Antineoplastic Agents (Chemotherapy) Flashcards
What are antineoplastic agents?
Drugs used to treat cancer
Principles of chemotherapy:
- _________ because cancer cells will ______ if chemo is given at _____ dose. Genetic factors may also contribute to resistance.
- _______ drugs are used to avoid _______. Different drugs are used for different parts of the cell cycle phases.
- Cannot administer drugs for too _______ because of how they affect the ______ _____, thus affecting the white blood cells, thus affecting _______.
- Must wait for white blood cell cycle to ____ _____ immune cells before __________ _____ to avoid ______
Principles of chemotherapy:
- Resistance because cancer cells will mutate if chemo is given at low dose. Genetic factors may also contribute to resistance.
- Multiple drugs are used to avoid toxicity. Different drugs are used for different parts of the cell cycle phases.
- Cannot administer drugs for too long because of how they affect the bone marrow, thus affecting the white blood cells, thus affecting immunity.
- Must wait for white blood cell cycle to produce more immune cells before administering more to avoid toxicity.
Steps to safely administering chemotherapy: (5)
- Know patient’s actual height and weight
- With another nurse, calculated patient’s body surface area
-Check labs/tests (LFT, kidney, wbc)
-Check blood (CBC, peak, and trough)
-Check for adequate blood return before administering chemo
Personal protective equipment (PPE) for the nurse.
Gloves- must be latex or nitrile, change every 30 min. 2 pairs used
Gown- disposable, line free. 2nd pair of glove over cuff
Eye and face mask- (PR mask, not surgical)
G0
Resting phase, cells are not replicating
G1
Enzymes necessary for DNA synthesis are produced (first gap phase or postmitotic phase)
S
DNA synthesis phase; DNA synthesis takes place, from DNA strand separation to replication of each strand to create duplicate DNA molecules.
G2
RNA and specialized proteins are made (second gap phase or premitotic phase)
M
Mitotic phase; prophase, metaphase, anaphase, and telophase. Cell divied and reproduces into two daughter cells.
Antimetabolite drugs are ____ ____ ___.
What phase are they?
What do they do?
Cell Cycle specific (S PHASE) inhibit protein synthesis.
Antimetabolites include
Methotrexate and Fluorouracil
Antimetabolites
-Methotrexate (IV, IM, PO, Intrathecal)
o Treats Cancer: _________________________________________________
o Non cancer treatment: _____________
o Side effects: ___________________________________
o Do not take with ______, , or _____________________
o Monitors _____
o Treats Cancer: Head, neck, breast, testicular, ovarian, bladder, lymphomas
o Non cancer treatment: rheumatoid arthritis
o Side effects: photosensitivity, liver dysfunction, myelosuppression, mucositis,
o Do not take with alcohol, NSAIDS, or salicylates (liver toxicity)
o Monitors LFT
- Fluorouracil (5-FU) – (IV, IA, Topical)
o Treats cancer: ___________________________________________________
o Side effects: Myelosuppression, alopecia, mucositis, _________,________
Treats cancer: Head, neck, breast, gastric
o Side effects: Myelosuppression, alopecia, mucositis, diarrhea, vein discoloration
Vinca alkaloid
Cell cycle specific, prevents Mitosis (METAPHASE)
Vinca alkaloid – Cell cycle specific, prevents Mitosis (METAPHASE)
- 3 types: ________,______,_____
o Side effects: ________ (______ neuropathies, foot ____, _______ in hands and feet, paralytic ileus), myelosuppression, nausea, and vomiting
o _______ agents
Vinca alkaloid – Cell cycle specific, prevents Mitosis (METAPHASE)
- 3 types: Vincristine, Vinblastine, Vinorelbine
o Side effects: Neurotoxic (peripheral neuropathies, foot drop, tingling in hands and feet, paralytic ileus), myelosuppression, nausea, and vomiting
o Vesicant agents
c. Taxanes –
- Paclitaxel and docetaxel
- Side effects: _________ (peripheral neuropathies, foot drop, tingling in hands and feet, _______ ______), ________, _________,
_________ (common to vinca alkaloid),
- __________ reactions- premeditate with steroids, antihistamine, h2 blocker,
Taxanes –
- Paclitaxel and docetaxel
- Side effects: Neurotoxic (peripheral neuropathies, foot drop, tingling in hands and feet, paralytic ileus), myelosuppression, nausea, and vomiting, ALOPECIA (common to vinca alkaloid),
- Hypersensitivity reactions- premeditate with steroids, antihistamine, h2 blocker,
Topoisomerase – 1 inhibitors –
Cell cycle specific, kills during S PHASE
inhibits cell replication by inhibiting enzyme
Topoisomerase – 1 inhibitors – Cell cycle specific, kills during S PHASE; inhibits cell replication by inhibiting enzyme.
