Chemotherapy Agents Flashcards
Chemotherapy Agents
- cure and/or augment treatment of cancers
- increase survival rate and time
- oral, parenteral, IV, intracavitary, intrathecal routes
- combination of medications act on different phases of cell cycle:
i. increase effectiveness
ii. reduce medication resistance
Types of Chemotherapy Agents
1) Cytotoxic:
- antimetabolites
- antitumor antibiotics
- antimitotics
- alkylating
- topoisomerase inhibitors
- other antineoplastic
2) noncytotoxic:
- hormonal
- biologic response modifiers
- targeted antineoplastic medications
Cytotoxic Agents
1) toxic to cancer cells
2) kill fast-growing cancer cells AND healthy cells (skin, hair, intestinal mucosa, hematopoietic)
3) common adverse effects:
- nausea, vomiting
- myelosuppression
- alopecia
4) vesicants can cause severe damage if leaked into tissue
Antimetabolites
- kill cancer cells by interrupting specific phase of cell reproduction
1) folic acid analog: methotrexate (Rhematrex, Trexall) - choriocarcinoma
- solid tumors of breast, lung, head, neck
- acute lymphocytic leukemia, non-Hodgkin’s lymphoma
2) phrimidine analog: cytarabine (Cytosar-U) - acute myelogenous leukemia
- solid tumors (e.g. breast, colon)
3) purine analog: mercaptopurine (Purinethol) - acute lymphocytic leukemia, acute non-lymphocytic leukemia
Antimetabolites:
adverse effects
1) bone marrow suppression
- low WBC count (neutropenia)
- thromobycytopenia (bleeding)
- low platelet count (bleeding)
- low RBC count (anemia)
2) GI discomfort
- nausea, vomiting
Antimetabolites: contraindications
Methotrexate
1) pregnancy risk category X
2) psoriasis, liver failure, blood dyscrasias, immunodeficiency
3) may reduce digoxin and Dilantin levels
4) NSAIDs, salicylates, and sulfonamides may increase toxicities
5) food may decrease absorption. take on empty stomach
Antimetabolites: contraindications
Cytarabine
1) pregnancy risk category D
2) use with caution in clients who have liver disease
3) may reduce digoxin levels
Antimetabolites: contraindications
Mercaptopurine
1) pregnancy risk category D
2) contraindicated in clients resistant to medication
3) caution with concurrent use of other hepatotoxic medications
4) may reduce anticoagulant effect of warfarin
Antimetabolites: nursing interventions
1) monitor WBC, absolute neutrophil count, platelet count, hemoglobin, hematocrit
2) assess for bruising and bleeding gums
3) instruct clients to avoid crowds and contact with infectious individuals
4) administer antiemetic such as ondansetron in combination with dexamethasone, granisetron, or metoclopramide before beginning chemotherapy
5) encourage 2-3 L/day fluid intake
6) advise female clients to use birth control during treatment
7) monitor skin for jaundice
8) advice clients to monitor for dark urine and clay-colored stools
Antitumor Antibiotics
- kill cancer cells by stopping synthesis of RNA, DNA, or proteins
1) anthracyclines: doxorubicin (Adriamycin) - solid tumors (eg. lung, bone, stomach, breast)
- hodgkin’s and non-hodgkin’s lymphomas
2) nonanthracyclines: dactinomysin (Actinomycin D) - wilms’ tumor
- rhabdomyosarcoma
- choriocarcinoma
- ewing’s sarcoma
- kaposi’s sarcoma
Antitumor Antibiotics: Adverse Effects
1) bone marrow suppression
- low WBC count (neutropenia)
- thromobycytopenia (bleeding)
- low platelet count (bleeding)
- low RBC count (anemia)
2) GI discomfort
- nausea, vomiting
3) extravasations of vesicants
- can cause severe tissue damage
4) alopecia
5) acute cardiac toxicity, dysrhythmias
6) cardiomyopathy, heart failure
Antitumor Antibiotics: Contraindications
Doxorubicin
1) pregnancy risk category D
2) severe myelosuppression and lifetime cumulative dose of 550 mg/m2
3) increase cardiotoxicity with calcium channel blockers
4) may increase digoxin and Dilantin levels
