ANTIFUNGAL, ANTIPROTOZOAL, ANTIHELMINTHIC, AND

ANTINEOPLASTIC AGENTS
Ma’am Ailun P. Jaugan || BSN || BATCH 2024 PHARMACOLOGY

ANTIFUNGAL AGENTS
❖Adverse effects are undesired effects that may
❖Mycosis - infection caused by fungus
❖Fungi differ from bacteria in that the fungus has
a rigid cell wall that is made up of chitin and
various polysaccharides and a cell membrane that
contains ergosterol
❖Because of their cellular makeup, bacteria are ❖CANDIDA
resistant to antifungal drugs
➢ fungus that is normally found on mucous
membranes, can cause yeast infections or
CELL STRUCTURE: BACTERIA V. FUNGI "thrush" in the GI tract and yeast infections or
"vaginitis" in the vagina

AZOLE ANTIFUNGALS
❖Large group of antifungals used to treat systemic
and topical fungal infections
❖MECHANISM OF ACTION: these drugs bind to
sterols and can cause cell death (a fungicidal
effect) or interfere with cell replications (a
fungistatic effect)
➢ Fluconazole
■ Treatment of
candidiasis,
cryptococcal
meningitis, other
systemic fungal
infections
➢ Itraconazole,
ketoconazole, posaconazole
■ One of the newest
antifungals
➢ Terbinafine [inhibits
cytochrome P450 2D6
(CYP2D6) enzyme]
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 ANTIFUNGAL, ANTIPROTOZOAL, ANTIHELMINTHIC, AND
ANTINEOPLASTIC AGENTS
Ma’am Ailun P. Jaugan || BSN || BATCH 2024 PHARMACOLOGY

➢ Voriconazole and posaconazole

■ One of the newest antifungals

ECHINOCANDIN ANTIFUNGALS
❖Inhibit glucan synthesis
❖Glucan is an enzyme present in the fungal cell wall
but not in human cell wall
❖If this enzyme is inhibited, the fungal cell wall
cannot form, leading to death of the cell wall
❖Example: anidulafungin (excreted in the feces),
caspofungin acetate, micafungin
❖CONTRAINDICATIONS
OTHER ANTIFUNGALS ➢ Avoid in patients with hepatic dysfunction; to
prevent serious hepatic toxicity
❖They work to cause fungal cell death or to prevent ➢ Avoid in patients with renal impairment;
fungal cell reproduction could cause renal toxicity
❖Example: amphotericin B (use is reserved for ➢ Pregnancy/lactation because of potential
progressive, potential fatal infections due to many adverse effects to the fetus/infant
associated adverse effects), flucytosine,
➢ Voriconazole
griseofulvin, nystatin (ttt or oral candidiasis;
■ Should not be combined with ergots (a
swish, swirl, swallow; NOT absorbed from the GI
herb frequently used to treat migraine
tract and passes unchanged in the stool)
headache and menstrual problems)
❖NYSTATIN ■ Can cause ergotism
➢ This medication is used to (convulsions/seizures, paresthesias,
treat fungal infections of mental effects including mania [mental
the mouth. illness marked by periods of great
➢ Swish and swallow/spit excitement or euphoria, delusions, and
(depending on the doctor’s overactivity] or psychosis [severe mental
instructions) disorder in which thought and emotions
➢ Do not eat or drink are so impaired that contact is lost with
anything for 20 minutes external reality], gangrene)
after using nystatin oral
suspension in order to
increase contact time with the mouth surface.

