Chemotherapy Flashcards
Chemotherapy (uses)
- can be used for cure, control, palliation
- antineoplastic drugs
- divided into 2 groups (cell cycle nonspecific CCNS, or cell cycle - specific
- narrow therapuetic index
- combination of drugs is more effective than single-use drug therapy
- dose calculated based on body surface area
Chemotherapy (toxicities)
- affect rapidly dividing cells (harmful and healthy: hair follicles, GI tract cells, bone marrow cells, neutrophils, ova or testes)
- symptoms: hair loss, nausea and vomiting, bone marrow toxicity (depletion of RBC, WBC, and platelets)
Myelosupression
bone marrow supression (BMS) or bone marrow depression
Nadir
the lowest level of WBC in the blood following chemotherapy or radiation. Normally occurs 10-28 days after dosing. Anticipation allows phrophylactic treatment admin of antibiotics or blood stimulants
Targeted drug therapy
recognition of a specific molecule involved in the growth of cancer cells while sparing healthy cells
Dose-limiting adverse effect
patient can no longer tolerate an increase in dosage (GI tract and bone marrow)
Emetic potential
likelihood that a drug will produce vomiting
Chemotherapy (contraindications)
- very low WBC count (ANC <500 = severe neutropenia)
- ongoing infectious process
- severe compromise in nutrition and hydration status
- reduced kidney or liver function
- decline in organ function
- pregnancy (category D or X)
Chemotherapy (routes)
- oral (more available today, storage and side effects)
- IM
- IV (most common, through CVAD)
- regional administration: directly into the tumor site = less toxcicity
Chemotherapy administration
- only people specially trained in chemotherapy handling technique should prepare and administer
- people handling chemo are at high risk of absorbing the durg
- there can be risk 48 hrs after chemo when handling body fluids and excretions
Chemotherapy side effects
- destruction of normal cells
- neurologic, cardiovascular, respiratory, hepatobiliary, gastrointestinal, genitourinary, dermatologic, ocular, otic, metabolic, musculoskeletal
Killing of normal cells in GI tract
- altered nutritonal status
- stomatitis: inflammation and/or ulceration of oral mucosa throughout GI tract
- altered bowel function
- poor appetite
- nausea
- vomiting
- diarrhea
Killing of normal cells of hair follicles
alopecia = loss of hair
killing of normal cells in bone marrow
- low, possibly life threatening blood cell count
- constantly assess WBCs, RBCs, hemoglobin, hematocrit, and platelet
- must monitor ANC (absolute neutrophil count), allows to identify nadir (< 500 cells/mm3 high risk of infection
killing of germinal epithelial cells
- sterility in males
- damage to ovaries with amenorrhea in females
- teratogenic effects with possible fetal death in pregnant women
killing of normal cells in chemo
can lead to release of waste products such as uric acid into the blood resulting in hyperuricemia
Cell cycle Specific drugs (function)
- cytotoxic during a specific cell cycle
- used to treat a variety of solid or circulating tumors
- drugs that work at different places in the cell cycle can more effectively kill cancer cells
Antimetabolites (function)
- CCS analouges that work by antagonizing the actions of key cellular metabolites
- “trick” cancer cells into using the drug instead of usinf the molecules it needs (folate, purines, pyrimidines) to make genetic material
- work primarily in the S phase when DNA synthesis is most active
Folate (folic acid) anatagonist
- antimetabolites
- inhibits the conversion of folic acid to folate which is needed for DNA synthesis
- methotrexate (MTX), pemetrexed, pralatrexate
Purine antagonists
- antimetabolites
- purine bases (adenine and guanine) inhibited
- inhibits synthesis of DNA and RNA
- fludarabine (F-AMP), mercaptoputine (6-MP), thioguanine (6-TG), cladribine, pentostatin
