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Drug Name Action Indication Contraindication Side Effects Nursing
ResponsibilitiesCytarabine
Ara-C
Cytosar
Drug
Classification
Antimetabolite
Antineoplastic
Inhibits DNA
polymerase;
cell cycle phase
specific-S phase
(stage of DNA
synthesis) also
blocks
progression ofcells from G1 to
S.
- Induction and
maintenance of
remission in AML
(higher response rate in
children than in adults)
- Treatment of acute
lymphocytic leukemia
in adults and children;treatment of chronic
myelocytic leukemia
and erythroleukemia
- Intrathecal use:
Treatment of
meningeal leukemia
- Liposomal: Treatment
of lymphomatous
meningitis
- In combination
therapy: Treatment of
non-hodgkins
lymphoma in children
- Unlabeled uses:
Hodgkins lymphoma,
bone marrow
transplantation
- Contraindicated with
allergy to cytarabine,
active meningeal
infection (liposomal).
- Use cautiously with
hematopoietic
depression secondary to
radiation orchemotherapy; hepatic
impairment, pregnancy,
lactation, premature
infants
- CNS: Neuritis,
neural toxicity
- Dermatologic:Fever, rash,
urticarial,
freckling, skin
ulceration, pruritus,
conjunctivitis,alopecia.
- GI: Anorexia,
nausea, vomiting,
diarrhea, oral and
anal inflammation
or ulceration;
esophageal
ulcerations,
esophagitis,
abdominal pain,
hepatic impairment
(jaundice), acute
pancreatitis
- GU: Renal
impairment, urine
retention
- Hematologic:Bone marrow
depression,
hyperuricemia,
leukopenia,
thrombocytopenia,
anemia
- Local:Thromboplebitis,
cellulitis at
injection site- Other:Cytarabine
syndrome (fever
myalgia, bone pain,
occasional chest
pain,
maculopapular
rash, conjunctivitis,
malaise, which is
sometimes
responsive to
corticosteroids),
fever, rash,arachnoiditis
(liposomal
preparation)
- Evaluate
hematopoietic
status before and
frequently during
therapy.
- Use Elliotts B
solution for diluent
similar to CSF, forintrathecal use.
Administer with
4hr after
withdrawal from
vial; contains no
preservatives. Do
not use in-line
filters; inject
directly into CSF.
- Use caution to
avoid skin contact
with liposomal
form; use liposoma
form within 4hr of
withdrawing from
vial
- Make sure
antiermetics are
ordered before each
dose.
- Give comfort
measures for anal
inflammation,
headache, other
pain associated
with cytarabine
syndrome.
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Drug Name Action Indication Contraindication Side Effects Nursing
ResponsibilitiesFluorouracil
5-FU
Drug
Classification
Antimetabolite
Antineoplastic
Inhibits
thymidylate
synthetase,
leading to
inhibition of
DNA synthesis
and cell death.
- Parenteral: Palliative
management of
carcinoma of the colon,
rectum, breast,
stomach, pancreas in
selected patients
considered incurable by
surgery or other means- Topical treatment of
superficial basal cell
carcinoma
- Orphan drug uses: In
combination with
interferon alfa 2-a
recombinant for
esophageal and
advanced colorectal
carcinoma; with
leucovorin for colon or
rectum metastatic
adenocarcinnoma
- Unlabeled use:
Topical treatment of
condylomata acuminata
- Contraindicated with
allergy to 5-FU; poor
nutritional status; serious
infection; lactation.
- Use cautiously with
hematopoietic
depression secondary to
radiation orchemotherapy; impaired
liver function;
pregnancy.
