Chapter 46: Adult Oncological and Hematological Medications

Antineoplastic drugs function through various mechanisms to inhibit or eliminate malignant cells, classified by their cell cycle specificity and mode of action. Alkylating agents such as cyclophosphamide and cisplatin break DNA helices and carry risks including hemorrhagic cystitis and nephrotoxicity respectively. Antitumor antibiotics like doxorubicin and bleomycin interfere with nucleic acid synthesis but present cardiotoxicity and pulmonary toxicity concerns. Antimetabolites including methotrexate and fluorouracil target specific cell cycle phases by disrupting protein synthesis, requiring careful monitoring for hepatotoxicity and cerebellar dysfunction. Mitotic inhibitors such as vincristine arrest cell division during mitosis and commonly produce peripheral neuropathy and paralytic ileus. Topoisomerase inhibitors block enzymes essential for DNA replication, while hormonal agents suppress immune function or block hormones in hormone-sensitive malignancies. Targeted therapies and immunomodulators employ monoclonal antibodies and biological response modifiers to stimulate immune recognition of cancer cells. Dosing calculations rely on body surface area measurements, demanding accurate anthropometric data before each administration. Critical nursing responsibilities encompass managing chemotherapy-induced side effects including alopecia, mucositis, nausea, and hyperuricemia from rapid tumor cell death. Safe preparation requires biological safety cabinets and appropriate personal protective equipment, with particular attention to extravasation prevention at infusion sites. Hematological monitoring necessitates bleeding precautions when thrombocytopenia develops and neutropenic precautions below absolute neutrophil counts of 1000. Patient education addresses infertility risks, teratogenic effects, live vaccine avoidance, and infection prevention strategies. The chapter also addresses anemia management through iron supplementation, vitamin B12 and folate replacement, and blood product transfusions based on specific deficiency types and clinical presentation.