Antineoplastic Drugs: Cell-cycle specific

Question 1

Classes of Cell-cycle specific drugs

Answer 1

• Antimetabolites = Methotrexate AND Cytarabine
• Topoisomerase II Inhibitors = Etoposide
• Mitotic Inhibitors = Paclitaxel AND Vincristine
• Antineoplastic Enzymes = Asparaginase

Question 2

Antimetabolites

Answer 2

MOA:
Have two phases: 1 . Inhibit cell growth by interfering with compounds needed for cell reproduction/synthesis - aka folic acid, purine and pyrimidine; 2. falsely substitute for purines, folic acid or pyrimidines

Indications:
Solid tumors, leukemias, & non-Hodgkin’s lymphoma

Adverse Effects:
Hair loss, nausea, vomiting, diarrhea, myelosuppression (Table 45-6)

Interactions:
Table 45-7

Nursing Considerations:
-educate on AEs like hair loss

Question 3

Antimetabolites - Key Drugs

Answer 3

Methotrexate

• Treatment of solid tumors such as breast, head and neck, lung cancers, acute lymphocytic leukemia, and non- Hodgkin’s lymphomas
• Severe bone marrow suppression with high doses
• “Rescue” drug is LEUCOVORIN

Cytarabine

• Treatment of acute myelocytic and lymphocytic leukemia, and non-Hodgkin’s lymphomas
• Cytarabine syndrome (can treat with CORTICOSTEROIDS): fever, muscle and bone pain, maculopapular rash, conjunctivitis, and malaise

Question 4

Topoisomerase II Inhibitors

Answer 4

MOA:
Inhibit enzyme topoisomerase II causing breaks in DNA strands

Indications:
Small cell lung cancer and testicular cancer

Adverse Effects:
Hair loss, nausea, vomiting

Interactions:
Table 45-9, warfarin and cyclosporine

Nursing Considerations:

• educate about possible bruising if on Warfarin
• educate about falls

Question 5

Topoisomerase II Inhibitors - Key Drugs

Answer 5

Etoposide:

• Treatment of small cell lung cancer and testicular cancer
• Interactions with WARFARIN and CYCLOSPORINE

**topo-break in DNA- bleeding - entopo

Question 6

Mitotic Inhibitors

Answer 6

MOA:
Work before or during cell mitosis to inhibit cell division

Indications:
Variety of solid tumors and some hematologic malignancies

Adverse Effects:
Hair loss, nausea, vomiting, myelosuppression

Interactions:
Table 45-9

Nursing Considerations:
- watch for common AEs

Question 7

Mitotic Inhibitors - Key Drugs

Answer 7

Paclitaxel:

• Treatment of ovarian cancer, breast cancer, non-small cell lung cancer, and Kaposi’s sarcoma
• Hypersensitivity associated with infusion (pre-treat); we PRE-TREAT with dexathemazone or H1 receptor antagonist like diphenhydramine or H2 receptor antagonist like renididine

Vincristine:

• Treatment of acute lymphocytic leukemia and other cancers
• Do NOT give via intrathecal route- fatal if administered this way!

**mitosis - blood cancer - P and V

Question 8

Antineoplastic Enzymes

Answer 8

MOA:
Catalyzes conversion of asparagine to aspartic acid and ammonia, SO cancer cells can’t synthesize asparagine gene which is needed for DNA reproduction

Indications:
Acute lymphocytic leukemia

Adverse Effects:
Impaired pancreatic function, which can lead to HYPERGLYCEMIA and PANCREATITIS

Interactions:
Table 45-11

Nursing Considerations:

• check blood sugar
• teach s/s of hypergly

**Antineoplastic - A to A+A - no DNA - Leuko

Question 9

Antineoplastic Enzymes - Key Drug

Answer 9

Asparaginase:

• Treatment of acute lymphocytic leukemia
• Derived from E. coli bacterium
• Common for patients to develop ALLERGIC reaction to it