Parenteral- CNS: Lethargy,
malaise, weakness,
euphoria, acute
cerebellar
syndrome,
photophobia,
lacrimanation,decreased vision,
nystagmus,
diplopia
- CV: Myocardial
ischemia, angina
- Dermatologic:Alopecia,
dermatitis,
maculopapular
rash,
photosensitivity,
nail changes
including nail loss,
dry skin, fissures
- GI: Anorexia,
nausea, vomiting,
diarrhea, cramps,
enteritis, duodenal
ulcer, duodenitis,
gastritis, glossitis,
stomatitis,
pharyngitis,
esophagopharyngiti
s
- Hematologic:
Leukopenia,
thrombocytopenia, elevations in
alkaline
phosphatase, serum
transaminase,
serum bilirubin,
lactate
dehydrogenase
- Other: Fever,
epistaxis
Topical
- Hematologic:Leukocytosis,
thrombocytopenia,toxic granulation ,
eosinophilia
- Local: Local
pain, pruritus,
hyperpigmentation,
irritation,
inflammation and
burning at the site
of application,
allergic contact
dermatitis,
scarring, soreness,
- Evaluate
hematologic status
before beginning
therapy and before
each dose.
- Discontinue drug
therapy at any sign
of toxicity(stomatitis,
esphagopharyngitis
, rapidly falling
WBC count,
intractable
vomiting, diarrhea,
GI ulceration and
bleeding,
thrombocytopenia,
haemorrhage);
consult with
physician.
- Arrange for
biopsies of skin
lesions to rule out
frank neoplasm
before beginning
topical therapy and
in all patients who
do not respond to
topical theray.
- Avoid occulusive
dressings with
topical application;
the incidence of
inflammatory
reactions inadjacent skin areas
is increased with
these dressings.
Use porous gauze
dressings for
cosmetic reasons.
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Drug Name Action Indication Contraindication Side Effects Nursing
ResponsibilitiesMercaptopurine
6-MP,
Purinethol
Drug
Classification
Antimetabolite
Antineoplastic
Tumor-
inhibiting
properties,
probably due to
interference
with purine
nucleotide
synthesis andhence with
RNA and DNA
synthesis,
leading to cell
death; cell-
cycle specific.
- Remission induction,
remission
consolidation, and
maintenance therapy
of acute leukemia (
lymphocytic,
myelogenous)
- Contraindicated with
allergy mercaptopurine,
prior resistance to
mercaptopurine (cross-
resistance with
thioguanine is frequent),
hematopoietic
depression, pregnancy,lactation
- Use cautiously with
impaired renal fuction
(slower elimination and
greater accumulation;
reduce dosage).
- GI: Hepato
toxicity; oral
lesions (resembling
thrush); nausea;
vomiting; anorexia,
pancreatitis
- Hematologic:
Bone marrowdepression,
immunosuppressio
n, hyperuricemia as
consequence of
atineoplastic effect
and cell lysis.
- Other: Drug
fever, cancer,
chromosomal
aberrations, rash,
hyperpigmentation
- Evaluate
hematopoietic
status before and
frequently during
therapy
- Round dose to
nearest 25mg
(tablets are scored)- Ensure that the
patient is well
hydrated before and
during therapy to
minimize adverse
effects of
hyperuricemia
- Caution the
patient bout the risk
of the serious fetal
harm while taking
this drug; advice
patient to use
barrier
contraceptives
- Administer as a
single daily dose.
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Drug Name Action Indication Contraindication Side Effects Nursing
ResponsibilitiesMethotrexate
Mexate
Drug
Classification
Antimetabolite
Antineoplastic
Inhibits
dihydrofolic
acid reductase,
leading to
inhibition of
DNA synthesisand inhibition
of cellular
replication;
selectively
affects the most
rapidly dividing
cells (neoplastic
and psoriatic
cells).
- Treatment of
gestational
choriocarcinoma,
chorioadenoma
destruens,
hydatidiform mole- Treatment and
prophylaxis of
meningeal leukemia,
mycosis fungoides
- Symptomatic
controlof severe,
recalcitrant disabling
psoriasis
- Management of
severe, active,
classical, or definite
rheumatoid arthritis
- High-dose regimenfollowed by
leucovorin rescue for
adjuvant therapy of
nonmetastatic
osteosarcoma (orphan
drug designation)
- Unlabeled uses: To
reduce corticosteroid
requirements in
patients with severe
corticosteroid-
dependent asthma; as a
maintenance regimen
for Wegenersagranulomatosis,
dermatomyositis,
relapsing-remitting
MS, myositis,
ulcerative colitis,
refractory Crohns
disease, uveitis, SLE,
psoriatic arthritis.
