Chapter 45: Antineoplastic Drugs Part 1: Cancer overview and cell cylce- specific drugs Flashcards
Extravasation
The leakage of any intravenously or intraarterially
administered medication into the tissue space surrounding
the vein or artery. Such an event can cause serious tissue
injury, especially with antineoplastic drugs. (p. 729)
Nadir
Lowest point in any fluctuating value over time; for
example, the lowest white blood cell count measured after
the count has been depressed by chemotherapy. (p. 729)
Sarcomas
Malignant neoplasms of the connective tissues arising
in bone, fibrous, fatty, muscular, synovial, vascular, or
neural tissue, often first presenting as painless swellings.
(p. 724)
Tumor lysis syndrome
A common metabolic complication of
chemotherapy for rapidly growing tumors. It is characterized
by the presence of excessive cellular waste products and
electrolytes, including uric acid, phosphate, and potassium,
and by reduced serum calcium levels. (p. 731)
Carcinomas
arise from epithelial tissue, which is located
throughout the body. This tissue covers or lines all body surfaces,
both inside and outside the body. Examples are the skin,
the mucosal lining of the entire gastrointestinal (GI) tract, and
the lining of the bronchial tree (lungs). The purpose of these
epithelial tissues is to protect the body’s vital organs
sarcomas
are malignant tumors that arise primarily from
connective tissues, but some sarcomas are tumors of epithelial
cell origin. Connective tissue is the most abundant and widely
distributed of all tissues and includes bone, cartilage, muscle,
and lymphatic and vascular structures. Its purpose is to support
and protect other tissues.
Lymphomas
are cancers within the lymphatic tissues.
Lymphomas
can be quite bulky and are usually classified as solid tumors.
Leukemias
arise from the bone marrow and are cancers of blood
and bone marrow. Leukemias differ from carcinomas and sarcomas
in that the cancerous cells do not form solid tumors but
are interspersed throughout the lymphatic or circulatory system
and interfere with the normal functioning of these systems this reason, they are sometimes referred to as circulating tumors,
although hematologic malignancy is a more precise term.
Cachexia
(general ill health and malnutrition)
Radiation is a well-known and potent carcinogenic agent. There
are two basic types of radiation:
(1) ionizing, or high-energy,
radiation, and (2) nonionizing, or low-energy, radiation
ionizing because
it causes the formation of ions within living cells. This type of radiation (e.g., that used in radiographic studies) is also used to treat (irradiate) cancerous tumors (e.g., radium implants).
Nonionizing radiation is much less potent and cannot penetrate
deeply into the body.
Ultraviolet light is an example of this
type of radiation and is the cause of skin cancer
Adverse effects of
radiation therapy
(e.g., radiation burns; nausea with GI tract
irradiation) tend to be more localized to the site of treatment
as well.
Neoplastic cells are believed to develop in everyone;
however, a healthy person’s immune system recognizes them
as abnormal and eliminates them by means of cell-mediated
immunity (cytotoxic T lymphocytes;
• Causative factors that have been identified include
include age-related and sex-related characteristics; genetic and ethnic factors; oncogenic viruses; environmental and occupational factors; radiation; and immunologic factors.
o Epstein-Barr virus is a
a type of herpesvirus commonly recognized as the cause of infectious mononucleosis. It is also associated with the development of Burkitt’s lymphoma and nasopharyngeal cancer
• The percentage of cells undergoing mitosis at any given time
is called the growth fraction of the tumor. The number of cells in the M phase of the cell cycle is called the mitotic index. Chemotherapy is most effective when used in a rapidly dividing or highly proliferative tumor.
• Factors that affect the chances of cure and the length of patient survival include
the cancer stage at time of diagnosis, the type of cancer and its doubling time, the efficacy of the cancer treatment, the development of drug resistance, and the general health of the patient.
• Most chemotherapy is withheld when the patient’s
absolute neutrophil count (ANC) is less than 500 cells/mm3 (severe neutropenia).
• Antimetabolite antineoplastic drugs are used for the treatment
of a variety of solid tumors and some hematologic cancers; they may also be used in combination chemotherapy
are cell cycle–specific analogues that work by antagonizing the actions of key cellular metabolites
• Allopurinol and rasburicase are both indicated
for the hyperuricemia associated with tumor lysis syndrome and are usually given in anticipation of this condition during various chemotherapy regimens associated with this syndrome.
• Mitotic inhibitors include
natural products from plants and semisynthetic drugs from plants. Depending on the particular drug, these plant-derived compounds can work in various phases of the cell cycle (late S phase, throughout G2 phase, and M phase), but they all work shortly before or during mitosis and thus retard cell division.
• Vincristine and other vinca alkaloids are not given intrathecally
Administering these drugs through the spinal route is almost always fatal, and the death is slow and excruciating.
antineoplastic enzymes is a fairly unique adverse effect
impaired pancreatic function. This can lead to hyperglycemia and severe or fatal pancreatitis.
• Complete an assessment of
cultural, emotional, spiritual, sexual, and financial influences, concerns, and issues.
• One specific assessment consideration associated with the use of the antimetabolite cytarabine is monitoring for the
occurrence of cytarabine syndrome. This usually occurs within 6 to 12 hours after drug administration and is characterized by fever, muscle and bone pain, maculopapular rash, conjunctivitis, and malaise.
• In patients receiving mitotic inhibitors (e.g., vinblastine, vincristine) and alkaloid topoisomerase II inhibitors (e.g., etoposide)
• In patients receiving mitotic inhibitors (e.g., vinblastine, vincristine) and alkaloid topoisomerase II inhibitors (e.g., etoposide)
• Assess individuals for the following characteristics before chemotherapy
(1) genetic markers for oral cancers, (2) genetic determinants of testosterone or estrogen metabolism, and (3) genetically linked enzyme system abnormalities such as those involving specific cytochrome P-450 enzymes that metabolically convert nicotine to a carcinogenic substance
• GI adverse effects usually occur
on about the fourth day, which may require preplanning for special pharmacologic interventions (e.g., antiemetics, antispasmodics, analgesics) and nonpharmacologic measures (dietary changes, oral care).