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Pharmacology · chapter 8 · Introduction to Cancer Therapy and Cancer Drugs

Chemotherapeutic Drugs

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. Principles of safe chemotherapy handling

    Principles of appropriate handling include, but are not limited to, storage of cytotoxic substances in impervious containers, double gloving (chemotherapy-rated gloves), compounding in a negative-pressure hood, and disposing of cytotoxic substances based on national standards and institutional policies.

  2. Vesicants must go intravenously

    For drugs that are vesicant s, which have the ability to cause necrosis if they extravasate, the intravenous route must be used. When a vesicant drug is being administered, slow administration in a rate/minute modality and vigilant assessment of the intravenous infusion site must be performed.

  3. Suspected compromised IV site

    If, for any reason, the nurse feels that an intravenous site could be compromised, the infusion should be immediately stopped and a new access obtained. Should an actual extravasation occur, the health care provider should be notified and any applicable protocols should be followed.

  4. Why normal fast-growing cells suffer

    Unfortunately, chemotherapy cannot tell the difference in cells that are abnormally dividing versus normally rapidly dividing; therefore, the client may experience effects on normal cells as well.

  5. Dangers of myelosuppression

    Without proper support during this myelosuppression, clients may experience sepsis, bleeding, and hypoxemia, which may result in increased mortality rates. Frequent monitoring of the client’s complete blood count is imperative.

  6. Infection without the usual signs

    With low white blood cell counts, normal immune responses to infection may be absent. For example, a client who has developed a local infection at a central venous access site would normally display warmth, redness, and edema at the site.

  7. Febrile neutropenia is the first priority

    When it occurs, febrile neutropenia should become first priority for assessment and intervention. The health care provider should be called immediately.

  8. Platelet thresholds for bleeding risk

    Platelet counts less than 50,000 per microliter require special precautions; below 20,000, the bleeding risk greatly increases, and the client may require platelet transfusions.

  9. Delayed nausea with cisplatin

    Some agents like cisplatin may cause delayed nausea and vomiting, defined as occurring more than 24 hours after administration. This may last 5 days or more.

  10. Mesna protects the bladder

    Cyclophosphamide and ifosfamide pose the risk of hemorrhagic cystitis, usually when high-dose therapy is used. To prevent this, a rescue agent, or uroprotectant, is given to prevent bladder irritation.

  11. Red urine is benign

    Many drugs in this class are red in color and can resultingly cause urine and other body fluids to turn red/orange. This is a benign side effect but is usually discussed with clients to avoid any panic.

  12. Anthracyclines and the heart

    These drugs are assigned maximum lifetime dose limits to aid in preventing debilitating chemotherapy-induced heart failure. Additionally, clients must have a left ventricular ejection fraction of at least 55% to receive these drugs.

  13. Vinca alkaloids never intrathecal

    However, close attention and safety measures (i.e., drug is always compounded in an IV bag for infusion) must be in place to ensure these are never administered via the intrathecal route. The drugs are fatal if administered intrathecally.

  14. Premedication before taxanes

    Adverse reactions include, most notably, hypersensitivity reactions. For this reason, clients will be premedicated, usually with corticosteroids, but may also receive diphenhydramine and a histamine-2 receptor antagonist to prevent these reactions from occurring.

Terms to know

pancytopenia
Myelosuppression affecting red blood cells, white blood cells, and platelets all together is referred to as pancytopenia.
nadir period
The nadir period, or lowest point of myelosuppression, differs for each specific chemotherapy.
Febrile neutropenia
Febrile neutropenia occurs when a client has an absolute neutrophil count that is less than 1.5 per microliter, accompanied by a body temperature above 100.4ºF.
Intracavitary administration
Intracavitary administration involves the infusion of a chemotherapeutic agent into a body cavity such as the bladder or abdomen.
Secondary cancers
Secondary cancers differ from recurrent cancer in that these tumors develop in different tissues than the original cancer.
cell-cycle nonspecific
Chemotherapy agents that cause cancer cell death in all phases of mitosis are referred to as cell-cycle nonspecific (CCNS), whereas those that are effective only in one phase of mitosis are called cell-cycle specific agents (CCS).

