1 / 38

Cancer Drugs: Antineoplastic Medications

Pharmacology in Nursing Antineoplastic Drugs Part 2: Cell Cycle – Nonspecific Drugs and Miscellaneous Drugs. Cancer Drugs: Antineoplastic Medications. Cell cycle – nonspecific (CCNS) drugs Alkylating drugs Cytotoxic antibiotics. Alkylating Drugs. Classic alkylators (nitrogen mustards)

lei
Download Presentation

Cancer Drugs: Antineoplastic Medications

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pharmacology in NursingAntineoplastic Drugs Part 2:Cell Cycle–Nonspecific Drugs and Miscellaneous Drugs

  2. Cancer Drugs:Antineoplastic Medications • Cell cycle–nonspecific (CCNS) drugs • Alkylating drugs • Cytotoxic antibiotics

  3. Alkylating Drugs • Classic alkylators (nitrogen mustards) • Nitrosoureas • Probable alkylators

  4. Alkylating Drugs (cont’d) • CCNS antineoplastics • Effective at any stage in the growth cycle of cancer cells • Prevent cancer cells from reproducing with the process of alkylation

  5. Alkylating Drugs: Indications • Used in combination with other drugs to treat various types of cancer, such as: • Recurrent ovarian cancer • Brain tumors • Lymphomas • Leukemias • Various forms of cancer (breast, ovarian, bladder) • Others

  6. Alkylating Drugs: Adverse Effects • Dose-limiting adverse effects • Nausea and vomiting, myelosuppresion • Alopecia • Nephrotoxicity, peripheral neuropathy, ototoxicity • Hydration can prevent nephrotoxicity • Extravasation causes tissue damage and necrosis

  7. Alkylating Drugs: Examples • cisplatin (Platinol-AQ) • cyclophosphamide (Cytoxan) • altretamine (Hexalen) • carmustine (BiCNU) • mechlorethamine (Mustargen) • temozolomide (Temodar) • thiotepa (Thioplex)

  8. Cytotoxic Antibiotics • Natural substances produced by the mold Streptomyces • Synthetic substances also used • Used to treat cancer–too toxic to treat infections

  9. Cytotoxic Antibiotics (cont’d) • All can produce BMS (except bleomycin) • Pulmonary toxicity (bleomycin) • Heart failure (daunorubicin)

  10. Cytotoxic Antibiotics (cont’d) • Anthracycline antibiotics • daunorubicin, doxorubicin, idarubicin, others • Anthracenedione antibiotics • mitoxantrone • Other cytotoxic antibiotics • bleomycin, dactinomycin, mitomycin, plicamycin, others

  11. Cytotoxic Antibiotics (cont’d) • Most are CCNS drugs, and are active in all phases of the cell cycle • Most act by the process of alkylation and resulting in blocking DNA synthesis • Some act by intercalation, resulting in blockade of DNA, RNA, and protein synthesis

  12. Cytotoxic Antibiotics: Indications • Used in combination chemotherapy regimens • Used to treat a variety of solid tumors and some hematologic malignancies • Leukemia, ovarian, breast, bone, others • Squamous cell carcinomas • AIDS-related Kaposi’s sarcoma (when intolerant to other treatments)

  13. Cytotoxic Antibiotics: Adverse Effects • Hair loss, nausea and vomiting, myelosuppression • Pulmonary fibrosis (bleomycin) • Liver, kidney, and cardiovascular toxicities • Many others

  14. Cytotoxic Antibiotics: Adverse Effects (cont’d) • Cardiomyopathy is associated with large amounts of doxorubicin • Dexrazoxane can be used as a cytoprotective drug • Monitor cardiac ejection fractions

  15. Miscellaneous Antineoplastics • bevacizumab (Avastin) • hydroxyurea (Hydrea) • imatinib (Gleevec) • mitotane (Lysodren) • Hormonal antineoplastic drugs • Radiopharmaceuticals

  16. Miscellaneous Antineoplastics (cont’d) • bevacizumab (Avastin) • Angiogenesis inhibitor • Blocks the blood supply to the growing tumor • Many adverse effects, including nephrotoxicity

  17. Miscellaneous Antineoplastics (cont’d) • hydroxyurea (Hydrea) • Action similar to antimetabolites • Used to treat squamous cell carcinoma and some leukemias • Oral form only • Many adverse effects

