1. Alkylating agents, antimetabolites, antitumor antibiotics, mitotic inhibitors, and hormones are common classifications of antineoplastic drugs used to treat cancers.
2. These drugs work by interfering with DNA, RNA, and protein synthesis in cancer cells to stop their growth and division.
3. Common adverse effects include bone marrow suppression, nausea, alopecia, and organ toxicity, requiring monitoring by nurses and lifestyle adjustments by patients undergoing chemotherapy.
1. Alkylating agents, antimetabolites, antitumor antibiotics, mitotic inhibitors, and hormones are common classifications of antineoplastic drugs used to treat cancers.
2. These drugs work by interfering with DNA, RNA, and protein synthesis in cancer cells to stop their growth and division.
3. Common adverse effects include bone marrow suppression, nausea, alopecia, and organ toxicity, requiring monitoring by nurses and lifestyle adjustments by patients undergoing chemotherapy.
1. Alkylating agents, antimetabolites, antitumor antibiotics, mitotic inhibitors, and hormones are common classifications of antineoplastic drugs used to treat cancers.
2. These drugs work by interfering with DNA, RNA, and protein synthesis in cancer cells to stop their growth and division.
3. Common adverse effects include bone marrow suppression, nausea, alopecia, and organ toxicity, requiring monitoring by nurses and lifestyle adjustments by patients undergoing chemotherapy.
1. Alkylating agents, antimetabolites, antitumor antibiotics, mitotic inhibitors, and hormones are common classifications of antineoplastic drugs used to treat cancers.
2. These drugs work by interfering with DNA, RNA, and protein synthesis in cancer cells to stop their growth and division.
3. Common adverse effects include bone marrow suppression, nausea, alopecia, and organ toxicity, requiring monitoring by nurses and lifestyle adjustments by patients undergoing chemotherapy.
1. Alkylating Agents 2. Antimetabolites 3. Antineoplastic antibiotics 4. Mitotic Inhibitors 5. Hormones and Hormones Modulators 6. Miscellaneous agents Alkylating Agents Alkylating Agent (Covalent DNA binding drugs) • Stops tumour growth by cross-linking guanine nucleobases in DNA double-helix strands - directly attacking DNA. • This makes the strands unable to uncoil and separate. • As this is necessary in DNA replication, the cells can no longer divide. • Cell-cycle nonspecific effect Alkylating Medications (TYPICAL/ATYPICAL AGENTS) Nitrogen Mustards chlorambucil (Leukeran) cyclophosphamide(Cytoxan) melphalan (Alkeran) Nitrosoureas Platinum Complexes carmustine (Bicnu) carboplatin (Biovenate) lomustine (Ceenu) docistin (Cisplatin, Platinol) oxaliplatin (Oxitel, Eloxatin) INDICATION:
• Lymphomas • Leukemias • Myelomas • Ovarian/ testicular/ breast cancers • Pancreatic cancers Adverse effects ▪ chlorambucil (Leukeran) may cause gonadal suppression and hyperuricemia ▪ cisplatin (Platinol) may cause ototoxicity, tinnitus, hypokalemia, hypocalcemia, hypermagnesemia, and nephrotoxicity ▪ cyclophosphamide (Cytoxan) may cause alopecia, gonadal suppression, hemorrhagic cystitis and hematuria Nursing Interventions 1. When administering cisplatin (Platinol), assess for dizziness, tinnitus, hearing loss, incoordination, & numbness or tingling of extremities 2. Encourage the client to drink 2-3 L/per day during cyclophosphamide (Cytoxan) therapy 3. Instruct the client that cyclophosphamide (Cytoxan) when prescribed orally, is administered without food. 4. Instruct the client to follow a diet low in purines to alkaline purine and lower uric acid blood levels