❖ NURSING CONSIDERATIONS
➢ Assess history of allergy to antifungals to
prevent potential hypersensitivity reactions
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 ANTIFUNGAL, ANTIPROTOZOAL, ANTIHELMINTHIC, AND
ANTINEOPLASTIC AGENTS
Ma’am Ailun P. Jaugan || BSN || BATCH 2024
➢ Liver/renal dysfunction that might interfere
with metabolism and excretion of the drug
➢ Evaluate renal and hepatic function tests
➢ Check for the complete blood count (WBC,
neutrophils, lymphocytes, monocytes)
➢ Obtain culture of the infected area to make
an accurate determination of the type and
responsiveness of the fungus
➢ Monitor IV sites to ensure that infiltration
(when the IV fluid leaks into the surrounding
tissue) or phlebitis (see picture) does not
occur
➢ Provide comfort or safety provisions if CNS
effects occur (e.g., side rails and assistance
with ambulation for dizziness and weakness,
analgesics for headache, antipyretics for fever
and chills, temperature regulation for fever)
to protect the patient from injury
➢ Provide small, frequent nutritious meals if GI
upset is severe; GI upset may be decreased by
taking an oral drug with food and try small,
frequent feedings
➢ Report to a health care provider if with any of
the following: sore throat, unusual bruising
and bleeding, or yellowing of the eyes or skin,
all of which could indicate hepatic toxicity; or
severe nausea and vomiting which could
interfere with nutritional state and slow
recovery
➢ Monitor patient response to the drug
(resolution of fungal infection)
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PHARMACOLOGY
➢ Monitor for adverse effects (orientation and
affect, nutritional state, skin color and
lesions, renal and hepatic function)
❖SAMPLE NURSING DIAGNOSES
➢ Acute pain r/t GI, CNS, and local effects of
the drug
➢ Disturbed sensory perception
(kinesthetic/tactile) r/t CNS effects
➢ Deficient knowledge regarding drug therapy
TOPICAL ANTIFUNGALS
❖Dermatophytes is the collective term/broad term
for all organisms that causes mycoses (fungal
infection of animals/humans)
❖Mycoses include tinea pedis (athlete's foot), tinea
cruris (jock itch), and yeast infection of the mouth
and vagina often caused by Candida
❖Care is necessary when using these topical
antifungals near open or draining wounds
because the antifungals drugs are too toxic for
systemic administration
❖MECHANISM OF ACTION
➢ Alter the cell permeability of the fungus,
causing prevention of replication and fungal
death
➢ They are indicated only for local treatment of
mycoses, including tinea infections
TINEA PEDIS, TINEA CRURIS
❖NURSING CONSIDERATIONS
➢ Assess for known allergy to any topical
antifungal agent
➢ Perform a physical assessment
■ To prevent hypersensitivity reactions.
■ To establish baseline data for evaluation of
the effectiveness of the drug and the
occurrence of any adverse effects
associated with drug therapy.
 ANTIFUNGAL, ANTIPROTOZOAL, ANTIHELMINTHIC, AND
ANTINEOPLASTIC AGENTS
Ma’am Ailun P. Jaugan || BSN || BATCH 2024
➢ Perform culture and sensitivity testing of the
affected area
➢ Inspect the area of application for color, ❖AMEBIASIS
temperature, and evidence of lesions
■ To determine the causative fungus and
appropriate medication.
■ To establish a baseline to monitor the
effectiveness of the drug and to monitor for
local adverse effects of the drug.
➢ Culture the affected area before beginning
therapy
➢ Ensure that the patient takes the complete
course of the drug regimen
➢ Instruct the patient in the correct method of
administration, depending on the route
■ To identify the causative fungus.
■ To achieve maximal results.
■ To improve effectiveness and decrease the
risk of adverse effects
➢ Advise the patient to stop the drug if a severe
rash occurs, especially if it is accompanied by
blisters or if local irritation and pain are very
severe. This development may indicate a ❖LEISHMANIASIS
sensitivity to the drug or worsening of the
condition being treated.
➢ Provide patient instruction to enhance
patient knowledge about drug therapy and to
promote compliance.
➢ Monitor patient response to the drug
➢ Evaluate the effectiveness of the teaching
plan ❖TRYPANOSOMIASIS
➢ Monitor the effectiveness of comfort and
safety measures and compliance with the
regimen.
■ Patient can name the drug, dosage,
possible adverse effects to watch for, and
specific measures to help avoid adverse
effects
PROTOZOA
❖Single-celled organisms that pass through several
stages in their life cycles, including at least one
phase as a human parasite
❖Are very common in several parts of the world
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PHARMACOLOGY
OTHER PROTOZOAL INFECTIONS
➢ Intestinal infection caused by Entamoeba
histolytica, often known as amebic dysentery
➢ Mode of transmission is during the cystic
stage (dormant stage) in fecal matter; can be
passed to humans when drinking infected
water or eat infected food that was grown in
the ground of the protozoa (where the fecal
matter is located)
➢ Protozoal disease passed from sand flies to
humans
➢ The sand fly injects promastigote (an asexual
form of the flagellated protozoan) into the
human body
➢ s/s include serious skin lesions, viscera, or
mucous membranes of the host
➢ Caused by Trypanosoma
➢ Has 2 species
■ African sleeping sickness - caused by
Trypanosoma brucei gambiense and
transmitted
by the
tsetse fly
(this
organism
invades the
CNS leasing
to an acute
inflammation that results in lethargy,
prolonged sleep, and even death)
 ANTIFUNGAL, ANTIPROTOZOAL, ANTIHELMINTHIC, AND
ANTINEOPLASTIC AGENTS
Ma’am Ailun P. Jaugan || BSN || BATCH 2024
❖CHAGAS’ DISEASE
➢ Caused by Trypanosoma cruzi and is passed
to humans by the common housefly; causes
severe cardiomyopathy
❖TRICHOMONIASIS
