[ppt]antineoplastics and antianemics - faculty site...

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Antineoplastics and Antianemics

Pharmacology INURS 1950

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Objective 1: Describe the general factors utilized to select the therapy used to treat cancer

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Objective 2: Describe the general uses of chemotherapy in the treatment of cancer

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Objective 3: Identify the basic types of antineoplastic drugs

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Alkylating agentsAntimetabolitesNatural productsAntineoplastic antibioticsHormones Biologic response modifiers & Misc.

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Bond with DNA so it can’t separate = no replication

Cell-cycle nonspecific◦Resistance can be a problemCreates cross resistance with other alkylating agents

Alkylating Agents

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Alkylating agents: non cell cycle specific drugs◦ Activity occurs when the cell tries to replicate and

the DNA can not separate

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Busulfan (Myleran)Carboplatin (Paraplatin)Carmustine (BCNU)Chloramubil (Leukeran)Cisplatin (Platinol)Cyclophosphamide (Cytoxan)

Drugs included

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Fudarabine (Fludara)Lomustine (CCNU, CeeNU)Mechlorethamine (Nitrogen mustard, Mustargen)

Melphalan (Alkeran)Streptozocin (Zanosar)Thiotepa

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

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Each drug may have specific toxicities◦Example: Zanosar causes hypoglycemia

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Drugs included◦Capecitabine (Xeloda)◦Cytarabine hydrochloride (Cytosar)

◦Fludarabine (Fludara)◦Flurouracil (5-FU, FU)◦Gemcitabine (Gemzar)

Antimetabolites

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Mercaptopurine (6-MP, Purinethol)

Methotrexate (MTX)Thioguanine (Lanvis)

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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)

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In general, toxicities include◦N/V, diarrhea, constipation, fatigue

◦Bone marrow depression, dermatitis

◦Oral and GI ulceration

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Come from periwinkle plant, specific yews

Cell-cycle specific: block mitotic spindle during mitosis

Natural Products/mitotic inhibitors

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Drugs include◦ Etoposide (VePesid)◦ Docetaxel (Taxotere)◦ Paclitaxel◦ Vinblastine sulfate (Velban, Velbe)◦ Vincristine sulfate (Oncovin)◦ Vinorelbine (Navelbine)

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General toxicities◦ N/V, stomatitis ◦ Leukopenia with VePesid: nadir in 10-14 days,

recovery 3 weeks◦ Bone marrow suppression, alopecia, peripheral

neuritis, hepatotoxicity, bronchospasm

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Bind to DNA, inhibit DNA, RNA synthesis

Cell-cycle nonspecific

Antineoplastic Antibiotics

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Drugs include◦Bleomycin (Blenoxane)◦Dactinomycin (Actinomycin D, Cosmegen)

◦Daunorubicin (Cerubidine)◦Doxorubicin (Adriamycin)◦Epirubicin (Ellence)

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Idarubicin Mitomycin CMitoxantronePlicamycinValrubicin

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Generally, toxicities include◦N/V, red tinged urine with some

◦Bone marrow depression◦Cardiotoxicity ◦ Pulmonary fibrosis (Bleomycin)

◦GI bleeding, CNS effects with some

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Corticosteroids: lymphoma and acute leukemia as suppress mitosis in lymphocytes◦Help restore sense of well being, decrease edema with radiation, increase appetite and strength

Hormones

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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)

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Drugs included◦Anastrozole (Arimidex)◦Diethylstilbestrol (DES)◦Prednisone◦Tamoxifen (Nolvadex)◦Testolactone (Teslac)◦Testosterone

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General toxicities◦N/V, headache◦Fluid retention, feminization or masculinization

◦Hot flashes Some can cause thrombocytopenia, leukopenia, hypercalcemia, increased bone and tumor pain

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Drugs included◦Altretamine (Hexalen)◦Dacarbazine (DTIC-dome)◦Hydroxyurea (Hydrea)◦Interferon alfa-2b (Roferon-a)◦Leuprolide acetate (Lupron)

Biologic response modifiers

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Toxicities in general◦N/V, hot flashes, bone marrow depression, arrhythmias

◦Flulike syndrome◦Anemia, leukopenia

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Drugs used as adjunct therapy◦Epoetin alfa (Procrit) stimulates production of red blood cells

◦Used to treat anemia induced by chemotherapy

Immunomodulators

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Filgastim (Neupogen) stimulates the production of neutrophils (WBC)

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Oprelvekin (Neumega) stimulates platelet production at stem cell level

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Rituximab (Rituxan) binds to the surface of B lymphocytes◦Used to treat relapsed B-cell non-Hodgkin’s lymphoma

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Sargramostim (Leukine) stimulates the production of granulocytes and macrophages

Also helpful in aplastic anemia

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Trastuzumab (Herceptin) inhibits growth of tumor cells (especially useful in metastatic breast cancer)

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Amifostine (Ethyol) reduces toxic effects of cisplatin◦Reduces renal toxicity

