Name of the Platinum Agents drugs
- Cisplatin
- Oxaliplatin
- Carboplatin
1.Cisplatin
| CISPLATIN |
| Availability: injection Solution: 1 mg/mL (50 mL, 100 mL, 200 mL). |
| Administration/handling: Wear protective gloves during handling. May be carcinogenic mutagenic, teratogenic. Handle with extreme care during preparation/administration. IV: Dilution • Dilute desired dose in 250–1,000 mL 0.9% NaCl, D5/0.45% NaCl, or D5/0.9% NaCl to concentration of 0.05–2 mg/mL. Solution should have final NaCl concentration of 0.2% or greater. Rate of administration • Infuse over 6–8 hrs (per protocol). • Avoid rapid infusion (increases risk of nephrotoxicity, ototoxicity). • Monitor for anaphylactic reaction during first few minutes of infusion. Storage • Protect from sunlight. • Do not refrigerate (may precipitate). Discard if precipitate forms. IV infusion: Stable for 72 hrs at 39°F–77°F. |
| Prepare drug with equipment that doesn’t contain aluminium. Give 2 L of I.V. fluids, as prescribed, 8 to 12 hours before drug infusion to help prevent toxicity. Dilute each dose in 2 L of dextrose 5% in 1/4 or 1/2 saline solution or 0.9% normal saline solution. Do not use dextrose 5% in water. Infuse each liter over 3 to 4 hours to minimize toxicity. In well-hydrated patients with good renal function, infusions of 100 to 500 ml may be given over 30 minutes. Follow facility policy for handling and disposal of antineoplastics. If solution contacts skin, wash immediately and thoroughly with soap and water. If solution contacts mucosa, flush with water immediately. Protect drug from light. |
| Pretreatment hydration with 1–2 Liters of fluid recommended. Adequate hydration, urine output greater than 100 mL/hr should be maintained for 24 hrs after administration. Verify any cisplatin dose exceeding 100 mg/m2/ course. |
| Bladder Cancer: IV: Adults, elderly: (Single agent): 50–70 mg/m2 q3–4wks. |
| Ovarian Cancer: IV: Adults, elderly: 75–100 mg/m2 q3–4wks (combination therapy) or 100 mg/m2 q4wks (single agent). |
| Testicular Cancer: IV: Adults, elderly: 20 mg/m2 daily for 5 days repeated q3wks (in combination with bleomycin and etoposide). |
Mechanism of Action:
Inhibits DNA synthesis by cross-linking with DNA strands. Cell cycle–phase nonspecific.
Therapeutic Effect: Prevents cellular division.
Indications:
- Treatment of metastatic testicular cancers
- Metastatic ovarian cancers
- Advanced bladder cancer.
OFF-LABEL:
Breast, cervical, endometrial, oesophageal, gastric, head and neck, lung (small cell, non–small-cell) carcinomas; Hodgkin’s and non-Hodgkin’s lymphomas; malignant melanoma, neuroblastoma, osteosarcoma, soft tissue sarcoma, Wilms’ tumour.
Cautions & Contraindications:
- Hypersensitivity to cisplatin.
- Hearing impairment
- Myelosuppression
- Preexisting renal impairment.
Cautions: elderly, renal impairment
Metabolism and Half- Life:
Widely distributed. Protein binding: greater than 90%. Undergoes rapid nonenzymatic conversion to inactive metabolite. Excreted in urine. Removed by haemodialysis. Half-life: 58–73 hrs (increased in renal impairment).
Drug Interactions:
- Bone marrow depressants (e.g., Paclitaxel) may increase myelosuppression.
- Live virus vaccines may potentiate virus replication, increase vaccine side effects, decrease pt’s antibody response to vaccine.
- May increase serum BUN, creatinine, uric acid, AST.
- May decrease CrCl, serum calcium, magnesium, phosphate, potassium, sodium.
- May cause positive Coombs’ test.
Side- Effects:
Frequent:
Nausea, vomiting (occurs in more than 90% of pts, generally beginning 1–4 hrs after administration and lasting up to 24 hrs), myelosuppression (affecting 25%–30% of pts, with recovery generally occurring in 18–23 days).
Occasional:
Peripheral neuropathy (with prolonged therapy [4–7 months]). Pain/redness at injection site, loss of taste, appetite.
Rare:
- Haemolytic anaemia, blurred vision, stomatitis.
- Anaphylactic reaction (angioedema, wheezing, tachycardia, hypotension) may occur in first few minutes of administration in pt previously exposed to Cisplatin.
