Cancer and Chemotherapy Drugs Flashcards
- Chemo overview
◦ Toxicities: Bone marrow suppression (risk for infxn, causes anemia, risk for bleeding), digestive tract injury, N/V, alopecia, reproductive injury, hyperuricemia (tumor lysis syndrome), secondary disease (later development of malignancy)
‣ Tumor lysis syndrome: uric acid causes kidney problems => from killed chemo cell wastes, can lead to AKI => hydrate, use allopurinol
* High: K, Ph ; Low: Ca
◦ Edu: RN must educate pt about all drug info at every admin, even if they have had it before
◦ Gold standard for cancer tx: combination therapy
‣ May target several cell cycles at once, prevents resistance to one specific method
- Alkylating agents
◦ Nitrogen mustards
‣ cyclophosphamide (Cytoxan)
- For: **solid AND hematological **cancers
* Admin: IV or PO (give with food)
* A/E: severe N/V, alopecia
◦ Acute hemorrhagic cystitis: bladder spasms, pain, blood in urine, cramping (Notify provider)
‣ Hydrate, urinate often, take Mesna to protect the bladder
* Dose limiting tox (inc dose = inc tox): bone marrow suppression
* CyPhoMi likes to help everyone, but can never make it bc he’s always going to the bathroom with Mesna saying AHC!
- Alkylating agents
◦ Nitrosoureas
‣ carmustine (Gliadel)
- For: crosses BBB (aka lipophilic)
* Admin: topical or IV, biodegradable wafer can be put in
* A/E: N/V, injury to liver & kidneys, pulmonary fibrosis
* Dose limiting tox: **delayed bone marrow suppression (4-6 weeks after admin)
* The Car Must go, but hit a BBBump which delayed the trip. The parents started drinking, the kids had to pee, and everyone had trouble breathing.**
- Platinum compounds
◦** cisplatin (Platinol)**
‣ MOA: forms DNA cross-links, cell phase NONspecific
‣ For: testicular & ovarian cancer, advanced bladder cancer, head / neck / lung cancer
‣ A/E: peripheral neuropathy (fall risk), bone marrow suppression, ototoxicity (report to provider), N/V in 100% of pts
‣ Dose limiting tox: kidney damage
Plat goes the kidney beans! bc Ci dropped them - the mess looks like major throw up. Ci stepped on the broken glass but didn’t feel it and didn’t hear it happen
- Antimetabolites
◦ Folic acid analogs
‣ methotrexate
- MOA: blocks conversion of folic acid to its active form, S-phase specific
* Admin: PO, IM, intrathecally
◦ Intrathecally: through spine by provider, pull X mLs and replace X mLs with med => lay flat for at least 15 min d/t dizziness and extreme HA
◦ Before admin alkyalize the urine: give Na bicarb until pH goal met, then admin
* For: solid AND hematological cancers, crosses BBB and placenta
* Contraindications: pregnancy- must do **pregnancy tests **and be on contraception methods
* Dose limiting tox: bone marrow suppression, pulmonary infiltrates and fibrosis, oral / GI ulceration
* Leukovorin rescue: enhances the effects of methotrexate, enhances drug clearance to protect the kidneys
- Antimetabolites
◦ Pyrimidine analogs
‣** fluorouracil (Adrucil) aka 5FU**
- MOA: inhibits thymidylate which is needed to make DNA
* Admin: Continuous IV- given slowly over several days (go home on it, send spill kit) d/t inc effectivenses and dec toxicity
* For: solid tumors, DOC for skin cancer d/t topical application
* Dose limiting tox: bone marrow suppression, oral / GI ulceration => STOP drug if diarrhea occurs and give antidote uridine triacetate to dampen 5FU effects
* A/E: hand foot syndrome- tingling, burning, redness, welling, blistering
* ME! slow runner, hand-foot disease, helps skin problems, oral / GI ulcers => STOP for diarrhea and give ant. uridine triacetate
- Antimetabolites
◦ Purine analogs
‣ mercaptopurine (Purinethol)
- MOA: disrupts purine biosynthesis, nucleotide interconversion, and biosynthesis of nucleic acid; S-phase specific
* For: long-term maintenance of acute lymphocytic leukemia
* Admin: PO (double glove, put pill on a mat, discard mat like chemo)
* Dose limiting tox: bone marrow suppression
* Contraindications: pregnancy
- Antimetabolites
◦ Hypomethylating agents
‣ azacitadine (Vidaza)
- MOA: inhibits DNA methyltransferase
* For: myelodysplastic syndrome, bone marrow disorders to decrease overproduced RBCs- preventative for leukemia
