ANTINEOPLASTIC DRUGS

Classification of Antineoplastic Drugs

1. Alkylating Agents
2. Antimetabolites
3. Antineoplastic antibiotics
4. Mitotic Inhibitors
5. Hormones and Hormones Modulators
6. Miscellaneous agents
Alkylating Agents
Alkylating Agent (Covalent DNA binding
drugs)
• Stops tumour growth by cross-linking
guanine nucleobases in DNA double-helix
strands - directly attacking DNA.
• This makes the strands unable to uncoil
and separate.
• As this is necessary in DNA replication, the
cells can no longer divide.
• Cell-cycle nonspecific effect
 Alkylating Medications
(TYPICAL/ATYPICAL AGENTS)
Nitrogen Mustards
chlorambucil (Leukeran)
cyclophosphamide(Cytoxan)
melphalan (Alkeran)
Nitrosoureas Platinum Complexes
carmustine (Bicnu) carboplatin (Biovenate)
lomustine (Ceenu) docistin (Cisplatin, Platinol)
oxaliplatin (Oxitel, Eloxatin)
INDICATION:

• Lymphomas
• Leukemias
• Myelomas
• Ovarian/ testicular/ breast cancers
• Pancreatic cancers
Adverse effects
▪ chlorambucil (Leukeran) may cause gonadal
suppression and hyperuricemia
▪ cisplatin (Platinol) may cause ototoxicity,
tinnitus, hypokalemia, hypocalcemia,
hypermagnesemia, and nephrotoxicity
▪ cyclophosphamide (Cytoxan) may cause
alopecia, gonadal suppression, hemorrhagic
cystitis and hematuria
Nursing Interventions
1. When administering cisplatin (Platinol), assess for
dizziness, tinnitus, hearing loss, incoordination, &
numbness or tingling of extremities
2. Encourage the client to drink 2-3 L/per day during
cyclophosphamide (Cytoxan) therapy
3. Instruct the client that cyclophosphamide
(Cytoxan) when prescribed orally, is administered
without food.
4. Instruct the client to follow a diet low in purines to alkaline
purine and lower uric acid blood levels

4. Instruct the client to report signs of infection or bleeding.

These drugs are highly toxic and may cause bone marrow
depression since these agents kill normal hemapoietic cells
so advise clients to avoid crowds and those with respiratory
conditions.
7. Instruct the client about good oral hygiene
and use of soft toothbrush
8. Arrange for proper head covering at extremes
temperatures if alopecia occurs; a wig, scarf,
or that is important for maintaining body
temperature.
ANTIMETABOLITES
Antimetabolites
• Replace normal proteins required for DNA
synthesis
• Inhibit DNA production in cells that depend
on certain natural metabolites to produce
their DNA
• Replace these needed metabolites and
thereby prevent normal cellular function
• Cell cycle phase specific and affect the S phase
Antimetabolites Folic Acid Antagonists
methotrexate (Folex, Mexate)
pemetrexel (Alimta)

Purine Analogs
fludarabine (Fludara)
mercaptopurine (Purinethol)
thioguanine (Lanvis)

Pyrimidine Analogs
cytarabine (Cytosar-U, Tarabine, DepoCyt)
fluorouracil (5-FU, Adrucil, Efudex)
gemcitabine (Gemzar)
INDICATION:

