DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATIONS SIDE EFFECTS/ NURSING

ACTION ADVERSE EFFECTS CONSIDERATIONS

GENERIC NAME: Inhibits DNS Myelodysplastic Hypersensitivity; CNS: fatigue; • Assess for bleeding (bleeding
azacitidine synthesis. syndromes Advanced malignant GI: HEPATOTOXICITY, gums, bruising, petechiae,
including: some hepatic tumors; constipation,diarrhea, stools, urine, emesis) and
BRAND NAME: Therapeutic refractory anemias, OB: Potential for nausea; avoid IM injections and taking
Vidaza effects: Death of chronic congenital anomalies; GU: nephrotoxicity, renal rectal temperatures if platelet
rapidly replicating myelomonocytic Lactation: Potential for tubular acidosis; count is low.
AVAILABLE cells, particularly leukemia. serious side effects in Derm: ecchymosis;
FORM: malignant ones. infants. F and E: hypokalemia; • Assess patient for nausea and
Suspension for Hemat: anemia, neutropenia, vomiting during therapy.
injection (requires thrombocytopenia;
reconstitution): Local: injection site • Lab test considerations:
100mg/vial erythema; - Monitor CBC with
Misc: allergic reactions differential and platelet count
DOSAGES: including ANAPHYLAXIS, prior to each dosing cycle.
Subcut, IV fever. - Monitor renal function
(Adults): 75 mg/m2/ during therapy.
day for 7 days every
4 wks. May be • Instruct patient to notify
increased to 100 health care professional
mg/m2/day for 7 promptly if fever; chills;
days every 4 wks if cough; hoarseness; sore throat;
no beneficial effect signs of infection; lower back
occurs after 2 cycles. or side; painful or difficult
Continue for as long urination; bleeding gums;
as patient benefits. bruising; petechiae; blood in
stools, urine or emesis;
increased fatigue; dyspnea or
orthostatic hypotension
occurs.

• Advise patient to notify

 health care professional if they
have underlying liver or renal
disease.

• OB: Advise both male and

female patient of the need for
contraception during therapy.

Evaluation/ Desired
Outcomes:
• Improved bone marrow and
blood count.

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATIONS SIDE EFFECTS/ NURSING

 ACTION ADVERSE EFFECTS CONSIDERATIONS
GENERIC NAME: Inhibits DNA Treatment of various Hypersensitivity; OB: CNS: confusion, fatigue, • Assess for bleeding.
decitabine methyltransferase, myelodysplastic Pregnancy or Lactation. insomnia, depression,
causing apoptosis. Has syndromes (MDS). lethargy; • Lab Test
BRAND NAME: more effect on rapidly EENT: blurred vision; Considerations:
Dacogen replicating cells. Resp: cough; - Monitor CBC prior to
CV: atrial fibrillation, each dosing cycle and
AVAILABLE FORM: Therapeutic effects: pulmonary edema, periodically as needed.
Lyophilized powder Improved hematologic tachycardia; - Obtain liver
for injection (requires and clinical GI: abdominal pain, chemistries and serum
reconstitution): 50 mg/ manifestations of MDS. constipation, diarrhea, creatinine prior to
vial stomatitis, vomiting, initiation of treatment.
abnormal liver function
DOSAGES: tests; • Caution patient to
IV (Adults): First Derm: petechiae, rash; avoid crowds and
treatment cycle- 15 F and E: edema, persons with known
mg/m2 as a continuous hypokalemia, infections. Report
infusion over 3 hours hypomagnesemia, symptoms of infection
repeated every 8 hours ascites; (fever, chills, cough,
for 3 days. Subsequent Hemat: BLEEDING, hoarseness, sore throat,
cycles- cycle should be anemia, neutropenia, lower back or side pain,
repeated every 6 wks for thrombocytopenia; painful or difficult
a minimum of 4 cycles; Local: injection site urination) immediately.
treatment may be irritation;
continued as ong as the Metab: hyperglycemia; • Instruct patient to
patient continues to MS: arthralgia, myalgia; report unusual bleeding.
benefit. Dose Misc: INFECTION, Advise patient of
adjustment/delay may be fever, lymphadenopathy. thrombocytopenia
required for hematologic precautions (use soft
toxicity, renal or hepatic toothbrush and electric
impairment, or infection. razor, avoid falls, do not
drink alcoholic
beverages or take
medication containing
aspirin or NSAIDS; may
precipitate gastric
bleeding).

• Inform patient that this

medication may have
teratogenic effects.
Advise women to avoid
becoming pregnant
during treatment and
advise men not to father
a child during or for 2
months after treatment.

