Antimetabolite, anthracycline, taxane, and vinca agents

Antimetabolite, anthracycline, taxane, and vinca agents

Drug monograph · NCLEX study reference
Therapeutic class	Antineoplastic
Pharmacologic class	Antimetabolite (5-FU), anthracycline (doxorubicin), taxane (paclitaxel), vinca alkaloid (vincristine)
Onset / peak / duration	Per cycle.
Half-life / level	Variable; no routine level.
Routes	IV, Intrathecal
High-alert (ISMP)	No
Black box warning	Yes (see Safety)
Antidote / reversal	Dexrazoxane for doxorubicin extravasation and cardioprotection; supportive care.
Pregnancy / lactation	Contraindicated.

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

Antimetabolite, anthracycline, taxane, and vinca agents — Antineoplastic; Antimetabolite (5-FU), anthracycline (doxorubicin), taxane (paclitaxel), vinca alkaloid (vincristine).

Identification

• Therapeutic class: Antineoplastic.
• Pharmacologic class: Antimetabolite (5-FU), anthracycline (doxorubicin), taxane (paclitaxel), vinca alkaloid (vincristine).

Pharmacology

• Mechanism of action: Interfere with DNA, RNA, or cell division at various phases.
• Onset / peak / duration: Per cycle.
• Half-life / therapeutic level: Variable; no routine level.

Clinical use

• Indications: Various solid tumors and hematologic cancers.
• Usual dose, route, frequency: IV per protocol.
• Maximum dose / adjustments: Doxorubicin has a lifetime cumulative dose limit (cardiotoxicity); paclitaxel requires premedication for hypersensitivity.

Safety

• Contraindications: Severe myelosuppression, pregnancy; vincristine must never be given by the intrathecal route.
• Black box warning: Doxorubicin carries boxed warnings for cardiomyopathy and heart failure (cumulative dose related), severe tissue necrosis if extravasated (a vesicant), and secondary leukemia; vincristine carries a boxed warning that it is fatal if given intrathecally and must be given only intravenously.
• Interactions: Other cardiotoxic or myelosuppressive drugs, live vaccines (avoid).
• Pregnancy / lactation: Contraindicated.
• High-alert: No.

Adverse effects

• Common side effects: Myelosuppression, nausea, alopecia, mucositis; 5-FU causes hand-foot syndrome; vincristine causes peripheral neuropathy.
• Serious effects to report: Doxorubicin heart failure, extravasation injury, vincristine neuropathy and constipation, paclitaxel hypersensitivity, severe myelosuppression.
• Antidote / reversal: Dexrazoxane for doxorubicin extravasation and cardioprotection; supportive care.

Nursing process

• Assessment before administration: CBC, cardiac function and ejection fraction (doxorubicin), premedication (paclitaxel), neuro status (vincristine), IV access.
• Interventions during therapy: Verify central or reliable access for vesicants; monitor the IV site closely; premedicate for paclitaxel; vincristine labeled IV only and given via the correct route.
• Monitor: CBC and nadir, cardiac function (doxorubicin), neuropathy (vincristine), infusion reactions (paclitaxel).
• Evaluation / expected outcome: Tumor response with managed toxicity.

Patient teaching

• Patient teaching: Doxorubicin harmlessly turns urine red; report swelling or breathlessness; report numbness or constipation (vincristine); infection precautions.
• Notify provider if: Shortness of breath or swelling, IV-site pain or burning, numbness, fever.
• Administration tips: Vesicant precautions; vincristine never intrathecal; hazardous-drug handling.