- Side effects:
o ________ (severe _____, administer______)
o Troptocan (severe diarrhea)
o Etoposide (hypotension, bronchospasm, monitor BP)
- Side effects:
o Irinotecan (severe diarrhea, administer strophine)
o Troptocan (severe diarrhea)
o Etoposide (hypotension, bronchospasm, monitor BP)
Alkylating agent –
Cell cycle NON-SPECIFIC, interfere with DNA structures
Types of alkylating agents
- Cyclophosphamide
- Cisplatin
Alkylating agent – Cell cycle NON-SPECIFIC, interfere with DNA structures
Cyclophosphamide (PO,IV)
o Treats Cancer: ______, _______, _____, HD & NH ____________, multiple ______
o Side effects: ______ _______(administer ____ hydrate, assess urine for _____, void frequently before bed time),______________________________________________________
Cyclophosphamide (PO,IV)
o Treats Cancer: Leukemia, ovarian, breast, HD & NH lymphomas, multiple myeloma
o Side effects: Hemorrhage cytisis (administer early, hydrate, assess urine for blood, void frequently before bed time), sterility, nausea, vomiting, myelosuppression, cardiotoxic.
Alkylating agent
-
Cisplatin (IV)
o _______________ (monitor I&O, hydrate, creatinine & BUN, mannitol)
o _______ _______
o ________ ______(watch K and Mg w/ electrolytes)
o ___________
o ______________
o Nephrotoxicity (monitor I&O, hydrate, creatinine & BUN, mannitol)
o Peripheral neuropathy
o Electrolyte imbalance (watch K and Mg w/ electrolytes)
o Ototoxicity
o Emetogenic
Antitumor antibiotic –
Cell cycle NON-SPECIFIC (block DNA synthesis)
Types of antitumor antibiotic
- Doxorubicin – (Vesicant Agent)
- Bleomycin (NOT VESICANT Agent)
Antitumor antibiotic –
- Doxorubicin – (Vesicant Agent)
o ____ in color
o Side effects: ___ ______,________
o Max accumulative dose ___________
o Red in color
o Side effects:hair loss, cardio-toxic
o Max accumulative dose 550 mg/m2, Zina Card
Anti tumor agent
- Bleomycin (NOT VESICANT Agent)
o ______ toxicity
o Test dose with ____ administration
____________
o Baseline BFT
o Not for people over the age of __ years old
Bleomycin (NOT VESICANT Agent)
o Pulmonary toxicity
o Test dose with Pirst administration
Hypersensitivity/anaphylaxis
o Baseline BFT
o Not for people over the age of 70 years old
Know what it means when a chemotherapeutic agent is classified as a “vesicant” agent:
Causes extravasation, leakage from blood vessel into tissue
Hormonal agents- Antiestrogen
- Aromatase Inhibitors
o Blocks enzyme from converting _______ to _______
o Used in ER-positive _____ _______ women with breast cancer
o Side effects: _______
- Aromatase Inhibitors
o Blocks enzyme from converting androgen –> estrogen
o Used in ER-positive POST MENOPAUSAL women with breast cancer
o Side effects: osteoporosis
Hormonal agents- Antiestrogen
- Tamoxifen, Raloxifene, Fulvestrant
o Used in estrogen receptor positive (ER+) women w/breast cancer
o Side effects: Hot Plashes, RISK OF _____ _____ ______, headaches
- Tamoxifen, Raloxifene, Fulvestrant
o Used in estrogen receptor positive (ER+) women w/breast cancer
o Side effects: Hot Plashes, RISK OF DEEP VEIN THROMBOSIS, headaches
Hormonal agents- Antiestrogen
- Progestins
o Used for….
women with endometrial cancer
Hormonal agents- Antiestrogen- Trastuzumab
Used in..
Side effects?
o Monoclonal antibody used in metastatic breast cancer treatment.
o Side effects: cardio-toxic, ventricular dysfunction, and C- heart failure
Biological Response Modifiers
- Interferon: enhance immune system & stops division
o Treats:
o Treats Cancer:
o Side Effects: fever like, diarrhea, anorexia, paranoid, dizziness, confusion, tachycardia, neutropenia, thrombocytopenia
o Renal: BUN & creatinine
o Psych: Depression and suicide.
o Treats: papilovirus, Hep C, multiple sclerosis
o Treats Cancer: Kaposi, myeloma, renal, bladder
o Side Effects: fever like, diarrhea, anorexia, paranoid, dizziness, confusion, tachycardia, neutropenia, thrombocytopenia
o Renal: BUN & creatinine
o Psych: Depression and suicide.
- Biological Response ModiPiers
- Interferon alpha
o Flu-like symptoms, nero changes, monitor CBC
Side effects of chemotherapy:
Myelosuppression
Mucositis
Alopecia
Reproductive organs
GI mucosa
- Myelosuppression: leukopenia, neutropenia, thrombocytopenia, anemia
o Neutropenia: low immune system, high-risk of infection. Hand washing, make sure vaccines are up to date.
o Thrombocytopenia: high risk of bleeding. Prevent bleeding, no razors, shaving.
o Anemia: rest, monitor oxygenation, erythropoietin, blood transfusions.
- Myelosuppression: leukopenia, neutropenia, thrombocytopenia, anemia
o Neutropenia: low immune system, high-risk of infection. Hand washing, make sure vaccines are up to date.
o Thrombocytopenia: high risk of bleeding. Prevent bleeding, no razors, shaving.
o Anemia: rest, monitor oxygenation, erythropoietin, blood transfusions.
- Mucositis: mouth blisters. Assess, pain control, dietary, oral hygiene.
- Alopecia: hair loss. It will grow back .
- Reproductive organs
- GI mucosa
- Mucositis: mouth blisters. Assess, pain control, dietary, oral hygiene.
- Alopecia: hair loss. It will grow back .
- Reproductive organs
- GI mucosa
