Antineoplastic Agents: Nursing Pharmacology Study Guide for Nurses

Antineoplastic agents comprise one aspect of chemotherapy. These drugs act on and kill altered human cells. While their action is intended to target abnormal cells, normal cells are also affected. These drugs can work by affecting cell survival or by boosting the immune system in its efforts to combat the abnormal cells.

Table of Common Drugs and Generic Names


Here is a table of commonly encountered antineoplastics, their generic names, and brand names:

Classification Generic Name Brand Name
Alkylating Agents altretamine Hexalen
bendamustine Treanda
busulfan Busulfan, Myleran
carboplatin Paraplatin
carmustine BiCNU, Gliadel
chlorambucil Leukeran
cisplatin Platinol-AQ
cyclophosphamide Cytoxan, Neostar
dacarbazine DTIC-Dome
ifosfamide Ifex
lomustine CeeNu
mechlorethamine Mustargen
melphalan Alkeran
oxaliplatin Eloxatin
procarbazine Matulane
streptozocin Zanosar
temozolomide Temodar
thiotepa Thioplex
Antimetabolites capecitabine Xeloda
cladribine Leustatin
clofarabine Clolar
cytarabine DepoCyt, Tarabine PFS
floxuridine FUDR
fludarabine Fludara
fluorouracil Adrucil, Carac, Efudex, Fluoroplex
gemcitabine Gemzar
mercaptopurine Purinethol
methotrexate Rheumatrex, Trexall
pemetrexed Alimta
pentostatin Nipent
pralatrexate Folotyn
thioguanine Tabloid
Antineoplastic Antibiotics bleomycin Blenoxane
dactinomycin Cosmegen
daunorubicin DaunoXome
doxorubicin Adriamycin, Doxil
epirubicin Ellence
idarubicin Idamycin
mitomycin Mutamycin
mitoxantrone Novantrone
valrubicin Valstar
Mitotic Inhibitors cabazitaxel Jevtana
docetaxel Taxotere
etoposide Toposar, VePesid
ixabepilone Ixempra
paclitaxel Abraxane, Onxol Taxol
teniposide Vumon
vincristine Oncovin, Vincasar
vinorelbine Navelbine
Hormones and Hormone Modulators anastrozole Arimidex
bicalutamide Casodex
degarelix Degarelix for Injection
estramustine Emcyt
exemestane Aromasin
flutamide (generic)
fulvestrant Faslodex
goserelin Zoladex
histrelin Vantas
letrozole Femara
leuprolide Lupron, Eligard
megestrol Megace
mitotane Lysodren
nilutamide Nilandron
tamoxifen Soltamox
toremifene Fareston
triptorelin pamoate Trelstar Depot
Cancer Cell-Specific Agents
  • Protein Tyrosine Kinase Inhibitors
everolimus Afinitor
gefitinib Iressa
imatinib Gleevec
lapatinib Tykerb
nilotinib Tasigna
pazopanib Votrient
sorafenib Nexavar
sunitinib Sutent
temsirolimus Torisel
  • Epidermal Growth Factor Inhibitor
erlotinib Tarceva
  • Proteasome Inhibitor
bortezomib Velcade
Other antineoplastics arsenic trioxide Trisenox
asparaginase Elspar
azacitidine Vidaza
bexarotene Targretin
decitabine Dacogen
hydroxyurea Hydrea
irinotecan Camptosar
nelarabine Arranon
pegaspargase Oncaspar
porfimer Photofrin
sipuleucel-T Provenge
talc powder Sclerosol
topotecan Hycamtin
tretinoin Vesanoid
vorinostat Zolinza

Disease Spotlight: Cancer


  • Cancer is the second leading cause of death in the United States. Treatment is usually multidisciplinary, prolonged, and often debilitating. It can develop at any age.
  • Proliferation of abnormally-dividing cells starts the pathologic process. Genetic abnormalities are passed along daughter cells, eventually producing a tumor or neoplasm that has characteristics quite different from those of the original tissue.
  • Consequently, original cell characteristics are lost. Anaplasia is the loss of cellular differentiation and organization. Autonomy is the ability to grow without usual homeostatic restrictions that regulate cell growth and control.
  • Uncontrolled growth of neoplastic cells will lead to invasion of healthy tissues in the area and metastasis, or traveling from the place of origin to develop new tumors in other areas of the body.
  • Cancers can be divided into two groups: 1) solid tumors; and 2) hematological malignancies. Solid tumors can further be differentiated into carcinomas, or tumors that originate in epithelial cells, and sarcomas, or tumors that originate in the mesenchyme and are made up of embryonic connective tissue cells.
  • The goal of cancer chemotherapy is to decrease the size of neoplasm so that the human immune system can deal with it.