➢ Caused by Trichomonas vaginalis
➢ Usually spread during sexual intercourse by
men who have no s/s of infection
➢ In women, this protozoan causes reddened,
inflamed vaginal mucosa, itching, burning,
and a yellowish-green discharge
➢ TRICHOMONIASIS: S/S
❖GIARDIASIS
➢ Caused by Giardia lamblia
➢ This protozoan forms cysts which survive
outside the body and allow transmission
through contaminated water/food
➢ Diarrhea, rotten egg-smelling stool, pale and
mucus-filled stool are commonly seen, along
with epigastric distress, weight loss,
malnutrition
❖PNEUMOCYSTIS JIROVECI PNEUMONIA
➢ Caused by Pneumocystis jiroveci
➢ An endemic protozoan that does not usually
cause illness in humans
➢ When an individual's immune system
becomes suppressed because of AIDS or
AIDS-related complex, use of
immunosuppressant drugs, or advanced age,
this parasite is able to invade the lungs
leading to severe inflammation; most
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PHARMACOLOGY
common opportunistic infection in patients
with AIDS
❖MALARIA
➢ Known method of transmission is through
the bite of the female Anopheles mosquito, an
insect that harbors the protozoal parasite and
carries it to humans.
➢ Malarial Strains
■ Plasmodium falciparum - most deadly;
most common in the Philippines
■ Plasmodium vivax
■ Plasmodium malariae
■ Plasmodium ovale
➢ ANTIMALARIALS
■ Quinine – 1st
drug found to
be effective in
the ttt of
malaria
■ Chloroquine
(Aralen)–
mainstay
antimalarial therapy
■ The drug enters the human RBCs and
changes the metabolic pathways
necessary for the reproduction of the
Plasmodium, this agent is directly toxic to
parasites that absorb it, is acidic, and
decreases the ability of the parasite to
synthesize DNA, leading to a blockage of
reproduction
■ Hydroxychloroquine (Plaquenil)
■ Mefloquine (Lariam) - increases the acidity
of plasmodial food vacuoles causing cell
rupture and death; also used in malarial
prevention and treatment when used in
combination therapy
■ Primaquine - very old drug to treat
malaria; similar to quinine; disrupts the
mitochondria of the Plasmodium
■ Primaquine - very old drug to treat
malaria; similar to quinine; disrupts the
mitochondria of the Plasmodium
■ Pyrimethamine (Daraprim) - used in
combination with agents that act more
rapidly to suppress malaria; acts by
 ANTIFUNGAL, ANTIPROTOZOAL, ANTIHELMINTHIC, AND
ANTINEOPLASTIC AGENTS
Ma’am Ailun P. Jaugan || BSN || BATCH 2024
blocking the use of folic acid in protein
synthesis by the Plasmodium, eventually
leading to inability to reproduce and cell
death
■ Fansidar (Sulfadoxine and Pyrimethamine)
- ttt of acute, uncomplicated P. falciparum
malaria when chloroquine resistance is
suspected
■ Malarone (atovaquone and proguanil)
➢ MECHANISM OF ACTION
■ Inhibit DNA synthesis in susceptible
protozoa, interfering with the cell's ability
to reproduce, subsequently leading to cell
death
❖OTHER ANTIPROTOZOAL AGENTS
➢ Atovaquone (Mepron)
➢ Metronidazole (Flagyl)
➢ Nitazoxanide (Alinia)
➢ Pentamidine (Pentam 300)
➢ Tinidazole (Tindamax)
❖NURSING CONSIDERATIONS
➢ MECHANISM OF ACTION
■ Inhibit DNA synthesis in susceptible
protozoa, leading to the inability of the cell
to reproduce and subsequent cell death
➢ INDICATION
■ Treatment of protozoal (malaria) infections
➢ CONTRAINDICATIONS
■ Hepatic dysfunction/liver
disease/alcoholism = because of the
parasitic invasion of the liver and because
of the need for the hepatic metabolism to
prevent toxicity
■ Renal impairment
■ Pregnancy = associated with birth defects
■ Lactation = drug can enter breastmilk and
could be toxic to the infant
■ Allergy
■ Retinal disease/damage = many of these
drugs can affect vision and the retina, and
the likelihood of problems increases if the
retina is already damaged
➢ ADVERSE EFFECTS
■ CNS effects: headache, dizziness
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PHARMACOLOGY
■ Immune reaction (related to release of
merozoites): fever, shaking, chills, malaise
■ GI effects: nausea, vomiting, diarrhea,
unpleasant taste, cramps, changes in liver
function
■ Hepatic dysfunction (related to toxic effects
of the drug and the disease on the liver)
■ Dermatological effects: rash, pruritus
(itching), and loss of hair associated with
changes in protein synthesis of the hair
follicles
■ Ototoxicity related to other nerve damage
■ Cinchonism (nausea, vomiting, tinnitus,
vertigo) may occur with high levels of
quinine/primaquine
■ Superinfections (the process by which a
cell that has been previously been infected
by one virus gets co-infected with a
different strain of the virus or another
virus at a later point in time) occur when
the normal flora is disrupted
➢ Assess for contraindications and cautions:
history of allergy to any of the antiprotozoals
to prevent hypersensitivity reactions; liver
dysfunction that might interfere with
metabolism and excretion of the drug or be
exacerbated by the drug; pregnancy, which is
a contraindication, and lactation because
these drugs could enter the breast milk and
be toxic to the infant; central nervous system
(CNS) disease that could be exacerbated by
the drug; and candidiasis that could become
severe as a result of the effects of these on the
normal flora
➢ Perform a physical assessment to establish
baseline data for determining the
effectiveness of the rug and the occurrence of
any adverse effects associated with drug
therapy
➢ Evaluate the CNS to check reflexes and
muscle strength to identify the need for
cautious drug use and to evaluate changes
that occur as a result of drug therapy
➢ Examine the skin and mucous membranes to
check for lesions, color, temperature, and
 ANTIFUNGAL, ANTIPROTOZOAL, ANTIHELMINTHIC, AND
ANTINEOPLASTIC AGENTS
Ma’am Ailun P. Jaugan || BSN || BATCH 2024 PHARMACOLOGY

