Questions and Answers
Through which primary route is cyclophosphamide excreted?
Kidneys
Which part of the cell does fluorouracil affect during the S phase of the cell cycle?
DNA
Which type of chemotherapy refers to chemotherapeutic drugs packaged in a fat globule?
Liposomal
Which statement is accurate regarding tamoxifen?
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During which time frame will anti-emetic therapy be most beneficial to J.W. before administering cyclophosphamide?
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Which location would the nurse prepare chemotherapeutic drugs before administration?
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Which chemotherapeutic agent would the nurse expect to administer for Philadelphia chromosome-negative acute lymphoblastic leukemia?
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CYP2D6 inducers have which effect on chemotherapeutic drugs?
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Match the chemotherapeutic drug to its class.
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In which phase of the cell cycle do most antimetabolites affect cells?
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A patient with multiple myeloma received cyclophosphamide at 0900. Which time would the nurse expect the drug to peak?
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What are the benefits of treating cancer cells with a combination of different classes of chemotherapeutic drugs?
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Why must vincristine be given intravenously?
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What should the nurse do if a patient with plant allergies is prescribed vincristine?
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Which statement made by the patient indicates a need for further teaching regarding doxorubicin?
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What action should a nurse take to decrease the risk for occupational exposure when disposing of urine from a patient receiving chemotherapeutic drugs?
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What should the nurse do first when a patient is prescribed oral cyclophosphamide 700 mg and weighs 125 pounds?
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What product would the nurse anticipate administering due to a significant drop in neutrophils?
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A patient receiving chemotherapeutic drugs complains of mouth lesions. Which drug would the nurse most likely provide?
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Which statements made by a male patient indicate an understanding of potential side effects of chemotherapeutic drugs?
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What is the treatment cycle frequency for fluorouracil when prescribed with other agents?
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Study Notes
Pharmacology Key Concepts
- Cyclophosphamide is primarily excreted through the kidneys.
- Fluorouracil affects DNA during the S phase of the cell cycle.
- Liposomal chemotherapy involves drugs packaged in fat globules, enhancing delivery.
- Tamoxifen functions as both an agonist and antagonist at estrogen receptor sites.
Anti-Emetic Administration
- Administer anti-emetic therapy just before cyclophosphamide administration to maximize its benefit.
Chemotherapy Administration Protocol
- Chemotherapeutic drugs should be prepared in a separate work area to ensure safety.
- Vincristine liposomal is an expected treatment for patients with Philadelphia chromosome-negative acute lymphoblastic leukemia.
Drug Interactions and Effects
- CYP2D6 inducers, like phenobarbital, decrease the concentration of chemotherapeutic drugs, potentially reducing their efficacy.
- The S phase is where most antimetabolites exert their effects on cells.
Pharmacokinetics
- Cyclophosphamide peaks in the bloodstream approximately two hours after administration.
Combination Therapy Advantages
- Using multiple classes of chemotherapeutic drugs enhances therapeutic effects and reduces drug resistance, increasing cancer cell destruction.
Drug Administration Methods
- Vincristine must be administered intravenously due to low absorption rates with oral ingestion.
- In cases of plant allergies (e.g., periwinkle), notify the healthcare provider if prescribing vincristine.
Patient Education
- Doxorubicin, an antitumor antibiotic, does not prevent infections; patients should remain vigilant about infection risks.
- Use of face shields while disposing of patient urine mitigates occupational exposure risks.
Dosage Considerations
- Hold oral cyclophosphamide for patients weighing 125 pounds if prescribed at 700 mg (consider dosage adjustment).
- Anticipate administering colony-stimulating factors (CSFs) in response to significant neutrophil drop.
Management of Side Effects
- For patients with mouth lesions due to chemotherapy, topical anesthetics are the most likely intervention to facilitate eating and swallowing.
Patient Understanding of Side Effects
- Patients should be educated on managing mouth care with a soft toothbrush, and the potential need for stool softeners to alleviate constipation.
- Banking sperm is advisable for male patients to preserve fertility options post-chemotherapy.
Treatment Schedule
- Fluorouracil is typically repeated every two weeks as part of a combination chemotherapy regimen for metastatic pancreatic cancer.
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