Mosby's 2014 Nursing Drug Reference (111 page)

BOOK: Mosby's 2014 Nursing Drug Reference
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Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

cyclopentolate
ophthalmic

 

HIGH ALERT
cyclophosphamide (Rx)

(sye-kloe-foss′fa-mide)

Cytoxan, Procytox

Func. class.:
Antineoplastic alkylating agent

Chem. class.:
Nitrogen mustard

Do not confuse:
cyclophosphamide
/cycloSPORINE
Cytoxan
/Cytosar/Cytotec/cytarabine

ACTION:

Alkylates DNA is responsible for cross-linking DNA strands; activity is not cell-cycle–phase specific

USES:

Hodgkin’s disease, lymphomas, leukemia; cancer of female reproductive tract, breast, lung, prostate; multiple myeloma; neuroblastoma; retinoblastoma; Ewing’s sarcoma; disseminated neuroblastoma, nephrotic syndrome

Unlabeled uses:
Aplastic anemia, chronic idiopathic thrombocytopenic purpura, dermatomyositis, pneumonitis, polymyositis, SLE, scleroderma, RA, Behçet’s syndrome, Churg-Strauss syndrome, polyarteritis nodosa, Wegener’s granulomatosis, idiopathic pulmonary fibrosis, localized neuroblastoma, CLL

CONTRAINDICATIONS:

Pregnancy (D), breastfeeding, severely depressed bone marrow function, hypersensitivity, prostatic hypertrophy, bladder neck obstruction

Precautions:
Radiation therapy, cardiac disease

DOSAGE AND ROUTES
Calculator

• Adult:
PO
Initially 1-5 mg/kg over 2-5 days, maintenance is 1-5 mg/kg;
IV
initially 40-50 mg/kg in divided doses over 2-5 days, maintenance 10-15 mg/kg q7-10 days or 3-5 mg/kg q3days

• Child:
PO/IV
2-8 mg/kg or 60-250 mg/m
2
in divided doses for 6 or more days; maintenance 10-15 mg/kg q7-10 days or 30 mg/kg q3-4wk; dose should be reduced by half when bone marrow depression occurs

Neuroblastoma

• Child and infant:
PO
150 mg/m
2
/day, days 1-7 with DOXOrubicin (
IV
35 mg/m
2
on day 8) q21days × 5 cycles

• Child:
IV
70 mg/kg/day with hydration on days 1, 2 with DOXOrubicin and vinCRIStine q21days for courses 1, 2, 4, 6 alternating with CISplatin and etoposide q21days for courses 3, 5, 7

Breast cancer

• Adult:
PO
100-200 mg/m
2
/day or 2 mg/kg/day × 4-14 days;
IV
500-1000 mg/m
2
on day 1 in combination with fluorouracil and methotrexate or DOXOrubicin or DOXOrubicin alone, also cyclophosphamide 600 mg/m
2
; may be given dose-dense on day 1 of q14days with DOXOrubicin (60 mg/m
2
) with growth-factor support

Operable node-positive breast cancer IV (TAC regimen)

• Adult:
IV
500 mg/m
2
with DOXOrubicin (50 mg/m
2
IV
) then docetaxel (75 mg/m
2
)
IV
given 1 hr later q3wk × 6 cycles

Nephrotic syndrome

• Adult:
PO
2-3 mg/kg/day for up to 12 wk when corticosteroids are unsuccessful

Aplastic anemia (unlabeled)

• Adult:
IV
45-50 mg/kg divided over 4 days

Behçet’s syndrome/Churg-strauss syndrome/polyarteritis nodosa/uveitis/Wegener’s granulomatosis (unlabeled)

• Adult:
PO
1-2 mg/kg/day,
IV
0.5-1 g/m
2

Rheumatoid arthritis (unlabeled)

• Adult and child:
PO
1.5-2.5 mg/kg/day

CLL (unlabeled)

• Adult:
IV
250 mg/m
2
/day on days 1-3 with fludarabine 30 mg/m
2
/day on days 1-3

Available forms:
Inj 100, 200, 500 mg, 1, 2 g; tabs 25, 50 mg

Administer:

• 
Use cytotoxic handling procedures

• 
In
AM
so product can be eliminated before bedtime

• 
Fluids IV or PO before chemotherapy to hydrate patient

• 
Antacid before oral agent; give after evening meal, before bedtime

• 
Antiemetic 30-60 min before product and prn

• 
Allopurinol or sodium bicarbonate to maintain uric acid levels, alkalinization of urine

PO route

• 
Take on empty stomach; do not crush, break, chew tabs

• 
May be taken as a single dose or divided doses

• 
Take in
AM
or afternoon, avoid evening

Direct IV route

• 
Reconstitute with NS only

Intermittent IV INF route

• 
Use cytotoxic handling procedures

• 
IV after diluting 100 mg/5 ml of sterile water or bacteriostatic water; shake; let stand until clear; may be further diluted in ≤250 ml D
5
or NS; give 100 mg or less/min through 3-way stopcock of glucose or saline inf

• 
Use 21, 23, 25G needle; check site for irritation, phlebitis

Solution compatibilities:
Amino acids 4.25%/D
25
, D
5
/0.9% NaCl, D
5
W, 0.9% NaCl

Syringe compatibilities:
Bleomycin, CISplatin, doxapram, DOXOrubicin, droperidol, fluorouracil, furosemide, heparin, leucovorin, methotrexate, metoclopramide, mitomycin, vinBLAStine, vinCRIStine

