Antineoplastic Drugs Flashcards
Asparaginase
Functional Classification
Antineoplastic
Asparaginase
Uses
Acute lymphocytic leukemia in combination with other antineoplastics
Asparaginase
Contraindications
Hypersensitivity to product or E. coli protein, thromboembolic disease, infants, breastfeeding, pancreatitis
Cytarabine
Functional Classification
Antineoplastic, antimetabolite
Cytarabine
Chemical Classification
Pyrimidine nucleoside analog
Cytarabine
Mechanism of Action
Competes with physiologic substrate of DNA synthesis, thus interfering with cell replication in the S phase of the cell cycle (before mitosis)
Cytarabine
Uses
Acute myelocytic leukemia, acute nonlymphocytic leukemia, chronic myelocytic leukemia; lymphomatous meningitis (intrathecal/intraventricular)
Cytarabine
Contraindications
Pregnancy (D), hypersensitivity
Cytarabine
Side Effects
CNS: neuritis, dizziness, headache, cerebellar syndrome, personality changes, ataxia, mechanical dysphagia, COMA; CHEMICAL ARACHNOIDITIS (IT)
CV: chest pain, CARDIOPATHY
CYTARABINE SYNDROME: Fever, myalgia, bone pain, chest pain, Rash, conjunctivitis, malaise (6-12 hr after administration)
EENT: sore throat, conjunctivitis
GI: Nausea, Vomiting, Anorexia, Diarrhea, Stomatitis, HEPATOTOXICITY, abdominal pain, hematemesis, GI HEMORRHAGE
GU: urinary retention, RENAL FAILURE, HYPERURICEMIA
HEMA: THROMBOPHLEBITIS, BLEEDING, THROMBOCYTOPENIA, LEUKOPENIA, MYELOSUPPRESSION, ANEMIA
INTEG: Rash, Fever, freckling, cellulitis
META: hyperuricemia
RESP: PNEUMONIA, dyspnea, PULMONARY EDEMA (high doses)
SYST: ANAPHYLAXIS
Cytarabine
Nursing Considerations
ASSESS:
- BONE MARROW SUPPRESSION: CBC (RBC, Hct, Hgb), differential, platelet count weekly; withhold product if WBC is <30ml/hr
- Monitor temp q4hr; fever may indicate beginning infection; no rectal temps
- HEPATOTOXICITY: hepatic studies before and during therapy: bilirubin, ALT. AST, alk phos, as needed or monthly; check for jaundice of skin, sclera; dark urine; clay-colored stools; pruritus; abdominal pain; fever; diarrhea
- blood uric acid therapy
- For anaphylaxis: rash, pruritus, facial swelling, dyspnea; resuscitation equipment should be nearby
- Chemical arachnoiditis (IT): headache, nausea, vomiting, fever; neck rigidity pain, meningism, CSF pleocytosis; may be decreased by dexamethasone
- Cytarabine syndrome 6-12hr after inf: fever, myalgia, bone pain, chest pain, rash, conjunctivitis, malaise; corticosteroids may be ordered
- Bleeding: hematuria, heme-positive stools, bruising or petechiae, mucosa or orifices q8hr
- Dyspnea, crackles, unproductive cough, chest pain, tachypnea, fatigue, increased pulse, pallor, lethargy; personality changes, with high doses; pulmonary edema may be fatal (rare)
- Buccal cavity q8hr for dryness, sores or ulceration, white patches, oral pain, bleeding, dysphagia
- Local irritation, pain, burning, discoloration at inj site
- GI symptoms: frequency of stools, cramping; antispasmodic may be used
- Acidosis, signs of dehydration: rapid respirations, poor skin turgor, decreased urine output, dry skin, restlessness, weakness
PERFORM/PROVIDE:
- Increased fluid intake to 2-3L/day to prevent urate deposits and calculi formation unless contraindicated
- Diet low in purines: absence of organ meats (kidney, liver), dried beans, peas to prevent increased urate deposits
- Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss
Etoposide