texture to monitor for adverse effects and

superinfections
➢ Evaluate liver function, including liver
function tests, to determine the
appropriateness of therapy and to monitor for
toxicity
➢ Obtain cultures to determine the exact
protozoal species causing the disease

INTESTINE-INVADING WORM INFECTIONS

➢ Threadworm infection
❖NEMATODES/ROUNDWORMS
■ Cause more damage to humans than other
➢ Pinworm infection
helminths
■ The most common helminthic infection
■ Transmitted as larvae found in the soil and
among school-aged children
are inadvertently ingested
■ Transmitted through ingestion or
■ The mature female worms lay eggs and
inhalation of eggs that become airborne
burrows into the wall of the small intestine
and are then swallowed
■ The eggs hatch into larvae and invade
■ Remain in the intestine, can cause
many body tissues including the lungs,
perianal itching and occasional vaginal
liver, and heart
itching
➢ Ascaris
■ Most prevalent helminthic infection
worldwide; occurs in poor sanitation
■ Eggs in the soil are ingested with
vegetables or other improperly washed
foods
■ Many individuals are unaware that they
COLONOSCOPY FINDING OF PINWORM have this manifestation unless they see a
INFECTION worm in their stool
■ Causes abdominal distention and pain;
➢ Whipworm infection intestinal obstruction in severe cases
■ Transmitted when eggs found in the soil ➢ Hookworm infection
are ingested ■ Penetrate the skin, enter the bloodstream,
■ Attach to the wall of the colon and attaches to the small intestine
■ Cause abdominal discomfort, bloody ■ The worms suck blood from the walls of the
diarrhea, anemia; also rectal prolapse intestine leading to severe anemia with
(telescoping of the anus/turning the anus lethargy (a lack of energy), weakness,
inside-out) in severe cases fatigue, and malabsorption problems
➢ Platyhelminths/flatworms
■ Cestodes (segmented flatworms)
● Enter the body as larvae that are found
in undercooked meat/fish
● May cause abdominal distention and
discomfort, and also weight loss
(because worm eats ingested nutrients)

