RAJKUMARI AMRIT KAUR COLLEGE OF NURSING

LAJPAT NAGAR, NEW DELHI

A MATERIAL ON DRUGS USED IN THE TREATMENT OF

CANCER

SUBMITTED BY - SUBMITTED TO-

MRS RUBY ANAND MRS S GEETHARAJKUMAR
MSC NURSING FINAL YEAR H.O.D. CHILD HEALTH NURSING
INTRODUCTION

Cancer is one of the major causes of death. Cancer is a disease characterized by uncontrolled multiplication
and spread of abnormal forms of the body's own cells. A normal cell turns into a cancer cell because of one
or more mutations in its DNA, which can be acquired or inherited. The treatment of cancers is still
unsatisfactory due to certain characteristics of the cancer cells— like capacity for uncontrolled proliferation,
invasiveness and metastasis. Moreover the cancer cells are our own cells unlike microbes, which means that,
drugs which destroy these cancer cells also can affect normal cells. The host defense mechanisms which
help us in infections is not doing so in cancers because these cancer cells are also host cells. Moreover, the
cancer cells can be in a resting phase during which they are not sensitive to anticancer drugs but such cells
start multiplying later-resulting in recurrence. These features have made cancer chemotherapy more
difficult.

CLASSIFICATION OF DRUGS USED IN TREATMENT OF CANCERS

S.NO. GROUP DRUGS

1. Alkylating agents Cyclophosphamide, ifosfamide, chlorambucil, melphalan,
thiotepa, streptozocin, cisplatin
2. Antimetabolites
Folate antagonist Methotrexate
Purine antagonist 6-mercaptopurine, azathioprine, thioguanine, pentostatin,
Pyrimidine antagonist 5-fluoouracil, floxuridine, cytarabine
3. Natural products
Antibiotics Actinomycin-d
Epipodophyllotoxins Etoposide
Camptothecins Topotecan
Taxanes Paclitaxel
Vinca alkaloids Vincristine,vinbvlastine
4. Miscellaneous Procarbazine, interferon alpha, monoclonial antibodies
5. Hormones Glucocorticoids, androgens, estrogens,
6. Biological response modifiers Interferon alpha, interleukin-2

ALKYALATING AGENTS

ACTIONS- alkyalating agents exert cytotoxic, immunosuppressant and radiomimetic (similar to

radiotherapy) effects. Moreover, alkyalation of DNA results in DNA strand.

Drug- Cyclophosphamide

DOSE 2-8 mg/kg daily in divided dose for 6 days

ACTION Action mechanism not known but thought to be the result of cross linkage of
DNA strands thereby blocking synthesis of DNA, RNA and protein. Has
immunosuppressive activity
INDICATION Used as a single agent or in combination with other chemotherapeutic agents in
 treatment of malignant lymphoma, leukemias, adenocarcinoma of ovary,
SIDE EFFECTS Alopecia, darkening of nails and skin, dermatitis, nausea vomiting, mucositis,
anorexia, nephrotoxicity, fatigue, facial flushing
CONTRAINDICATION chicken pox or herpis infection
NURSING  Pre-Administration Responsibilities
RESPONSIBILITIES  Patient Assessment:
 Assess baseline renal and liver function, complete blood count (CBC), and
hydration status.
 Obtain a detailed medical history, especially regarding infections and
bleeding tendencies.
 2. Patient Preparation:
 Educate the patient and family about the purpose of the drug, its potential
side effects, and the importance of reporting symptoms.
 Ensure adequate hydration before starting treatment to prevent hemorrhagic
cystitis.
 3. Medication Preparation:
 Verify the correct dose based on the child’s body surface area (BSA) or
weight.
 Prepare the drug under sterile conditions in a designated chemotherapy area.

 During Administration
o 4. Monitor Infusion:
 Administer the drug via slow intravenous infusion as prescribed.
 Monitor the IV site for signs of infiltration or extravasation.
o 5. Hydration Protocol:
 Maintain high fluid intake during and after administration to minimize the
risk of hemorrhagic cystitis.
 Administer mesna (a uroprotective agent) as prescribed to protect the
bladder lining.
 Vital Signs Monitoring:
 Monitor vital signs regularly during infusion to detect any adverse reactions
such as hypersensitivity or hypotension.

 Post-Administration Responsibilities
 Monitor Side Effects:
 Watch for nausea, vomiting, alopecia, mucositis, myelosuppression, and
signs of infection.
 Assess urine output for hematuria (sign of hemorrhagic cystitis).
 Infection Prevention:
 Follow neutropenic precautions if the child’s white blood cell count drops.
 Educate caregivers about hand hygiene and infection control practices.
 Lab Monitoring:
 Regularly monitor CBC, renal function, and electrolyte levels.
 Notify the physician of any significant abnormalities.
 Emotional Support:
 Provide psychological support to the child and family.
 Encourage communication about fears and concerns related to
chemotherapy.
  Documentation
 Record the drug administration details, side effects, vital signs, and any
interventions in the patient’s medical record.

