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Antineoplastics and Antianemics

Antineoplastics and Antianemics. Pharmacology NURS 1950. Objective 1: Describe the general factors utilized to select the therapy used to treat cancer Surgery Radiation Chemotherapy Most effective against rapidly growing cells.

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Antineoplastics and Antianemics

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  1. Antineoplastics and Antianemics Pharmacology NURS 1950

  2. Objective 1: Describe the general factors utilized to select the therapy used to treat cancer • Surgery • Radiation • Chemotherapy • Most effective against rapidly growing cells

  3. Objective 2: Describe the general uses of chemotherapy in the treatment of cancer • Through blood • Into body cavities • As adjuvant therapy

  4. Therapy terms • Cure: • Palliation • prophylaxis

  5. Objective 3: Identify the basic types of antineoplastic drugs

  6. Cell cycle • G0 Phase: resting stage • G1 Phase: synthesizes material needed to duplicate DNA • S Phase: duplicates DNA • G2 Phase: premitotic phase • M Phase: mitosis occurs • Cell returns to G0 phase

  7. Alkylating agents • Antimetabolites • Natural products • Antineoplastic antibiotics • Hormones • Biologic response modifiers & Misc.

  8. Alkylating Agents • Bond with DNA so it can’t separate = no replication • Cell-cycle nonspecific • Resistance can be a problem • Creates cross resistance with other alkylating agents

  9. Alkylating agents: non cell cycle specific drugs • Activity occurs when the cell tries to replicate and the DNA can not separate • Blood cells are very sensitive/responsive to this activity

  10. Drugs included • Busulfan (Myleran) • Carboplatin (Paraplatin) • Carmustine (BCNU) • Chloramubil (Leukeran) • Cisplatin (Platinol) • Cyclophosphamide (Cytoxan) • prototype

  11. Fudarabine (Fludara) • Lomustine (CCNU, CeeNU) • Mechlorethamine (Nitrogen mustard, Mustargen) • Melphalan (Alkeran) • Streptozocin (Zanosar) • Thiotepa

  12. In general, toxicities include • N/V, anorexia • Bone marrow depression • Anemia • Nephrotoxicity • Hepatic and renal toxicity • Alopecia • Cystitis • infertility

  13. Nursing Interventions • Discontinue if RBC, WBC and platelet counts fall • Caution use: hepatic or renal impairment • Hydrate before chemo—IV or oral • Advise to avoid crowds • Monitor nutritional intake • Assess for N/V—admin meds as needed • Offer non meds to relieve mouth pain

  14. Interventions con’t • Assess skin integrity • Monitor for hearing loss • Inform regarding impact of infertility • Maintain strict medical asepsis

  15. Each drug may have specific toxicities • Example: Zanosar causes hypoglycemia

  16. Antimetabolites • Drugs included • Capecitabine (Xeloda) • Cytarabine hydrochloride (Cytosar) • Fludarabine (Fludara) • Flurouracil (5-FU, FU) • Gemcitabine (Gemzar)

  17. Mercaptopurine (6-MP, Purinethol) • Methotrexate (MTX) prototype • Overdosed: Leucovorin as rescue drug • Thioguanine (Lanvis)

  18. Antimetabolites are subclassed as folic acid, purine, and pyrimidine antagonists • Inhibit key enzymes in biosynthetic pathways of DNA and RNA synthesis • Many are cell-cycle specific (S phase) • Uses: choriocarcinoma, breast, head and neck and lung ca, leukemia

  19. In general, toxicities include • N/V, diarrhea, constipation, fatigue • Bone marrow depression, dermatitis • Oral and GI ulceration

  20. Nursing interventions • Contraindicated in pregnancy, hepatic and renal insufficiency, cardiac conditions • Avoid pregnancy for 6 months with category X drug • Monitor for photosensitivity and idiosyncratic pneumonitis • Teach good oral hygiene, mouth rinses • Monitor IV site for extravasation

  21. Natural Products/mitotic inhibitors • Come from periwinkle plant, specific yews • Cell-cycle specific: block mitotic spindle during mitosis • Use: Hodgkins, non hodgkins, Karposi, Wilm’s tumor, bladder and breast CA

  22. Drugs include • Etoposide (VePesid) • Docetaxel (Taxotere) • Paclitaxel • Vinblastine sulfate (Velban, Velbe) • Vincristine sulfate (Oncovin) Prototype • Vinorelbine (Navelbine)

  23. Nursing interventions • Assess for allergies to plants, foods • Vincristine may produce acute broncho spasm and rash • Ask about pregnancy/breast feeding • Emphasize nutritional plan to combat constipation • Monitor BP; watch for syncope, HA, dizziness • May produce mental depression; assess for suicidal ideation

