Alkylating agents prevent cancer cells from reproducing by attaching an alkyl group to DNA. The medications inhibit DNA transcription into RNA to prevent protein synthesis and stop cell growth. The drugs form covalent bonds in DNA and cause cross-linking.
The drug binds to cell and forms cross-links within strands of DNA to prevent DNA replication and lead to cell death. By inhibiting protein synthesis, alkylating agents such as cisplatin trigger apoptosis in rapidly dividing tumor cells. Although the drug primarily affect rapidly proliferating tumor cells, cisplatin will also affect cells of the gastrointestinal tract and bone marrow.
Cisplatin is indicated to help treat metastatic testicular cancer. To increase the effectiveness of chemotherapy, cisplatin may be administered with other chemotherapy drugs for the treatment of testicular cancer.
This medication is indicated to help treat metastatic ovarian cancer and advanced bladder cancer. The drug also has an off-label use for lung, head, and neck cancers.
Cisplatin may cause intractable nausea and vomiting characterized by repeated vomiting relief from anti-emetic medications. The patient may experience symptoms within 1 hour of administration. The continuous vomiting leads to anorexia, headaches, and electrolyte imbalances. Ensure the patient maintains adequate hydration and assess electrolyte levels.
Cisplatin may cause profound bone marrow suppression known as myelosuppression. Since the bone marrow is unable to make enough red blood cells, white blood cells, and platelets, monitoring the patient's blood counts is critical during drug therapy. Symptoms of anemia include fatigue, chest pain, shortness of breath, and dizziness. A decrease of white blood cells increases the patient's risk of infection while a low platelet count increases the risk of bleeding.
A dose-limiting factor, renal damage may occur within 2 weeks of using cisplatin. Administering the medication with other nephrotoxic drugs will potentiate the effects of kidney damage. To minimize nephrotoxicity, ensure the patient is well hydrated while undergoing diuretic therapy. Monitor the patient's urine output and specific gravity to assess kidney function. The dose of cisplatin may be decreased if the patient has reduced creatinine clearance.
Ototoxicity is a neurological, dose-dependent side effect of cisplatin that may happen soon after initiating treatment. The drug inhibits a certain transporter found on cochlear hair cells that receive input for the auditory system. Damage to these cells lead to high frequency hearing loss and tinnitus. Since loop diuretics may also induce ototoxicity, concurrent administration of cisplatin with furosemide (Lasix) may potentiate the effects of hearing damage.
A side effect of Cisplatin is peripheral neuropathy caused by the inhibition of certain ion transporters found on cells of the peripheral nervous system. Symptoms include numbness, tingling, burning, or pain in the hands or feet. Since the side effect is dose-dependent, high doses and long-term use increases the likelihood of developing peripheral neuropathy.
Cisplatin is administered by IV infusion. Before administering cisplatin, antiemetics may be given to decrease nausea and vomiting caused by damage to cells of the gastrointestinal tract. Severe nausea and vomiting may occur within 1 hour of administration and may last up to 5 days.
To minimize the risk of renal damage, aggressive hydration is done before and after the administration of cisplatin. Oral fluids are encouraged and additional IV hydration and electrolyte supplementation may be administered. Increasing the patient's fluid intake also helps decrease the risk of dehydration caused by repeated vomiting.
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