Antineoplastic Drugs. Antineoplastic Drugs. Herbal Alert. Pharmacology Chapter 51. Green tea

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1 Antineoplastic Drugs Pharmacology Chapter 51 Carolyn Wright, RN, BSN Ford, S. & Roach, S. (2010). Roach's introductory clinical pharmacology (9 th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. 1 Antineoplastic Drugs Chemotherapy is a term used to refer to therapy with antineoplastic drugs. Cure Control Palliation 2 Herbal Alert Green tea Polyphenols (flavonoids) Antioxidants Benefits Side Effects 3 1

2 CELL CYCLE All cells have a specific pattern (phase) of growth and division Some cells divide and reproduce in a manner of hours, others years. Chemotherapy administered in series of courses Why? 4 Hormones Exact action unclear May counteract effect of male and female hormones in hormone-dependent tumors. Alter the hormonal environment of the cell progestin megestrol (Megace) Breast or endometrial cancer Luprolide (Lupron) Prostate cancer 5 Cell Cycle-Specific Plant Alkaloids Vinca Alkaloids vinblastine sulfate (Velban) Antimetabolites Folic Acid Antagonist methotrexate (Rheumatrex) Antidote = leucovorin (Wellcovorin) 6 2

3 Plant Alkaloids Interferes with or stops cell division. Causes long term fertility problems Additive bone marrow depressive effects when administered with other antineoplastics/radiation 7 Plant Alkaloids Interactions Digoxin Anticoagulants vinblastine sulfate (Velban) increases risk of seizures 8 Antimetabolites Interfere with metabolic functions Inactivate enzymes or alter the structure of DNA and its ability to replicate. Most effective in tx of rapidly dividing neoplastic cells. When administered with other antineoplastic drugs, bone marrow depression is additive. Decreases serum digoxin levels 9 3

4 Antimetabolites Interactions methotrexate (Rheumatrex) NSAIDs = methotrexate toxicity Folic acid may decrease effects Alcohol may increase risk of hepatotoxicity fluorouracil (Adrucil, 5-FU) Food decreases absorption Not compatible with diazepam, doxorubicin, and methotrexate Inactivate live vaccines Severe cardiac problems if given with cisplatin 10 Cell Cycle Nonspecific Alkylating agents Nitrogen Mustard Derivatives mechlorethamine (Mustargen) Nitrosoureas carmustine (BCNU) (Gliadel) Platinum-Based Drugs cisplatin (Platinol-AQ) Anitineoplastic Antibiotics bleomycin sulfate (Blenoxane) 11 Alkylating Drugs Interferes with the process of cell division of malignant and normal cells. Binds with DNA, causing breaks and prevents DNA replication. Makes the cell a more alkaline environment, thus damage to the cell. Highly toxic. Many unpleasant/dangerous side effects. 12 4

5 Alkylating Drugs Interactions Cisplatin (Platinol) decreases the effects of antigout drugs. Used with aminoglycosides may increase nephrotoxicity & ototoxicity. Used with loop diuretics may increase risk for ototoxicity. Prior to Cisplatin hydrate with 1-2 L of IV fluid Mechlorethamine (Mustargen) Vesicant 13 Antineoplastic Antibiotics No anti-infective ability. Interfere with DNA & RNA synthesis delay/inhibit cell division May decrease antibody response to live virus vaccines. Increased risk of bleeding when administered with ASA, warfarin, heparin and NSAIDS Additive bone marrow depressant when given with other antineoplastics. 14 Antineoplastic Antibiotics Interactions bleomycin sulfate (Blenoxane) May decrease plasma serum digoxin levels Increased risk of toxicity when administered with cisplatin. Pulmonary toxicity may occur with other antineoplastic drugs. dactinomycin (Cosmegen) Potentiates skin/gi reactions of radiation tx doxorubicin (Adriamycin) Cardiotoxicity Hyperuricemia Encourage po of 2000mL per day 15 5

6 Adverse Reactions Potentially toxic associated with serious adverse reactions. Immediate During Cycle of therapy Long term 16 Adverse Reactions Anitineoplastic drugs affect rapidly proliferating cell, both cancer cells and normal cell, so common adverse reactions are: Bone marrow depression Stomatitis Diarrhea Hair loss 17 Adverse Reactions Often dose dependent Severity may increase with repeated doses Pre-medicate in anticipation of these adverse reaction IV Fluids Electrolytes Antiemetics 18 6

7 Antineoplastic Drugs Contraindications Leukopenia Thrombocytopenia, Anemia Serious infections Serious renal disease Hypersensitivity to drug Pregnancy 19 Cytoprotective Agents Drugs given with antineoplastic drugs to protect normal cells or organs or counteract the adverse affects, thus preventing irreversible harm. Allopurinol Leucovorin 20 Herbal Alert Shiitake Mushrooms Lentinan Benefits Mild Side Effects 21 7

8 Nursing Assessment Preadministration assessment Stage, location, and type of cancer Overall physical condition Psychosocial Previous or concurrent treatments Medical history Knowledge Family support, financial concerns ect. Initial physical assessment (baseline data) 22 Nursing assessment Preadministration Some Anitineoplastic drugs require treatment measure before the administration. Examples: Antiemetics Hydration Patient receive 1-2 Liters of IV fluids before administration of cisplatin (Platinol) 23 Nursing Assessment Ongoing assessment: Pt general condition Response to treatment Adverse reactions Infection Labs CBC Kidney function test 24 8

9 Nursing Assessment Leukopenia: Leukocyte count less than 5000/mm 3 (normal ,000/mm 3 ) Neutrophils are major component of the inflammatory process and defense against bacterial infection Thrombocytopenia: Low platelets or thrombocytes less than 100,000/mm 3 (normal 150, ,000/mm 3 ) Know your Nursing interventions? 25 Nursing Assessment (anemia) Hematocrit Male: 40-54% Female: 37-47% Hemoglobin Male: g/dl Female: g/dl Red Cell Count Male: million/ml Female: million/ml 26 NADIR The lowest counts after chemo tx, before recovery begins. Drugs to treat NADIR Neupogen Neulasta 27 9

10 Planning Optimal response to therapy Management of adverse reactions Patient understanding of therapy 28 Implementation Care of the Patient Settings Written guidelines & protocols 29 Safety Table 51.1 & Display 51.5, pg 525 Wear disposable gloves Preparation 30 10

11 Routes of Administration Oral Convenient and non-invasive Most are absorbed well through the GI tract Taken at home Examples: Xeloda Temodar 31 Parenteral Administration IM SQ IV 32 Managing Adverse Reactions Alopecia Anorexia Bone marrow suppression 33 11

12 Managing Adverse Reactions Nausea and Vomiting Stomatitis Diarrhea Tissue integrity Anxiety 34 Vesicants Some antineoplastic drugs are vesicants Mustargen Adriamycin Vinblastine Vincristine Vesicants cause tissue necrosis when they infiltrate or extravasate out of the blood vessel and into the soft tissue Vesicants are usually given through a central line Must keep an extravasation kit containing all material to manage an extravasation, along with policies and procedure guideline. 35 Patient and Family Education Must educate patient and family on the basics Take medication as directed Follow all recommendations No OTC drugs without consulting MD Know the name of the medication Never omit a dose Watch for adverse reactions Keep all appointments Emotional support 36 12

13 Important Read ALL Nursing Alerts, Boxes, Displays, & Tables Study Guide 37 13