  24. General toxicities • N/V, stomatitis • Leukopenia with VePesid: nadir in 10-14 days, recovery 3 weeks • Bone marrow suppression, alopecia, peripheral neuritis, hepatotoxicity, bronchospasm

  25. Antineoplastic Antibiotics • Bind to DNA, inhibit DNA, RNA synthesis • Cell-cycle nonspecific • Admin IV or via catheter to body cavity • Use: breast, bladder, lung, ovary

  26. Drugs include • Bleomycin (Blenoxane) • Dactinomycin (Actinomycin D, Cosmegen) • Daunorubicin (Cerubidine) • Doxorubicin (Adriamycin) • prototype • Epirubicin (Ellence)

  27. Idarubicin • Mitomycin C • Mitoxantrone • Plicamycin • Valrubicin • Bladder specific

  28. Generally, toxicities include • N/V, red tinged urine with some • Bone marrow depression • Cardiotoxicity • Pulmonary fibrosis (Bleomycin) • GI bleeding, CNS effects with some

  29. Nursing interventions • Assess cardiac status—EKG • Ask about pregnancy/lactation • Risk of hypersensitivity as in other antibx • No rectal suppositories or temp due to rectal mucosal changes • Wear protective clothing when preparing drug • Monitor IV site • Give drug thru large bore, quickly running IV

  30. Hormones • Corticosteroids: lymphoma and acute leukemia as suppress mitosis in lymphocytes • Help restore sense of well being, decrease edema with radiation, increase appetite and strength • Action: mostly unknown

  31. Estrogens and androgens: malignancies of sexual organs • Use estrogen for prostate cancer (suppress the amount of androgen available) • Use androgens for breast cancer (suppress the amount of estrogen available) • Normally given as palliation

  32. Drugs included • Anastrozole (Arimidex) • Diethylstilbestrol (DES) • Prednisone • Tamoxifen (Nolvadex) • prototype • Testolactone (Teslac) • Testosterone

  33. General toxicities • N/V, headache • Fluid retention, feminization or masculinization • Hot flashes • Some can cause thrombocytopenia, leukopenia, hypercalcemia, increased bone and tumor pain

  34. Nursing interventions • Assess for pregnancy/lactation • Tamoxifen is only ‘curative’ drug • Important that family knows and understands limitations of this category • Fertility affected

  35. Biologic response modifiers • Drugs included • Altretamine (Hexalen) • Dacarbazine (DTIC-dome) • Hydroxyurea (Hydrea) • Interferon alfa-2b (Intran) • prototype • Leuprolide acetate (Lupron) Action: stimulate immune system to fight tumor cell growth

  36. Toxicities in general • N/V, hot flashes, bone marrow depression, arrhythmias • Flulike syndrome • Anemia, leukopenia • Less toxic than other CA drugs

  37. Immunomodulators • Drugs used as adjunct therapy • Epoetin alfa (Procrit) stimulates production of red blood cells • Used to treat anemia induced by chemotherapy • Increased risk of thrombus formation

  38. Colony Stimulating Factors • Filgastim (Neupogen) stimulates the production of neutrophils (WBC)

  39. Monoclonal antibodies • Rituximab (Rituxan) binds to the surface of B lymphocytes • Used to treat relapsed B-cell non-Hodgkin’s lymphoma

  40. Colony stimulating factor • Sargramostim (Leukine) stimulates the production of granulocytes and macrophages • Also helpful in aplastic anemia • Side effects: • Resp distress with initial dosing • Follow protocol • Use: AML, bone marrow transplant

  41. Platelet enhancer • Oprelvekin (Neumega) stimulates platelet production at stem cell level

  42. Monoclonal antibody • Trastuzumab (Herceptin) inhibits growth of tumor cells (especially useful in metastatic breast cancer) • Binds to specific protein in breast ca cells that leads to death of cell.

  43. New class: antiangiogenesis • Prevent new blood vessels

  44. Multiple Drug Strategy • Multiple drugs from different classes • Affect different stages in cell cycle • Use different mechanisms of action to increase cell kill • Combinations allow for lower doses • Reduce toxicity • Slow development of resistance

  45. Dosing schedules • Specific dosing protocols • Depend on the type of tumor, stage of disease, overall condition of the client • Given as single dose or several • Over days or weeks • Allows normal cells to recover • Sometimes doses needs to be delayed • Allow client to recover • ie bone marrow depression

  46. Objective 4: identify the 2 factors that play a major role in the response of the cancer cell to the antineoplastic drug • Tumor size • Rate of cell replication

  47. Objective 5: describe what “tumor resistance” means • Tumor cells are not as susceptible to antineoplastic agents as they should be • Cells escape damage from the drugs

  48. Objective 6: specify which normal cells are frequently affected by antineoplastic therapy; and signs and symptoms that result most frequently

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