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Chapter 21
Antineoplastic Drugs
Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Antineoplastic Drugs



Antineoplastic drugs are sometimes called cancer
chemotherapeutic agents and are primarily used
to treat cancer.
These drugs are also used to treat inflammatory
disorders such as psoriasis, rheumatoid arthritis,
and systemic lupus erythematosus.
More often than not, multiple drug therapy is used
to treat the different types of cancers.
Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
2
Antineoplastic Drugs

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These drugs exert their pharmacologic effects by
interfering with the metabolism or reproductive
cycle of the tumor cells and thereby destroying
them.
Antineoplastic drugs are classified as either cell
cycle specific or cell cycle nonspecific.
Antineoplastic drugs target rapid dividing tumor
cells.
However, they also affect rapidly dividing normal
cells that leads to their many adverse effects.
Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
3
Adverse Drug Effects

Bone Marrow Suppression

Bone marrow suppression leads to leukopenia,
agranulocytosis, thrombocytopenia, or anemia.
 This puts the patient at risk for serious infection
because of the lack of white blood cells.

Osteonecrosis

Osteonecrosis of the jaw bone is a recently
recognized adverse effect of the bisphosphonates.
 The majority of cases (94%) have been reported in
patients receiving intravenous bisphosphonates to
treat multiple myeloma or metastatic carcinomas.
Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
4
Adverse Drug Effects

Osteonecrosis



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Most of the cases have been reported after
tooth extractions and other dental procedures
that traumatize the jaw.
It is very difficult to treat once it is diagnosed.
Good home oral hygiene can help to minimize
the risk of osteonecrosis.
Maintenance of oral health exams and other
dental procedures should be performed prior to
starting therapy or within 3 months of
beginning therapy.
Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
5
Adverse Drug Effects

Osteonecrosis



If osteonecrosis is present, then dead bone
should be removed as necessary with minimal
trauma to the adjacent tissue.
Chlorhexidrine rinses, systemic antibiotics, and
analgesics should be used if clinically
necessary.
Bisphosphonates are normally stopped until
the bone heals or the patient requires it to treat
the cancer.
Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
6
Adverse Drug Effects

Gastrointestinal



These drugs are known for causing significant
nausea, vomiting, diarrhea, stomatitis, and oral
ulcerations.
Patients should rinse with a dilution of
lukewarm water and baking soda after
vomiting.
Aspirin and NSAIDs should be avoided
because of the increased risk for GI adverse
effects.
Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
7
Adverse Drug Effects

Immunosuppression


Patients are at higher risk for bacterial, viral,
and fungal infections.
Oral Effects


Antineoplastic drugs can cause oral
discomfort, sensitivity of the teeth and gums,
mucosal pain and ulceration, gingival
hemorrhage, xerostomia, and impaired taste
sensation.
Ice chips and nonalcohol mouth rinses can
help with the dry mouth.
Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
8
Managing Patients Receiving
Antineoplastic Drugs
Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
9
Managing Patients Receiving
Antineoplastic Drugs
Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
10