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  Ifosfamide Ifosfamide is associated with an encephalopathy thought to result from one of its metabolites, chloroacetaldehyde. The incidence ranges from 10% to 20%; it presents hours to days after initiation of treatment with confusion and disorientation and is generally self-limiting. Methylene blue, albumin, and thiamine have been used for both prevention and treatment. Conclusive evidence to promote routine prophylaxis is not available. 158 Reported risk factors for this complication include a history of ifosfamide-induced encephalopathy, prior cisplatin exposure, concomitant opioids, concomitant CYP2B6 inhibitors, renal dysfunction, low serum albumin, increased hemoglobin, and abdominal disease. 159,160 CASE 94-6, QUESTION 2: What is the most likely medication causing A.L.’s numbness? Peripheral Neuropathy Paresthesia (numbness and tingling) involving the feet and/or hands is an early subjective symptom of vincristine neurotoxicity, which often appears within the first days to wee

  Table 94-3 Chemotherapeutic Drugs Reported to Produce Local Toxicities Potential Vesicants Dactinomycin Epirubicin Daunorubicin Streptozocin Doxorubicin Vinblastine Idarubicin Vincristine Mechlorethamine Paclitaxel Mitomycin Oxaliplatin Potential Irritants Carmustine Etoposide Cisplatin Mitoxantrone Dacarbazine Melphalan Vinorelbine Vindesine Cyclophosphamide Teniposide Source: Doellman D et al. Infiltration and extravasation: update on prevention and management. J Infus Nurs. 2009;32:203; Boulanger J et al. Management of the extravasation of antineoplastic agents. Support Care Cancer. 2015;23(5):1459. p. 1979 p. 1980 CASE 94-4, QUESTION 6: What factors in C.W. increase her risk of extravasation, and what administration techniques and precautions can minimize these risks? Several factors have been associated with an increased risk of extravasation and subsequent tissue damage after administration of cytotoxic chemotherapy. Risk factors include generalized vascular disease commonly fo