Y-site compatibilities:
Acyclovir, alfentanil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin-sulbactam, anidulafungin, atenolol, atracurium, azlocillin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, cefamandole, ceFAZolin, cefepime, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, cladribine, clindamycin, codeine, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, DAUNOrubicin, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doripenem, dox
acurium, DOXOrubicin, DOXOrubicin liposomal, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, ertapenem, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, gallium, ganciclovir, gatifloxacin, gemcitabine, gentamicin, granisetron, haloperidol, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, imipenem-cilastatin, inamrinone, insulin (regular), irinotecan, isoproterenol, kanamycin, ketorolac, labetalol, leucovorin, levofloxacin, levorphanol, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, melphalan, meperidine, meropenem, mesna, methohexital, methotrexate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, minocycline, mitoMYcin, mitoXANtrone, mivacurium, morphine, nafcillin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, PEMEtrexed, penicillin G potassium, pentamidine, PENTobarbital, PHENobarbital, phenylephrine, piperacillin, piperacillin-tazobactam, potassium chloride/phosphates, procainamide, prochlorperazine, promethazine, propofol, propranolol, quinupristin-dalfopristin, ranitidine, rapacuronium, remifentanil, riTUXimab, rocuronium, sargramostim, sodium acetate/bicarbonate/phosphates, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacrolimus, teniposide, theophylline, thiopental, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, TNA, tobramycin, topotecan, TPN, trastuzumab, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid

SIDE EFFECTS

CNS:
Headache, dizziness

CV:
Cardiotoxicity (high doses), myocardial fibrosis, congestive heart failure, pericarditis

ENDO:
SIADH, gonadal suppression

GI:
Nausea, vomiting, diarrhea, weight loss
, colitis,
hepatotoxicity

GU:
Hemorrhagic cystitis,
hematuria, neoplasms, amenorrhea, azoospermia, sterility, ovarian fibrosis
,
renal tubular fibrosis

HEMA:
Thrombocytopenia, leukopenia, pancytopenia; myelosuppression

INTEG:
Alopecia
, dermatitis

META:
Hyperuricemia

MISC:
Secondary neoplasms,
anaphylaxis

RESP:
Pulmonary fibrosis, interstitial pneumonia

PHARMACOKINETICS

Metabolized by liver, excreted in urine, half-life 4-6½ hr, 50% bound to plasma proteins

INTERACTIONS

Increase:
neuromuscular blockade—succinylcholine

Increase:
cyclophosphamide toxicity—barbiturates

Increase:
action of warfarin

Increase:
bone marrow depression—allopurinol, thiazides

Increase:
hypoglycemia—insulin

Decrease:
digoxin levels—digoxin

Decrease:
cyclophosphamide effect—chloramphenicol, corticosteroids

Decrease:
antibody response—live virus vaccines

Drug/Herb

• 
Toxicity: St. John’s wort

Drug/Lab Test

Increase:
uric acid

False positive:
Pap smear

False negative:
PPD, mumps, trichophytin,
Candida, Trichophyton
, Pap smear

NURSING CONSIDERATIONS
Assess:

• 
Hemorrhagic cystitis;
renal studies: BUN, serum uric acid, urine CCr before, during therapy; I&O ratio; report fall in urine output <30 ml/hr

• 
Bone marrow depression:
CBC, differential, platelet count baseline, weekly; withhold product if WBC is <2500 or platelet count is <75,000; notify prescriber of results

• 
Pulmonary function tests, chest x-ray films before, during therapy; chest film should be obtained q2wk during treatment

• 
Monitor temp q4hr; elevated temp may indicate beginning infection

• 
Hepatotoxicity:
hepatic studies before, during therapy (bilirubin, AST, ALT, LDH), as needed; jaundice of skin, sclera; dark urine, clay-colored stools; itchy skin; abdominal pain; fever; diarrhea

• 
Bleeding:
hematuria, guaiac, bruising or petechiae, mucosa or orifices q8hr

• 
Dyspnea, crackles, unproductive cough, chest pain, tachypnea

• 
Effects of alopecia on body image, discuss feelings about body changes

• 
Buccal cavity q8hr for dryness, sores or ulceration, white patches, oral pain, bleeding, dysphagia; obtain prescription for viscous lidocaine (Xylocaine)

 
Symptoms that indicate severe allergic reaction: rash, pruritus, urticaria, purpuric skin lesions, itching, flushing

Perform/provide:

• 
Storage in tight container at room temp

• 
Increase fluid intake to 2-3 L/day to prevent urate deposits, calculi formation, reduce incidence of hemorrhagic cystitis

• 
Diet low in purines: organ meats (kidney, liver), dried beans, peas to maintain alkaline urine

• 
Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss

• 
Warm compresses at inj site for inflammation

Evaluate:

• 
To take adequate fluids to eliminate product

• 
Therapeutic response: decreased tumor size, spread of malignancy

Teach patient/family:

• 
That amenorrhea can occur and may last up to 1 yr after therapy but is reversible after stopping treatment

• 
To report any changes in breathing or coughing

• 
That hair may be lost during treatment; a wig or hairpiece may make patient feel better; new hair may be different in color, texture

• 
To avoid foods with citric acid, hot or rough texture

• 
To report signs of infection: increased temp, sore throat, flulike symptoms

• 
To report signs of anemia: fatigue, headache, faintness, SOB, irritability

• 
To report bleeding (bruising, hematuria, petechiae); to avoid use of razors, commercial mouthwash

• 
To use reliable contraception during and for 4 mo after treatment; not to breastfeed

• 
To avoid use of aspirin products, ibuprofen

• 
To avoid vaccinations during therapy

• 
Advise patient on proper handling and disposal of chemotherapy drugs

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