Chapter 42: Oncological and Hematological Medications

Oncological and Hematological Medications begins with foundational pharmacology concepts including the distinction between cell cycle-specific agents that target actively dividing cells during particular phases and cell cycle-nonspecific agents that act regardless of cell cycle stage, along with the rationale for combination chemotherapy approaches to maximize therapeutic effect while managing resistance. Body surface area-based dosing calculations are emphasized as the standard method for determining safe and individualized treatment doses. The chapter systematically reviews major drug classifications: alkylating agents such as cyclophosphamide and cisplatin that damage deoxyribonucleic acid through cross-linking; antitumor antibiotics including doxorubicin with its significant cardiotoxic potential and bleomycin with pulmonary complications; antimetabolites like methotrexate requiring leucovorin rescue protocols and fluorouracil affecting nucleotide synthesis; mitotic inhibitors such as vincristine associated with peripheral neuropathy; topoisomerase inhibitors including etoposide and irinotecan; hormonal therapies targeting receptor-positive malignancies; immunomodulators enhancing immune function; and monoclonal antibodies with targeted mechanisms. Critical nursing priorities address the substantial adverse effect profile including mucositis, alopecia, myelosuppression manifesting as neutropenia and thrombocytopenia, nausea requiring aggressive antiemetic management, and peripheral neuropathy. The chapter emphasizes chemotherapy safety protocols including appropriate personal protective equipment, prevention and management of extravasation injuries from vesicant agents, central venous access benefits, and hydration strategies. Emergency management protocols for anaphylactic reactions and supportive care through colony-stimulating factors for bone marrow recovery are detailed. Psychosocial dimensions including fertility preservation counseling, contraception discussions, body image concerns, and comprehensive patient education are integrated throughout. Laboratory monitoring requirements and medication-specific toxicities guide clinical decision-making throughout treatment courses.