Chemotherapy Drugs And Cancer Adaptation Flashcards
What are the major toxicities with antineoplastic drugs/chemo drugs and why?
Theses drugs kill fast growing (rapidly dividing) cells, including cancer cells and healthy human cells.
Types of fast growing cells: hair follicles, GI tract cells and bone marrow cells
So major toxicities:
- alopecia (hair loss)
- nausea and vomiting (GI tract)
- bone marrow suppression (risk of infection) (myelosuppression)
What does myelosuppression cause?
- low WBCs (leukopenia)
- low RBCs (anemia)
- low platelets (thrombocytopenia)
Pt referred to as neutropenic (often on antibiotics IV to treat or prevent bacterial infections)
= increased risk of infection due to leukopenia and increased risk of bleed due to thrombocytopenia
Risk of fatigue and hypoxia (anemia)
What are some contraindications for cancer drugs?
- weakened status of pt (extremely low WBC)
- ongoing infectious process
- severe compromise in nutritional status or hydration status
- reduced kidney/ liver function
- severe neutropenia
- not recommended in pregnancy (especially in first trimester)
What are some AE of methotrexate?
Forms available?
- methotrexate fog
- bone marrow suppression (risk of infection and bleeding)
- mucositis
- fever
- malaise
- alopecia
- n/v/d
- metabolic toxicity
- AKI
- nephrotoxicity
- anorexia
High emetic potential
Available PO and IV
What is often taken with methotrexate to prevent an AE?
For methotrexate Iv: Often given leucovorin (active form of folic acid) to prevent death of normal cell due to lack of folic acid 24hrs post methotrexate infusion to help eliminate medication and reduce IV
with methotrexate PO: folate supplements or diet with foods high in folic acid (beans, nuts, fresh fruits, asparagus), to decrease AE of mucositis with PO methotrexate
Drug drug interactions with methotrexate?
GI and hematotoxicity with :
- NSAIDs
- Penicillins
Increase methotrexate toxicity:
- salicylates
- sulfonyureas
- phenytoin
Increases hepatotoxicity
- with meds causing hepatotoxicity
What are some nursing assessments needed to be done prior to administering antineoplastic drugs? (Methotrexate, paclitaxel, vincristine)
Through physical assessment:
- present and past medical history
- list of all medications
- any allergies
- baseline VS, weight, height
- hearing and vision testing
- skin and mucosa (turgor, hydration, color, and temperature)
- signs of fear or anxiety (insomnia, irritability, shakiness, restlessness, palpitations)
- cultural, emotional, spiritual, sexual and financial assessment
- pts ability to do ADLs
- mobility status and gait
- cardio assessment (heart sounds, rhythm, etc)
- lungs assessment (breath sounds, lung function)
- full pain assessment
- any oral, pharyngeal, esophageal, abdominal pain or gastric pain
- aching in joints or lower extremities (numbness or tingling)
- levels of electrolytes , minerals
- kidney (BUN, GFR, creatinine) and liver function tests (AST, etc)
- CBC, bleeding time, hbg, hct, cardiac enzyme levels
- altered nutritional status and impaired mucosa (weight loss, abnormal BUN and serum protein albumin, weakness, fatigue, lethargy, poor skin turgor, pale conjunctiva.
- assess oral mucosa for signs of stomatitis (pain, burning in mouth, difficultt swallowing, taste chabges, viscous salive, dryness, cracking and fissures)
- hydration status
- GI assessment (if any diarrhea, abdominal cramps, presence of blood, consistency, odor, color, and amount)
- assess for nausea and vomiting (amount, color, consistency, frequency, odor)
- for alopecia: view of pt on futur hair loss and plans
- for myelosuppression: signs of anemia or decrease RBCs, hgb levels, htc (pallir of skin, oral mucous membranes and conjuctiva, fatigue, loss of interest in activities, SOB, )
- signs of leukopenia
- neutropenia (fever, chills, tachycardia, abnormal breath sounds, productive cough, change in urine color, etc)
- signs of bleeding due to thrombocytopenia (bleeding gums, etc)
- possible sterility (damage to ovaries, etc)
-for vincristine: assess neurological function
- for paclitaxel: assess for neuropathies, and neutrophils count and allergies
- for methotrexate:
What are the normal ranges related to myelosuppression?
- RBC:
men: 4.5-6x 10ex12/L
Women: 4.2-5.4x10ex12/L - WBC:
- Absolute neutrophils count (ANC): below normal range of 1.5 x 10ex9/L
- Severe neutropenia: less than 0.05x 10ex9/L
- Platelets: less than 100 x 10 ex9 normal range: (150-400x10ex9/L)
- HCT:
Men: 0.4-0.5%
Women: 0.38-0.47% - hemoglobin (hgb):
Men: 135-180 g/L
Women: 120-160 g/L
What is methotrexate fog associated with tx with methotrexate (antimetabolite Antibes plastic drug)?
Pt explained it as a “blah” feeling
Feeling unwell, generally feeling like crap while on this medication
What are some nursing implications with methotrexate (antimetabolite antineoplastic drug)?
- need folate supplements to manage AE of methotrexate PO (mucositis, n&v) given at intervals
- leucovin : given 24hrs post methotrexate infusion to help eliminate methotrexate and decrease AE of medication
- take precautions in the sun
- not safe in pregnancy
- has interactions with caffeine, melatonin and echinacea
- increase intake of foods high in folic acid (dried beans, nuts, fruits, asparagus, fresh vegetables) to help prevent toxicity
- avoid alcohol
- avoid NSAIDs
What are the main toxicities associated with paclitaxel IV (mitotic inhibitors: taxanes)?
- risk of hypersensitivity (anaphylaxis) (dyspnea, hives, hypotension, angioedema, urticaria)
- neuropathy (tingling, numbness of extremities)
- severe neutropenia and thrombocytopenia
What are some nursing considerations with paclitaxel (only IV) ?
Mitotic inhibitors- taxanes (chemo drug)
- assess for hypersensitivity
- assess IV site often for signs of extravasation (q1hr)
- vesicant and irritant medication
- vs 15min prior infusion and q15min during infusion
- premeds may be needed (corticosteroids, h1 receptor blocker and h2 receptor blocker)
What is an irritant medication and what is a vesicant medication?
Irritant: irritates the Iv site and the vein
Vesicant: causes cell death with extravasation and may lead to necrosis with ulcerations
What are the main worries with vincristine?
Mitotic inhibitors : vinca alkaloids
- can cause severe neurotoxicity (confusion, sleep disorders, headaches, eye problems, balance problems, anxiety, muscle weakness)
- high risk of extravasation (vesicant medication requires antidote)
- myelosuppression
What are some assessments/ considerations with vincristine?
Mitotic inhibitors : vinca alkaloids
- monitor closely for signs of extravasation (redness, swelling, pain, tenderness around site, IV not working, cool skin, discomfort)
- monitor liver and kidney functions
- assess IV site q1hr
- high risk for infection and bleeding