- Nephrotoxicity occurs in 28%–36% of pts treated with a single dose, usually during second week of therapy.
- Ototoxicity (tinnitus, hearing loss) occurs in 31% of pts treated with a single dose (more severe in children). Symptoms may become more frequent, severe with repeated doses.
Nursing Considerations
Baseline assessment
- Obtain baseline CBC, BMP, LFT.
- Pts should be well hydrated before and 24 hrs after medication to ensure adequate urinary output (100 mL/hr), decrease risk of nephrotoxicity.
Intervention/evaluation
- Measure all emesis, urine output (general guideline requiring immediate notification of physician: 750 mL/8 hrs, urinary output less than 100 mL/hr).
- Monitor I&O q1–2h beginning with pretreatment hydration, continue for 48 hrs after dose.
- Assess vital signs q1–2h during infusion.
- Monitor urinalysis, serum electrolytes, LFT, renal function tests, CBC, platelet count for changes from baseline.
- Before starting therapy and before each subsequent dose, assess renal function test results and CBC with white cell differential.
- Monitor neurologic status, hepatic enzyme and uric acid levels, and audiogram results.
Patient/family teaching
- Report signs of ototoxicity (tinnitus, hearing loss).
- Do not have immunizations without physician’s approval (lowers body’s resistance).
- Avoid contact with those who have recently taken oral polio vaccine.
- Report if nausea/vomiting continues at home.
- Report signs of peripheral neuropathy.
- Instruct patient to drink 8 oz of water every hour while awake.
- Advise patient to promptly report bleeding, bruising, hearing loss, yellowing of skin or eyes, decreased urine output, or suspected infection.
- Tell patient that drug may cause hair loss.
- Instruct female patient to use reliable contraception; drug can harm foetus.
2.Oxaliplatin
| OXALIPLATIN |
| Availability : Powder for reconstitution for injection, lyophilized: 5 mg/ml in 50-mg and 100-mg single-use vials Solution for injection: 5 mg/ml in 10-ml, 20-ml, and 40-ml single-use vials |
| Administration/handling: Wear protective gloves during handling of oxaliplatin. If solution comes in contact with skin, wash skin immediately with soap, water. Do not use aluminium needles or administration sets that may come in contact with drug; may cause degradation of platinum compounds. Pt should avoid ice, drinking cold beverages, touching cold objects during infusion and for 5 days thereafter (can exacerbate acute neuropathy) |
| IV: Reconstitution • Dilute with 250–500 mL D5W (never dilute with sodium chloride solution or other chloride containing solutions) to final concentration of 0.2–0.6 mg/mL. Rate of administration • Infuse over 2–6 hrs. Storage • Do not freeze. • Protect from light. • Store vials at room temperature. • After dilution, solution is stable for 6 hrs at room temperature, 24 hrs if refrigerated. |
| Pretreat pt with antiemetics. Repeat courses should not be given more frequently than every 2 weeks. |
| Colon Cancer, Advanced: IV: Adults: 85 mg/m2 q2wks until disease progression or unacceptable toxicity (in combination with fluorouracil/leucovorin). |
| Colon Cancer, Stage III (adjuvant therapy): IV: Adults: 85 mg/m2 q2wks for total of 6 months (in combination with fluorouracil/leucovorin). |
| Metastatic cancer of colon or rectum, given with 5-fluorouracil (5-FU) and leucovorin: Adults: On day 1, 85 mg/m2 oxaliplatin : I.V. infusion and 200 mg/m2 leucovorin; give both drugs simultaneously over 2 hours, followed by 400 mg/m2 I.V. bolus of 5-FU over 2 to 4 minutes, then 600 mg/m2 5-FU I.V. as 22-hour continuous infusion. On day two, 200 mg/m2 leucovorin I.V. infusion over 2 hours, followed by 400 mg/m2 5-FU I.V. bolus over 2 to 4 minutes, then 600 mg/m2 5-FU I.V. as 22-hour continuous infusion. |
Mechanism of Action:
Inhibits DNA replication and transcription by cross-linking with DNA strands. Cell cycle–phase nonspecific.
Therapeutic Effect: Causes cellular death (apoptosis).
Indications:
- Treatment of stage III colon cancer after complete resection of primary tumor (in combination with infusional 5-fluorouracil and leucovorin)
- Treatment of advanced colon cancer (in combination with infusion 5-fluorouracil and leucovorin).
OFF-LABEL:
Treatment of ovarian cancer, pancreatic cancer, hepatobiliary cancer, testicular cancer, oesophageal cancer, gastric cancer, non- Hodgkin’s lymphoma, chronic lymphocytic leukaemia.
