Unit 7 Pt 1 - Chemotherapies/Antirheumatics Flashcards
What nursing considerations/implementations would you make for general chemotherapies?
- They are all PINCH drugs, so the administration must be followed very carefully. Usually you have to be a licensed chemo nurse to do these.
- Assess and monitor all basic blood counts due to risk of bone marrow suppression (mainly CBCs)
- Monitor for anaphylaxis (keep epinephrine and antihistamines on hand!)
- Monitor for IV extravasation
- Monitor for drug toxicity because they have a narrow therapeutic range
- Cautious or no use in pregnancy
- Provide intense emotional support for patients on these. Chemo is tough
- Monitor for oncologic emergencies: bone marrow suppression - infections, bleeding/anemia; allergic reactions (anaphylaxis); stomatitis with severe ulceration; metabolic changes (weight loss or gain); bowel irritability with severe diarrhea; renal/liver/cardiac/lung toxicity.
Extravasation Rules:
if IV extravasation is suspected, STOP the infusion but leave the IV tube in place, contact HCP, and then follow facility guidelines for antidotes like hot/cold packs or other medications.
What instructions would you give a patient who is experiencing a lot of GI upset from her chemotherapy meds?
Emphasize the importance of maintaining proper hydration and nutrition during treatment. To help with this we may use: antiemetics (Zofran), small meals, maintaining good oral hygiene.
A 40-year old woman has just been diagnosed with RA. What medication would the nurse expect to be prescribed first?
Generally, NSAIDs like ibuprofen. Once the pain progresses, we will give a non-biologic medication like methotrexate. After that quits working, we will move to a biologic medication like Humira (monoclonal antibody)
What should the nurse check prior to administering methotrexate?
Check for latent infections like tuberculosis (TB) or hepatitis.
Reasoning: If we give a cell-modifying medication like methotrexate, it could modify the TB cells and reactivate the infection.
A patient with RA is scheduled for discharge. What information does the nurse include about methotrexate therapy?
Administer this injection subcutaneously into the thigh, abdomen, or upper arm, rotating the sites - aka, this is a subcutaneous injection.
T/F: mouth sores is an expected effect of methotrexate
False. No adverse effect should be “expected.”
Biologic vs Non-biologic medications (DMARDs)
Biologics are derived from living organisms (like E.coli or molds), and can be harder for the body to break down, causing more serious side effects
Examples: monoclonal antibodies (Humira), Etanercept
Non-biologics are chemical compounds made in a lab that are generally safer and easier on the body than biologics, which is why these are preferred
Examples: Methotrexate, hydroxychloroquine
T/F: Hydroxychloroquine is only used for malaria.
False! It’s a non-biologic DMARD and it can be used for RA and lupus.
Cell-cycle Specific Chemotherapies (CCSC) vs Non-cell cycle Specific Chemotherapies (NCCSC)
CCSC - cytotoxic to specific portions of the cell cycle; usually the S phase where DNA is most active. These include: Antimetabolites, mitotic inhibitors
NCCSC - generally cytotoxic - not correlated with a specific phase of the cell cycle. These include: Alkylating drugs and cytotoxic antibiotics
Miscellaneous Chemotherapies:
Bevacizumab (Avastin), Hydroxyurea, and Octreotide
Antimetabolites (methotrexate)
MOA: folic acid antagonist.
Uses: low-dose forms for maintenance or palliative therapy in cancer / severe cases of psoriasis and RA
Considerations: Monitor liver function and also folic acid levels - you don’t want to deplete all your folic acid! Not too concerned with kidney and lungs for this one, mainly liver.
Special side effects: megaloblastic anemia in specific, hand-foot syndrome (redness, swelling, pain on hands/feet), Steven Johnson syndrome/toxic epidermal necrolysis; only hepatotoxicty but not the other toxicities
Mitotic inhibitors (vincristine)
MOA: destroys ability for cells to perform mitosis.
Considerations: known for IV extravasation. Monitor liver, kidney, and lungs for toxicities (just like any chemotherapy).
Special side effects: convulsions.