Alkylating Agents


Description

  • Alkylating agents are non-cell cycle specific antineoplastics drugs. They can affect cells even in the resting phase.
  • These are the agents of choice for slow-growing cancers.

Therapeutic Action

The desired and beneficial action of agents for alkylating agents is:

  • Reacting chemically with portions of RNA, DNA, or other cellular proteins to produce their cytotoxic effects.
  • Alkylating agents are most potent when binding with cellular DNA.
  • The oldest drugs in this class are nitrogen mustards.

Indications

Alkylating agents are indicated for the following medical conditions:

  • Treatment of slow-growing cancers, like lymphomas, leukemias, myelomas, some ovarian, testicular, and breast cancers, and pancreatic cancers. 

Here are some important aspects to remember for indication of antineoplastics in different age groups:

Children

  • Treatment of pediatric cancers follow developed antineoplastic protocols and combination therapy is stressed to eliminate as many of the mutant cells as possible. Checking the dosage for children is crucial because of possible drug toxicity. In addition, the nutritional needs and hydration status of children should be included in the considerations for formulating a care plan.
  • Even under therapy, children must be allowed to explore and learn like any other children. They would need extra support and comfort as body image problems, lack of energy, and risk for infection can isolate them. Lastly, bone marrow activity should be monitored carefully and dose should be adjusted carefully.

Adults

  • Adults are also challenged with changes in body image and activities that come with chemotherapy. It is usual for this age group to fear the diagnosis too. Therefore, establishing a good support system is important.
  • Antineoplastic agents are contraindicated to pregnant and nursing women. Education, support, and referrals to appropriate specialists are important. Women of childbearing age should use barrier contraceptives when these drugs are being taken.

Older adults

  • Older patients are more susceptible to GI and CNS adverse effects of antineoplastic therapy, particularly those with hepatic and renal dysfunctions. Precautions are used accordingly. Protection from infection and injury should be the focus of nurses.

Pharmacokinetics

Here are the characteristic interactions of alkylating agents and the body in terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration
Oral Varies 1 h 15-20 h
T1/2: 60-90 min
Metabolism: liver
Excretion: kidney (urine)

Contraindications and Cautions

The following are contraindications and cautions for the use of alkylating agents:

  • Pregnancy and lactation. Severe effects to fetus and neonate.
  • Known allergy to drugs. Caution is exercised to prevent hypersensitivity reactions.
  • Bone marrow suppression. The index for redosing and dosing levels
  • Suppressed renal or hepatic function. Interfere with drug metabolism and excretion.

Adverse Effects

Use of alkylating agents may result to these adverse effects:

  • GI: nausea, vomiting, anorexia, diarrhea, and mucous membrane deterioration, hepatic toxicity
  • GU: renal toxicity, potentially toxic increase in uric acid levels
  • Hematological: bone marrow suppression
  • Alopecia or hair loss

Antimetabolites


Description

  • Antimetabolites are drugs that have chemical structures similar to those of various natural metabolites that are necessary for growth and division of rapidly growing neoplastic cells and normal cells.

Therapeutic Action

The desired and beneficial action of antimetabolites is:

  • Inhibiting DNA production in cells that depend on certain natural metabolites to produce their DNA. They replace these needed metabolites and thereby prevent normal cellular function.
  • Inhibit thymidylate synthase, DNA polymerase, or folic acid reductase, all of which are needed for DNA synthesis.
  • Considered to be S phase specific in the cell cycle, they are most effective in rapidly dividing cells, preventing cell replication, and leading to cell death.

Indications

Antimetabolites are indicated for the following medical conditions:

  • Treatment of various leukemias and some GI and basal cell cancers
  • Use has been somewhat limited because neoplastic cells rapidly develop resistance to these agents. Therefore, they are commonly administered as part of combination therapy.

