Select a medication used in evidence-based treatment guidelines for the condition chosen in the first discussion question. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions of which one should be aware. Make sure that you select a different me

Cyclophosphamide

Cyclophosphamide, with the brand name of Cytoxan, is one of the medications given for Goodpasture disease to suppress the immune system in making anti-glomerular basement membrane (GBM) antibodies. Primarily this medication is for cancer like ovaries, breasts, blood, and others.

Mechanism of action

Cyclophosphamide is a cancer drug under a class of alkylating agents. The CYP450 system converts cyclophosphamide and ifosfamide to hydroxylated intermediates in the liver. The active chemicals phosphoramide mustard, and acrolein, are formed from the hydroxylated intermediates. The phosphoramide mustard reacts with DNA, causing cytotoxicity (LaPlant, & May 2019). Cyclophosphamide slows the development of cancer cells, which the body eventually destroys. Other side effects may develop because cyclophosphamide affects normal cell growth.

Hints for monitoring

Cyclophosphamide can temporarily reduce white blood cell counts, increasing the risk of infection and reducing the platelet count required for blood clotting (Mayo Clinic, 2022). Particular care must be taken to avoid infection or bleeding. Therefore, it is essential to instruct the patient to follow bleeding precautions. Avoiding contact sports and other circumstances that might cause bruising, cuts, and brushing or flossing teeth; monitor for signs of bleeding like bruises, blood in the urine or stools, or tiny red patches on the skin. Cyclophosphamide may reduce the body’s resistance, causing the vaccination to fail or the illness to occur; the patient should also avoid others who have received live virus vaccinations since they may spread the infection to the patient (Mayo Clinic, 2022).

Side effects

More common side effects are cough or hoarseness, fever or chills; lower back or side pain; missing menstrual periods; and painful or difficult urination (Mayo Clinic, 2022). The following side effects with high doses and long-term treatment are blood in the urine; dizziness, confusion, or agitation; fast heartbeat; joint pain; shortness of breath; swelling of the feet or lower legs; and unusual tiredness or weakness. Studies on nursing mothers show detrimental impacts on babies. It should be provided an alternative or discontinue nursing while using it.

Drug interaction

Cyclophosphamide has notable drug interactions with phenobarbital, phenytoin, digoxin, and anticoagulants (LaPlant, & May 2019). Chronic high dosages of phenobarbital enhance the metabolism and leukopenic action of cyclophosphamide. Therefore, warfarin’s impact is enhanced or decreased in individuals receiving warfarin plus cyclophosphamide (U.S. National Library of Medicine, 2021).

References:

LaPlant, K., & May, P. (2019). Anticancer Drugs. In K. Whalen (Ed.), Lippincott® illustrated reviews: Pharmacology (7th ed.). Wolters Kluwer.

Mayo Clinic. (2022, February 14). Cyclophosphamide (Oral route, intravenous route) description and brand names – Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/cyclophosphamide-oral-route-intravenous-route/description/drg-20063307

U.S. National Library of Medicine. (2021, September 28). Cyclophosphamide injection, solution. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a0e99679-f939-4fb3-9d38-dfdb824f89bc