- Contraindicated with
pregnancy, lactation,
alcoholism, chronic liver
disease, immune
deficiencies, blood
dyscrasias,hypersensitivity to
methotrexate
- Use cautiously with
renal disease, infection,
peptic ulcer, ulcerative
colitis, debility
- CNS: Headache,
drowsiness, blurred
vision, aphasia,
hemiparesis,
paresis, seizures,
fatigue, malaise,dizziness
- Dermatologic:Erythematous
rashes, pruritus,
urticarial,
photosensitivity,
depigmentation,
alopecia,
ecchymosis,
teangietasia. Acne,
furunculosis
- GI: Ulcerative
stomatitis,gingivitis,
pharyngitis,
anorexia, nausea,
vomiting, diarrhea,
hematemesis,
melena, GI
ulceration and
bleeding, enteritis,
hepatic toxicity
- GU: Renal
failure, effects on
fertility (defective
oogenesis,
defectivespermatogenesis,
transient
oligospermia,
menstrual
dysfunction,
infertility, abortion,
fetal defects)
- Hematologic:
Severe bone
marrow
depression,increased
susceptibility toinfection
- Hypersensitivity:
Anaphylaxis
sudden death
- Respiratory:
Interstitial
pneumonitis,chronic interstitial
obstructive
pulmonary disease
- Other: Chills and
fever, metabolic
- Arrange for tests
to evaluate CBC,
urinalysis, renal
and liver function
tests, and chest x-
ray before therapy,during therapy, and
for several weeks
after therapy;
severe toxicity
could occur.
- Ensure that
patient is not
pregnant before
administering this
drug; counsel
patient about the
severe risks of fetal
abnormalitiesassociated with this
drug.
- Reconstitute
powder for
intrathecal use with
preservative-free
sterile sodium
chloride injection;
intended for one
dose only; discard
remainder. The
solution for
injection contains
benzyl alcohol andshould not be given
intrathecally.
- Arrange for an
antiemetic if nausea
and vomiting are
severe.
- Arrange for
adequate hydration
during therapy to
reduce the risk of
hyperuricemia.
- Do not administer
any othermedications
containing alcohol
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changes (diabetes,
osteoporosis),
cancer
7/31/2019 Cancer Drug Study
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Drug Name Action Indication Contraindication Side Effects Nursing
ResponsibilitiesThioguanine
TG
6-Thioguanine
Drug
Classification
Antimetabolite
Antineoplastic
Tumor-
inhibiting
properties,
probably due to
interference
with a numberof steps in the
synthesis and
use of purine
nucleotides,
which are
normally
incorporated
into DNA and
RNA.
- Remission induction,
remission
consolidation, and
maintenance therapy
of acute
nonlymphocyticleukemias-usually
used in combination
therapy
- Contraindicated with
allergy to thioguanine,
prior to resistance to
thioguanine or
mercaptopurine ,
hematopoietic,depression, pregnancy
(potential, mutagen and
teratogen, lactation)
- Use cautiously with
impaired renal fuction
- GI: Hepato
toxicity, nausea;
vomiting; anorexia,
stomatitis
- Hematologic:
Bone marrowsuppression,
immunosuppressio
n, hyperuricemia
due to rapid lysis
of malignant cells
- Other: Fever
weakness, cancer,
chromosomal
aberrations
- Evaluate
hematopoietic
status before and
frequently during
therapy
- Administer as asingle daily dose
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Drug Name Action Indication Contraindication Side Effects Nursing
ResponsibilitiesFludarabine
Phosphate
Fludara
Drug
Classification
Antimetabolite
Antineoplastic
Inhibits DNA
polymerase
alpha,
ribonucleotidereductase and
DNA primase,
which inhibits
DNA synthesis
and prevents
cell replication.
- Chronic lymphocytic
leukemia (CLL);
unresponsive B-cell
CLL or no progressduring treatment with
atleast one standard
regimen that contains
an alkalating drug
- Unlabeled uses: Non-
Hodgkins, lymphoma,
relapsing and
secondary AML, acute
lymphoblastic anemia
- Contraindicated with
allergy to fludarabine or
any component,
lactation, pregnancy,severe bone marrow
depression.