Cautions & Contraindications:
- History of allergy to oxaliplatin, other platinum compounds.
Cautions:
Previous therapy with other antineoplastic agents, radiation, renal impairment, pregnancy, immunosuppression, presence or history of peripheral neuropathy, elderly pts.
Metabolism and Half- Life:
Rapidly distributed. Protein binding: 90%. Undergoes rapid, extensive nonenzymatic biotransformation.
Excreted in urine. Half-life: 391 hrs.
Drug Interactions:
- Bone marrow depressants (e.g., cladribine) may increase myelosuppression, GI effects.
- Live virus vaccines may potentiate virus replication, increase vaccine side effects, decrease pt’s antibody response to vaccine.
- May increase serum creatinine, bilirubin, ALT, AST, INR.
- May prolong prothrombin time.
Side- Effects:
Frequent :
Peripheral/sensory neuropathy (usually occurs in hands, feet, perioral area, throat but may present as: jaw spasm, abnormal tongue sensation, eye pain, chest pressure, difficulty walking, swallowing, writing), nausea, fatigue, diarrhea, vomiting, constipation, abdominal pain, fever, anorexia.
Occasional :
Stomatitis, earache, insomnia, cough, difficulty breathing, backache, Edema.
Rare:
Dyspepsia, dizziness, rhinitis, flushing, alopecia.
Nursing Considerations
Baseline assessment
- Obtain baseline renal function, WBC, platelet count.
- Question medical history as listed in Precautions.
- Offer emotional support.
Intervention/evaluation
- Monitor for decrease in WBC, platelets (myelosuppression is minimal).
- Monitor daily pattern of bowel activity, stool consistency.
- Monitor for diarrhoea, GI bleeding (bright red, black tarry stool), signs of neuropathy.
- Pt should avoid ice or drinking, holding glass of cold liquid during IV infusion and for 5 days following completion of infusion; may precipitate/exacerbate neuropathy (occurs within hrs or 1–2 days of dosing, lasts up to 14 days).
- Maintain strict I&O.
- Assess oral mucosa for stomatitis.
- Monitor I.V. site frequently to avoid extravasation.
- Monitor CBC, blood chemistry, and kidney and liver function tests before each treatment cycle.
- Watch closely for blood dyscrasias, haemolytic uremic syndrome, serious pulmonary problems, and anaphylaxis.
- Conduct complete neurologic exam before and after each dose.
- Monitor vital signs and ECG. Evaluate cardiovascular and respiratory status closely.
- Assess patient’s comfort level. Keep him warm during infusion to minimize neurologic effects.
- Watch for signs and symptoms of toxicity (paraesthesia, nausea, vomiting).
Patient/family teaching
- Inform patient that chemotherapy drugs can cause many adverse effects.
- Promptly report fever, sore throat, signs of local infection, unusual bruising/ bleeding from any site, persistent diarrhoea, difficulty breathing.
- Do not have immunizations without physician’s approval (drug lowers resistance).
- Avoid contact with those who have recently taken oral polio vaccine.
- Avoid cold drinks, ice, cold objects (may produce neuropathy).
- Tell patient he’ll receive drug from trained health care professionals in hospital setting.
- Instruct patient to inform nurse immediately if drug contacts his skin, eyes, or mouth.
- Advise patient to notify nurse if pain or redness occurs at I.V. site.
- Instruct patient to stay warm and avoid iced drinks to minimize neurologic symptoms.
- Tell patient to report itching, hives, swelling of hands or face, chest tightness, difficulty breathing, unsteadiness, severe diarrhoea or vomiting, or tingling sensation in hands, arms, legs, or feet.
