Antineoplastic Drugs Flashcards
Cancer Treatments?
- Chemotherapy
- Surgery
- Radiation
Describe Chemotherapy.
- Combination of drugs is usually more effective than single-drug therapy
Antineoplastics primary complications?
- Emetic potential
- Harmful to all rapidly growing cells
- Cancer cells
- Healthy, normal human cells
- Bone Marrow Suppression
- No chemo if ANC < 1000; < 500 = severe neutropenia
How to treat Emetic potential?
- ondansetron
- Aprepitant, fosaprepitant
- dronabinol
- ginger (herbal)
Antineoplastics potential complications?
- Extravasation
- If suspected, STOP the infusion immediately - Tumor Lyse Syndrome: Medical Emergency
- Hemorrhagic Cystitis
- Cardiotoxicity
- Constipation
- Learning or cognitive issues for prepubertal clients
- Infertility
Describe the electrolyte levels during Tumor Lyse Syndrome.
- ↑ Hyperphosphatemia
- ↑ Hyperkalemia
- ↑ Hyperuricemia
- ↓ Hypocalcemia
What does Folate (Folic Acid) Antagonist - MTX (Methotrexate) treat?
- Monotherapy
- Non-Hodgkin’s lymphoma
- Squamous cell carcinoma of the head/neck
- Mycosis fungoides (cutaneous T-cell lymphoma)
- In combination w/ other drugs
- Acute lymphoblastic leukemia
- Osteosarcoma
- Breast cancer
What drug needs to be given after Methotrexate (MTX)?
- Leucovorin will always be given after HD MTX
- Starts 24 hrs after the end of chemotherapy; “rescue”
What does Vincristine treat?
- Hodgkin’s disease
- Leukemias
- Neuroblastomas
- Malignant lymphomas
- Wilms’ tumor
- Rhabdomyosarcoma
Vincristine adverse effects?
May cause progressive peripheral neuropathy
How is vincristine administered?
Intravenous ONLY
Leucovorin indication?
- Helps prevent severe myelosuppression
- Treats anemia caused by the lack of folic acid
How do Alkylating Drugs work?
Prevents cancer cells from reproducing by altering structure of the DNA
cisplatin indications?
- Metastatic testicular and ovarian carcinoma
- H & N cancer
- Cervical cancer
- Lung cancer
When should you seek caution for cisplatin?
Hearing loss
cisplatin adverse effect?
EENT: ototoxicity, tinnitus
cyclophosphamide indications?
- Hodgkin’s disease
- Leukemias
- Neuroblastoma
- Malignant lymphomas
- Mycosis fungoides
- Multiple myeloma
- Ovarian carcinoma
- Breast carcinoma
cyclophosphamide management?
- Prevention of hemorrhagic cystitis
- mesna
- Increase fluids to 2000-3000 mL/day
How do Antineoplastic Antibiotics work?
Block DNA synthesis through a process called intercalation
Doxorubicin indications?
- Alone or w/ others in the treatment of various solid tumors including:
- Breast
- Ovarian
- Bladder
- Also, malignant lymphomas and leukemias
Doxorubicin adverse effects?
- GU: red urine (normal finding)
- Cardiotoxicity
- Acute left ventricular HF
- Administer dexrazoxane (cardioprotective)
- Routine monitoring of cardiac ejection fraction
Bleomycin indications?
- Lymphomas
- Squamous cell carcinoma
- Testicular embryonal carcinoma
Bleomycin adverse effects?
- Pulmonary fibrosis
- Pneumonitis
tamoxifen indications?
- Estrogen-receptor positive (ER+) metastatic breast cancer
- Adjuvant treatment of early-stage ER+ breast cancer
- Prevention of breast cancer in high-risk patients
Leuprolide indications?
- Advanced prostate cancer in patients who are unable to tolerate orchiectomy (surgical removal of the testes) or estrogen therapy
Rituximab indications?
- Relapse of refractory, low-grade or follicular B-cell non-Hodgkin’s lymphoma
- Chronic lymphocytic leukemia
Rituximab Adverse Effects?
- hypersensitivity reactions (including anaphylaxis & angioedema)
- infusion reactions
- flu like symptoms
Rituximab Special Considerations?
pre-medicate w/ acetaminophen & diphenhydramine
Antineoplastics nursing considerations (drug adverse)?
Doxorubicin and daunorubicin may turn the urine a reddish color
Antineoplastics nursing intervention?
notify prescriber immediately if client starts coughing, SOB, or abnormal breath sounds
Antineoplastics Patient Education?
- increase fluids
- avoid aspirin and ibuprofen
- avoid foods that may irritate GI tract
- diarrhea or constipation may occur
What do Hematopoietic Drugs-Colony Stimulating Factors (CSFs) do?
Reduce the duration of low neutrophil counts
Types of CSFs?
- Filgrastim (Neupogen)
- Pegfilgrastim (Neulasta)
CSFs adverse effects?
bone pain
When should filgrastim be given?
Must be given BEFORE a client develops an infection; given after 24 hours after myelosuppressive chemotherapy
Hematopoietic Drugs Implementation?
- Assess pain level
- Administer scheduled PRN pain meds
- Offer non-pharmacologic methods of pain reduction
Types of Modifying Drugs?
- Monoclonal Antibodies
- adalimumab
- infliximab
- Disease-modifying antirheumatic drugs (DMARDs)
- MTX
- leflunomide
- etanercept
adalimumab indications?
- Crohn’s disease
- UC
- plaque psoriasis
- psoriatic arthritis
adalimumab contraindication?
Active infection
infliximab indications?
- Ankylosing spondylitis
- Crohn’s Disease
- UC
- plaque psoriasis
- RA
Infliximab special considerations?
- Contraindication in severe heart failure; it will worsen this condition
- FDA black box warning reporting cases of TB and fungal infections
Examples of DMARDs?
Nonbiologic:
- Methotrexate
- Leflunomide
Biologic:
- Etanercept
DMARDs are NOT used in patients with?
- active bacterial infection
- active herpes zoster
- active or latent TB
- acute or chronic hepatitis B or C
Leflunomide contraindication?
Contraindicated in clients who are or may become pregnant (Category X)
Methotrexate (MTX) drug profile?
- Commonly used to treat RA in much lower doses
- Weekly dosing (NOT DAILY!!!!)
- Advise to take folic acid supplement to lessen likelihood of adverse effects
What does Etanercept treat?
- RA (including juvenile RA)
- psoriasis
