Pharmacologic Management

Bleomycin
Brand names: Blenoxane
Classifications: ANTINEOPLASTIC, ANTIBIOTIC; GLYCOPEPTIDE
Pregnancy Category: D
Action and Therapeutic Effect: Inhibits synthesis of DNA, RNA, protein; derived from Streptom ces verticillus; phase specific to
the G2 and M phases; a nonvesicant, sclerosing agent

Indications:

Cancer of head, neck, penis, cervix, vulva of squamous cell origin; Hodgkins/non-Hodgkins disease; testicular
carcinoma; as a sclerosing agent for malignant pleural effusion
Contraindications: Pregnancy (D), breastfeeding, hypersensitivity, prior idiosyncratic reaction

Route and Dosage: Adult and child (unlabeled): IM/IV/ SUBCUT #2 units for first 2 doses followed by 24 hr of observation
Adult and child: SUBCUT/IV/IM 0.25- 0.5 units/kg 1-2 3/wk or 10-20 units/ m2, then 1 unit/day or 5 units/wk; may also
be given by CONT INF; do not exceed total dose of 400 units during life- time
Adverse Effects: CNS: Pain at tumor site, headache, confusionCV: MI, stroke GI: Nausea, vomiting, anorexia, stomatitis, weight
loss, ulceration of mouth, lipsGU: Hemolytic-uremic syndrome IDIOSYNCRATIC REACTION: Hypotension, confusion,
fever, chills, wheezing INTEG: Rash, hyperkeratosis, nail changes, alopecia, pruritus, acne, striae, peeling,
hyperpigmentation, phlebitis RESP: Fibrosis, pneumonitis, wheezing, pulmonary toxicity SYST: Anaphylaxis, radiation
recall, Raynauds phenomenon
Interactions: Avoid live virus vaccines concurrently Increase: toxicityother antineoplastics, radiation therapy, general anesthesia,
filgrastim, sargramostim Decrease: serum phenytoin levelsphenytoin, fosphenytoin
Pharmacokinetics: Half-life 2 hr; when CCr is .35 ml/min, half-life is increased with lower clearance; metabolized in liver; 50%
excreted in urine (unchanged)
Nursing Implications: IM test dose in patients with lymphoma of 1-2 units before 1st 2 doses
Temp; fever may indicate beginning infection
Renal status: serum creatinine/BUN; CBC
Effects of alopecia, skin color alterations on body image; discuss feelings about body changes
Buccal cavity q8hr for dryness, sores, ulceration, white patches, oral pain, bleeding, dysphagia
Local irritation, pain, burning, discoloration at inj site
Storage for 2 wk after reconstituting if refrigerated or for 24 hr at room temp; discard unused portions