FLUOROURACIL Drug Study

FLUOROURACIL (5-FU); ADRUCIL
A Drug Study Presented to

the Faculty of the Nursing Department
____________________________, RN
In Partial Fulfilment of
the Requirements in NCM 212–RLE
IMMUNOLOGIC RESPONSE/CANCER NURSING ROTATION
By
__________________________________________
September 3, 2020
Generic Name fluorouracil, 5-FU
Brand Name Adrucil
Classification Antimetabolite; antineoplastic; immunosuppressive
Mode of Action Blocks formation of thymidylic acid. Cell cycle–specific for S phase
of cell division. Therapeutic Effect: Inhibits DNA, RNA synthesis.
Dose / Route Colorectum Cancer

 IV Infusion: in combination with leucovorin alone, or in
combination with leucovorin and oxaliplatin or irinotecan; 400
mg/m² by IV bolus on Day 1, followed by 2400 mg/m² to 3000
mg/m² IV as a continuous infusion over 46 hours every two
weeks.
 IV bolus: in combination with leucovorin; 500 mg/m by IV bolus
on Days 1, 8, 15, 22, 29, and 36 in 8-week cycles.
Breast Cancer
 Administered as a component of a cyclophosphamide-based
multidrug regimen; 500 mg/m² or 600 mg/m² intravenously on
Days 1 and 8 every 28 days for 6 cycles.
Gastric Cancer
 Administered as a component of a platinum-containing
multidrug chemotherapy regimen; 200 mg/m² to 1000 mg/m²
intravenously as a continuous infusion over 24 hours. The
frequency of dosing in each cycle and the length of each cycle
will depend on the dose of Adrucil and the specific regimen
administered.
Pancreatic Cancer
 IV Infusion: in combination with leucovorin or as a component of
a multidrug chemotherapy regimen that includes leucovorin; 400
mg/m² IV bolus on Day 1, followed by 2400 mg/m² IV as a
continuous infusion over 46 hours every two weeks.
Indication Colorectal cancer; breast cancer; gastric cancer; pancreatic cancer
Contraindication  Hypersensitive to drug and in those with bone marrow

suppression (WBC counts of 5,000/mm3 or less or platelet
counts of 100,000/mm3 or less) or potentially serious
infections.
 Contraindicated in patients in a poor nutritional state and those
who have had major surgery within previous month.
 Use cautiously in patients who have received high-dose pelvic
radiation or alkylating drugs and in those with impaired hepatic
or renal function or widespread neoplastic infiltration of bone
marrow
 Hypersensitivity to amitriptyline
 Acute recovery period after MI, co-administered with or within
14 days of MAOIs.
 Pregnancy and lactation: severe effects on the fetus and
neonate
 Bone marrow suppression: index of redosing and dosing
levels
 Renal and hepatic dysfunction: interfere with drug
metabolism and excretion
 Known GI ulceration or ulcerative diseases: can be
exacerbated by the effects of the drug
 Cautions: Prostatic hypertrophy, history of urinary retention or
obstruction, narrow-angle glaucoma, diabetes, seizures,
hyperthyroidism, cardiac/hepatic/renal disease, schizophrenia,
xerostomia, visual problems, constipation or bowel obstruction,
elderly, increased intraocular pressure (IOP), hiatal hernia,
suicidal ideation.
Side Effects  Frequent (greater than 10%): Alopecia, dermatitis, anorexia,

diarrhea, esophagitis, dyspepsia, stomatitis.
 Occasional (10%–1%): Cardiotoxicity (angina, EKG changes),
skin dryness, epithelial fissuring, nausea, vomiting, excessive
lacrimation, blurred vision.
 Rare (less than 1%): Headache, photosensitivity, somnolence,
allergic reaction, dyspnea, hypotension, MI, pulmonary edema.
Adverse Effects  Earliest sign of toxicity (4–8 days after beginning therapy) is
stomatitis (dry mouth, burning sensation, mucosal erythema,
ulceration at inner margin of lips).
 Most common dermatologic toxicity is pruritic rash (generally
on extremities, less frequently on trunk).
 Leukopenia (WBC less than 3500 cells/mm3 ) generally
occurs within 9–14 days after drug administration but may
occur as late as 25th day.
 Thrombocytopenia (platelets less than 100,000 cells/mm3 )
occasionally occurs within 7–17 days after administration.
 Pancytopenia
 CNS: acute cerebellar syndrome, confusion, disorientation,
euphoria, ataxia, headache, dizziness, weakness, malaise,
drowsiness, aphasia, fatigue.
 CV: myocardial ischemia, angina, thrombophlebitis.
 EENT: epistaxis, photophobia, lacrimation, lacrimal duct
stenosis, nystagmus, visual changes, eye irritation.
 Respiratory: pulmonary toxicity, interstitial pneumonitis
 GI: stomatitis, GI ulcer, nausea, vomiting, diarrhea, anorexia,
mucous membrane deterioration, hepatic toxicity, GI bleeding.
 Hematologic: leukopenia, thrombocytopenia,
agranulocytosis, anemia, bone marrow suppression.
 GU: renal toxicity
 Other: anaphylaxis.
Drug  DRUG: Bone marrow depressants may increase risk of

