- uses more than 1 agent - more effective than monotherapy - reduce medication resistance, increase effectiveness, + reduce toxic effects

- hair loss occur 7-10 days after start - will last a max of 2 mo after last admin

- as cells due, contents spill into bloodstream + cause negative effects - hyperuricemia, hyper-K, hyper-PO4, hyper-Ca - AKI - onset begin 12-24 hr after first IV infusion

methotrexate [MTX] Tx

- breast tumor - lung tumor - sarcoma - Non-Hodgkin Lymphoma - ALL

methotrexate [MTX] AE

category X - mucositis - gastric ulcers - perforations - liver damage

- sickle cell anemia - can cross BBB - CML

- NVD - bone marrow suppression - rapid drop in WBC - neutropenic (risk of infectn) - thrombocytopenia (risk of bleed) - anemia

Chemotherapy Agents Flashcards by jessica quintos

chemotherapy agents A.K.A.

antineoplastic agents

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chemotherapy/antineoplastic agents

used to cure some CA, augment TX of other, or increase survival rate
works by killing fast-growing cells

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combo therapy

uses more than 1 agent
more effective than monotherapy
reduce medication resistance, increase effectiveness, + reduce toxic effects

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examples of fast-growing cells

skin, hair, intestinal mucosa, hematopoietic cells

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common A/E of chemotherapy/antineoplastic agents

NVD
alopecia
mylosuppression
infection
tumor lysis syndrome

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alopecia

hair loss occur 7-10 days after start

- will last a max of 2 mo after last admin

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myelosuppression/infection risk

7-10 days after each chemo dose

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tumor lysis syndrome

as cells due, contents spill into bloodstream + cause negative effects
hyperuricemia, hyper-K, hyper-PO4, hyper-Ca
AKI
onset begin 12-24 hr after first IV infusion

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types of antineoplastic agents

1 antimetabolite
2 hormonal agents
3 biological response modifiers
4 monoclonal antibody [MAB]
5 growth factors

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antimetabolite

drug names

methotrexate
fluorouracil
cytarabine
hydroxyurea

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methotrexate, cytarabine, fluorouracil (antimetabolite)

route

MTX: PO, IV, IM, Intrathecal

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methotrexate IV requires…

a dedicated IV line

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methotrexate [MTX]

MOA

stops cell reproduction needed for synth of DNA by inhibiting folic-acid conversion

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methotrexate [MTX]

breast tumor
lung tumor
sarcoma
Non-Hodgkin Lymphoma
ALL

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methotrexate [MTX]

category X
mucositis
gastric ulcers
perforations
liver damage

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methotrexate, cytarabine, fluorouracil (antimetabolite)

RN/teaching

if uric acid levels rise, then anticipate PRN Allopurinol
increase fluid intake 2-3L/day
take med on empty stomach
monitor for GI bleed (coffee ground emesis or tarry black stools), mouth sores

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methotrexate [MTX] (antimetabolite)

RN/teaching

admin w leucovorin to reduce toxicity to healthy cells

–it enters healthy cells + blocks MTX

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hydroxyurea

route

common PO antimetabolites

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hydroxyurea

MOA

interrupts DNA synthesis + is cell “S” phase-specific

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hydroxyurea

sickle cell anemia
can cross BBB
CML

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hydroxyurea

NVD
bone marrow suppression
rapid drop in WBC - neutropenic (risk of infectn)
thrombocytopenia (risk of bleed)
anemia