- Use cautiously with
renal impairment
- CNS: Weakness,
paresthesia,
headache, visual
disturbance,hearing loss, sleep
disorder,
depression, CNS
toxicity
- CV: Edema,
angina
- Dermatologic:Rash, pruritus,
seborrhea
- GI: Diarrhea,
anorexia, nausea,
vomiting,
stomatitis,esophagopharyngiti
s, GI bleeding,
mucositis
- GU: Dysuria,
urinary infection,
hematuria, renal
failure
- Hematologic:Bone marroe
toxicity,
autoimmune
haemolytic anemia
- Respiratory:Cough, pneumonia,
dyspnea, sinusitis,
URI, epistaxis,
bronchitis, hypoxia
-Other: Fever,
chills, fatigue,
infection, pain,
malaise,
diaphoresis,
haemorrhage,
myalgia, arthralgia,
osteoporosis, tumor
lysis syndrome
- Evaluate
hematopoietic
status before and
frequently duringtherapy
- Caution patient to
avoid pregnancy
while taking this
drug.
.
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Drug Name Action Indication Contraindication Side Effects Nursing
ResponsibilitiesPentostatin
Nipent
Drug
Classification
Antineoplastic
Antibiotic
A potent
transition state
inhibitor of
adenosine
deaminase
(ADA), thegreatest activity
of which is
found in cells of
the lymphoid
system. T-cells
have higher
ADA activity
than B-cells,
and T-cell
malignancies
have higher
activity than B-
cellmalignancies.
The
cytotoxicity that
results from
prevention of
catabolism of
adenosine or
deoxyadenosine
is thought to be
due to elevated
intracellular
levels of dATP,
which can block
DNA synthesisthrough
inhibition of
ribonucleotide
reductase.
Intracellular
activation
results in
incorporation
into DNA as a
false purine
base. An
additional
cytotoxic effectis related to its
incorporation
into RNA.
Cytotoxicity is
cell cycle
phase-specific
(S-phase).
- Treatment for adults
with alpha interferon
refractory hairy cell
leukemia, chronic
lymphocytic leukemia,
cutaneous T-celllymphoma, peripheral
T-cell lymphoma
- Contraindicated with
allergy to fludarabine or
any component,
lactation, pregnancy,
severe bone marrow
depression.- Use cautiously with
renal impairment
- CNS: Weakness,
paresthesia,
headache, visual
disturbance,
hearing loss, sleep
disorder,depression, CNS
toxicity
- CV: Edema,
angina
- Dermatologic:Rash, pruritus,
seborrhea
- GI: Diarrhea,
anorexia, nausea,
vomiting,
stomatitis,
esophagopharyngiti
s, GI bleeding,mucositis
- GU: Dysuria,
urinary infection,
hematuria, renal
failure
- Hematologic:Bone marroe
toxicity,
autoimmune
haemolytic anemia
- Respiratory:Cough, pneumonia,
dyspnea, sinusitis,
URI, epistaxis,bronchitis, hypoxia
-Other: Fever,
chills, fatigue,
infection, pain,
malaise,
diaphoresis,
haemorrhage,
myalgia, arthralgia,
osteoporosis, tumor
lysis syndrome
- Evaluate
hematopoietic
status before and
frequently during
therapy
- Caution patient toav oid pregnancy
while taking this
drug.
.
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Drug Name Action Indication Contraindication Side Effects Nursing
ResponsibilitiesVinorelbine
Tartrate
Navelbine
Drug
Classification
Antineoplastic
Mitotic
Inhibitor
Affects cell
energy
production
required for
mitosis; has
antimioticeffect, prevents
the formation of
microtubules
and leads to cell
death; cell cycle
specific.
- First-line treatment
Of ambulatory patients
with unresectable
advanced non-small-
cell lung cancer
- Treatment of stageIV non-small-cell lung
cancer alone or with
cisplastin
- Treatment of stage
III non-small-cell lung
cancer with cisplastin
- Unlabeled uses:
Breast cancer, ovarian
cancer, Hodgkins
lymphoma, desmoid
tumors and fibro
mitosis, advanced
Kaposis sarcoma
- Contraindicated with
allergy to vinca
alkaloids, pretreatment
granulocyte counts of
1,000 cells/mm3 or less,
pregnancy, lactation- Use cautiously with
liver disease.
