DRUGS

(ALKYLATIN
G)
CHLORAMBU
CIL
Brand Name:
Leukeran

Dosage:
0.1 to 0.2
mg/kg body
weight daily

MECHANISM
OF ACTION

INDICATIO
N

CONTRAINDICA
TION

LEUKERAN
(chlorambucil
) was first
synthesized
by Everett et
al. It is a
bifunctional
alkylating
agent of the
nitrogen
mustard type
that has been
found active
against
selected
human
neoplastic
diseases.
Chlorambucil
is known
chemically as
4-[bis(2chlorethyl)am
ino]benzeneb
utanoic acid

LEUKERAN
(chlorambu
cil) is
indicated in
the
treatment
of chronic
lymphatic
(lymphocyti
c)
leukemia,
malignant
lymphomas
including
lymphosarc
oma, giant
follicular
lymphoma,
and
Hodgkin's
disease. It
is not
curative in
any of
these
disorders
but may
produce
clinically
useful
palliation.

Chlorambucil
should not be
used in patients
whose disease
has
demonstrated a
prior resistance
to the agent.
Patients who
have
demonstrated
hypersensitivity
to chlorambucil
should not be
given the drug.
There may be
crosshypersensitivity
(skin rash)
between
chlorambucil and
other alkylating
agents.

SIDE
EFFECTS/ADVE
RSE REACTION
Black, tarry
stools
bleeding gums
blood in the
urine or stools
chest pain
cough or
hoarseness,
accompanied by
fever or chills
fever or chills
lower back or
side pain,
accompanied by
fever or chills
painful or
difficult
urination,
accompanied by
fever or chills
pinpoint red
spots on the skin
shortness of
breath
sores, ulcers,

NURSING
IMPLICATIO
N
Because of its
carcinogenic
properties,
chlorambucil
should not be
given to
patients with
conditions
other than
chronic
lymphatic
leukemia or
malignant
lymphomas.
Convulsions,
infertility,
leukemia, and
secondary
malignancies
have been
observed
when
chlorambucil
was
employed in
the therapy
of malignant
and nonmalignant
diseases.

DRUGS
(ALKYLATING)

CYCLOPHOSPHAMI
DE
Brand Name:
Cytoxan

Dosage:
IV- 40 to 50 mg
kg/5days
Oral 1mg to 5mg
kg/day

MECHANI
SM OF
ACTION
Drugs that
act to
destroy
rapidly
dividing
cells; cellcycle
nonspecific
(drugs that
act at any
time during
the cell
cycle)

INDICATI
ON

CONTRAINDICAT
IONS

Leukemia,
lymphoma
s;many
solid
cancers(li
ke lung,
breast,
ovarian
CA);
multiple
myelomas
; can also
be used
for
refractory
rheumatoi
d arthritis
since it
can also
suppress
inflammat
ion

-Hypersensitivity
Cyclophosphamid
e is
contraindicated in
patients who have
a history of
severe
hypersensitivity
reactions to it,
any of its
metabolites, or to
other components
of the product.
Anaphylactic
reactions
including death
have been
reported with
cyclophosphamid
e. Possible crosssensitivity with
other alkylating
agents can occur.
-Urinary Outflow
Obstruction
Cyclophosphamid
e is
contraindicated in
patients with
urinary outflow

SIDE
EFFECTS/ADVE
RSE REACTION
Bone marrow
depression,
alopecia,
impotence and
sterility,
anorexia,
nausea/vomiting,
GI disturbance
(diarrhea/constip
ation),fatigue,
weight loss,
stomatitis,
rashes, dry skin,
vesicant action if
extravasation or
leakage of drug
from a vein into
the
extravascular
space occurs;
Hemorrhagic
cystitis,
hepatotoxicity,
cardiotoxicity(ver
y high doses)

NURSING
IMPLICATION
-

Closely
monitor
blood
counts
and
teach
client
safety
precauti
ons
concern
ing low
counts
Advise
client of
possible
hair loss
&
impoten
ce
Advise
good
oral
hygiene
to
prevent
stomatit
is
Watch
for

obstructio

DRUGS
(ALKYLATIN
G)

MECHANISM
OF ACTION
Ifosfamide has

INDICATIO
N
IFEX

CONTRAINDICA
TION
Continued use of

nausea
and
vomitin
g

SIDE EFFECTS/
ADVERSE
REACTION
an allergic

NURSING
IMPLICATION
-It is

IFOSFAMIDE
Brand name:
Ifex
Dosage:
1.2g m/2 per
day for 5
days

been shown to
require
metabolic
activation by
microsomal
liver enzymes
to produce
biologically
active
metabolites.
Activation
occurs by
hydroxylation at
the ring carbon
atom 4 to form
the unstable
intermediate 4hydroxyifosfami
de. This
metabolite
rapidly
degrades to the
stable urinary
metabolite 4ketoifosfamide.

