Chemotherapy Agents Flashcards
What is another name for chemotherapy agents?
antineoplastics
What is the therapeutic action of antineoplastics, and what is there purpose?
kill cancer cells or boost the immune system of the host; either way the ultimate goal is to shrink the size of the tumor so the immune system can deal with it.
cure, palliation, prophylactic (to prevent recurrence)
Can any nurse administer antineoplastics?
No, they require someone with special training and certification.
What happens if an antineoplastic spills?
This requires special precautions that will be included in institutional policy, at the very least a spill kit will be needed (full gown, goggles, mask, shoe covers, hat, special bags)
What type of cells are antineoplastics most effective against?
cells that replicate faster (high growth fraction)
What two types of cancer are less responsive to antineoplastics?
breast and lung cancers
What cells in our body (non-cancerous) are more susceptible to side effects of antineoplastics?
hair, GI, and bone marrow (high growth fraction)
Why are multiple drugs given during chemotherapy treatment?
different drugs act at different replication stages (increases effectiveness)
lower doses cause less toxicity and less resistance of cells (mutation)
Why are antineoplastics sometimes given as a series?
this gives normal cells time to recover
target new replicating cells
What is the therapeutic action of antimetabolites (cytotoxic chemotherapy agent)?
causes cell death by interrupting cell reproduction (inhibits folic acid conversion that is part of the replication process)
What pregnancy category is methotrexate?
category X
What may the nurse administer to reduce the toxicity of antimetabolites to healthy cells?
leucovorin (folic acid derivative)
What are some adverse effects of antimetabolites and nursing considerations for them?
bone marrow suppression - monitor for bleeding, bruising, and infection, monitor CBC, WBC, and platelets
mucositis, gastric ulcer, perforation - maintain good oral hygiene, avoid mouthwash with alcohol (irritates oral mucosa)
Renal dysfunction - monitor and encourage 2-3L of fluid daily
N/V - give antiemetic, avoid mouthwash with alcohol, and maintain good oral hygiene (usually antiemetic is given before treatment to avoid n/v)
What is the difference between methotrexate being used as a DMARD and methotrexate being used as a cyotoxic chemotherapy agent?
when it is used as a DMARD it is given at a lower dose
What is the therapeutic action of antitumor (cytotoxic chemotherapy agent) drugs?
causes cell death by stopping RNA and DNA synthesis.
What are some adverse effects of antitumor drugs and some nursing considerations for them?
bone marrow suppression - monitor for bleeding, signs of infections, bruising, monitor CBC, WBC, platelets
n/v, stomatitis - good oral hygiene, avoid mouthwash with alcohol, give antiemetic
cardiotoxic (can induce CHF) - monitor ECG, symptoms of CHF
alopecia (hair loss) will occur after 7-10 days and last 2 months after therapy has stopped - pick out wig before hair loss begins, avoid vigorous brushing
extravasation (tissue damage around administration site) - use central line for infusions (usually use portacaths now), MONITOR IV SITE FOR LEAKS
discoloration of urine and sweat (red) - harmless, make sure patient knows
When does hair loss begin to occur when on chemotherapy and how long does it last after therapy has stopped?
starts after 7-10 days and will last 2 months after therapy has stopped
What pregnancy category is adriamycin?
cat D
What is the therapeutic action of antimitotics (cytotoxic chemotherapy agent)?
causes cell death by inhibiting mitosis and preventing cell division
What are some adverse effects of antimitotics and some nursing considerations for them?
peripheral neuropathy effects - report weakness, paresthesia, tingling, ataxia
alopecia - will begin 7-10 days after therapy and last 2 months after stopped (pick out wig before hair loss begins, avoid vigorous brushing)
tissue damage from extravasation - use central line(most have portacaths), MONITOR IV SITE FOR LEAKS
n/v - give antiemetics before therapy, maintain good oral hygiene, avoid mouthwash with alcohol
What pregnancy category is vincristine (antimitotic)?
Cat D
Is vincristine (antimitotic) bone marrow toxic?
NO NO NO
What is the therapeutic action of alkylating (cytotoxic chemotherapy agent) agents?
causes cell death by altering DNA and preventing cell reproduction
What pregnancy category are alkylating agents in?
category C
What are some adverse effects of alkylating agents and some nursing considerations for them
hemorrhagic cystitis - encourage 3L fluid daily, monitor urine for blood and pain urinating, mesa (mesnex) may be given to reduce hematuria
bone marrow suppression - monitor for bleeding, bruising, signs of infection, monitor CBC, WBC, platelets
n/v - give antiemetic before therapy, maintain good oral hygiene, avoid mouthwash with alcohol
alopecia - will begin 7-10 days after therapy and last 2 months after stopped (pick out wig before hair loss begins, avoid vigorous brushing)
What medication can be given to reduce hematuria from hemorrhagic cystitis?
mesa (Mesnex)
- helps break down metabolites from medication that cause the hematuria
What is the therapeutic action of topoisomerase inhibitors?
causes cell death by interrupting DNA synthesis
What pregnancy category are topoisomerase inhibitors?
cat C
What are some adverse effects of topoisomerase inhibitors and some nursing considerations for them?
bone marrow suppression - monitor for bleeding, bruising, signs of infection, monitor CBC, WBC, platelets
n/v - give antiemetic before therapy, maintain good oral hygiene, avoid mouthwash with alcohol
alopecia - will begin 7-10 days after therapy and last 2 months after stopped (pick out wig before hair loss begins, avoid vigorous brushing)
What are three things to monitor for in most antineoplastics?
bone marrow suppression (except for vincristine (Oncovin) an antimitotic)
alopecia
n/v
What two antineoplastic medications can cause extravasation?
adriamycin (Doxorubicin)
vincristine (Oncovin)
Should we monitor IV sites whether medications can cause extravasation or not?
YES YES YES
What is the therapeutic action of estrogen receptor blockers (noncytotoxic chemotherapy agent)?
antiestrogen/hormonal agents; stops the growth of breast cancer cells which are estrogen-dependent cancer
USED FOR BREAST CANCER ONLY
NONTOXIC TO HEALTHY CELLS
What pregnancy category are estrogen receptor blockers?
cat D
What are some adverse effects for estrogen receptor blockers and some nursing considerations for them?
increased risk of stroke/PE - monitor for symptoms
increased risk for endometrial cancer - monitor for abnormal vaginal discharge or bleeding
n/v - give antiemetic (good oral hygiene, avoid mouthwash with alcohol)
hot flashes - educate patient
hypercalcemia (rare) - monitor levels (not sure if its because of the breast cancer or the Tamoxifen)
When is nalvadex (Tamoxifen), an estrogen receptor blocker, contraindicated?
In patients taking warfarin because it increases the risk for bleeding - MONITOR PT/INR
What is the therapeutic action of biologic response modifiers?
energizes the immune system: increase immune system response and decreases production of cancer cells
What are some adverse effects of interferons (antiviral/anticancer) and interleukins (similar to interferons) and some nursing considerations for them?
Bone marrow suppression of RBCs from the increase in demand of WBCs - monitor for anemia
flu-like symptoms (fever, fatigue, HA, chills) - monitor and report
cardiotoxicity - monitor and report symptoms
peripheral neuropathy effects - report weakness, paresthesia, tingling, ataxia
depression/anxiety - educate and report