- CNS: Numbness,
paresthesias (less
common than with
other vinca
alkaloids);
headache,weakness,
dizziness
- Dermatologic:Topical epilation
(loss of hair),
vesiculation of the
skin
- GI: Nausea,
vomiting,
stomatitis,
pharyngitis,
vesiculation of the
mouth, ileus,diarrhea,
constipation,
anorexia,
abdominal pain,
increased liver
enzyme
Hematologic:Granulocytopenia,
leukopenia
- Local: Local
cellulitis, phlebitis,
sloughing with
extravasation
Other: Myalgia,arthralgia
- Ensure that the
patient is not
pregnant before
use; advise patient
with to use barrier
contraceptives.- Consult with
physician if
antiemetic is
needed for severe
nausea and
vomiting
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Drug Name Action Indication Contraindication Side Effects Nursing
ResponsibilitiesVincrictine
Sulfate
Oncovin
Drug
Classification
Antineoplastic
Mitotic
Inhibitor
Mitotic
inhibitor:
Arrests mitotic
division at the
stage of
metaphase;exact
mechanism of
action unknown
- Acute leukemia
- Hodgkins
lymphoma, non-
hodgkins lymphoma,
rhabdomyosarcoma,
neuroblastoma,Wilms tumor as part
of combination
therapy
- Contraindicated with
allergy to vincristine,
leukopenia, acute
infection, pregnancy,
lactation, demyelinating
form of Charcot-marietooth syndrome.
- Use cautiously with
neuromuscular disease,
diabetes insipidus ,
heptic impairment.
- CNS: Ataxia,
cranial nerve
manifestations;
foot drop,
headache, seizures,
bladderneuropathy,
paresthesias,
sensory
impairment,
neuritic pain,
muscle wasting,
SIADH, optic
atrophy, transient
cortical blindness,
ptosis, diplopia,
photophobia
- GI: Constipation,
oral ulcerations,abdominal cramps,
diarrhea, vomiting,
intestinal necrosis -
GU: Acute uric
acid nephropathy,
polyuria, dysuria
- Hematologic:Lekopenia
- Local: Local
irritation, cellulitis
if extravasation
occurs
-Other: Weight
loss, loss of hairfever, death with
serious overdose
- Enssure that the
patient is not
pregnant before
Administering;
using barrier
contraceptives isadvised
- Tell patient to
avoid grapefruit
juice while being
treated with this
drug
- Arrange for wig
or suitable head
covering if hair loss
occurs; ensure thatpatients head is
covered in
extremes oftemperature.
- Monitor urine
output and serum
sodium; if SIADH
occurs with
physician, and
arrange for fluid
restriction and
perhaps a potent
diuretic.
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Drug Name Action Indication Contraindication Side Effects Nursing
ResponsibilitiesVincrictine
Sulfate
Oncovin
Drug
Classification
Antineoplastic
Mitotic
Inhibitor
Mitotic
inhibitor:
Arrests mitotic
division at the
stage of
metaphase;exact
mechanism of
action unknown
- Acute leukemia
- Hodgkins
lymphoma, non-
hodgkins lymphoma,
rhabdomyosarcoma,
neuroblastoma,Wilms tumor as part
of combination
therapy
- Contraindicated with
allergy to vincristine,
leukopenia, acute
infection, pregnancy,
lactation, demyelinating
form of Charcot-marietooth syndrome.
- Use cautiously with
neuromuscular disease,
diabetes insipidus ,
heptic impairment.
- CNS: Ataxia,
cranial nerve
manifestations;
foot drop,
headache, seizures,
bladderneuropathy,
paresthesias,
sensory
impairment,
neuritic pain,
muscle wasting,
SIADH, optic
atrophy, transient
cortical blindness,
ptosis, diplopia,
photophobia
- GI: Constipation,
oral ulcerations,abdominal cramps,
diarrhea, vomiting,
intestinal necrosis -
GU: Acute uric
acid nephropathy,
polyuria, dysuria
- Hematologic:Lekopenia
- Local: Local
irritation, cellulitis
if extravasation
occurs
-Other: Weight
loss, loss of hairfever, death with
serious overdose
- Ensure that the
patient is not
pregnant before
Administering;
using barrier
contraceptives isadvised
- Tell patient to
avoid grapefruit
juice while being
treated with this
drug
- Arrange for wig
or suitable head
covering if hair loss
occurs; ensure thatpatients head is
covered in
extremes oftemperature.
