Following is "Practice Safe Nursing With Oral Hazardous Drugs," an article featured in the January 2010 issue of ONS Connect.
The number of currently available hazardous oral drugs is increasing and now includes small molecules and hormones in addition to traditional agents such as cyclophosphamide. Nurses are presented with unique safety challenges in handling these medications.
General guidelines should be followed for handling hazardous oral drugs.
- Use double gloves.
- Wear a face shield if there is a potential for spraying, aerosolization, or splashing.
- Crushing or manipulating should be done in a biologic safety cabinet.
- Wash hands thoroughly with soap and water after removing gloves.
- Spoons, oral syringes, disposable medicine cups, or other equipment used to administer the agents must be discarded as hazardous waste.
Some medications cannot be crushed, often because of timed-release or enteric coatings. When crushing hazardous oral drugs is necessary for use in nasogastric or gastric tubes or to mix with food, nurses may be at extremely high risk for exposure.
A recommended method for dissolving and administering a capsule by syringe is to remove the plunger from the oral syringe and place the capsule inside. Replace the plunger, draw warm fluid into the syringe, and allow the capsule to dissolve. The suspension can be administrated orally or via feeding tube.
The Institute for Safe Medical Practices emphasizes the use of specialized oral syringes (not standard slip tip or luer-lock syringes) for administering oral hazardous drugs to prevent inadvertent IV administration.
Figure 1. Oral Chemotherapy Agents
Altretamine, hexamethylmelamine, HMM (Hexalen®, MGI Pharmaceuticals)
Bexarotene (Targretin®, Ligand Pharamceuticals)
Busulfan (Myleran®, GlaxoSmithKline)
Capecitabine (Xeloda®, Roche Laboratories)
Chlorambucil (Leukeran®, GlaxoSmithKline)
Cyclophosphamide (Cytoxan®, Bristol-Myers Squibb)
Estramustine (Emcyt®, Pfizer Inc.)
Etoposide (VePesid®, Bristol-Myers Squibb)
Hydroxyurea (Hydrea®, Bristol-Myers Squibb)
Lenalidomide (Revlimid®, Celgene Corp.)
Lomustine (CCNU, CeeNu®, Bristol-Myers Squibb)
Melphalan (Alkeran®, GlaxoSmithKline)
Mercaptopurine (6-MP, Purinethol®, Gate Pharmaceuticals)
Methotrexate (Trexall®, Barr Laboratories)
Mitotane (Lysodren®, Bristol-Myers Squibb)
Procarbazine (Matulane®, Sigma-Tau Pharmaceuticals)
Temozolomide (Temodar®, Schering Corp.)
Thalidomide (Thalomid®, Celgene Corp.)
Thioguanine (Tabloid®, GlaxoSmithKline)
Tretinoin (Vesanoid®, Roche Laboratories)
Vorinostat (Zolinza®, Merck & Co., Inc.)
Figure 2. Hormones and Tyrosine Kinase Inhibitors
Tamoxifen (Nolvadex®, AstraZeneca Pharmaceuticals)
Anastrazole (Arimidex®, AstraZeneca Pharmaceuticals)
Exemestane (Aromasin®, Pfizer Inc.)
Letrazole (Femara®, Novartis Pharmaceuticals)
Dasatinib (Sprycell®, Bristol-Myers Squibb)
Erlotinib (Tarceva®, Genentech, Inc.)
Gefitinib (Iressa®, AstraZeneca Pharmaceuticals)
Imatinib (Gleevec®, Novartis Pharmaceuticals)
Lapatinib (Tykerb®, GlaxoSmithKline)
Nilotinib (Tasigna®, Novartis Pharmaceuticals)
Sorafenib (Nexavar®, Bayer HealthCare and Onyx Pharmaceuticals)
Sunitinib (Sutent®, Pfizer Inc.)