NCLEX Review Guide: Alkylating Medications

Mechanism of Action

• Alkylating agents work by cross-linking DNA strands, preventing cell division and causing cell death in rapidly dividing cancer cells.
• These medications are cell cycle non-specific, meaning they can kill cells in any phase of the cell cycle.

Major Drug Categories

• Cyclophosphamide (Cytoxan) - Most commonly used, requires activation in the liver
• Cisplatin - Platinum-based compound, highly nephrotoxic and ototoxic
• Carboplatin - Less nephrotoxic than cisplatin but causes more myelosuppression
• Mechlorethamine - Nitrogen mustard, highly vesicant if extravasated

Life-Threatening Complications

• Myelosuppression - Monitor CBC weekly, nadir occurs 7-14 days post-treatment
• Hemorrhagic cystitis (cyclophosphamide) - Encourage fluid intake 2-3L/day, monitor for blood in urine
• Nephrotoxicity (cisplatin) - Monitor creatinine, BUN, and urinalysis before each cycle
• Ototoxicity (cisplatin) - Assess hearing before and during treatment

Pre-Administration Assessment

1. Obtain baseline CBC with differential, platelet count
2. Assess kidney function (creatinine, BUN, creatinine clearance)
3. Evaluate liver function tests (for cyclophosphamide)
4. Perform hearing assessment (for cisplatin)
5. Ensure adequate hydration status

Administration Guidelines

• Vesicant precautions - Use central line when possible, monitor IV site continuously
• Pre-medicate with antiemetics 30-60 minutes before administration
• Ensure adequate hydration before cisplatin (1-2L normal saline)
• Use protective equipment when handling - these are hazardous drugs

Essential Teaching Points

• Report signs of infection immediately (fever >100.4°F, chills, sore throat)
• Avoid crowds and people with infections due to immunosuppression
• Increase fluid intake to 2-3 liters daily (especially with cyclophosphamide)
• Report any hearing changes, ringing in ears, or balance problems
• Use reliable contraception - these drugs are teratogenic