Chemoprotective Agents

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Dexrazoxane (Zinecard) used with doxorubicin◦Reduces cardiomyopathy

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Mesna (Mesnex) reduces toxic effects of Ifex and Cytoxan◦Reduces hemorrhagic cystitis

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New class: antiangiogenesis◦ Prevent new blood vessels

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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

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Objective 5: describe what “tumor resistance” means◦Tumor cells are not as susceptible to antineoplastic agents as they should beCells escape damage from the drugs

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

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Normal cells responding to chemotherapy◦Rapidly growing cellsGI tractHair follicles RBCs, WBCs, platelets

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Side effects/toxicities to expect◦GI tract: N/V, diarrhea or constipation, stomatitis Take PRN medications as needed Will have pre-treatment drugs for N/V

Stomatitis requires good oral hygiene, mouth wash with local anesthetic

Weekly weights

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◦Diarrhea: skin care a must◦Avoid foods that stimulate bowel motility

◦Eat foods high in K+ (loose it with diarrhea)

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Alopecia ◦Hair will begin to fall out in clumpsDevastating—cut hair short; get wigs, caps, turbans

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Skin care: lukewarm water, mild soap

Keep skin clean and dry If drugs cause photosensitivity, avoid sun

Skin creams available from MD to heal, protect◦Especially important with radiation

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Decreased RBCs = decreased 02 transport◦May receive Procrit◦May have blood transfusion◦Need to rest often◦Avoid orthostatic hypotension

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Neutropenia: avoid crowds (infections)◦Neupogen may be used◦Meticulous care of central lines needed

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Thrombocytopenia: client needs to watch for bleeding◦Nurse: use smallest needle when MUST give parenteral medication

◦Neumega may be used◦Teach safety measures

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Objective 7: discuss the nursing care for the client receiving antineoplastic therapy

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Clients with cancer require holistic nursing◦Medications◦Physical assessment◦Psychosocial support◦Emotional support◦Growth and development support, esp. for kids

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Care of the nurse◦Prevent inhalation of aerosols◦Prevent drug absorption through the skin

◦Safe disposal◦Prevent contamination of body fluids

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Objective 8: describe the types of anemias

Anemia is a condition in which the hemoglobin concentration or the number of circulating RBCs is decreased

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◦Anemia occurs because of: Blood loss Hemolysis Bone marrow dysfunction Deficiencies of substances essential for hematopoiesis Lack of iron, vitamin B12 or folic acid

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Objective 9: identify drugs used to treat iron deficiency anemia

Drugs include ferrous sulfate, ferrous gluconate, ferrous fumarate and iron dextran (Imferon); iron polysaccharide

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Objective 10: describe the nursing responsibilities associated with administering iron preparations

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Ferrous sulfate◦Oral, usually tablet or capsule◦SE: usually GI—nausea, pyrosis, bloating, constipation or diarrhea

◦If liquid prep: stains teethDilute in water or juiceAdminister with a strawRinse mouth after administration

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High doses are toxic◦Usually accidental◦Children susceptible: >3 gms can be fatal

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Ascorbic acid promotes absorption

Tetracycline and antacids decrease absorption

Iron (Fe) used for iron deficiency anemia or to prevent (pregnancy)

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Ferrous gluconate and ferrous fumarate◦Same therapeutic effect as ferrous sulfate

◦If no response to one drug form, no response to the others

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Iron dextran: for parenteral administration◦Used when oral iron ineffective or intolerable

◦Given IM or IV

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Major adverse effect◦Anaphylactic shock◦Test doses given for IV before the doseHave emergency drugs available STAT

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IM iron◦Persistent pain and discoloration at site occur

◦Can cause anaphylactic reactions

◦Must use Z track method of administration

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Objective 11: describe pernicious anemia and identify the drug used to treat it◦May see it called vitamin B12 deficiency anemia or megaloblastic anemia

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Vitamin B12 deficiency occurs because of◦Lack of B12 in diet◦Lack of intrinsic factor in stomach Causes oversized erythroblasts; can be fatal

Have CNS effects, neurological damage

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Vitamin B12 can be oral or parenteral administration

Cyanocobalamin can be given IM or deep subq

Oral form usually as dietary supplement

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Folic acid deficiency Folic acid available as tablet and for IM, IV, or subq administration

Leucovorin: active form of folic acid used as a rescue drug in cancer therapy; may also see in rheumatoid arthritis clients taking methotrexate

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Objective 12: apply the nursing process when caring for the client receiving antineoplastic and antianemic agents

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Anxiety Knowledge deficitDisturbed body imageAnticipatory grievingRisk for infectionRisk for injury

Nursing Diagnoses (Cancer)

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Nutrition: less than body requirements (or a risk for)

Impaired tissue integrity (or risk for)

Chronic pain (or acute, depending upon the situation)

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Activity intolerance Impaired oral mucous membranes

Self-care deficitNutrition: less than body requirements

Nursing Diagnoses (Anemia)