• Leukemias
• GI and basal cell cancers
Adverse effects
• cytarabine ( Cytosar): alopecia, stomatitis,
hyperuricemia, and hepatotoxicity
• 5-Flourouracil (Fluroblastin): phototoxicity
reactions, & cerebellar dysfunction
• mercaptopurine (Empurine): hyperuricemia &
hepatotoxicity
• methotrexate (Emthexate): hyperuricemia,
photosensitivity, hepatotoxicity,
hematological, gastrointestinal and skin
toxicity
Nursing Interventions
• 5-Fluorouracil (Fluroblastin): assess for signs of
cerebellar dysfunction, such as dizziness,
weakness, and ataxia.
• methotrexate (Emthexate): prepare to administer
leukovorin to prevent toxicity especially in large
doses
• leucovorin (Wellcovorin) is an active form of
folic acid that is used to “rescue” cells from
the adverse effects of methotrexate therapy.
• Given orally or IV at the time of methotrexate
therapy and for the next 72 hours
Client Teachings
1. Practice reliable contraception and notify
health care provider if pregnancy is planned
2. Avoid pregnancy for 4 to 6 months after
completing antineoplastic therapy
3. Do not breastfeed during treatment
4. Immediately report buzzing, ringing, or
tingling sensation in the ears, or decreased
hearing
5. Immediately report palpitations and dizziness
or fainting when moving to an upright
position
6. Report for any fever, chills or sore throat
7. Amenorrhea, menstrual irregularities, and
sterility may occur in premenopausal women;
impotence for men
8. Avoid citric acid and foods high in purines
(organ meats, beans, peas)
ANTITUMOR ANTIBIOTICS
Antitumor Antibiotics
• Interfere with DNA and RNA synthesis
• Mechanism of action is similar to the alkalyting
agents
• Contains substance obtained from bacteria
that have the ability to kill cancer cells.
• Cell cycle phase non-specific medications
• Examples:
bleomycin (Blenoxane)
doxurubicin (Mycin, Adrinablastina)
idarubicin ( Zavedos)
Adverse Effects
• Cardiotoxicity may occur within minutes of
administration
• Cardiomyopathy and ECG changes
• Pulmonary toxicity can occur with bleomycin
(Blenoxane)
Nursing Interventions

1. Monitor ECG changes especially for T-wave

flattening or ST depression
2. Assess lung sounds for crackles
3. Assess for congestive heart failure including
dyspnea, crackles, peripheral edema, and
weight gain.
Nursing Interventions

4. Avoid the use of aspirin, anticoagulants, and

thrombolytic agents.
5. Hydrate the client.
6. Administer antiemetic 30 to 60 minutes
before the medication.
MITOTIC INHIBITORS
VINCA ALKALOIDS
Mitotic Inhibitors
• Interferes with the ability of a cell to divide
• Block or alters DNA synthesis, thus causing cell
death
• Cell cycle phase-specific and act on the M phase
• Used for the treatment of a variety of tumors and
leukemias
Vinca alkaloids
• vincristine ( Nevexitin, Oncovin)
• vinblastine sulfate (Velban)

Taxanes
• docetaxel (Daxotel)
• paclitaxel (Taxol)

Topoisomerase Inhibitors
• etoposide (Posid, Phytosid)
• irinotecan (Camptosar)
Adverse Effects

• Leukopenia, thrombocytopenia, anemia,

pancytopenia
• Neurotoxicity with vincristine sulfate
(Oncovin), manifested as numbness and
tingling in the fingers and toes
• Necrosis and cellulitis if extravasation occurs
Nursing Interventions
1. Arrange for blood tests to monitor bone marrow
function before, periodically during, and for at
least 3 weeks after therapy to arrange to
discontinue the drug or reduce the dose as
needed.
2. Avoid direct skin or eye contact with the drug.
Wear protective clothing and goggles while
preparing and administering the drug to prevent
toxic reaction to the drug.
3. Ensure that the patient is well hydrated to
decrease the risk of renal toxicity.
4. Protect the patient from exposure to
infection because bone marrow suppression
will decrease immune/ inflammatory
responses.
5. Monitor injection sites to arrange appropriate
treatment for extravasation, local
inflammation, or cellulitis.
Preventing Extravasation
1. Use a distal vein, avoiding small veins on the
wrists or digits.
2. Never use existing line unless it is clearly open and
running well.
3. Start the infusion with D5W
4. Check the site frequently and ask the patient to
report any discomfort in the area.
Note: When IV antineoplastic drug extravasates, or
infiltrates into the surrounding tissue, serious tissue
damage can occur. These drugs are toxic to cells, and the
resulting tissue injury can result in severe pain, scarring,
nerve damage, infection
HORMONES AND HORMONE
MODULATORS
Hormone and Hormone Modulators
• Hormonal medications are used to interfere
with estrogen receptor sites so as to prevent
growth of the cancer
• Suppress the immune system and block
normal hormones in hormone sensitive tumor
• Change the hormonal balance and slow the
growth rates of certain tumors
Hormone and Hormone Modulators
• Indicated for the treatment of breast cancer in
postmenopausal women or in other women
without ovarian function
• Some drugs are indicated for the treatment of
prostatic cancers that are sensitive to
hormone manipulation
Hormone and Hormone Modulators
• tamoxifen (Novaldex)
• megestrol acetate (Megace)
• leuprorelin (Luprolex
• goserelin acetate (Zoladex)
• asparaginase (Elspar)
• diethystilbestrol (Stilphostrol)
Adverse Effects
• Menopause-associated effects: hot flashes,
vaginal spotting, vaginal dryness, moodiness,
and depression
• Bone marrow suppression and GI toxicity,
including hepatic dysfunction
• Hypercalcemia as the calcium is pulled out of
the bones without estrogen activity to
promote calcium deposition
Adverse Effects
• Increases the risk for cardiovascular disease
because of their effects on the body
• Leukopenia
• Impaired pancreatic function with
asparaginase (Elspar)
• Gynecosmatia or breast swelling
• Weight gain
Specific Adverse Effects
• tamoxifen (Novaldex) may cause edema,
hypercalcemia, & elevated cholesterol and
triglyceride levels
• Diethystilbestrol may cause impotence and
gynecosmatia in men; may alter the effects of
insulin and anticoagulants
Nursing Interventions

