Chemotherapy Agents (Pharmacology Ch 42)

Question 1

Cytotoxic Chemotherapy Medications

Answer 1

1) antimetabolites
2) antitumor antibiotics
3) antimitotics
4) alkylating agents
5) topoisomerase inhibitors
6) other

Question 2

Cytotoxic chemotherapy

Answer 2

-kill fast-growing cancer cells and healthy cells

Question 3

Cytotoxic chemotherapy agents:

common adverse effects

Answer 3

• many due to the unintentional harm done to normal rapidly proliferating cells (those found in GI tract, hair follicles, bone marrow)
  1) nausea and vomiting
  2) myelosuppression
  3) alopecia

Question 4

Antimetabolites
pharmacological action
medications

Answer 4

• kill cancer cells by interrupting a specific phase of cell reproduction
  1) folic acid analog
• prototype = methotrexate (Rheumatrex, Trexall)
• other = pemetrexed (Alimta)
  2) pyrimidine analog
• prototype = cytarabine (Cytosar-U)
• other =
  i. fluorouracil (Adrucil, Carac)
  ii. capecitabine (Xeloda)
  iii. floxuridine (FUDR)
  3) purine analogs
• prototype = mercaptopurine (Purinethol)
• other =
  i. thioguanine (Tabloid)
  ii. pentostatin (nipent)
  iii. fludarabine (Fludara

Question 5

All Antimetabolite Agents

adverse effects and nursing interventions/client education

Answer 5

1) bone marrow suppression (low WBC count or neutropenia, bleeding caused by thrombocytopenia or low platelet count, and anemia or low RBCs)
- monitor WBC, absolute neutrophil count, platelet count, Hgb, Hct
- assess clients for bruising and bleeding gums
- instruct clients to avoid crowds and contact with infectious individuals
2) GI discomfort (nausea & vomiting)
- administer antiemetic such as ondansetron (Zofran) in combination with dexamethasone, granisetron (Kytril), or metoclopramide (Reglan) before beginning chemotherapy

Question 6

Methotraxate specific adverse effects

Answer 6

1) mucositis (GI tract), gastric ulcers, perforation
- monitor for GI bleed and assess client’s mouth for sores
- provide frequent oral hygiene using soft toothbrushes and avoid alcohol mouthwashes
2) reproductive toxicity (congenital abnormalities)
- advise female clients against becoming pregnant while taking these and 6 months after
3) renal damage due to hyperuricemia or elevated levels of uric acid
- monitor kidney function, BUN, creatinine, and I&O
- encourage adequate fluid intake of 2-3 L/day
- administer allopurinol if uric acid elevated

Question 7

Cytarabine specific adverse effects

Answer 7

1) liver disease
- monitor liver enzymes. monitor for indications of jaundice
2) PE
- monitor breath sounds. advise clients to notify provider of SOB
3) arachnoiditis (indications include nausea, headache, and fever)
- advise clients to notify provider of N, V, headache, or fever. manifestations may be treated with dexamethasone (Decadron)

Question 8

Mercaptopurine specific adverse effects

Answer 8

1) liver toxicity
- monitor liver enzymes. monitor for indications of jaundice
2) mucositis (GI tract), gastric ulcers, perforation
- monitor for GI bleed and assess client’s mouth for sores
- provide frequent oral hygiene using soft toothbrushes and avoid alcohol mouthwashes
3) reproductive toxicity (congenital abnormalities)
- advise female clients against becoming pregnant while taking these and 6 months after

Question 9

Antitumor Antibiotics
pharmacological action
medications

Answer 9

• kill cancer cells by stopping the synthesis of RNA, DNA, or proteins
  1) anthracyclines
• prototype = doxorubicin (Adriamycin)
• other =
  i. liposomal doxorubicin (Doxil)
  ii. daunorubicin (Cerubidine)
  2) nonanthracyclines
• prototype = dactinomycin (Cosmegen)
• other =
  i. bleomycin (Blenoxane)
  ii. mitomycin (Mutamycin)
  iii. dactinomycin, liposomal (Doxil)

