chemotherapy drug notes

8/8/2019 chemotherapy drug notes

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Two types of chemotherapeutic agents:

1. Cell cycle specific drug will work on cells only in a certain phase2. Cell cycle nonspecific drug will work on cells in any phase or multiple phases at once.

Cell cycle specific drugs:

1. Antimetabolites: structural analogs of important natural metabolites.MOA mimic folic acid, pyrimidines, & purines and disrupt the cells ability to undergo DNA replication.

2 ways Falsely substituting purines, pyrimidines, or folic acidOR by inhibiting critical enzymes

DRUGS:

y Capecitabiney Fluorouracily Floxuridiney Fludarabiney Methotrexatey Cytarabiney Mercaptopuriney Thioguanine

Methotrexate: (folic acid analog)

Route: IV, IM, PO, intrathecal Uses: RA, cancer (breast, head & neck, renal, ovarian, bladder, testicular, lymphomas) AE: Photosensitivity, liver dysfunction, mucositis, myelosuppression (dec bone marrow activity) Guidelines for HighDoseMTX:

j Leucovorin rescue administer leucovorin to permit normal cells to synthesize importantcompounds needed for survival. SerumMTX must not exceed 5x10

-8. Monitor MTX levels every 12-

24 hrs. Failure to administer leucovorin at the right time/right dose can be fatal.

j Acute tumor lysis syndrome massive release of intracellular components. Can result in kidneyfailure, dysrhythmias, etc. Causes hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia

- Allopurinol (for uric acid) must be started several days before therapy begins- pH of urine must be above 7.0- If pH falls below 7.0, NaHCO3 is given (IVF and/or PO)- Bicitra (makes urine less acidic)

Fluorouracil: (pyrimidine analog)-c, t, u

Route: IV, IA, topical Uses: gastric, head & neck, breast cancers AE: alopecia, diarrhea, discoloration of veins, mucositis, myelosuppression Note: a derivation of this drug can be administered intrahepatically and is compatible with heparin


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2. Mitotic Inhibitors:a. VincaAlkaloids

MOA: Act during M phase to prevent cell division.

DRUGS:

Vinblastine Vincristine (2mg/wk maximum) Vinorelbine

AE: vesicant agents, n/v, neurotoxic (foot drop, paralytic i leus, paresthesias), myelosuppression

b. Taxanes from the Pacific Yew treeMOA:similar to Vinca Alkaloids

DRUGS:

Paclitaxel SE: hypersensitivity rxns premedicate w/ steroid, antihistamine & H2 blocker; hair loss Docetaxel

AE: similar to Vinca Alkaloids

3. Topoisomerase 1 Inhibitors:MOA: kill cells in S phase. Inhibits enzyme Topoisomerase 1; (makes single-stranded cuts in DNA preventing

replication)

DRUGS:

Irinotecan (severe diarrhea give atropine) Topotecan (diarrhea) Etoposide PO, IV (hypotension, bronchospasm) monitor BP closely

Cell Cycle NonspecificDrugs:

1. Alkylating Agents:MOA: interfere with chemical structure of DNA; alkyl group attaches to nucleic acid instead of H+

DRUGS:

Nitrogen mustard Chlorambucil Cyclophosphamide Ifosfamide Busulfan Carboplatinum

Cisplatinum Thiotepa

Cyclophosphamide:

Route: PO, IV Uses: chronic leukemia, ovarian, breast, HD & NH lymphomas, multiple myeloma AE: hemorrhagic cystitis (admin early in the day, need hydration, assess urine for blood, void frequently

esp before bed); sterility; n/v; myelosuppression; cardiotoxic (at high doses)

Cisplatin:


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Route: IV AE: nephrotoxic (I&O, hydration, Cr & BUN, Mannitol); peripheral neuropathy; electrolyte imbalance

(Mg & K, may be admin these in IVF); ototoxic (high freq audiograms); very emetogenic

Nitrosoureas: unique b/c they cross bbb; can be used to treat brain tumors.