Functional Classification
Antineoplastic-miscellaneous
Etoposide
Chemical Classification
Semisynthetic podophyllotoxin
Etoposide
Mechanism of Action
Inhibits mitotic activity through metaphase to mitosis; also inhibits cells from entering mitosis, depresses DNA/RNA synthesis, cell-cycle-specific S and G2; binds to a complex of DNA and topoisomerase II
Etoposide
Uses
Testicular cancer, small-cell carcinoma of the lung
Etoposide
Contraindications
Pregnancy (D), breastfeeding, hypersensitivity, severe renal/hepatic disease
Etoposide
Side Effects
CNS: headache, Fever, peripheral neuropathy, paresthesias, confusion, chills, fever
CV: Hypotension, MI, DYSRHYTHMIAS
GI: Nausea, Vomiting, Anorexia, HEPATOTOXICITY, dyspepsia, diarrhea, constipation
GU: NEPHROTOXICITY
HEMA: THROMBOCYTOPENIA, LEUKOPENIA, MYELOSUPPRESSION, ANEMIA
INTEG: Rash, Alopecia, phlebitis at IV site, radiation recall, STEVENS-JOHNSON SYNDROME
RESP: BRONCHOSPASM, pleural effusion
SYST: ANAPHYLAXIS
Etoposide
Nursing Considerations
ASSESS:
- BONE MARROW DEPRESSION: CBC, differential, platelet count weekly; withhold product if WBC is <90mmHg, discontinue inf, notify prescriber
- Buccal cavity q8hr for dryness, sores or ulceration, white patches, oral pain, bleeding dysphagia
- Local irritation, pain, burning, discoloration at inj site
- SYMPTOMS INDICATING SEVERE ALLERGIC REACTION: rash, pruritus, urticaria, purpuric skin lesions, itching, flushing, restlessness, coughing, difficulty breathing
- FREQUENCY OF STOOLS, CHARACTERISTICS: cramping, acidosis; SIGNS OF DEHYDRATION: rapid respirations, poor skin turgor, decreased urine output, dry skin, restlessness, weakness
- GERIATRIC PATIENTS: increased alopecia, GI effects, infection, nephrotoxicity, myelosuppression
PERFORM/PROVIDE:
-Increased fluid intake to 2-3L/day to prevent urate deposits, calculi formation
Methotrexate
Functional Classification
Antineoplastic-antimetabolite (Vesicant)
Methotrexate
Chemical Classification
Folic Acid Antagonist
Methotrexate
Mechanism of Action
Inhibits an enzyme that reduces folic acid, which is needed for nucleic acid synthesis in all cells; specific to S phase of cell cycle’ immunosuppressive
Methotrexate
Uses
Acute lymphocytic leukemia; in combination for breast, lung, head, neck carcinoma; lymphosarcoma, gestational choriocarcinoma, hydatidiform mole, psoriasis, RA, mycosis fungoides, osteosarcoma
Methotrexate
Contraindications
Hypersensitivity, leukopenia (<100,000/mm3), anemia; psoriatic patients with severe renal disease, alcoholism, HIV
Pregnancy (X), hepatic disease
Methotrexate
Side Effects
CNS: dizziness, SEIZURES, LEUKOENCEPHALOPATHY, headache, confusion, hemiparesis, malaise, fatigue, chills, fever; arachnoiditis (intrathecal)
EENT: blurred vision, optic neuropathy
GI: Nausea, Vomiting, Anorexia, Diarrhea, Ulcerative Stomatitis, HEPATOTOXICITY, cramps, ulcer, gastritis, GI HEMORRHAGE, abdominal pain, hematemesis, HEPATIC FIBROSIS, ACUTE TOXICITY
GU: urinary retention, RENAL FAILURE, menstrual irregularities, defective spermatogenesis, HEMATURIA, AZOTEMIA, URIC ACID NEPHROPATHY
HEMA: LEUKOPENIA, THROMBOCYTOPENIA, MYELOSUPPRESSION, ANEMIA
INTEG: Rash, Alopecia, dry skin, urticaria, photosensitivity, folliculitis, vasculitis, petechiae, ecchymosis, acne, alopecia, SEVERE FATAL SKIN REACTION
RESP: METHOTREXATE-INDUCED LUNG DISEASE
SYST: SUDDEN DEATH, Pneumocystis Jiroveci, TUMOR LYSIS SYNDROME
Methotrexate
