3 Chemotherapeutic Agents Lecture Part 3

Notre Dame of Marbel University
College of Arts and Sciences

Nursing Department
VI. ANTI-VIRAL AGENTS

AGENTS FOR HIV AND AIDS
The human immunodeficiency virus (HIV) attacks the helper T cells (CD4
cells) within the immune system.
the cell loses its ability to perform normal immune functions.
as more and more viruses are released and invade more CD4 cells, the
immune system loses full immune action when body is invaded.
causes acquired immune deficiency syndrome (AIDS) and AIDS-
related complex (ARC), diseases that are characterized by the
emergence of a variety of opportunistic infections and cancers.
Nursing Department
NONNUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS
Therapeutic Actions and Indications
Includes: delavirdine (Rescriptor), efavirenz (Sustiva), etravirine (Intelence),
and nevirapine (Viramune) and rilpivirine (Edurant)
They prevent the transfer of information that would allow the virus to carry
on the formation of viral DNA.
As a result, the virus is unable to take over the cell and reproduce
Nursing Department
Pharmacokinetics
generally absorbed directly in the GI tract
metabolized in the liver
Excreted through feces and urine
Nursing Department
Contraindications and Cautions
There are no adequate studies of nonnucleoside reverse transcriptase
inhibitors in pregnancy,
use should be limited to situations in which the benefi ts clearly outweigh
any risks.
Nursing Department
There are no adequate studies of nonnucleoside reverse transcriptase
inhibitors in pregnancy,
use should be limited to situations in which the benefi ts clearly outweigh
any risks.
Nursing Department
M. ANTI-VIRAL AGENTS
Adverse Effects
GI related—dry mouth, constipation or diarrhea, nausea, abdominal pain,
and dyspepsia.
Dizziness, blurred vision, and headache
A flu-like syndrome of fever, muscle aches and pains, fatigue, and loss of
appetite
Nursing Department
NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS
include the following agents: abacavir (Ziagen), didanosine (Videx),
emtricitabine (Emtriva), lamivudine (Epivir), stavudine (Zerit XR),
tenofovir (Viread), and zidovudine (Retrovir).
compete with the naturally occurring nucleosides within the cell that
the virus would use to build the DNA chain
chain cannot lengthen and cannot insert and cannot reproduce.
Nursing Department
Pharmacokinetics
Generally absorbed in the GI tract
Metabolized in the liver
Excreted in the urine and feces
Nursing Department
zidovudine is the only agent that has been proven to be safe when
used during pregnancy and caution if with bone marrow supression
Pregnancy -use should be limited to situations in which the benefits
clearly outweigh any risks.
Tenofovir, zidovudine, and emtricitabine-used with caution in the
presence of hepatic dysfunction or severe renal impairment
Nursing Department
Adverse Effects
Serious-to-fatal hypersensitivity reactions
(fever, chills, rash, fatigue, GI upset, flu-like symptoms)
Serious pancreatitis, hepatomegaly, and neurological problem
Severe hepatomegaly with steatosis
Severe bone marrow suppression
Nursing Department
PROTEASE INHIBITORS
include atazanavir (Reyataz), darunavir (Prezista). fosamprenavir
(Lexiva), indinavir (Crixivan), lopinavir (Kaletra), nelfi navir (Viracept),
ritonavir (Norvir), saquinavir (Fortovase), and tipranavir (Aptivus).
block protease activity within the HIV virus
Protease is essential for the maturation of an infectious virus;
without it, an HIV is immature and noninfective.
Nursing Department
PROTEASE INHIBITORS
Pharmacokinetics
Generally absorbed in the GI tract
Excreted in the urine and feces
Nursing Department
PROTEASE INHIBITORS
use during pregnancy should be limited
limited to situations in which the benefi ts clearly outweigh any
risks
Use in caution with Hepatic Dysfunction
Nursing Department
PROTEASE INHIBITORS
Adverse Effects
GI effects, including nausea, vomiting, diarrhea, anorexia, and
changes in liver function
Elevated cholesterol and triglyceride levels
Rashes, pruritus, and the potentially fatal Steven–Johnson syndrome
Nursing Department
PROTEASE INHIBITORS
Adverse Effects
GI effects, including nausea, vomiting, diarrhea, anorexia, and
changes in liver function
Elevated cholesterol and triglyceride levels
Rashes, pruritus, and the potentially fatal Steven–Johnson syndrome
Nursing Department
NURSING IMPLEMENTATIONS
Assess for the any allergy with retroviral medications
Evaluate hepatic and renal function tests
Ensure that the patient takes the complete course of the drug
regimen
Report extreme fatigue, severe headache, diffi culty breathing, or
severe rash to a health care provider.
Stop and refer if with Hypersensitivity reaction to medications
Nursing Department
VII. ANTINEOPLASTIC
AGENTS
Nursing Department
VII. ANTINEOPLASTIC AGENTS
intended to target the abnormal cells that compose the neoplasm or cancer
unfortunately, normal cells also are affected by antineoplastic agents
Cancer -start with a single cell that is genetically different from the other cells in the
surrounding tissue. eventually producing a tumor or neoplasm .
2 TYPES OF CANCER:
1. SARCOMA - originated from mesenchyme and are made up of embryonic
connective tissue cells
2. CARCINOMA - originated from epithelial cells
Nursing Department
ALKYLATING AGENTS
include: altretamine (Hexalen), bendamustine (Treanda), busulfan (Busulfex, Myleran),

