APHON Pediatric Chemotherapy-Biotherapy Renewal

Oxaliplatin. Oxaliplatin is a platinum-based alkylating agent used to treat non-Hodgkin lymphoma as well as germ cell and solid tumors. It is administered intravenously and can cause acute sensory neuropathy. This neurotoxicity can occur within 30 to 60 minutes of the oxaliplatin infusion and consists of paresthesia, cold hypersensitivity, jaw and eye pain, ptosis, leg cramps, and visual and voice changes (Verstappen et al., 2003). Symptoms may last for several days after infusion, and the patient must be instructed to avoid cold food, drinks, and ambient temperatures during the infusion and for several days afterward. A chronic, cumulative neuropathy may also occur in patients who receive several courses of oxaliplatin. Symptoms include tingling, numbness, and even loss of sensation for touch or temperature. Chronic symptoms can last for weeks and may interfere with activities of daily living such as buttoning, writing, and walking. This cumulative neuropathy can be a dose-limiting toxicity. Vinca Alkaloids Vincristine. Vincristine, a cell-cycle-specific vinca alkaloid, arrests cell division by the inhibition of microtubule formation in the mitotic spindle; therefore, it is classified as a tubulin inhibitor. Vincristine has indications for use in protocols of treatment for hematologic malignancies and solid tumors such as leukemia, Ewing sarcoma, rhabdomyosarcoma, Wilms tumor, and retinoblastoma. The central nervous system toxicities associated with vincristine include encephalopathy and seizures. Seizure activity may come as a result of hyponatremia due to syndrome of inappropriate antidiuretic hormone, a rare but possible side effect of vincristine. The administering nurse and the nurse performing the double check must be cognizant of the dose of vincristine being given because accidental overdose with vincristine may cause a central nervous system toxicity that may lead to death. Fatal myeloencephalopathy may also occur if the vincristine is accidentally administered intrathecally. Vincristine is administered intravenously only. Although the central nervous system toxicities related to vincristine are quite serious, patients more frequently experience peripheral nervous system toxicities. These peripheral nervous system toxicities are thought to be caused by inhibition of fast axonal transport by microtubules (Verstappen et al., 2003) and include paresthesia in the fingers and toes and weakness in the extensor muscles of the wrist and dorsiflexors of the toes. An altered gait, difficulty walking, and numbness or tingling of the fingers and toes could help a healthcare provider recognize this neurotoxicity. Cranial nerve palsies such as vocal cord paresis, diplopia, facial nerve palsy, ophthalmoplegia, and sensorineural hearing loss have also been experienced. It is important to ensure that a thorough neurologic assessment is performed for any patient receiving vincristine therapy. Vincristine therapy can also cause autonomic neuropathies in the form of constipation, which may lead to paralytic ileus or megacolon; bladder atony, impotence, orthostatic hypotension, and disturbed heart rate may also occur. When assessing a patient receiving vincristine therapy, the nurse should ask questions about elimination to safeguard against the downstream complications of paralytic ileus and urinary retention.