Download - Chapter 39
Antineoplastic Agents and Adjunct Drugs Used in Cancer Treatment
Cancer
Broad term A group of diseases characterized by uncontrolled cellular growth
Invasion into surrounding tissue Metastasis
Cancer spreads to other areas in the body
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Etiology of Cancer
May be:EnvironmentLifestyleOccupationGenetic and ethnic factors
Age- and sex-related differences
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Cell Growth Cycle
Normal cells and cancer cells go through five distinct growth phase cycles
-G0 -resting cycle -G1 -first growth -S –DNA synthesis phase -G2 –second growth -M1 -mitosis phase Cancer cells divide rapidly
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Treatment Considerations
Growth Fraction -The fraction of cells that are in active phases Mitotic index -Percentage of cell undergoing
mitosis Antineoplastics most effective when
the growth fraction and mitotic index are high
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Treatment Considerations
Cancer stage when it is discovered
Efficacy of the cancer treatment
Development of drug resistance
General health of the client6
Antineoplastics
Divided into two groups -Cell cycle nonspecific (CCNS) -Cell cycle specific (CCS) CCNS effective against slow-
growing cancer cells CCS effective against fast-
growing cancer cells
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Agents Used in the Treatment of Cancer Alkylating agents Antimetabolites Mitotic inhibitors Antibiotics Hormones
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Agents used in the Treatment of Cancer
Radioactive drugs Biological response modifiers Miscellaneous agents Combination therapy Adjuvant agents
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Agents Used in the Treatment of Cancer Alkylating agents: cell cycle
nonspecific Antimetabolites: cell cycle
specific in the S phase Mitotic inhibitors: cell cycle
specific in the M phase
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Antineoplastic Agents
Affect all cells, both healthy and sick
Dose-limiting effects Hair falls out Cells in the gastrointestinal tract
die Nausea and vomiting occur;
emetic potential Myelosuppression
Nadir: lowest point for the bone marrow cells, WBCs, platelets
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Antineoplastics: Adverse/Side Effects Common
Fever, chills, headache, nausea, and vomiting
Serious Bronchospasm, dyspnea, hypotension, and angioedema
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Combination Therapy
Use of several antineoplastic agents at the same time
Proven effectiveness Rationale of using combination
therapy Have a more beneficial effect than when used alone
Each agent exhibits different actions and toxicities 13
Adjuvant Agents
Antiemetics Ondansetron HCl (Zofran)
Appetite Stimulants Megace ES (megestrol acetate) Marinol (THC)
Blood cell-forming agents Epoetin alfa (Procrit) Neulasta
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Nursing Implications
During administration of the antineoplastic:
-Provide significant hydration to prevent nephrotoxicity
-Provide periodic monitoring of heart and lung function
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Nursing Considerations
Obtain thorough health history and physical assessment
Assess support systems Provide for expression of feelings Provide education regarding illness
and treatment regimen Pain control Assessment of the patient’s
emotional status
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Nursing considerations
Monitoring of labs, fluid and electrolyte balance
Nutritional evaluation Address infection status and
education Provide for safety needs Be alert for adverse effects of the
drugs Ongoing assessment is crucial
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Adverse Effects: Chemotherapy Risk for infection
Risk for bleeding Risk for ineffective tissue perfusion Nausea and vomiting Risk for vesicant extravasation Body image disturbances Uric acid neuropathy Hemorrhagic cystitis Pain
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Handling of Cytotoxic Drugs
Be familiar with institution policies and procedures
Use proper protective equipment
Do not handle if pregnant
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Handling of Cytotoxic Drugs Take all special precautions Contaminated material must
be disposed of properly Spill kit Follow proper procedures for
exposure
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Investigational Drugs
Written prescription
Signed consent Drug information
available Follow research
protocol Keep thorough
records
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Patient Teaching Provide education regarding cancer
and treatment Emphasize importance of following
chemotherapy regimen Teaching regarding central venous
catheters Education regarding signs and
symptoms to report to provider Address appropriateness of home
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Legal and Ethical Principles
To avoid errors Standardized, preprinted
order forms
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