Pyrimidine antagonists
- antimetabolites
- pyrimidine bases (cytosine, thymine, uracil)
- inhibits synthesis of DNA and RNA
- flurouracil (5-FU), cytarabine (ara-C), capecitabine, floxuridine (FUDR), gemcitabine
Antimetabolites (indications)
- oral and topical can only bve used for low dose maintenance and palliative cancer therapy
- often used in combination chemotherapy regimens
- methotrexate is also used to treat severe cases of psoriasis and rheumatoid arthritis because it decreases lymphocyte and cytokine production
Mitotic Inhibitors
- natural products obtained from the periwinkle plant (vinka alkaloids) or the mandrake plant (taxanes)
- can work in various phases of the cell cycle (late S phase, throughout G2 phase and M phase)
- all work shortly before or during mitosis and thus retard cell division
Mitotic Inhibitors (adverse effects)
vincristine: peripheral neuropathy
Taxanes: severe hypersensitivy
Examples of vinva alkaloids
- vincristine
- vinblastine
Mitotic Inhibitors (indications)
- Kaposi sarcomma
- small cell lung cancer
- others
Alkaloid Topoisomerase II inhibitors
- used to treat small cell lung cancer and testicular cancer
- not used much now because of significant toxicictes without therapuetic benefit
- EX: etoposide
Antineoplastic enzymes
- synthesized using cultures of bacteria and recombinant DNA technology
- isolated and purified for clinical use
- Asparaginase (elspar: used to treat acute lymphocytic leukemia)
- Pegaspargase (oncaspar)
Topoisomerase I inhibitors
- used primarily to treat ovarian and colorectal cancer
- derived from camptothecin (substance taken from chinese shrub)
- Topotecan (hycamtin)
- Irinotecan (CPT-11, camptosar)
Antineoplastic enzymes (adverse effects)
imparied pancreatic function, which can lead to hyperglycemia and severe or fatal pancreatitis, dermatologic, hepatic, genitourinary, neurologic, musculoskeletal, GI, and cardiovascular effects
Cell cycle specific drugs (CCS)
- antimetabolites
- mitotic inhibitors
- alkaloid topoisomeras II inhibitors
- toposiomerase I inhibitors
- antineoplastic enzymes
Cell cycle - nonspecific (CCNS) drugs
- alkylating drugs
- cytotoxic antibiotics
Alkylating drugs (function)
- works by preventing cancer cells from reporducing
- alter the chemical strucutre of the cells DNA
Alkylating drugs (indications)
- recurrent ovarian cancer
- brain tumors
- lymphomas
- leukemias
- breast cancer
- bladder cancer
- others
Alkylating drugs (adverse effects)
- possible ototoxcicity: rinings or roaring in ear
- peripheral neuropathies may occur, report tingling, numbness, or pain in extremities
- dose limitng adverse effects: nausea and vomitting, myelosupression
- alopecia
- nephrotoxicity, peripheral neurophathy, ototoxicity (hydration can prevent nephrotoxicity)
- extravasation causes tissue damage and necrosis
Alkulating drugs (common names)
- Cisplatin (platinol): treat solid tumors
- Cyclophosphamide (Cytoxan): treat bone, lymph, blood and solid tumors
- Mechlorethamine (Mustargen, nitrogen mustard): hodkins lymphoma
Cytotoxic antibiotics (function)
- natural substances produced by the mold streptomyces
- block DNA synthesis
- semisynthetic subtances alo used
- common toxicity: bone marrow supression
Cytotoxic antibiotics (adverse effects)
- Bleomycin: pulmonary toxicity
- Danotubicin: heart failure, dysrhythmias
- Doxorubicin: left ventricular failure, dysrhythmias
Cytotoxic Antibodies (Indications)
- used in combination chemotherapy regimens
- used to treat a variety of solid tumors and some heamtologic malignacies
- leukemia, ovarian, breast, bone
- squamous cell carcinomas
- AIDS - related Kapoti’s Sarcoma (when intolerant to other treatments)
Bevacizumab (Avastin)
- Angiogenesis inhibitor
- Blocks blood supply to the growing tumor
- Used to treat metastatic colon, ovarian and rectal cancer in combination with 5-fluorouracil, non–small cell lung cancer, and malignant glioblastoma
