Oncology and hematology medications

Oncology medication items turn on marrow rescue drugs, the nadir calendar, mucosal injury, and vesicant spills into tissue. PPE and hazardous-drug spills are taught in Oncology care. Transfusion reaction management lives in Bleeding and transfusion. This chapter owns growth factors and chemo effect teaching.

Hematopoietic growth factors

Myelosuppressive chemotherapy kills rapidly dividing marrow cells along with tumor. Filgrastim and related G-CSF agents bind neutrophil precursors and speed recovery of absolute neutrophil count (ANC), shortening the neutropenic window. Timing is protocol-specific: giving G-CSF too close to chemo can theoretically worsen marrow stress on some regimens, so exams expect you to follow the separation order rather than invent same-bag convenience. Bone pain — especially sternum, pelvis, and long bones — is the signature side effect; analgesics as ordered and honest teaching beat stopping a needed drug for expected ache.

Epoetin alfa and cousins stimulate erythroid lines for anemia of chronic disease or chemo-related anemia when ordered. More red cells mean higher viscosity and blood pressure risk; thrombosis (including vascular access clots and cardiovascular events) is the safety theme. Protocols set hemoglobin ceilings — if the value climbs above target, hold and call rather than chasing a “normal” that increases clot risk. Iron stores may need support for EPO to work; that is ordered supplementation, not megadose freelancing. Teach subcutaneous technique and storage per product when clients self-administer.

• Report chest pain, severe headache, or unilateral leg swelling on EPO.
• Filgrastim does not treat fever — febrile neutropenia still needs urgent workup.
• Do not shake some biologic vials; follow pharmacy prep rules.

Chemo nadir: infection and bleeding

Nadir is the predictable low point of WBC, neutrophils, and often platelets after a chemo cycle — commonly one to two weeks later depending on the regimen. Neutrophils are the bacterial defense; when ANC crashes, ordinary skin and gut flora can invade. Teaching: take temperature seriously, report fever as an emergency, avoid crowds and sick contacts, practice hand hygiene, and skip invasive procedures that can be delayed. Fresh flowers, standing water, and undercooked foods appear as teaching details on some stems. Growth factors may blunt the depth of nadir but do not erase fever protocols.

Low platelets and chemo-induced coagulopathy raise bleeding risk. Use soft toothbrushes, electric razors, and fall precautions; avoid IM injections and rectal temperatures when counts are critically low per policy. Petechiae, gum bleeding, hematuria, and melena are reportable. Transfusion thresholds and reaction recognition belong in Bleeding and transfusion — here, emphasize prevention and early reporting during nadir.

1. Know the client's expected nadir window from the regimen.
2. Fever → notify, cultures, antibiotics as protocoled without delay.
3. Bleed precautions scale with platelet count and clinical oozing.

Mucositis and extravasation basics

Mucositis is inflammatory injury to rapidly dividing oral and GI mucosa from chemo or radiation. Painful ulcers impair intake and open a portal for infection during neutropenia. Assess the mouth every shift, start soft mechanical care early, use saline or ordered rinses, avoid alcohol-based mouthwash that burns tissue, manage pain so the client can swallow, and watch for fungal superinfection. Neutropenic diet and swallowing safety connect when mucositis is severe. Hydration and calorie support prevent the downward spiral of weight loss plus infection.

Extravasation occurs when IV chemo — especially vesicants such as anthracyclines or vinca alkaloids as commonly tested — leaks into subcutaneous tissue. Early cues are pain, burning, swelling, and lack of blood return. Stop the infusion immediately. Do not reflexively yank the catheter if protocol uses the line to aspirate residual drug or instill antidote. Notify the provider or chemo team, mark the area, elevate as directed, and apply cold or heat according to the specific agent (vinca alkaloids often differ from anthracyclines). Photograph and incident-report per policy. Prevention: verify blood return, use appropriate access for vesicants, and stay with the client during the risk window. Hazardous spill cleanup and PPE for nurses are covered in Oncology care.

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