Antineoplastic Drugs

Adams et al Chapter 37

Cancer

STAGES

Anaplasia Loss of cellular

differentiation & organization

Autonomy Grow without rules or

boundaries Metastasis

Leaves “home”, travels from place of origin▪ Breast tissue found in

lung mass

CAUSES

Genetic predisposition Viral infection Constant irritation and

cell turnover Stress (suppresses

immune system) Pipe smokers Exposure to

carcinogens

Types of Cancer

Solid Carcinomas▪ Originate in epithelial cells; breast, bronchial

tubes, skin Sarcomas▪ Originate in mesenchyme and made of

embryonic connective tissue; bone, cartilage, blood, lymphatic system

Hematological Leukemias (bone marrow) Lymphomas (lymphatic system)

Goal of cancer treatment

Destroying cancer cells through several methods: Surgery to remove them Stimulation of the immune system to

destroy them Radiation therapy to destroy them Drug therapy to kill them during various

phases of the cell cycle (replication phase)

Categories of Antineoplastics

Alkylating Agents React chemically with portions of the

RNA, DNA, or other cellular proteins Antimetabolites

Have chemical structures similar to those of natural metabolites

Antineoplastic Antibiotics Not selective only for bacterial cells;

toxic to human cells

Categories of Antineoplastics Mitotic Inhibitors

Drugs that kill cells as the process of mitosis begins

Hormones and Hormone Modulators Used in cancers that are sensitive to

estrogen and androgen stimulation Cancer Cell Specific Agents (Biologics)

Treat chronic myeloid leukemia (CML) and CD117-positive unresectable or metastatic malignant GI stromal tumors (GIST)

Nursing Considerations for all Antineoplastics

Do not administer during pregnancy Do not administer during lactation Assess renal/hepatic function tests Assess all drugs metabolized by liver GI effects

N/V/D, anorexia, mucous membrane deterioration

Administer allopurinol (Zyloprim) as drug causes ↑ uric acid levels

Alopecia major concern for patients

Nursing Assessments

Assess allergies Perform baseline physical assessment

Anthropometrics (height, weight, BMI) Orientation and reflexes CBC

Before, during, 3 weeks after last treatment Maintain proper hydration Protect patient from infection

Protective environment, isolation during hospital stay

Nursing Assessments

Small, frequent meals Frequent mouth care Dietary consult PRN Proper head covering Patient teaching regarding

Refraining from eating harsh foods if experiencing mouth/throat pain, no fresh fruits/veggies

Plan rest periods Barrier contraceptives

Bone Marrow Suppression Patient

experiences fatigue d/t low RBC

Space activities to allow rest periods

Inform pt. this is normal experience

↑ bruising d/t ↓ PLT Protect from infection

d/t ↓ WBC

Antiemetics with Cancer Chemotherapy

Antihistamines, corticosteroids adjuvant therapy

Ice chips, mouth care, environmental control with emetics

Marinol Zofran Emend Xanax, Ativan Reglan Haldol

Extravasation

Alkylating Agents

Non-cell specific Treat slow growing

cancer Cisplatin most

common medication Adverse effects

Bone marrow suppression

Thrombocytopenia, anemia, pancytopenia, leukopenia

Antimetabolites

Inhibit DNA synthesis in S phase thus preventing cell replication

Treat leukemias, some GI, basal cell cancers

Used as combo drugs as cells develop resistance

Leucovorin to help normal cells

Antineoplastic Antibiotics Treat leukemias

and AIDS associated Kaposi sarcoma

Does not cross blood- brain barrier

Zinecard as a cardioprotective drug

Mitotic Inhibitors (Natural Products)

Kill cells at beginning of mitosis

effect rapidly dividing cells

Treat leukemias, tumors

Hormone Modulators

Breast, ovaries, uterus, prostate, testes=all sensitive to estrogen stimulation

Can mimic s/s menopause

Hypercalcemia ↑ CVD ↑ risk of bleeding with

anticoagulants

Cancer cell specific: Gleevec Treats CML Treat cells specific to the cancer type

without interfering with normal cell growth&function

1st line of defense drug, given PO Expensive, $30,000-$35,000/year Administer with a meal, full glass of water Small, frequent meals; analgesics for

headache/muscle pain CBC, edema Oral administration

Across the Lifespan