Evaluation/ Desired
Outcomes:
• Improved hematologic
and clinical
manifestations of MDS.
Miscellaneous
Antineoplastics
 DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATIONS SIDE EFFECTS/ NURSING
ACTION ADVERSE EFFECTS CONSIDERATIONS
GENERIC NAME: Inhibits the production PO: Prevention of attack Hypersensitivity. CV: hypotension, • Monitor intake and
allopurinol of uric by inhibiting the of gouty arthritis and flushing, hypertension, output ratios.
action of xanthine nephropathy; bradychardia and heart
BRAND NAME: oxidase. failure (reported with IV • Assess patient for rash
Alloprim administration); or more severe
Therapeutic effects: PO, IV: Treatment of CNS: drowsiness; hypersensitivity
AVAILABLE FORM: Lowering of serum uric secondary GI: diarrhea, hepatitis, reactions.
(generic available) acid levels. hyperuricemia, which nausea, vomiting;
Tablets: 100 mg, 300 may occur during GU: renal failure, • Gout: Monitor for joint
mg treatment of tumors and hematuria; pain and swelling.
Injection: 500 mg/vial leukemias. Derm: rash (discontinue
drug at first sign of • Lab Test
DOSAGES: rash); Considerations:
Management of Gout: Hemat: bone marrow - Monitor blood glucose
• PO (Adults and depression; in patients receiving oral
Children >10 yr): Misc: hypersensitivity hypoglycemic agents.
Initially- 100 mg/day; reactions. - Monitor hematologic,
increase at weekly renal, and liver function
intervals based on serum tests before and
uric acid (not to exceed periodically during
800 mg/day). Doses therapy especially during
>300 mg/day should be the first few months.
given in divided doses.
Maintenance dose- 100- • Instruct patient to take
200mg 2-3 times daily. allopurinol as directed.
Management of Take missed doses as
Secondary soon as remembered.
Hyperuricemia:
• PO (Adults and • Instruct patient to
Children >10 yr): 600- continue taking
800 mg/day in 2-3 allopurinol along with an
divided doses starting 1- NSAID or colchicine
2 days before during an acute attack of
chemotherapy or gout.
radiation.
• PO (Children 6-10 • Instruct patient to
yr): 10 mg/kg/day in 2-3 report skin rash, blood in
divided doses urine or influenza
(maximum 800 mg/day) symptoms.
or 300 mg daily in 2-3
divided doses. • Advise patient that
large amounts of alcohol
• PO (Children <6 yr): increase uric acid
10 mg/kg/day in 2-3 concentrations and may
divided doses decrease the
(maximum 800 mg/day) effectiveness of
or 150 mg daily in 3 allopurinol.
divided doses.
• Emphasize the
• IV (Adults and importance of follow-up
Children > 10 yr): 200- exams to monitor
400 mg/m2/day (up to effectiveness and side
600 mg/day) as a single effects.
daily dose or in divided
doses every 8-24 hr. Evaluation/ Desired
Outcomes:
• IV (Children <10 yr): • Decreased serum and
200 mg/m2/day initially urinary uric acid level.
as a single dose daily or May take 2-6 wks to
in divided doses q 8-24 observe clinical
hr (maximum dose 600 improvement in patients
mg/day). treated for gout.
 DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATIONS SIDE EFFECTS/ NURSING
ACTION ADVERSE EFFECTS CONSIDERATIONS
GENERIC NAME: Binds to the toxic Prevention of Hypersensitivity to mesna CNS: Dizziness, • Monitor for
mesna metabolites of ifosamide ifosfamide-induced or other thiol (rubber) drowsiness, headache; development of
in the kidneys. hemorrhagic cystitis. compounds. GI: anorexia, diarrhea, hemorrhagic cystitis in
BRAND NAME: nausea, unpleasant taste, patients receiving
Mesnex Therapeutic effects: Unlabeled uses: May vomiting; ifosfamide.
Prevents hemorrhagic also prevent Derm: flushing; Lab Test
AVAILABLE FORM: cystitic from ifosfamide. hemorrhagic cystitis Local: injection site Considerations: may
Tablets: 400 mg from cyclophosphamide. reactions; cause a false positive
Injection: 100 mg/ml in Misc: flu-like result when testing
2-, 4-, and 10-ml symptoms. urinary ketones.
ampules
In combination with: • Inform patient that
Ifosfamide (in a kit). unpleasant taste may
occur during
DOSAGES: administration.
IV (Adults): Give a
dose of mesna equal to •Advise patient to notify
20% of the ifisfamide health care professional
dose at the same time as if nausea, vomiting or
ifosfamide and 4-8 hr diarrhea persists or is
after. severe.

PO, IV (Adults): Give a

dose of IV mesna equal Evaluation/ Desired
to 20% of the ifosfamide Outcomes:
dose at the same time as • Prevention of
ifosfamide; then give PO hemorrhagic cystitis
mesna equal to 40% of associated with
the ifosfamide dose 2 ifosfamide therapy.
and 6 hours after
ifosfamide.
 Antineoplastic
Adjunctive Therapy