Chemotherapy Drugs Flashcards
Review classification of chemotherapy drugs.
What is another term for Chemotherapy Drugs?
Antineoplastic Drugs
What is the property of chemotherapy drugs?
Broad range of chemicals which treat cancer by eradicating malignant cells
What is the treatment regimen of Chemotherapy?
Treatment regimens may use a combination of chemotherapeutic drugs concurrently or in a planned sequence is done to eradicate tumor cell populations
What is the combination therapy of chemo medications?
Drugs that work through differing mechanisms of action and that do not share similar toxic effects are combined
What is the administration of Chemotherapy – Antineoplastic Drugs?
Usually administered over short periods at specific treatment intervals, not continuously
How are Chemotherapy – Antineoplastic Drugs classified?
Classified according to their mechanism of action (adverse effects of these drugs are generally similar among drugs with similar mechanisms of action)
Why is drug classifications important?
Knowledge of drug classifications and inherent side effects is necessary in ordering preoperative testing
What are some labs that maybe needed for chemotherapy?
Indicated lab tests may include: Hgb, platelet count, WBC count, coagulation profile, ABGs, blood glucose, electrolytes, renal and liver function tests, EKG, and CXR
What is the components of immunosupression?
Immunosuppression places these patients at an inherent risk of iatrogenic infections, so asepsis and appropriate antibiotic therapy is critical
What are vomiting and diarrhea associated with?
electrolyte imbalances and dehydration
What is a characteristics of mucositis?
insertion of OPAs and LMAs require caution
What is the relationship of chemo drugs and inhaled or injected anesthetic agents?
Response to inhaled or injected anesthetic agents may be affected by drug-induced cardiac, hepatic, or renal dysfunction and induction of hepatic enzymes
What can impaired renal function effect?
Impaired renal function may alter a patient’s response to neuromuscular blocking agents
What can happen with decreased pseudocholinesterase activity?
It is possible that certain patients have a prolonged response to succinylcholine if they have decreased pseudocholinesterase activity
What are included in the Alkylating Agents?
Includes nitrogen mustards, alkyl sulfonates, nitrosureas, and triazines
What do Alkylating Agents drugs inhibit?
These drugs inhibit DNA replication & transcription
What is produced by Alkylating Agents?
DNA damage produced by alkylating chemotherapeutic drugs more likely to kill malignant cells than nonmalignant cells b/c rate of proliferation greater for cancer cells
What is the most important dose limiting factor?
Bone marrow suppression is the most important dose-limiting factor
When is lymphoctyopenia from Alkylating Agents occur?
Lymphocytopenia is present within 24 hours
What coagulation changes occur wirth Alkylating Agents?
Depression of platelet and erythrocyte counts may occur as well as hemolytic anemia
What can cyclophosphamide or ifosfamide cause?
Hemorrhagic cystitis
What can GI mucosa from Alkylating Agents result in?
GI mucosa is sensitive to alkylating agents, resulting in cellular hypertrophy and desquamation of the epithelium
What integumentary effects can occur with Alkylating Agents?
Alopecia is common, increased skin pigmentation
What is true about all Alkylating Agents?
All alkylating agents are powerful CNS stimulants manifesting as nausea & vomiting, skeletal muscle weakness and seizures
What are potential adverse respiratory effects of Alkylating Agents?
Pneumonitis and pulmonary fibrosis are potential adverse effects
What can patients demonstrate with Alkylating Agents?
Patients may demonstrate a decreased pulmonary diffusing capacity
What can patients aquire with Alkylating Agents?
Acquired pseudocholinesterase deficiency can be present up to 2 to 3 weeks after receiving alkylating agents (can result in prolonged response to SCh)
What kidney effects can occur with Alkylating Agents?
Uric acid-induced nephropathy
What are examples of Alkylating Agents- Nitrogen Mustards?
- Mechlorethamine
- Cyclophosphamide
- Melphalan
- Clorambucil
What is Mechlorethamine used for?
used in the treatment of Hodgkin disease and other lymphomas
What is Mechlorethamine used in combo with?
Often used in combination with vincristine, procarbazine, and prednisone.
What are major side effects of Mechlorethamine?
Major side effects include N&V and myelosuppression.
What limits the amount of Mechlorethamine given?
Leukopenia and thrombocytopenia are the principle limitations on the amount that can be given.
What is the most commonly used chemotherapeutic drugs?
Cyclophosphamide: it is effective in a wide range of cancers and inflammatory diseases; hypersensitivity reactions and fibrosing pneumonitis have been noted
What are large doses of cyclophosphamide associated with?
Large doses asso/w high incidence of pericarditis and pericardial effusion; some patients have developed hemorrhagic myocarditis with symptoms of CHF (fulminant CHF)
What are common side effects of Alkylating Agents: Nitrogen Mustards?