Question 10

All Antitumor Antibiotics

adverse effects and nursing interventions/client education

Answer 10

1) bone marrow suppression
- monitor WBC, absolute neutrophil count, platelet count, Hgb, Hct
- assess clients for bruising and bleeding gums
- instruct clients to avoid crowds and contact with infectious individuals
2) GI manifestations (including nausea/vomiting, stomatitis)
- administer antiemetic such as ondansetron (Zofran) in combination with dexamethasone, granisetron (Kytril), or metoclopramide (Reglan) before beginning chemotherapy
- provide gentle oral care; rinse mouth with warmed saline solution
3) severe tissue damage due to extravasations of vesicants
- stop chemotherapeutic medications if extravasation occurs
- use central line for infusion
- only clinically trained personnel should give these meds IV
4) alopecia
- advise clients hair loss will occur 7-10 days after beginning of treatment and last max of 2 months after last administration of chemotherapeutic agent
- advise clients who want to do so to select hairpiece before occurrence of hair loss

Question 11

Doxorubicin specific adverse effects

Answer 11

1) acute cardiac toxicity, dysrhythmias
- monitor ECG and echocardiogram
- client may be treated with dexrazoxane (Zinecard), but this med may increase myelosuppression
2) cardiomyopathy, heart failure (may have delayed onset)
- monitor ECG and echocardiogram
- client may be treated with ACE inhibitors
3) red coloration to urine and sweat
- advise clients this effect is not harmful

Question 12

Antimitotics
pharmacological action
medications

Answer 12

• kill cancer cells by inhibiting mitosis and preventing cell division
  1) vinca alkaloids
• prototype = vincristine (Oncovin, Vincasar PFS)
• other =
  i. vinblastine (Velban)
  ii. vinorelbine (Navelbine)
  2) taxanes
• prototype = paclitaxel (Abraxane)
• other =
  i. docetaxel (Taxotere)

Question 13

Vincristine

adverse effects and nursing interventions/client education

Answer 13

1) peripheral neuropathy effects (weakness, paresthesia)
- advise clients to report manifestations. use caution to prevent injury
2) severe tissue damage due to extravasations of vesicants
- stop chemotherapeutic medications if extravasation occurs
- use central line for infusion
- only clinically trained personnel should give these meds IV
3) alopecia
- advise clients hair loss will occur 7-10 days after beginning of treatment and last max of 2 months after last administration of chemotherapeutic agent
- advise clients who want to do so to select hairpiece before occurrence of hair loss

Question 14

Paclitaxel

adverse effects and nursing interventions/client education

Answer 14

1) bone marrow suppression
- monitor WBC, absolute neutrophil count, platelet count, Hgb, Hct
- assess clients for bruising and bleeding gums
- instruct clients to avoid crowds and contact with infectious individuals
2) bradycardia, heart block, MI
- monitor for cardiac effects
- advise clients to inform the nurse of any chest pain or SOB
3) alopecia
- advise clients hair loss will occur 7-10 days after beginning of treatment and last max of 2 months after last administration of chemotherapeutic agent
- advise clients who want to do so to select hairpiece

Question 15

Alkylating Agents
pharmacological action
medications

Answer 15

• kill fast-growing cancer cells by altering DNA structure and preventing cell reproduction
  1) nitrogen mustards
• prototype = cyclophosphamide (Cytoxan, Neosar)
• other =
• mechlorethamine (Mustargen), bendamustine (Treanda)
• chlorambucil (Leukeran
  2) nitrosoureas
• prototype = carmustine (BiCNU, Gliadel)
• other =
  i. lomustine (CCNU)
  ii. streptozocin (Zanosar)
  3) platinum compounds
• prototype = cisplatin (Platinol)
• other = carboplatin (Paraplatin)

Question 16

All Alkylating Agents

adverse effects and nursing interventions/client education

Answer 16

1) bone marrow suppression
- monitor WBC, absolute neutrophil count, platelet count, Hgb, Hct
- assess clients for bruising and bleeding gums
- instruct clients to avoid crowds and contact with infectious individuals
2) GI discomfort (nausea & vomiting)
- administer antiemetic such as ondansetron (Zofran) in combination with dexamethasone, granisetron (Kytril), or metoclopramide (Reglan) before beginning chemotherapy