Nursing Considerations
ASSESS:
- Make sure product is taken weekly in RA, JRA
- CBC, differential, platelet count weekly; withhold product if WBC is <30ml/hr
- Monitor temp; fever may indicate beginning infection; no rectal temp
- Hepatic studies before and during therapy: bilirubin, alk phos, AST, ALT; liver biopsy should be done before start of therapy (psoriasis)
- Bleeding time, coagulation time during treatment; bleeding: hematuria, guaiac, bruising, or petechiae in mucosa or orifices
- Effects of alopecia on body image; discuss feelings about body changes
- PULMONARY TOXICITY: those with ascites or pleural effusion at greater risk for toxicity; fluid should be removed before treatment; monitor plasma methotrexate levels
- TUMOR LYSIS SYNDROME: hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalemia, decreased urine output; use aggressive hydration, allopurinol to correct severe electrolyte imbalances, renal toxicity
- Hepatotoxicity: jaundiced skin and sclera, dark urine, clay-colored stools, pruritus, abdominal pain, fever, diarrhea
- Monitor methotrexate levels, adjust leucovorin dose based on level
- Buccal cavity for dryness, sores, ulceration, white patches, oral pain, bleeding, dysphagia
- SEVERE ALLERGIC REACTION: rash, urticaria, itching, flushing
- RHEUMATOID ARTHRITIS: ROM, pain, joint swelling before, during treatment
- PSORIASIS: skin lesions before, during treatment
PERFORM/PROVIDE:
- Increased fluid intake to 2-3L/day to precent urate deposits, calculi formation unless contraindicated
- Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss
- Storage in tightly closed container in cool environment; store injection, powder for inj in dark, dry are
Paclitaxel
Functional Classification
Antineoplastic-miscellaneous
Paclitaxel
Chemical Classification
Taxane
Paclitaxel
Mechanism of Action
Inhibits reorganization of microtubule network needed for interphase and mitotic cellular functions; causes abnormal bundles of microtubules during cell cycle and multiple esters of microtubules during mitosis
Paclitaxel
Uses
Taxol: metastatic carcinoma of the ovary, breast; AIDS-related Kaposi’s sarcoma (2nd-line), non-small-cell lung cancer (1st-line), adjuvant treatment for node-positive breast cancer
Paclitaxel
(Contraindications):
Pregnancy (D); hypersensitivity to paclitaxel or other products with polyoxyethylated castor oil, albumin, Neutropenia of <1500/mm3
Paclitaxel
Side Effects
CNS: Peripheral Neuropathy
CV: bradycardia, Hypotension, abnormal ECG, SUPRAVENTRICULAR TACHYCARDIA (SVT)
GI: Nausea, Vomiting, Diarrhea, Mucositis, Stomatitis, Increased Bilirubin, Alk Pho, AST
HEMA: NEUTROPENIA, LEUKOPENIA, THROMBOCYTOPENIA, ANEMIA, bleeding, infections
INTEG: Alopecia, TISSUE NECROSIS, generalized urticaria, Flushing
MS: Arthralgia, Myalgia
RESP: PULMONARY EMBOLISM, dyspnea
SYST: Hypersensitivity Reactions, ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, ANGIOEDEMA
Paclitaxel
Nursing Considerations
ASSESS:
- CBC, differential, platelet count before treatment and weekly; withhold product if WBC is </=48hr
- Effects of alopecia on body image; discuss feelings about body changes
PERFORM/PROVIDE:
-Confirmation that dexamethasone was given 12hr and 6hr before inf begins
Vincristine
Functional Classification
Anti-neoplastic-miscellaneous
Vincristine
Chemical Classification
Vinca alkaloid
Vincristine
Mechanism of Action