  18. Miscellaneous Antineoplastics (cont’d) • imatinib (Gleevec) • Used to treat chronic myeloid leukemia (CML), especially in cases where interferon alfa therapy failed • It is NOT a monoclonal antibody • Works by inhibiting an enzyme that is active in the CML process • Use with other hepatic-metabolized drugs may cause severe interactions

  19. Miscellaneous Antineoplastics (cont’d) • mitotane (Lysodren) • Adrenal cytotoxic drug • Used specifically for adrenal corticoid carcinoma • Oral form only

  20. Hormonal Drugs • Used to treat a variety of neoplasms in males and females • Hormonal therapy used • To oppose effects of hormones • To block the body’s sex hormone receptors • Used most commonly as adjuvant and palliative therapy

  21. Hormonal Drugs (cont’d) • Drugs for female-specific neoplasms • anastrozole (Arimidex) • tamoxifen (Nolvadex) • megestrol (Megace) • medroxyprogesterone (Provera) • fluoxymesterone (Halotestin) • fulvestrant (Faslodex) • Several others

  22. Hormonal Drugs (cont’d) • Drugs for male-specific neoplasms (prostate cancer) • bicalutamide (Casodex) • flutamide (Eulexin) • nilutamide (Nilandron) • leuprolide (Lupron) • goserelin (Zoladex) • estramustine (Emcyt)

  23. Miscellaneous Antineoplastics (cont’d) • Radiopharmaceuticals • Used to treat a variety of cancers, or symptoms caused by cancers • Porfimer sodium • Chromic phosphate P 32 • Samarium SM 153 lexidronam • Sodium iodide I 131 • Sodium phosphate P 32 • Strontium Sr 89

  24. Extravasation • Leaking of an antineoplastic drug into surrounding tissues during IV administration • Can result in permanent damage to nerves, tendons, muscles, loss of limbs • Skin grafting or amputations may be necessary

  25. Extravasation (cont’d) • Prevention is essential • Continuous monitoring of the IV site is essential

  26. Extravasation (cont’d) • If suspected, stop the IV infusion immediately but do not remove the IV tube • If possible, aspirate remaining drug or blood from the tube • Follow instructions for giving the appropriate antidote through the existing IV tube, then remove the catheter • Some antidotes are not given through the IV catheter

  27. Extravasation (cont’d) • Cover area with sterile, occlusive dressing if ordered • Apply warm or cold compresses, depending on the extravasated drug • Rest and elevate the affected limb • PREVENTION is the best approach!

  28. Handling Antineoplastic Drugs • Those preparing and administering these drugs may be exposed to negative consequences • Most facilities have these drugs mixed under special environments in the pharmacy

  29. Handling Antineoplastic Drugs (cont’d) • During care of a patient receiving these drugs, special precautions may be implemented, depending on facility policies • Double flushing of bodily fluids in the commode • Special hampers for disposal of all objects that contact the patient’s body fluids • Personal protective equipment • Special concerns if chemotherapy liquid spills

  30. Nursing Implications • Assess baseline blood counts before giving any antineoplastic drugs • Follow specific administration guidelines for each antineoplastic drug

  31. Nursing Implications (cont’d) • Alkylating drugs • Monitor for expected effects of bone marrow suppression • Expect nausea, vomiting, diarrhea, stomatitis • Hydration is important to prevent nephrotoxicity • Report ANY ringing/roaring in the ears—possible ototoxicity • Peripheral neuropathies may occur—report tingling, numbness, pain in extremities

  32. Nursing Implications (cont’d) • Cytotoxic antibiotics • Expect bone marrow suppression, nausea, vomiting, diarrhea, stomatitis • Monitor pulmonary status • Monitor for nephrotoxicity, liver toxicity • Monitor cardiovascular status • Daunorubicin may turn the urine to a reddish color

  33. Nursing Implications (cont’d) • In general • Monitor closely for anaphylactic reactions • Keep epinephrine, antihistamines, antiinflammatory drugs on hand • Monitor closely for complications associated with bone marrow suppression • Anemia, thrombocytopenia, neutropenia

  34. Nursing Implications (cont’d) • Cytoprotective drugs may be used to reduce toxicities • IV amifostine (Ethyol) to reduce renal toxicity associated with cisplatin • IV or PO allopurinol (Zyloprim) to reduce hyperuricemia

  35. Nursing Implications (cont’d) • Monitor for oncologic emergencies • Infections • Pulmonary toxicity • Allergic reactions • Stomatitis with severe ulcerations • Bleeding • Metabolic aberrations • Bowel irritability with diarrhea • Renal, liver, cardiac toxicity

More Related