Oncological and Hematological Medications

Question 1

Antineoplastic Medications

Answer 1

• kill or inhibit the reproduction of neoplastic cells and are used to cure, increase survival time, and decrease life-threatening complications.
• effect may not be limited to neoplastic cells and normal cells also are affected.
• can be phase-specific or non-specific, usually used in combination to increase response.
• IV, oral, intra-arterial, isolated limb perfusion, or intracavity route with dose usually based on BSA and type of cancer.
• side and adverse effects: mucositis, alopecia, anorexia, nausea, vomiting, diarrhea, anemia, low WBC count (neutropenia), thrombocytopenia, infertility, sexual alterations, neuropathy.
  Important:
• withhold med and initiate neutropenic precautions if the segmented neutrophil count decreases below 18%
• fluid intake of at least 2L/day to maintain adequate renal function.
• chemo should be prepared in a air-vented space (pregnant nurses should avoid preparation and adm).
• reduce IV site pain by altering IV rates or warming the injection site to distend the vein.
• in case of extravasation, heat or ice is applied depending on the med and an antidote may be injected into the site.
• new hair growth will occur several months after the final treatment.
• need for contraception because of teratogenic effects

Question 2

Alkylating Medications

• Nitrogen mustards: Bendamustine, Chlorambucil, Cyclophosphamide, Ifosfamide, Estramustine, Mechlorethamine, Melphalan.
• Nitrosoureas: Carmustine, Lomustine, Streptozocin.
• Alkylating-Like Meds: Altretamine, Busulfan, Carboplatin, Cisplatin, Dacarbazine, Oxaliplatin, Temozolomide, Thiotepa.

Answer 2

• break the DNA helix, thereby interfering with DNA replication; cell cycle phase nonspecific med.
  Side and adverse effects:
• anorexia, nausea, vomiting, stomatitis, rash, IV site pain.
• Busulfan may cause hyperuricemia;
• Chlorambucil and mechlorethamine may cause gonadal suppression and hyperuricemia.
• Cisplatin, a platinum compound, may cause ototoxicity, tinnitus, hypokalemia, hypocalcemia, hypomagnesemia, and nephrotoxicity.
• Cyclophosphamide may cause alopecia, gonadal suppression, hemorrhagic cystitis, and hematuria.
• Ifosfamide may cause hemorrhagic cystitis and neurotoxicity.

Question 3

Alkylating Medications: important interventions

Answer 3

• when adm cisplatin, assess client for dizziness, tinnitus, hearing loss, incoordination, and numbness or tingling of extremities.
• Mesna may be adm with ifosfamide to reduce the potencial for ifosfamide-induced cystitis.
• instruct client that oral cyclophosphamide is adm without food.
• instruct client to follow a diet low in purines to alkalinize the urine and lower uric acid blood levels.
• encourage increase in fluid intake (2-3L/day) when taking cyclophosphamide and ifosfamide because can cause hemorrhagic cystitis.

Question 4

Antitumor Antibiotic Medications

Answer 4

• interfere with DNA and RNA synthesis; cell cycle phase-nonspecific med.
  Side and adverse effects:
• nausea, vomiting, fever, bone marrow depression, rash, alopecia, stomatitis, gonadal suppression, hyperuricemia, vesication (at IV site).
• Daunorubicin may cause heart failure and dysrhythmias.
• Doxorubicin and Idarubicin may cause cardiotoxicity, cardiomyopathy, and ECG changes (dexrazoxane may be used in combination to reduce cardiomyopathy).
• pulmonary toxicity can occur with Bleomycin.
  Med names:
• Bleomycin sulfate; Dactinomycin; Daunorubicin; Doxorubicin; Epirubicin; Idarubicin; Mitomycin; Mitoxantrone; Valrubicin.

Question 5

Antimetabolite Medications

• Azacitidine, Capecitabine, Cladribine, Clofarabine, Cytarabine, Decitabine, Floxuridine, Fludarabine, Fluorouracil, Gemcitabine, Hydroxyurea, Mercaptopurine, Methotrexate, Nelarabine, Pemetrexed, Pentostatin, Pralatrexate, Thioguanine, Uracil.

Answer 5

• halt the synthesis of cell protein and impairs cell division; cell cycle phase-specific (S phase).
  Side and adverse effects:
• anorexia, nausea, vomiting, diarrhea, alopecia, stomatitis, depression of bone marrow.
• Cytarabine and Mercaptopurine may cause hyperuricemia and hepatotoxicity.
• Fluorouracil may cause phototoxicity reactions and cerebellar dysfunction.
• Methotrexate may cause hyperuricemia, photosensitivity, hepatotoxicity; hematological, GI, and skin toxicity.
  Important:
• when adm fluorouracil or methotrexate, instruct the client to use sunscreen and protective clothing.
• when adm fluorouracil assess for signs of cerebellar dysfunction, stomatitis and diarrhea, which may necessitate med discontinuation.
• when adm large doses of methotrexate, prepare to adm leucovorin to prevent toxicity (known as leucovorin rescue).