Pharmacokinetics

Here are the characteristic interactions of antimetabolites and the body in terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration
Oral Varies 1-4 h
IV Rapid 0.5-2 h
T1/2: 2-4 h
Metabolism: none
Excretion: kidney (urine); unchanged

Contraindications and Cautions

The following are contraindications and cautions for the use of antimetabolites:

  • Known allergy to drug. Prevent hypersensitivity reactions
  • Pregnancy and lactation. Severe effects on the fetus and neonate
  • Bone marrow suppression. Index of redosing and dosing levels
  • Renal and hepatic dysfunction. Interfere with drug metabolism and excretion
  • Known GI ulceration or ulcerative diseases. Can be exacerbated by the effects of the drug

Adverse Effects

Use of antimetabolites may result to these adverse effects:

  • CNS: headache, drowsiness, aphasia, fatigue, malaise, dizziness
  • Respiratory: pulmonary toxicity, interstitial pneumonitis
  • Hematological: bone marrow suppression
  • GI: nausea, vomiting, anorexia, diarrhea, mucous membrane deterioration, hepatic toxicity
  • GU: renal toxicity
  • Leucovorin is an active form of folic acid that is used to rescue normal cells from the adverse effects of methotrexate therapy in the treatment of osteosarcoma.

Antineoplastic Antibiotics


Description

  • This group of drugs is selective for bacterial cells. However, they are also toxic to human cells.
  • They are aimed towards rapidly-multiplying cells.

Therapeutic Action

The desired and beneficial action of antineoplastics antibiotic is:

  • Either breaking up DNA links or preventing DNA synthesis
  • They interfere with cellular DNA synthesis by inserting themselves between base pairs in the DNA chain. This causes a mutant DNA molecule, leading to cell death.

Indications

Antineoplastic antibiotics are indicated for the following medical conditions:

  • Treatment of various types of cancer, particularly those with rapidly-dividing nature.
  • These drugs have potentially adverse effects which limit their usefulness in patients with pre-existing disease and those who are debilitated.

Pharmacokinetics

Here are the characteristic interactions of antineoplastic antibiotics and the body in terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration
IV Rapid 2 h 24-36 h
T1/2: 12 min, then 3.3 h, then 29.6 h
Metabolism: liver
Excretion: kidney (urine), liver (bile), colon (feces)

Contraindications and Cautions

The following are contraindications and cautions for the use of antineoplastic antibiotics:

  • Known allergy to drug. Prevent hypersensitivity reactions
  • Pregnancy and lactation. Severe effects on the fetus and neonate
  • Bone marrow suppression. Index of redosing and dosing levels
  • Renal and hepatic dysfunction. Interfere with drug metabolism and excretion
  • Known GI ulceration or ulcerative diseases. Can be exacerbated by the effects of the drug
  • Pulmonary problems. Exacerbated by bleomycin or mitomycin
  • Cardiac problems. Exacerbated by idarubicin or mitoxantrone

Adverse Effects

Use of antineoplastic antibiotics may result to these adverse effects:

  • CNS: headache, drowsiness, aphasia, fatigue, malaise, dizziness
  • Respiratory: pulmonary toxicity, interstitial pneumonitis
  • Hematological: bone marrow suppression
  • GI: nausea, vomiting, anorexia, diarrhea, mucous membrane deterioration, hepatic toxicity
  • GU: renal toxicity
  • Alopecia

Mitotic Inhibitors


Description

  • Drugs that kill cells as the process of mitosis begins.
  • Mitotic inhibitors are cell cycle-specific agents that inhibit DNA synthesis.

Therapeutic Action

The desired and beneficial action of mitotic inhibitors is:

  • Interfering with the ability of the cell to divide by blocking or altering the M phase of the cell cycle.

Indications

Mitotic inhibitors are indicated for the following medical conditions:

  • Treatment of a variety of tumors and leukemias.

Pharmacokinetics

Here are the characteristic interactions of mitotic inhibitors and the body in terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration
IV Varies 15-30 min
T1/2: 5 min, then 2.3 hrs, then 85 hrs
Metabolism: liver
Excretion: kidney (urine), colon (feces)

Contraindications and Cautions

The following are contraindications and cautions for the use of mitotic inhibitors:

  • Known allergy to drug. Prevent hypersensitivity reactions
  • Pregnancy and lactation. Severe effects on the fetus and neonate
  • Bone marrow suppression. Index of redosing and dosing levels
  • Renal and hepatic dysfunction. Interfere with drug metabolism and excretion
  • Known GI ulceration or ulcerative diseases. Can be exacerbated by the effects of the drug

