A nurse is caring for a client who has multiple myeloma and is receiving thalidomide, an angiogenesis inhibitor, as part of targeted therapy. The nurse should instruct the client to report which of the following adverse effects of this drug? (Select all that apply.)

Choice A reason:

Numbness, tingling, or pain in the extremities are signs of peripheral neuropathy, which is a common and serious side effect of thalidomide³. This condition can affect the nerves that control sensation and movement in the arms and legs, and can lead to permanent nerve damage if not treated.

Choice B reason:

Drowsiness, dizziness, or confusion are signs of central nervous system depression, which is a common and serious side effect of thalidomide³. This condition can affect the brain's ability to regulate alertness, cognition, and coordination, and can increase the risk of falls, accidents, and injuries.

Choice C reason:

Constipation, nausea, or vomiting are signs of gastrointestinal distress, which is a common and mild side effect of thalidomide. This condition can affect the digestive system's ability to process food and fluids, and can lead to dehydration, malnutrition, and electrolyte imbalance if not managed.

Choice D reason:

Swelling, redness, or warmth in the legs are not directly related to thalidomide use, but may indicate a deep vein thrombosis (DVT), which is a blood clot that forms in a vein deep in the body. Thalidomide can increase the risk of DVT by affecting the blood's ability to clot normally. A DVT can be lifethreatening if it breaks off and travels to the lungs, causing a pulmonary embolism.

Choice E reason:

Rash, itching, or hives are signs of allergic reaction, which is a rare but serious side effect of thalidomide³. This condition can affect the skin's immune response to the drug, and can lead to severe skin reactions such as StevensJohnson syndrome or toxic epidermal necrolysis if not treated.

Choice A reason:

Administering dexrazoxane as prescribed before doxorubicin infusion can help prevent cardiotoxicity by inhibiting the formation of DNA doublestrand breaks mediated by topoisomerase II beta, which is a key mechanism of doxorubicininduced cardiac damage³. Dexrazoxane is a chelating agent that binds to iron and prevents the generation of reactive oxygen species that can cause oxidative stress and DNA damage⁴. Dexrazoxane is the only drug approved by the Food and Drug Administration (FDA) for the prevention of doxorubicin cardiotoxicity in patients with metastatic breast cancer who have received a cumulative dose of 300 mg/m2 or more⁵.

Choice B reason:

Monitoring electrocardiogram (ECG) and cardiac enzymes during treatment can help detect cardiotoxicity from doxorubicin, but not prevent it. ECG can show changes such as ST segment depression, T wave inversion, arrhythmias, or conduction abnormalities that indicate cardiac ischemia or injury. Cardiac enzymes such as troponin and creatine kinaseMB (CKMB) can show elevation that indicates myocardial damage or necrosis.

Choice C reason:

Assessing for signs and symptoms of heart failure such as dyspnea, edema, and crackles can help diagnose cardiotoxicity from doxorubicin, but not prevent it. Dyspnea is the difficulty or discomfort in breathing that indicates reduced cardiac output or pulmonary congestion. Edema is the swelling of the lower extremities or abdomen that indicates fluid retention or rightsided heart failure. Crackles are the abnormal lung sounds that indicate pulmonary edema or leftsided heart failure.

Choice D reason:

Administering dexrazoxane as prescribed before doxorubicin infusion is the only intervention that can prevent cardiotoxicity from doxorubicin. Monitoring ECG and cardiac enzymes during treatment and assessing for signs and symptoms of heart failure can help detect and treat cardiotoxicity, but not prevent it. Other strategies that may help prevent doxorubicin cardiotoxicity include limiting the cumulative dose of doxorubicin to less than 450 to 550 mg/m2, administering the drug as an infusion rather than an injection, using a liposomal formulation of doxorubicin, and using other agents with antioxidant or antiinflammatory properties⁴.