaLe anLldlureLlc hormone secreLlon (SlAuP)
LvALuA1lCn
CllenL was free of lnfecLlon
8owel funcLlon was malnLalned
erlpheral neuropaLhy dld noL occur
Slde effecLs of Lherapy were conLrolled
LxLravasaLlon and Llssue necrosls dld noL occur
CllenL/famlly/careglver educaLlon needs were meL




SubmlLLed Lo
ZanlLa Clenda A laga 8n
SubmlLLed by
?na lempla A aez 8Sn 2u