carboplatin

Carboplatin, a chemotherapy agent. Its MOA, uses, contraindications,precautions, Nursing intervention, family/ patient teaching.

1. Presentation on Carboplatin Prepared by : Kalpana Kawan Roll no. 06 BNS 3 rd year

2. I ntroduction Functional class : Antineoplastic alkylating agent Chemical class : Platinum coordination compound Pregnancy category D

3. ACTION Carboplatin interferes with the development of the genetic material in a cell, the DNA. This stops it from dividing into 2 new cells and kills it.

4. USES Mainly ovarian cancer . O ther types of cancer, including lung, head and neck, endometrial, esophageal, bladder, breast, and cervical; central nervous system or germ cell tumors; osteogenic sarcoma; and as preparation for a stem cell or bone marrow transplant.

5. C ontraindications Pregnancy H ypersensitivity to platinum compound B reastfeeding S ignificant bleeding Severe bone marrow depression

6. Precautions Geriatric patients R enal disease liver disease Anemia I nfection

7. Available forms Lyophilized powder for inj 50, 150, 450 mg vials Aqueous solution for inj 50 mg/5 ml vial, 150 mg/15 ml vial, 450 mg/45 mg vial, 600 mg/60 ml vial

8. Dosage and Routes Advanced ovarian cancer Single agent: 360 mg/m² IV every 4Weeks   Combination treatment: 300 mg/m² IV (plus cyclophosphamide 600 mg/m² IV) every 4Weeks, 6 cycles R efractory tumors 360 mg/m2 single dose, may repeat every 4 week as needed.

9. Dosage and Routes Renal dose Adult: IV INF CCr 41-59 ml/min 250 mg/m2 , CCr 16-40 ml/min 200 mg/m2 ; do not use in CCr ,15 ml/min The amount of carboplatin depends on many factors, including height and weight , general health or other health problems, and how the body responds to it. 

10. Adverse effects CNS : Seizures, central neurotoxicity, peripheral neuropathy, dizziness, confusion CV : Cardiac abnormalities stroke EENT: Tinnitus, hearing loss, vestibular toxicity, visual changes GI: Severe nausea, vomiting, diarrhea, weight loss, mucositis , anorexia, constipation, taste change

11. Adverse effects contd … HEMA: Thrombocytopenia, leukopenia, pancytopenia, neutropenia, anemia, bleeding INTEG: Alopecia, dermatitis, rash, erythema, pruritus, urticaria META: hyponatremia , hypokalemia, Hypomagnesemia , hypocalcemia ,

12. Adverse effects contd … SYST: Anaphylaxis RENAL : Serum creatitine elevations, Blood Urea Nitrogen elevation HEPATIC: Bilirubin elevation, Alkaline phosphatage elevations

13. Pharmacokinetics Absorption Complete Distribution Unknown Metabolism Liver Excretion Kidneys Half-life Initial 1-2 hr ; postdistribu­tion 2½-6 hr ; increased in renal disease

14. Pharmacodynamics Onset ½ hr Peak Unknown Duration 4-6 hr

15. Interactions Amphotericin B : increased nephrotoxicity or ototoxicity Aspirin, anticoagulants, platelet inhibitors : increased risk of bleeding Radiation : increased toxicity, bone marrow suppression

16. Nursing considerations Assess for anaphylaxis: pruritus, wheezing, tachycardia; may occur within a few minutes of use; notify physician after discontinuing products; resuscitation equipment should be available Peripheral neuropathy: may be increased in geriatrics

17. Nursing considerations contd … Monitor renal function studies. Monitor liver function tests before, during therapy as needed or monthly; note jaundice of skin or sclera, dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea Monitor temperature every 4 hour (may indicate beginning of infection)

18. Nursing considerations contd … Assess for bleeding: hematuria , bruising or petechiae , inflammation of mucosa, breaks in skin; avoid all IM injections if platelets <50,000/mm3 Identify effects of alopecia on body image; discuss feelings about body changes

19. Nursing considerations contd … Bone marrow depression: Monitor CBC, differential, platelet count weekly; withhold product if neutrophil count is <2000/mm3 or platelet count is <100,000/mm3 Assess serum electrolyte value ( sodium, potassium, calcium , magnesium )

20. Nursing considerations contd … Implementation Pre medication: Inj. Aciloc 50mg Inj. Dexona 8 mg in 100 ml N/S over 30 min Inj. Ondem 8 mg Inj. Carboplatin 600 mg in 250ml 5% dextrose over 2 hour Flush with 500ml/100ml NS

21. Nursing considerations contd … IV route - Do not use needles or IV administration sets containing aluminum; may cause precipitate or loss of potency Use cytotoxic handling procedures Store and protected from light at room temperature; reconstituted solution is stable for 8 hours at room temperature

22. Patient/family education Teach patient to avoid use of products con­taining aspirin or ibuprofen, NSAIDs, alcohol, razors, since bleeding may occur. Advise patient to report ringing/roaring in the ears , numbness, tingling in face, extremities. Teach to report symptoms of bleeding (hematuria, tarry stools ).

23. Patient/family education contd.. Instruct patient to report signs of anemia Instruct patient to report any changes in breathing or coughing even several months after treatment Instruct to avoid crowds and persons with respiratory tract or other infections

24. Patient/family education contd.. Report fever or any other signs of infection immediately to health care provider. Advise patient that hair may be lost during treatment; a wig or hairpiece may make patient feel better . Caution patient not to have any vaccinations without the advice of the prescriber.

25. Patient/family education contd …. Teach patient that contraception is needed during treatment and for several months after the completion of therapy Not to breastfeed dur­ing treatment. To notify prescriber if pregnancy is planned or suspected.

26. Patient/family education contd …. Teach patient that impotence or amenor­rhea can occur. Drink at least 2- 3 liter of fluid every 24 hours . Wash your hands often. Use an electric razor and a soft toothbrush to minimize bleeding.

27. Patient/family education contd …. Avoid contact sports or activities that could cause injury. Delay dental work until blood counts have returned to normal To reduce nausea, take anti emetics drugs as prescribed by doctor, and eat small, frequent meals.  Get plenty of rest.  Maintain good nutrition.

28. References Grover, JK. Monica, M. (2002) Textbook of pharmacology for nurses (3 rd ed ).p.422 CBS Publishers and Distributors Pvt Ltd Tripathi , KD. (2019) Essentials of medical pharmacology (8 th ed ). P. 918-920.Jaypee Brothers Medical Publishers(P)Ltd Skidmore, L.S.(2015).Mosby’s drug guide for nursing students (11 th ed ).p. 168-170.Elsevier Medscape( n.d . ). Carboplatin. Accessed https :// reference.medscape.com/drug/paraplatin- carboplatin-342107 on Dec 15, 2021