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NCLEX > Antineoplastic Drugs > Flashcards

Antineoplastic Drugs Flashcards

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0
Q

Asparaginase

Chemical Classification

A

Escherichia coli enzyme

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1
Q

Asparaginase

Functional Classification

A

Antineoplastic

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2
Q

Asparaginase

Uses

A

Acute lymphocytic leukemia in combination with other antineoplastics

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3
Q

Asparaginase

Contraindications

A

Hypersensitivity to product or E. coli protein, thromboembolic disease, infants, breastfeeding, pancreatitis

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4
Q

Cytarabine

Functional Classification

A

Antineoplastic, antimetabolite

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5
Q

Cytarabine

Chemical Classification

A

Pyrimidine nucleoside analog

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6
Q

Cytarabine

Mechanism of Action

A

Competes with physiologic substrate of DNA synthesis, thus interfering with cell replication in the S phase of the cell cycle (before mitosis)

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7
Q

Cytarabine

Uses

A

Acute myelocytic leukemia, acute nonlymphocytic leukemia, chronic myelocytic leukemia; lymphomatous meningitis (intrathecal/intraventricular)

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8
Q

Cytarabine

Contraindications

A

Pregnancy (D), hypersensitivity

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9
Q

Cytarabine

Side Effects

A

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

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10
Q

Cytarabine

Nursing Considerations

A

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
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11
Q

Etoposide

Functional Classification

A

Antineoplastic-miscellaneous

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12
Q

Etoposide

Chemical Classification

A

Semisynthetic podophyllotoxin

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13
Q

Etoposide

Mechanism of Action

A

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

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14
Q

Etoposide

Uses

A

Testicular cancer, small-cell carcinoma of the lung

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15
Q

Etoposide

Contraindications

A

Pregnancy (D), breastfeeding, hypersensitivity, severe renal/hepatic disease

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16
Q

Etoposide

Side Effects

A

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

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17
Q

Etoposide

Nursing Considerations

A

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

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18
Q

Methotrexate

Functional Classification

A

Antineoplastic-antimetabolite (Vesicant)

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19
Q

Methotrexate

Chemical Classification

A

Folic Acid Antagonist

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20
Q

Methotrexate

Mechanism of Action

A

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

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21
Q

Methotrexate

Uses

A

Acute lymphocytic leukemia; in combination for breast, lung, head, neck carcinoma; lymphosarcoma, gestational choriocarcinoma, hydatidiform mole, psoriasis, RA, mycosis fungoides, osteosarcoma

22
Q

Methotrexate

Contraindications

A

Hypersensitivity, leukopenia (<100,000/mm3), anemia; psoriatic patients with severe renal disease, alcoholism, HIV
Pregnancy (X), hepatic disease

23
Q

Methotrexate

Side Effects

A

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

24
Q

Methotrexate

Nursing Considerations

A

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
25
Q

Paclitaxel

Functional Classification

A

Antineoplastic-miscellaneous

26
Q

Paclitaxel

Chemical Classification

A

Taxane

27
Q

Paclitaxel

Mechanism of Action

A

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

28
Q

Paclitaxel

Uses

A

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

29
Q

Paclitaxel

(Contraindications):

A

Pregnancy (D); hypersensitivity to paclitaxel or other products with polyoxyethylated castor oil, albumin, Neutropenia of <1500/mm3

30
Q

Paclitaxel

Side Effects

A

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

31
Q

Paclitaxel

Nursing Considerations

A

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

32
Q

Vincristine

Functional Classification

A

Anti-neoplastic-miscellaneous

33
Q

Vincristine

Chemical Classification

A

Vinca alkaloid

34
Q

Vincristine

Mechanism of Action

A

Inhibits mitotic activity, arrests cell cycle at metaphase; inhibits RNA synthesis, blocks cellular use of glutamic acid needed for purine synthesis; vesicant

35
Q

Vincristine

Uses

A

Lymphomas, neuroblastoma, Hodgkin’s disease, acute lymphoblastic and other leukemias, rhabdomyosarcoma, Wilms’ tumor, non-Hodgkin’s lymphoma, malignant glioma, soft-tissue sarcoma

36
Q

Vincristine

Contraindications

A

Pregnancy (D), breastfeeding, infants, hypersensitivity, radiation therapy

37
Q

Vincristine

Side Effects

A

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)

38
Q

Vincristine

Nursing Considerations

A

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

39
Q

Cisplatin

Functional Classification

A

Antineoplastic alkylating agent

40
Q

Cisplatin

Chemical Classification

A

Platinum Complex

41
Q

Cisplatin

Mechanism of Action

A

Alkylates DNA, RNA; inhibits enzymes that allow for the sythesis of amino acids in proteins; activity not cell-cycle-phase specific

42
Q

Cisplatin

Uses

A

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

43
Q

Cisplatin

Contraindications

A

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

44
Q

Cisplatin

Side Effects

A

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

45
Q

Cisplatin

Nursing Considerations

A

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
46
Q

Cyclophosphamide (Cytoxan)

Functional Classification

A

Antineoplastic alkylating agent

47
Q

Cyclophosphamide (Cytoxan)

Chemical Classification

A

Nitrogen mustard

48
Q

Cyclophosphamide (Cytoxan)

Mechanism of Action

A

Alkylates DNA is responsible for cross-linking DNA strands; activity is not cell-cycle-phase specific

49
Q

Cyclophosphamide (Cytoxan)

Use

A

Hodgkin’s disease; lymphomas; leukemia; cancer of female reproductive tract, breast, lung, prostate; multiple myeloma; neuroblastoma; retinoblastoma; Ewing’s sarcoma; disseminated neuroblastoma, nephrotic syndrome

50
Q

Cyclophosphamide (Cytoxan)

Contraindications

A

Pregnancy (D), breastfeeding, severely depressed bone marrow function, hypersensitivity, prostatic hypertrophy, bladder neck obstruction

51
Q

Cyclophosphamide (Cytoxan)

Side Effects

A

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

52
Q

Cyclophosphamide (Cytoxan)

Nursing Considerations

A

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

NCLEX (40 decks)

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