Drug Name Generic Name: Fluorouracil Brand Name: Adrucil, Carac, Efudex and Fluoroplex

Action Fluorouracil is part of a group of chemotherapy drugs known as the anti metabolites. Anti metabolites are similar to normal body molecules but they have a slightly different structure. These differences mean that anti metabolites stop cells working properly. They stop cells making and repairing DNA. Cancer cells need to make and repair DNA in order to grow and multiply. Anti metabolites also stop normal cells working properly.

Side effect Common side effects: Increased risk of getting an infection from a drop in white blood cells - it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery Tiredness and breathlessness due to a drop in red blood cells (anaemia) - you may need a blood transfusion Bruising more easily due to a drop in platelets -

Adverse reaction Stomatitis and esophagopharyngitis (which may lead to sloughing and ulceration), diarrhea, anorexia, nausea and emesis are commonly seen during therapy. Leukopenia usually follows every course of adequate therapy with fluorouracil. The lowest white blood cell counts are commonly observed between the 9 th and 14th days after the first course of treatment, although uncommonly the maximal depression may be delayed for as long as 20 days. By the 30th day the count has usually

Contraindication Leucopenia, thrombocytopenia, advanced liver insufficiency, pregnancy.

Nursing Management Monitor vital signs before and frequently during therapy Assess mucous membranes, number and consistency of stools, and frequency of vomiting. Assess for signs of infection (fever, chills, sore throat, cough, hoarseness, pain in lower back or side, difficult or painful urination). Assess for bleeding (bleeding gums; bruising; petechiae; and guaiac test stools, urine, and emesis). Avoid IM injections and taking rectal temperatures. Apply pressure to venipuncture sites for 10 min. Notify health care professional if symptoms of toxicity (stomatitis or esophagopharyngitis, uncontrollable vomiting, diarrhea, GI bleeding, myocardial ischemia, leukocyte count <3500/mm3, platelet count <100,000/mm3, or hemorrhage from any site) occur; drug will need to be discontinued. May be reinitiated at a lower dose

This is why you get side effects.

you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia) Other common side effects include
Tiredness

returned to the normal range. Alopecia and dermatitis may be seen in a substantial number of cases. The dermatitis most often seen is a pruritic maculopapular rash usually appearing on the extremities and less frequently on the trunk. It is generally reversible and usually responsive to symptomatic treatment. Other adverse reactions are: Hematologic: pancytopenia, thrombocytopenia, agranulocytosis,

when side effects have subsided Assess IV site frequently for inflammation or infiltration. Patient should notify nurse if pain or irritation at injection site occurs. May cause thrombophlebitis. If extravasation occurs, infusion must be stopped and restarted in another vein to avoid damage to subcut tissue. Report immediately. Standard treatment includes application of ice compresses Assess skin for palmar-plantar erythrodysesthesia (tingling of hands and feet followed by pain, erythema, and swelling) throughout therapy Monitor intake and output, appetite, and nutritional intake. GI effects usually occur on 4th day of therapy. Adjusting diet as tolerated may help maintain fluid and electrolyte balance and nutritional status

(fatigue) during and after treatment most people find their energy levels are back to normal from 6 months to a year after their treatment finishes

Feeling or being

sick, which is usually mild Mouth sores and ulcers Diarrhoea - you should drink plenty of fluids. If the diarrhoea becomes severe or continues you could get dehydrated so tell your doctor or nurse This drug may have a harmful effect on a baby developing in the womb. It is not advisable to become pregnant or father a child while having chemotherapy. It is important to talk to your doctor about contraception

anemia. Cardiovascular: myocardial ischemia, angina. Gastrointestinal: gastrointestinal ulceration and bleeding. Allergic Reactions: anaphylaxis and generalized allergic reactions. Neurologic: acute cerebellar syndrome (which may persist following discontinuance of treatment), nystagmus, headache. Dermatologic: dry skin; fissuring; photosensitivity, as

