BONE CANCER

is one of the most uncommon form of cancer that can affect any bone in the
body. It destroys healthy bone tissue and forms a malignant bone tumors.
DOXORUBICIN HYDROCHLORIDE
GN:ADRIAMYCIN
I:CYTOTOXIC ANTIBIOTIC WITH WIDE SPECTRUM OF ANTITUMOR ACTIVITY AND STRONG
IMMUNOSUPPRESSIVE PROPERTIES. INTERCALATES WITH PREFORMED DNA RESIDUES,
BLOCKING EFFECTIVE DNA AND RNA TRANSCRIPTION. A POTENT RADIOSENSITIZER CAPABLE
OF ENHANCING RADIATION REACTIONS. NO CLINICAL CROSS-RESISTANCE TO STANDARD
ANTINEOPLASTICS; THEREFORE, IT MAY BE ESPECIALLY EFFECTIVE IN PATIENTS WITH LESS
ADVANCED DISEASE.
D:ADULT: IV 6075 MG/M2 AS SINGLE DOSE AT 21 D INTERVALS OR 30 MG/M2 ON EACH
OF 3 CONSECUTIVE DAYS REPEATED EVERY 4 WK (MAX: TOTAL CUMULATIVE DOSE 500550
MG/M2)
CHILD: IV 3575 MG/M2 AS SINGLE DOSE, REPEAT AT 21-D INTERVAL, OR 2030 MG/M2
ONCE WEEKLY
CI:MYELOSUPPRESSION, IMPAIRED CARDIAC FUNCTION, OBSTRUCTIVE JAUNDICE, PREVIOUS
TREATMENT WITH COMPLETE CUMULATIVE DOSES OF DOXORUBICIN OR DAUNORUBICIN;
LACTATION. SAFE USE DURING PREGNANCY (CATEGORY D) IS NOT ESTABLISHED.
SP:IMPAIRED HEPATIC OR RENAL FUNCTION; PATIENTS WHO HAVE RECEIVED
CYCLOPHOSPHAMIDE OR PELVIC IRRADIATION OR RADIOTHERAPY TO AREAS
SURROUNDING HEART; HISTORY OF ATOPIC DERMATITIS.
AR:HYPERSENSITIVITY (RED FLARE AROUND INJECTION SITE, ERYTHEMA, SKIN RASH, PRURITUS,
ANGIOEDEMA, URTICARIA, EOSINOPHILIA, FEVER, CHILLS, ANAPHYLACTOID REACTION). CV:
SERIOUS, IRREVERSIBLE MYOCARDIAL TOXICITY WITH DELAYED CHF, VENTRICULAR
ARRHYTHMIAS, ACUTE LEFT VENTRICULAR FAILURE.
 NURSING MANAGEMENT
Stop infusion, remove IV needle, and notify physician promptly if patient complains of stinging or burning sensation at the injection
site.
Monitor any area of extravasation closely for 34 wk. If ulceration begins (usually 14 wk after extravasation), a plastic surgeon
should be consulted.
Begin a flow chart to establish baseline data. Include temperature, pulse, respiration, BP, body weight, laboratory values, and I&O
ratio and pattern.
Lab tests: Baseline and periodic hepatic function, renal function, CBC with differential throughout therapy.
Note: The nadir of leukopenia (an expected 1000/mm3) typically occurs 1014 d after single dose, with recovery occurring within
21 d.
Evaluate cardiac function (ECG) prior to initiation of therapy, at regular intervals, and at end of therapy.
Be alert to and report early signs of cardiotoxicity (see Appendix F). Acute life-threatening arrhythmias may occur within a few
hours of drug administration.
Report promptly objective signs of hepatic dysfunction (jaundice, dark urine, pruritus) or kidney dysfunction (altered I&O ratio and
pattern, local discomfort with voiding).
Promote fastidious oral hygiene, especially before and after meals. Stomatitis, generally maximal in second week of therapy,
frequently begins with a burning sensation accompanied by erythema of oral mucosa that may progress to ulceration and
dysphagia in 2 or 3 d.
Report signs of superinfection (see Appendix F) promptly; these may result from antibiotic therapy during leukopenic period.
Avoid rectal medications and use of rectal thermometer; rectal trauma is associated with bloody diarrhea resulting from an
antiblastic effect on rapidly growing intestinal mucosal cells.
TAMOXIFEN CITRATE
GN:NOLVADEX
I:PALLIATIVE TREATMENT OF ADVANCED BREAST CANCER IN
POSTMENOPAUSAL WOMEN, ADJUNCTIVELY WITH SURGERY IN
THE TREATMENT OF BREAST CARCINOMA WITH POSITIVE LYMPH
NODES.
D:ADULT PO 1020 MG 12 TIMES/D (MORNING AND
EVENING)
ADULT: PO 540 MG B.I.D. FOR 4 D
CI:ANTICOAGULANT THERAPY, PREGNANCY (CATEGORY D),
ESPECIALLY DURING FIRST TRIMESTER; PREEXISTING
ENDOMETRIAL HYPERPLASIA; INTRAMUSCULAR INJECTIONS IF
PLATELETS <50,000/MM3; HISTORY OF THROMBOEMBOLIC
DISEASE; LACTATION; CHILDREN.
SP:VISION DISTURBANCES; CATARACTS, VISUAL DISTURBANCE;
LEUKOPENIA, BONE MARROW SUPPRESSION;
THROMBOCYTOPENIA; HYPERCALCEMIA;
HYPERCHOLESTEROLEMIA, LIPID PROTEIN ABNORMALITIES.
AR:INCREASED BONE PAIN, AND TRANSIENT LOCAL DISEASE
FLAIR; LOSS OF HAIR, WEIGHT GAIN, SHORTNESS OF BREATH,
PHOTOSENSITIVITY, HOT FLASHES.
 NURSING MANAGEMENT