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 ANTIFUNGAL, ANTIPROTOZOAL, ANTIHELMINTHIC, AND
ANTINEOPLASTIC AGENTS
Ma’am Ailun P. Jaugan || BSN || BATCH 2024
TISSUE-INVADING WORM INFECTIONS
❖Trichinosis
➢ Caused by Trichinella spiralis in
undercooked pork
➢ Penetrate skeletal muscle and can cause
inflammatory reaction in the cardiac muscle
and brain
➢ Fatal pneumonia, heart failure, and
encephalitis may occur
❖Filariasis
➢ Enter the body via insect (mosquito) bite
➢ Caused by Wuchereria bancrofti, Brugia
malayi, Brugia timori
➢ They overwhelm the lymphatic system and
can cause massive inflammatory reactions
➢ Elephantiasis=severe swelling of hands, feet,
legs, arms, scrotum, or breast
❖Schistosomiasis/bilharzia
➢ A platyhelmintic infection caused by a
freshwater snail
➢ Caused by Schistosoma mansoni, S.
haematobium, S. japonicum
➢ Cercariae=infectious form of the parasite
➢ Eggs that are excreted in the urine and feces
of the infected individuals hatch in the fresh
water into a form that infects the freshwater
snail
➢ The larvae attach in the skin and quickly
burrow in the bloodstream and lymphatics
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PHARMACOLOGY
ANTIHELMINTHICS
❖Mebendazole (Vermox) – ttt of pinworms,
roundworms, whipworms and hookworms
❖Pyrantel (Antiminth)
❖Tiabendazole (Mintezol)
❖Albendazole (Albenza) – ttt for pork tapeworm
❖Ivermectin (Stromectol)
❖Praziquantel (Biltricide) - drug of choice for
schistosomiasis
❖MECHANISM OF ACTION
➢ Interfere with the metabolic processes in
particular worms
❖INDICATION
➢ Treatment of infections by susceptible worms
❖CONTRAINDICATIONS
➢ Allergy
➢ Lactation
➢ Pregnancy
➢ Note: albendazole-should only be used after
the causative worm has been identified
because of its adverse effects on the liver,
which could become problematic if the patient
has liver involvement
➢ Renal/hepatic disease
❖ADVERSE EFFECTS
➢ Mebendazole and pyrantel-cause abdominal
discomfort/pain, and diarrhea
➢ Antihelmintics that are not absorbed
systemically may cause the following effects:
HA, dizziness, fever, shaking, chills, malaise
associated with an immune reaction to the
death of the worms; rash; pruritus; loss of
hair
❖NURSING CONSIDERATIONS
➢ Assess history of allergy to any of the
anthelmintics to avoid hypersensitivity
reactions; history of hepatic or renal
dysfunction that might interfere with drug
metabolism and excretion of drug; and
current status related to pregnancy and/or
lactation
➢ Perform physical assessment to establish
baseline data
 ANTIFUNGAL, ANTIPROTOZOAL, ANTIHELMINTHIC, AND
ANTINEOPLASTIC AGENTS
Ma’am Ailun P. Jaugan || BSN || BATCH 2024 PHARMACOLOGY

➢ Obtain a culture of stool for ova and parasites

to determine the infecting worm and establish
appropriate treatment
➢ Evaluate liver function and renal function
➢ Examine skin, including color, temperature,
and texture, and note any lesions
➢ Assess abdomen to evaluate for any changes
from baseline related to infection (because
worm eats ingested nutrients)