Alkylating drugs (Cisplatin/Cyclophosphamide)
MOA: prevents cancer cells from reproducing by directly attacking the DNA.
Considerations: Watch for IV extravasation in Cisplatin / Cyclophosphamide can only be given orally. Watch kidney function and baseline hearing ability/loss (document beforehand) for Cisplatin.
Cisplatin’s special effects: ototoxicity (very prevalent), nephrotoxicity, peripheral neuropathy.
Cyclophosphamide specific effects: cardiac toxicity.
Side/Adverse Effects to Watch for or expect in all chemotherapies:
- Bone marrow suppression (anemia, bleeding, neutropenia, thrombocytopenia, and infections).
- Alopecia.
- GI upset
- Metabolic fluctuations - Anorexia.
- Liver/kidney/lung/and cardiac toxicities.
Cytotoxic antibiotics (daunorubicin, doxorubicin, bleomycin):
MOA: Blocks DNA synthesis in all phases of the cell cycle.
Considerations: Monitor the same parameters as other chemotherapies (liver/lung/heart/kidney). Monitor for the special side effects & what assessments would need to be performed.
Special side effects: specific to each drug
Daunorubicin - heart failure
Doxorubicin - acute left ventricular failure
Bleomycin - pulmonary fibrosis; pneumonitis.
Bevacizumab (Avastin)
MOA: angiogenesis inhibitor - blocking the cancer cells from making their own blood supply.
Special notes/considerations/side effects: very nephrotoxic - moreso than the others lol.
Hydroxyurea
MOA: stops DNA replication in the cancer cell.
Special considerations/side effects: edema, dysurea, pulmonary fibrosis (moreso than the others, like bleomycin).
Octreotide
MOA: blocking growth hormones.
Uses: Carcinoid crisis
Special considerations/side effects: monitoring weight & growth in children since it’s an antigrowth hormone; I’s and o’s and bowel movements also.
Hormonal Chemotherapies
MOA: Oppose effects of hormones / block body’s sex hormone receptors.
Uses: Certain neoplasms (tumors) in men and women.
Specific considerations and effects vary on the type…
Hormonal drugs for female-specific neoplasms:
**Give me the name of each class & I’ll tell you the considerations and side effects!
Aromatase inhibitors (aminoglutethimide) - it’s a steroid so watch all the steroid parameters, especially in periods of stress.
SERMS/estrogen receptor modulators (Tamoxifen) - causes uterine receptors to downgrade; used Specifically for things like breast cancer. The con is that it does unfortunately actually increase uterine cancer risk, pulmonary embolisms and DVTs.
Progestins (medroxyprogesterone aka Depo-provera) - not just used as birth control! Watch for edema, weight change, fatigue, depression - the usual BC side effects.
Androgens (fluoxymesterone) - May see secondary sex characteristics develop like hair growth and deepening of a voice, since you’re giving a female an androgen.
Estrogen receptor antagonists/blockers (Fulvestrant) - injection site reactions; may not want to use in breast-feeding.
Hormonal drugs for male-specific neoplasms:
**Give me the name of each class & I’ll tell you the considerations and side effects!
Anti-androgens (bicalutamide, flutamide, nilutamide… -ide endings) - block androgens (testosterone). May cause voice changes, breast development, emotional changes because of the lowering of testosterone.
Antineoplastic hormone (estramustine) - monitor for allergic reactions, pulmonary symptoms, and angioedema
Biologic Response-Modifying Drugs (BRMs) aka Antirheumatic Drugs
MOA:
1. alter the body’s response to diseases such as cancer and autoimmune conditions by enhancing/restoring the host’s immune system
2. adversely modify tumor biologies
3. cytotoxic to cancer cells.
Uses: autoimmune disorders, cancers, and viral infections
Special considerations for all BRMs: 1. Cross-check for egg, IgG, and neomycin allergies.
2. Some conditions like hepatitis and cardiac issues would be contraindicated.
3. Teach patients to report signs of infection immediately (vomiting, high fever, etc).
What classes are included as BRMs?
Hematopoietics, immunomodulators, monoclonal antibodies, interleukin receptor agonists, and DMARDs