Monitor therapeutic effectiveness. An objective response may require 410 wk

of therapy, longer if there is bone metastasis.
Administer analgesics for pain relief as necessitated by bone and tumor pain or
local disease flair.Monitor
Reassure patient
carefully that
during this month
the first discomfort frequently
of therapy for S&S of signals a
good tumor response.spinal cord compression or ureteral obstruction in patients with
prostate cancer. Report immediately to physician.
Be aware that local swelling
Anticipate and marked
a transient worseningerythema
of symptomsover
(e.g., preexisting
bone pain) lesions or
the developmentduring
of new the lesions may
first weeks signalinsoft-tissue
of therapy patients with disease
prostate response to
tamoxifen. These symptoms
cancer. rapidly subside.
Lab tests: Assess CBC, including platelet counts, periodically. Transient
leukopenia and thrombocytopenia (50,000100,000/mm3) without hemorrhagic
tendency have been reported. Monitor serum calcium periodically.
ESTRADIOL
GN:ALORA
I:NATURAL OR SURGICAL MENOPAUSAL SYMPTOMS, KRAUROSIS VULVAE, ATROPHIC VAGINITIS, PRIMARY
OVARIAN FAILURE, FEMALE HYPOGONADISM, CASTRATION. USED ADJUNCTIVELY WITH DIET, CALCIUM, AND
PHYSICAL THERAPY TO PREVENT AND TREAT POSTMENOPAUSAL OSTEOPOROSIS; ALSO FOR PALLIATION IN
ADVANCED PROSTATIC CARCINOMA AND INOPERABLE METASTATIC BREAST CANCER IN WOMEN AT LEAST 5 Y
AFTER MENOPAUSE. COMBINED WITH PROGESTINS IN MANY ORAL CONTRACEPTIVE FORMULATIONS.
D:PO 0.452 MG/D IN A CYCLIC REGIMEN TOPICAL 24 G VAGINAL CREAM INTRAVAGINALLY ONCE/D FOR
12 WK, THEN 12 G/D FOR 12 WK, THEN 1 G 13 TIMES/WK; TRANSDERMAL PATCH ESTRADERM TWICE
WEEKLY; CLIMARA, FEMPATCH, MENOSTAR QWK IN A CYCLIC REGIMEN; ESTRASORB APPLY 1 PACKET TO THE
LEFT THIGH AND CALF AND 1 PACKET TO THE RIGHT THIGH AND CALF ONCE DAILY IN THE MORNING;
ESTROGEL APPLY 1.25 G (ONE-HALF APPLICATORFUL) TO ONE ARM EVERY DAY (USUALLY IN THE MORNING).
IM CYPIONATE 15 MG ONCE Q34WK; VALERATE 1025 MG ONCE Q4WK; ACETATE INSERT 1 VAGINAL RING
INTO THE UPPER THIRD OF THE VAGINAL VAULT. KEEP IN PLACE CONTINUOUSLY FOR 3 MO, THEN REMOVE.
CI:KNOWN OR SUSPECTED PREGNANCY (CATEGORY X); ESTROGENIC-DEPENDENT NEOPLASMS, BREAST
CANCER (EXCEPT IN SELECTED PATIENTS BEING TREATED FOR METASTATIC DISEASE). HISTORY OF
THROMBOEMBOLIC DISORDERS; ACTIVE ARTERIAL THROMBOSIS OR THROMBOPHLEBITIS; UNDIAGNOSED
ABNORMAL GENITAL BLEEDING; HISTORY OF CHOLESTATIC DISEASE; THYROID DYSFUNCTION; BLOOD
DYSCRASIAS.
AR:PAIN AND POSTINJECTION FLARE AT INJECTION SITE; STERILE ABSCESS; LEG CRAMPS, WEIGHT CHANGES.
HEMATOLOGIC: ACUTE INTERMITTENT PORPHYRIA.
NURSING MANAGEMENT

