Pharmacotherapy of Neoplastic Disorders

Question 1

Antineoplastic Drugs: Chemotherapy

Answer 1

Adjuvant
* Administration of antineoplastic drugs after surgery or radiation
* Purpose: Rid the body of cancerous cells not
removed, or treat micro metastases that may be developing
Neoadjuvant
* Administration of antineoplastic drugs before surgery or radiation
* Purpose: Shrink a large tumor to a more manageable size. Results in less surgical invasion during removal of tumor.

Question 2

Immunomodulators: Interferons and interleukins

Answer 2

Agents that stimulate body’s immune system to kill tumour cells
Interferons
* Suppress cell division in certain cancers
* Activate macrophages and T cytotoxic cells
Interleukins
* IL-2 activates T cytotoxic cells
* Promotes other actions of the immune response
* Indicated for metastatic renal cell carcinoma

Question 3

Hormone antagonists / Antiestrogen: Tamoxifen

Answer 3

Indication
*Prophylaxis of breast cancer for high-risk clients
*Treat metastatic breast cancer
*Adjunctive therapy following a mastectomy to decrease potential for cancer in contralateral breast
Mechanism of action
*Antagonizes estrogen receptors in breast
*Effective against breast tumours requiring estrogen for their growth
*Blocks estrogen receptors in breast thus reduces tumour growth
Adverse effects
*Nausea, vomiting
*Hot flashes, rash, fluid retention
*Vaginal discharge, irregular menses
*Headaches, light-headedness
Serious adverse effects
*Increased risk of endometrial cancer
*Small increased risk of thromboembolic disease (CVA, DVT, PE)

Question 4

Monoclonal antibody: Bevacizumab

Answer 4

Indications
* Metastatic colorectal cancer, renal cell carcinoma, glioblastoma, non–small cell lung cancer
Mechanisms of action
* Binds to and inhibits activity of human vascular endothelial growth factor (VEGF) to reduce microvascular
growth and inhibit metastatic disease progression
Desired effects
* Selectively targets cancer cells while leaving normal cells unharmed
* Decreased tumour size and growth
Adverse effects
* Asthenia, dizziness, impaired wound healing

Question 5

Antiemetic / Glucocorticoids: Dexamethasone

Answer 5

Classification
* Synthetic glucocorticoid
Indications
* Management of nausea and vomiting associated with emetogenic chemotherapy
Mechanisms of action
* Antagonizes serotonin receptors
Desired effects
* Reduces nausea and vomiting related to cancer treatment
* Reduces weight loss (stimulates appetite)
* Reduces tissue inflammation
Adverse effects
* Fluid retention, poor wound healing, thrombocytopenia, infections

Question 6

Antiemetic / Serotonin 5-HT3 receptor antagonist: Ondansetron

Answer 6

Indications
- Prevention of nausea, vomiting associated with chemotherapy, radiotherapy
- Prevention of postoperative nausea, vomiting
Mechanisms of action
- Antagonizes serotonin receptors peripherally, centrally, and in small intestine
Desired effects
- Prevent nausea and vomiting
Adverse effects
- headache, diarrhea, constipation, abdominal pain,
fever, urinary retention

Question 7

Biologic response modifiers (BRMs)/
Granulocyte colony-stimulating factor
(GCSF): Filgrastim

Answer 7

Indication
* Neutropenia
Mechanisms of action
* Increases neutrophil (most common
type of granulocyte – GCSF))
production in bone marrow
* Enhances phagocytic and cytotoxic
functions of existing neutrophils
Desired effects
* Shorten length of neutropenia in
clients with cancer whose bone
marrow has been suppressed by
antineoplastic agents
Adverse effects
* Bone pain
* Allergic reaction