Question 6

Miotic Inhibitor Medications (Vinca Alkaloids)

Answer 6

• prevent mitosis, causing cell death; cell cycle phase-specific (act on M phase).
  Side and adverse effects:
• leukopenia, ptosis, hoarseness, motor instability, anorexia, nausea, vomiting, peripheral neuropathy, alopecia, stomatitis, hyperuricemia, phlebitis (IV site).
• neurotoxicity with vincristine, manifested as numbness and tingling in the fingers and toes; constipation and paralytic ileus can also occur.
  Med names:
• Vinblastine sulfate; Vincristine sulfate; Vinorelbine.
• Docetaxel; Paclitaxel (Taxanes)

Question 7

Topoisomerase Inhibitors

Answer 7

• block an enzyme needed for DNA synthesis and cell division; cell cycle phase-specific (G2 and S phases).
  Side and adverse effects:
• leukopenia, thrombocytopenia, anemia, anorexia, nausea, vomiting, diarrhea, alopecia, orthostatic hypotension, hypersensitivity reaction.
  Med names:
• Etoposide; Irinotecan; Teniposide; Topotecan.

Question 8

Hormonal Medications and Enzymes

• Estrogens: Estramustine, Ethinyl estradiol.
• Antiestrogens: Anastrozole, Exemestane, Fulvestrant, Letrozole, Raloxifene, Tamoxinfen citrate, Toremifene.
• Antiandrogens: Bicalutamide, Enzalutamide, Flutamide, Goserelin acetate, Histrelin, Nilutamide, Triptorelin.
• Progestins: Medroxyprogesterone, Megestrol acetate.
• Other hormonal antagonists and enzymes: Asperaginase, Leuprolide acetate, Mitotane.

Answer 8

• suppress the immune system and block normal hormones in hormone-sensitive tumors; change the hormonal balance and slow the growth rates of certain tumors.
  Side and adverse effects:
• anorexia, nausea, vomiting, leukopenia, impaired pancreatic function with asparaginase, breast swelling, hot flashes, weight gain, hypertension, thromboembolic disorders, edema, electrolyte imbalances.
• sex alterations: masculinizing effect in women (chest and facial hair, menses stops); feminine manifestations in men (gynecomastia).
• hemorrhagic cystitis, hypouricemia, and hypercholesterolemia with mitotane.
• tamoxifen citrate decreases the effects of estrogen.

Question 9

Immunomodulator (immunotherapy) agents: biological response modifiers

Answer 9

• stimulate the immune system to recognize cancer cells and take action to eliminate or destroy them.
• interleukins help various immune system cells to recognize and destroy abnormal body cells.
• interferons slow tumor cell division, stimulate proliferation, and cause cancer cells to differentiate into nonproliferative forms.
• colony-stimulating factors induce more rapid bone marrow recovery after suppression by chemotherapy (Sangramostim, Filgrastim, Pegfilgrastin, Epoetin a, Darbepoetin a, Oprelvekin).
• interleukins and interferons meds: Aldesleukin, Interferon a-2a, Interferon a-2b, Interferon a-n3, Recombinant Interferon a-2a, Recombinant Interferon a-2b.

Question 10

Target Therapy

Answer 10

• medications used as targeted therapies are monoclonal antibodies and small molecule inhibitors that target a cellular element of the cancer cell or antisense medications that work at the gene level.
• adverse effects: allergic reactions.
• common monoclonal antibodies med: Bevacizumab, Cetuximab, Ibritumomab, Infliximab, Panitumumab, Pembrolizumab, Rituximab, Trastuzumab.
• small molecule inhibitors: Bortezomib, Desatinib, Erlotinib, Gefitinib, Imatinib, Lapatinib, Nilotinib, Sorafenib, Sunitinib, Temsirolimus.

Question 11

Other Antineoplastic Medications

Answer 11

• Altretamine: cytotoxic agent used to treat ovarian canver.
• Denileukin Diftitox: recombinant DNA-derived med used to treat cutaneous T-cell Lymphoma.
• Pegaspargase: used in combination chemotherapies for acute lymphoblastic leukemia in clients unable to take asparaginase.
• Bexarotene: used to treat advanced-stage cutaneous T-cell lymphoma.

Question 12

Medications to Treat Anemia

Answer 12

• iron-deficiency anemia: iron, oral or IV.
• vit B12-deficiency anemia: vit B12, oral or IM.
• folate-deficiency anemia: folate, oral.
• acute blood loss anemia: blood transfusion, packed red blood cells, platelets, or frozen plasma depending on cause.
• anmeia of chronic disease: iron (oral or IV), erythropoietic growth factors, leukopoietic growth factors, and thrombopoietic growth factors.