Oncology Medications Chemotherapy Agents. Oncology Medications Key Terms Cancer – uncontrolled...

Oncology Medications

Chemotherapy Agents


Key Terms• Cancer – uncontrolled cell division and growth

• Malignant – invade other tissues

• Proliferation – multiply rapidly

• Metastasis – the spread of cancerous cells

• Antineoplastics – drugs used to control the growth of malignant cells


• Proliferation– The purpose of antineoplastic drug therapy is to attack

cells that rapidly divide and reproduce

– Malignant cells usually proliferate rapidly

• Other Rapidly Growing Cells– Oral and GI mucosal lining

– Bone marrow

– Hair follicles

– Gonads

– Lymph


• Cell Cycle– G1-RNA and proteins

are built– S-DNA is made– G2-RNA and protein

prepare for cell division

– M-Mitosis occurs– G3-Cell rests


• Cell Cycle Specific Drugs– Attack cells

somewhere during mitosis


• Cell Cycle Nonspecific Drugs– Attack cells anywhere

in the cell cycle


Uses

• Cure – destroy all malignant cells

• Control – delay metastasis

• Control – slow tumor growth

• Palliative – provide comfort


Cell Cycle Specific Drugs

• Plant Alkaloids– Prevent mitosis

• Antimetabolites– Prevent mitosis


Cell Cycle Nonspecific Drugs

• Alkylating agents– Change to alkaline environment

• Antineoplastic antibiotics– Prevent or inhibit cell division

• Miscellaneous antineoplastics– Number of actions


Combination Therapy

• Combination of one or more chemotherapy agents

• May include radiation as well


Common Chemotherapy Agents

– paclitaxel (Taxol): ovarian, breast cancers– fluorourecil [5-FU] (Adrucil): breast, stomach,

pancreas, colon, rectum– cyclophosphamide (Cytoxan): Lymphomas,

Hodgkin’s disease, RA, SLE– methotrexate (Rheumatrex): Leukemia, non-

Hodgkin’s lymphoma, breast, RA


Adverse Reactions


Adverse Reactions

Hand and Foot Syndrome


Adverse Reactions

Hyperuricemia


Adverse Reactions

Urine Discoloration


Adverse Reactions

Radiation Recall


Adverse Reactions

NauseaDiarrhea

Extravasation

AlopeciaStomatitis - Mucositis


Adverse ReactionsMyelosuppression (Bone Marrow Suppression)

ThrombocytopeniaPlatelet count less than 100,000 mm3

LeukopeniaNeutropenia

WBC less than 2,500 / mm3infection

AnemiaDecreased RBC and Hct

fatigue


Adverse Reactions

– Inevitable

–Dose dependent

–May delay chemotherapy

Lactation

Pregnancy

Renal or hepatic dysfunction

Previous allergic or hypersensitivity reactions


Use cautiously with

Infection or debillitating illness


Precautions Protecting the Health Care

Provider


Preparing the Medications


Handling urine and

other bodily fluids


InteractionsPlant Alkaloids

– Digoxin (decreased serum level of digoxin)– Phenytoin (increased risk of seizures)– Oral anticoagulants (prolonged bleeding)


InteractionsAntimetabolites

– Digoxin (decreased serum level of digoxin)– Phenytoin (decreased need for antiseizure

medication)– NSAID’s (methotrexate toxicity)


InteractionsAlkylating Drugs

– Aminoglycosides (increased risk of nephrotoxicity and ototoxicity)

– Loop Diuretics (increased risk of ototoxicity)– Phenytoin (increased risk of seizure)


InteractionsAntineoplastic Antibiotics

– Digoxin (decreased serum level of digoxin)


InteractionsMiscellaneous Antineoplastics

– Insulin and oral hypoglycemics (increased risk for hyperglycemia)

– Oral anticoagulants (prolonged bleeding times)– CNS depressants (increased CNS depression)


Special CircumstancesExtravasation

• Is this a vesicant drug?• Is a vesicant protocol

in place?• What are the

symptoms?• What is the response?


Special CircumstancesOral Mucositis - Stomatitis

• Good mouth care• Avoid strong or

alcohol-based mouthwashes

• Saline rinses• Offer ice cubes during

chemotherapy


Special CircumstancesMyelosuppression

• Anemia (Decreased RBC, Hct)

• Leukopenia / Neutropenia (WBC < 2,500)

• Thrombocytopenia (Platelet Count < 100,000)

Oncology MedicationsNursing Process

• Assessment

– Type and location of neoplasm– Stage of the disease– General physical condition– Emotional response to disease– Previous or concurrent therapies– Knowledge– Lab results


• Planning

– Adverse reactions– Premedicate for nausea (Zofran)– Oral complications (NS rinses, ice cubes)– Anemia (epoetin, blood transfusions)– Neutropenia (Neupogen)– Leukopenia (Leukogen)– Thrombocytopenia (platelet transfusions)


• Suggested Nursing Diagnoses

– Imbalanced nutrition: less than body requirements r/t adverse drug effects (e.g., anorexia, stomatitis)

– Fatigue r/t adverse drug effects (decreased RBC, Hct)

– Risk for injury r/t adverse drug effects (thrombocytopenia)


• Suggested Nursing Diagnoses (cont.)

– Risk for infection r/t adversedrug effects (leukopenia)

– Disturbed body image r/t drug effects (e.g., alopecia, weight loss, fluid retention)

– Anxiety r/t to diagnosis, anticipatory grieving– Impaired tissue integrity r/t adverse drug

effects (e.g., radiation recall, extravasation)


• Implementation

– Route of administration– Precautions for patient– Precautions for health care provider


• Evaluation

– Response to treatment– Evidence of adverse reactions– Pain management


• Patient Teaching

– Follow physician’s directions at all time– Good hygiene, stay away from crowds, sick

people– Contact primary physician before taking any

prescribed or OTC meds, herbs, etc.– Avoid alcohol– Keep radiated areas clean and dry

Oncology MedicationsKey Points

• Why are antineoplastics used?• What are the adverse effects?– Benign– Potentially lethal

• What can nurses do to minimize these adverse effects?

• What precautions should be taken to protect the patient?

• What precautions should be taken to protect the health care provider?

Oncology Medications Chemotherapy Agents. Oncology Medications Key Terms Cancer – uncontrolled...

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