- Many adverse effects, including nephrotoxicity
Hydroxyurea (Hydrea, Droxia)
- Action similar to antimetabolites
- Used to treat squamous cell carcinoma and some leukemias
- Many adverse effects such as edema, drowsiness, headache, rash, hyperuricemia, nausea, vomiting, dysuria, myelosuppression, nephrotoxicity, and pulmonary fibrosis
Octreotide (sandostatin)
- Management of a cancer-related condition called carcinoid crisis (life-threatening complication with neuroendocrine tumors)
- Treatment of the diarrhea caused by vasoactive intestinal peptide–secreting tumors (VIPomas)
- Suppresses insulin release
Aromatase Inhibitor
- fem. specific neoplasm hormonal drug
- anastrozole, aminogluthimide
Selective estrogen receptor modulators
- fem. specific neoplasm hormonal drug
- tamoxifen
- toremifene
Progestins
- fem. specific neoplasm hormonal drug
- megestrol
- medroxyprogesterone
Androgens
- fem. specific neoplasm hormonal drug
- fluoxymesterone
- testolactone
Estrogen receptor antagonist
- fem. specific neoplasm hormonal drug
- fluvestrant
Antiandrogens
- male specific neoplasm hormonal drugs
- bicalutamide
- flutamide
- nilutamide
Antineoplastic hormone
- male specific neoplasm hormonal drugs
- estramustine
Normal ANC
1500 - 8000
Severe neutropenia
ANC <500
Signs of Myelosupression
RBC, Hgb, Hct (anemia): pale skin and mucosa, fatigue, lethargy, SOB< inability to concentrate, tachycardia
WBC (leukopenia): fever, chills, tachycardia, productive cough with purulent sptutum, change in urine
Platelets (thrombocytopenia): petechiae, ecchymosis, gingival bleeding, blood in urine/stool/vomit, prolonged bleeding from IV
GI: stomatisits, altered bowel function, poor appetitie, nausea, vomiting, diarrhea, and inflammation, and possible ulcerations of GI mucosa
vesicants
cause severe local tissue breakdowm
Extravasation
- leaking of an antineoplastic drug into surrounding tissues during intravenous administration is extravasation
- can result in premanent damage to nerves, tendons, muscles, loss of limbs
- skin gafting or amputation may be necessary
- prevention is essential
- continous monitoring of the IV site is essential
- If suspected, stop the infusion immediately and contact the prescriber but leave the IV catheter in place.
- ## Aspirate any residual drug or blood from the catheter.
Oncologic emergencies
- infections
- pulmonary toxicity
- allergic reactions
- stomatitis with severe ulcerations
- bleedings
- metabolic aberrations
- bowel irritability with diarrhea
- renal, liver, cardiac toxicity
Erythropoietic Drugs (common names)
- epoetin alfa, darbepoetin alfa
Erythropoietic Drugs (Indications)
anemia of chronic cancer (epoetin)
anemia related to chemotherapy (darbepoetin)
Erythropoietic Drugs (Action)
stimulates the bone marrow to make more RBCs
Erythropoietic Drugs (adverse effects)
- hypertension
- thrombosis
- Headache
Erythropoeitc Drugs (nursing considerations)
- Not given when the hemoglobin is above 10 for cancer patients. Can cause heart attack, stroke or death when continued with hemoglobin above 11.
- Must have adequate iron for drug to be effective- may need iron supplement
Granulocyte colony stimulating factor (G-CSF)
- use: chemotherapy induced neutropenia
- adverse effects: bone pain, nausea, vomiting
- filgrastim (neupogen)
- filgrastim-sndz (zarxio)
- pegfilgrastim (neulasta
- tbo-fligrastim (granix)
Granulocyte-macrophage colony-simulating factor (GM-CSF)
- use: myeloid cell recovery after bone marrow transplantation
- adverse effects: nausea, vomiting, diarrhea, fever, chills, myalgia, headache, fatigue
- sargramostim: leukine
Interleukin-II (platelet growth factor
- use: thrombocytopenia related to chemotherapy
- adverse effects: fluid retention, peripheral edema, dyspnea, increase HR, nausea, mouth sores
- oprelvekin (neumega)
