Cyclophosphamide

Cyclophosphamide

1. PRESENTATION ON CYCLOPHOSPHAMIDE Prepared by: Aasha Budhathoki Roll no. 1 BNS 3 rd year, MNC Adult Health Nursing Major

2. Introduction Cyclophosphamide is a synthetic antineoplastic drug also known as cytophosphane , a nitrogen mustard alkylating agent from the oxazophorines group. It is a prodrug, converted in the liver to active forms that have chemotherapeutic activity. Soluble in water, saline and ethanol.

3. Introduction (cont’d…) Classification: Antineoplastic; alkylating agent Availability: 25 mg, 50 mg tablets 100 mg, 200 mg, 500 mg, 1 gram, 2 gram vials Storage: Room temperature (20 to 25 degree celsius ), protect from sunlight and do not freeze.

4. Pharmacokinetics Absorption: Readily absorbed from GI tract and Peak: 1 h PO. Distribution: Widely distributed, including brain, breast milk; crosses placenta Metabolism: Metabolized in liver Elimination: Excreted in urine as active metabolites and unchanged drug Half-Life: 4–6 h.

5. Mechanism of action Alter DNA structure by misreading DNA code, initiating breaks in the DNA molecule. Alkylating metabolites ( P hosphoramide mustard) interfere with the growth of susceptible rapidly proliferating malignant cells and forms cross linking of DNA strands of tumor cell thereby blocking synthesis of DNA, RNA, and protein.

6. Indications Malignant lymphoma Multiple myeloma Leukemia Mycosis fungoides (advanced disease) Neuroblastoma Retinoblastoma

7. Indications (cont’d…) Adenocarcinoma of ovary Carcinoma of breast Malignant neoplasms of lung Rheumatoid arthritis

8. Contraindications Severely depressed bone marrow Leukopenia and thrombocytopenia Pregnancy and lactation women

9. Adverse effects Gastrointestinal: Nausea, vomiting, mucositis, anorexia, hepatotoxicity, diarrhea . Hematologic: Leukopenia, neutropenia, acute myeloid leukemia , anemia , thrombophlebitis, interference with normal healing. Metabolic: Severe hyperkalemia , hyponatremia, weight gain (but without edema ) or weight loss

10. Adverse effects (cont’d…) Skin: Alopecia (reversible), transverse ridging of nails, pigmentation of nail beds and skin (reversible), nonspecific dermatitis. Urogenital: hemorrhagic and non- hemorrhagic cystitis, bladder fibrosis, nephrotoxicity.

11. Preparation Pre medication Inj. Normal saline 100 ml/ 250 ml pre-flush Inj. ondem 8 mg bolus or Tab ondem 4 mg TDS/ BD for 2 days. Inj. Cyclophosphamide (15 mg/kg or 0.5-1 gram/m2) in 500 ml Normal saline for rheumatology. Inj. Cyclophosphamide 40-50 mg/kg in Neoplasm. In nephro and rheumatology case infuse over 3-4 hours.

12. Preparation (cont’d…) In nephro and rheumatology case infuse over 3-4 hours. In hematology case over 1 hours. In oncology over half an hour over 100 ml Normal saline. Then post flush with 100 ml Normal saline.

13. Nursing implications Assess the lab reports such as total and differential leukocyte count, platelet count, and Hematocrit , baseline liver and kidney function , serum electrolytes initially and at least 2 times per week during maintenance period. Thrombocytopenia is rare, but if it occurs (count of 100,000/mm3 or lower), assess for signs of unexplained bleeding or easy bruising. If platelet count indicates thrombocytopenia (100,000/mm3), drug will be discontinued. Monitor body weight twice a week.

14. Nursing implications (cont’d…) During severe leukopenic period, protect patient from potential source of infection and trauma and from visitors. Monitor temperature and report immediately if onset of unexplained chills, sore throat, tachycardia, fever. Fever in a neutropenic patient (granulocyte count <1000) is a medical emergency because sepsis can develop quickly in these patients. Monitor Intake output and increased per oral and iv fluid to help prevent renal irritation and hemorrhagic cystitis.

15. Patient & Family Education Adhere to dosage regimen and do not omit, increase, decrease, or delay doses. If for any reason drug cannot be taken, notify physician. Alopecia occurs in about 33% of patients on cyclophosphamide therapy. Hair loss may be noted 3 weeks after therapy begins; regrowth (often differs in texture and color) usually starts 5–6 weeks after drug is withdrawn and may occur while on maintenance doses.

16. Patient & Family Education (cont’d…) Use adequate means of contraception during and for at least 4 months after termination of drug treatment. Breast-feeding should be discontinued before cyclophosphamide therapy is initiated. Amenorrhea may last up to 1 year after cessation of therapy in 10–30% of women. Do not breast feed while taking this drug.

17. References Medscape. Cyclophosphamide . Accessed from https://reference.medscape.com/drug/cytoxan-cyclophosphamide-342214 16th December 2021 . Rob holland. Cyclophosphamide . Accessed from http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/C122.html 15 th December 2021. Skidmore , L.S. (2015). Mosby’s drug guide for nursing students (11 th ed.). ELSEVIER publication. Smeltzer et al., (2012). Brunner and Suddharth’s Textbook of medical surgical nursing (12 th ed.). Pp 354. Wolters Kluwer Publication. Tripathi, K.D. (2019). Essential of medical pharmacology . Jaypee publication.