5) phenobarbital may increase metabolism
Antitumor Antibiotics: Contraindications
Dactinomycin
1) pregnancy risk category D
2) active chicken pox or herpes zoster
Antitumor Antibiotics: nursing interventions
1) monitor for bleeding (bruising) or infection (fever, sore throat)
2) monitor CBC and liver enzymes
3) administer antiemetic for N&V
4) advise good oral hygiene and to avoid mouthwash with alcohol
5) hair loss may occur 7-10 days after beginning treatment and last about 2 months after last administration
6) select hairpiece prior to beginning chemo
7) stop medications immediately if extravasation occurs
Antimitotics
- kill cancer cells by inhibiting mitosis and preventing cell division
1) vinca alkaloids: vincristine (Oncovin, Vincasar) - acute lymphocytic leukemia
- wilms’ tumor
- rhabdomyosarcoma
- solid tumors (eg. bladder and breast)
- hodgkin’s and non-hodgkin’s lymphomas
2) taxanes: paclitaxel (Taxol, Onxol) - ovarian
- non-small cell lung tumors
- kaposi’s sarcoma
Antimitotics: adverse effects
1) bone marrow suppression
- low WBC count (neutropenia)
- thromobycytopenia (bleeding)
- low platelet count (bleeding)
- low RBC count (anemia)
2) peripheral neuropathy
3) extravasations of vesicants
4) alopecia
5) bradycardia, heart block, MI
Antimitotics: contraindications
Vincristine
1) pregnancy risk category D
2) liver or neuromuscular disease
3) may reduce effect of digoxin and Dilantin
4) calcium channel blockers and asparaginase (Elspar) may increase accumulation of medication and increase toxicities
Antimitotics: contraindications
Paclitaxel
1) pregnancy risk category D
2) hypersensitivity to castor oil
3) neutrophil count < 1,500/mm3
4) cisplatin may increase myelosuppression if used concurrently
5) cyclosporine, dexamethasone, diazepam, verapamil, quinidine, and vincristine may slow clearance of medication
Antibiotics: nursing interventions
1) assess for indications of neuropathy:
- weakness
- numbness
- tingling
- foot drop
- ataxia
2) assess for breath sounds and bronchospasm
3) monitor carefully for hypersensitivity reaction
4) monitor for bleeding (bruising) or infection (fever, sore throat)
5) administer antiemetic for N&V
6) advise good mouth care
7) stop medication immediately if extravasation occurs
8) advise clients to use birth control during treatment
Alkylating Agents
- kill fast-growing cancer cells by altering DNA structure and preventing cell reproduction
1) nitrogen mustards: cyclophosphamide (Cytoxan, Neosar) - acute lymphomas
- solid tumors (head, neck, breast)
- hodgkin’s and non-hodgkin’s lymphoma
2) nitrosoureas: carmustine (BiCNU) - brain tumors
- hodgkin’s and non-hodgkin’s lymphomas
- multiple myeloma
3) platinum compounds: cisplatin (Platinol-AQ) - bladder, testicular, ovarian cancers
Alkylating Agents: adverse reactions
1) bone marrow suppression
- low WBC count (neutropenia)
- thromobycytopenia (bleeding)
- low platelet count (bleeding)
- low RBC count (anemia)
2) GI discomfort
- nausea, vomiting
3) acute hemorrhagic cystitis
4) alopecia
5) pulmonary fibrosis
6) liver and kidney toxicities
7) reproductive toxicity
8) hearing loss
Alkylating Agents: Contraindications
Cyclophasphamide
1) pregnancy risk category D
2) severe myelosuppression
3) caution with kidney or liver disorders, leukopenia, thrombocytopenia
4) caution with cardiotoxic medications
5) may reduce digoxin levels
Alkylating Agents: Contraindications
Carmustine
1) pregnancy risk category D
2) anticoagulants, aspirin, NSAIDs may increase bleeding
3) concurrent use of carmustine and cimetidine (Tagamet) may increase bone marrow suppression
Alkylating Agents: Contraindications
Cisplatin
1) pregnancy risk category D
2) myelosuppression, kidney disorders, hearing loss
3) may reduce levels of Dilantin
Alkylating Agents:
nursing interventions
1) encourage fluid intake 2-3 L/day