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

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Every question here, with the answer

  1. A client receiving chemotherapy has an absolute neutrophil count below 1.5 and a temperature of 101.2°F (38.4°C). What is the nurse's priority action?

    1. Call the health care provider immediately.
    2. Encourage oral fluids and document the finding.
    3. Place the client on bleeding precautions.
    4. Give acetaminophen and recheck the temperature in 4 hours.

    Answer: Call the health care provider immediately.

    Febrile neutropenia must become the first priority for assessment and intervention, and the provider should be called immediately so blood cultures and empiric antibiotics can start. Treating only the fever or waiting delays care and risks life-threatening sepsis; bleeding precautions address platelets, not neutrophils.

  2. A client with severe neutropenia has a central venous catheter. The site looks normal, with no redness, warmth or swelling. How should the nurse interpret this?

    1. The usual signs of infection may be absent because of the low white blood cell count.
    2. Infection at the site is ruled out.
    3. Neutropenia makes local infection impossible.
    4. The catheter can remain without further assessment.

    Answer: The usual signs of infection may be absent because of the low white blood cell count.

    With low white blood cell counts, normal immune responses may be absent, so a neutropenic client with a site infection may not show warmth, redness, or edema. A normal-looking site does not rule out infection, and vigilant assessment remains a priority.

  3. A nurse is teaching a client how to prevent infection during chemotherapy. Which instructions should the nurse include? Select all that apply.

    1. Cook eggs, meats, and seafood thoroughly.
    2. Wear gloves when gardening.
    3. Eat plenty of raw fruits and vegetables.
    4. Avoid cleaning the cat litter box.
    5. Report a temperature greater than 100.4°F (38°C).

    Answer: Cook eggs, meats, and seafood thoroughly., Wear gloves when gardening., Avoid cleaning the cat litter box., Report a temperature greater than 100.4°F (38°C).

    The client should garden with gloves, cook eggs, meat and seafood thoroughly, avoid cat litter boxes, and report a temperature above 100.4°F. Raw fruits and vegetables should be avoided because they raise the risk of foodborne illness.

  4. During a peripheral infusion of a vesicant chemotherapy drug, the nurse suspects the IV site may be compromised. What should the nurse do?

    1. Finish the dose, then change the site.
    2. Slow the infusion and reassess in 30 minutes.
    3. Stop the infusion immediately and obtain a new access.
    4. Flush the line with saline and continue.

    Answer: Stop the infusion immediately and obtain a new access.

    If the nurse feels an IV site could be compromised during a vesicant infusion, the infusion should be stopped immediately and a new access obtained, because vesicants cause necrosis if they extravasate. Slowing, flushing or finishing the dose keeps drug going into possibly damaged tissue.

  5. A client is scheduled for doxorubicin. Which finding in the chart should the nurse report before the drug is given?

    1. Red-orange urine after the previous dose
    2. Hair thinning since the last cycle
    3. Mild fatigue
    4. Left ventricular ejection fraction of 45%

    Answer: Left ventricular ejection fraction of 45%

    Clients must have a left ventricular ejection fraction of at least 55% to receive anthracyclines, because of the risk of chemotherapy-induced heart failure. Red urine is a benign effect, and alopecia and fatigue are expected side effects, not contraindications.

  6. A client is receiving vincristine. Which findings should the nurse assess for and report as adverse effects of this plant alkaloid? Select all that apply.

    1. Hemorrhagic cystitis
    2. Decreased bowel movements and abdominal distension
    3. Hearing loss
    4. Numbness and tingling in the feet
    5. Red-orange urine

    Answer: Decreased bowel movements and abdominal distension, Hearing loss, Numbness and tingling in the feet

    Plant alkaloids decrease nerve function and can cause hearing loss, neuropathies, and severe constipation that may progress to paralytic ileus. Red urine is linked to anthracyclines, and hemorrhagic cystitis to cyclophosphamide and ifosfamide.

Where every quote comes from

Section 8.2 Chemotherapeutic Drugs of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.