Principles of Principles of ChemotherapyChemotherapy

ObjectivesObjectivesAt the completion of this session the participant will be able to:◦Define combination chemotherapy

◦Recognize classifications for chemotherapeutic agents

◦Identify common side effects for selected agents

◦Describe nursing interventions for selected agents

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Factors Affecting Factors Affecting Response to Response to MedicationMedication

Pharmacogenetics

Diet

Kidney Function

Liver Function

Infections3

Classes of Classes of Chemotherapeutic Chemotherapeutic

AgentsAgents

ClassificationsClassificationsCell-cycle-specific

◦Cell-cycle specific drugs kill cells that are actively dividing during specific phases of the cell life cycle

Cell-cycle-nonspecific◦Affects cells equally regardless of the cell phase

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Alkylating AgentsAlkylating AgentsEither inaccurately replicate or inhibit the replication of DNA causing cell mutation or death

They are most active in the resting (Go) phase

Examples:◦cyclophosphamide◦ifosfamide◦platinum complexes◦topoisomerase I inhibitors

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Antitumor Antitumor AntibioticsAntibiotics

Bind to DNA and interfere with further replication of DNA, and transcription of RNA

They are active in all phasesExamples:

◦doxorubicin◦daunorubicin◦idarubicin◦dactinomycin

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AntimetabolitesAntimetabolitesResemble essential metabolic elements needed for cell growth and are altered so that synthesis of RNA and DNA is inhibited

Examples:◦cytarabine◦methotrexate◦6-mercaptopurine

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Plant AlkaloidsPlant AlkaloidsArrest cells in metaphase and prevent spindle formation by binding to the microtubules

Examples:◦vincristine◦vinblastine◦etoposide

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HormonesHormonesAct in a variety of ways and their

mechanism of action is not fully understood

Have a “direct lytic action” on cells in certain diseases such as leukemia and lymphoma

They inhibit tumor proliferation by blocking naturally occurring substances that stimulate tumor growth

Examples:◦dexamethasone◦prednisone

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ImmunosuppressantImmunosuppressantssClass of drugs capable of inhibiting

the body’s immune systemDecrease the body’s own natural

defense to foreign bodies and is useful in treating non-cancer diseases and organ rejection

Examples:◦Cellcept◦Rapamycin◦Tacrolimus◦Imuran◦Cyclosporin

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MiscellaneousMiscellaneousWide variety of agents which do not fit into any other category or whose mechanism of action is not fully understood

Example:◦asparaginase◦hydroxyurea

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Combination Combination ChemotherapyChemotherapy

The use of two or more drugs given simultaneously or in sequence, in an effort to achieve the best therapeutic response within a range of toxicity

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Chemotherapy Used Chemotherapy Used For Non-Cancer For Non-Cancer DiseasesDiseasesCyclophosphamide (Cytoxan)Methotrexate (Mexate)Mercaptopurine (6-MP)Vincristine (Oncovin®)Daunorubicin Doxorubicin (Adriamycin PFS®)Mitoxantrone(Novantrone®)Pentostatin (Nipent®)Hydroxurea(Hydrea®)

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Immunosupressant Immunosupressant Agents Used For Non-Agents Used For Non-Cancer DiseasesCancer Diseases

Sirolimus (Rapamycin)Tacrolimus (Prograf®)Mycophenolate Mofetil

(CellCept®)Imuran (Azathioprine)Cyclosporin (Neoral,

Sandimmune)15

QUESTIONS?QUESTIONS?