carboplatin (Paraplatin), carmustine (BiCNU, Gliadel), chlorambucil (Leukeran), cisplatin
(Platinol-AQ), cyclophosphamide (Cytoxan, Neosar).
produce their cytotoxic effects by reacting chemically with portions of the RNA, DNA, or
other cellular proteins, most potent when they bind with cellular DNA.
These drugs are most useful in the treatment of slow-growing cancers such as various
lymphomas, leukemias, myelomas, some ovarian, testicular, and breast Ca.
Nursing Department
ALKYLATING AGENTS
Pharmacokinetics
They are metabolized and sometimes activated in the liver.

Excreted in the urine.
Nursing Department
ALKYLATING AGENTS
contraindicated during pregnancy and lactation

Caution to any individual with:
known allergy to any of them;
with bone marrow suppression
with suppressed renal or hepatic function
Nursing Department
ALKYLATING AGENTS
Adverse Effects
Hematological effects include bone marrow suppression, with leukopenia,

thrombocytopenia, anemia, and pancytopenia.
GI effects include nausea, vomiting, anorexia, diarrhea, and mucous membrane
deterioration
Hepatic toxicity and renal toxicity
Alopecia, or hair loss
Nursing Department
ALKYLATING AGENTS
Nursing Implementations
Assess for contraindications or cautions: history of allergy to any of the alkylating agents
Monitor the results of laboratory tests such as complete blood count with differentials
Arrange for blood tests before, periodically during, and for at least 3 weeks after therapy
Ensure that the patient is well hydrated
Protect the patient from exposure to infection
Provide small, frequent meals, frequent mouth care
Arrange for proper head covering at extremes of temperature if alopecia occurs; a wig,
scarf, or hat
Nursing Department

ANTIMETABOLITES
Therapeutic Indications and Cautions
include capecitabine (Xeloda), cladribine (Leustatin), clofarabine (Clolar),
cytarabine (DepoCyt, Tarabine PFS), fl oxuridine (FUDR), fl udarabine
(Fludara), fluorouracil (Adrucil, Carac, Efudex, Fluoroplex), gemcitabine
(Gemzar), mercaptopurine (Purinethol), methotrexate (Rheumatrex, Trexall)
inhibit DNA production in cells that depend on certain natural metabolites to
produce their DNA.
most effective in rapidly dividing cells, preventing cell replication, and leading
to cell death
Nursing Department

ANTIMETABOLITES
Pharmacokinetics
Generally absorbed well in the GI tract
Excreted in the urine
Nursing Department

ANTIMETABOLITES
Caution is necessary to any individual with:
known allergy
bone marrow suppression
with renal or hepatic dysfunction
with known GI ulcerations or ulcerative diseases
Nursing Department

