Alkylating drugs
Alkylating drugs
Alkylating drugs are cytotoxic They alkylate cellular DNA, interfering with the replication of susceptible cells and causing cell death. Their action is most evident in rapidly divid- ing cells.
Indications
Palliative treatment of chronic lymphocytic leukemia; malignant lymphomas, including lymphosarcoma, giant follicular lymphoma; brain tumors; Hodgkin’s lymphoma; multiple myelomas; testicular cancers; pancreatic cancer; ovarian and breast cancers Used as part of multiple drug regimens Contraindications and cautions
Contraindicated with hypersensitivity to the drugs, concurrent radiation therapy, hematopoietic suppression, pregnancy, lactation. Adverse effects
CNS: Tremors, muscular twitching, confusion, agitation, ataxia, flaccid paresis, hallucinations, seizures Dermatologic: Skin rash, urticaria, alopecia, keratitis GI: Nausea, vomiting, anorexia, hepatotoxicity GU: Sterility Hematologic: Bone marrow depression, hyperuricemia Respiratory: Bronchopulmonary dysplasia, pulmonary fibrosis Other: Cancer, acute leukemia Nursing considerations
Assessment
History: Hypersensitivity to drug, radia- tion therapy, hematopoietic depression, preg- nancy, lactation Physical: T; weight; skin color, lesions; R, adventitious sounds; liver evaluation; CBC, differential, Hgb, uric acid, LFTs, renal func- tion tests Interventions
Black box
warning Arrange for blood tests to evaluate hematopoietic function prior to and weekly during therapy; severe bone marrow suppression is possible. Restrict dosage within 4 wk after a full course of radiation therapy or chemother- apy because of risk of severe bone marrow suppression. Ensure that patient is well hydrated before treatment. Arrange for frequent small meals and dietary consultation to maintain nutrition if GI upset occurs. Arrange for skin care for rashes. Black box
warning Suggest use of contraception; serious fetal abnormalities or death is possible. Teaching points
You may experience these side effects: Nausea, vomiting, loss of appetite (dividing dose may help; frequent small meals may help; maintain fluid intake and nutrition; drink at least 10–12 glasses of fluid each day); infertility (potentially irreversible and irregular menses to amenorrhea and aspermia; discuss feelings with your health care provider); these drugs can cause severe birth defects; use birth control methods while on these drugs. Report unusual bleeding or bruising; fever, chills, sore throat; cough, shortness of breath; yellowing of the skin or eyes; flank or stomach pain. Representative drugs
altretamine bendamustine busulfan carboplatin carmustine chlorambucil cisplatin cyclophosphamide dacarbazine estramustine Alkylating Drugs ifosfamide lomustine mechlorethamine melphalan oxaliplatin procarbazine streptozocin thiotepa