Monitor adverse GI effects. Nausea, frequently at breakfast time,

usually disappears after 1 or 2 wk of drug use.
Check BP on a regular basis in patients with cardiac or kidney
dysfunction or hypertension; monitored carefully.
Note: Severe hypercalcemia (>15 mg/dL) may be caused by
estradiol therapy in patients with breast cancer and bone
metastasis.
Interrupt estrogen treatment at least 4 wk before surgery
associated with a prolonged period of immobilization or vascular
complications.
CARBOPLATIN
GN:PARAPLATIN
I:MONOTHERAPY OR COMBINATION THERAPY FOR OVARIAN CANCER.
D:IV 360 MG/M2 ONCE Q4WK. MAY BE REPEATED WHEN NEUTROPHIL
COUNT IS AT LEAST 2000 MM3 AND PLATELET COUNT IS AT LEAST 100,000
MM3. IF NEUTROPHIL AND PLATELET COUNTS ARE LOWER, DOSE OF
CARBOPLATIN SHOULD BE REDUCED BY 5075% OF INITIAL DOSE.
ALTERNATIVELY, 400 MG/M2 AS A 24-H INFUSION FOR 2 CONSECUTIVE D
CAN BE USED
CI:HISTORY OF SEVERE REACTIONS TO CARBOPLATIN OR OTHER PLATINUM
COMPOUNDS, SEVERE BONE MARROW DEPRESSION; SIGNIFICANT
BLEEDING; IMPAIRED RENAL FUNCTION; PREGNANCY (CATEGORY D), AND
LACTATION
SP:USE WITH OTHER NEPHROTOXIC DRUGS.
AR: HYPERSENSITIVITY REACTIONS. GI: MILD TO MODERATE NAUSEA AND
VOMITING, ANOREXIA, HYPOGEUSIA, DYSGEUSIA, MUCOSITIS, DIARRHEA,
CONSTIPATION, ELEVATED LIVER ENZYMES. HEMATOLOGIC:
THROMBOCYTOPENIA, LEUKOPENIA, NEUTROPENIA, ANEMIA. METABOLIC:
MILD HYPONATREMIA, HYPOMAGNESEMIA, HYPOCALCEMIA, AND
HYPOKALEMIA. CNS: PERIPHERAL NEUROPATHY. SKIN: RASH, ALOPECIA.
SPECIAL SENSES: TINNITUS. UROGENITAL: NEPHROTOXICITY.
 NURSING MANAGEMENT
Monitor closely during first 15 min of infusion, since allergic reactions have occurred
within minutes of carboplatin administration.
Lab tests: Baseline and periodic CBC with differential, platelet count, Hgb and Hct.
Monitor periodically kidney function with creatinine clearance tests and serum
electrolytes.
Monitor results of peripheral blood counts. Median nadir occurs at day 21. Leukopenia,
neutropenia, and thrombocytopenia are dose related and may produce dose-limiting
toxicity.
Monitor for peripheral neuropathy (e.g., paresthesias), ototoxicity, and visual
disturbances.
Monitor serum electrolyte studies, because carboplatin has been associated with
decreases in sodium, potassium, calcium, and magnesium. Special precautions may be
warranted for patients on diuretic therapy.
HYDROXYUREA
GN:HYDREA, DROXIA
I:PALLIATIVE TREATMENT OF METASTATIC MELANOMA,
CHRONIC MYELOCYTIC LEUKEMIA; RECURRENT METASTATIC, OR
INOPERABLE OVARIAN CANCER. ALSO USED AS ADJUNCT TO X-
RAY THERAPY FOR TREATMENT OF ADVANCED PRIMARY
SQUAMOUS CELL (EPIDERMOID) CARCINOMA OF HEAD
(EXCLUDING LIP), NECK, LUNGS.
D:ADULT: PO 80 MG/KG Q3D OR 2030 MG/KG/D
ADULT: PO 15 MG/KG/D, MAY INCREASE BY 5 MG/KG/D (MAX:
OF 35 MG/KG/D OR UNTIL TOXICITY DEVELOPS
CI:PREGNANCY (CATEGORY D), LACTATION, CHILDREN,
MYELOSUPPRESSION.
SP:RECENT USE OF OTHER CYTOTOXIC DRUGS OR IRRADIATION;
RENAL DYSFUNCTION; OLDER ADULTS; HISTORY OF GOUT.
AR:HEADACHE, DIZZINESS, HALLUCINATIONS, CONVULSIONS. GI:
STOMATITIS, ANOREXIA, NAUSEA, VOMITING, DIARRHEA,
CONSTIPATION. HEMATOLOGIC: BONE MARROW SUPPRESSION
(LEUKOPENIA, ANEMIA, THROMBOCYTOPENIA), MEGALOBLASTIC
ERYTHROPOIESIS. SKIN: MACULOPAPULAR RASH, FACIAL
ERYTHEMA, POSTIRRADIATION ERYTHEMA. UROGENITAL: RENAL
TUBULAR DYSFUNCTION, ELEVATED BUN, SERUM, CREATININE
LEVELS, HYPERURICEMIA. BODY AS A WHOLE: FEVER, CHILLS,
MALAISE
 NURSING MANAGEMENT