Interactions myelosuppression. Live virus vaccines may potentiate virus
replication, increase vaccine side effects, decrease patient’s
antibody response to vaccine.
 HERBAL: Echinacea may decrease effects. Avoid use of black
cohosh, dong quai in patients with estrogen dependent tumors.
 FOOD: None known.
 LAB VALUES: May increase alkaline phosphatase, AST, ALT,
bilirubin, 5-hydroxyindoleacetic acid (in urine), and LDH levels;
may decrease hemoglobin and plasma albumin levels; may
decrease granulocyte, platelet, RBC, and WBC counts.
Nursing Assessment
Responsibilities  Assess for the mentioned cautions and contraindications
(e.g. drug allergies, hepatorenal impairment, bone marrow
suppression, pregnancy and lactation, etc.) to prevent any
untoward complications.
 Perform a thorough physical assessment (other medications
taken, orientation and reflexes, vital signs, bowel sounds, etc.)
to establish baseline data before drug therapy begins, to
determine effectiveness of therapy, and to evaluate for
occurrence of any adverse effects associated with drug
therapy.
 Monitor result of laboratory tests such as CBC with
differential to identify possible bone marrow suppression and
toxic drug effects and establish appropriate dosing for the drug;
and liver and renal function tests to determine need for
possible dose adjustment and identify toxic drug effects.
Interventions
 Watch for stomatitis or diarrhea (signs of toxicity). Consider
using topical oral anesthetic to soothe lesions. Stop drug and
notify prescriber if diarrhea occurs.
 Encourage diligent oral hygiene to prevent superinfection of
denuded mucosa.
 Monitor WBC and platelet counts. WBC counts with
differential are recommended before each dose. Watch for
ecchymoses, petechiae, easy bruising, and anemia.
 Monitor fluid intake and output, CBC, and renal and hepatic
function tests.
 Long-term use may cause erythematous, desquamative rash
of the hands and feet, which may be treated with pyridoxine 50
to 150 mg P.O. daily for 5 to 7 days.
 Dermatologic adverse effects are reversible when drug is
stopped.
 To prevent bleeding, avoid I.M. injections when platelet
count is below 50,000/mm3.
 Anticipate blood transfusions because of cumulative anemia.
Patient teaching
 Warn patient that hair loss may occur but is reversible.
 Caution patient to avoid prolonged exposure to sunlight or
ultraviolet light when topical form is used.
 Tell patient to use highly protective sunblock to avoid
inflammatory skin irritation.
 Warn patient that topically treated area may be unsightly
during therapy and for several weeks afterward. Complete
healing may take 1 or 2 months.
 Caution women of childbearing age to consult prescriber
before becoming pregnant.
 Advise women to stop breast-feeding during therapy
because of risk of toxicity to infant
References
Kozier, R.J., Hodgson, K.J., & EBSCO Publishing. (2019). Fluorouracil. Saunders
nursing drug handbook 2019. St. Louis, Missouri: Elsevier.
RNpedia. (2020). Antineoplastic drugs nursing considerations & management.
Retrieved September 3, 2020 from https://www.rnpedia.com.
RxList. (2020). Adrucil. Retrieved September 3, 2020 from https://www.rxlist.com.
Wolters Kluwer. (2017). Fluorouracil. Nursing 2017 drug handbook (37th ed.).
Philadelphia, PA: Author.

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FLUOROURACIL (5-FU); ADRUCIL

A Drug Study Presented to

Brand Name Adrucil

Classification Antimetabolite; antineoplastic; immunosuppressive

Dose / Route Colorectum Cancer

Indication Colorectal cancer; breast cancer; gastric cancer; pancreatic cancer

Contraindication  Hypersensitive to drug and in those with bone marrow

Side Effects  Frequent (greater than 10%): Alopecia, dermatitis, anorexia,

Drug  DRUG: Bone marrow depressants may increase risk of

RxList. (2020). Adrucil. Retrieved September 3, 2020 from https://www.rxlist.com.

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