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Anticancer Drugs: Nur Permatasari
Anticancer Drugs: Nur Permatasari
Nur Permatasari
“CANCER”
Refers to a Malignant neoplasm (New growth)
• Uncontrolled Proliferation.
• Loss of function due to lack of ability to differentiate.
• Do not die on schedule
Causal Factors
Familial
Physical
Viral
Dietary
Lifestyle
Environmental
Chemical Carcinogenesis
Colorectal Cancer – 5%
Ultraviolet radiation
Induces DNA change that leads to malignant
transformation
Asbestos inhalation
Synergistic with tobacco smoke
PHASE NONSPECIFIC
• Tumor Suppressor
alkylating agents, cis-platinum
Genes -ve (p53)
nitrosoureas,
• Growth Factors dacarbazine G 1 G0 G0
Antibiotics
Oncogenes +ve R Differentiation
CELL GROWTH CYCLE
5 DISTINCT PHASES OF MITOSIS
1. G0 - Resting - no mitosis
2. G1 - Postmitotic - first growth
3. S - DNA synthesis phase
4. G2 - Premitotic - second growth
5. M- Mitosis phase
GENERATION TIME - one complete cycle different
in all tumors, from hours to days
ANTINEOPLASTIC AGENTS
2 MAIN GROUPS OF AGENTS:
Ribonucleotides
6-MERCAPTOPURINE HYDROXYUREA
6-THIOGAUNINE
Inhibit Puring ring Inhibit
biosynthesis Ribonucleotide
Deoxyribonucleotides
Inhibit Neocleotide Reductase
interconversions
METHOTREXATE 5-FLOUROURACIL
Inhibit dihydrofolate
Inhibit TMP
reduction, blocks
Synthesis
TMP and Purine
synthesis DNA
BLEOMYCIN CYTARABINE
ETOPOSIDE FLUDARABINE
TENIPOSIDE 2-CHLORODEOXY
DNA ADENOSINE
Damage DNA and
Prevent repair Inhibit DNA
Synthesis
A-ASPARAGINASE PACLITAXEL
Deaminate VINCA ALKALOIDS
asparagine PROTEINS COLCHICINE
Inhibits protein Inhibit function of
synthesis Microtubules
Enzymes Microtubules
ANTINEOPLASTIC AGENTS
ADVERSE EFFECTS:
SELECTED AGENTS:
USES:
•Solid tumors
(breast, lung, liver, brain, colon. Stomach, pancreas)
•Lymphomas, leukemias.
•Some agents also immunosuppressive,
•Useful in treating immune-mediated diseases
ANTIMETABOLITES
SELECTED AGENTS: (FOLIC ACID ANALOG)
• METHOTREXATE (Folex, Rheumatrex, MTx)
• Folic acid antagonist
• PO & IM, adult and pediatric use
• Also used to treat immune-mediated diseases,
• Used incombination with misoprostol for therapeutic
abortion
• Causes profound anemia (folate depletion)
• Therefore leucovorin “rescue” often used to
counteract
ANTIMETABOLITES
SELECTED AGENTS:
• PURINE ANALOG
- MERCAPTOPURINE (6-MP, Purinethol)
- Purine antagonist
- PO only, adult and pediatric use
• PYRIMIDINE ANALOG -
•CYTARABINE (Ara-C, Cytosar-U)
-Pyrimidine antagonist
-IV and intrathecal (within spinal canal)
MITOTIC INHIBITORS
ACTIONS:
Plant alkaloids (periwinkle, yew tree, mandrake plant, etc.)
Bind to and disrupt mitotic spindles
USES:
Lymphomas (Hodgkin’s and non-Hodgkin’s),
Neuroblastoma
Kaposi’s sarcoma,
Solid tumors (breast, testicular, etc.)
MITOTIC INHIBITORS
SELECTED AGENTS:
ETOPOSIDE (VP-16, VePesid)
IV and PO, adult use only
PACLITAZEL (Taxol)
IV only, adult use only
drug of choice for ovary and breast ca
VINCRISTINE (LCR, VCR,Oncovin)
IV only, adult and pediatric use
drug of choice for acute leukemia
CYTOTOXIC ANTIBIOTICS
ACTIONS:
• Source: Streptomyces mold - work by intercalation
(insertion of drug molecule between the 2 DNA strands
causing it to (“unwind”)
• Kill some bacteria and viruses but are too toxic to use for
infections
IV extravasation constant danger !
USES:
wide variety of solid tumors,
always used in combination with other agents
CYTOTOXIC ANTIBIOTICS
SELECTED AGENTS:
SELECTED AGENTS:
•Cisplatin (Platinol)
IV, adult and pediatric use
•ALTRETAMINE (Hexalen)
PO only, adult use only, primarily used to treat ovarian cancer
•ASPARAGINASE (Elspar)
IV only, adult and pediatric use
•HYDROXYUREA (Hydrea)
PO only, adult use only
MISCELLANEOUS ANTINEOPLASTICS
HORMONES AND ANTAGONISTS.
1. Adrenocortical Suppressant:
Mitotane, Aminoglutethimide. (Adrenal Cortex)
2.Adrenocortical Steroids.
Prednisone. (Lukemias, Lymphomas, Breast)
3.Progestins.
Hydroxyprogestrone.(Endometrium, (Breast)
Medroprogestrone, Megesterol acetate.
4.Estrogens.
DES, Ethinylesterdiol.(Breast, Prostate)
5.Antiestrogens.
Tamoxifen .(Breast)
6.Androgens. Testosterone (Breast)
7.Antiandrogens. Flutamide (Prostate).
8.Gonadotropin Releasing Hormone Analog.
Leuprolide. (Prostate)
NURSING MANAGEMENT
NO ASA or NSAIDS
Nothing inserted into rectum or vagina
No foley catheters if at all possible
No IM injections
Limit venipunctures and invasive procedures
Soft toothbrush-no flossing - electric razor
No vigorous exercise
Avoid straining at stool
Anemia
Multiple causes
Most common side effect from chemo
Not relieved by sleep
Prevention of anemia can reduce incidence
Short periods of mild exercise can reduce severity
Teach energy conservation and appropriate rest
periods
Need for caregiver assistance
Nausea & Vomiting
Type Onset
Acute emesis 24 h postchemotherapy
Cerebral Cortex
Vomiting Center
EFFERENT PATHWAYS
Vagi
Sympathetics
Phrenics
Treat prophylactically
Adequate fluid intake
Increased fiber intake
Increased activity
Stool softeners taken routinely (Senekot)
Laxative or Cathartic if no BM in 3 days
Try to avoid enemas
Stomatitis/Mucositis
Inflammation or ulceration of mouth which can progress
to entire GI tract
Destruction of fast-growing epithelial cells
Drugs: 5-FU, Methotrexate, Xeloda, Bleomycin, HD
chemo
Radiation fields that include mouth or throat
Alcohol, tobacco use
Poor oral hygiene, dental caries
Causes pain, infection, dehydration, weight loss
Management of Mucositis
Patient education
Discuss concerns frankly
Sperm banking
Birth control
Lubrications
Position changes
Counseling (time of high stress)