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hydroxyurea

caution w antivirals

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hydroxyurea

RN/teaching

withhold if WBC<2.5K
withhold if platelets<100k
BMS can occur 4-6wk after admin
avoid crowds, sick ppl, kids

hormonal agents

drug names

tamoxifen, raloxifene, anastrazole

tamoxifen, raloxifene, anastrazole (hrmnl agent) | MOA

ERB: stops growth of breast CA cells which are estrogen dependant aromatase inhibitors: blocks estrogen production

tamoxifen, raloxifene, anastrazole (hrmnl agent) | Tx

- breast CA - prevention of breast CA - post chemo to prevent breast CA fr returning

tamoxifen (hrmnl agent) | AE

- DVT/PE - hot flashes - endometrial CA - hyper-Ca - bone pain - vaginal DC bleeding

anastrazole (hrmnl agent) | AE

- muscle pain - hot flashes - vaginal bleed

tamoxifen, raloxifene, anastrazole (hrmnl agent) | CI

- Hx of blood clots | - category D/X

tamoxifen, raloxifene, anastrazole (hrmnl agent) | RN/teaching

- increase fluids | - discuss travel/surgeries

biological response modifiers [BRM] | drug names

interferon: alfa-2A or 2B | - --anti neoplasm

chemotherapy is always give via

central venous catheter | bc chemo is v irritating

interferon: alfa-2A or 2B | MOA

INCREASES immune response | decreases production of CA cells

interferon: alfa-2A or 2B | Tx

- treat/prevent leukemia - CML - lymphoma - kaposi's sarcoma other use: anti viral

interferon: alfa-2A or 2B | AE

**depression -flu like s/s -BMS alopecia -thyroid dysfunction -neurotoxicity

interferon: alfa-2A or 2B | CI

pancreatitis

interferon: alfa-2A or 2B should be administered at _____ temp

room temp -but store in fridge

interferon: alfa-2A or 2B | RN/teaching

* *monitor for suicidal ideation - ordered in MU (million units) - pre-med w APAP

4 MOA of interferon A (alfa-2B)

1 ANTIVIRAL: stim body cells to prevent viral entry 2 IMMUNOMODULATORY: incr immune response 3 ANTIPROLIFERATIVE: prevent virus fr replicating inside cells 4 ANTINEOPLASTIC: fights cancer cells

Monoclonal Antibodies [MAB] | drug names

- rituximab - blinatumomab - trastuzumab ends in mab

rituxi, blinatumo, trastuzu [-MAB] | RN/teaching

- have emergency resuscitative equipment readily available - stay w patient for first 15 mins of infusion - client should be tested for TB prior to MAB infusion

rituxi, blinatumo, trastuzu [-MAB] | AE

- can cause instant anaphylaxic or other life threatening rxn - ---often w first dose

rituxi, blinatumo, trastuzu [-MAB] | route

SQ or IV infusion

growth factor [GF] | drug names

- epoiten alfa - filgastim - pegfilgastim - sargramostin - oprevelkin

epoiten alfa [GF] | MOA

acts on bone marrow to increase production of RBC

epoiten alfa [GF] | Tx

- CKD patients - anemia 2n2 chemo therapy - HIV/AIDS

epoiten alfa [GF] | RN/teaching

- hold if Hgb>11 - each vial is for single dose (no reinsterting needle) - dose is often MWF

filgastim, pegfilgastim [GF] | MOA

acts on bone marrow to incease NEUTROPHILS * **drugs that increase neutroPHIL have -FIL in the name * **all neutroPHILS can get FILtered in the spleen to cause splenomegaly

filgastim, pegfilgastim [GF] | Tx

- CA w neutropenia, agranulocytosis | - prior to harvest of stem cells

if your spleen ruptures, you can feel pain in

left quadrant pain that may be referred to left shoulder | aka Kehr's sign

filgastim, pegfilgastim [GF] | AE

* splenomegaly - incr uric acid - LDH - alk phos - bone pain - leukocytosis

filgastim, pegfilgastim [GF] | CI

sickle cell disease

filgastim, pegfilgastim [GF] | RN teaching

- monitor pain in LUQ or left shoulder [kehr's sign=spleen rupture] - admin SQ 24hr after each round of therapy - ----wait 14 days for next round of chemo

sagramostin [GF] | MOA

stimulates bone marrow to make WBC

sagramostin [GF] | Tx

hastens bone marrow function after bone marrow transplant

oprelvekin | MOA

increase production of PLATELETS