ANTIMETABOLITES
Adverse Effects
Hematological effects include bone marrow suppression, with leukopenia,
thrombocytopenia, anemia, and pancytopenia,
Toxic GI effects include nausea, vomiting, anorexia, diarrhea, and mucous
membrane deterioration
CNS effects include headache, drowsiness, aphasia, fatigue, malaise, and
dizziness.
possible hepatic or renal toxicity,
Alopecia
Nursing Department

ANTIMETABOLITES
Assess for contraindications and cautions: history of allergy to the specifi c antimetabolite
Arrange for blood tests to monitor bone marrow function before, periodically during, and
for at least 3 weeks after therapy
Monitor the results of laboratory tests such as complete blood count
scarf, or hat
Plan for appropriate rest periods because fatigue and weakness are common effects of the
drugs.
Avoid situations that might lead to infection
Nursing Department
ANTINEOPLASTIC ANTIBIOTICS
include:bleomycin (Blenoxane), dactinomycin (Cosmegen), daunorubicin (DaunoXome),

doxorubicin (Adriamycin, Doxil), epirubicin (Ellence), idarubicin (Idamycin), mitomycin
(Mutamycin), mitoxantrone (Novantrone), and valrubicin (Valstar).
break up DNA links, and others prevent DNA synthesis

are cytotoxic and interfere with cellular DNA synthesis by inserting themselves between
base pairs in the DNA chain
Nursing Department
Pharmacokinetics
Generally Absorbed in the GI Tract

Excreted in the urine
Nursing Department
Adverse Effects
leukopenia, thrombocytopenia, anemia, and pancytopenia
Toxic GI effects include nausea, vomiting, anorexia, diarrhea, and mucous membrane
deterioration
renal or hepatic toxicity
Alopecia
Nursing Department
Assess for contraindications or cautions: history of allergy to antibiotics
scarf, or hat
Plan for appropriate rest periods because fatigue and weakness are common effects of
the drugs.
Nursing Department
MITOTIC INHIBITORS
include cabazitaxel (Jevtana), docetaxel (Taxotere), etoposide (Toposar, VePesid),
ixabepilone (Ixempra), paclitaxel (Abraxane, Onxol, Taxol), teniposide (Vumon),
vinblastine (Velban), vincristine (Oncovin, Vincasar), and vinorelbine (Navelbine).
interfere with the ability of a cell to divide; they block or alter DNA synthesis, thus
causing cell death
are used for the treatment of a variety of tumors and leukemias

Nursing Department
MITOTIC INHIBITORS
Pharmacokinetics
Generally, these drugs are given intravenously because they are not well absorbed
from the GI tract
excreted primarily in the feces
safer for use in patients with renal impairment
Nursing Department
MITOTIC INHIBITORS
Pharmacokinetics
Generally, given intravenously because they are not well absorbed from the GI tract
excreted primarily in the feces
safer for use in patients with renal impairment
Nursing Department
MITOTIC INHIBITORS
should not be used during pregnancy or lactation
Use caution when giving to anyone with:
known allergy to the drug or related drugs
renal or hepatic dysfunction
known GI ulcerations or ulcerative diseases
Nursing Department
MITOTIC INHIBITORS
Adverse Effect
leukopenia, thrombocytopenia, anemia, and pancytopenia
GI effects include nausea, vomiting, anorexia, diarrhea, and mucous membrane
deterioration
Alopecia
necrosis and cellulitis if extravasation occurs
Nursing Department
MITOTIC INHIBITORS
Nursing Implentations
Assess for contraindications or cautions: history of allergy to the drug used
Regularly inspect IV insertion sites for signs of extravasation or infl ammation
Avoid direct skin or eye contact with the drug. Wear protective clothing and goggles
while preparing and administering the drug
Arrange for proper head covering at extremes of temperature if alopecia occurs; a
wig, scarf, or hat
Nursing Department
HORMONES AND HORMONE MODULATORS
include:anastrazole (Arimidex), bicalutamide (Casodex), degarelix (Degarelix for Injection),

