Overview
This lecture reviews key chemotherapy drugs, their side effects, safety precautions, and priority nursing interventions for cancer patients, focusing on exam-critical points.
Chemotherapy Drug Basics
- Chemotherapy kills fast-growing cells, including healthy bone marrow, skin, and hair cells.
- Main side effects: hair loss, weak skin, and especially bone marrow suppression (suppressed blood cell production).
- Bone marrow suppression leads to anemia (low RBC), thrombocytopenia (low platelets), and leukopenia (low WBCs).
Doxorubicin
- Not to be confused with doxycycline (antibiotic).
- Causes bone marrow suppression; monitor for anemia, infection, and low platelets.
- Fever over 100.3°F (38°C) is a priority and may signal infection.
- May cause hyperglycemia due to decreased insulin sensitivity.
- Never use rectal thermometers (risk of bowel perforation in weak skin).
- Stop chemo and give ondansetron for severe nausea/vomiting.
Cisplatin
- Major risk: renal (kidney) toxicity; monitor input/output, creatinine (>1.3 bad), BUN (>20 bad), and urine output (<30mL/hr).
- Give antiemetics prophylactically, rinse mouth with saline before/after meals, increase fluids for three days, and manage fatigue.
- Memory trick: "pissplatin" for decreased urination.
Other Chemotherapy Agents
- Cyclophosphamide: bone marrow suppression—watch for infection and bleeding.
- Vincristine: does NOT cause bone marrow suppression; main risk is neuropathy.
Hormonal Therapy: Tamoxifen
- Estrogen modulator for breast and endometrial cancer.
- Main risks: heavy bleeding (report immediately), increased clot risk (embolism).
- Contraindicated in patients with history of DVT or PE.
- Hot flashes are expected and not reportable.
Colony Stimulating Factors & Immunotherapy
- Oprelvekin: increases platelets; watch for fluid retention, AFib, anaphylaxis.
- Filgrastim (Neupogen): boosts neutrophil count (not hemoglobin or platelets).
- Interferon: stimulates immune response; flu-like symptoms are expected.
Radiation & Brachytherapy
- External radiation irritates skin: avoid lotions, perfumes, creams, tape, and shaving; wash with hands, not washcloth.
- Brachytherapy (internal radioactive implant): strict safety—limit caregiver time, use dosimeter, stay >6 feet away, private room, no pregnant visitors or under-18s, lead apron for direct care.
- Key cancers: endometrial and cervical cancer; keep patients on bedrest, no touching implants.
Key Terms & Definitions
- Bone Marrow Suppression — Decrease in blood cell production, leading to anemia, infection, and bleeding.
- Thrombocytopenia — Low platelet count, increases bleeding risk.
- Leukopenia/Neutropenia — Low white blood cell count, increases infection risk.
- Immunocompromised — Reduced immune defense, high infection risk.
- Brachytherapy — Internal radiation treatment using implanted radioactive material.
- Antiemetic — Medication that prevents or relieves nausea and vomiting.
Action Items / Next Steps
- Memorize normal lab values: RBC 4.5–6 million, WBC 5,000–10,000, Platelets 150,000–400,000, Creatinine ≤1.3, BUN ≤20, urine output >30 mL/hr.
- Know key safety and priority actions for chemo, radiation, and brachytherapy.
- Review major side effects and interventions for doxorubicin, cisplatin, tamoxifen, vincristine, and cyclophosphamide.
- Be ready to answer exam questions on chemo complications and required nurse actions.