* A/E: myelosuppression, N/V, CNS depression
* aZa CNS is the last thing you’d think of - Not cancer. For bone marrow disorders
- Anti-tumor antibiotics
◦ Anthracyclines
‣ doxoRUBIcin (Adriamycin)
‣ Derived from bacteria Steptomyces (not actually abx)
‣ Admin: IV only bc poorly absorbed in GI
* MOA: kills cells by intercalation with DNA and inhibition of topoisomerase II; cycle NONspecific
* For: broad spectrum
* Admin: IV only through CVC or PICC line
◦ Before admin: EKG (for baseline), echocardiogram (for ejection fraction, hold med < 55%, notify provider)
◦ Check line Q5 min (dress in chemo PPE) and confirm blood return
◦ Max lifetime dose: 550 mg
* A/E: N/V, red colored urine and sweat (expected), extravasation injury to tissues,
◦ Cardiotoxicity (acute or delayed, min-2 weeks): dysrhythmias, may manifest as CHF years later (bc does not respond to tx), cardiomyopathy (all ages)
* Dose limiting tox: bone marrow suppression
* Zinecar: protects from cardiac damage (not given often bc can dec drug effectiveness)
- Mitotic inhibitors
◦ Vinca Alkaloids
‣** vincristine (Oncovin)**
‣ MOA: M-phase specific
* MOA: block mitosis during metaphase
* For: broad spectrum
* Admin: IV
* Dose limiting tox: peripheral neuropathy - fall risk, check reflexes, can cause constipation / urinary hesistancy d/t effects on autonomic and sensory nerves
- Mitotic inhibitors
◦ Taxanes
‣** paclitaxel (Taxol)**
- MOA: G2 and M-specific
* For: DOC for ovarian cancer and non-small cell lung cancer
* Admin: often given in combo (more drugs = inc tox risk)
* A/E: Peripheral neuropathy (after several doses), bradycardia, 2nd or 3rd degree heart block, fatal myocardial infarction
◦ Severe hypersensitivity rxns (fever, chills, shakey, anaphylaxis): premedicate with Tylenol bc fever can spike (usually do not use Tylenol bc can mask fever thus mask infxn), pause drug, tx S/S, restart at possibly dec dose
* Dose limiting tox: bone marrow suppression
* Contraindications: cardiac pts
**Pac M-phase man is on lvl G2. He barely has any hearts left, and can’t feel anything since his ovaries and lungs are not small - so he took some Tylenol **
** asparaginase (Elspar)*
◦ MOA: converts asparagine into aspartic acid
◦ A/E: leukemic lymphoblasts, fatal anaphylaxis / hypersensitivity (may premedicate), N/V, coagulation deficiencies, toxicity to liver / pancreas / kidneys, CNS depression (can progress to coma)
‣** Does NOT cause:** bone marrow, suppression, alopecia, does NOT cross BBB
- Anti-estrogens
◦** tamoxifen (Nolvadex)**
‣ MOA: blocks activity of estrogen ONLY in estrogen sensitive (ER+) cells
‣ For: tx and prevention of breast cancer (gold standard for both); used pre OR post menopause
‣ A/E: menopausal (hot flashes, vaginal discharge, fluid retention, menstrual irregularities)
‣ Contraindications: pregnancy risk category D
‣ Caution: risk for development of endometrial cancer and blood clots (DVT)
- Aromatase inhibitors
◦ anastrozole (Arimidex)
‣ MOA: blocks production of estrogen
‣ For: used to tx ER+ breast cancer in post-menopausal women (DOC)
‣ A/E: inc risk for fractures, moderate to severe myalgias (muscle pain- stop if impedes ADLs)
* May need to admin Ca / Vit D / biphosphonates / weight bearing exercise d/t inc fracture risk
‣ Admin: PO daily for 2-5 years
‣ A/E: musculoskeletal pain (feels like RA, can make RA worse), HA can indicate BP changes, nausea, irritability
* If pt has** HA => take BP **and notify provider if abnormal
- GnRH Agonists
◦ leuprolide (Lupron Depot)
‣ Prostate cancer can respond to hormonal therapy (anti-androgens, leuprolide, flutamide)
‣ MOA: suppress production of androgens by testes (not by adrenal glands and prostate cancer cells) aka anti-androgens
‣ For: advanced prostate cancer (bc surgery and radiation are prefered as 1st line), often palliative
‣ A/E: hot flashes (menopause in men), generally well-tolerated, risk for fractures (give Ca / Vit D / biphosphonates)
* Tumor flare symptoms: bone pain, dec urine flow, numbness / weakness in legs / arms
* Initially: see inc testosterone lvls- bone pain and urinary obstruction
‣ Referred to as chemical castration
