DRUG STUDY

LEUCOVORIN

Classification: Reduced folic acid. Leucovorin is used in combination with other

chemotherapy drugs to either enhance effectiveness, or as a "chemoprotectant."

Action

Leucovorin is a compound similar to folic acid, which is a necessary vitamin. Leucovorin

is not a chemotherapy drug itself, however it is used in addition to these chemotherapy

drugs to enhance anti-cancer effects (with fluorouracil) or to help prevent or lessen side

effects (with methotrexate). Leucovorin is also used by itself to treat certain anemia

problems when folic acid deficiency is present.

Indications:

In combination with fluorouracil to treat cancers such as; colon and rectal, head

and neck, esophageal, and other cancers of the gastrointestinal tract.

As an antidote to effects of certain chemotherapy drugs such as methotrexate.

Treatment of megaloblastic anemia when folic acid deficiency is present.

Leucovorin is also indicated for use in combination with 5-fluorouracil to prolong

survival in the palliative treatment of patients with advanced colorectal cancer.

Leucovorin should not be mixed in the same infusion as 5-fluorouracil because a

precipitate may form.

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Side Effects:

Allergic reaction: rash, itching, facial flushing. Rarely severe.

Nausea and vomiting (rare)

Nursing Considerations:

Instruct patient to drink at least two to three quarts of fluid every 24 hours, unless

contraindicated.

Instruct patient to get plenty of rest and maintain good nutrition

Advise patient to notify physician/health care team if he/she experiences

symptoms or side effects. They can prescribe medications and/or offer other

suggestions that are effective in managing such problems.

FLUOROURACIL ( 5-Fluorouracil, 5-FU)

Classification: 5-FU is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy

drug. This medication is classified as an "antimetabolite."

Action:

5-FU belongs to the category of chemotherapy called antimetabolites. Antimetabolites

are very similar to normal substances within the cell. When the cells incorporate these

substances into the cellular metabolism, they are unable to divide. Antimetabolites are

cell-cycle specific. They attack cells at very specific phases in the cycle.

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Indications:

Colon and rectal cancer.

Breast cancer.

Gastrointestinal cancers including: anal, esophageal, pancreas and gastric

(stomach).

Head and neck cancer

Hepatoma (liver cancer).

Ovarian cancer.

Side effects:

Diarrhea.

Nausea and possible occasional vomiting.

Mouth sores.

Poor appetite.

Watery eyes, sensitivity to light (photophobia) (see eye problems).

Taste changes, metallic taste in mouth during infusion.

Discoloration along vein through which the medication is given.

Low blood counts. Your white and red blood cells and platelets may temporarily

decrease. This can put you at increased risk for infection, anemia and/or bleeding.

Serious adverse reactions to 5-FU are; chest pain, EKG changes and increases in cardiac

enzymes - which may indicate problems with the heart. These symptoms are very rare

but increased for patients with a prior history of heart disease.

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Nursing Considerations:

Instruct patient to suck on ice chips 10-15minutes before and after IV injections

of 5-FU to reduce the incidence and severity of mouth sores.

Advise to observe good oral care and use soft toothbrush to help prevent mouth

sores.

Instruct to drink at least two to three quarts of fluid every 24 hours, unless

contraindicated.

Instruct patient to avoid sun exposure. Wear SPF 15 (or higher) sunblock and

protective clothing.

IRINOTECAN

Classification: Irinotecan is an anti-cancer ("antineoplastic" or "cytotoxic")

chemotherapy drug. This medication is classified as a "plant alkaloid" and

"topoisomerase I inhibitor."

Action:

Topoisomerase inhibitors (such as ironotecan) are drugs that interfere with the action of

topoisomerase enzymes (topoisomerase I and II). Topoisomerase enzymes control the

manipulation of the structure of DNA necessary for replication.

Indications:

Metastatic colon or rectal cancer

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Administration:

This medication is given by infusion through a vein (intravenously, IV).

There is no pill form of this medication.

Note: Irinotecan is an irritant. An irritant is a chemical that can cause inflammation of

the vein through which it is given. If the medication escapes from the vein it can cause

tissue damage. The nurse or doctor who gives this medication must be carefully trained.

Side effects:

Diarrhea; two types early and late forms.

Nausea and vomiting.

Weakness.

Low white blood cell count. (This can put you at increased risk for infection).

Low red blood cell count (anemia).

Hair loss

Poor appetite

Fever

Weight loss

Nursing considerations:

Advise to notify health care professional and may apply ice at the infusion site if

there is redness or pain.

Instruct to follow regimen of anti-diarrhea medication as prescribed by your

health care professional.

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 Instruct to take anti-nausea medications as prescribed by your doctor, and eat

small, frequent meals to reduce nausea. Sucking on lozenges and chewing gum

may also help.

Advise to avoid crowds or people with cold and wash hands often to prevent
infections.
Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.

Advise patient to get plenty of rest and maintain good nutrition.

DEXAMETHASONE

Classification: It is classified as a glucocorticosteroid.

Indications:

As an anti-inflammatory medication. Dexamethasone relieves inflammation in

various parts of the body. It is used specifically to decrease swelling (edema),

associated with tumors of the spine and brain, and to treat eye inflammation.

To treat or prevent allergic reactions.

As treatment of certain kinds of autoimmune diseases, skin conditions, asthma

and other lung conditions.

As treatment for a variety of cancers, such as leukemia, lymphoma, and multiple

myeloma.

To treat nausea and vomiting associated with some chemotherapy drugs.

Used to stimulate appetite in cancer patients with severe appetite problems.

Also used to replace steroids in conditions of adrenal insufficiency (low

production of needed steroids produced by the adrenal glands).

Dexamethasone is classified as a corticosteroid (more precisely a glucocorticosteroid),

and has many uses in the treatment of cancer. One way that it works is to decrease

inflammation (swelling). It does this by preventing infection- fighting white blood cells

(polymorphonuclear leukocytes) from traveling to the area of swelling in your body.

Dexamethasone is also used in the short-term treatment of nausea caused by

chemotherapy.

Side effects:

The following side effects are common (occurring in greater than 30%) for patients

taking dexamethasone:

Increased appetite

Irritability

Difficulty sleeping (insomnia)

Swelling in your ankles and feet (fluid retention)

Heartburn

Muscle weakness

Impaired wound healing

Increased blood sugar levels. (Persons with Diabetes may need to have blood

sugar levels monitored more closely and possible adjustments to diabetes

medications).

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Nursing considerations:

Advise the patient not to receive any kind of immunization or vaccination without

your doctor's approval while taking dexamethasone.

Instruct on good hygiene especially if patient is on this medication for a long

period of time, (more susceptible to infection). Wash your hands well, and report

any symptoms of infection.

Instruct to take this medication with food to lessen an upset stomach. Also take

this medication early on in the day (before 12:00 noon, if possible), so patient will

be able to sleep better at night.

Encourage patient to maintain good nutrition and drink 2 to 3 quarts of fluid a

day, unless contraindicated.

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