major drug groups neoplastic, body defenses. cytotoxic agents act with a degree of selectivity...
TRANSCRIPT
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MAJOR DRUG GROUPS Neoplastic, Body Defenses
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CYTOTOXIC AGENTS
Act with a degree of selectivity against the uncontrolled proliferation of cancerous cells.
Act directly or indirectly affecting DNA or DNA function to cause cell death.
Have a particular affinity for cells that are in the process of dividing.
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2 Types
Cell cycle specific; these destroy proliferating (dividing) cells throughout the cycle, and phase specific agents that destroy or attest cells during a specific phase of the cell cycles
Cell – cycle non- specific agents that destroy both proliferating and resting cells
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Increased susceptibility during cell division
Malignancies that respond best are the rapid growth or high growth fraction (testicular, lymphomas acute leuk)
Adverse reactions occur in the non-malignant tissue which has a high growth fraction
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USES
1. Disease regression2. Palliative care 3. Pain relief
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Administered
Orally Intramuscularly Intravenously Intrathecally Combination of the above High doses may by given
intermittently to allow normal cells to recover
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Adverse affects
Bone marrow = myelo-supppression
Hair follicles = alopecia GIT mucosa = mucositis or
Diarrhoea Gonads = menstrual irregularities,
dec spermatogenesis, sterility
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Adverse effects related to administration
Anorexia, Nausea & vomiting Fever headache, hypotension Fatigue/ weakness Anaphylaxis, Rah pruitus,erythema Pain / irritation / inflammation at
local site
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Adverse effects related to later reactions
Bone marrow suppression (Peak 10 14 days post chemo)
Leucopenia = Infection Thrombocyopenia = haemorrhage Anaemia Alopecia & GIT ulcers (mouth) Kidney and liver toxicity
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Precautions/Contraindications
Breast feeding Pregnancy Drug interactions Elderly and Paediatric have
increased effects
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Nursing Interventions Patients fully informed re effects Staff use care re self protection, staff
blood tests Personal protection equipment (PPE)
Care handing pt excreta ( contaminated) Guidelines for spills, extravasation Neutopenic pt requires isolation (DAY 10
– 12) Temp >38 medical emergency
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Nursing Interventions
Drugs should be prepared under a Bilogical Cabinet/Class Laminar flow to prevent breathing mists
Linen put in labeled bag (Purple)
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Nursing Interventions Dietary modification Program of ant emetics Protection from general population
(infection) TLC re alopecia and changed
physical appearance Care and complete instructions re
complicated oral drug administration
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Hormonal treatments
Tamoxifen (Common) Non steroidal, antioestrogen Precise mechanism of
controlling breast cancer unknown
S/E hot flushes, nausea pain headaches
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Medical Devices
Hickman catheter Port a cath Pic line Portable drug pumps
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Examples
Cisplatin Methotrexate Fluorouracil Bleomycin Vincristine Hydroxyurea Cyclophosphamide
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Drugs affecting the Body Defenses
2 methods of resistance Specifically through developed
immunity Non-specifically through
barriers (skin, mucus membranes and gastric acidity
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Anti inflammatory drugs
NSAIDs Inhibit the synthesis of
prostoglandins Symptomatic relief of pain and
inflammation and fever Arthritis, gout, bowel disease Oral, IV, IMI, Topical, PR,
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Adverse effects
Bronchospasm (asthmatics) GIT upset Peptic ulceration Inhibition of platelet aggregation Mask S&S of infection Fluid retention
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Precautions /Contraindications
Asthmatics Pts with history of GIT
bleeding Alcohol and anticoagulants Not used in pregnancy
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Nursing intervention
Take with food Takes time to be effective Pt education re signs of bleeding
(Black stools) Protect skin (Photosensitivity) Regular blood screens (Renal
impairment)
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Examples Aspirin =tinnitus, dizziness, bleeding Diflunisal (dolobid) = general Indomethacin = potent, blood
discrasias, headache, Ibuprofen, (brufen)= precaution with
liver and cardiac failure Naproxen = drowsiness, vertigo,
bleeding
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Immunomodulation agents(immunosuppressants)
Modify the immune system (organ transplant immunosuppressants)
Pt is susceptible to various infections Adverse effects depends on drug Diarrhoea, N & V, Pancytopenia Depression, anxiety confusion Pg234
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Nursing interventions
Pt education re long term therapy and compliance issues
Regular checks, blood, liver, renal. Panadol as pain relief, No NSAIDs Beware of minor infections Good mouth care
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Examples
Steroids; prednisone Azathioprine; Imuran Cyclosporin; Sandimmun
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Complications
Higher incidence of cancer, eg NHL, ca lip, skin, and urogenital tract.
Inc susceptibility to bacterial infection.
Inc susceptibility to opportunistic infections eg cytomegalovirus, herpes and fungal infections and Pneumocyctis carinii.
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HISTAMINE AND ALLERGIES Histamine is a naturally occurring
substance Stored in mast cells (skin, nose,
lungs, GIT When damaged, (chemicals, drugs,
heat, trauma), large amts released = allergic reaction
Act on specific receptor sites, H1, H2, H3,
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Antihistamines
Block the H1 receptor sites Decrease itching, depress CNS,
sedation, supression of nausea and vomiting.
Oral rapid absorption, 15-30 min S/E drowsiness, dry mouth, Promethazine, loratadine,
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Drugs affecting the SKIN
Treat a variety of conditions E.g.Burns, Infections, Acne, Sunscreens, emollients,
antipruritics Systemic (oral), topical
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Soothing and Protective
Calamine; zinc oxide in water Aqueous cream; sorbolene Oily glycerine; Barrier; dimethicone, silicon Soft parraffin; vaseline Woolfat; lanolin Bath oil; alpha-Keri, Q.V. Tar,
Pinetarsal
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Cleansers and Keratolytics (cause flaking and scaling)
Soap Hydrogen Peroxide Benzol Perozide; acne Salicylic acid; (K) Warts Urea; promote hydration of the
skin,
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Retinoids
Treatment with Vitamin A; Psoriasis & Acne; Retin-A, Airol, Tigason,
Rocaccutane is teratogenic Increases skin sensitivity to light
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Application Bathoils; correct strength and temp Lotions; used sparingly Wet dressings; kept wet Powders; used sparingly, not on
wet or hairy areas Ointments; thin smear, not
removed between applications or over oozing lesions
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Application
Creams; not on chronic scaling skin
Keratolytics; minimal use, healthy skin protected.
Retinoids, beware of side effects
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Anti-infective preparations
Tricolsan; Clearasil, sapoderm Chlorhexidine; Hibitane Povidone iodine; Betadine Metronidazole; Rozex, Antibiotics; Neosporin, Sofra-Tulle,
Bactroban,
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Nursing Implications Protect yourself from the medication Use sparingly SSD, 3-5cm thick, max 3 days, wash
off completely, between applications Protect pts clothes Discard expired creams and inc
concentration of medication. Prolonged use = superinfections