DRUG- CISPLATIN

DOSE For solid tumours 60-100mg/mm2 I/V as a single dose every 3-4 weeks
Neuroblastoma 50 mg/mm2 I/V
ACTION It is a platinum based chemotherapy. Preventing DNA, RNA and protein
synthesis
INDICATION Neuroblastoma, osteosarcoma, hepatoblastoma,
SIDE EFFECTS Facial edema, wheezing, ototoxicity: tinnitus or hearing loss, seizures,
headache, nausea, vomiting,
CONTRAINDICATION History of hypersensitivity
NURSING
RESPONSIBILITIES a. Evaluate baseline renal function (serum creatinine, BUN) and electrolyte
levels (magnesium, potassium, calcium).
b. Perform baseline audiometry to assess hearing, as cisplatin can cause
ototoxicity.
c. Obtain a complete blood count (CBC) to check for adequate bone marrow
reserve.
d. Ensure pre-hydration with intravenous fluids (e.g., normal saline with
potassium and magnesium) to protect the kidneys.
e. Administer antiemetics before starting the infusion to prevent severe
nausea and vomiting.
f. Inform about potential side effects like nephrotoxicity, ototoxicity, and
myelosuppression.
g. Stress the importance of reporting symptoms such as decreased urine
output or hearing changes
h. Administer cisplatin via slow intravenous infusion (usually over 6–8
hours) as prescribed.
i. Continuously monitor the IV site for extravasation and other reactions.
j. Regularly check blood pressure, pulse, and temperature during the
infusion.
k. Observe for signs of an allergic reaction or hypersensitivity.
l. Ensure the patient maintains adequate urine output (at least 100
mL/m²/hour) during and after the infusion.
m. Monitor for hematuria or reduced output, indicating potential
nephrotoxicity.
n. Ototoxicity: Assess for tinnitus, hearing loss, or balance issues.
o. Electrolyte Imbalance: Monitor for symptoms like muscle cramps, fatigue,
or arrhythmias due to low magnesium or potassium.
p. Arrange regular hearing tests post-treatment, especially in younger
children.
DRUG- CHLORAMBUCIL

DOSE 0.1-0.2 mg/kg/day or 4.5 mg/mm2 / day as single dose or in divided dose
ACTION It causes cytotoxic cross linkage in DNA thus prevent synthesis of DNA, RNA,
protein
INDICATION Chronic lymphocytic leukemia, lymphomas, hodgkin’s disease
SIDE EFFECTS Bone marrow depression, fever, rashes, thrombocytopenia
CONTRAINDICATION hypersensitivity
NURSING  Nausea and vomiting may be controlled by giving entire dose at one time,
RESPONSIBILITIES one hour before breakfast or 2 hours after evening meal
 CBC, hemoglobin, total and differential leukocyte counts, and serum uric
acid should be checked initially and at least once weekly during treatment
 body weight, size of spleen, and temperature charted before initiation of
therapy and at the time of blood counts provide a useful profile for
determining degree of bone marrow Leukopenia usually develops after the
third week of treatment; it may continue for up to10 days after last dose then
rapidly return to normal.
 With confirmation of bone marrow depression (low platelet and neutrophil
counts, it is recommended that dosage not exceed 0.1 mg/kg.
 If possible, avoid or reduce to minimum injections and other invasive
procedures (e.g., rectal temperatures, enemas) when platelet count is low
because of danger of bleeding.
 Advise patient to notify physician if the following symptoms occur: unusual
bleeding or bruising, sores on lips or in mouth; flank, stomach or joint pain;
fever, chills, or other signs of infection, sore throat, cough, dyspnea.
 Skin reactions are rare, but all appear to show a consistent pattern: pustular
eruption on mouth, chin, cheeks; urticarial erythema on trunk that spreads to
legs. The rash occurs early in treatment period and lasts about 10 days after
last dose. Responses become more and more severe with repeated
challenges. Urge the patient to report immediately the onset of cutaneous
reaction.
 Because of drug impaired immune response, pneumococcus vaccine
effectiveness is reduced and small pox vaccination can lead to progressive
vaccinia; therefore neither is generally given during chlorambucil therapy.

