Ifosfamide

Ifosfamide is an alkylating agent and an antineoplastic that acts by interfering with the
replication of susceptible cells. It is cell cycle nonspecific. Throughout the cell cycle, it destroys
DNA by binding to protein and DNA cross-linking with DNA, and causing chain disruption as
well as the inhibition of DNA synthesis. It is immunosuppressive and lymphocytes have an
increased sensitivity to its effects. It is indicated for the treatment of soft-tissue sarcomas such as
rhabdomyosarcoma. The patient does not have any contraindications for this medication.
Contraindications include hypersensitivity to Ifosfamide, pregnancy, and lactation. Common side
effects are nausea, vomiting, loss of appetite, skin darkening, and loss of hair. Possible adverse
effects include hemorrhagic cystitis, leukopenia, thrombocytopenia, increased serum uric acid
levels, somnolence, and immunosuppression. Among the mentioned side effects, nausea,
vomiting, loss of appetite and alopecia are the ones experienced by the patient.
It is essential to watch out for unusual bleeding or bruising and for any signs of infection.
It is important to observe infection precautions for the patient since this medication can leave the
patient immunosuppressed because of its effects on the lymphocytes and on other blood
components.
Etoposide
Etoposide is classified as an antineoplastic and a mitotic inhibitor. It acts on the G2 phase
of the cell cycle by lysing cells that enter mitosis. It prevents cells from entering prophase and
inhibits DNA synthesis. Its terminal effect is cell death. It is indicated for treatment of
rhabdomyosarcoma as in the case of the patient. Common side effects are loss of appetite,
nausea, vomiting, mouth sores, and alopecia. Of these, the patient experienced a loss of appetite,
nausea, vomiting, and alopecia. The patient does not possess any contraindication to the drug. It
is contraindicated in patients with hypersensitivity to etoposide, teniposide, and Cremophor;
pregnancy and lactation. Adverse effects that can possibly happen are somnolence, fatigue,
myelotoxicity, and carcinogenesis.
It is essential to watch out for severe GI upset, diarrhea, vomiting, unusual bleeding or
bruising, fever, chills, sore throat, and dyspnea. Signs of infection should be watched out for as
well. It is important that infection precautions be observed since this drug can leave the patient
immunosuppressed because of it can cause significant myelosuppression thereby impairing the

secondary defenses of the patient. Its myelosuppressive effects are greater when combined with
other neoplastics. As for the patient, Etoposide is given in combination with Ifosfamide.
Therefore, risk for infection is very high.
Mesna
Mesna is a chemoprotectant that is used to prevent hemorrhagic cystitis due to the use of
Ifosfamide. It acts by binding to and inactivating acrolein, a metabolite which is produced by
some chemotherapeutic drugs that is toxic to the bladder, such as Ifosfamide. It is indicated for
the patient since the patient is being treated with Ifosfamide. The patient does not have any
contraindication for this medication. Contraindications for the use of Mesna include
hypersensitivity to it, pregnancy, lactation, and auto-immune disorders. It can cause fatigue,
fever, abdominal pain, constipation, dyspnea, alopecia, leukopenia, granulocytopenia, and
anemia as its adverse effects. Of these, besides those already caused by Ifosfamide and
Etoposide, constipation and abdominal pain are the effects of Mesna felt by the patient. So far,
the patient has not developed hemorrhagic cystitis. It is important to monitor the patient for
possible hematuria which is a sign of hemorrhagic cystitis. Vigorous hydration is essential and
must be maintained while the patient is being treated to aid in flushing out the toxins from the
urinary bladder.
Ondansetron
Ondansetron is an antiemetic drug which acts by blocking specific receptor sites (5-HT3)
which are associated with nausea and vomiting in the chemoreceptor trigger zone. It is given to
the patient thirty minutes before chemotherapy so as to counteract the induction of nausea and
vomiting by the chemotherapeutic agents. It is contraindicated when the patient has
hypersensitivity to it or when the patient is pregnant, lactating, or with hepatic impairment.
Despite its purpose of preventing nausea and vomiting, it can however cause the following side
effects: weakness, dizziness, and drowsiness. Its adverse effects include headache, myalgia,
diarrhea, abdominal pain, constipation, and urinary retention. Of these, weakness, abdominal
pain and constipation are experienced by the patient. Timing is important for this medication. It
must correspond with the timing of chemotherapy to ensure that it serves its purpose of