2) monitor for blood in urine
3) monitor for bleeding (bruising) or infection (fever, sore throat)
4) monitor CBC, uric acid level, liver enzymes
5) administer antiemetic for N&V
6) advise good mouth care
7) stop medications if extravasation occurs
8) advise clients to use birth control during treatment
9) monitor hearing prior to treatment with cisplatin
Topoisomerase Inhibitors
- kill cancer cells by interrupting DNA synthesis
1) Topotecan (Hycamtin) - ovary and small-cell lung tumors
Topoisomerase Inhibitors: adverse reactions
1) bone marrow suppression
- low WBC count (neutropenia)
- thromobycytopenia (bleeding)
- low platelet count (bleeding)
- low RBC count (anemia)
2) GI discomfort
- nausea, vomiting
3) alopecia
Topoisomerase Inhibitors: contraindications
1) pregnancy risk category D
2) severe myelosuppression
Topoisomerase Inhibitors: nursing interventions
1) monitor for bleeding (bruising) or infection (fever, sore throat)
2) monitor CBC, uric acid level, liver enzymes
3) administer antiemetic for N&V
4) advise good mouth care and to avoid mouth wash with alcohol
5) advise clients to use birth control during treatment
Other Antineoplastic Agents
- kill cells by various mechanisms including interrupting DNA and RNA synthesis in leukemia cells
1) asparaginase (Elspar) - acute lymphocytic leukemia
2) hydroxyurea (Hydrea, Mylocel) - chronic myelogenous leukemia
- ovarian, squamous cell
3) procarbazine (Matulane) - brain tumors
- hodgkin’s and non-hodgkin’s lymphomas
Other Antineoplastic Agents: adverse reactions
1) bone marrow suppression
- low WBC count (neutropenia)
- thromobycytopenia (bleeding)
- low platelet count (bleeding)
- low RBC count (anemia)
2) GI discomfort
- nausea, vomiting
3) alopecia
4) hypersensitivity reaction
5) liver and pancreas toxicity
6) peripheral neuropathy
Other Antineoplastic Agents:: Contraindications
Asparaginase
1) pregnancy risk category C
2) pancreatitis
3) use caution with liver disease
4) may decrease effects of methotrexate
5) prednisone and vincristine may increase toxicities
Other Antineoplastic Agents:: Contraindications
Hydroxyurea
1) pregnancy risk category D
2) severe myelosuppression or anemia
3) use caution with kidney disease
4) cytotoxic medications may increase effects
Other Antineoplastic Agents:: Contraindications
Procarbazine
1) pregnancy risk category D
2) severe myelosuppresion
3) use caution with liver or kidney disease
4) may increase depressant effects of CNS depressants
5) may decrease digoxin levels
6) opioids may cause hypotension
Other Antineoplastic Agents: nursing interventions
1) monitor for allergic reaction. administer test dose
2) give antiemetic for N&V
3) advise good mouth care
4) advise clients to use birth control during treatment
5) monitor for neurological effects (confusion, parasthesia)
6) monitor for bleeding (bruising) or infection (fever, sore throat)
7) monitor CBC
Non-Cytotoxic Agents: Overview
1) nontoxic to cells
2) biological response modulators act as immunostimulants to increase immune response
3) targeted antineoplastic agents are antibodies that attach to specific target sites to stop growth
4) hormonal agents are effective against tumors that are supported or suppressed by hormones
- agonists cause increase in hormone and are effective against tumors that require particular hormone for support
- antagonists can block certain hormones and may be effective against tumors that require hormone for support
Hormonal Agents: Prostate Cancer Medications
1) Gonadotropin-releasing: leuprolide (Eligard, Lupron)
2) Androgen receptor blocker: flutamide (Eulexin)
Prostate Cancer Medications:
Adverse Reactions
1) hot flashes
2) decreased libido
3) decreased bone density
4) arrhythmias, pulmonary edema
5) thrombocytopenia
6) gynecomastia