CANCER
❖CHARACTERISTICS OF CANCER CELLS
➢ Anaplasia
❖ALKYLATING AGENTS
■ loss of cellular differentiation and
organization ➢ Are non-cell cycle specific because these
agents can affect cells even in the resting
➢ Autonomy
phase
■ growing without the usual homeostatic
restrictions that regulate cell growth and ➢ Useful in the ttt of slow-growing cancers,
control which have many cells in the resting phase
❖CHARACTERISTICS OF CANCER CELLS ➢ ACTION
■ Work by disrupting cellular mechanisms
➢ Metastasis
that affect DNA (being most potent), RNA,
■ travelling of neoplastic cells from the place
or other cellular proteins causing cell
of origin to develop new tumors in other
death
areas of the body favorable for cell growth
➢ INDICATION
➢ Angiogenesis
■ Lymphomas, leukemias, myelomas,
■ abnormal cells release enzymes that
ovarian, testicular and breast cancer,
generate blood vessels in the area to
pancreatic cancer
supply oxygen and nutrients to the cells
➢ CONTRAINDICATION
➢ Cell kill theory
■ Pregnancy
■ a set percentage of cells is killed after each
■ Lactation
dose of chemotherapy; the percentage
■ Allergy
killed is dependent upon the drug therapy
■ Bone marrow suppression
❖GOAL OF CANCER THERAPY
■ Renal/hepatic dysfunction
➢ To limit the offending cells to the degree that
➢ ADVERSE EFFECTS
the immune system can then respond
■ Hematological effects: bone marrow
without too much toxicity to the host (but this
suppression including leukopenia,
is difficult since most antineoplastic agents
thrombocytopenia, anemia, pancytopenia,
affect normal human cells as well; primarily
secondary to the effects of the drugs on the
affect human cells that are rapidly
rapidly multiplying cells of the bone
multiplying such as hair follicles, GI tract,
marrow
and bone marrow).
■ GI effects: N&V, anorexia, diarrhea,
mucous membrane deterioration related to
the drug’s effects on the rapidly
multiplying cells of the GI tract
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 ANTIFUNGAL, ANTIPROTOZOAL, ANTIHELMINTHIC, AND
ANTINEOPLASTIC AGENTS
Ma’am Ailun P. Jaugan || BSN || BATCH 2024
■ Hepatic and renal toxicity
■ Alopecia
➢ KEY POINTS
■ Alkylating agents affect cellular RNA, DNA
or other cellular proteins, are cell-cycle
nonspecific, and are most effective against
slow-growing tumors
■ Patients receiving alkylating agents may
experience alopecia, N&V, and need to be
monitored for bone marrow suppression
and CNS toxicity
❖SAMPLE MEDICATIONS
➢ ANTIMETABOLITES
■ Have chemical structures similar to those
of various natural metabolite that are
necessary for the growth and division of
rapidly growing neoplastic and normal
cells
■ Effective in rapidly dividing cells
■ ACTION
● Inhibit DNA production in cells that
depend on certain natural metabolites to
produce their DNA
● Inhibit thymidylate synthetase, DNA
polymerase, or folic acid reductase, all of
which are needed for DNA synthesis
● Considered to be S-phase specific in the
cell cycle
■ INDICATION
● Leukemias, some GI and basal cell
cancers
■ CONTRAINDICATIONS
● Pregnancy
● Lactation
● Allergy
● Bone marrow suppression
● Renal/hepatic dysfunction
● GI ulcerations
■ ADVERSE EFFECTS
● Leucovorin-used to counteract the
effects of methotrexate
● Hematological effects
● CNS effects: HA, drowsiness, aphasia
(problem w/ communication), fatigue,
malaise, dizziness
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PHARMACOLOGY
● Pulmonary toxicity, interstitial
pneumonitis or interstitial lung disease
(thickening of the supporting tissues
between the air
● Hepatic/renal toxicity
● Alopecia
■ KEY POINTS
● Antimetabolites inhibit DNA production
by inhibiting metabolites needed for the
synthesis of DNA in susceptible cells
● Antimetabolites are S-phase cell cycle
specific and are used for some
leukemias, as well as some GI and basal
cell cancers
● Bone marrow suppression, alopecia, and
toxic GI effects are common adverse
effects of antimetabolites
➢ ANTINEOPLASTIC ANTIBIOTICS
■ Although selective to bacterial cells, are
also toxic to human cells
■ More toxic to cells that are multiplying
rapidly
■ ACTION
● Break up DNA links and prevent DNA
synthesis by inserting themselves
between base pairs in the DNA chain,
which causes a mutant DNA molecule,
leading to cell death
■ INDICATION
● Palliative treatment of squamous cell
carcinomas, testicular cancers and
lymphomas; used to treat malignant
pleural effusion
● Part of combination drug regimen in the
treatment of a variety of sarcomas and
carcinomas
● First-line treatment of advanced HIV
infection and associated Kaposi sarcoma
● Leukemias and cancers
 ANTIFUNGAL, ANTIPROTOZOAL, ANTIHELMINTHIC, AND
ANTINEOPLASTIC AGENTS
Ma’am Ailun P. Jaugan || BSN || BATCH 2024 PHARMACOLOGY

