Transcript Roach: Introductory Clinical Pharmacology

Introduction to Clinical
Pharmacology
Chapter 50
Antineoplastic Drugs
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Antineoplastic Agents
• May not always lead to a complete cure of the cancer,
they slow the rate of tumor growth and delay
metastasis*
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Herbal Alert
• Green tea
– Antioxidant
– Patients with insomnia and ulcers should use green
tea with caution
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Cell Cycle–Specific Drugs: Actions and
Uses
• Plant alkaloids:
– Vinca alkaloids: Interfere with amino acid
production in S phase and formation of
microtubules in M phase
– Taxanes: Interfere in M phase with
microtubules
– Podophyllotoxins: Cells are unable to divide
since cells are stopped during S and G2
phases by the podophyllotoxins
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Cell Cycle–Specific Drugs: Actions and
Uses (cont.)
• Antimetabolites:
– Incorporate themselves into the cellular
components during the S phase of cell
division
– Drugs are used to treat:
•Leukemia, lymphoma, solid tumors,
autoimmune diseases
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Cell Cycle–Nonspecific Drugs: Actions
and Uses
• Alkylating agents:
– Change cell to more alkaline environment, which
in turn damages the cell
• Antineoplastic antibiotics:
– Interfere with DNA and RNA synthesis, delaying
or inhibiting cell division
• Miscellaneous antineoplastic drugs:
– A number of drugs are used for antineoplastic
actions, do not belong to any one category
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Cell Cycle–Nonspecific Drugs: Adverse
Reactions
• Nausea and vomiting from highly emetic drugs or
potential of IV extravasation of irritating solutions
• Adverse reactions common to antineoplastic drugs:
– Bone marrow suppression; stomatitis; diarrhea;
hair loss
– Leukopenia and thrombocytopenia may cause
cycles of chemotherapy to be delayed until
blood cell counts can be raised
– Damage gonads, causing fertility problems
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Cell Cycle–Nonspecific Drugs:
Interactions
Interactant drug
Effect of interaction
Plant alkaloids
Digoxin
Decreased serum level
of digoxin
Phenytoin
Increased risk for seizures
Oral anticoagulants
Prolonged bleeding
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Cell Cycle–Nonspecific Drugs:
Contraindications and Precautions
• Antineoplastic drugs are contraindicated in patients:
– With leukopenia, thrombocytopenia, anemia,
serious infections, renal disease, and
hypersensitivity to drug; during pregnancy or
lactation
• Used cautiously in:
– Patients with renal or hepatic impairment, active
infection, and debilitating illnesses; those who have
completed treatment with other antineoplastic
drugs or radiation therapy
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Cytoprotective Agents
• Table 50.4
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Nursing Process: Assessment
• Preadministration assessment:
– Initial assessment:
•The type and location of the neoplastic
lesion
•The stage of the disease
•Patient’s general physical condition,
emotional response to the disease
•Anxiety or fears the patient may have
regarding chemotherapy treatments
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Nursing Process: Assessment (cont.)
• Preadministration assessment (cont.):
– Initial assessment (cont.):
•Previous, concurrent treatments
•Current nonmalignant disease or
disorder
•The patient’s knowledge or
understanding of the proposed
chemotherapy regimen
•Depressing effects on bone marrow-lab
test such as a CBC are ordered
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Nursing Process: Assessment (cont.)
• Ongoing assessment:
– The patient’s general condition
– The patient’s individual response to the drug
– Adverse reactions that may occur
– Guidelines established by the primary health
care provider or hospital
– Results of periodic laboratory tests and
radiographic scans
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Nursing Process: Nursing Diagnoses
• Imbalanced Nutrition: Less Than Body Requirements
related to anorexia, nausea, vomiting, and stomatitis
• Fatigue related to anemia and myelosuppression
• Risk for Injury related to thrombocytopenia and
myelosuppression
• Risk for Infection related to neutropenia, leukopenia, and
myelosuppression
• Disturbed Body Image related to adverse reactions of
antineoplastic drugs (e.g., alopecia, weight loss)
• Anxiety related to diagnosis, necessary treatment measures,
the occurrence of adverse reactions, other factors
• Impaired Tissue Integrity related to adverse reactions of
the antineoplastic drugs (radiation recall and extravasation)
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Nursing Process: Planning
• Expected outcomes:
– An optimal response to therapy
– Support of patient needs related to the
management of adverse reactions
– Understanding of prescribed treatment
modalities
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Nursing Process: Implementation (cont.)
