Which of the following anticancer drug causes "Hand and foot syndrome" as a side effect

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2024

Pharmacology

Easy

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2024

Explanation

Capecitabine is an oral prodrug of 5-Fluorouracil, and this class of drugs (fluoropyrimidines) is classically associated with Hand-and-Foot Syndrome (HFS).
HFS, also known as palmar-plantar erythrodysesthesia, is a common and often dose-limiting dermatological toxicity of Capecitabine.
The syndrome is characterized by redness, swelling, tingling, and pain on the palms of the hands and soles of the feet due to drug leakage from capillaries.

Option A: Vincristine's primary dose-limiting toxicity is peripheral neuropathy (nerve damage), causing symptoms like tingling, numbness, and constipation. It does not typically cause the skin reaction seen in HFS.
Option B: Vinblastine's main dose-limiting toxicity is bone marrow suppression (myelosuppression), leading to leukopenia and thrombocytopenia. Neurotoxicity is less common and less severe than with vincristine.
Option D: Methotrexate, a folate antagonist, is primarily associated with toxicities like myelosuppression, mucositis (mouth sores), and liver damage. HFS is not a characteristic side effect.

Clinical Relevance

Nursing practice connection: Knowing Pharmacology: Side Effects of Antineoplastic Agents helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses must educate patients starting Capecitabine to recognize the early signs of HFS (tingling, redness) and to report them immediately, as this often requires dose modification or treatment interruption to prevent severe symptoms.
Proactive management is a key nursing role. This includes advising patients on preventative measures like using moisturizers, avoiding hot water, and minimizing friction on hands and feet to improve comfort and treatment adherence.
What if? If a patient on Vincristine reports tingling in their hands and feet, the nurse should suspect peripheral neuropathy, not HFS. The assessment would focus on sensory loss, motor weakness, and constipation (autonomic neuropathy), and the intervention would be reporting to the oncologist for potential dose reduction, not applying ice packs or emollients for a skin condition.

How to Approach the Question

Identify the core of the question: linking a specific, named side effect ('Hand and foot syndrome') to a list of anticancer drugs.
Recognize this as a factual recall question from pharmacology, requiring knowledge of the unique or 'classic' toxicities of major chemotherapy agents.
Systematically evaluate each option by recalling its most prominent side effect.
Recall: Vincristine is famous for neurotoxicity. Vinblastine is known for myelosuppression ('blasting' the marrow). Methotrexate has a broad profile including myelosuppression and mucositis.
Recall: Capecitabine (and its parent drug 5-FU) are classically linked to Hand-and-Foot Syndrome and diarrhea.
Conclude that Capecitabine is the drug most specifically and commonly associated with this particular syndrome.

Concept Tested & Keywords

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E6 Pharmacology KD Tripathi Essentials 9e Part 3 p. 204-206

E6 Pharmacology Nurses Shanbhag 3e p. 346-348