- Significant thrombocytopenia less common but alopecia is more common
- mucosal ulcerations and hepatotoxicity are possible side effects.
What are the side effects of Melphalan?
- side effects are primarily hematologic, usually necessary to maintain a significant degree of bone marrow depression to achieve therapeutic effect
- pulmonary fibrosis possible.
What is the clinical use of Chlorambucil?
Treatment of choice for chronic lymphocytic leukemia and in primary macroglobulinemia
What are the effects of Chlorambucil?
- cytotoxic effects similar on the bone marrow, lymphoid organs, and epithelial tissues to other alkylating drugs
- myelosuppressive action is generally moderate, gradual, and rapidly reversible;
- pulmonary fibrosis possible
What are Melphalan & Chlorambucil prone to?
Prone to N&V.
What are examples of Alkylating Agents: Alkyl Sulfonates?
Busulfan
What is the clinical use of Busulfan?
produces remission in up to 90% of patients with chronic myelogenous leukemia
What is likely to develop with Busulfan?
Alkyl Sulfonates
- Progressive pulmonary fibrosis in up to 4% of patients – poor prognosis with median survival of 5 months
What are side effects of Alkylating Agents: Alkyl Sulfonates?
Busulfan
- Myelosuppression and thrombocytopenia common, as is N&V and diarrhea
What kidney effect can be seen with Alkylating Agents: Alkyl Sulfonates?
Busulfan
- Hyperuricemia results from extensive purine catabolism accompanying the rapid cellular destruction and renal damage from precipitation of urates has been noted
What are examples of Alkylating Agents: Nitrosoureas?
Carmustine, lomustine, semustine, streptozocin, & mitomycin
What are Alkylating Agents: Nitrosoureas used in treating?
Carmustine, lomustine, semustine, streptozocin, & mitomycin are used in treating meningeal leukemias and intracranial tumors (high lipid solubility crossing the blood-brain barrier), melanomas, and gastrointestinal and hematologic malignancies
Which Alkylating Agents: Nitrosoureas has the largest use?
Carmustine
has the widest clinical use of the nitrosoureas
What side effects occur with Carmustine?
Side effects include interstitial pneumonitis and fibrosis.
What is the respiratory effects of Carmustine?
Incidence of pulmonary toxicity is 20-30%, with a mortality rate of 24-90%.
What is a unique side effect of carmustine?
is a delayed onset (6 weeks) of leukopenia and thrombocytopenia
What are common side effects of Alkylating Agents: Nitrosoureas reported?
CNS toxicity, N&V, flushing of skin and conjunctiva, nephrotoxicity, and hepatotoxicity have been reported
What are the side effects of Lomustine and semustine?
similar clinical toxicity to carmustine, including delayed BM depression manifesting as leukopenia and thrombocytopenia
What is the use of Streptozocin?
useful in the treatment of pancreatic islet cell carcinoma and malignant carcinoid
What is a side effect of Streptozocin?
- nearly 70% of patients develop renal or hepatic toxicity
- hyperglycemia
What is the cause of renal toxicity from Streptozocin?
renal toxicity manifests as tubular damage to renal failure and death
What does not occur with Streptozocin?
myelosuppression does not occur with this drug
What is Mitomycin used for?
used in the palliative treatment of gastric adenocarcinoma in combination with fluorouracil and doxorubicin
What are side effects of Mitomycin?
- side effects include severe leukopenia and thrombocytopenia; can induce pulmonary fibrosis
- N&V, mucositis, and alopecia occur
What is true about limit exposure and Mitomycin?
limit exposure of treated patients to hyperoxia
What are renal effects of Mitomycin?
glomerular damage resulting in renal failure is a well recognized complication
What is an example of Alkylating Agents: Platinating Drugs?
Cisplatin
Cisplatin is a _______ agent.
Alkylating-like agent
What is the clinical use of Cisplatin?
Cisplatin and its analogue carboplatin useful in treating nonhematologic malignancies, including lung, bladder, testicular, and ovarian cancer
What are the renal effects of Cisplatin?
- Renal toxicity is common and is the dose-limiting toxic effect of cisplatin
- Decreased glomerular filtration rate and renal tubular dysfunction begin as early as 3-5 days after initiating drug treatment
What are the lab effects of Cisplatin?
Increasing BUN and Cr concentrations, proteinuria, hyperuricemia, and magnesium wasting defect can occur
What electrolyte effect can occur with Cisplatin?
Hypomagnesia can cause cardiac dysrhythmias and decrease the dose requirements of NMBD
What can actue tubular necrosis from Cisplatin progress to?