Adverse Effects

Use of mitotic inhibitors may result to these adverse effects:

  • CNS: headache, drowsiness, aphasia, fatigue, malaise, dizziness
  • Respiratory: pulmonary toxicity, interstitial pneumonitis
  • Hematological: bone marrow suppression
  • GI: nausea, vomiting, anorexia, diarrhea, mucous membrane deterioration, hepatic toxicity
  • GU: renal toxicity
  • Can cause necrosis and cellulitis if extravasation occurs

Hormones and Hormone Modulators


Description

  • Some cancers are sensitive to estrogen stimulation. Estrogen-receptor sites on the tumor react with circulating estrogen, and this reaction stimulates the tumor cells to grow and divide.
  • Hormones and hormone modulators block or interfere with these receptor sites to prevent growth of the cancer and cause cell death.
  • Some hormones are used to block the release of gonadotropic hormones in breast or prostate cancer if the tumors are responsive to gonadotropic hormones. Others may block androgen-receptor sites directly.

Therapeutic Action

The desired and beneficial action of hormones and hormone modulators is:

  • Blocking the stimulation of growing cancer cells that are sensitive to the presence of that hormone.

Indications

Hormones and hormone modulators are indicated for the following medical conditions:

  • Treatment of breast cancer in postmenopausal women or in other women without ovarian function.
  • Treatment of prostatic cancers that are sensitive to hormone manipulation.

Pharmacokinetics

Here are the characteristic interactions of hormones and hormone modulators and the body in terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration
Oral Varies 4-7 h
T1/2: 7-14 days
Metabolism: liver
Excretion: colon (feces)

Contraindications and Cautions

The following are contraindications and cautions for the use of hormones and hormone modulators:

  • Known allergy to drug. Prevent hypersensitivity reactions
  • Hypercalcemia. Contraindication to the use of toremifene because the drug can increase serum calcium levels.
  • Pregnancy and lactation. Severe effects on the fetus and neonate
  • Bone marrow suppression. Index of redosing and dosing levels
  • Renal and hepatic dysfunction. Interfere with drug metabolism and excretion
  • Known GI ulceration or ulcerative diseases. Can be exacerbated by the effects of the drug

Adverse Effects

Use of hormones and hormone modulators may result to these adverse effects:

  • Menopause-associated effects: hot flashes, vaginal spotting, vaginal dryness, moodiness, and depression
  • Hematological: bone marrow suppression
  • GI: hepatic toxicity
  • GU: renal toxicity
  • Hypercalcemia is encountered as the calcium is pulled out of the bones without estrogen activity to promote calcium deposition.

Cancer Cell-Specific Agents


Description

  • These agents are only specific to cancer cells and spare the healthy cells its devastating effects. Patients do not experience the numerous adverse effects associated with antineoplastic chemotherapy.
  • Three groups of drugs are cancer cell-specific: protein tyrosine kinase inhibitors, epidermal growth factor inhibitor, and proteasome inhibitor.

Therapeutic Action

The desired and beneficial action of cancer cell-specific agents is:

  • Protein tyrosine kinase inhibitors act on specific enzymes that are needed for protein building by specific tumor cells. Blocking of these enzymes inhibits tumor cell growth and division.
  • Epidermal growth factor inhibitors are drugs that act on epidermal growth factor receptors which are found in both normal and cancerous cells but are more abundant on the latter.
  • Proteasome inhibitors are drugs indicated for inhibition of proteasome in human cells, a large protein complex that works to maintain cell homeostasis and protein production.

Indications

Cancer cell-specific agents are indicated for the following medical conditions:

  • Imatinib, the first drug approved protein tyrosine kinase inhibitor, is given orally and is approved to treat chronic myelocytic leukemia (CML). It selectively inhibits the Bcr-Abl tyrosine kinase created by the Philadelphia chromosome abnormality in CML.
  • Bortezomib is used for the treatment of multiple myeloma in patients whose disease had progressed after two standard therapies.