Lab tests: Determine status of kidney, liver, and bone marrow

function before and periodically during therapy; monitor
hemoglobin, WBC, platelet counts at least once weekly.
Interrupt therapy if WBC drops to 2500/mm3 or platelets to
100,000/mm3.
Monitor I&O. Advise patients with high serum uric acid levels to
drink at least 1012 240 mL (8 oz) glasses of fluid daily to prevent
uric acid nephropathy.
Note: Patients with marked renal dysfunction may rapidly
develop visual and auditory hallucinations and hematologic
toxicity.
GOSERELIN ACETATE
GN:ZOLADEX
I:PROSTATE CANCER, BREAST CANCER. ENDOMETRIAL
THINNING AGENT PRIOR TO ENDOMETRIAL ABLATION FOR
DYSFUNCTIONAL UTERINE BLEEDING.
D:ADULT: SC 3.6 MG ONCE Q28D. 10.8 MG DEPOT Q12
WK
ADULT: SC 3.6 MG ONCE Q28D
CI:PREGNANCY (CATEGORY X); LACTATION; KNOWN
HYPERSENSITIVITY TO A LHRH; ENDOMETRIOSIS OR
ENDOMETRIAL THINNING; HYPERCALCEMIA
SP:URINARY TRACT OBSTRUCTION AND CHILDREN; FAMILY
HISTORY OF OSTEOPOROSIS; CONCURRENT USE WITH
ANTICONVULSANTS OR CORTICOSTEROIDS. SAFETY AND
EFFICACY IN CHILDREN <18 Y ARE NOT ESTABLISHED.
AR:HEADACHE, TUMOR FLARE. ENDOCRINE:
GYNECOMASTIA, BREAST SWELLING AND TENDERNESS,
POSTMENOPAUSAL SYMPTOMS (HOT FLASHES, VAGINAL
DRYNESS). GI: NAUSEA. UROGENITAL: VAGINAL SPOTTING,
BREAKTHROUGH BLEEDING, DECREASED LIBIDO,
IMPOTENCE. MUSCULOSKELETAL: BONE PAIN, BONE LOSS
 NURSING MANAGEMENT

Monitor carefully during the first month of therapy for S&S of spinal
cord compression or ureteral obstruction in patients with prostate
cancer. Report immediately to physician.
Anticipate a transient worsening of symptoms (e.g., bone pain)
during the first weeks of therapy in patients with prostate cancer.