4. Instruct the client to report signs of infection or bleeding.
These drugs are highly toxic and may cause bone marrow depression since these agents kill normal hemapoietic cells so advise clients to avoid crowds and those with respiratory conditions. 7. Instruct the client about good oral hygiene and use of soft toothbrush 8. Arrange for proper head covering at extremes temperatures if alopecia occurs; a wig, scarf, or that is important for maintaining body temperature. ANTIMETABOLITES Antimetabolites • Replace normal proteins required for DNA synthesis • Inhibit DNA production in cells that depend on certain natural metabolites to produce their DNA • Replace these needed metabolites and thereby prevent normal cellular function • Cell cycle phase specific and affect the S phase Antimetabolites Folic Acid Antagonists methotrexate (Folex, Mexate) pemetrexel (Alimta)
• Leukemias • GI and basal cell cancers Adverse effects • cytarabine ( Cytosar): alopecia, stomatitis, hyperuricemia, and hepatotoxicity • 5-Flourouracil (Fluroblastin): phototoxicity reactions, & cerebellar dysfunction • mercaptopurine (Empurine): hyperuricemia & hepatotoxicity • methotrexate (Emthexate): hyperuricemia, photosensitivity, hepatotoxicity, hematological, gastrointestinal and skin toxicity Nursing Interventions • 5-Fluorouracil (Fluroblastin): assess for signs of cerebellar dysfunction, such as dizziness, weakness, and ataxia. • methotrexate (Emthexate): prepare to administer leukovorin to prevent toxicity especially in large doses • leucovorin (Wellcovorin) is an active form of folic acid that is used to “rescue” cells from the adverse effects of methotrexate therapy. • Given orally or IV at the time of methotrexate therapy and for the next 72 hours Client Teachings 1. Practice reliable contraception and notify health care provider if pregnancy is planned 2. Avoid pregnancy for 4 to 6 months after completing antineoplastic therapy 3. Do not breastfeed during treatment 4. Immediately report buzzing, ringing, or tingling sensation in the ears, or decreased hearing 5. Immediately report palpitations and dizziness or fainting when moving to an upright position 6. Report for any fever, chills or sore throat 7. Amenorrhea, menstrual irregularities, and sterility may occur in premenopausal women; impotence for men 8. Avoid citric acid and foods high in purines (organ meats, beans, peas) ANTITUMOR ANTIBIOTICS Antitumor Antibiotics • Interfere with DNA and RNA synthesis • Mechanism of action is similar to the alkalyting agents • Contains substance obtained from bacteria that have the ability to kill cancer cells. • Cell cycle phase non-specific medications • Examples: bleomycin (Blenoxane) doxurubicin (Mycin, Adrinablastina) idarubicin ( Zavedos) Adverse Effects • Cardiotoxicity may occur within minutes of administration • Cardiomyopathy and ECG changes • Pulmonary toxicity can occur with bleomycin (Blenoxane) Nursing Interventions
1. Monitor ECG changes especially for T-wave
flattening or ST depression 2. Assess lung sounds for crackles 3. Assess for congestive heart failure including dyspnea, crackles, peripheral edema, and weight gain. Nursing Interventions
4. Avoid the use of aspirin, anticoagulants, and
thrombolytic agents. 5. Hydrate the client. 6. Administer antiemetic 30 to 60 minutes before the medication. MITOTIC INHIBITORS VINCA ALKALOIDS Mitotic Inhibitors • Interferes with the ability of a cell to divide • Block or alters DNA synthesis, thus causing cell death • Cell cycle phase-specific and act on the M phase • Used for the treatment of a variety of tumors and leukemias Vinca alkaloids • vincristine ( Nevexitin, Oncovin) • vinblastine sulfate (Velban)
pancytopenia • Neurotoxicity with vincristine sulfate (Oncovin), manifested as numbness and tingling in the fingers and toes • Necrosis and cellulitis if extravasation occurs Nursing Interventions 1. Arrange for blood tests to monitor bone marrow function before, periodically during, and for at least 3 weeks after therapy to arrange to discontinue the drug or reduce the dose as needed. 2. Avoid direct skin or eye contact with the drug. Wear protective clothing and goggles while preparing and administering the drug to prevent toxic reaction to the drug. 3. Ensure that the patient is well hydrated to decrease the risk of renal toxicity. 4. Protect the patient from exposure to infection because bone marrow suppression will decrease immune/ inflammatory responses. 