Nursing Pharmacology

Anti- Neoplastic Chemotherapeutic Drugs

General Description
These

agents kill or inhibit the reproduction of neoplastic cells They may be cycle specific or non specific They are used in combination, or with other treatment modalities Usull given IV

Undesirable effects

BARFS
Bone

Marrow Depression Alopecia Retching- Nausea and Vomiting Fear and Anxiety Stomatitis

General Guidelines for Anti-Neoplastic Agents CBC and Platelets monitoring

Anti-emetics are given BEFORE drug NEPHROTOXICITY is an important Side effect Counseling regarding reproductive issues Encourage hand washing and avoidance of crowds Recommend wig for alopecia

General guidelines
Monitor CBC To note BMD

Avoid frequent injection

Provide small feedings And anti-emetics Encourage hydration

To prevent bleeding
To manage NV To prevent renal damage To prevent uric acid To prevent infiltration For alopecia

Administer allopurinol
Ensure patent IV line Wig

General Types
ALKYLATING

agents ANTI METABOLITES ANTIBIOTICS MITOTIC INHIBITORS HORMONAL agents IMMUNOSUPPRESANTS

Alkylating Agents
DYNAMICS:

cause cell death or

mutation INDICATIONS: Palliative treatment of chronic lymphocytic leukemia, malignant lymphomas, Hodgkins disease, cancers of the breast, lungs and ovaries ADVERSE EFFECTS: Bone marrow depression, anorexia, alopecia, N/V

Alkylating Agents
Busulfan Carboplatin Carmustine

Chlorambucil
Cisplatin Cyclophosphamide Ifosphamide Mecholethamine

Alkylating Agents
Nursing Interventions Monitor CBC weekly Hydrate patient well Pre-medicate with anti-emetics Monitor IV site Prepare epi, steroids and antiH1

Drug Specific Side effects

Alkylating agents Adverse Effects
Cyclophosphamide Hemorrhagic cystitis

Busulfan Mechlorethamine

Hyperuricemia Gonadal suppression Ototoxicity

Cisplatin

ANTI-METABOLITE
DYNAMICS:

interferes with the building block of DNA synthesis INDICATIONS: Myelocytic leukemia, acute lymphocytic leukemia, cancers of breast, cervix, colon, liver, ovaries ADVERSE EFFECTS: GI disturbance, oral and anal inflammation, bone marrow depression, alopecia, renal dysfunction and thrombocytopenia

General Guidelines for anti-metabolites

Monitor

CBC and Platelets weekly Evaluate renal functions Take temperature Q 4 hours Aseptic techniques Bleeding, anemia, infection and nausea Oral hygiene Lots of fluids (2-3 liters/day) Intake and output, nutrition The protocols for handling- follow them Emphasize protective isolation

Anti-metabolites
Capecitabine

Cytarabine
Fluouracil Methotrexate Mercaptopurine Thioguanine Floxuridine

Anti-Metabolites
Nursing Interventions Evaluate complete blood count Pre-medicate with anti-emetics Safety measures for dizziness Instruct to report fever, sore throat, rash and bleeding Provide small, frequent feedings Suncreens for photosensitivity

Anti-Metabolites
Nursing Interventions When administering methotrexate, prepare to administer leucovorin (folinic acid or citrovorum factor) to prevent toxicity

Anti-Neoplastic Antibiotics
DYNAMICS:

these kill cancer cells by disrupting the DNA synthesis and breaking up the DNA linkages INDICATIONS: Leukemia, carcinomas, adenocarcinoma ADVERSE EFFECTS: bone marrow suppression, alopecia, NAVD, renal toxcity

Anti-Neoplastic Antibiotics
Bleomycin

Dactinomycin
Daunorubicin Doxorubicin Idarubicin Mitocycin Plicamycin

Anti-Neoplastic Antibiotics
Daunorubicin

CHF and Dysrhythmia Doxorubicin Cardiotoxicity Bleomycin pulmonary toxicity Plicamycin excessive bleeding

Anti-Neoplastic Antibiotics
NURSING INTERVENTIONS Monitor blood tests, cardiac functions Ensure that the patient is well-hydrated Provide small, frequent feedings Advise wig for alopecia Instruct to maintain oral hygiene Assess the ECG frequently

MITOTIC INHIBITORS
DYNAMICS:

kill the cells as the process of Mitosis begins by blocking the mitotic spindles causing cell death INDICATIONS: Combination therapy for reproductive cancer, cancers of the lungs, Lymphomas ADVERSE EFFECTS: bone marrow suppression, NAVD, renal and hepatic toxicity , alopecia

MITOTIC INHIBITORS
Etoposide

Teniposide
Vinblastine Vincristine

(Oncovin) Vinorelbine

MITOTIC INHIBITORS
Vincristine

(Oncovin)

Can cause NEUROTOXICITY Cause severe bone depression check CBC

MITOTIC INHIBITORS
NURSING INTERVENTIONS Arrange for blood tests Avoid direct skin and eye contact with drugs Ensure hydration Small, frequent meals Wig Anti-emetics

Hormone and Immunomodulators

DYNAMICS: receptor-site specific drugs that block the specific hormones in the cancer INDICATIONS: Breast cancer, prostate cancer ADVERSE EFFECTS: menopause associated effects like hot flashes, vaginal dryness. Bone marrow depression and HYPERCALCEMIA

Hormone and Immunomodulators

Tamoxifen anti-estrogen Anastrazole Estramustine Letrozole Testolactone Toremifene Goserelin GnRH analogue Flutamide Fluoxymesterone an ANDROGEN Diethylstilbestrol (DES) estrogen preparation

Hormone and Immunomodulators

NURSING INTERVENTIONS Arrange for blood tests to monitor bone marrow depression Provide small, frequent meals Advise comfort measures for menopausal symptoms Utilize BARRIER methods of contraception

Miscellaneous
L-Asparaginase Enzyme that destroys ASPARAGINE needed by malignant cells for protein synthesis Indicated for acute lymphocytic leukemia Adverse effects: PANCREATITIS, bone marrow depression, fatal hyperthermia, hypersensitivity

Miscellaneous
Azathioprine Used as adjunct to cyclosporine and steroids to suppress immune system CAN CAUSE bone marrow suppression and increase incidence of cancers Taken with meals Avoid crowds, maintain hygeine

Anti-emetics
Metoclopromide

Odansetron
Dronabinol

In Summary
Cancers

arise from a single abnormal cell that multiplies and grows Cancers can come from epithelia cellsCARCINOMA or mesenchymal cellsSARCOMA Cancer cells lose their normal functions and they grow uninhibited

In Summary
Anti-neoplastic

agents affects both the normal cells and the cancers cells They act by disrupting cell function and division Most cancer drugs are MOST effective against cancer cells that multiply RAPIDLY

In Summary
The

ULTIMATE GOAL of cancer therapy is to decrease the size of the cancer so that the bodys immune system can eliminate the cancer Anti-cancer drugs are BEST given in combination so as to affect the cancer cells in various stages

In Summary
ADVERSE

effects commonly encountered with cancer therapy are related to damage to RAPIDLY multiplying cells like the BONE MARROW, hair follicle and Gastrointestinal lining

In Summary
In

general, these drugs SHOULD NOT be used during pregnancy or lactation because they may cause serious adverse effects on the FETUS