3.Carboplatin
| CARBOPLATIN |
| Availability: Injection Solution: 10 mg/mL (5 mL, 15 mL, 45 mL, 60 mL) |
| Administration/handling: May be carcinogenic, mutagenic, teratogenic. Handle with extreme care during preparation/administration. IV: Reconstitution • Dilute with D5W or 0.9% NaCl to a final concentration as low as 0.5 mg/mL. Rate of administration • Infuse over 15–60 min. • Rarely, anaphylactic reaction occurs minutes after administration. Use of epinephrine, corticosteroids alleviates symptoms Storage • Store vials at room temperature. After dilution, solution is stable for 8 hrs. |
| Premedicate with antiemetics, as prescribed. When preparing and administering drug, follow facility protocol for handling cytotoxic drugs. Reconstitute powder for injection by adding sterile water for injection, 0.9% sodium chloride injection, or 5% dextrose injection, as appropriate, to provide 10-mg/ml solution. Drug may be further diluted to concentrations as low as 0.5 mg/ml. Don’t use with needles or I.V. sets containing aluminium. Administer I.V. infusion over at least 15 minutes. Make sure patient maintains adequate fluid intake. Know that drug is given in combination with other agents. |
| Ovarian Carcinoma : IV: Adults: Target AUC 5–6 over 1 hr on day 1; repeat q3 weeks for 3–6 cycles (in combination with paclitaxel). Do not repeat dose until neutrophil and platelet counts are within acceptable levels. |
| Initial treatment of advanced ovarian cancer or palliative treatment of ovarian cancer unresponsive to other chemotherapeutic modalities : Adults: Initially, 300 mg/m2 I.V. (given with cyclophosphamide) at 4-week intervals. For refractory tumors, 360 mg/m2 I.V. as a single dose; may be repeated at 4-week intervals, depending on response. However, single dose shouldn’t be repeated until neutrophil count is at least 2,000/mm3 and platelet count at least 100,000/mm3. Subsequent dosages are based on blood counts. |
Mechanism of Action:
Inhibits DNA synthesis by cross-linking with DNA strands, preventing cell division.
Therapeutic Effect: Interferes with DNA function.
Indications:
- Treatment of advanced ovarian carcinoma.
- Palliative treatment of recurrent ovarian cancer.
Off-label:
- Brain tumors
- Hodgkin’s and non-hodgkin’s lymphomas
- Malignant melanoma
- Retinoblastoma
- Treatment of breast, bladder, cervical, endometrial, oesophageal, small cell lung, non–small-cell lung, head and
- Neck, testicular carcinomas
- Germ cell tumors, osteogenic sarcoma.
Cautions & Contraindications:
- Hypersensitivity to carboplatin.
- History of severe allergic reaction to cisplatin, platinum compounds, mannitol
- Severe bleeding
- Severe myelosuppression.
Cautions:
Moderate bone marrow depression, renal impairment, elderly.
Metabolism and Half- Life:
Protein binding: Low. Hydrolysed in solution to active form. Primarily excreted in urine. Half-life: 2.6–5.9 hrs.
Drug Interactions:
- Bone marrow depressants (e.g., cladribine) may increase myelosuppression.
- May increase adverse effects of clozapine, natalizumab, leflunomide.
- May increase immunosuppressive effect of baricitinib, fingolimod.
- May increase concentration/effect of bexarotene.
- May decrease therapeutic effect of BCG (intravesical), vaccines (live).
- May increase adverse effects of vaccines (live).
- May decrease serum calcium, magnesium, potassium, sodium. May increase serum BUN, alkaline phosphatase, bilirubin, creatinine, AST.
Side- Effects:
- Frequent: Nausea, vomiting.
- Occasional : Generalized pain, diarrhoea/constipation, peripheral neuropathy.
- Rare : Alopecia, asthenia, hypersensitivity reaction (erythema, pruritus, rash, urticaria)
Nursing Considerations
Baseline assessment
- Obtain ECG, CBC, serum chemistries, renal function test.
- Offer emotional support.
- Do not repeat treatment until WBC recovers from previous therapy.
- Transfusions may be needed in pts receiving prolonged therapy (myelosuppression increased in those with previous therapy, renal impairment).
Intervention/evaluation
- Monitor pulmonary function studies, hepatic/renal function tests, CBC, serum electrolytes to help detect drug induced anemia and other hematologic reactions.
- Monitor for fever, sore throat, signs of local infection, unusual bruising/ bleeding from any site, symptoms of anemia
- (excessive fatigue, weakness).
- Assess for signs and symptoms of hypersensitivity reactions.
- Evaluate fluid and electrolyte balance
Patient/family teaching
- Nausea, vomiting generally abate within 24 hrs.
- Do not have immunizations without physician’s approval (drug lowers body’s resistance).
- Avoid contact with those who have recently received live virus vaccine.
- Instruct patient to report signs and symptoms of allergic response and other adverse reactions, such as breathing problems, mouth sores, rash, itching, and reddened skin.
- Advise patient to report unusual bleeding or bruising.
- Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
- Urge patient to avoid activities that can cause injury. Advise him to use soft toothbrush and electric razor to avoid gum and skin injury.
- Instruct patient to drink plenty of fluids to ensure adequate urinary output.
- Provide dietary counselling and refer patient to dietitian as needed if GI adverse effects significantly limit food intake.
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
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