Med-Surg: Chemotherapy Agents Flashcards
Cytotoxic Chemotherapy Agents
toxic to cancer cells
- kill fast-growing cancer cells as well a healthy cells, including skin, hair, intestinal mucosa, and hematopoietic cells
- many adverse effects are r/t the unintentional harm done to rapidly proliferating cells (those found in the GI tract, hair follicles, and bone marrow)
> Adverse Effects:
- nausea, vomiting, myelosuppression, and alopecia
- vesicants: cause severe damage if there is leakage into tissue
Antimetabolite (Methotrexate)
kill cancer cells by interrupting a specific phase of cell reproduction
- Folic acid analog
- stops cell reproduction needed for the synthesis of DNA by inhibiting folic acid conversion
- can be used for rheumatoid arthritis
> Complications:
- Mucositis (GI tract), gastric ulcers, perforation
- Reproductive toxicities
- Renal Damage due to hyperuricemia or elevated levels of uric acid
> Nursing:
- monitor for GI bleed (coffee ground emesis or tarry black stools)
- assess mouth for sores
- provide frequent oral hygiene using soft tooth brush and avoid alcohol mouthwashes
- monitor kidney function, BUN, Creatinine, and I’s and O’s
- fluid intake of 2/3 L per day
- administer Allopurinol if uric acid level elevated
- administer with leucovorin rescue to reduce toxicity to healthy cells
> Education:
-avoid becoming pregnant while on this medication and for 6 months after
Antitumor (cytotoxic) Antibiotics: Doxorubicin (IV)
kills cancer cells by stopping the synthesis of RNA, DNA, or proteins
-binds to DNA, altering its structure; therefore inhibits synthesis of DNA and RNA
> Complications:
- Cardiac changes: acute toxicity can cause dysrhythmias and ECG changes; HF secondary to cardiomyopathy can occur months to years after treatment
- Red coloration to urine and sweat; not harmful
> Nursing Actions:
- monitor ECH and echocardiogram
- for acute changes the client can be treated with dexrazoxane, but this can increase myelosuppression
Alkylating Agents: Cyclophosphamide
kill fast-growing cancer cells by altering DNA structure and preventing cell reproduction
-crosses blood-brain barrier; useful against primary and metastatic tumors of brain
> Complications
- Acute hemorrhagic cystitis: increase fluids to 3 L/day; monitor for blood in urine, Mesna can be given if needed (a uroprotectant agent that detoxifies metabolites to reduce hematuria)
- can cause sterility or decreased immune response
- alopecia; can occur 7 to 10 days after beginning of treatment and will last 2 months after the last administration of chemotherapeutic agent; select hair piece before occurrence of hair loss
Alkylating Agents: Cisplatin
platinum compounds
-kills rapidly growing cells by interrupting DNA and RNA synthesis
> Complications:
- Highly emetogenic: nausea, vomiting begin within one hour after dosing and can persist for several days
- Renal toxicity: monitor kidney function; increase fluids; give diuretics if indicated
- Hearing loss: monitor for tinnitus and hearing loss
Complications for Alkylating Agents
(Cyclophosphamide, Cisplatin)
> 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 for bruising and bleeding gums
- avoid crowds and contact with infectious individuals
> GI discomfort (nausea and vomiting)
-administer an antiemetic (ondansetron in combination with dexamethasone, granisetron, or metoclopramide0 before chemotherapy
> Cyclophosphamide
- Acute hemorrhagic cystitis
- Sterility or decreased immune response
- Alopecia
> Cisplatin
- Highly emetogenic
- Renal toxicity
- Hearing Loss
Alkylating Agents: Nursing Administration
(Cyclophosphamide, Cisplatin)
- adequate fluid intake of 2-3 L/day
- monitor for blood in urine; Mesna may be indicated
- reduce dose for clients who have liver disease
- monitor for bleeding (bruising) or infection (fever, sore throat)
- monitor CBC, uric acid level, and liver enzymes
- give antiemetic for nausea and vomiting
- stop chemotherapeutic medications if extravasation occurs
- assess hearing prior to treatment with cisplatin
Alkylating Agents: Client Education
- good oral hygiene
- use birth control during treatment
Hormonal Agents: Leuprolide
gonadotropin-releasing hormone (GnRH) agonist
- for prostate cancer
- prevents the release of luteinizing and follicle-stimulating hormones to prevent testosterone production by the testicles
> Complications:
- hot flashes, decreased libido, erectile dysfunction, and gynecomastia
- decreased bone density: increase calcium and vitamin D intake, increase bone mass with weight-bearing exercises
- dysrhythmias, pulmonary edema
- disease flare
> Nursing:
-warn clients about adverse effects
-perform bone density testing
-monitor for dysrhythmias and assess breath sounds
-monitor PSA and testosterone levels, which both should decrease with treatment
-
Education:
-increase calcium and vitamin D intake
-minimize bone loss with weight-bearing exercises
-monitor for bone pain
-prostate manifestations can worsen at beginning of treatment (disease flare) and can be prevented by adding flutamide to treatment
Hormonal Agents: Tamoxifen (oral)
stops growth of breast cancer cells, which are estrogen-dependent cancers
-used to treat or prevent breast cancer
> Complications:
- Endometrial cancer: monitor for abnormal bleeding; yearly gynecological exam and Pap smear
- Hypercalcemia (bone pain): monitor calcium level
- Nausea and Vomiting: monitor fluid status, administer fluids and antiemetics
- Thromboembolic events (DVT, PE, stroke): assess breath sounds; report chest pain, edema of the leg or calf, SOB
- Hot flashes
- Vaginal Discharge or bleeding; monitor bleeding and discharge, have yearly gynecological exam and Pap smear
> Education:
-increase calcium and vitamin D intake
Monoclonal Antibody: Belimumab or Trastuzumab
targets breast cancer cells, prevents cell growth, and causes cell death
- only effective against tumors that are HER2-positive
- used to treat metastatic breast cancer
Biologic Response Modifiers: Interferon alfa-2b
increases immune response and decreases production of cancer cells
> complications:
- flu-like manifestations
- bone marrow suppression, alopecia, cardiotoxicity, thyroid dysfunction, and neurotoxicity with prolonged therapy
- depression, anxiety, insomnia, altered mental states