preventing nausea and vomiting. In the case of the patient, this medication is given 30 minutes
prior to chemotherapy.
Dexamethasone
Dexamethasone is classified as a corticosteroid, glucocorticoid, and a hormone. It acts by
entering target cells and binding to specific receptors to initiate reactions that are needed for its
anti-inflammatory and immunosuppressive effects. Dexamethasone is given to the patient to
counteract certain side-effects of chemotherapy. Dexamethasone serves its purpose by enhancing
the antiemetic effect of ondansetron. It also serves to prevent the possible occurrence of
ulcerative colitis. In addition, it can also recruit malignant cells out of the G 0 phase thereby
making them susceptible to damage caused by cell-cycle phase-specific agents. This is given to
the patient thirty minutes prior to each administration of chemotherapeutic agents. Timing is
crucial since it may not serve its purpose of minimizing or preventing side effects when given in
close chronologic proximity with the chemotherapeutic medications themselves. This medication
is contraindicated when there is an infection present since it can further aggravate the infection.
It is also contraindicated in patients who are hypersensitive to it. Dexamethasone, however, can
cause seizures, vertigo, headaches, insomnia, depression, mood swings, hypertension, muscle
weakness, and immunosuppression. The nurse must observe strict infection prevention measures
for the patient.
Cotrimoxazole
Cotrimoxazole is an antibacterial that acts by inhibiting the reduction of folic acid to
tetrahydrofolate in susceptible bacteria. It is given to the patient to serve as prophylaxis against
certain infections such as those caused by various bacteria such as E. coli and K. pneumonia
given that the patient is highly susceptible to infections due to the immunosuppressive effects of
his medications. Contraindications for this medication are hypersensitivity, lactation, and
megaloblastic anemia. The patient does not possess any of the contraindications. Possible
adverse effects of this medication include rashes, epigastric distress, nausea, vomiting,
thrombocytopenia, leucopenia, and neutropenia. The nurse must watch out for fever, sore throat,
any unusual bleeding or bruising, dizziness, headache, and rash.

Filgastrim (GCSF)
Filgastrim is a colony-stimulating factor. It is a human granulocyte colony-stimulating
factor produced through recombinant DNA technology. It serves to increase the production of
neutrophils inside the bone marrow. It has little effect on other hematopoietic cells. It is indicated
for the patient because of the high possibility of neutropenia secondary to chemotherapy.
Neutrophils, which serve as the bodys first line of internal defense against infection or invading
microorganisms, are the most important of the granulocytes (Burke et al, 1991). The bone
marrow which responds to the bodys needs for white blood cells, red blood cells, and platelets is
temporarily injured by chemotherapy. Because of this, production of white blood cells is
impaired. Along with this, neutrophils are decreased and need to be increased through
stimulation of production by this medication. Common side effects are bone pain, nausea,
vomiting, and alopecia. Adverse effects include headache, fatigue, generalized weakness,
mucositis, and sore throat. Infection prevention measures must be observed and blood counts
should be monitored so as to ensure that the neutrophil count has reached normalcy.
Metoclopramide
Metoclopramide is classified as an antiemetic, dopaminergic blocker, and GI stimulant. It
is given to the patient, as needed, for its antiemetic effect. It acts by blocking the dopamine
receptors in the chemoreceptor trigger zone in the CNS. It is contraindicated to patients with
hypersensitivity to it, GI hemorrhage, lactation, pregnancy, fluid overload, and renal impairment.
Common side effects of this medication include drowsiness, dizziness, restlessness, anxiety,
depression, headache, insomnia, nausea, and diarrhea. Of these, only nausea has been
experienced by the patient. Adverse effects then include transient hypertension and
extrapyramidal reactions. None of these have been experienced by the patient. As mentioned
before, this medication is given to the patient PRN or as needed in case of episodes of vomiting.
It is then important for the nurse to monitor the patient and to watch out for episodes of vomiting
so this medication can be administered immediately.
Diphenhydramine
Diphenhydramine is placed under many classifications: antihistamine, anti-motionsickness drug, antiparkinsonian, cough suppressant, and sedative-hypnotic. But mainly, in this

case it is used for treatment of nausea. It acts by competitively blocking the effects of histamine
at H1-receptor sites. It has atropine-like, antipruritic, and sedative effects. As seen in the
assessment, the patient has widely-dilated pupils (6mm in both eyes) which may be due to the
atropine-like effects of this medication. This medication is given to the patient PRN or as needed
in cases of vomiting. Contraindications to this drug include hypersensitivity, narrow-angle
glaucoma, and pregnancy. Common side effects of this drug include dizziness, sedation,
drowsiness, and a dry mouthnone of which have been experienced by the patient. The nurse
must carefully observe and assess the patient for the occurrence of nausea which often precedes
the occurrence of vomiting.