ANTIMETABOLITES

Drug-METHOTREXATE

DOSE 1-5 g/m2

ACTION It is a folic acid antagonist. Cytotoxic actions-mainly affects the bone marrow,
skin and GI mucosa , immunosuppressant property
INDICATION Acute leukemia soft tissue carcinoma
SIDE EFFECTS Rashes, hepatotoxicity hematuria,pneumonitis

NURSING o Review baseline labs (CBC, liver and kidney function, electrolytes).
RESPONSIBILITIES o Ensure hydration and urinary alkalization (pH >7) before starting high-dose
methotrexate to prevent nephrotoxicity.
 Proper Drug Preparation and Verification:
o Verify the dose based on the child’s body surface area (BSA) or weight.
o Prepare methotrexate under sterile conditions, adhering to chemotherapy
handling protocols.
o For IV infusion, monitor the infusion site for signs of infiltration or
extravasation.
o Observe for immediate adverse reactions like nausea, vomiting, or
hypersensitivity.
o Administer leucovorin as prescribed to mitigate methotrexate’s toxic
effects on healthy cells.
o Monitor methotrexate plasma levels to ensure proper leucovorin dosing.
o Watch for mucositis, myelosuppression, hepatotoxicity (jaundice, elevated
liver enzymes), and nephrotoxicity (reduced urine output, elevated
creatinine).

Drug—mercaptopurine

DOSE 2.5mg/kg/day in single or divided doses

ACTION Atimetabolite and purine antagonist. Inhibits purine metabolism
INDICATION Primarily for lymphocytic leukemias
SIDE EFFECTS Stomatitis, esophagitis, anorexia nausea, intestinal ulceration
NURSING  Jaundice signals onset of hepatotoxicity and may necessitate terminating
RESPONSIBILITIES use
 Report other signs as clay colored stools and frothy dark urie.
 Record baseline data.

Drug—fluoouracil

DOSE 12mg/kg/body weight

ACTION It blocks action of enzymes essential to normal DNA and RNA synthesis
INDICATION Antineoplastics for palliative treatment
SIDE EFFECTS Leukopenia, Gi haemorrhage, burning at the site of application
NURSING  Administer only by or under the direct supervision
RESPONSIBILITIES  Avoid skin exposure and inhalation of drug
 Given without dilution by direct IV or IV infusion with 5% dextrose
 Inspect injection site frequently
 Protect patient from trauma
 Administer antiemetics
Drug – Actinomycin

DOSE 0.015mg/kg/day
ACTION Potent cytotoxic antibiotic
INDICATION Antineoplastics ,wilm’s tumour
SIDE EFFECTS Hyperpigmentation, alopecia chelitis, anorexia, dysphagia
NURSING  Patient Assessment:
RESPONSIBILITIES o Assess baseline organ function (renal, hepatic, and hematologic
parameters).
o Check for any signs of infection or bleeding.
 Proper Drug Handling:
o Prepare actinomycin D in a designated chemotherapy area under aseptic
conditions.
o Use personal protective equipment (PPE) as it is a vesicant and highly toxic
to skin and mucous membranes.
 Patient Education:
o Explain the purpose of the medication, potential side effects, and the
importance of reporting symptoms like pain or redness at the infusion site.

 ⸻

 During Administration Responsibilities

 Monitor IV Site:
o Administer via a central venous catheter if possible, as actinomycin D is a
vesicant.
o Closely monitor for signs of extravasation, such as redness, swelling, or
pain, and immediately stop the infusion if it occurs.
 Vital Signs Monitoring:
o Observe for acute reactions like nausea, vomiting, or hypersensitivity.
o Monitor vital signs throughout the infusion.

 ⸻

 Post-Administration Responsibilities
 Monitor for Toxicity:
o Myelosuppression: Monitor CBC for anemia, leukopenia, or
thrombocytopenia and implement infection and bleeding precautions.
o GI Toxicity: Watch for nausea, vomiting, and diarrhea, and provide
supportive care as needed.
o Hepatotoxicity: Monitor liver function tests (LFTs) for elevated enzymes or
jaundice.
 Extravasation Management:
o If extravasation occurs, follow institutional protocols (e.g., applying cold
compresses and notifying the physician immediately).
 Educate and Support the Patient and Family:
o Teach the importance of hydration, infection prevention, and adherence to
follow-up lab tests.
 o Provide emotional support and address concerns about side effects or long-
term outcomes.

 Documentation
 9. Record the dose, time, infusion site condition, patient response, and any
adverse events in the patient’s medical record.

