Transcript Antineoplastics and Antianemics

Pharmacology
NURS 1950
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Objective 1: Describe the general factors
utilized to select the therapy used to treat
cancer
◦ Surgery
◦ Radiation
◦ Chemotherapy
 Most effective against rapidly growing cells
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Objective 2: Describe the general uses of
chemotherapy in the treatment of cancer
◦ Through blood
◦ Into body cavities
◦ As adjuvant therapy
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Cure:
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Palliation
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prophylaxis
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Objective 3: Identify the basic types of
antineoplastic drugs
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◦ G0 Phase: resting stage
◦ G1 Phase: synthesizes material needed to duplicate
DNA
◦ S Phase: duplicates DNA
◦ G2 Phase: premitotic phase
◦ M Phase: mitosis occurs
◦ Cell returns to G0 phase
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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
◦ Blood cells are very sensitive/responsive to this
activity
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 Busulfan
(Myleran)
 Carboplatin (Paraplatin)
 Carmustine (BCNU)
 Chloramubil (Leukeran)
 Cisplatin (Platinol)
 Cyclophosphamide
◦ prototype
(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
◦ infertility
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Discontinue if RBC, WBC and platelet counts
fall
Caution use: hepatic or renal impairment
Hydrate before chemo—IV or oral
Advise to avoid crowds
Monitor nutritional intake
Assess for N/V—admin meds as needed
Offer non meds to relieve mouth pain
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Assess skin integrity
Monitor for hearing loss
Inform regarding impact of infertility
Maintain strict medical asepsis
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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
Purinethol)
 Methotrexate
(6-MP,
(MTX) prototype
◦ Overdosed: Leucovorin as rescue
drug
 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)
 Uses: choriocarcinoma, breast, head
and neck and lung ca, leukemia
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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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Contraindicated in pregnancy, hepatic and
renal insufficiency, cardiac conditions
Avoid pregnancy for 6 months with category
X drug
Monitor for photosensitivity and idiosyncratic
pneumonitis
Teach good oral hygiene, mouth rinses
Monitor IV site for extravasation
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 Come
from periwinkle plant,
specific yews
 Cell-cycle specific: block mitotic
spindle during mitosis
 Use: Hodgkins, non hodgkins,
Karposi, Wilm’s tumor, bladder
and breast CA
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Drugs include
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Etoposide (VePesid)
Docetaxel (Taxotere)
Paclitaxel
Vinblastine sulfate (Velban, Velbe)
Vincristine sulfate (Oncovin) Prototype
Vinorelbine (Navelbine)
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Assess for allergies to plants, foods
Vincristine may produce acute broncho
spasm and rash
Ask about pregnancy/breast feeding
Emphasize nutritional plan to combat
constipation
Monitor BP; watch for syncope, HA, dizziness
May produce mental depression; assess for
suicidal ideation
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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
 Admin IV or via catheter to body
cavity
 Use: breast, bladder, lung, ovary
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 Drugs
include
◦ Bleomycin (Blenoxane)
◦ Dactinomycin (Actinomycin D,
Cosmegen)
◦ Daunorubicin (Cerubidine)
◦ Doxorubicin (Adriamycin)
 prototype
◦ Epirubicin (Ellence)
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 Idarubicin
 Mitomycin
C
 Mitoxantrone
 Plicamycin
 Valrubicin
◦ Bladder specific
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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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Assess cardiac status—EKG
Ask about pregnancy/lactation
Risk of hypersensitivity as in other antibx
No rectal suppositories or temp due to rectal
mucosal changes
Wear protective clothing when preparing drug
Monitor IV site
Give drug thru large bore, quickly running IV
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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
 Action:
mostly unknown
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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)
◦ Normally given as palliation
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Drugs included
◦ Anastrozole (Arimidex)
◦ Diethylstilbestrol (DES)
◦ Prednisone
◦ Tamoxifen (Nolvadex)
 prototype
◦ 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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Assess for pregnancy/lactation
Tamoxifen is only ‘curative’ drug
◦ Important that family knows and understands
limitations of this category
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Fertility affected
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Drugs included
◦ Altretamine (Hexalen)
◦ Dacarbazine (DTIC-dome)
◦ Hydroxyurea (Hydrea)
◦ Interferon alfa-2b (Intran)
 prototype
◦ Leuprolide acetate (Lupron)
Action: stimulate immune system
to fight tumor cell growth
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 Toxicities
in general
◦ N/V, hot flashes, bone marrow
depression, arrhythmias
◦ Flulike syndrome
◦ Anemia, leukopenia
◦ Less toxic than other CA drugs
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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
◦ Increased risk of thrombus
formation
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 Filgastim
(Neupogen) stimulates
the production of neutrophils
(WBC)
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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
◦ Side effects:
 Resp distress with initial dosing
 Follow protocol
 Use: AML, bone marrow transplant
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 Oprelvekin
(Neumega) stimulates
platelet production at stem cell
level
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 Trastuzumab
(Herceptin) inhibits
growth of tumor cells (especially
useful in metastatic breast cancer)
◦ Binds to specific protein in breast ca
cells that leads to death of cell.
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◦ Prevent new blood vessels
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Multiple drugs from different classes
◦ Affect different stages in cell cycle
◦ Use different mechanisms of action to increase cell
kill
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Combinations allow for lower doses
◦ Reduce toxicity
◦ Slow development of resistance
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Specific dosing protocols
◦ Depend on the type of tumor, stage of disease,
overall condition of the client
◦ Given as single dose or several
◦ Over days or weeks
 Allows normal cells to recover
◦ Sometimes doses needs to be delayed
 Allow client to recover
 ie bone marrow depression
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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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