● Adjunctive therapy in patients with ■ INDICATION

evidence of axillary node tumor ● Hormone refractory metastatic prostate
● Combination therapy for ttt of acute cancer
myeloid leukemia in adults ● Breast cancer and non-small cell lung
● Disseminated adenocarcinoma of the cancer
stomach and pancreas ● Testicular cancers
■ CONTRAINDICATIONS ● Advanced ovarian cancer, AIDS-related
● Pregnancy Kaposi sarcoma
● Lactation ● Acute lymphoblastic leukemia
● Allergy ● Advanced Hodgkin disease
● bone marrow suppression ■ CONTRAINDICATION
● renal/hepatic dysfunction ● Pregnancy
● GI ulcerations ● Lactation
● Bleomycin, mitomycin=pulmonary ● Allergy
problems ● Bone marrow suppression
● Idarubicin, mitoxantrone- cardiac ● Renal/hepatic dysfunction
problems ● GI ulcerations
■ ADVERSE EFFECTS ● Eribulin=may prolong QT interval
● Hematological effects leading to potentially serious
● CNS effects: HA, drowsiness, aphasia arrhythmias
(problem w/ communication), fatigue,
malaise, dizziness
● Pulmonary toxicity, interstitial
pneumonitis
● Hepatic/renal toxicity
● Alopecia
■ KEY POINTS
● Antineoplastic antibiotics are toxic to
rapidly dividing cells.
● These drugs are cell cycle specific,
affecting the S phase.
● Bone marrow suppression, alopecia, and
toxic GI effects are common adverse
effects of antineoplastic antibiotics.

■ ADVERSE EFFECTS
● Hematological effects
● CNS effects: HA, drowsiness, aphasia
(problem w/ communication), fatigue,
malaise, dizziness
➢ MITOTIC INHIBITOR ● Pulmonary toxicity, interstitial
■ Kill cells as the process of mitosis begins pneumonitis
■ ACTION ● Hepatic/renal toxicity
● Interfere with the ability of the cell to ● Alopecia
divide and block/alter DNA synthesis ● Necrosis and cellulitis if extravasation
● Work on the M-phase of the cell cycle occurs at IV sites

11 Compiled by Team Shawties

 ANTIFUNGAL, ANTIPROTOZOAL, ANTIHELMINTHIC, AND
ANTINEOPLASTIC AGENTS
Ma’am Ailun P. Jaugan || BSN || BATCH 2024 PHARMACOLOGY

■ KEY POINTS ■ ADVERSE EFFECTS

●
Mitotic inhibitors kill cells during the M ● Menopause-associated effects: hot
phase and are used to treat a variety of flashes, vaginal spotting, vaginal
cancers. dryness, moodiness, depression
● These drugs are usually given IV and ● Hypercalcemia is encountered as the
extravasation could be a serious calcium is pulled out of the bones
problem. without estrogen activity to promote
● Bone marrow suppression, alopecia, and calcium deposition
toxic GI ● Increase in risk for cardiovascular
effects are disease
common ● Abiraterone-increase risk of
adverse adrenocortical insufficiency
effects of ■ KEY POINTS
mitotic ● Hormones and hormonal agents are
inhibitors used to treat specific cancers that
➢ HORMONES AND respond to hormone stimulation such as
HORMONE breast cancer or prostate cancer.
MODULATORS ● The adverse effects of hormone and
■ Some cancers, particularly those involving hormonal agent used to treat cancers are
the breast tissue, ovaries, uterus, prostate, increased/decreased effects of the
and testes are sensitive to estrogen hormones on the body: virilization (when
stimulation women develop male-pattern hair growth
■ Estrogen receptor sites on the tumor react and other masculine physical traits),
with circulating estrogen, and this reaction increased risk of cardiovascular disease,
stimulates the tumor cells to grow and and increased calcium levels
divide
■ ACTION
● Other hormonal agents are used to block
the release of gonadotropic hormones in
breast/prostate cancer if the tumors are
responsive to gonadotropic hormones
(hormone site specific)
CANCER-CELL SPECIFIC AGENTS: PROTEIN
● Other agents may block/interfere with
TYROSINE KINASE INHIBITORS, EPIDERMAL
the receptor sites on the tumor/cancer GROWTH FACTOR INHIBITORS, PROTEASOME
(receptor-site specific) INHIBITORS
■ INDICATIONS
❖ Are cancer-specific and would not affect healthy
● Breast cancer in post menopausal
cells on the body
women, prostatic cancer
■ CONTRAINDICATIONS ❖ ACTIONS
● Pregnancy ➢ Act on specific enzymes needed for protein
● Lactation building by specific tumor cells, which inhibit
● Allergy tumor cell growth and division
● Bone marrow suppression ➢ Work by inhibiting various kinases in specific
● Renal/hepatic dysfunction cancer cells
● GI ulcerations ➢ Epidermal Growth Factor Inhibitor: Erlotinib
● Toremifene-hypercalcemia (Tarceva) inhibits cell epidermal growth factor

