antineoplastic agents Flashcards
Cancer Pathophysiology
Dysregulation of cell cycle
Continuous growth and division
Imbalance between oncogene expression and tumor suppressor gene expression
Tumor development
antineoplastic agents MOA
Stop or slow growth of cancer cells, which grow and divide quickly
Also affect healthy cells that grow quickly
Bone marrow cells
Cells of the gastrointestinal (GI) tract including cells that line the mouth and intestines
Hair
antineoplastic agents adverse effects
Bone marrow suppression (BMS)/myelosuppression
Neutropenia, anemia, thrombocytopenia
Nausea, vomiting, diarrhea, mucositis
Alopecia
antineoplastic agents counseling
Watch for fever, malaise, sore mouth or throat
May cause hair loss
antineoplastic agents interactions
Vaccines:
Inactivated
Live
antineoplastic agents key points
Monitor for signs of BMS and infection Often give antiemetics for N/V Dosing: Body surface area (BSA) Adjustments
Cyclophosphamide Alkylating Agents MOA
Forms strong covalent bonds with DNA inhibiting replication and causing bond breaks and cell death.
Cyclophosphamide Alkylating Agents uses
Cancers, autoimmune disorders
Cyclophosphamide Alkylating Agents dosing
Dosage forms: injection, tablets
Usual doses: 400-1800 mg/m2 IV x 1 dose that may be repeated at 2-4 week intervals, 50-100 mg/m2 PO daily for up to 14 continuous days
Cyclophosphamide Alkylating Agents adverse effects
BMS, N/V/D/mucositis, alopecia, hemorrhagic cystitis
Amenorrhea, sterility, secondary malignancies
Cyclophosphamide Alkylating Agents Hemorrhagic cystitis
Acrolein metabolite binds to bladder wall
Cystitis with tissue edema, ulceration, local hemorrhage
Painful urination, hematuria
Prevention:
Hydration
Mesna
Cyclophosphamide Alkylating Agents counseling
Drink plenty of fluids
Take oral doses early in the day
Report painful urination, discolored or bloody urine
Cyclophosphamide Alkylating Agents key points
Hydration ± Mesna to prevent hemorrhagic cystitis
Give antiemetics to prevent N/V
Doxorubicin Anthracyclines MOA
Inhibition of DNA and RNA synthesis by intercalation of DNA base pairs and inhibition of DNA repair by topoisomerase
Doxorubicin Anthracyclines uses
Cancers
Doxorubicin Anthracyclines dosing
Dosage forms: injection
Usual doses: 60-75 mg/m2 per dose every 3-4 weeks; 20-30 mg/m2 per day for 3 days every 4 weeks; 60 mg/m2 per dose every 2 weeks (dose dense
Doxorubicin Anthracyclines adverse effects
BMS, N/V/D/mucositis, alopecia, cardiotoxicity
Extravasation
Amenorrhea, sterility, secondary malignancies
Doxorubicin Anthracyclines cardiotoxicity
Measure ejection fraction (EF) prior to starting therapy Echocardiogram Limit cumulative lifetime dose 550 mg/m2 Dexrazoxane Chemoprotectant Liposomal doxorubicin (Doxil)
Doxorubicin Anthracyclines extravasation
Leakage of vesicants into surrounding tissue leading to tissue necrosis
Central access preferred
Dimethylsulfoxide and cold compresses
Dexrazoxane
Doxorubicin Anthracyclines interactions
Trastuzumab
Doxorubicin Anthracyclines counseling
Watch for pain or swelling at injection site
Doxorubicin Anthracyclines key points
Cardiotoxicity
Extravasation
Give antiemetics to prevent N/V
Cytarabine, 5-Fluorouracil, Capecitabine, Methotrexate, Antimetabolites MOA
Similar in structure to naturally occurring compounds
Incorporate themselves into DNA leading to cell death
Cytarabine, 5-Fluorouracil, Capecitabine, Methotrexate, Antimetabolites uses
Cancers
Methotrexate – psoriasis, rheumatoid arthritis, ectopic pregnancy, Chron’s disease
Cytarabine, 5-Fluorouracil, Capecitabine, Methotrexate, Antimetabolites adverse effects
All: BMS, N/V/D, mucositis
Cytarabine: tumor lysis syndrome, CNS toxicity, conjunctivitis
5-Fluorouracil and Capecitabine: photosensitivity, palmar-plantar erythrodysesthesias (hand-foot syndrome), eye irritation/lacrimation
Methotrexate: neurotoxicity, hepatotoxicity, nephrotoxicity
Cytarabine adverse effects
!!Tumor lysis syndrome!! Caused by tumor cell lysis Release of intracellular contents Potassium, phosphate, nucleic acids/uric acid Acute renal failure
5-Fluorouracil adverse effects
Palmar-plantar erythrodysesthesias
Methotrexate adverse effects
neurotoxicity, hepatotoxicity, nephrotoxicity
Cytarabine, 5-Fluorouracil, Capecitabine, Methotrexate, Antimetabolites counseling points
Cytarabine: stay well hydrated, report changes in mental status, steroid eye drops
5-Fluorouracil and Capecitabine: Avoid sunlight exposure and use sunscreen when exposure cannot be avoided, may cause painful rash on the hands and feet
Methotrexate: watch for fever, malaise, bleeding, bruising, flank pain, leucovorin rescue
Carboplatin, Cisplatin. Platinum Compounds MOA
form strong covalent bonds with DNA inhibiting replication and causing cell death
Carboplatin, Cisplatin. Platinum Compounds uses
cancers
Carboplatin, Cisplatin. Platinum Compounds adverse effects
BMS, N/V, peripheral neuropathies, alopecia, ototoxicity
Carboplatin – hypersensitivity
Cisplatin – nephrotoxicity, ELYTE losses (K, Mag)
Carboplatin, Cisplatin. Platinum Compounds interactions
Aminoglycosides
Carboplatin, Cisplatin. Platinum Compounds counseling
Drink plenty of fluids, contact your healthcare provider if you are unable to keep fluids down, or if there is any hearing loss
Carboplatin, Cisplatin. Platinum Compounds key points
Cisplatin nephrotoxicity
Docetaxel, Paclitaxel- Taxanes MOA
Promote assembly and preventing depolymerization, leading to stabilization of microtubule bundles and inhibition of cell replication
Docetaxel, Paclitaxel- Taxanes uses
: cancers
Docetaxel, Paclitaxel- Taxanes counseling
Peripheral neuropathies can occur with continued use
Docetaxel, Paclitaxel- Taxanes adverse effects
BMS, peripheral neuropathy, myalgia, arthralgia, alopecia
Docetaxel – fluid retention syndrome, skin and nail changes
Paclitaxel – hypersensitivity
Docetaxel, Paclitaxel- Taxanes key points
Docetaxel – premedicate with corticosteroid to reduce fluid retention
Paclitaxel – premedicate with a corticosteroid, diphenhydramine, and histamine-2 blocker to prevent hypersensitivity
Imatinib (Gleevec), Rituximab (Rituxan), Trastuzumab (Herceptin) MOA
Target abnormal genetic signaling proteins specific to the cancer Imatinib (Gleevec) Targets Philadelphia fusion gene Rituximab (Rituxan) Targets CD-20 antigen on B-cells Trastuzumab (Herceptin) Targets HER2/neu oncogene Breast Cancer
NCI Toxicity Rating
0: no toxicity
4: life threatening toxicity
Chemotherapeutic Agents are ISMP High-Alert Medications
Methods to prevent medication errors
Double-check orders
Specialist prescribers
Protocol adherence