estramustine (Emcyt), exemestane (Aromasin), fl utamide (generic), fulvestrant (Faslodex),
goserelin (Zoladex), histrelin (Vantas), letrozole (Femara), megestrol (Megace)
are receptor-site specific or hormone specific to block the stimulation of growing cancer
cells that are sensitive to the presence of that hormone
indicated for the treatment of breast cancer in postmenopausal women or in other women
without ovarian function and some for prostatic cancers.
Nursing Department
Pharmacokinetics
readily absorbed from the GI tract
excreted in the urine.
Nursing Department
Hypercalcemia is a contraindication to the use of toremifene
Use caution when giving to an individual with:
known allergy to any of these drugs
with renal or hepatic dysfunction
Nursing Department
Adverse Effects
Menopause-associated effects include hot fl ashes, vaginal spotting, vaginal dryness,
moodiness, and depression.
GI toxicity, including hepatic dysfunction.
Hypercalcemia d/t blockage of estrogen needed for calcium deposition
increase the risk for cardiovascular disease
Nursing Department
Assess for contraindications or cautions: history of allergy to the drug in use or any related
drugs
Arrange for blood tests to monitor bone marrow function before and periodically during
therapy
Provide comfort measures to help the patient cope with menopausal signs and symptoms
Maintain nutrition even if GI effects are severe.
Monitor for adverse effects (bone marrow suppression, GI toxicity, menopausal signs and
symptoms, hypercalcemia, and cardiovascular effects).
Nursing Department
CANCER CELL–SPECIFIC AGENTS
The goal of much of the current antineoplastic drug research is directed at
finding drugs that are cancer cell specific.
no devastating effects on healthy cells in the body and would be more
effective against particular cancer cells.
3 GROUPS OF DRUGS AVAILABLE
1. protein tyrosine kinase inhibitors
2. an epidermal growth factor inhibitor
3. a proteasome inhibitor
Nursing Department
PROTEIN TYROSINE KINASE INHIBITORS
act on specific enzymes that are needed for protein building by specific
tumor cells and blocking of these enzymes inhibits tumor cell growth and
division.
include everolimus (Afinitor), gefitinib (Iressa), imatinib (Gleevec), lapatinib
(Tykerb), nilotinib (Tasigna), pazopanib (Vorient), sorafenib (Nexavar),
sunitinib (Sutent), and temsirolimus (Torisel).
chronic myelocytic leukemia (CML).
Nursing Department
Pharmacokinetics
Slowly absorbed by the GI
Metabolized by the liver
excreted through the feces
Nursing Department
All of these drugs are in pregnancy category D.
Women of childbearing age should be advised to use barrier
contraceptives while taking this drug.
only if the benefits to the mother clearly outweigh the risks to the baby
contraindicated with patients who have or who are at risk for prolonged
QT intervals (hypokalemia, hypomagnesia,)
Nursing Department
Assess for contraindications or cautions: history of allergy to any of the alkylating agents
Arrange for proper head covering at extremes of temperature if alopecia occurs; a wig, scarf,
or hat

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Notre Dame of Marbel University

College of Arts and Sciences

VI. ANTI-VIRAL AGENTS

include: altretamine (Hexalen), bendamustine (Treanda), busulfan (Busulfex, Myleran),

They are metabolized and sometimes activated in the liver.

contraindicated during pregnancy and lactation

Hematological effects include bone marrow suppression, with leukopenia,

VII. ANTINEOPLASTIC AGENTS

VII. ANTINEOPLASTIC AGENTS

VII. ANTINEOPLASTIC AGENTS

VII. ANTINEOPLASTIC AGENTS

VII. ANTINEOPLASTIC AGENTS

include:bleomycin (Blenoxane), dactinomycin (Cosmegen), daunorubicin (DaunoXome),

break up DNA links, and others prevent DNA synthesis

Generally Absorbed in the GI Tract

are used for the treatment of a variety of tumors and leukemias

include:anastrazole (Arimidex), bicalutamide (Casodex), degarelix (Degarelix for Injection),

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