What is a major safety concern with vincristine administration and what explicit precaution is required?

• A. Fatal if given intrathecally; ensure vincristine is never administered intrathecally and verify route and labeling prior to administration.
• B. Causes severe nephrotoxicity if misadministered; ensure aggressive hydration.
• C. Can cause immediate anaphylaxis if given IV; requires premedication.
• D. Should be given intrathecally to ensure CNS penetration is achieved.

Answer: (A)

The major safety concept is that vincristine must never be given intrathecally because intrathecal exposure is fatal; the explicit precaution is to verify the route and labeling before administration to ensure it is given IV only. This means double-checking the medication name, dose, and route on the order and the label, and using pharmacy-prepared, clearly labeled IV material to prevent any mix-up with intrathecal medications. The other described risks aren’t the primary concern with vincristine in practice, and the idea of giving it intrathecally is specifically contraindicated.