1

Antineoplastics and Antianemics

Pharmacology INURS 1950

2

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

3

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

4

Objective 3: Identify the basic types of antineoplastic drugs

5

6

7

Alkylating agentsAntimetabolitesNatural productsAntineoplastic antibioticsHormones Biologic response modifiers & Misc.

8

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

9

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

the DNA can not separate

10

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

Drugs included

11

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

Melphalan (Alkeran)Streptozocin (Zanosar)Thiotepa

12

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

13

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

14

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

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

Antimetabolites

15

Mercaptopurine (6-MP, Purinethol)

Methotrexate (MTX)Thioguanine (Lanvis)

16

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)

17

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

◦Bone marrow depression, dermatitis

◦Oral and GI ulceration

18

Come from periwinkle plant, specific yews

Cell-cycle specific: block mitotic spindle during mitosis

Natural Products/mitotic inhibitors

19

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

20

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

recovery 3 weeks◦ Bone marrow suppression, alopecia, peripheral

neuritis, hepatotoxicity, bronchospasm

21

Bind to DNA, inhibit DNA, RNA synthesis

Cell-cycle nonspecific

Antineoplastic Antibiotics

22

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

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

23

Idarubicin Mitomycin CMitoxantronePlicamycinValrubicin

24

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

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

◦GI bleeding, CNS effects with some

25

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

26

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)

27

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

28

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

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

29

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

Biologic response modifiers

30

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

◦Flulike syndrome◦Anemia, leukopenia

31

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

◦Used to treat anemia induced by chemotherapy

Immunomodulators

32

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

33

Oprelvekin (Neumega) stimulates platelet production at stem cell level

34

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

35

Sargramostim (Leukine) stimulates the production of granulocytes and macrophages

Also helpful in aplastic anemia

36

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

37

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

Chemoprotective Agents

38

Dexrazoxane (Zinecard) used with doxorubicin◦Reduces cardiomyopathy

39

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

40

New class: antiangiogenesis◦ Prevent new blood vessels

41

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

42

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

43

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

44

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

45

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

46

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

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

47

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

48

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

49

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

50

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

51

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

◦Neumega may be used◦Teach safety measures

52

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

53

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

54

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

◦Safe disposal◦Prevent contamination of body fluids

55

56

Objective 8: describe the types of anemias

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

57

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

58

Objective 9: identify drugs used to treat iron deficiency anemia

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

59

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

60

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

61

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

62

Ascorbic acid promotes absorption

Tetracycline and antacids decrease absorption

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

63

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

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

64

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

◦Given IM or IV

65

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

66

IM iron◦Persistent pain and discoloration at site occur

◦Can cause anaphylactic reactions

◦Must use Z track method of administration

67

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

68

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

69

Vitamin B12 can be oral or parenteral administration

Cyanocobalamin can be given IM or deep subq

Oral form usually as dietary supplement

70

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

71

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

72

Anxiety Knowledge deficitDisturbed body imageAnticipatory grievingRisk for infectionRisk for injury

Nursing Diagnoses (Cancer)

73

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

Impaired tissue integrity (or risk for)

Chronic pain (or acute, depending upon the situation)

74

Activity intolerance Impaired oral mucous membranes

Self-care deficitNutrition: less than body requirements

Nursing Diagnoses (Anemia)