Monitor patient for cerebellar dysfunction (weakness, ataxia, dizziness). This may persist after discontinuation of therapy Topical Inspect involved skin before and throughout therapy Lab Test Considerations May cause in plasma albumin Monitor hepatic (AST, ALT, LDH, and serum bilirubin), renal, and hematologic (hematocrit, hemoglobin, leukocyte, platelet count) functions before and periodically during therapy. Monitor CBC daily during IV therapy. Report WBC of <3500/mm3 or platelets <100,000/mm3 immediately; they are criteria for discontinuation. Nadir of leukopenia usually occurs in 914 days, with recovery by day 30. May also cause

before having the treatment Occasional side effects:

and ridged nails

skin to sunlight - you should not use sunbeds or sit in the sun if having fluorouracil. Cover up or use a sun block Rashes, which may be itchy Watery eyes from increased production of tears Gritty eyes and blurred vision Loss of appetite Brown marking on the skin

manifested by erythema or increased pigmentation of the skin; vein pigmentation; palmar-plantar erythrodysesthesia syndrome, as manifested by tingling of the hands and feet followed by pain, erythema and swelling. Ophthalmic: lacrimal duct stenosis, visual changes, lacrimation, photophobia. Psychiatric: disorientation, confusion, euphoria. Miscellaneous: thrombophlebitis,

thrombocytopenia May cause in urine excretion of 5-hydroxyindoleacetic acid (5HIAA)

following the line of the vein where fluorouracil has been injected Continuous infusion of fluorouracil can occasionally cause soreness, redness and peeling on the palms of the hands and soles of the feet (palmar plantar syndrome) which may cause tingling, numbness, pain and dryness. Rare Side effects:
Total hair loss Darkened skin Heart problems -

epistaxis, nail changes (including loss of nails).

such as angina,

heart failure or a heart attack Confusion or unsteadiness Women may stop having periods (amenorrhoea) this may only be temporary Loss of fertility you may not be able to get pregnant or father a child after treatment with this drug. It is important to talk to your doctor about your fertility before starting treatment http://www.cancerhelp.org.uk/about-cancer/treatment/cancer-drugs/fluorouracil Drug Name Action Side effect Adverse reaction Generic Name: It is an Common side effects: diarrhea, nausea, mercaptopurine immunosuppresive vomiting, loss of drug. appetite, fatigue, Increased risk of

Contraindication PURINETHOL should not be used in patients whose disease

Nursing Management

Brand name: Purinethol

6-MP ribonucleotide inhibits purine nucleotide synthesis and metabolism. This alters the synthesis and function of RNA and DNA. Mercaptopurine interferes with nucleotide interconversion and glycoprotein synthesis.

getting an infection from a drop in white blood cells it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery. Tiredness and breathlessness due to a drop in red blood cells (anaemia) - you may need a blood transfusion Bruising more easily due to a drop in platelets you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or

stomach/abdominal pain, weakness, skin rash, darkening of the skin, or hair loss Serious adverse reactions: mouth sores, fever, sore throat, easy bruising or bleeding, pinpoint red spots on the skin, yellowing of eyes or skin, dark urine, painful or difficult urination. Unlikely but serious side effects: black or tarry stools (melena), bloody stools, and bloody urine

has demonstrated prior resistance to this drug. In animals and humans, there is usually complete cross-resistance between mercaptopurine and thioguanine. PURINETHOL should not be used in patients who have a hypersensitivity to mercaptopurine or any component of the formulation.

bruises on your arms or legs (known as petechia). These effects on your bone marrow can begin about 7 days after each treatment and usually go back to normal after about 21 to 28 days. Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these side effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Fatigue (tiredness)during and after treatment most people find their energy levels are back to normal within 6 months to a year