Question 17

Cyclophosphamide specific adverse effects

Answer 17

1) acute hemorrhagic cystitis
- increase fluids (3 L daily)
- monitor for blood in urine
- mesna (Mesnex) may be given if needed. (a uroprotectant agent that detoxifies metabolites to reduce hematuria)
2) alopecia
- advise clients hair loss will occur 7-10 days after beginning of treatment and last max of 2 months after last administration of chemotherapeutic agent
- advise clients who want to do so to select hairpiece

Question 18

Carmustine specific adverse effects

Answer 18

1) pulmonary fibrosis
- monitor lung function
- client may be treated with corticosteroids
2) liver and kidney toxicity
- monitor liver and kidney function

Question 19

Cisplatin specific adverse effects

Answer 19

1) renal toxicity
- monitor kidney function.
- increase fluids and give a diuretic if indicated
2) hearing loss
- monitor for tinnitus and hearing loss

Question 20

Topoisomerase Inhibitors
pharmacological action
medications

Answer 20

• kill cancer cells by interrupting DNA synthesis

1) prototype = topotecan (Hycamtin)

Question 21

Topoisomerase Inhibitors

adverse effects and nursing interventions/client education

Answer 21

1) bone marrow suppression (low WBC count or neutropenia, bleeding caused by thrombocytopenia or low platelet count, and anemia or low RBCs)–may occur 4-6 wks after infusion
- monitor WBC, absolute neutrophil count, platelet count, Hgb, and Hct
- assess for bruising and bleeding gums
- instruct clients to avoid crowds and contact with infectious individuals. advise clients to continue precautions after treatment is completed.
2) GI discomfort (nausea & vomiting)
- administer antiemetic such as ondansetron (Zofran) in combination with dexamethasone, granisetron (Kytril), or metoclopramide (Reglan) before beginning chemotherapy
3) alopecia
- advise clients hair loss will occur 7-10 days after beginning of treatment and last max of 2 months after last administration of chemotherapeutic agent
- advise clients who want to do so to select hairpiece

Question 22

Other Antineoplastic Agents
pharmacological action
medications

Answer 22

• kill cells by various mechanisms including interrupting DNA and RNA synthesis
  1) asparaginase (Elspar)
  2) hydroxyurea (Hydrea, Mylocel)
  3) procarbazine (Matulane)

Question 23

Asparaginase, hydroxyurea, and procarbazine

adverse effects and nursing interventions/client education

Answer 23

1) GI discomfort (nausea & vomiting)
- administer antiemetic such as ondansetron (Zofran) in combination with dexamethasone, granisetron (Kytril), or metoclopramide (Reglan) before beginning chemotherapy

Question 24

Asparaginase specific adverse effects

Answer 24

1) hypersensitivity reaction
- premedicate if needed.
- monitor for wheezing and/or rash
- give test dose
- monitor closely
2) CNS effects ranging from confusion to coma; temporary tremor may occur
- monitor for CNS effects and evaluate frequently for changes
3) liver and pancreas toxicity
- monitor liver enzymes
- monitor for indications of jaundice
- monitor pancreatic enzymes
4) renal toxicity
- monitor kidney function.
- increase fluids and administer a diuretic if indicated

Question 25

Hydroxyurea and procarbazine specific adverse reactions

Answer 25

1) bone marrow suppression (low WBC count or neutropenia, bleeding caused by thrombocytopenia or low platelet count, and anemia or low RBCs)–may occur 4-6 wks after infusion
- monitor WBC, absolute neutrophil count, platelet count, Hgb, and Hct
- assess for bruising and bleeding gums
- instruct clients to avoid crowds and contact with infectious individuals. advise clients to continue precautions after treatment is completed.

