Chemotherapy Toxicity by Organ: Cardiotoxic vs Nephrotoxic/Ototoxic vs Neurotoxic vs Myelosuppressive
When a patient on chemo develops new symptoms, the drug-to-organ map tells you whether to order an echocardiogram, check creatinine, test reflexes, or hold the next dose for low counts. Picking the wrong monitoring priority on NCLEX means missing the life-threatening toxicity the question is testing.
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- Doxorubicin (anthracycline)
- Trastuzumab
- Cisplatin
- Vincristine, paclitaxel, oxaliplatin
- Most agents: alkylators, antimetabolites
- ★Cumulative dose-dependent cardiomyopathy
- Renal tubular damage + ototoxicity
- Peripheral neuropathy (axonal)
- Marrow suppression: ↓ WBC, RBC, platelets
- ↓ ejection fraction, dyspnea, edema
- ↑ creatinine
- Tinnitus, hearing loss
- ★Numbness/tingling hands & feet
- ↓ deep tendon reflexes
- Fever, fatigue, bruising, bleeding
- Baseline & serial echo/MUGA (EF)
- Renal function, audiometry, hydration
- Serial neuro exam, gait, fine motor
- CBC with differential
- ANC before each dose
- Cumulative — limit lifetime dose
- Within days — hydrate before & after
- Oxaliplatin: acute, cold-triggered
- ★Nadir 7–14 days after dose
- Monitor EF
- Hold dose if EF declines
- Aggressive IV hydration
- Report hearing changes
- Fall/safety precautions
- Report new numbness
- ★Neutropenic precautions
- Neutropenic fever = emergency
- Dexrazoxane (cardioprotectant)
- Amifostine
- Mannitol + hydration
- Dose reduction
- No specific antidote
- Filgrastim (G-CSF)
- Transfuse RBCs/platelets as needed
- Report dyspnea, swelling, weight gain
- Report ↓ urine, ringing, hearing loss
- Protect numb limbs
- Report falls
- Avoid crowds
- Report fever ≥ 100.4°F (38°C)
Cardiotoxic
- Doxorubicin (anthracycline)
- Trastuzumab
Nephrotoxic/Ototoxic
- Cisplatin
Cardiotoxic
- ★Cumulative dose-dependent cardiomyopathy
Nephrotoxic/Ototoxic
- Renal tubular damage + ototoxicity
Cardiotoxic
- ↓ ejection fraction, dyspnea, edema
Nephrotoxic/Ototoxic
- ↑ creatinine
- Tinnitus, hearing loss
Cardiotoxic
- Baseline & serial echo/MUGA (EF)
Nephrotoxic/Ototoxic
- Renal function, audiometry, hydration
Cardiotoxic
- Cumulative — limit lifetime dose
Nephrotoxic/Ototoxic
- Within days — hydrate before & after
Cardiotoxic
- Monitor EF
- Hold dose if EF declines
Nephrotoxic/Ototoxic
- Aggressive IV hydration
- Report hearing changes
Cardiotoxic
- Dexrazoxane (cardioprotectant)
Nephrotoxic/Ototoxic
- Amifostine
- Mannitol + hydration
Cardiotoxic
- Report dyspnea, swelling, weight gain
Nephrotoxic/Ototoxic
- Report ↓ urine, ringing, hearing loss
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Doxorubicin→heart (LVEF), cisplatin→kidneys+ears (hydrate+audiometry), vincristine→nerves (reflexes): drug maps to organ maps to monitor.
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