Alkylating and platinum chemotherapy agents

Alkylating and platinum chemotherapy agents

Drug monograph · NCLEX study reference
Trade names	Cytoxan
Therapeutic class	Antineoplastic
Pharmacologic class	Alkylating agent (cyclophosphamide), platinum agents
Onset / peak / duration	Per cycle; effect over weeks.
Half-life / level	Variable; no routine level.
Routes	PO (oral), IV
High-alert (ISMP)	No
Black box warning	Yes (see Safety)
Antidote / reversal	Mesna and hydration prevent cyclophosphamide cystitis; amifostine may reduce cisplatin toxicity; 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.

Alkylating and platinum chemotherapy agents (brand name Cytoxan) — Antineoplastic; Alkylating agent (cyclophosphamide), platinum agents.

Identification

• Therapeutic class: Antineoplastic.
• Pharmacologic class: Alkylating agent (cyclophosphamide), platinum agents.

Pharmacology

• Mechanism of action: Damage DNA to prevent cancer cell division (cell-cycle nonspecific).
• Onset / peak / duration: Per cycle; effect over weeks.
• Half-life / therapeutic level: Variable; no routine level.

Clinical use

• Indications: Many solid tumors and lymphomas; cyclophosphamide also for severe autoimmune disease.
• Usual dose, route, frequency: IV per protocol (cyclophosphamide also PO).
• Maximum dose / adjustments: Cisplatin requires aggressive hydration; reduce in renal impairment.

Safety

• Contraindications: Severe myelosuppression, pregnancy.
• Black box warning: Cisplatin carries warnings for cumulative nephrotoxicity, ototoxicity, severe nausea and vomiting, and anaphylactic reactions.
• Interactions: Other nephrotoxic and ototoxic and myelosuppressive drugs, live vaccines (avoid).
• Pregnancy / lactation: Contraindicated.
• High-alert: No.

Adverse effects

• Common side effects: Nausea and vomiting, myelosuppression, alopecia, fatigue.
• Serious effects to report: Cyclophosphamide hemorrhagic cystitis (blood in urine), cisplatin nephrotoxicity, ototoxicity, and neuropathy, severe myelosuppression, infection.
• Antidote / reversal: Mesna and hydration prevent cyclophosphamide cystitis; amifostine may reduce cisplatin toxicity; supportive care.

Nursing process

• Assessment before administration: CBC, renal function, hydration, hearing (cisplatin), pregnancy status.
• Interventions during therapy: Hydrate and give mesna with cyclophosphamide; aggressive hydration and antiemetics with cisplatin; safe handling.
• Monitor: CBC and nadir, renal function, hearing (cisplatin), urine (cyclophosphamide), infection.
• Evaluation / expected outcome: Tumor response with managed toxicity.

Patient teaching

• Patient teaching: Drink plenty of fluids; report blood in urine, ringing in the ears, or fever; infection precautions.
• Notify provider if: Fever or infection, blood in urine, hearing changes, numbness.
• Administration tips: Hydration protocols; hazardous-drug handling.