C H A P T E R 1 4
Antineoplastic agents
211
drugs known to have the same adverse effect. Check
specific drug–drug interactions for each agent in a drug
guide.
Safe medication administration
Preventing and treating extravasation
When an IV antineoplastic drug extravasates or infiltrates
into the surrounding tissue, serious tissue damage can
occur. These drugs are toxic to cells, and the resulting
tissue injury can result in severe pain, scarring, nerve and
muscle damage, infection and, in very severe cases, even
amputation of the limb.
Prevention is the best way to deal with extravasation.
Interventions that can help to prevent extravasation include
the following: use a distal vein, and avoid small veins on
the wrist or digits; never use an existing line unless it is
clearly open and running well; start the infusion with plain
5% dextrose in water (D5W) and monitor for any sign of
extravasation; check the site frequently and ask the person
to report any discomfort in the area; and, if at all possible, do
not use an infusion pump to administer one of these drugs
because it will continue to deliver the drug under pressure
and can cause severe extravasation.
Prototype summary: Vincristine
Indications:
Acute leukaemia, Hodgkin’s disease,
non-Hodgkin’s lymphoma, rhabdomyosarcoma,
neuroblastoma, Wilms tumour.
Actions:
Arrests mitotic division at the stage of
metaphase; the exact mechanism of action is not
understood.
Pharmacokinetics:
Route
Onset
Peak
IV
Varies
15–30 mins
T
1/2
:
5 minutes, then 2.3 hours, then 85 hours;
metabolised in the liver and excreted in the faeces
and urine.
Adverse effects:
Ataxia, cranial nerve manifestations,
neuritic pain, muscle wasting, constipation,
leucopenia, weight loss, loss of hair, death.
Care considerations for
people receiving mitotic inhibitors
Assessment: History and examination
■
■
Assess for contraindications or cautions: history
of allergy to the drug used (or related drugs)
to avoid hypersensitivity reactions
; bone marrow
suppression
to prevent further suppression
; renal
or hepatic dysfunction
that might interfere with
drug metabolism and excretion
; current status of
pregnancy or breastfeeding
to prevent potentially
serious adverse effects on the fetus or breastfeeding
baby
; and GI ulcerative disease,
which could be
exacerbated by these drugs
.
■
■
Perform a physical assessment
to establish baseline
data for determining the effectiveness of the
drug and the occurrence of any adverse effects
associated with drug therapy
.
■
■
Assess orientation and reflexes
to evaluate any
CNS effects
; skin
to evaluate for lesions
; hair
and hair distribution
to monitor for adverse
effects
; respiratory rate and adventitious sounds
to
monitor the disease and to evaluate for respiratory
or hypersensitivity effects
; and bowel sounds and
mucous membrane status
to monitor for GI effects
.
■
■
Monitor the results of laboratory tests such as
FBC with differential
to identify possible bone
marrow suppression and toxic drug effects
; and
renal and liver function tests
to determine the need
for possible dose adjustment as needed and to
evaluate toxic drug effects
.
■
■
Regularly inspect IV insertion sites
for signs of
extravasation or inflammation, which need to be
treated quickly
.
Implementation with rationale
■
■
Arrange for blood tests to monitor bone marrow
function before, periodically during, and for
at least 3 weeks after therapy
to arrange to
discontinue the drug or reduce the dose as needed
.
■
■
Avoid direct skin or eye contact with the drug.
Wear protective clothing and goggles while
preparing and administering the drug
to prevent
toxic reaction to the drug
.
■
■
Administer medication according to scheduled
protocol and in combination with other drugs
as indicated
to improve the effectiveness of drug
therapy
.
■
■
Ensure that the person is well hydrated
to decrease
the risk of renal toxicity
.
■
■
Monitor injection sites
to arrange appropriate
treatment for extravasation, local inflammation or
cellulitis
.
■
■
Protect the person from exposure to infection
because bone marrow suppression will decrease
immune/inflammatory responses
.
■
■
Provide small, frequent meals, frequent mouth care
and dietary consultation as appropriate
to maintain
nutrition if GI effects are severe
. Anticipate the
need for antiemetics as necessary. (See Box 14.5.)
■
■
Arrange for proper head covering at extremes of
temperature if alopecia or epilation occurs; a wig,