- Monitor urine
output and serum
sodium; if SIADH
occurs with
physician, and
arrange for fluid
restriction and
perhaps a potent
diuretic.
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Drug Name Action Indication Contraindication Side Effects Nursing
ResponsibilitiesVinblastine
sulfate
Velban
Drug
Classification
Antineoplastic
Mitotic
Inhibitor
Affects cell
energy
production
required for
mitosis, has
antimitoticeffect and
causes
abnormal
mitotic figures
- Palliative treatment
for lymphocytic
lymphoma, histiocytic
lymphoma,generalized, hodgkins
lymphoma (stage IIIand IV), mycosis
funcoides, advanced
testicular carcinoma,
Kaposis sarcoma,
letterer-Siwe disease.
- Treatment of
choriocarcinoma,
breast cancer
unresponsive to other
therapies.
- Hodgkins
lymphoma (advanced)
alone or incombination therapies
- Advanced testicular
germinal-cell cancers
alone or in
combination therapy.
- Contraindicated with
allergy to vinblastine,
leukopenia, acute
infection, pregnancy ,
lactation.
- Use cautiously withliver disease.
- CNS: Numbness,
paresthesias,
peripheral neuritis,
mental depression,
loss of deep
tendon reflexes,headache, seizures,
malaise, weakness,
dizziness
- Dermatologic:Topical epilation
(loss of hair),
vesiculation of the
skin
- GI: Nausea,
vomiting,
pharyngitis,
vesiculation of the
mouth, ileus,diarrhea,
constipation,
anorexia,
abdominal pain,
rectal bleeding,
hemorrhagic
enterocolitis
- GU: Aspermia
- Hematologic:Lekopenia
- Local: Local
cellulitis, phlebitis,
sloughing if
extravasationoccurs
-Other: Pain in
tumor site
- Ensure that the
patient is not
pregnant before
administering;
advise patients to
use contraceptivemeasures
- Consult with
physician if
antiemetic is
needed for severe
nausea and
vomiting.
- Check CBC
before each dose.
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Drug Name Action Indication Contraindication Side Effects Nursing
ResponsibilitiesEtoposide
(VP-16)
Etopophos
Toposar
VePesid
Drug
Classification
Antineoplastic
Mitotic
Inhibitor
G2-specific cell
toxic: Lyses
cells entering
mitosis; inhibits
cells from
enteringprophase;
inhibits DNA
synthesis,
leading to cell
death
- Palliative treatment
for lymphocytic
lymphoma, histiocytic
lymphoma,generalized, hodgkins
lymphoma (stage IIIand IV), mycosis
funcoides, advanced
testicular carcinoma,
Kaposis sarcoma,
letterer-Siwe disease.
- Treatment of
choriocarcinoma,
breast cancer
unresponsive to other
therapies.
- Hodgkins
lymphoma (advanced)
alone or incombination therapies
- Advanced testicular
germinal-cell cancers
alone or in
combination therapy.
- Contraindicated with
allergy to etoposide,
teniposide, Cremophor
El; pregnancy, lactation.
- Use cautiously with
marrow suspensiontransplants.
- CNS:Somnolence,
fatigue,peripheral
neuropathy
- CV: Hypotension
(after rapid IVadministration)
- Dermatologic:
Alopecia
- GI: Nausea,
vomiting,anorexia,
diarrhea, stomatitis,
after taste, liver
toxicity
- Hematologic:Myelotoxicity
- Hypersensitivity:Chills, fever,
tachycardia,anaphylactic-like
reaction, broncho
spasm and
dyspenea
-Other:Carcinogenesis
- Ensure that the
patient is not
pregnant before
administering;
advise patients to
use contraceptivemeasures
- Consult with
physician if
antiemetic is
needed for severe
nausea and
vomiting.
- Check CBC
before each dose.