Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Chemotherapeutic agents

Varies with drug; treatment for AML generally uses higher doses over a shorter period of time, whereas treatment for ALL uses lower doses over a longer period of time; treatment varies for children and adults and with phases of treatment

Adult

AML remission Induction: Anthracycllne (idarubicin or daunorubicin) or anthracenedione (mitoxantrone) combined with arabinosylcytosine (araC)

For ALL, induction therapy involves a four-drug regimen (vincristine, prednisone, anthracycline, and cyclophosphamide or L-asparaginase) or a five-drug regimen (vincristine, prednisone, anthracycline, cyclophosphamide, and L-asparaginase) over the course of 4-6 wk. Complete remissions are obtained in 65% to 85% of patients

Child

AML induction: Daunomycin or idarubicin, cytosine arabinoside, and etoposide along with oral 6-thioguanine and dexamethasone ALL induction: Prednisone, asparaginase, vincristine, and anthracycline

Decrease replication of leukemia cells and kill them

Other Treatment: Supportive care and management of complications from chemotherapy are handled with blood products and pharmacologically with antibiotics, antifungals, and antiviral drugs. Growth factors (colony-stimulating factors) may be given to elevate blood counts.

Independent

Focus on providing comfort and support, managing complications, and providing patient education. Determine how the patient is coping with the disease and where you can best provide support. For some patients, improving their comfort is the highest priority, either physically, such as with a bed bath or back rub, or emotionally, such as by listening to fears and concerns and providing interesting distractions. Teach the patient stress- and pain-reduction techniques. Provide mouth care to lessen the discomfort from oral lesions. Support the patient's efforts to maintain grooming and a positive body image. If the patient is a child, provide age-appropriate diversions, and work with the parents or caregivers to keep the significant others present and involved in the child's care.

Protect the patient from injury and infection. To limit the risk of bleeding, hold firm pressure on all puncture wounds for at least 10 minutes or until they stop oozing. Limit the use of intramuscular injections and intravenous catheter placement when the patient is pancytopenic. Avoid taking rectal temperatures, using rectal suppositories, or performing a rectal examination. If the patient does not respond to treatment, be honest about the patient's prognosis. Determine from parents how much information they want to share with the child about a terminal disease. Work with the patient, significant others, and chaplain to help the patient plan for a terminal illness and achieve a compassionate death.

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