McKenna's Pharmacology for Nursing, 2e

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P A R T 2  Chemotherapeutic agents

TABLE 14.1

DRUGS IN FOCUS Alkylating agents

Drug name

Dosage/route

Usual indications

busulfan (Busulfex, Myleran)

Induction: 0.06 mg/kg/day PO up to 4 mg maximum Maintenance: 0.5–2 mg/day PO Injection: 0.8 mg/kg as a 2-hour IV infusion q 6 hours for 4 days via a central venous catheter

Treatment of chronic myelogenous leukaemia; not effective in blastic phase or without the Philadelphia chromosome Special considerations: dosing monitored by effects on bone marrow; always push fluids to decrease toxic renal effects; alopecia is common Palliative or initial treatment of returning ovarian cancer after prior chemotherapy; initial treatment of ovarian cancer with other chemotherapy; may be useful in several other cancers Special considerations: dose and timing determined by bone marrow response; alopecia is common Treatment of brain tumours, Hodgkin’s disease and multiple myelomas; available in implantable wafer form for treatment of glioblastoma Special considerations: dose determined by bone marrow toxicity; do not repeat for 6 weeks because of delayed toxicity; often used in combination therapy Palliative treatment of lymphomas and leukaemias including Hodgkin’s disease; being considered for the treatment of rheumatoid arthritis and other conditions Special considerations: toxic to liver and bone marrow; dosing based on bone marrow response Combination therapy for metastatic testicular or ovarian tumours, advanced bladder cancers Special considerations: neurotoxic, nephrotoxic, and can cause serious hypersensitivity reactions Treatment of lymphoma, myelomas, leukaemias and other cancers in combination with other drugs Special considerations: haemorrhagic cystitis is a potentially fatal side effect; alopecia is common Treatment of metastatic malignant melanoma and as second-line therapy with other drugs for the treatment of Hodgkin’s disease severe photosensitivity are common; extravasation can cause tissue necrosis or cellulitis—use extreme care, and monitor injection sites regularly Management of disseminated malignant melanoma, including cerebral metastases Special considerations: monitor liver function, blood counts prior to each administration Special considerations: bone marrow depression, GI toxicity,

carboplatin (Carbaccord)

400 mg/m 2 IV on day one every 4 weeks; reduce dose as needed based on blood counts and with renal impairment

carmustine (BiCNU, Gliadel)

150–200 mg/m 2 IV every 6 weeks as a single dose or divided daily injections; implanted into brain at time of surgery

0.1–0.2 mg/kg per day PO for 3–6 weeks; or 0.4 mg/kg PO every 2 weeks with maintenance dose of 0.03–0.1 mg/kg per day PO

chlorambucil (Leukeran)

cisplatin (generic)

50–100 mg/m 2 IV as single infusion q 3–4 weeks, or slow IV 15–20 mg/m 2 /day × 5 days every 3–4 weeks

cyclophosphamide (Cytoxan, Endoxan)

Induction: 40–50 mg/kg per day IV over 2–5 days, or 1–5 mg/kg per day PO Maintenance: 1–5 mg/kg per day PO, or 10–15 mg/kg IV q 7–10 days

dacarbazine (generic)

2 mg/kg per day IV for 10 days, repeat at 4-week intervals; or 250 mg/m 2 per day IV for 5 days in combination with other drugs

fotemustine (Muphoran)

100 mg/m 2 IV. Initially, three consecutive doses at weekly intervals, followed by one administration every 3 weeks