(ifosfamide)
, used in
combination
with certain
other
approved
antineoplasti
c agents, is
indicated for
third line
chemothera
py of germ
cell
testicular
cancer. It
should be
used in
combination
with a
prophylactic
agent for
hemorrhagic
cystitis,
such as
mesna.

IFEX (ifosfamide)
is
contraindicated
in patients with
severely
depressed bone
marrow function.
IFEX (ifosfamide)
is also
contraindicated
in patients who
have
demonstrated a
previous
hypersensitivity
to it.

reaction
(shortness of
breath; closing of
your throat;
difficulty
breathing;
swelling of your
lips, face, or
tongue; or
hives);
blood in the
urine;
lower back or
side pain;
frequent, painful
or difficult
urination;
black or tarry
stools;
signs of infection
such as fever;
chills, or sore
throat;
extreme
sleepiness,
confusion,

recommended
that a
urinalysis
should be
obtained prior
to each dose
of IFEX
(ifosfamide)
-When IFEX
(ifosfamide) is
given in
combination
with other
chemotherape
utic agents,
severe
myelosuppress
ion is
frequently
observed.
Close
hematologic
monitoring is
recommended.
-Neurologic
manifestations
consisting of
somnolence,
confusion,
hallucinations

DRUGS
(ALKYLATIN
G)

BUSULFAN
Brand Name:
Myleran

Dosage:
Oral 4 to 8
mg/daily

MECHANISM
OF ACTION

INDICATION

CONTRAINDICA
TION

Busulfan is a
small, highly
lipophilic
molecule that
easily crosses
the blood brain
barrier.
Following
absorption,
32% and 47%
of busulfan are
bound to
plasma
proteins and
red blood cells,
respectively.

MYLERAN
(busulfan) is
indicated for
the palliative
treatment of
chronic
myelogenous
(myeloid,
myelocytic,
granulocytic)
leukemia.

MYLERAN is
contraindicated
in patients in
whom a
definitive
diagnosis of
chronic
myelogenous
leukemia has not
been firmly
established.
MYLERAN is
contraindicated
in patients who
have previously
suffered a
hypersensitivity
reaction to
busulfan or any
other component
of the
preparation.

SIDE
EFFECTS/ADV
ERSE
REACTION
Common side
effects include
darkening skin
or dry mouth.
The most
frequent,
serious, toxic
effect of
busulfan is
dose-related
myelosuppressi
on resulting in
leukopenia,
thrombocytope
nia, and
anemia.
Interstitial
pulmonary
fibrosis has
been reported
rarely, but it is
a clinically
significant
adverse effect

NURSING
IMPLICATION

The most
consistent,
dose-related
toxicity is bone
marrow
suppression.
This may be
manifest by
anemia,
leukopenia,
thrombocytope
nia, or any
combination of
these. It is
imperative that
patients be
instructed to
report promptly
the
development of
fever, sore
throat, signs of
local infection,
bleeding from
any site, or
symptoms
suggestive of
anemia. Any
one of these
findings may
indicate
busulfan
toxicity;

DRUGS
(ALKYLATIN
G)

CARBOPLATI
N
Brand Name:
Paraplatin
Dosage:
300 mg/m2
IV on day 1
every 4
weeks for 6
cycles

MECHANISM
OF ACTION

INDICATION

CONTRAINDICA
TION

Carboplatin,
like cisplatin,
produces
predominantly
interstrand
DNA crosslinks rather
than DNAprotein crosslinks. This
effect is
apparently
cell-cycle
nonspecific.
The aquation
of carboplatin,
which is
thought to
produce the
active species,
occurs at a
slower rate

PARAPLATIN
(carboplatin
aqueous
solution)
INJECTION is
indicated for
the initial
treatment of
advanced
ovarian
carcinoma in
established
combination
with other
approved
chemotherap
eutic agents.

PARAPLATIN
(carboplatin
aqueous
solution)
INJECTION is
contraindicated
in patients with a
history of severe
allergic reactions
to cisplatin or
other platinumcontaining
compounds.
PARAPLATIN
(carboplatin)
should not be
employed in
patients with
severe bone
marrow
depression or

SIDE
EFFECTS/
ADVERSE
REACTION
Common side
effects of
Paraplatin
include nausea,
vomiting, loss
of appetite,
feeling tired,
hair loss, pain,
swelling and
redness where
the medicine
was injected.

NURSING
IMPLICATION

Needles or
intravenous
administration
sets containing
aluminum parts
that may come
in contact with
PARAPLATIN
(carboplatin
aqueous
solution)
INJECTION
should not be
used for the
preparation or
administration
of the drug.
Aluminum can
react with
carboplatin
causing
precipitate

than in the
case of
cisplatin.
Despite this
difference,

significant
bleeding.

formation and
loss of potency.