Download Chemotherapy 1st semester-3

ANTI-NEOPLASTIC DRUGS
unit-ii
1
YOUNAS MASIH
RN, POST RN BSCN
(LECTURER)
NEW LIFE COLLEGE OF NURSING KARACHI
chemotherapy
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Objectives
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By the end of this session the learners will be able to,
1. Review the characteristics of normal and malignant
cells.
2. Explain characteristics of anti-neoplastic drugs.
3. Classify anti-neoplastic drugs
4. Discuss the nursing care of patients who are on antineoplastic drugs.
5. Calculate the drug dosage for Anti-neoplastic drugs.
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Anti-neoplastic drugs
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Cancer
 It is a term used for diseases in which abnormal cells divide without control and are able to
invade other tissues. Cancer cells can spread to other parts of the body through the blood
and lymph systems, this process is called metastasis.
Categories of cancer
Categorized based on the functions/locations of the cells from which they originate:
•Carcinoma : skin or in tissues that line or cover internal organs. E.g., Epithelial cells. 80-90%
reported cancer cases are carcinomas.
•Sarcoma : bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.
•Leukemia : White blood cells and their precursor cells such as the bon marrow cells, causes
large numbers of abnormal blood cells to be produced and enter the blood.
•Lymphoma : cells of the immune system that affects lymphatic system.
•Myeloma: B-cells that produce antibodies- spreads through lymphatic system.
•Central nervous system cancers : cancers that begin in the tissues of the brain and spinal cord.
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Cancer Therapeutic Modalities
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 There are traditionally (classical) following
modalities for the treatment of the cancer
 Surgery: 1/3 of patients without metastasis respond to
surgery and radiation
 Radiation: If diagnosed at an early stage, close to 50%
cancer could be cured.
 Chemotherapy: 50% patients will undergo
chemotherapy, to remove micro metastasis. However,
chemotherapy is able to cure only about 10-15% of all
cancer patients
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New types of cancer treatment
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 Hormonal Treatments:
These drugs are designed to prevent cancer cell growth by preventing the cells from
receiving signals necessary for their continued growth and division. E.g., Breast
cancer – tamoxifen after surgery and radiation
 Specific Inhibitors:
Drugs targeting specific proteins and processes that are limited primarily to cancer
cells or that are much more prevalent in cancer cells.
 Antibodies:
The antibodies used in the treatment of cancer have been manufactured for use as
drugs. E.g., Herceptin, avastin
 Biological Response Modifiers:
The use of naturally occurring, normal proteins to stimulate the body's own defenses
against cancer. E.g., Abciximab, rituxmab
 Vaccines:
Stimulate the body's defenses against cancer. Vaccines usually contain proteins
found on or produced by cancer cells. By administering these proteins, the treatment
aims to increase the response of the body against the cancer cells.
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Chemotherapy or Anti-neoplastic drugs
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 It is the drug that is used to eliminate the cancer cells
without affecting normal tissues (the concept of
differential sensitivity).
or
 Chemotherapy is the use of drugs to inhibit or kill
proliferating cancer cells , while leaving host cells
unharmed, or at least recoverable.
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General Rules for the chemotherapy
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 Adjuvant therapy:
 Additional cancer treatment given after the primary
treatment to lower the risk that the cancer will come back.
Adjuvant therapy may include chemotherapy, radiation
therapy, hormone therapy, targeted therapy, or biological
therapy.
 Neo adjuvant therapy:
 Treatment given as a first step to shrink a tumor before the
main treatment, which is usually surgery, is given. Examples
of neo adjuvant therapy include chemotherapy, radiation
therapy, and hormone therapy. It is a type of induction
therapy.
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Cancer cells
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These cells can be divided in to 2 categories
 Proliferating
Based on the DNA changes in cells, proliferating cycle of tumor cells
can be divided into 4 phases
 Pre-synthetic phase (Gap 1 phase or G1 phase).
Cells chiefly make preparations for the synthesis of DNA.
 Synthetic phase (S phase).
Cells are synthesizing their DNA.
 Post-synthetic phase (Gap 2 phase or G2 phase).
DNA duplication has been finished and they are equally divided to the
two of future sub-cells.
 Mitosis phase (M Phase).
Each cell is divided into two sub cells. Some of these new cells enter
the new proliferating cycle, the others become non-proliferating cell
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Non proliferating
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 Non-proliferating cells include G0 phase cells (resting-
phase cells),
 G0 phase cells have proliferation ability but do not
divide temporally.
 When proliferating cells are suffered heavy casualties,
G0 phase cells will get into proliferating cycle and
become the reasons of tumor recurrence.
 G0 phase cells are usually not sensitive to antineoplastic
drugs, which is the important obstacle to tumor
chemotherapy.
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Classification of the antineoplastic drugs
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 Alkylating agents,
 Antimetabolites,
 Natural products,
 Hormones and antagonists
 Miscellaneous agents.
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Mechanisms of Antineoplastic Drugs
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Most antineoplastic drugs act on the proliferating cycle
of cell
(1) Destruction of DNA or inhibition of DNA duplication
e.g. alkylating agents, mitomycin C
(2) Inhibition of nucleic acid (DNA and RNA synthesis
e.g. 5-fluorouracil, 6-mercaptopurine, methotrexate,
cytarabine, etc.
(3). Interfering with the transcription to inhibit RNA
Synthesis e.g. dactinomycin, dauoruicin, and doxorubicin
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Mechanisms of Antineoplastic Drugs
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(4) Inhibition of protein synthesis e.g. vinca alkaloids,
epipodophylotoxins, and paclitaxel
(5) Interfering with hormone balance e.g. adrenal
corticosteroids, estrogens, tamoxifen etc.
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Types of the antineoplastic drugs
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(Ⅰ) Alkylating Agents
Alkylating agents act via a reactive alkyl (RCH2-CH2
+ -) group that reacts to form covalent bonds with nucleic
acids.
 There follows either cross-linking of the two strands of DNA,
preventing replication, or DNA breakage.
 All alkylating agents are phase-nonspecific. kill rapidly
proliferating cells, also kill non proliferating cells
 Cyclophosphamide: Most widely used in clinical
therapy for treatment of cancer at present. It has no
antineoplastic action outside the body and must be
activated in the liver
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(Ⅱ) Antimetabolites
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 It acts mainly on the S phase cells. has a serious
myelo suppression
 Example:
5 FU, Methotrexate
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(Ⅲ) Natural Products
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The major classes of natural products include
 Antibiotics( Antitumor antibiotics)
 Vinca alkaloids
 Biologic response modifiers
 Enzymes
 Epipodophyllotoxins
 Taxanes
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Antibiotic antineoplastic agents
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 Antibiotic antineoplastic agents: Damage DNA in
cycling and non cycling cells
Example: Dactinomycin (actinomycin D)
 This drug binds no covalently to double-stranded
DNA and inhibits DNA-directed RNA synthesis.
 Dactinomycin is a phase-nonspecific agent, but it is
more active against G1 phase cells.
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Vinca (plant) alkaloids
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 Vincristine and vinblastine are alkaloids derived
from the periwinkle plant.
 interfere with the assembly of spindle proteins
during mitosis..
 Act in M phase to inhibit mitosis, blocking
proliferating cells as they enter metaphase.
 Both can cause bone marrow suppression and
neurotoxicity
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(Ⅳ) Hormones and antagonists
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 Adrenocortical steroids to inhibit the growth of
cancers of lymphoid tissue and blood.
 Estrogen antagonists ( tamoxifen ) is indicated for
breast cancer.
 Estrogen is used for prostatic cancer
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(Ⅴ) Miscellaneous agents
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 Hydroxyurea inhibits ribonucleotidereductase.
inhibition of DNA synthesis.
 It is specific for the cells of S phase
 The major adverse effect of this drug is bone marrow
depression.
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Principles of combination therapies
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1. Select drugs according to their phase specific
characteristics
2. Combinations of antineoplastic drugs with different
action mechanism
3. Combinations of antineoplastic drugs with other
therapies
4. Select drugs according to antineoplastic range
(spectrum)
5. Use right dose
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LIMITATIONS OF CYTOTOXIC AGENTS
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 There are a number of problems with the safety profile
and efficacy of chemotherapeutic agents
 These affect rapidly dividing cells so do not specifically
target cancer cells in the resting phase.
 They also only influence a cell’s ability to divide and
have little effect on other aspects of tumor progression
such as tissue invasion, metastases or progressive loss of
differentiation.
 cytotoxic are associated with a high incidence of adverse
effects
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Side effects
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The most notable examples include
 Bone marrow suppression,
 Alopecia,
 Mucositis,
 Nausea and vomiting.
 Skin color changes
 Body ache
 Dirreahea
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Nursing care of the patients with chemotherapy
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 Induction chemotherapy: chemotherapy given to induce a remission.
 Consolidation chemotherapy: chemotherapy given once a remission is
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achieved to sustain a remission.
Maintenance chemotherapy: chemotherapy given after an initial
chemotherapy course to prolong a response.
Palliative chemotherapy: chemotherapy that is given specifically to
address symptom management.
First line chemotherapy: chemotherapy first used for treating cancer
that has metastasized.
Second line chemotherapy: chemotherapy given when a disease has
recurred or the patient no longer responds to first line chemotherapy.
Third and fourth line chemotherapy: chemotherapy given when a
disease has recurred or the patient no longer responds to second and third
line chemotherapy
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Nursing care of the patients with
chemotherapy
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Following are the nursing management and care of the
patient who is receiving chemotherapy
 Pre chemotherapy teaching of the patient , that
includes
(1). Teaching of side effects
(2). Prevention
(3). Diet
(4). Regimen and cycles of the chemotherapy
 Decrease the level of anxiety of the patient
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Nursing care of the patients with
chemotherapy
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 Proper I/V cannulation
(1). Proper site and side selection (mastectomy).
(2). Proper vein selection
 Hydration teachings and checking of the patients
(1). Pre hydration
(2). Post hydration
(3). Urinary output
 Keep patient under observation
 Check for I/V flow
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Nursing care of the patients with
chemotherapy
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 Check for signs of extravasations
 Check for hemorrhage and bleeding
 Check CBC ( RBC, WBC, Plt),
 Preventions (gum bleeding, urinary retention, proper
diet and fluid intake )
 Nausea and vomiting reducing strategies
 Teachings to increase the dietary intake
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Extravasations
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Extravasations has been termed “a dreaded
complication of chemotherapy. Left untreated,
vesicant chemotherapy extravasations have the
potential to cause tissue necrosis, functional
impairment, and permanent disfigurement. Surgical
intervention and wound care often are required
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Extravasations
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Extravasations
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Management of the patients with extravasations
1. Ask patient and other staff to keep on eye on the
area which is cannulated for chemotherapy
2. If signs of extravasations occurs immediately stop
the medicine
3. common symptoms of vesicant extravasations are
redness and swelling and discomfort may or may
not be present,10 application of a transparent
dressing secures the IV device
4. A blood return from the IV device should be
obtained before administering a vesicant
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Extravasations
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6. Apply topical heat or cooling (Local cooling using ice packs
or cold gel packs whereas, Local warming (dry heat) is
indicated for non-DNA-binding vesicant extravasation).
7. Antidotes and treatments (Local injection of sodium
thiosulfate is the recommended antidote, Local injection of
hyaluronidase)
8. Document the event
9. Inform the supervisor or manager about the event and
explain to the patient and family
10. Monitor the site for further complications
11. Don’t use the area for chemotherapy
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References
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Cancer Chemotherapy. (2010, December 31). Retrieved from
http://www.uic.edu/classes/pcol/pcol331/Antineoplastic%
20Agents%202011%20Dental%20MARCH-1.pdf
Kishore", W. (2011, March 23). Pharmacology of
Antineoplastic Agents. Retrieved from
http://pharmacology.xjtu.edu.cn/ppt/Anticancer.pdf
Schulmeister, L. (2010). Preventing and Managing Vesicant
Chemotherapy Extravasations. THE JOURNAL OF
SUPPORTIVE ONCOLOGY, 8(5), 212-215.
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