Antineoplastic Drugs Flashcards
Treatment Modalities
Surgery: solid cancers (breast, lung, prostate, colon, rectum)
Radiation
Drug Therapy (treatment of choice for disseminated cancers such as leukemia, disseminated lymphomas, widespread metastases)
Tissue Growth and Chemotherapy
Chemotherapeutic drugs are more toxic to tissue with a high growth fraction such as bone marrow, skin, hair follicles, sperm, and GI tract
Dose-Limiting Adverse Effects
Patient reaches maximum tolerance dose
Nadir
Lowest WBC count after therapy
Antimetabolites
METHOTREXATE (MTX)
Folate Antagonist, deprives cell of folic acid
Used to treat solid tumors and some hematologic cancers
Also used to treat severe cases of psoriasis and rheumatoid arthritis
Adverse Effects of Antimetabolites
Hair loss, nausea, vomiting, myelosuppression, tumor lysis syndrome, palmar-plantar dysesthesia, mouth sores
Mitotic Inhibitors
VINCRISTINE
Used to treat a variety of solid tumors and some hematologic malignancies
Can injure peripheral nerves
Adverse Effects of Mitotic Inhibitors
Hair loss, nausea, vomiting, myelosuppression, liver toxicity, kidney toxicity, lung toxicity, convulsions, extravasation
Alkylating Drugs
CISPLATIN (PLATINOL) AND CYCLOPHOSPHAMIDE (CTOXAN)
Indications for Alkylating Drugs
Used in combination with other drugs to treat various types of cancer
Adverse Effects of Alkylating Drugs
Nausea, vomiting, myelosuppression, alopecia, extravasation, nephrotoxicity, peripheral neuropathy, ototoxicity
Cytotoxic Antibiotics
DOXORUBICIN (ADRIAMYCIN)
Indications for Cytotoxic Antibiotics
Used to treat a variety of solid tumors and hematologic malignancies
AIDS-related Kaposi’s sarcoma
Adverse Effects of Cytotoxic Antibiotics
ACUTE LEFT VENTRICULAR FAILURE
Bone marrow suppression, hair loss, nausea, vomiting
Miscellaneous Antineoplastics
BEVACIZUMAB (AVASTIN)
OCTREOTIDE (SANDOSTATIN)
Bevacizumab (Avastin)
Angiogenesis inhibitor, blocks blood supply to growing tumor
Many adverse effects, including nephrotoxicity
Octreotide (Sandostatin)
Management of carcinoid crisis
Treatment of diarrhea caused by VIPomas
Hormonal Drugs for Female-Specific Neoplasms
SELECTIVE ESTROGEN RECEPTOR MODULATORS (TAMOXIFEN)
PROGESTINS (MEGESTROL)
Tamoxifen
Used for established breast cancer disease and for reducing occurrence in high-risk patients
Treatment of metastatic disease
Adverse effects include hot flashes, fluid retention, vaginal discharge, menstrual irregularities, endometrial cancer, teratogenic
Gonadotropin-Releasing Hormone Agonists
LEUPROLIDE
Suppresses production of androgens by testes
Cotreatment with an androgen receptor blocker
Androgen Receptor Blockers
BICALUTAMIDE
Indicated for advanced androgen-sensitive prostate cancer with castration
Glucocorticoids
Immunosuppressants
Reduce cerebral edema, pain
Can improve appetite and promote weight gain
Major Toxicities of Cancer Chemotherapy
INFECTION (LOSS OF NEUTROPHILS)
BLEEDING (LOSS OF PLATELETS)
ANEMIA (LOSS OF ERYTHROCYTES)
Patient Care for Thrombocytopenia
USE CAUTION WHEN PERFORMING PROCEDURES THAT MIGHT PROMOTE BLEEDING (RECTAL SUPPOSITORIES, ENEMAS, VAGINAL SUPPOSITORIES)
SOFT BRISTLE TOOTHBRUSHES
AVOID IM INJECTIONS
Stomatitis
Inflammation of the oral mucosa, treated by mouthwash containing a topical anesthetic (lidocaine)
Diarrhea
Treatment is Immodium
Nausea and Vomiting
Treated with premedication with antiemetics and/or odansetron (Zofran)
Nursing Implications
Never give chemotherapy in peripheral IV
Monitor for and prevent infection in patients with neutropenia or leukopenia
Implement measures to monitor for and prevent bleeding in patients with thrombocytopenia and anemia
Keep epinephrine, antihistamines, and antiinflammatory drugs on hand
Extravasation
If suspected, stop infusion immediately but leave the IV catheter in place
Aspirate any residual drug and/or blood from catheter
Skin grafting or amputation may be necessary due to permanent damage to nerves, tendons, and/or muscles