1. Monitor VS, serum calcium levels, cholesterol

levels, and uric acid
2. Monitor for signs of alterations in sexual
characteristics
4. Monitor pancreatic functions with
asparaginase (Elspar)
5. Encourage fluid intake of 2 to 3 L per day
6. Monitor for signs of hemorrhagic cystitis
Nursing Interventions
7. Provide comfort measures to help the
patient cope with menopausal signs and
symptoms such as hygiene measures,
temperature control, and stress reduction.
Expect to reduce the dose if these effects
become severe or intolerable.
8. Advise the patient of the need to use barrier
contraceptive measures while taking these
drugs to avert serious fetal harm.
CANCER CELL-SPECIFIC
AGENTS
 CANCER CELL-SPECIFIC AGENTS

Protein tyrosine kinase inhibitors

(Imatinib)

Epidermal growth factor inhibitors

Proteasome inhibitors
INTERACTIONS:
▪ Any drug that has potential for hepatic or renal toxicity
▪ Adversely affect drugs metabolized in the liver (e.g.
oral anticoagulants)
▪ Antineoplastic antibiotics can increase toxicity of drugs that are
toxic to the heart and lungs.
▪ Echinacea: increased risk of hepatotoxicity with antineoplastics
INTERACTIONS:
▪ Ginkgo: inhibits blood clotting, which can cause problems
after surgery or with bleeding neoplasms
▪ Saw palmetto: increase the effects of various estrogen hormones
and hormone modulators; advise patients taking such drugs to avoid
this herb
St. John’s wort: can greatly increase photosensitivity
TARGETTED THERAPY
IMMUNOTHERAPY
 TYPES:

IMMUNE CHECKPOINT INHIBITORS

T-CELL TRANSFER THERAPY
MONOCLONAL ANTIBODIES
TREATMENT VACCINES
IMMUNE SYSTEM MODULATORS
•Karch, A. M., & Karch. (2011). Focus on nursing
pharmacology. Wolters Kluwer Health/Lippincott
Williams & Wilkins. [Link]
•Katzung, B. G. (2017). Basic and clinical
pharmacology. McGraw-Hill Education.
•Lehne, R. A., Moore, L. A., Crosby, L. J., &
Hamilton, D. B. (2004). Pharmacology for nursing
care.
•Smeltzer, S. C., & Bare, B. G. (1992). Brunner &
Suddarth’s textbook of medical-surgical nursing.
Philadelphia: JB Lippincott.
•Raven, Masleed, R, et al. (2017). Lippincott’s
Nursing Guide.Pharmacology, Drug Therapy and
Nursing. (4thEd).Philadelphia: JB Lippincott
INTERNET SOURCE:

https://www.youtube.com/watch?v=cwl84rwyYeQ
https://www.youtube.com/watch?v=QgZNfuxP0wM
https://www.youtube.com/watch?v=59aJJ6N2a3c
https://www.youtube.com/watch?v=RAVfM8ebkTY
https://www.youtube.com/watch?v=ddq3ge6XYO0
https://www.youtube.com/watch?v=PTLUZ8PnocM