Drugs for Neoplasia

Chapter 37
 Cancer: Basic Facts
• Carcinoma
• Abnormal, uncontrolled cell division
• Suppressor genes
• Damaged cells unresponsive to chemical
signals
• Cancer cells create tumors
• Cancer cells can metastasize
• Named according to tissue of origin
Factors Causing or Associated with Increased
Cancer Risk
• Chemical carcinogens
• Excess x-ray exposure
• Ultraviolet light exposure
• Viruses
• Immune system suppression
• Genetic component
• Environmental component
 Lifestyle Risks
• Inadequate/improper nutrition
• Chemical risks
• Noncompliance with screening
recommendations

Discuss lifestyle factors important to cancer

prevention or diagnosis.
 Curing Cancer
• Discuss challenges to curing cancer.

• Discuss treatment approaches:

– Surgery
– Radiation
– Chemotherapy
 Antineoplastic Therapy

Describe the general

purposes of antineoplastic
therapy.
 Cell Cycle
• Figure 37.2 Antineoplastic agents and the cell
cycle, p. 555
• Important to pharmacodynamics of
antineoplastic therapy
– Some drugs are specific to certain cell cycle
phases
• Growth Fraction
– Ratio of # of replicating cells to # of resting cells
 Special Protocols and Strategies
• Protocols:
– Therapy will be designed to optimize cancer cell
death.
– Specific dosing schedules
• Strategies:
– Multiple drugs from different classes
– Combination therapy
 Toxicity
• Antineoplastics also affect normal cells
• Replicating cells most susceptible
– Hair follicle, epithelial lining of gastric mucosa
• Vomiting center triggered
• Premedications may decrease toxic effects
• Bone marrow toxicity is most frequent dose-
limiting effect
 Bone Marrow Toxicity

Discuss strategies to
minimize bone marrow
toxicity.
 Nadir and Absolute Neutrophil Count

• Nadir: “lowest point at which neutrophil count

is depressed by the chemotherapeutic agent.”
p. 557

• Describe the significance of monitoring the

absolute neutrophil count.
 Administration Considerations
• Identify delivery strategies to minimize systemic
toxicity.

• Discuss the practice implications of IV

administration of antineoplastics, most of which
are vesicants.

• What must a nurse know before administering an

antineoplastic IV?
 Question
• Antineoplastic agents are toxic to normal cells
as well as cancer cells and can cause long term
consequences such as infertility and induction
of secondary malignancies.

Why would drugs that could cause such

serious side effects and other cancers be
administered?
 Classifications of Antineoplastics
• Alkylating Agents
• Antimetabolites
• Antitumor Antibiotics
• Hormones and Hormone Antagonists
• Natural Products
• Biological Response Modifiers and
Miscellaneous Anticancer Drugs
 Antineoplastic Drugs
• Develop a table to include:
– MOA
– Prototype and examples
– Indications for therapy
– Common adverse effects
– Nursing considerations
– Key teaching points
 General Nursing Considerations
• Baseline: VS, CBC with Diff, RFTs, LFTs, I&O, wt.
– Hearing test with some drugs
• Cautious:
– hepatic, cardiac, renal impairment
– Recent steroids, leukopenia, thrombocytopenia
• Well hydrated prior to therapy
• Avoid crowds/those with respiratory infections
– Incorporate measures to facilitate respiratory function
• Be alert for bruising and bleeding
• Monitor CBC and platelet count during therapy
 General Nursing Considerations
• Anticipate side effects
– Premedicate with antiemetic
• Monitor nutritional intake
– Assess for n/v; medicate as appropriate
– Offer foods/fluids to minimize nausea/vomiting
– Small, frequent meals
– Avoid high purine and citric acid
– Ice chips/ice pops to decrease mouth pain
• Assess skin integrity
• Monitor IV site
• No rectal temps or OTC suppositories
 General Teaching Points
• Reliable contraception
• No breast feeding
• Hearing screening during therapy
• Immediately report s/s of ototoxicity
• Immediately report s/s of anemia, infection,
blood dyscrasias, gout/kidney stones, rashes
• Avoid crowds or anyone with respiratory
infection
 General Teaching Points
• Good oral care
• Inform that hair loss is possible
• Inform regarding:
– Women: amenorrhea, menstrual irregulrities,
sterility
– Men: impotence
• Avoid citric acid and high purine foods
• Small frequent meals
 Key Drug Specific Points
• Platinum alkylating agents: hearing loss
• Antimetabolites:
– temperature monitoring
– Monitor IV site for extravasation
• Antitumor Antibiotics:
– Weekly CBC with diff, platelet count
– May need prophylactic antibiotics
– Baseline assessment of cardiac status; ECG
– Potential for angioedema
 Key Drug Specific Points
• Doxorubicin (Adriamycin):
– Gloves and protective clothing
– Severe vesicant
• Natural Products:
– Steroid therapy to ameliorate infusion hypersensitivity
• Vincristine
– Contraindicated in obstructive jaundice and Charcot-Marie-
Tooth
– Cautiously: leukopenia, neuromuscular disease, HTN
– Prevent constipation
– Can cause severe mental depression
 Key Drug Specific Points
• Hormones and Hormone Antagonists:
– All but tamoxifen may be palliative, be sure
patient and family understand this
– Cross-gender secondary sex characteristics can
develop
• Glucocorticoids:
– ↑ risk of STDs and infection
– ↑ glucose– may need to adjust antidiabetic meds