hydroxyurea (Rx)

Assessment - Assess buccal cavity q8 hr for dryness, sores or ulceration, white patches, oral pain, bleeding, dysphagia; obtain prescription for viscous lidocaine (Xylocaine) - Assess symptoms indicating severe allergic reaction: rash, pruritus, urticaria, purpuric skin lesions, itching, flushing - Bone marrow suppression: Determine the hemoglobin concentration, total leukocyte count, and platelet count at least once a week during entire course; if the WBC ≤2500/mm3 or platelets ≤100,000/mm3, interrupt Hydrea until the values rise significantly toward normal concentrations. If severe anemia occurs, manage it without interrupting Hydrea receipt. For Droxia, monitor blood counts q2 wk and interrupt drug receipt if neutrophils <2000/mm3, platelets <80,000/mm3, hemoglobin <4.5 g/dl, or if reticulocytes <80,000/mm3 when the hemoglobin concentration is <9 g/dl. After recovery, Droxia may be resumed at a lower dose; Droxia therapy requires an experienced clinician knowledgeable in the use of this medication for the treatment of sickle cell anemia - Assess for increased uric acid levels, swelling, joint pain primarily in extremities; patient should be well hydrated to prevent urate deposits - Monitor renal function studies: BUN, creatinine, serum uric acid, urine CCr before, during therapy; • I&O ratio; report fall in urine output to <30 ml/hr - Monitor temp (may indicate beginning of infection) - Monitor liver function tests before, during therapy (bilirubin, AST, ALT, LDH) as needed or monthly - Cutaneous vasculitic toxicity and gangrene: more common in those receiving interferon - Assess for bleeding: hematuria, stool guaiac, bruising or petechiae, mucosa or orifices q8 hr - Assess for tumor lysis syndrome: hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, uric acid nephropathy, acute renal failure; metabolic acidosis can occur, aggressive alkalinization of urine and allopurinol can prevent this - Severe allergic reaction: assess for rash, urticaria, itching, flushing -

Neurotoxicity: assess for headaches, hallucinations, seizures, dizziness - Pulmonary reactions: assess for pulmonary fibrosis, fever, dyspnea, diffuse pulmonary infiltrates Patient/family education - Teach patient to notify prescriber if pregnancy is planned or suspected, pregnancy (D) - Teach patient to avoid use of products containing aspirin or ibuprofen, razors, commercial mouthwash, since bleeding may occur; instruct patient to report symptoms of bleeding (hematuria, tarry stools) - Teach patient to rinse mouth tid-qid with water, club soda; brush teeth bid-qid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss - Instruct patient to report signs of anemia (fatigue, headache, irritability, faintness, shortness of breath) - Advise patient to report any changes in breathing or coughing even several months after treatment; to avoid crowds and persons with respiratory tract or other infections - Caution patient not to have any vaccinations without the advice of the prescriber; serious reactions can occur - Advise patient to notify prescriber of fever, chills, sore throat, nausea, vomiting, anorexia, diarrhea, bleeding, bruising; may indicate blood dyscrasias; mental status change

Evaluation

Positive therapeutic outcome: Prevention of rapid division of malignant cells