Question 26

Procarbazine specific adverse reactions

Answer 26

1) peripheral neuropathy symptoms may include weakness and paresthesia
- advise clients to report manifestations
- use caution to prevent injury

Question 27

Noncytotoxic Chemotherapeutic Medications

Answer 27

1) hormonal agents
- prostate cancer medications
- breast cancer medications
2) biologic response modifiers
3) targeted antineoplastic medications

Question 28

Noncytotoxic Chemotherapy

Answer 28

-nontoxic to cells

Question 29

Hormone Agonists

Answer 29

-cause an increase in a hormone and may be effective against tumors that require a particular hormone for support

Question 30

Hormone Antagonists

Answer 30

-block certain hormones and may be effective against tumors that require a particular hormone for support

Question 31

Hormonal Agents–Prostate Cancer Medications

Answer 31

1) gonadotropin-releasing hormone agonists
* testes stop producing testosterone
* Palliative treatment for advanced prostate cancer
- prototype = leuprolide (Eligard, Lupron)
- other = triptorelin (Trelstar Depot)
2) androgen receptor blocers
* blocks testosterone at receptor site; used in conjunction with gonadotropin-releasing hormone agonists to block androgen receptors and suppress the growth of prostate cancer
* treatment of prostate cancer
- prototype = flutamide (Eulexin)
- other = bicalutamide (Casodex)

Question 32

Leuprolide specific adverse effects

Answer 32

1) hot flashes, decreased libido, and gynecomastia
- warn clients about adverse effects.
- adverse reactions may be transient
2) decreased bone density
- advise clients to increase calcium and vitamin D intake
- advise clients to increase bone mass with weight-bearing exercise
3) arrhythmias, PE
- monitor for arrhythmias and assess breath sounds

Question 33

Flutamide specific adverse effects

Answer 33

1) hot flashes, decreased libido, and gynecomastia
- warn clients about adverse effects
2) nausea, vomiting, diarrhea
- monitor I&O
3) hepatitis
- monitor liver enzymes

Question 34

Hormonal Agents–Breast Cancer Medications

Answer 34

1) estrogen receptor blockers
* stops growth of breast cancer cells, which are estrogen-dependent cancers
- prototype = tamoxifen (Nolvadex)
- others =
i. raloxifene (Evista)
ii. fulvestrant (Faslodex)
2) aromatase inhibitors
* stops growth of breast cancer cells by blocking estrogen production
* used to treat breast cancer in postmenopausal women
- prototype = anastrozole (Arimidex)
- others =
i. letrozole (Femara)
ii. exemestane (Aromasin)
3) monoclonal antibody
* targets breast cancer cells, prevents cell growth, and causes cell death
* used to treat metastatic breast cancer; may be used alone or in conjunction with paclitaxel
- prototype = trastuzumab (Herceptin)

Question 35

Tamoxifen specific adverse effects

Answer 35

1) endometrial cancer
- monitor for abnormal bleeding. advise clients to have yearly gynecological exam and PAP smear
2) hypercalcemia
- monitor calcium level
3) nausea and vomiting
- monitor fluid status. administer fluids and antiemetics as prescribed
4) PE
- assess breath sounds. advise clients to report chest pain or SOB
5) hot flashes
- warn clients about adverse effects
6) vaginal discharge or bleeding
- monitor bleeding and discharge

Question 36

Anastrozole specific adverse effects

Answer 36

1) muscle and joint pain, headache
- treat pain with mild analgesic as prescribed
2) nausea
- monitor fluid status. administer fluids and antiemetics as prescribed
3) vaginal bleeding
- monitor bleeding and CBC
4) increased risk for osteoporosis
- advise clients to take calcium and vitamin D supplements and perform weight-bearing exercises
5) hot flashes
- warn clients about adverse effects

Question 37

Trastuzumab specific adverse effects

Answer 37

1) cardiac toxicity, tachycardia, heart failure
- obtain baseline ECG and monitor
- monitor for dyspnea and edema. advise clients to report chest pain or SOB
2) hypersensitvity reaction
- monitor closely during infusion. have resuscitation equipment nearby
3) nausea and vomiting
- monitor fluid status