Pharmacokinetics

Here are the characteristic interactions of cancer cell-specific agents and the body in terms of absorption, distribution, metabolism, and excretion:

Route Onset Peak Duration
Oral Slow 2-4 h
T1/2: 18-40 h
Metabolism: liver
Excretion: colon (feces)

Contraindications and Cautions

The following are contraindications and cautions for the use of cancer cell-specific agents:

  • Pregnancy. All drugs in this class is pregnancy category D.
  • Women of childbearing age. Must be advised to use barrier contraceptives while taking these drugs.
  • Lactation. Can enter breastmilk and use is only justified if benefits outweigh the risks.
  • Hepatic dysfunction. Increased risk of toxicity with imatinib and pazopanib.
  • Risk for prolonged QT intervals (hypokalemia, hypomagnesia, taking drugs that can prolong QT intervals). Contraindicated with nilotinib.
  • Known allergy to the drug. Prevent hypersensitivity reactions.

Adverse Effects

Use of cancer cell-specific agents may result to these adverse effects:

  • Imatinib: GI upset, muscle cramps, heart failure, fluid retention, skin rash. Severe adverse effects of traditional antineoplastic therapy (severe bone marrow depression, alopecia, severe GI effects) do not occur.
  • Gefitinib: potentially severe interstitial lung disease and various eye symptoms
  • Pazopanib: some bone marrow depression, diarrhea, hypertension, and liver impairment, change in hair color
  • Lapatinib: diarrhea, liver impairment, altered heart function
  • Erlotinib and bortezomib: cardiovascular events, pulmonary toxicity
  • Bortezomib: peripheral neuropathy, liver and kidney impairment

Interactions

The following are drug-drug interactions involved in the use of antineoplastic agents:

  • Any drug that has potential for hepatic or renal toxicity
  • Adversely affect drugs metabolized in the liver (e.g. oral anticoagulants)
  • Antineoplastic antibiotics can increase toxicity of drugs that are toxic to the heart and lungs.
  • Echinacea: increased risk of hepatotoxicity with antineoplastics
  • Ginkgo: inhibits blood clotting, which can cause problems after surgery or with bleeding neoplasms
  • Saw palmetto: increase the effects of various estrogen hormones and hormone modulators; advise patients taking such drugs to avoid this herb
  • St. John’s wort: can greatly increase photosensitivity, which can cause problems in patient who have received radiation therapy or are taking drugs that cause other dermatological effects. In addition, it can decrease the effectiveness of some antineoplastic agents.

Nursing Considerations


Here are important nursing considerations when administering antineoplastic agents:

Nursing Assessment

These are the important things the nurse should include in conducting assessment, history taking, and examination:

  • Assess for the mentioned cautions and contraindications (e.g. drug allergies, hepatorenal impairment, bone marrow suppression, pregnancy and lactation, etc.) to prevent any untoward complications.
  • Perform a thorough physical assessment (other medications taken, orientation and reflexes, vital signs, bowel sounds, etc.) to establish baseline data before drug therapy begins, to determine effectiveness of therapy, and to evaluate for occurrence of any adverse effects associated with drug therapy.
  • Monitor result of laboratory tests such as CBC with differential to identify possible bone marrow suppression and toxic drug effects and establish appropriate dosing for the drug; and liver and renal function tests to determine need for possible dose adjustment and identify toxic drug effects.

Nursing Diagnoses

Here are some of the nursing diagnoses that can be formulated in the use of these drugs for therapy:

Implementation with Rationale

These are vital nursing interventions done in patients who are taking alkylating agents:

  • Arrange for blood tests before, periodically during, and for at least 3 weeks after therapy to monitor bone marrow function to aid in determining the need for a change in dose or discontinuation of the drug.
  • Administer medication according to scheduled protocol and in combination with other drugs as indicated to improve effectiveness.
  • Ensure that patient is well hydrated to decrease risk of renal toxicity.
  • Protect the patient from infection; limit invasive procedures when bone marrow suppression limits the patient’s immune/inflammatory responses.
  • Provide small, frequent meals, frequent mouth care, and dietary consultation as appropriate to maintain nutrition when GI effects are severe.
  • Arrange for proper head covering at extremes of temperature if alopecia occurs; a wig, scarf, or hat is important for maintaining body temperature.
  • Plan for rest periods because fatigue and weakness are common effects of the drug.

Evaluation

Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:

  • Monitor patient response to therapy (alleviation of cancer being treated, palliation of signs and symptoms of cancer).
  • Monitor for adverse effects (bone marrow suppression, GI toxicity, neurotoxicity, and alopecia, renal or hepatic dysfunction).
  • Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for.
  • Monitor patient compliance to drug therapy.