Inhibits mitotic activity, arrests cell cycle at metaphase; inhibits RNA synthesis, blocks cellular use of glutamic acid needed for purine synthesis; vesicant
Vincristine
Uses
Lymphomas, neuroblastoma, Hodgkin’s disease, acute lymphoblastic and other leukemias, rhabdomyosarcoma, Wilms’ tumor, non-Hodgkin’s lymphoma, malignant glioma, soft-tissue sarcoma
Vincristine
Contraindications
Pregnancy (D), breastfeeding, infants, hypersensitivity, radiation therapy
Vincristine
Side Effects
CNS: Decreased Reflexes, Numbness, Weakness, Motor Difficulties, CNS depression, cranial nerve paralysis, SEIZURES, peripheral neuropathy
CV: orthostatic hypotension
EENT: Diplopia
GI: Nausea, Vomiting, Anorexia, Stomatitis, Constipation, PARALYTIC ILEUS, Abdominal Pain, HEPATOTOXICITY
GU: RENAL TUBULAR OBSTRUCTION
HEMA: THROMBOCYTOPENIA, LEUKOPENIA, MYELOSUPPRESSION, ANEMIA
INTEG: Alopecia, extravasation
SYST: TUMOR LYSIS SYNDROME (TLS)
Vincristine
Nursing Considerations
ASSESS:
- CBC, differential, platelet count before each dose; withhold product if WBC is <75,000/mm3, notify prescriber; RBC, Hct, Hgb; may be decreased
- Renal studies: BUN, serum uric acid, urine CCr, electrolytes before, during therapy; I&O ratio; report fall in urine output of 30ml/hr
- Monitor temp q4hr; may indicate beginning infection
- Hepatic studies before, during therapy (bilirubin, AST, ALT, LDH) as needed or monthly
- Deep Tendon Reflexes; product is neurotoxic
- Sensitivity of feet/hands, which precedes neuropathy
- TUMOR LYSIS SYNDROME: hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia
- EXTRAVASATION: pain swelling, poor blood return; if extravasation occurs, local inj of hyaluronidase and moderate heat to area may help disperse product
- INTRATHECAL ADMINISTRATION: BLEEDING: hematuria, guaiac, bruising, petechiae, mucosa or orifices q8hr. Effects of alopecia on body image discuss feelings about body changes. Jaundiced skin, sclera; dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea. Buccal cavity q8hr for dryness, sores, ulcerations, white patches, oral pain, bleeding, dysphagia. Symptoms indicating severe allergic reaction: rash, pruritus, urticaria, purpuric skin lesions, itching, flushing
PERFORM/PROVIDE:
-Brushing of teeth bid-tid with soft brush or cotton-tipped applicator for stomatitis; use unwaxed dental floss
Cisplatin
Functional Classification
Antineoplastic alkylating agent
Cisplatin
Chemical Classification
Platinum Complex
Cisplatin
Mechanism of Action
Alkylates DNA, RNA; inhibits enzymes that allow for the sythesis of amino acids in proteins; activity not cell-cycle-phase specific
Cisplatin
Uses
Advanced bladder cancer; adjunct in metastatic testicular cancer; osteosarcoma; soft-tissue sarcomas; adjunct in metastatic ovarian cancer; head, neck cancer; esophagus, prostate, lung, cervical cancer; lymphoma
Cisplatin
Contraindications
Pregnancy (D), breastfeeding; radiation or chemotherapy within 1 mo; thrombocytopenia; recent smallpox vaccination; aluminum products used to prepare or administer CISplatin
Preexisting hearing impairment, bone marrow suppression, platinum compound hypersensitivity, renal disease/failure
Cisplatin
Side Effects
CNS: SEIZURES, peripheral neuropathy
CV: cardiac abnormalities
EENT: Tinnitus, Hearing Loss, Vestibular Toxicity, blurred vision, altered color perception
GI: Severe Nausea, Vomiting, Diarrhea, Weight Loss