• Promoting an optimal response to therapy
– Protection of the provider:
•The Occupational Safety and Health
Administration (OSHA) guidelines
•Nurses need to be protected during
administration and cleanup from
accidental ingestion, inhalation, or
absorption of drugs
•Table 50-1**
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Nursing Process: Implementation (cont.)
• Promoting an optimal response to therapy
(cont):
– Oral administration:
•Administer antineoplastic drugs orally
•GI tract functions normally when oral
drugs are well absorbed
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Nursing Process: Implementation (cont.)
• Promoting an optimal response to therapy
(cont.):
– Parenteral administration:
•Give injection into large muscles using
Z-track method
•Sites should be rotated, charted
appropriately if the injections are given
frequently
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Nursing Process: Implementation (cont.)
• Monitoring and managing patient needs:
– Imbalanced nutrition: Less than body
requirements
•Assess nutritional status of patient before
and during treatment
•Provide small, frequent meals to coincide
with patient’s tolerance for food to
stimulate appetite
•Stress importance of eating meals high in
nutritive value, particularly protein
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Nursing Process: Implementation (cont.)
• Monitoring and managing patient needs (cont.):
– Fatigue, infection and injury:
Myelosuppression
•Help patient learn to prioritize activity to
conserve energy
•Monitor patients with thrombocytopenia
for bleeding tendencies and take
precautions to prevent bleeding
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Nursing Process: Implementation (cont.)
• Monitoring and managing patient needs (cont.):
– Fatigue, infection and injury:
Myelosuppression (cont.):
• Apply pressure to injection site for 3 to 5
minutes to prevent bleeding into tissue
and formation of hematoma
• Inform patient to avoid use of electric
razors, nail trimmers, dental floss, firm
toothbrushes, any sharp objects
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Nursing Process: Implementation (cont.)
• Monitoring and managing patient needs (cont.):
– Disturbed body image: Inform patient that
hair loss may occur if hair loss is associated
with antineoplastic drug being given
•Forewarn patient that hair loss may occur
suddenly and in large amounts
•Assist in making plans for purchase of wig
or cap to disguise hair loss until hair grows
back
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Nursing Process: Implementation (cont.)
• Monitoring and managing patient needs (cont.):
– Impaired tissue integrity (cont.):
• Monitor IV site continuously and check for blood
return frequently during IV push procedures
• Keep extravasation kit containing all materials
necessary to manage extravasation available,
along with extravasation policy and procedure
guidelines
• Monitor for erythema**
• Wear loose protective clothing**
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Nursing Process: Implementation
• Educating the patient and family:
– Take drug only as directed and do not alter
the dose unless advised
– All recommendations given by the primary
health care provider are important
– Effectiveness or action of the drug could be
altered if these directions are ignored
– Keep all appointments for chemotherapy
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Nursing Process: Implementation (cont.)
• Educating the patient and family (cont.):
– Do not take nonprescription drug unless
approved by primary health care provider
– Avoid drinking alcoholic beverages unless
approved by PHCP
– Inform physicians, dentists, medical
personnel of therapy with this drug
– Keep all appointments for laboratory tests
ordered by the primary health care provider
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Nursing Process: Evaluation
• The therapeutic effect is achieved
• Adverse reactions are identified, reported, and
managed
• Anxiety is reduced
• The patient verbalizes:
– An understanding of the dosage regimen;
understanding of treatment modalities;
importance of continued follow-up care;
complying with the prescribed therapeutic
regimen
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