5. Monitor injection sites to arrange appropriate treatment for extravasation, local inflammation, or cellulitis. Preventing Extravasation 1. Use a distal vein, avoiding small veins on the wrists or digits. 2. Never use existing line unless it is clearly open and running well. 3. Start the infusion with D5W 4. Check the site frequently and ask the patient to report any discomfort in the area. Note: When IV antineoplastic drug extravasates, or infiltrates into the surrounding tissue, serious tissue damage can occur. These drugs are toxic to cells, and the resulting tissue injury can result in severe pain, scarring, nerve damage, infection HORMONES AND HORMONE MODULATORS Hormone and Hormone Modulators • Hormonal medications are used to interfere with estrogen receptor sites so as to prevent growth of the cancer • Suppress the immune system and block normal hormones in hormone sensitive tumor • Change the hormonal balance and slow the growth rates of certain tumors Hormone and Hormone Modulators • Indicated for the treatment of breast cancer in postmenopausal women or in other women without ovarian function • Some drugs are indicated for the treatment of prostatic cancers that are sensitive to hormone manipulation Hormone and Hormone Modulators • tamoxifen (Novaldex) • megestrol acetate (Megace) • leuprorelin (Luprolex • goserelin acetate (Zoladex) • asparaginase (Elspar) • diethystilbestrol (Stilphostrol) Adverse Effects • Menopause-associated effects: hot flashes, vaginal spotting, vaginal dryness, moodiness, and depression • Bone marrow suppression and GI toxicity, including hepatic dysfunction • Hypercalcemia as the calcium is pulled out of the bones without estrogen activity to promote calcium deposition Adverse Effects • Increases the risk for cardiovascular disease because of their effects on the body • Leukopenia • Impaired pancreatic function with asparaginase (Elspar) • Gynecosmatia or breast swelling • Weight gain Specific Adverse Effects • tamoxifen (Novaldex) may cause edema, hypercalcemia, & elevated cholesterol and triglyceride levels • Diethystilbestrol may cause impotence and gynecosmatia in men; may alter the effects of insulin and anticoagulants Nursing Interventions
1. Monitor VS, serum calcium levels, cholesterol
levels, and uric acid 2. Monitor for signs of alterations in sexual characteristics 4. Monitor pancreatic functions with asparaginase (Elspar) 5. Encourage fluid intake of 2 to 3 L per day 6. Monitor for signs of hemorrhagic cystitis Nursing Interventions 7. Provide comfort measures to help the patient cope with menopausal signs and symptoms such as hygiene measures, temperature control, and stress reduction. Expect to reduce the dose if these effects become severe or intolerable. 8. Advise the patient of the need to use barrier contraceptive measures while taking these drugs to avert serious fetal harm. CANCER CELL-SPECIFIC AGENTS CANCER CELL-SPECIFIC AGENTS
Protein tyrosine kinase inhibitors
(Imatinib)
Epidermal growth factor inhibitors
Proteasome inhibitors INTERACTIONS: ▪ Any drug that has potential for hepatic or renal toxicity ▪ Adversely affect drugs metabolized in the liver (e.g. oral anticoagulants) ▪ Antineoplastic antibiotics can increase toxicity of drugs that are toxic to the heart and lungs. ▪ Echinacea: increased risk of hepatotoxicity with antineoplastics INTERACTIONS: ▪ Ginkgo: inhibits blood clotting, which can cause problems after surgery or with bleeding neoplasms ▪ Saw palmetto: increase the effects of various estrogen hormones and hormone modulators; advise patients taking such drugs to avoid this herb St. John’s wort: can greatly increase photosensitivity TARGETTED THERAPY IMMUNOTHERAPY TYPES:
IMMUNE CHECKPOINT INHIBITORS
T-CELL TRANSFER THERAPY MONOCLONAL ANTIBODIES TREATMENT VACCINES IMMUNE SYSTEM MODULATORS •Karch, A. M., & Karch. (2011). Focus on nursing pharmacology. Wolters Kluwer Health/Lippincott Williams & Wilkins. [Link] •Katzung, B. G. (2017). Basic and clinical pharmacology. McGraw-Hill Education. •Lehne, R. A., Moore, L. A., Crosby, L. J., & Hamilton, D. B. (2004). Pharmacology for nursing care. •Smeltzer, S. C., & Bare, B. G. (1992). Brunner & Suddarth’s textbook of medical-surgical nursing. Philadelphia: JB Lippincott. •Raven, Masleed, R, et al. (2017). Lippincott’s Nursing Guide.Pharmacology, Drug Therapy and Nursing. (4thEd).Philadelphia: JB Lippincott INTERNET SOURCE:
