Download Antineoplastics and Antianemics

Pharmacology I
NURS 1950
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
Objective 1: Describe the general factors
utilized to select the therapy used to treat
cancer
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
Objective 2: Describe the general uses of
chemotherapy in the treatment of cancer
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
Objective 3: Identify the basic types of
antineoplastic drugs
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 Alkylating
agents
 Antimetabolites
 Natural products
 Antineoplastic antibiotics
 Hormones
 Biologic response modifiers &
Misc.
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 Bond
with DNA so it can’t
separate = no replication
 Cell-cycle nonspecific
◦ Resistance can be a problem
 Creates cross resistance with
other alkylating agents
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
Alkylating agents: non cell cycle specific
drugs
◦ Activity occurs when the cell tries to replicate and
the DNA can not separate
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 Busulfan
(Myleran)
 Carboplatin (Paraplatin)
 Carmustine (BCNU)
 Chloramubil (Leukeran)
 Cisplatin (Platinol)
 Cyclophosphamide (Cytoxan)
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 Fudarabine
(Fludara)
 Lomustine (CCNU, CeeNU)
 Mechlorethamine (Nitrogen
mustard, Mustargen)
 Melphalan (Alkeran)
 Streptozocin (Zanosar)
 Thiotepa
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 In
general, toxicities include
◦ N/V, anorexia
◦ Bone marrow depression
◦ Anemia
◦ Nephrotoxicity
◦ Hepatic and renal toxicity
◦ Alopecia
◦ Cystitis
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 Each
drug may have specific
toxicities
◦ Example: Zanosar causes
hypoglycemia
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 Drugs
included
◦ Capecitabine (Xeloda)
◦ Cytarabine hydrochloride
(Cytosar)
◦ Fludarabine (Fludara)
◦ Flurouracil (5-FU, FU)
◦ Gemcitabine (Gemzar)
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 Mercaptopurine
(6-MP,
Purinethol)
 Methotrexate (MTX)
 Thioguanine (Lanvis)
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
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)
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 In
general, toxicities include
◦ N/V, diarrhea, constipation,
fatigue
◦ Bone marrow depression,
dermatitis
◦ Oral and GI ulceration
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 Come
from periwinkle plant,
specific yews
 Cell-cycle specific: block mitotic
spindle during mitosis
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
Drugs include
◦
◦
◦
◦
◦
◦
Etoposide (VePesid)
Docetaxel (Taxotere)
Paclitaxel
Vinblastine sulfate (Velban, Velbe)
Vincristine sulfate (Oncovin)
Vinorelbine (Navelbine)
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
General toxicities
◦ N/V, stomatitis
◦ Leukopenia with VePesid: nadir in 10-14 days,
recovery 3 weeks
◦ Bone marrow suppression, alopecia, peripheral
neuritis, hepatotoxicity, bronchospasm
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 Bind
to DNA, inhibit DNA, RNA
synthesis
 Cell-cycle nonspecific
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 Drugs
include
◦ Bleomycin (Blenoxane)
◦ Dactinomycin (Actinomycin D,
Cosmegen)
◦ Daunorubicin (Cerubidine)
◦ Doxorubicin (Adriamycin)
◦ Epirubicin (Ellence)
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 Idarubicin
 Mitomycin
C
 Mitoxantrone
 Plicamycin
 Valrubicin
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 Generally,
toxicities include
◦ N/V, red tinged urine with
some
◦ Bone marrow depression
◦ Cardiotoxicity
◦ Pulmonary fibrosis
(Bleomycin)
◦ GI bleeding, CNS effects with
some
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 Corticosteroids:
lymphoma and
acute leukemia as suppress
mitosis in lymphocytes
◦ Help restore sense of well being,
decrease edema with radiation,
increase appetite and strength
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
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)
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
Drugs included
◦ Anastrozole (Arimidex)
◦ Diethylstilbestrol (DES)
◦ Prednisone
◦ Tamoxifen (Nolvadex)
◦ Testolactone (Teslac)
◦ Testosterone
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
General toxicities
◦ N/V, headache
◦ Fluid retention, feminization or
masculinization
◦ Hot flashes
 Some can cause
thrombocytopenia, leukopenia,
hypercalcemia, increased bone
and tumor pain
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 Drugs
included
◦ Altretamine (Hexalen)
◦ Dacarbazine (DTIC-dome)
◦ Hydroxyurea (Hydrea)
◦ Interferon alfa-2b (Roferon-a)
◦ Leuprolide acetate (Lupron)
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 Toxicities
in general
◦ N/V, hot flashes, bone marrow
depression, arrhythmias
◦ Flulike syndrome
◦ Anemia, leukopenia
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 Drugs
used as adjunct therapy
◦ Epoetin alfa (Procrit) stimulates
production of red blood cells
◦ Used to treat anemia induced by
chemotherapy
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 Filgastim
(Neupogen) stimulates
the production of neutrophils
(WBC)
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 Oprelvekin
(Neumega) stimulates
platelet production at stem cell
level
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 Rituximab
(Rituxan) binds to the
surface of B lymphocytes
◦ Used to treat relapsed B-cell
non-Hodgkin’s lymphoma
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 Sargramostim
(Leukine)
stimulates the production of
granulocytes and macrophages
 Also helpful in aplastic anemia
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 Trastuzumab
(Herceptin) inhibits
growth of tumor cells (especially
useful in metastatic breast cancer)
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 Amifostine
(Ethyol) reduces toxic
effects of cisplatin
◦ Reduces renal toxicity
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 Dexrazoxane
(Zinecard) used with
doxorubicin
◦ Reduces cardiomyopathy
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 Mesna
(Mesnex) reduces toxic
effects of Ifex and Cytoxan
◦ Reduces hemorrhagic cystitis
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
New class: antiangiogenesis
◦ Prevent new blood vessels
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 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
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 Objective
5: describe what
“tumor resistance” means
◦ Tumor cells are not as
susceptible to antineoplastic
agents as they should be
 Cells escape damage from
the drugs
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 Objective
6: specify which normal
cells are frequently affected by
antineoplastic therapy; and signs
and symptoms that result most
frequently
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 Normal
cells responding to
chemotherapy
◦ Rapidly growing cells
 GI tract
 Hair follicles
 RBCs, WBCs, platelets
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
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
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◦ Diarrhea: skin care a must
◦ Avoid foods that stimulate bowel
motility
◦ Eat foods high in K+ (loose it
with diarrhea)
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 Alopecia
◦ Hair will begin to fall out in
clumps
 Devastating—cut hair short;
get wigs, caps, turbans
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 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
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 Decreased
RBCs = decreased 02
transport
◦ May receive Procrit
◦ May have blood transfusion
◦ Need to rest often
◦ Avoid orthostatic hypotension
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 Neutropenia:
avoid crowds
(infections)
◦ Neupogen may be used
◦ Meticulous care of central lines
needed
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 Thrombocytopenia:
client needs
to watch for bleeding
◦ Nurse: use smallest needle when
MUST give parenteral medication
◦ Neumega may be used
◦ Teach safety measures
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 Objective
7: discuss the nursing
care for the client receiving
antineoplastic therapy
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
Clients with cancer require holistic nursing
◦ Medications
◦ Physical assessment
◦ Psychosocial support
◦ Emotional support
◦ Growth and development support,
esp. for kids
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 Care
of the nurse
◦ Prevent inhalation of aerosols
◦ Prevent drug absorption
through the skin
◦ Safe disposal
◦ Prevent contamination of body
fluids
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 Objective
8: describe the types of
anemias
 Anemia is a condition in which the
hemoglobin concentration or the
number of circulating RBCs is
decreased
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◦ Anemia occurs because of:
 Blood loss
 Hemolysis
 Bone marrow dysfunction
 Deficiencies of substances
essential for hematopoiesis
 Lack of iron, vitamin B12 or folic
acid
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 Objective
9: identify drugs used to
treat iron deficiency anemia
 Drugs include ferrous sulfate,
ferrous gluconate, ferrous
fumarate and iron dextran
(Imferon); iron polysaccharide
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 Objective
10: describe the nursing
responsibilities associated with
administering iron preparations
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 Ferrous
sulfate
◦ Oral, usually tablet or capsule
◦ SE: usually GI—nausea,
pyrosis, bloating, constipation
or diarrhea
◦ If liquid prep: stains teeth
 Dilute in water or juice
 Administer with a straw
 Rinse mouth after
administration
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 High
doses are toxic
◦ Usually accidental
◦ Children susceptible: >3 gms
can be fatal
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 Ascorbic
acid promotes
absorption
 Tetracycline and antacids
decrease absorption
 Iron (Fe) used for iron deficiency
anemia or to prevent (pregnancy)
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 Ferrous
gluconate and ferrous
fumarate
◦ Same therapeutic effect as
ferrous sulfate
◦ If no response to one drug form,
no response to the others
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 Iron
dextran: for parenteral
administration
◦ Used when oral iron ineffective
or intolerable
◦ Given IM or IV
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 Major
adverse effect
◦ Anaphylactic shock
◦ Test doses given for IV before
the dose
 Have emergency drugs
available STAT
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 IM
iron
◦ Persistent pain and discoloration
at site occur
◦ Can cause anaphylactic reactions
◦ Must use Z track method of
administration
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 Objective
11: describe pernicious
anemia and identify the drug used
to treat it
◦ May see it called vitamin B12
deficiency anemia or
megaloblastic anemia
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
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
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 Vitamin
B12 can be oral or
parenteral administration
 Cyanocobalamin can be given IM
or deep subq
 Oral form usually as dietary
supplement
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 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
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 Objective
12: apply the nursing
process when caring for the client
receiving antineoplastic and
antianemic agents
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 Anxiety
 Knowledge
deficit
 Disturbed body image
 Anticipatory grieving
 Risk for infection
 Risk for injury
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 Nutrition:
less than body
requirements (or a risk for)
 Impaired tissue integrity (or risk
for)
 Chronic pain (or acute, depending
upon the situation)
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 Activity
intolerance
 Impaired oral mucous membranes
 Self-care deficit
 Nutrition: less than body
requirements
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