12 Compiled by Team Shawties

 ANTIFUNGAL, ANTIPROTOZOAL, ANTIHELMINTHIC, AND
ANTINEOPLASTIC AGENTS
Ma’am Ailun P. Jaugan || BSN || BATCH 2024 PHARMACOLOGY

receptors which is found on normal and

MISCELLANEOUS ANTINEOPLASTICS
cancerous cells but is more abundant on
rapidly growing cells ❖These do not fit into one of the previously
➢ Proteasome Inhibitor: inhibits proteasome in discussed groups
human cells, a large protein complex that ❖ACTION
works to maintain cell homeostasis and ➢ Are used to cause cell death
protein production, without it the cell loses ❖INDICATION
homeostasis and dies ➢ Acute promyelocytic leukemia (APL)
❖INDICATION ➢ Myelodysplastic syndrome
➢ Protein Tyrosine Kinase Inhibitor: Imatinib ➢ Cutaneous T-cell lymphoma
(Gleevec) – ttt of chronic myelocytic leukemia ➢ Metastatic colon or rectal cancer
➢ Proteasome Inhibitor: bortezomib ❖CONTRAINDICATION
➢ (Velcade) for multiple myeloma ➢ Pregnancy
❖CONTRAINDICATIONS ➢ Lactation
➢ Pregnancy ➢ Allergy
➢ Lactation ❖ADVERSE EFFECTS
➢ Allergy ➢ Hematological effects
➢ Patients with arrhythmia (prolonged QT ➢ CNS effects: HA, drowsiness, aphasia
interval) or at risk for arrhythmia (problem w/ communication), fatigue,
❖ADVERSE EFFECTS malaise, dizziness
➢ Imatinib-GI upset, muscle cramps, heart ➢ Hepatic/renal toxicity
failure, fluid retention, skin rash ➢ Alopecia
➢ Other adverse effects seen in other ➢ Necrosis and cellulitis if extravasation occurs
antineoplastics do not occur in this type of at IV sites
antineoplastic (e.g. bone marrow
❖NURSING CONSIDERATIONS
suppression, alopecia, severe GI effects)
➢ Amifostine (Ethyol) – preserves healthy cells
❖KEY POINTS
from the toxic effects of cisplatin
➢ Cancer-cell specific drugs have been ➢ Mesna (Mesnex) – cytoprotective drugs that
developed to target processes that occur in may be given to limit certain effects of
cancer cells but not in healthy cells cisplatin & ifosfamide in order to decrease
➢ This specificity results hemorrhagic cystitis
in fewer toxic effects ➢ Leucovorin is given to counter the effects of
than with traditional methotrexate
antineoplastic therapy
➢ Tumor Lysis Syndrome – a complication
➢ Protein tyrosine kinase during cancer ttt where large amounts of
inhibitors, epidermal tumor cells are killed (lysed) releasing their
growth factor contents into the bloodstream
inhibitors, and
➢ Allopurinol (Zyloprim) lowers the serum uric
proteasome inhibitors
acid that results from the rapid destruction of
have been developed to
the cells
target cancer cells
➢ Monitor for s/s of hemorrhagic cystitis
specifically
(hematuria, dysuria) during
cyclophosphamide or ifosfamide therapy;
EOF
13 Compiled by Team Shawties