A nurse is caring for a client who has prostate cancer and is receiving chemotherapy that causes anemia and neutropenia. The nurse should identify that which of the following drugs can be used to treat both conditions by stimulating the production of red blood cells and neutrophils in the bone marrow? (Select all that apply.)

Choice A reason:

Epoetin alfa (Epogen) is a drug that stimulates the production of red blood cells in the bone marrow, but not neutrophils. It is used to treat anemia caused by chemotherapy, chronic kidney disease, or other conditions.

Choice B reason:

Filgrastim (Neupogen) is a drug that stimulates the production of neutrophils in the bone marrow, but not red blood cells. It is used to prevent or treat neutropenia caused by chemotherapy, bone marrow transplant, or other conditions.

Choice C reason:

Sargramostim (Leukine) is a drug that stimulates the production of both red blood cells and neutrophils in the bone marrow. It is used to prevent or treat anemia and neutropenia caused by chemotherapy, bone marrow transplant, or other conditions.

Choice D reason:

Pegfilgrastim (Neulasta) is a drug that stimulates the production of both red blood cells and neutrophils in the bone marrow⁴. It is a longacting form of filgrastim that works in the same way but can be given less often. It is used to prevent or treat anemia and neutropenia caused by chemotherapy.

Choice E reason:

Darbepoetin alfa (Aranesp) is a drug that stimulates the production of red blood cells in the bone marrow, but not neutrophils. It is a longacting form of epoetin alfa that works in the same way but can be given less often. It is used to treat anemia caused by chemotherapy, chronic kidney disease, or other conditions.

Choice A reason:

Bone marrow suppression is an adverse effect of dactinomycin, which is an antineoplastic antibiotic that works by binding to DNA and inhibiting RNA synthesis. Bone marrow suppression is the decrease in the production of blood cells, such as red blood cells, white blood cells, and platelets. This can cause anemia, increased risk of infection, and bleeding problems. The nurse should monitor the complete blood count and differential, which measure the number and type of blood cells in a sample of blood. The nurse should report any abnormal results to the provider and provide supportive care as ordered³.

Choice B reason:

Skin reactions are an adverse effect of dactinomycin, which can cause inflammation, rash, acne, erythema multiforme, or increased pigmentation of previously irradiated skin. Skin reactions can occur due to the direct toxicity of dactinomycin on the skin cells or due to the hypersensitivity or allergic reactions induced by dactinomycin. The nurse should monitor the skin appearance and texture and report any changes to the provider. The nurse should also provide skin care and topical agents as ordered³.

Choice E reason:

Extravasation injury is an adverse effect of dactinomycin, which can occur when the drug leaks out of the vein into the surrounding tissue during intravenous infusion. Extravasation injury can cause severe pain, swelling, redness, blistering, ulceration, or necrosis of the affected tissue. The nurse should monitor the infusion site and stop the infusion immediately if extravasation occurs. The nurse should also elevate the affected limb and apply cold compresses as ordered. The nurse should consult with the provider for further management of extravasation injury³.

Choice C reason:

Cardiotoxicity is not an adverse effect of dactinomycin, but rather of doxorubicin, which is another antineoplastic antibiotic that can cause damage to the heart muscle or valves. Cardiotoxicity can manifest as acute or chronic heart failure, arrhythmias, or myocardial infarction. The nurse should monitor the blood pressure, heart rate, oxygen saturation, and electrocardiogram (ECG) regularly and report any abnormal findings to the provider .

Choice D reason:

Pulmonary fibrosis is not an adverse effect of dactinomycin, but rather of bleomycin, which is another antineoplastic antibiotic that can cause scarring of the lung tissue. Pulmonary fibrosis can manifest as shortness of breath, coughing, or reduced lung function. The nurse should monitor the respiratory rate, breath sounds, and chest xray regularly and report any abnormal findings to the provider .