Oncological & Hematological Medications — Chemotherapy, Targeted Therapies, and NCLEX Nursing Safety | Chapter 42: Saunders NCLEX-PN Review

Oncological & Hematological Medications — Chemotherapy, Targeted Therapies, and NCLEX Nursing Safety | Chapter 42: Saunders NCLEX-PN Review

Chapter 42 of Saunders Comprehensive Review for the NCLEX-PN® Examination (7th Edition) by Linda Anne Silvestri and Angela E. Silvestri delivers a comprehensive overview of pharmacologic agents used in oncology and hematology. This chapter equips nursing students with essential knowledge of medication classes, side effects, nursing precautions, and patient education strategies for NCLEX success and safe clinical practice.

Watch the video above for a focused high-yield review, then dive into the expanded notes below. For more NCLEX-PN pharmacology and nursing care resources, subscribe to Last Minute Lecture on YouTube.

Book cover

Antineoplastic Medication Classifications

Antineoplastic drugs are classified as cell cycle–specific or nonspecific, with combination regimens designed to maximize tumor cell kill and reduce resistance. Dosing is often based on body surface area (BSA) to individualize therapy.

Common Classes and Key Agents

  • Alkylating Agents: Cyclophosphamide (use mesna for hemorrhagic cystitis prevention), cisplatin (monitor for nephrotoxicity and ototoxicity).
  • Antitumor Antibiotics: Doxorubicin (cardiotoxicity risk; monitor ECG and echocardiogram), bleomycin (pulmonary toxicity).
  • Antimetabolites: Methotrexate (requires leucovorin rescue), fluorouracil, cytarabine.
  • Mitotic Inhibitors: Vincristine (neurotoxicity; monitor for peripheral neuropathy), paclitaxel.
  • Topoisomerase Inhibitors: Etoposide (orthostatic hypotension), irinotecan.
  • Hormonal Agents: Tamoxifen (estrogen receptor blocker; monitor for thromboembolism), leuprolide, asparaginase.
  • Immunomodulators: Interferons, interleukins, colony-stimulating factors such as epoetin alfa (stimulates RBCs) and filgrastim (stimulates neutrophils).
  • Monoclonal Antibodies: Rituximab, trastuzumab, bevacizumab — targeted therapies with specific immune-mediated actions.

Common Side and Adverse Effects

  • Mucositis and stomatitis — provide oral care, avoid irritating foods
  • Myelosuppression — implement neutropenic and bleeding precautions
  • Alopecia — offer scalp cooling, wigs, and emotional support
  • Nausea and vomiting — administer antiemetics before treatment
  • Peripheral neuropathy — monitor gait and safety in ambulation

Safety in Chemotherapy Administration

Strict safety measures include wearing PPE (gloves, gown, mask), using central lines for vesicant drugs, and following protocols for extravasation management. Nurses should double-check doses, monitor for hypersensitivity reactions, and keep emergency equipment nearby for anaphylaxis management.

Special Nursing Considerations

  • Hydration protocols to prevent nephrotoxicity
  • Monitoring lab values — CBC, renal and hepatic function, electrolytes, uric acid
  • Education on avoiding live vaccines during immunosuppression
  • Fertility preservation counseling before starting therapy
  • Psychosocial support for body image changes and treatment fatigue

Oncologic Emergencies Related to Medications

Be alert for severe infusion reactions, tumor lysis syndrome, and extravasation injuries. Immediate intervention can prevent permanent damage or life-threatening complications.

Conclusion

Understanding the pharmacology of oncological and hematological medications is critical for safe administration and effective patient education. Mastery of drug classes, side effects, and safety measures ensures both NCLEX readiness and competent clinical care.

If you found this breakdown helpful, be sure to subscribe to Last Minute Lecture for more chapter-by-chapter textbook summaries and academic study guides.

Explore the full playlist for Saunders Comprehensive Review for the NCLEX-PN® Examination (7th Edition) here: Complete NCLEX-PN Review Playlist

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