7) nausea, vomiting, diarrhea
8) hepatitis
Prostate Cancer Medications: Contraindications
Leuprolide
1) pregnancy risk category X
2) hypersensitivity to gonadotropin-releasing agents
Prostate Cancer Medications: Contraindications
Flutamide
1) pregnancy risk category D
2) severe liver disease
3) concurrent use with warfarin may increase anticoagulation
Prostate Cancer Medications: nursing interventions
1) advise clients to increase calcium and vitamin D intake
2) advise clients to increase bone mass with weight-bearing exercises
3) monitor for arrhythmias
4) assess breath sounds
5) warn clients that prostate symptoms may worsen at beginning of treatment
6) advise clients of adverse effects such as gynecomastia
Hormonal Agents: Breast Cancer Medications
1) estrogen receptor blockers: tamoxifen (Nolvadex)
2) aromatase inhibitors: anastrozole (Arimidex)
3) monoclonal antibody: trastuzumab (Herceptin)
Breast Cancer Medications: Adverse Reactions
1) endometrial cancer
2) hypercalcemia
3) pulmonary embolus
4) hot flashes
5) vaginal discharge or bleeding
6) muscle and joint pain, headache
7) nausea
8) cardiac toxicity
9) tachycardia
10) heart failure
11) hypersensitivity reaction
Breast Cancer Medications: Contraindications
Tamoxifen
1) pregnancy risk category D
2) history of blood clots or PE
3) may increase anticoagulation of warfarin
4) antacids may alter absorption
Breast Cancer Medications: Contraindications
Anastrozole
1) pregnancy risk category D
2) hypersensitivity to medication
3) liver disease
4) tamoxifen and estrogen-like medications may reduce effects
Breast Cancer Medications: Contraindications
Trastuzumab
1) pregnancy risk category B
2) hypersensitivity to medication
3) hear disease
Breast Cancer Medications: nursing interventions
1) increase calcium and vitamin D intake
2) increase bone mass with weight-bearing exercises
3) monitor for arrhythmias
4) assess breath sounds
5) perform monthly breast self-examination and yearly mammogram
6) monitor CBC and calcium levels
7) monitor fluid status
8) advise female clients to use birth control during therapy
Biologic Response Modifiers
1) increases immune response
2) decreases production of cancer cells
3) used to treat or prevent:
- hairy cell leukemia
- chronic myelogenous leukemia
- malignant melanoma
- AIDS-related Kaposi’s sarcoma
4) interferon, Alfa-2a, interleukin-2
Biologic Response Modifiers: Adverse Reactions
1) flulike symptoms
- fever
- fatigue
- headache
- chills
- myalgia
2) bone marrow suppression
3) alopecia
4) cardiotoxicity
5) neurotoxicity
6) hypotension
Biologic Response Modifiers: Contraindications
1) pregnancy risk category C
2) hypersensitivity to medication
3) liver or kidney failure
4) cardiac history
5) compromised immune systme
6) use with theophylline can lead to theophylline toxicity
7) use with retrovir may increase risk of neutropenia
Biologic Response Modifiers: Nursing Interventions
1) store medication in refrigerator. do not freeze
2) administer at room temperature
3) do not shake vial
4) monitor for flu symptoms. administer acetaminophen if needed
5) advise good mouth care
6) monitor CBC, platelets, electrolytes
7) monitor fluid status
Targeted Antineoplastic Medications
1) EGFR-tyrosine kinase inhibitors: cetuximab (Erbitux)
- cancers that are EGFR positive
- colorectal and solid tumors of head and neck
2) BCR-ABL tyrosine kinase inhibitors: imatinib (Gleevec)
- chronic myeloid leukemia
3) CD20-directed antibodies: rituximab (Rituxan)
- non-hodgkin’s lymphoma
- IV route
4) angiogenesis inhibitors: bevacizumab (Avastin)
Targeted Antineoplastic Medications: Adverse Reactions
1) infusion reaction:
- rash
- hypotension
- wheezing
2) PE
3) skin toxicity, rash
4) GI: nausea, vomiting
5) flulike symptoms
6) edema
7) hypokalemia
8) neutropenia, anemia
9) alopecia
10) hypertension