Question 38

Biologic Response Modifiers

Answer 38

• increases immune response and decreases production of cancer cells
• used to treat or prevent hairy cell leukemia, chronic myelogenous leukemia, malignant melanoma, and AIDS-related Kaposi’s sarcoma
  1) prototype = interferon alfa-2b (Intron A)
  2) other =
• aldesleukin (Interleukin-2)
• BCG vaccine (TheraCys)

Question 39

Biologic Response Modifiers

adverse effects and nursing interventions/client education

Answer 39

1) flulike symptoms (fever, fatigue, headache, chills, myalgia)
- administer acetaminophen as prescribed
2) bone marrow suppression, alopecia, cardiotoxicity, and neurotoxicity (with prolonged therapy)
- monitor CBC, fatigue level, and indications of cardiotoxicity (arrhythmias, palpitations, MI, heart failure) and neurotoxicity (confusion, ataxia, inability to concentrate)
- monitor clients for manifestations of infection
- instruct clients to report dizziness or tingling/numbness of the hands or feet
- monitor for bruising, bleeding, and blood in stools, urine, sputum, and/or emesis
3) depression, anxiety, insomnia, altered mental states
- monitor mood and mental status and assess for suicidal thoughts

Question 40

Targeted Antineoplastic Medications

Answer 40

1) EGFR-tyrosine Kinase Inhibitors
* antibody that stops cancer cell growth and increases cell death
- prototype = cetuximab (Erbitux)
- other = panitumumab (Vectibix)
2) BCR-ABL Tyrosine Kinase Inhibitors
* stops cancer growth by inhibiting intracellular enzymes
- prototype = imatinib (Gleevec)
3) CD20-Directed Antibodies
* antibody that stops cancer cell growth and increases cell death
- prototype = rituximab (Rituxan)
4) Angiogenesis Inhibitors
* antibody that stops cancer cell growth and increases cell death
- prototype = bevacizumab (Avastin)

Question 41

Cetuximab specific adverse effects

Answer 41

1) infusion reaction, rash, hypotension, wheezing
- monitor carefully for indications of a reaction
- premedicated if needed with diphenhydramine or corticosteroids
- stop treatment and administer antihistamines as prescribed
2) PE
- monitor breath sounds. Monitor SaO2
3) skin toxicity, rash
- monitor for rash over 2 wks of treatment. Treat with topical antibiotics if needed

Question 42

Imatinib specific adverse effects

Answer 42

1) GI discomfort, such as N&V
- administer antiemetic such as ondansetron in combination with dexamethasone, granisetron, or metoclopramide before beginning chemotherapy
- take with food
2) flulike symptoms (fever, fatigue, headache, chills, myalgia)
- administer acetaminophen as prescribed
3) edema
- monitor for edema
4) hypokalemia
- monitor potassium level
5) neutropenia, anemia
- monitor CBC
- assess for bruising and bleeding gums
- instruct clients to avoid crowds and contact with infectious individuals

Question 43

Rituximab specific adverse effects

Answer 43

1) infusion reaction, rash, hypotension, wheezing
- monitor carefully for indications of a reaction
- premedicated if needed with diphenhydramine or corticosteroids
- stop treatment and administer antihistamines as prescribed
2) flulike symptoms (fever, fatigue, headache, chills, myalgia)
- administer acetaminophen as prescribed
3) tumor lysis syndrome due to rapid cell death may lead to kidney failure, hypocalcemia and hyperuricemia
- monitor kidney function, dialyze if needed. monitor fluids and electrolytes
- teach client to report manifestations, which begin 12-24 hr after first medication infusion

Question 44

Bevacizumab specific adverse reactions

Answer 44

1) thromboembolism, including cerebrovascular accident, myocardial infarction, transcient ischemic attacks (TIA)
- monitor for thromboembolic disorders
2) alopecia
- advise clients hair loss will occur 7-10 days after beginning of treatment and last max of 2 months after last administration of chemotherapeutic agent
- advise clients who want to do so to select hairpiece
3) hemorrhage–GI, vaginal, nasal, intracranial, or pulmonary
- monitor carefully for hemorrhage from any site, including hemoptysis
4) hypertension
- monitor BP
5) gastric perforation
- advise clients to notify provider if they experience abdominal pain associated with vomiting and constipation