Nursing Pharmacology

Anti- Neoplastic
Chemotherapeutic Drugs
 Learning Objectives
➢ Describe chemotherapy as a therapy in
treating cancer.

➢ Identify the general types of chemotherapeutic

agents.

➢ Describe the special nursing needs of patients

receiving chemotherapy.
 Chemotherapy
➢ antineoplastic agents are used in an attempt to destroy tumor
cells by interfering with cellular functions, including replication.
➢ It is used primarily to treat systemic disease rather than
localized lesions that are amenable to surgery or radiation.
➢ Chemotherapy may be combined with surgery, radiation
therapy, or both, like:
⚫ to reduce tumor size preoperatively - Neoadjuvant
⚫ to destroy any remaining tumor cells postoperatively - Adjuvant
⚫ to treat some forms of leukemia or lymphoma - Primary
➢ The goals of chemotherapy:
⚫ Cure
⚫ Control

⚫ Palliation

must be realistic because they will determine the medications that are
used and the aggressiveness of the treatment plan.
 Chemotherapeutic Agents
➢ These agents kill or inhibit the
reproduction of neoplastic cells
➢ They may be cell cycle specific or non
specific
➢ They are used in combination, or with
other treatment modalities
➢ Usually given IV
➢ Cell Cycle Specific (CCS)
⚫ Acts on cells in a specific phase
⚫ Most effective against tumors that have a large
proportion of cells actively moving through the
cell cycle and cycling at a fast rate

➢ Cell Cycle Nonspecific (CCNS)

⚫ Kill the cell in various multiple phases of the cell
cycle
Cell Cycle
The cell cycle of any cell has four distinct phases,
each with a vital underlying function:

1. G1 phase—RNA and protein synthesis occur

2. S phase—DNA synthesis occurs
3. G2 phase—premitotic phase; DNA synthesis is
complete, mitotic spindle forms
4. Mitosis—cell division occurs

The G0 phase, the resting or dormant phase of

cells, can occur after mitosis and during the G1
phase.
 Undesirable effects

“BARFS”
➢ Bone Marrow Depression
➢ Alopecia
➢ Retching- Nausea and Vomiting
➢ Fear and Anxiety
➢ Stomatitis
 General Guidelines for
Anti-Neoplastic Agents

➢ CBC and Platelets monitoring

➢ Anti-emetics are given BEFORE
administering the drug
➢ NEPHROTOXICITY is an important side
effect
➢ Counseling regarding reproductive issues
➢ Encourage hand washing and avoidance
of crowds
➢ Recommend wig for alopecia
 General guidelines
Monitor CBC To note BMD
Avoid frequent injection To prevent bleeding
Provide small feedings To manage N/V
and anti-emetics
Encourage hydration To prevent renal
damage
Administer allopurinol To prevent ↑ uric acid
Ensure patent IV line To prevent infiltration
Wig For alopecia
General Classification
1. ALKYLATING agents
2. ANTI METABOLITES
3. ANTIBIOTICS
4. MITOTIC INHIBITORS
5. HORMONAL agents
6. IMMUNOSUPPRESANTS
 ALKYLATING AGENTS
➢ DYNAMICS: cause cell death or
mutation
➢ INDICATIONS: Palliative treatment of
chronic lymphocytic leukemia,
malignant lymphomas, Hodgkin’s
disease, cancers of the breast, lungs
and ovaries
➢ ADVERSE EFFECTS: Bone marrow
depression, anorexia, alopecia, N/V
 Alkylating Agents
➢ Busulfan
➢ Carboplatin
➢ Carmustine
➢ Chlorambucil
➢ Cisplatin
➢ Cyclophosphamide
➢ Ifosphamide
➢ Mecholethamine
 Alkylating Agents
Nursing Interventions
➢ Monitor CBC weekly
➢ Hydrate patient well
➢ Pre-medicate with anti-emetics
➢ Monitor IV site
➢ Prepare epinephrine, steroids and
antihistamines
 Drug Specific Side effects

Alkylating agents Adverse Effects

*Cyclophosphamide Hemorrhagic cystitis
Busulfan Hyperuricemia

Mechlorethamine Gonadal suppression

*Cisplatin Ototoxicity
 ANTI METABOLITES
➢ DYNAMICS: interferes with the building
block of DNA synthesis
➢ INDICATIONS: Myelocytic leukemia,
acute lymphocytic leukemia, cancers of
breast, cervix, colon, liver, ovaries
➢ ADVERSE EFFECTS: GI disturbance,
oral and anal inflammation, bone
marrow depression, alopecia, renal
dysfunction and thrombocytopenia
 General Guidelines for Anti Metabolites
➢ Monitor CBC and Platelets weekly
➢ Evaluate renal functions
➢ Take temperature Q 4 hours
➢ Aseptic techniques
➢ Bleeding, anemia, infection and nausea
➢ Oral hygiene
➢ Lots of fluids (2-3 liters/day)
➢ Intake and output, nutrition
➢ The protocols for handling- follow them
➢ Emphasize protective isolation
 Anti Metabolites
➢ Capecitabine
➢ *Cytarabine
➢ *Fluorouracil
➢ *Methotrexate
➢ Mercaptopurine
➢ Thioguanine
➢ Floxuridine
Cytarabine syndrome despite corticosteroid premedication
in an adult undergoing induction treatment for acute
myelogenous leukemia
Abstract
Cytarabine syndrome is a rare clinical condition characterized by fever,
malaise, myalgia, arthralgia, and/or rash that occurs after receipt of
cytarabine. Our patient developed fever, malaise, and diffuse body pain
shortly following cytarabine initiation despite receiving prophylactic
dexamethasone. The patient's discomfort was treated with intravenous
morphine and her other symptoms were controlled with a higher dose of
dexamethasone. Although the exact cause is not fully understood,
cytarabine syndrome is hypothesized to be an immune-mediated response
following cytarabine-induced apoptosis that results in a rapid increase in
proinflammatory cytokines. While there is no standard therapy for cytarabine
syndrome, corticosteroids appear to play a role in the treatment and
prevention of the condition by suppressing the proinflammatory response.
Since our case describes the development of cytarabine syndrome despite
dexamethasone, clinicians should monitor for this adverse event if patients
begin exhibiting characteristics of this syndrome.
 Anti Metabolites
Nursing Interventions
➢ Evaluate complete blood count
➢ Pre-medicate with anti-emetics
➢ Safety measures for dizziness
➢ Instruct to report fever, sore throat,
rash and bleeding
➢ Provide small, frequent feedings
➢ Suncreens for photosensitivity
 Anti Metabolites
Nursing Interventions
➢ When administering methotrexate,
prepare to administer Leucovorin
(folinic acid or citrovorum factor) to
prevent toxicity
⚫ *Leucovorin is sometimes called a
“rescue” medicine. It is taken in an
effort to ‘rescue’ the normal cells in the
body from the side effects of methotrexate
 Anti Neoplastic ANTIBIOTICS
➢ DYNAMICS: these kill cancer cells by
disrupting the DNA synthesis and
breaking up the DNA linkages
➢ INDICATIONS: Leukemia, carcinomas,
adenocarcinoma
➢ ADVERSE EFFECTS: bone marrow
suppression, alopecia, and renal toxicity
 Anti Neoplastic Antibiotics
➢ *Bleomycin
➢ Dactinomycin
➢ Daunorubicin
➢ *Doxorubicin
➢ Idarubicin
➢ *Mitocycin
➢ Plicamycin
 Anti Neoplastic Antibiotics
➢ Daunorubicin→ CHF and Dysrhythmia
➢ Doxorubicin→ Cardiotoxicity
➢ Bleomycin→ Pulmonary toxicity
➢ Plicamycin→ excessive bleeding
 Anti-Neoplastic Antibiotics
NURSING INTERVENTIONS
➢ Monitor blood tests, cardiac functions
➢ Ensure that the patient is well-hydrated
➢ Provide small, frequent feedings
➢ Advise wig for alopecia
➢ Instruct to maintain oral hygiene
➢ Assess the ECG frequently
 MITOTIC INHIBITORS
➢ DYNAMICS: kill the cells as the process
of Mitosis begins by blocking the
mitotic spindles causing cell death
➢ INDICATIONS: Combination therapy for
reproductive cancer, cancers of the
lungs, Lymphomas
➢ ADVERSE EFFECTS: bone marrow
suppression, NAVD, renal and hepatic
toxicity , alopecia
 Mitotic inhibitors

➢ Etoposide
➢ Teniposide
➢ Vinblastine
➢ *Vincristine (Oncovin)
➢ Vinorelbine
 MITOTIC INHIBITORS

➢ Vincristine (Oncovin)
⚫ Can cause NEUROTOXICITY
⚫ Cause severe bone marrow depression→
check CBC
 MITOTIC INHIBITORS
NURSING INTERVENTIONS
➢ Arrange for blood tests
➢ Avoid direct skin and eye contact with
drugs
➢ Ensure hydration
➢ Small, frequent meals
➢ Anti-emetics
➢ Wig
HORMONE AND IMMUNOMODULATORS

DYNAMICS: receptor-site specific drugs

that block the specific hormones in the
cancer
INDICATIONS: Breast cancer, prostate
cancer
ADVERSE EFFECTS: menopause
associated effects like hot flashes,
vaginal dryness. Bone marrow
depression and HYPERCALCEMIA
 Hormone and Immunomodulators
➢ Tamoxifen → anti-estrogen
➢ Anstrazole (Arimedex) - treatment of advanced
breast cancer in post menopausal women following
Tamoxifen therapy
➢ *Estramustine (Emcyt) -palliative treatment of
metastatic and progressive prostate cancer
➢ Paclitaxel (Tazol) -treatment of ovarian cancer,
breast cancer and AIDS related to Kaposi’s sarcoma
➢ Irinotecan (Camptosar) -treatment of metastatic
colon or rectal cancer after treatment with 5-FU/
Fluorouracil
➢ Diethylstilbestrol (DES)→ estrogen preparation
Hormone and Immunomodulators

NURSING INTERVENTIONS
➢ Arrange for blood tests to monitor bone
marrow depression
➢ Provide small, frequent meals
➢ Advise comfort measures for
menopausal symptoms
➢ Utilize BARRIER methods of
contraception
 MISCELLANEOUS
L-Asparaginase
➢ Enzyme that destroys ASPARAGINE
needed by malignant cells for protein
synthesis
➢ Indicated for acute lymphocytic
leukemia
➢ Adverse effects: PANCREATITIS, bone
marrow depression, fatal hyperthermia,
hypersensitivity
 Miscellaneous
*Azathioprine
➢ Used as adjunct to cyclosporine and
steroids to suppress immune system
➢ CAN CAUSE bone marrow suppression
and increase incidence of cancers
➢ Taken with meals
➢ Avoid crowds, maintain hygiene
 Anti-emetics
➢ Metoclopromide
➢ Odansetron
➢ Dronabinol
 In Summary
➢ Cancers arise from a single abnormal
cell that multiplies and grows
➢ Cancers can come from epithelial cells-
CARCINOMA or mesenchymal cells-
SARCOMA
➢ Cancer cells lose their normal
functions and they grow uninhibited
 In Summary

➢ Anti-neoplastic agents affects both the

normal cells and the cancers cells
➢ They act by disrupting cell function and
division
➢ Most cancer drugs are MOST effective
against cancer cells that multiply
RAPIDLY
 In Summary
➢ The ULTIMATE GOAL of cancer therapy
is to decrease the size of the cancer so
that the body’s immune system can
eliminate the cancer

➢ Anti-cancer drugs are BEST given in

combination so as to affect the cancer
cells in various stages
 In Summary
➢ ADVERSE effects commonly encountered
with cancer therapy are related to damage
to RAPIDLY multiplying cells like the
BONE MARROW, hair follicles and
gastrointestinal lining
 In Summary
➢ In
general, these drugs SHOULD NOT be
used during pregnancy or lactation
because they may cause serious
adverse effects on the FETUS