Practice Test: Antineoplastic Agents


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1. All of the following statements are not true about antineoplastic agents, except:

A. These drugs assume the role of the innate defenses of humans in destroying rapidly-dividing cells.
B. Normal cells are always spared from the effects of antineoplastic agents.
C. A and B
D. None of the above

1. Answer: D. None of the above.

Drugs boost the immune system in its efforts to combat the abnormal cells and do not necessarily assume its roles. In more traditional antineoplastic chemotherapy, normal cells are also affected. Hence, the severe adverse effects on bone marrow, GIT, and other rapidly-dividing cells.

2. A student nurse was asked to give an example of an antimetabolite. He would be correct to state which drug as an example?

A. mercaptopurine
B. cisplatin
C. dactinomycin
D. vincristine

2. Answer: A. mercaptopurine.

  • Option B is an alkylating agent.
  • Option C is an antineoplastic antibiotic.
  • Option D is a mitotic inhibitor.

3. The goal of utilization of drugs as one component of chemotherapy is: 

A. to disintegrate the tumors completely
B. to decrease the size of the neoplasm
C. to stop the genetic mutations responsible for cancers
D. to prevent metastasis of neoplasms

3. Answer. B. To decrease the size of the neoplasm.

This is to the point in which the human immune system can deal with it.

4. Which patient complaint would be the least of concern of a nurse taking care of an elderly on antineoplastic agents?

A. RUQ pain
B. facial puffiness
C. keloid formation on previous IV site
D. oliguria

4. Answer: C. keloid formation on previous IV site.

Options A, B, and D, may be a sign of hepatic and renal toxicity.

5. At which stage of cell cycle is alkylating agent specific?

A. G1 phase
B. S phase
C. M phase
D. None. It is non-specific.

5. Answer: D. None. It is non-specific.

Antimetabolites are S phase-specific. Mitotic inhibitors alter the M phase of the cell cycle.

6. Antineoplastic antibiotics exert their therapeutic action through which mechanism?

A. Causing a mutant DNA molecule
B. Inhibiting DNA polymerase
C. Preventing the cells to divide.
D. Works with hormones to stop stimulating growth of tumors

6. Answer: A. Causing a mutant DNA molecule.

They do this by inserting themselves between base pairs in the DNA chain. Option B is for antimetabolites. Option C is the work of mitotic inhibitors. Option D is for hormones and hormone modulators.

7. As part of pre-operative preparation, a patient showing signs of problems with blood clotting should be asked about usage of which herb?

A. Saw palmetto
B. Echinacea
C. St. John’s wort
D. Ginkgo

7. Answer: D. Ginkgo.

It inhibits blood clotting and can cause problems after surgery. Option A can increase the effects of various estrogen hormones. Option B can increase the risk for hepatotoxicity. Option C can increase photosensitivity.

8. How soon after therapy should blood tests be done to monitor bone marrow function?

A. At least a week after
B. 2 weeks after
C. 3 weeks after
D. 5 days

8. Answer: C. 3 weeks after.

9. Which drug has been approved for use in treating CML?

A. Bortezomib
B. Imatinib
C. Pazopanib
D. Erlotinib

9. Answer: B. Imatinib

10. Which is an absolute contraindication in patients receiving nilotinib, a cancer cell-specific agent?

A. hypomagnesemia
B. short QT syndrome
C. hypercalcemia
D. intake of digitalis

10. Answer: A. hypomagnesemia.

Any condition that can prolong QT interval is a contraindication to the use of nilotinib. All other options can shorten QT interval.

See Also


Here are other nursing pharmacology study guides:

Endocrine System Drugs

Autonomic Nervous System Drugs

Immune System Drugs

Chemotherapeutic Agents

Reproductive System Drugs

Nervous System Drugs

Cardiovascular System Drugs

Further Reading and Resources


Recommended resources and books:

  1. Focus on Nursing Pharmacology - Easy to follow guide for Pharmacology
  2. NCLEX-RN Drug Guide: 300 Medications You Need to Know for the Exam - Great if you're reviewing for the NCLEX
  3. Nursing 2017 Drug Handbook (Nursing Drug Handbook) - Reliable nursing drug handbook!
  4. Lehne's Pharmacology for Nursing Care - Provides key information on commonly used drugs in nursing
  5. Pharmacology and the Nursing Process - Learn how to administer drugs correctly and safely!
  6. Pharm Phlash Cards!: Pharmacology Flash Cards - Flash Cards for Nursing Pharmacology