Carmustine: PO, IV

Lomustine: PO, IV

2. Antitumor Antibiotics:MOA: act either by alkylation process or intercalation process insertion of drug btw 2 strands of DNA to block

synthesis; (anthracyclines subgroup works by intercalation)

DRUGS: (inanthracyclines group):

Daunorubicin Doxorubicin Idarubicin

Doxorubicin:

AE: red skin, vesicant, cardiotoxic (baseline & periodic ECHOs), hair loss DOSE: max accumulative dose 550mg/m2

Dexrazoxane:

Bleomycin:

AE: pulmonary toxicity (baseline PFTs); anaphylaxis (give test dose) CI: contraindicated in people over 70 only drug inthis category that is nota vesicant

AE: (of all antitumor antibiotics): Vesicants!

- Check for blood return every 2-3 ccs (ifIVP)- If admin via CVC, verify blood return w/ 2ndRN before starting check every 4 hrs- Stop infusion if pain, redness, or infiltration call MD

3. Miscellaneous Agents:DRUGS:

y Asparaginase IV; 2nd line for acute lymphocytic leukemia; give test dose each time (anaphylaxis)y Hydroxyurea PO; certain solid tumors, CML, sickle cell, AIDS; bone marrow toxicity occurs w/in one

week of starting


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HORMONES MOA AE USES

Interfere w/ protein

synthesis or rec blockade

Less toxic than

antineoplastic agents

Antiestrogens

Tamoxifen Approved for breast cancer

prevention (in high risk pts)

Hot flashes; risk for DVT; HA Used in postmenopausal

women w/ breast cancer

Aromatase Inhibitors Inhibits enzyme from

Anastrozole converting androgens intoestrogen

Osteoporosis In postmenopausal womenw/ breast cancer

Progestins

Megestrol To manage cachexia in

advanced AIDS & cancer

Palliation for women w/

endometrial cancer

**General side effects for all chemo drugs: They all affect rapidly dividing cell types to a degree hair follicles,

myelosuppression (leukopenia, neutropenia, thrombocytopenia, anemia), GI mucosa, & reproductive organs.


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Immunomodulating Agents: (Interferons, Interleukins, CSFs)

Interferons:

Classification Antiviral & antineoplastic

MOA (brief) Directly inhibits effects on DNA & protein synthesis & inc cancer cell Ag on cell surface (enables

immune sys to recognize cancer cells more easily); stop virus replication, stop penetration into

healthy cells, enhance actions of immune sys cells, and stop division of cancer cellsAdverse Effects Fever, chills, HA, malaise, myalgia, fatigue; n/v, diarrhea, anorexia; paranoia, dizziness,

confusion; tachycardia; neutropenia, thrombocytopenia; inc BUN & Cr; depression, suicidal

When is it used? Viruses: rhinovirus, retrovirus, papillovirus, hep C, condyloma. Cancers: Kaposi sarcoma,

multiple myeloma, renal cell carcinoma, bladder cancer. Autoimmune:MS

Lab considerations CBC, renal fcn; vital signs @ ea visit; Tylenol for flu s/s;

Nursing

considerations

Teach about fever patterns. Watch for depression & suicidal ideation.

Interleukins:

MOA Enhances multiplication of NK cells, which recognize cancer cells as non-self. Also inc

production ofB lymphocytes.

Adverse Effects Capillary leak syndrome (severe toxicity)-hypotension, pulmonary edema; fluid retention can

lead to CHF, arrhythmias, MI; fever, chills, rash, fatigue, HA, myalgias

Drug Interactions DO NOT GIVE DIURETICS

When is it used? Renal cell carcinoma, malignant melanoma, colorectal cancer, limited use in HD

Nursing

considerations

Monitor fluid balance, I&O, wt gain, edema; treat flu s/s w/ tylenol

Colony

Stimulating

Factors

MOA Complex network of glycoprotein hormones responsible for the differentiation, proliferation,

maturation, & functional activity of hematopoietic cells

Subtypes: Granulocyte CSF:

y Filgrastim, Pegfilgrastim, & SargramostimErythropoietin:

y Epoetin-alphaThrombopoiesis:

y OprelvekinUses: Dec chemo-induced myelosuppression; stimulate hematopoiesis in marrow failure; promote

cellular differentiation; support peripheral stem cell harvesting; enhance antibiotic therapy

Route: SQ; must teach family how to give; given until reach parameter set by practitioner (i.e. wbc >

3000)


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chemotherapy drug notes

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