Drug- Etoposide

DOSE 50-150mg/m2
ACTION Inhibits DNA ligation and causes critical errors in DNA synthesis and can lead
to apoptosis
INDICATION Acute lymphocytic leukemia
SIDE EFFECTS Alopecia, constipation, diarrhea, nausea, vomiting
NURSING  Patient Assessment:
RESPONSIBILITIES o Evaluate baseline blood work, including CBC, liver function tests (LFTs),
and renal function tests.
o Check for any signs of infection, bleeding, or hypersensitivity history.
 Drug Preparation:
o Prepare etoposide under sterile conditions in a designated chemotherapy
area.
o Dilute the drug as per institutional guidelines (usually in normal saline or
D5W).
o Avoid rapid IV administration to minimize the risk of hypotension.
 Patient and Family Education:
o Explain the purpose of the drug, potential side effects, and the importance
of reporting any symptoms like fever, pain, or rash.

 ⸻

 During Administration Responsibilities

 Infusion Monitoring:
o Administer etoposide slowly (over 30–60 minutes) to reduce the risk of
hypotension and hypersensitivity reactions.
o Continuously monitor for signs of an allergic reaction (e.g., flushing,
dyspnea, or rash).
 Vital Signs Monitoring:
o Regularly check blood pressure, heart rate, and respiratory rate during and
after infusion.
o Be prepared to manage anaphylactic reactions if they occur.

 ⸻

 Post-Administration Responsibilities
 Monitor for Side Effects:
o Myelosuppression: Monitor CBC and watch for signs of infection, anemia,
or bleeding.
 o Gastrointestinal Toxicity: Manage nausea, vomiting, and mucositis with
appropriate supportive care.
o Alopecia: Educate the family about the potential for temporary hair loss.
 Neutropenic Precautions:
o Implement infection prevention measures, including strict hand hygiene
and avoiding exposure to sick individuals

 Long-Term Responsibilities
 Lab Monitoring:
o Regularly monitor CBC, renal function, and liver function during the
treatment cycle.
o Adjust dosage based on lab results and treatment protocols.
 Educate and Support the Family:
o Address concerns about side effects, treatment efficacy, and coping
strategies.
o Encourage adherence to follow-up appointments and lab tests.
.

Drug- Topotecan

DOSE 1.5mg/m2/day
ACTION It is a topoisomerase inhibitor and interferes with DNA replication and
transcription leading to DNA strands breaks and cell death
INDICATION Neuroblastoma, medulloblastoma, leukemias
SIDE EFFECTS Myelosuppressio, constipation, mucocytosis, haemorrhage
NURSING  Assess baseline CBC, LFT, KFT
RESPONSIBILITIES  Use antiemetics to manage nausea and vomiting

Drug- Procarbazine

DOSE 50 mg daily
ACTION Antineoplastic suppresses mitosis
INDICATION Hodgkin’s lymphoma
SIDE EFFECTS Myalgia, weakness, fatigue,dermatitis hyperpigmentation
NURSING  Toxicity is a serious problem and demands that patient be hospitalized
RESPONSIBILITIES and under close medical and nursing supervision during treatment
induction period.
 Hematologic status (hemoglobin, hematocrit, WBC, differential,
reticulocyte, and platelet counts) should be determined initially and at
least every 3 to 4 days. Hepatic and renat studies (transaminase,
alkaline phosphatase, BUN, urinalysis) are aiso indicated initially and
at least weekly during therapy.
 Start flow sheet, and record baseline blood pressure, weight,
temperature, pulse, and intake. output ratio and pattern.
 Since procarbazine has MAO inhibitory activity, OTC nose drops,
 cough medicines, and an-tiobesity preparations containing
sympathomimetic drugs (e.g., ephedrine, amphetamine, epinephine)
and tricyclic antidepressants should be avoided because they may cause
hypertensive crises. Warn patient not to use OTC preparations without
physician's approval.
 Intake of foods high in tyramine content should also be avoided (see
Index: Food sources).
 Warn patient that ingestion of any form of alcohol may precipitate a
disulfiram-like reaction.
 Be alert to signs of hepatic dysfunction: jaundice (yellow skin, sclerae,
and soft palate), frothy or dark urine, clay-colored stools.
 Patient's hematologic status should be monitored carefully for
indicators that suggest special nursing interventions and need for
dosage adjustment or drug withdrawal.
 As patient approaches nadir of leukopenia (below 4000/mm'), protect
patient from exposure to infection and trauma. Visitors and personnel
with common colds should not visit. Alert patient to report any sign of
impending infection. Note and report changes in voiding pattern,
hematuria, and dysuria (possible signs of urinary tract infection). Intake
output ratio and temperature should be closely monitored.
 Tolerance to nausea and vomiting (most common side effects) usually
develops by end of first week of treatment. Doses are kept at a
minimum during this time. If vomiting persists, therapy will be
interrupted.
 Symptoms of pleural effusion, an allergic reaction to procarbazine
(chills, fever, weakness, Shortness of breath, productive cough) should
be reported promptly. Drug will be discontin ued.
 Instruct patient to report immediately signs of hemorrhagic tendencies: