Chemotherapeutic Agents, Antibiotics,
Immunosuppressive Agents
Chemotherapy (chemo; drug | therapy;
treatment)
- is the treatment of cancer by means
of chemicals that kill cancer cells.
These “anti-cancer” drugs destroy
cancer cells by stopping their growth
and reproduction. Unfortunately,
normal healthy cells are also
affected and this causes the
well-known side effects of
chemotherapy.
- Does not only refer to “cancer”, as
long as you administer a drug,
you’re doing chemotherapy. (Ex: TB)
Chemotherapeutic Agents
- also referred to as antineoplastic
agents, are used to directly or
indirectly inhibit the proliferation of
rapidly growing cells, typically in the
context of malignancy
The History of Chemotherapy: Overview
Paul Ehrlich
- developed the concept of
chemotherapy to treat microbial
diseases; he predicted the
development of chemotherapeutic
agents, which would kill pathogens
without harming the host.
Sulfa drugs
- came into prominence in the late
1930s.
Alexander Fleming
- discovered the first antibiotic,
penicillin, in 1929; its first clinical
trials were done in 1940.
Chemotherapy
- Treatment of a disease by a
chemical compound selectively
directed against invading microbes
or abnormal cells. The treatment of a
disease with a chemical substance
is known as chemotherapy. The
chemical substance is called a
chemotherapeutic agent.
CHEMOTHERAPEUTIC AGENTS
- Synergistic effects help potentiate to
achieve each other
- Administer 2-3 drugs
People prone of cancer:
- Cancer happens genetically
- Exposure to certain hazards.
- Frequent exposure with
Chemotherapeutic drugs
1. Alkylating agents
- Alkylating agents keep the cell from
reproducing (making copies of itself)
by damaging its DNA.
- These drugs work in all phases of
the cell cycle and are used to treat
many different cancers, including
cancers of the lung, breast, and
ovary as well as leukemia,
lymphoma, Hodgkin disease,
multiple myeloma, and sarcoma.
- Examples of alkylating agents
include: Altretamine,
Bendamustine, Busulfan,
Carboplatin (fewer side effects),
Carmustine, Chlorambucil
2. Antimetabolites
- Antimetabolites interfere with DNA
and RNA by acting as a substitute
for the normal building blocks of
RNA and DNA. When this happens,
 the DNA cannot make copies of
itself, and a cell cannot reproduce.
- They are commonly used to treat
leukemias, cancers of the breast,
ovary, and the intestinal tract, as well
as other types of cancer.
- Examples of antimetabolites include:
Azacitidine, 5-fluorouracil (5-FU),
6-mercaptopurine (6-MP),Capecitabine
(Xeloda), Cladribine, Clofarabine.
3. Topoisomerase inhibitors
- These drugs are also called plant
alkaloids. They interfere with
enzymes called topoisomerases,
which help separate the strands of
DNA so they can be copied
(Enzymes are proteins that cause
chemical reactions in living cells.)
- Topoisomerase inhibitors are used to
treat certain leukemias, as well as
lung, ovarian, gastrointestinal,
colorectal, and pancreatic cancers.
4. Topoisomerase I inhibitors
- (also called camptothecins) include:
Irinotecan, Irinotecan liposomal,
Topotecan
5. Topoisomerase II inhibitors
- Most potent that enhance secondary
cancer. Happens when primary
cancer has not been treated which
then metastasizes.
- (also called epipodophyllotoxins)
include: Etoposide (VP-16),
Mitoxantrone (also acts as an
anti-tumor antibiotic), Teniposide.
Topoisomerase II inhibitors can
increase the risk of a second cancer
6. Mitotic inhibitor
- are also called plant alkaloids.
They are compounds derived from
natural products, such as plants.
They work by stopping cells from
dividing to form new cells, but
can damage cells in all phases by
keeping enzymes from making
proteins needed for cell
reproduction.
7. Anti-tumor antibiotics
- These drugs are not like the
antibiotics used to treat infections.
They work by changing the DNA
inside cancer cells to prevent
them from growing and multiplying.
- Examples of anthracyclines include:
Daunorubicin, Doxorubicin
(Adriamycin), Doxorubicin
liposomal, Epirubicin,
Idarubicin,Valrubicin
Opioid depresses respiration. Naloxone
is the antidote for opioid analgesic
agents. Watch out for Respiratory rate
vital signs.
Goals of chemotherapy
1. Cure cancer
2. Control growth of cancer
3. Alleviate symptoms
Chemotherapy treatment Plan
Each treatment plan is tailor-made to suit
every individual and will depend on:
- The type of cancer.
- The area of the body where the
cancer is.
- The stage of the development of the
cancer
- Spread of CA to the rest of the body
- How cancer influences the
functioning of your body.
 - The general health of the patient.
- The purpose of the treatment, either
curative or to relieve symptoms.
Brain, adrenal
PURPOSES OF CHEMOTHERAPY
- Shrink a tumor before radiotherapy
or surgery. This is called
neo-adjuvant therapy
(chemotherapy comes first)
- Destroy any remaining cancer cells
after surgery or radiotherapy. This
is called adjuvant (last treatment is
chemotherapy) therapy.
- Enhance the effect of radiotherapy
and biological therapy. Destroy
recurring cancer or destroy cancer
that has spread to other parts of the
body.
- Destroy recurring cancer or destroy
cancer that has spread to other parts
of the body.
Example: thyroid cancer
Patient undergoing chemotherapy is
- Risk of hemorrhage
automatically immunocompromise
- Must shrink the cancer first then now
remove by surgery then radiation
therapy.
ROUTES OF ADMINISTRATION
1. Intravenous
- This is the most common method of
administration. A thin needle is
inserted into a vein on the hand or
lower arm.
- Peripheral Vein
2. Oral
- The chemotherapy comes in pills,
capsules, or liquids that is
swallowed
3. Topical
- The chemotherapy comes in a
cream that you rubs the skin
4. Injection
- A needle and syringe deliver the
chemotherapy drug either
intramuscularly (into a muscle) or
subcutaneously (just below the skin)
5. Intra-arterial
- The chemotherapy goes directly into
the artery that is feeding the cancer
- Do not administer thru peripheral
veins; it may increase risk of
phlebitis.
- Normally given thru central line
which is the brachial artery.
6. Intra peritoneal
- The chemotherapy goes directly into
the peritoneal cavity
- (the area that contains organs such
as your intestines, stomach, liver,
and ovaries)

Ondancentron antiemetic given prior
chemotherapy for nausea and vomiting
Side effects of chemotherapy
- IONVACSCDAFIP
OHSA SAFE CANCER DRUGS
ADMINISTRATION
- Obtain special training for drug
administration.
- Use two pairs of powder-free,
dispensable chemotherapy gloves,
and a disposable, closed,
long-sleeved gown with outer pair of
gloves covering gown cuff whenever
there is risk of exposure to
hazardous drugs.
- Provide syringes and IV sets with
Luer lock fittings for preparing and
administering hazardous drugs. Also
provide containers for their disposal.
- Use a closed-system drug-transfer
device and needleless system to
protect nursing personnel during
drug administration.
- Label all prepared drugs
appropriately.
- Double-bag chemotherapy drugs
once prepared, before transport.
- Have equipment ready to clean up
any accidental spill (spill kit).
- Dispose of all materials in marked
containers labeled hazardous waste.
- Dispose of all needles and syringes
intact.
- Follow the facility's policies and
procedures when preparing to
administer chemotherapy.
- Double-check chemotherapy orders
with another oncology nurse.
- Read material safety data sheets
(MSDS) prior to administration.
- Use personal protective equipment
(PPE).
- Wash your hands both before you
put on and after you take off gloves.
- After infusion is complete, promptly
dispose of any equipment that
contains the drug in a puncture-proof
container that is clearly marked.
- Chemotherapy agents may be
excreted in body fluids; these may
be contaminated for 48 hours after
the last drug dose. Wear PPE when
handling such excreta, and wash
your hands after removing gloves.
- Check facility’s policies about
handling linen that’s been
contaminated with chemotherapy.
- If a chemotherapy drug comes into
contact with your skin or a client’s
skin, thoroughly wash the affected
area with soap and water, but don’t
abrade the skin with a scrub brush.
- If the drug gets in your eyes, flush
with copious amounts of water for at
least 15 minutes while holding back
your eyelids. Then get evaluated by
employee health or the emergency
department (ED).
ANTIBIOTICS VS. ANTIVIRAL

Antibiotics
- are molecules that kill, or stop the
growth of, microorganisms, including
both bacteria and fungi.
- Antibiotics that kill bacteria are
called "bactericidal"
- Antibiotics that stop the growth of
bacteria are called "bacteriostatic"
- Classified according to mode of
action.
Antiviral drugs
- are a class of medication used for
treating viral infections.
- Most antivirals target specific
viruses, while a broad-spectrum
antiviral is effective against a wide
Macrolides: given before meals for better absorption.
range of viruses.

Antibiotics: Nursing Implications

- Take exactly what is prescribed and
do not stop early when feeling better
- Assess for signs and symptoms of
superinfection: fever, perineal
itching, cough, lethargy, or any
unusual discharge
- Before therapy, assess for allergies:
hepatic, liver, and cardiac functions,
other lab studies
- Obtain patient health history,
including immune status (allergies)
- Assess for contraindications and
potential drug interactions

Antivirals Implications
- Monitor therapeutic effects
depending on the type of viral
infection
- Effects range from delayed
progression of AIDS and ARC to
decrease flu-like symptoms,
decreased frequency of herpes-like
flare-ups or crusting over of herpetic
lesion
 - Educate patients rheumatoid arthritis, autoimmune
conditions and so on.
ANTIVIRAL DRUGS - Graft rejection won’t happen,
transplant organs will be accepted.
HIV
- Lamivudine (NRTI) Nucleoside
Reverse Transcriptase Inhibitor
stops enzymes that the virus needs
to replicate itself.
● Zidovudine does not affect
the fetus in placenta
- Efavirenz (NNRTI)
- Duranavir (PI)

HSV,HCMV,VZV
- Acyclovir and other nucleoside
analogues for herpes

Influenza viruses
Steroids: increases blood glucose level
- Oseltamivir- tamiflu
Table 1: FOR DONATION OF ORGANS
- Zanamivir

Hepatitis viruses
- Entecavir (HBV) Hepa B
- Sofosbuvir (HCV) Hepa C

ANTIVIRALS: NURSING IMPLICATION

- Be sure to teach proper application
- Emphasize hand washing before
after medication
- Patients wear gloves when applying
ointment or solution

IMMUNOLOGIC AGENTS

Immunologic agents
- include drugs used for
immunosuppression to prevent graft
rejection. They can be used as
cancer chemotherapy agents. Some
immunologic agents can
down-regulate the inflammatory
process and can be used to treat
inflammatory conditions such as