McKenna's Pharmacology for Nursing, 2e

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P A R T 2  Chemotherapeutic agents

TABLE 14.2

DRUGS IN FOCUS Antimetabolites (continued)

Drug name

Dosage/route

Usual indications

Dose varies with route and disease being treated; 15–30 mg/day PO or IM is common

Treatment of leukaemias, psoriasis, rheumatoid arthritis and choriocarcinomas Special considerations: hypersensitivity reactions can be severe; liver toxicity and GI complications are common; monitor for bone marrow suppression and increased susceptibility to infections; dose pack available for the oral treatment of psoriasis and rheumatoid arthritis Treatment of malignant mesothelioma in people whose disease is unresectable or who are not candidates for surgery; locally advanced or metastatic non–small cell lung cancer as a single agent after other chemotherapy Special considerations: pretreat with corticosteroids, folic acid and vitamin B12; monitor for bone marrow suppression and GI effects Palliative treatment for advanced colorectal cancer Special considerations: GI and haematologic toxicity; full blood count prior to each treatment Remission induction and maintenance of acute leukaemias alone or as part of combination therapy Special considerations: bone marrow suppression, GI toxicity, miscarriage and birth defects have been reported; monitor bone marrow status to determine dose and redosing; ensure that the person is well hydrated during therapy to minimise hyperuricaemia—person may respond to allopurinol and urine alkalinisation

methotrexate (Methoblastin)

pemetrexed (Alimta)

500 mg/m 2 IV over 10 minutes on day one with 75 mg/m 2 cisplatin IV over 2 hours; repeat cycle every 21 days

raltitrexed (Tomudex)

Dosage: 3 mg/m 2 IV over 15 minutes; repeated q 3 weeks

thioguanine (Lanvis)

2 mg/kg per day PO for 4 weeks; then dose may be increased if tolerated well

Antimetabolites inhibit DNA synthesis

G 2

S

Mitotic inhibitors prevent mitosis

M

Phases of cell cycle

G 0

G 1

FIGURE 14.5  Sites of action of cell cycle–specific antineoplastic agents.