GU: RENAL TUBULAR DAMAGE, renal insufficiency, impotence, sterility, amenorrhea, gynecomastia, hyperuremia
HEMA: THROMBOCYTOPENIA, LEUKOPENIA, PANCYTOPENIA
INTEG: Alopecia, dermatitis
META: hypomagnesemia, hypocalcemia, hypokalemia, hypophosphatemia
RESP: FIBROSIS
SYST: ANAPHYLAXIS
Cisplatin
Nursing Considerations
ASSESS:
- Bone marrow depression: CBC, differential, platelet count weekly; withhold product if WBC is <100,000/mm3
- Increase fluid intake to 2-3L/day to prevent urate deposits, calculi formation; promote elimination of product
Cyclophosphamide (Cytoxan)
Functional Classification
Antineoplastic alkylating agent
Cyclophosphamide (Cytoxan)
Chemical Classification
Nitrogen mustard
Cyclophosphamide (Cytoxan)
Mechanism of Action
Alkylates DNA is responsible for cross-linking DNA strands; activity is not cell-cycle-phase specific
Cyclophosphamide (Cytoxan)
Use
Hodgkin’s disease; lymphomas; leukemia; cancer of female reproductive tract, breast, lung, prostate; multiple myeloma; neuroblastoma; retinoblastoma; Ewing’s sarcoma; disseminated neuroblastoma, nephrotic syndrome
Cyclophosphamide (Cytoxan)
Contraindications
Pregnancy (D), breastfeeding, severely depressed bone marrow function, hypersensitivity, prostatic hypertrophy, bladder neck obstruction
Cyclophosphamide (Cytoxan)
Side Effects
CNS: headache, dizziness
CV: CARDIOTOXICITY (HIGH DOSES), MYOCARDIAL FIBROSIS
ENDO: SIADH, gonadal suppression
GI: Nausea, Vomiting, Diarrhea, Weight Loss, colitis, HEPATOTOXICITY
GU: HEMORRHAGIC CYSTITIS, Hematuria, Neoplasms, Amenorrhea, Azoospermia, Sterility, Ovarian Fibrosis
HEMA: THROMBOCYTOPENIA, LEUKOPENIA, PANCYTOPENIA, MYELOSUPPRESSION
INTEG: Alopecia, dermatitis
META: hyperuricemia
MISC: secondary neoplasms, ANAPHYLAXIS
RESP: PULMONARY FIBROSIS, INTERSTITIAL PNEUMONIA
Cyclophosphamide (Cytoxan)
Nursing Considerations
ASSESS:
- HEMORRHAGIC CYSTITIS: renal studies: BUN, serum uric acid, urine CCr before, during therapy; I&O ratio; report fall in urine output <75,000; notify prescriber of results
- Pulmonary function tests, chest x-ray films before, during therapy; chest film should be obtained 2qwk during treatment
- Monitor temp q4hr; elevated temp may indicated beginning infection
- HEPATOTOXICITY: hepatic studies before, during therapy (bilirubin, AST, ALT, LDH), as needed; jaundice of skin, sclera; dark urine, clay-colored stools; itchy skin; abdominal pain; fever; diarrhea
- BLEEDING: hematuria, guaiac, bruising or petechiae, mucosa or orifices q8hr
- Dyspnea, crackles, unproductive cough, chest pain, tachypnea
- Effects of alopecia on body image, discuss feelings about body changes
- Buccal cavity q8hr for dryness, sores or ulceration, white patches, oral pain, bleeding, dysphagia; obtain prescription for viscous lidocaine (Xylocaine)
- Symptoms that indicate severe allergic reaction: rash, pruritus, urticaria, purpuric skin lesions, itching, flushing
PERFORM/PROVIDE:
- Strict medical asepsis, protective isolation if WBC levels are low
- Increased fluid intake to 2-3L/day to precent urate deposits, calculi formation, reduce incidence of hemorrhagic cystitis
- Diet low in purines: organ meats(kidney,liver), dried beans, peas to maintain alkaline urine
- Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft bursh or cotton-tipped applicators for stomatitis; used unwaxed dental floss
- Warm compresses at inj site for inflammation
Asparaginase
Chemical Classification
Escherichia coli enzyme