Occasional side effects: Diarrhoea - drink plenty of fluid and tell your doctor if diarrhoea becomes severe, or continues for more than 3 days Feeling or being sick is usually well controlled with anti sickness drugs medications Sore mouth and throat Liver changes that are very mild and

unlikely to cause symptoms the liver will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your liver is working Loss of fertility we dont know exactly how this drug affects fertility so do talk with your doctor before starting treatment if this is important to you Women may stop having periods (amenorrhoea) but this may only be temporary Mercaptopurine may have a harmful effect on a developing baby

do talk to your doctor about contraception before having treatment if there is any chance that you or your partner could become pregnant Doctors do not recommend breast feeding while taking mercaptopurine in case the drug could be passed on in the milk An itchy rash Rare side effects: Hair loss is rare, but can begin 2 to 5 weeks after treatment starts Kidney changes that are mild and unlikely to cause symptoms may

occur they will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your kidneys are working Reddening of the skin in areas where you have had radiotherapy in the past, and the skin may get dry and flaky and feel sore and hot this goes away on its own but keep affected areas out of the sun Fever and chills http://en.wikipedia.org/wiki/Mercaptopurine#Precautions http://www.rxlist.com/purinethol-drug.htm Drug Name Action Side effect Adverse reaction Contraindication Generic Name: Paclitaxel treated cells Common Side effect: CNS: peripheral TAXOL is Paclitaxel have defects in mitotic neuropathy contraindicated in spindle assembly, patients who have a With this drug, many

Nursing Management Watch closely for hypersensitivity reaction.

Brand Name: Taxol, Onxol, Abraxane, ApoPaclitaxel, Aclixel, Asotax, Bristaxol, Cryoxet, and Praxel

chromosome segregation, and cell division. However, unlike other tubulin targeted drugs such as colchicine that inhibit microtubule assembly, paclitaxel stabilizes the microtubule polymer and protects it from disassembly. The inability of the chromosomes to achieve a metaphase spindle configuration leads to a mitotic block in which there is prolonged activation of the mitotic checkpoint with the subsequent triggering of apoptosis or slippage back into the G1-phase of the cell cycle without cell division.The ability of paclitaxel to inhibit spindle function is generally attributed to its suppression of

people have a temporary drop in the number of blood cells made by the bone marrow, leading to the following side effects Increased risk of getting an infection from a drop in white blood cells it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery Tiredness and breathlessness due to a drop in red blood cells (anaemia) you may need a blood

CV: hypotension, hypertension, syncope, abnormal ECG, bradycardia, venous thrombosis GI: nausea, vomiting, diarrhea, stomatitis, mucositis

history of hypersensitivity reactions to TAXOL or other drugs formulated in Cremophor EL (polyoxyethylated castor oil).

Monitor heart rate and blood pressure. Assess infusion site for local effects and extravasation, especially during prolonged infusion.

Monitor CBC, TAXOL should not be including platelet count. If neutropenia Hematologic: anemia, used in patients with solid tumors who have develops, monitor leukopenia, patient for infection; if baseline neutrophil neutropenia, thrombocytopenia counts of < 1500 bleeding, develops, watch for cells/mm or in thrombocytopenia signs and symptoms patients with AIDSof bleeding. related Kaposi's Musculoskeletal: sarcoma with baseline If patient has joint pain, myalgia neutrophil counts of < preexisting cardiac conduction 1000 cells/mm. Skin: alopecia, abnormality, maintain radiation reactions continuous cardiac monitoring. Other: infection, injection site reaction, hypersensitivity Instruct neutropenic reactions including patient to minimize anaphylaxis infection risk by avoiding crowds,

microtubule dynamics; but recent studies have demonstrated that suppression of dynamics occurs at concentrations lower than those needed to block mitosis. At the higher antimitotic concentrations, paclitaxel appears to act by suppressing microtubule detachment from centrosomes, a process that is normally activated during mitosis. The binding site for paclitaxel has been shown to reside on the beta-tubulin subunit.

