McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 1 4  Antineoplastic agents

TABLE 14.2

DRUGS IN FOCUS Antimetabolites (continued)

Drug name

Dosage/route

Usual indications

clofarabine (Evoltra)

52 mg/m 2 by IV infusion over 2 hours daily for 5 days; repeat every 2–6 weeks, based on baseline function

Treatment of people 1–21 years of age with acute lymphocytic leukaemia (ALL) after at least two relapses on other regimens Special considerations: GI toxicity, bone marrow suppression and infection are common Treatment of acute lymphoblastic leukaemia, myeloid leukaemia and malignant lymphoma Special considerations: Test dose usually administered to check for hypersensitivity. Use with caution in people with renal or hepatic impairment Treatment of meningeal and myelocytic leukaemias; used in combination with other agents; lymphomatous meningitis; non-Hodgkin’s lymphoma in children Special considerations: GI toxicity and cytarabine syndrome (fever, myalgia, bone pain, chest pain, rash, conjunctivitis, Treatment of chronic lymphocytic leukaemia (CLL); unresponsive B cell CLL with no progress with at least one other treatment Special considerations: CNS toxicity can be severe; GI toxicity, respiratory complications, renal failure and a tumour lysis syndrome are common Palliative treatment of various GI cancers; topical treatment of basal cell carcinoma and actinic and solar keratoses Special considerations: GI toxicity, bone marrow suppression, alopecia and skin rash are common; avoid occlusive dressings with topical forms; wash hands thoroughly after coming in contact with drug Treatment of locally advanced or metastatic adenocarcinoma of the pancreas; given with cisplatin for the treatment of inoperable non–small cell lung cancer; metastatic breast cancer, ovarian cancer after failure of a platinum- based therapy Special considerations: can cause severe bone marrow depression, GI toxicity, pain, alopecia, interstitial pneumonitis Remission induction and maintenance therapy in acute leukaemias Special considerations: bone marrow toxicity and GI toxicity are common; hyperuricaemia is a true concern— ensure that the person is well hydrated during therapy and malaise) are common—this syndrome sometimes responds to corticosteroids; alopecia may occur

colaspase (Leunase)

50–200 KU/kg IV daily or every alternate day

cytarabine (generic)

200 mg/m 2 per day by continuous IV infusion for 5 days, repeat every 2 weeks; intrathecal use, 30 mg/m 2 every 4 days

fludarabine (Farine, Fludara)

25 mg/m 2 per day IV for 5 days; repeat every 28 days or 40 mg/m 2 /day PO for 5 days every 28 days

fluorouracil (Efudix)

12 mg/kg per day IV on days 1–3, then 6 mg/kg IV on days 5, 7, 9; Maintenance: 5–10 mg/kg once weekly

gemcitabine (Gemcite, Gemzar)

1000–1250 mg/m 2 IV over 30 minutes once a week; timing based on other therapies and response

mercaptopurine (Puri-Nethol)

2.5 mg/kg per day PO for 4 weeks; then re-evaluate

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