MECHANISM OF CONTRA-

DRUG NAME ROUTE/DOSAGE SIDE EFFECTS NURSING CONSIDERATIONS

ACTION INDICATIONS
ALKYLATING AGENTS
Altretamine The precise Hypersensitivity to Adult: Oral/ PO 260 CNS: Paresthesias, hyporeflexia, Lab tests: Monitor blood counts at least monthly and prior to each c
mechanism by which altretamine, severe bone mg/m2/d for 14 or 21 muscle weakness, peripheral therapy.
Brand Name: altretamine exerts its marrow depression, consecutive d in a 28-d numbness, ataxia, Parkinson-like
Hexalen cytotoxic effect is neurologic toxicity, cycle tremors
unknown although it is pregnancy (category D),
classified as an lactation. Perform a neurologic examination regularly; question patient about the p
alkylating anti- of: paresthesias, hypoesthesias, muscle weakness, peripheral numbness
neoplastic agent. GI: Nausea, vomiting decreased sensations, and alterations in mood or consciousness.
Through this
mechanism, the drug
is metabolized into
alkylating agents by Hematologic: Leukopenia, Withhold medication if neurologic symptoms fail to resolve with dose re
N-demethylation. thrombocytopenia Notify physician.
These alkylating
species consequently
damage tumor cells.
Urogenital: Slight increase in serum Monitor for nausea and vomiting, which are related to the cumulative
creatinine altretamine. After several weeks some patients develop tolerance to
effects. Antiemetics may be required to control GI distress.

Skin: Alopecia and eczema

Report symptoms indicative of neurotoxicity to physician (pare
hypoesthesias, muscle weakness, peripheral numbness, ataxia, de
sensations, and alterations in mood or consciousness).

Note: GI, hematologic, and neurologic adverse effects may be severe

breast feed while taking this drug.

Bendamustine Bendamustine TREANDA is Adult: 100 mg/m² Nausea, vomiting, diarrhea, tiredness, Monitor signs of leukopenia and neutropenia (fever, sore throat,
injection is used to contraindicated in patients administered intravenously weakness, mouth sores, constipation, infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or
Brand Name: treat chronic with a known over 30 minutes on Days 1 upset stomach, swelling in your hands weakness and fatigue that might be due to anemia. Report these sign
Treanda lymphocytic leukemia hypersensitivity (e.g., and 2 of a 28-day cycle, up or feet, headache, dizziness, physician or nursing staff immediately.
(CLL, cancer of white anaphylactic and to 6 cycles. drowsiness, loss of appetite, weight
blood cells) and anaphylactoid reactions) to loss, mild skin rash
indolent B-cell non- bendamustine.
Hodgkin's lymphoma
(NHL) in patients who
have already received
other treatments. It
interferes with the
growth of cancer cells,
which are eventually
destroyed by the
body.
Note: Dose modifications
for hematologic toxicity: for
Grade 3 or greater toxicity,
reduce the dose to 50
mg/m² on Days 1 and 2 of
each cycle; if Grade 3 or
greater toxicity recurs,
reduce the dose to 25
mg/m² on Days 1 and 2 of
each cycle.
Dose modifications for
non-hematologic toxicity:
for clinically significant
Grade 3 or greater toxicity,
reduce the dose to 50
mg/m² on Days 1 and 2 of
each cycle.
Be alert for signs of electrolyte imbalances that might indicate tum
syndrome. Signs include severe muscle weakness or paralysis due to in
plasma potassium (hyperkalemia), or muscle hyperexcitability and tetan
phosphate and calcium imbalances (hyperphosphatemia and hypoca
Notify physician or nursing staff immediately if these signs occur.
Monitor signs of allergic reactions and anaphylaxis, including pu
symptoms (tightness in the throat and chest, wheezing, cough, dyspnea
reactions (rash, pruritus, urticaria). Reactions may be especially prevale
or immediately after administration (infusion reactions). Notify phys
nursing staff immediately if these reactions occur.
For patients who are medically able to begin exercise, implement app
resistive exercises and aerobic training to maintain muscle strength and
capacity during cancer chemotherapy or to help restore functio
chemotherapy.
Advise patient to guard against infection (frequent hand washing, etc.) a
crowds and contact with persons with contagious diseases.
Advise patient that weakness and fatigue are likely, and may be
Implement assistive devices (walker, crutches, cane) and appropriat
precautions to guard against falls due to weakness.
Instruct patient to report other bothersome side effects, including se
prolonged cough, fever, skin reactions, or GI problems (nausea, v
diarrhea).