Chemotherapy Agents Flashcards
chemotherapy agents A.K.A.
antineoplastic agents
chemotherapy/antineoplastic agents
- used to cure some CA, augment TX of other, or increase survival rate
- works by killing fast-growing cells
combo therapy
- uses more than 1 agent
- more effective than monotherapy
- reduce medication resistance, increase effectiveness, + reduce toxic effects
examples of fast-growing cells
skin, hair, intestinal mucosa, hematopoietic cells
common A/E of chemotherapy/antineoplastic agents
- NVD
- alopecia
- mylosuppression
- infection
- tumor lysis syndrome
alopecia
- hair loss occur 7-10 days after start
- will last a max of 2 mo after last admin
myelosuppression/infection risk
7-10 days after each chemo dose
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
types of antineoplastic agents
1 antimetabolite 2 hormonal agents 3 biological response modifiers 4 monoclonal antibody [MAB] 5 growth factors
antimetabolite
drug names
methotrexate
fluorouracil
cytarabine
hydroxyurea
methotrexate, cytarabine, fluorouracil (antimetabolite)
route
MTX: PO, IV, IM, Intrathecal
methotrexate IV requires…
a dedicated IV line
methotrexate [MTX]
MOA
stops cell reproduction needed for synth of DNA by inhibiting folic-acid conversion
methotrexate [MTX]
Tx
- breast tumor
- lung tumor
- sarcoma
- Non-Hodgkin Lymphoma
- ALL
methotrexate [MTX]
AE
- category X
- mucositis
- gastric ulcers
- perforations
- liver damage
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
methotrexate [MTX] (antimetabolite)
RN/teaching
admin w leucovorin to reduce toxicity to healthy cells
–it enters healthy cells + blocks MTX
hydroxyurea
route
common PO antimetabolites
hydroxyurea
MOA
interrupts DNA synthesis + is cell “S” phase-specific
hydroxyurea
Tx
- sickle cell anemia
- can cross BBB
- CML
hydroxyurea
AE
- NVD
- bone marrow suppression
- rapid drop in WBC - neutropenic (risk of infectn)
- thrombocytopenia (risk of bleed)
- anemia
hydroxyurea
CI
caution w antivirals
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
