A patient is taking cyclophosphamide for the treatment of the lymphoma The nurse is very cautious while administering the medication because this drug poses the fatal side effect of ?

1. A

   Alopecia

2. B

   Myeloma

3. C

   CNS toxicity

4. D

   Hemorrhagic cystitis

Appeared in: Chitranjjan National Cancer Institute Kolkata - 2021

Explanation

• Hemorrhagic cystitis is a severe, life-threatening side effect of cyclophosphamide.
• It is caused by the accumulation of acrolein, a toxic metabolite of cyclophosphamide, in the bladder.
• Acrolein directly damages the bladder's epithelial lining (urothelium), causing inflammation and significant bleeding.
• Without preventive measures like hydration and the use of mesna, this condition can be fatal.

Why Other Options Were Wrong

• Option A: Alopecia (hair loss) is a common and distressing side effect of cyclophosphamide, but it is not fatal and is typically reversible.
• Option B: Myeloma is a type of cancer affecting plasma cells. It is a disease that cyclophosphamide may be used to treat, not a side effect caused by the drug.
• Option C: Significant CNS toxicity is not a primary or common fatal side effect of cyclophosphamide. It is more characteristically seen with ifosfamide, a similar alkylating agent.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Adverse effects of chemotherapy agents, specifically cyclophosphamide to guide bedside assessment, documentation, and the next nursing action.
• The nurse's primary role is prevention and early detection of hemorrhagic cystitis. This includes patient education on hydration, ensuring Mesna is administered as prescribed, and vigilant monitoring of urine output and color.
• Any sign of hematuria (blood in urine) in a patient receiving cyclophosphamide is a medical emergency that requires immediate cessation of the drug and notification of the healthcare provider.
• What if? If the patient was unable to maintain adequate oral hydration due to severe nausea and vomiting (another side effect), the nurse should anticipate an order for intravenous fluids to ensure the bladder is continuously flushed.

How to Approach the Question

• First, identify the key drug in the question: cyclophosphamide.
• Next, recall the major toxicities associated with this specific chemotherapy agent. Cyclophosphamide is an alkylating agent known for bone marrow suppression and a unique, severe bladder toxicity.
• Analyze the lead-in phrase "fatal side effect." This requires you to differentiate between common, manageable side effects and those that are life-threatening.
• Evaluate each option: Alopecia is common but not fatal. Myeloma is a disease, not a side effect. CNS toxicity is less common with cyclophosphamide. Hemorrhagic cystitis is a well-known, severe, and potentially fatal complication.
• Select the option that matches the criteria of being both a known side effect of cyclophosphamide and potentially fatal.

Concept Tested & Keywords

• Concept Tested: Adverse effects of chemotherapy agents, specifically cyclophosphamide.
• Stem keywords: cyclophosphamide, lymphoma, fatal side effect
• Lead-in keywords: fatal side effect
• Clinical cues: The use of cyclophosphamide, a potent chemotherapy drug, signals the need to monitor for severe toxicities.

Question ID

QLyPeMdoZ2yvET0xa2zGPK

Copy ID

Reference Book

E6 Pharmacology Nurses Shanbhag 3e p. 346-348

E6 Medicine Harrison 22e Part 1 p. 604-606

E6 Pharmacology Katzung 16e p. 1482-1484