transfusion Bruising more easily due to a drop in platelets you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia) Other common side effects include: Fatigue during and after treatment most people find their energy levels are back to normal from 6 months to a year after their treatment finishes Feeling or being sick is generally very well

plants, and fresh fruits and vegetables. Tell thrombocytopenic patient to avoid activities that can cause injury. Advise him to use soft toothbrush and electric razor. Advise patient to promptly report signs and symptoms of infection, bleeding, or peripheral neuropathy (such as numbness and tingling of feet and hands). Tell patient to promptly report pain or burning at injection site. Explain that temporary hair loss may occur. As appropriate, review all other significant and lifethreatening adverse

controlled with anti sickness injections and tablets, so tell your doctor or nurse if you are still having sickness they can give you other anti sickness medicines Hair loss (alopecia) may be complete and includes all body hair but is only temporary and your hair will grow back after your treatment ends a cold cap may help to stop you losing your hair, but is not suitable for all types of cancer, so talk to your doctor about whether it may help you Numbness or tingling in fingers and toes can cause difficulty with

reactions and interactions, especially those related to the drugs and tests mentioned above.

fiddly things such as doing up buttons this starts within a few days or weeks and usually goes within a few months of finishing treatment Aching joints (arthralgia) and muscles (myalgia) affects about 6 out of 10 people (60%) it may start a couple of days after treatment and last for about 5 days Mouth sores and ulcers Diarrhoea drink plenty of fluids and if this becomes severe or lasts more than a couple of days, tell your doctor as you could get dehydrated This drug may

harm a baby developing in the womb so it is not advisable to become pregnant or father a child when having paclitaxel talk to your doctor about contraception before you start treatment if there is any chance that you or your partner could become pregnant Mild allergic reactions occur in about 1 in 5 people (20%) this usually shows as a rash or a red face You should not breast feed while having this drug as it may come through in the breast milk Occasional side

effects: Some people have the following side effects An immediate severe allergic reaction doctors usually give steroids and other medicines routinely to try to stop this happening Low blood pressure Slowing down of the heart rate (bradycardia) Abdominal pain Temporary taste alterations Headaches Liver changes that are very mild and you are unlikely to notice

any symptoms the liver will almost certainly go back to normal when treatment is finished, but your doctor will check your liver with blood tests Inflammation around the drip site if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse immediately Loss of fertility you may not be able to get pregnant or father a child after treatment with this drug so it is important to talk to your doctor before starting treatment if having a baby is important to you

Women may stop having periods (amenorrhoea) but this may only be temporary

http://en.wikipedia.org/wiki/Paclitaxel http://www.cancerhelp.org.uk/about-cancer/treatment/cancer-drugs/paclitaxel#common http://www.rxlist.com/taxol-drug.htm http://medical-dictionary.thefreedictionary.com/paclitaxel

Drug Name Generic Name: Fentanyl Brand Name: Abstral, Actiq,

Action Fentanyl provides most of its effects typical of other opioids (especially analgesia, euphoria,

Side effect Common side effects

Adverse reaction Fentanyl's major side effects include Many people have one diarrhea, nausea, constipation, dry or more of the following side effects mouth, somnolence,

Contraindication Contraindicated in the presence of hypersensitivity to narcotics, diarrhea caused by

Nursing Management

Durogesic, Effentora, Instanyl

and respiratory depression) through its agonism of the opioid receptors. Its strong potency in relation to that of morphine is largely due to its high lipophilicity. Because of this, it can more easily penetrate the CNS.

from fentanyl. Constipation - to prevent this, try and drink at least 2 litres of fluid, eat at least 5 portions of fruit and vegetables a day, and ask your doctor if you should have a laxative. Contact your doctor if you have a change in your normal bowel movements for more than a few days Feeling or being sick usually wears off after a few days, but tell your doctor if it continues. You may need an anti sickness drug at first Drowsiness may be a problem at

confusion, asthenia (weakness), and sweating and, less frequently, abdominal pain, headache, fatigue, anorexia and weight loss, dizziness, nervousness, hallucinations, anxiety, depression, flu-like symptoms, dyspepsia (indigestion), dyspnea (shortness of breath), hypoventilation, apnea, and urinary retention. Fentanyl use has also been associated with aphasia.

poisoning, acute bronchial asthma, upper airway obstruction, pregnancy. Use caution in the presence of bradycardia, history of seizures, lactation.

http://en.wikipedia.org/wiki/Fentanyl#Mechanism_of_action http://www.cancerhelp.org.uk/about-cancer/treatment/cancer-drugs/fentanyl#common