Acute tubular necrosis may progress to renal failure
What are side effects of Cisplatin?
•Ototoxicity, marked N&V, transient leukopenia and thrombocytopenia, peripheral sensory neuropathies can occur
What are life threatening side effects of Cisplatin?
Seizures, cardiac dysrhythmias
What are Antimetabolites?
Nucleic acid synthesis inhibitors (antimetabolites) include folate analogues, pyrimidine analogues, and purine analogues
What are Antimetabolites effect in destroying?
Effective in destroying cells during the S phase of the cell cycle, which is when DNA is synthesized
What is an example of Antimetabolites: Folate Analogue?
Methotrexate
What are Methotrexate effective in treating?
Effective in the treatment of acute lymphocytic leukemia in children and choriocarcinoma; used in the treatment of rheumatoid arthritis and psoriasis (c-spine concerns with rheumatoid arthritis)
What is the most important side effevt occur witth Methotrexate?
Most important side effects occur in the GI tract and bone marrow
What are other side effects of Methotrexate?
- leukopenia and thrombocytopenia reflect bone marrow suppression
- ulcerative stomatitis and diarrhea are common
What can cause death from Methotrexate?
hemorrhagic enteritis and death from intestinal perforation can occur
What are the respiratory effects of Methotrexate?
Pulmonary toxicity occurs in approximately 8% of patients (higher with repeated use)
What are the kidney effects of Methotrexate?
Associated with renal toxicity and renal insufficiency & fulminate noncardiogenic pulmonary edema
What are the liver effects of Methotrexate?
Measure LFTs preop in these patients-hepatic dysfunction is usually reversible but can lead to cirrhosis
What can be used to protect normal cells when Methotrexate is used?
Normal cells can be protected from folate antagonists with administration of folic acid, thymidine, or both
What do Antimetabolites: Pyrimidine Analogues prevent?
Prevent the biosynthesis of pyrimidine nucleotides or to mimic these natural metabolites to such an extent that they interfere with vital cellular activities such as the synthesis and functioning of nucleic acids
What is an example of Antimetabolites: Pyrimidine Analogues?
- Fluorouracil
- Cytarabine
- Gemcitabine
What are the clinical uses of Fluorouracil?
palliative value in breast and GI carcinomas and topical treatment for premalignant keratoses and superficial basal cell carcinomas
What are the side effects of Fluorouracil?
drug induced myocardial ischemia (rare), stomatitis, myelosuppression (leukopenia)
When dose myelosuppression from Fluorouracil manifest?
9-14 days of therapy
What are side effects of Fluorouracil?
Alopecia, nail changes, dermatitis, increased skin pigmentation and skin atrophy can occur
What are the neurological manifestations of Fluorouracil?
Neurological manifestations include acute cerebellar syndrome (ataxia)
What is the clinical use of Cytarabine (cytosine arabinoside)?
used in the treatment of acute leukemia in children and adults and exhibits potent immunosuppressive properties
What are the side effects of Cytarabine (cytosine arabinoside)?
Produces severe leukopenia, thrombocytopenia, and anemia
What are neurological effects of Cytarabine (cytosine arabinoside)?
Cerebellar toxicity and ataxia may occur
What are the uses of Gemcitabine?
used to treat several nonhematologic cancers, and solid organ cancers in the pancreas, breast, and lung
What are common side effects of Gemcitabine?
Common side effects include bone marrow suppression, flulike symptoms, fever, fatigue, and mild GI symptoms
What are examples of Antimetabolites: Purine Analogues?
- Mercaptopurine
- Thioguanine
- Pentostatin
- cladribine
- Hydroxyurea
What is the use of Mercaptopurine?
useful in the treatment of acute leukemia in children
What are principle side effects of Mercaptopurine?
Principle side effect is a gradual development of bone marrow suppression (thrombocytopenia, granulocytopenia, anemia) after several weeks of therapy
What are other side effects of Mercaptopurine?
Other side effects include anorexia, nausea and vomiting, jaundice
What is the use of Thioguanine?
Treatment of acute myelogenous leukemia, especially if given with cytarabine
What are toxic manifestations of Thioguanine?
Toxic manifestations include bone marrow depression and GI effects
What is the use of Hydroxyurea?
Used in the treatment of chronic myelogenous leukemia, and temporary remission in patients with metastatic malignant melanoma have been reported
What are the indications of Pentostatin and cladribine?
effective in the treatment of indolent lymphoid tumors (hairy cell leukemia
What can Pentostatin and cladribine produce?
Both drugs can produce immunosuppression
What are major side effects of Hydroxyurea?
Myelosuppression (leukopenia, megaloblastic anemia, thrombocytopenia) is the major side effect
What are other effect of Hydroxyurea?
N&V
