CHEMOTHERAPY OF

PARASITIC DISEASE
PRESENTED BY: KATHYRINE A. CALONG CALONG ,MA,RN
Parasites include protozoa & worms which
may infect humans, causing parasitic disease.

• A parasitic infection is an infection

caused or transmitted by parasite.
• Many parasites do not cause diseases.
• Parasitic infection can affect practically
all living organisms including plants and
animals.
BASIC TERMINOLOGY AND PRINCIPLES
COMMON TYPES OF PARASITES:
ROUNDWORMS

TAPEWORMS

EACH CAUSES DIFFERENT

HOOK WORMS
SYMPTOMS AND
DIFFERENT INFECTIONS.
HEART WORMS

AMOEBA

FLIES, FLIES, LICE, MITES,

TICKS & SPIDERS.
 INVECTION VS. DISEASE

SUCCESSFUL PARASITE- LIVE IN, BUT DO NOT KILL

THEIR HOSTS.
PROTOZOA -MULTIPLY WITHIN HOSTS EXPRESSION OF
DISEASE DEPENDS ON HOST FACTORS
HELMINTHS -DO NOT MULTIPLY WITHIN HOSTS
SEVERITY OF DISEASE DEPENDS ON PARASITE BURDEN
AND IMMUNOLOGIC RESPONSE TO PARASITES.
PARASITE MODE OF ENTRY
INGESTION

ARTHROPODA
BITES

PENETRATION
OF INTACT
SKIN

OR MUCOUS
MEMBRANE
SPREAD AND TROPISMS

Some parasites must migrate to

certain locations within the host
in order to complete their life
cycle

Non-human parasites, in
humans, often fail to migrate
properly and become “dead-
end infections”
 SYMBIOSIS AND MUTUALISM

AN ASSOCIATION WHICH IS
THE RELATIONSHIP BETWEEN TWO LIVING BENEFICIAL TO BOTH LIVING
THINGS (ANIMALS). THINGS.

TWO LIVING THINGS LIVE TOGETHER AND

INVOLVE PROTECTION OR OTHER
ADVANTAGES TO ONE OR BOTH
PARTNERS.
 COMMENSALISM

BOTH PARTNERS ARE ABLE TO

LEAD INDEPENDENT LIVES, BUT
ONE MAY GAIN ADVANTAGE
FROM THE ASSOCIATION WHEN
THEY ARE TOGETHER AND LEAST
NOT DAMAGE TO THE OTHER.
 PARASITISM
Endoparasites-
which cause
infection inside
the body.
 An association which is
beneficial to one partner
and harmful to the other  Human
partner. parasites
 The former that is beneficial
to is called parasite, the Ectoparasites-
which cause
latter that is harmful to is infection
called host. superficially
within the skin.
List of parasites of human
ENDOPARASITES

PROTOZOAN ORGANISMS

HELMINTHS ORGANISMS (WORM)

• TAPEWORMS
• FLUKES
• ROUNDWORMS

OTHERS
 I. ANTIHELMINTHICS
DRUG ACTION USE ADVERSE EFFECTS NURSING IMPLICATIONS

PYRANTEL Paralyzes intestinal Roundworm, Pinworm Nausea, vomiting, anorexia,  Give with milk or fruit juice.
(ANTIMINTH) tract of worm. Hookworm abdominal cramps,  Entire dose must be taken
diarrhea. at once.
 Offer frequent, small meals.

MEBENDAZOLE Inhibits glucose and Pinworm, roundworm, Abdominal cramping,  Can be taken with or
(VERMOX) other nutrient uptake of Threadworm occasional fever without food.
helminth. Hookworm  Tablet can be chewed or
crushed.
 Examine stool for presence
of worms.
THIABENDAZOLE Interferes with parasitic Threadworm, Pinworm Dizziness, drowsiness,  Give with food
(MINTEZOL) metabolism. headache, anorexia,  Chew tablets before
nausea, malodor of urine. swallowing
 Avoid activities such as
driving and working with
machinery.
PRAZIQUANTEL Enhances permeability Schistosomes and flukes Headache, dizziness,  Give with food or liquids
(BILTRICIDE) of the cell membranes abdominal pain, increase  Do not chew
of the parasite to liver enzymes.  No not breastfeed.
calcium.
 II. CHEMOTHERAPY FOR MALARIA
MALARIA – is an acute infectious disease caused
by four species of protozoal genus Plasmodium.

It is transmitted to humans through…

Plasmodium falciparum is the most dangerous species,

causing an acute, rapidly fulminating disease that is
characterized by:
• Persistent high fever
• Orthostatic hypotension
• Massive erythrocytosis (increase RBC)
 4 SPECIES
P. Falciparum infection can lead to Capillary obstruction
and death without prompt treatment.
Plasmodium Vivax causes a milder form of the disease.

Plasmodium Malariae is common to many tropical

regions.
Plasmodium Ovale is rarely encountered.
CHEMOTHERAPY FOR MALARIA

Primaquine
Chloroquine
Atovaquone-proguanil
Mefloquine
Quinine
Artemisinin
A. PRIMAQUINE
B. CHLOROQUINE
C. ATOVAQUONE-PROGUANIL
D. MEFLOQUINE
E. QUININE
F. ARTEMINISININ
G. PYRIMETHAMINE
 CANCER
CHEMOTHERAPY
CANCER
NEOPLASM
Uncontrolled A mass of tissue formed as a result of:
multiplication and  Abnormal
spread within the body  Excessive
of abnormal forms of  Uncoordinated
body’s own cells.  Autonomous
 Purposeless
 Proliferation of cells
Chemo
“chemical induced”

-chemicals
administered to
destroy cancerous
tissues.
CA CHEMOTHERAPY NOT SUCCESSFUL AS
ANTIMICROBIAL CHEMOTHERAPY…

Metabolism in parasites
differ qualitatively from
host cells.
Metabolism in cancer
cells differ from
quantitatively from
normal host cells.
 MODALITIES OF TREATMENT IN CANCER

 SURGERY 1/3 OF PX CAN BE

CURED,
EFFECTIVE WHEN
TUMOR HAS NOT
METASTASIZED
 RADIOTHERAPY
 CHEMOTHERAPY: 50% OF THE PATIENTS
CAN BE TREATED WITH CHEMOTHERAPY
CONTRIBUTING TO CURE IN 15-20% OF
PATIENTS
 CANCER CELLS DIFFER
FROM NORMAL CELLS BY…

UNCONTROLLED PROLIFERATION

DE-DIFFERENTIATION & LOSS OF FUNCTION

INVASIVENESS

METASTASIS
ADJUVANT & NEOADJUVANT CHEMOTHERAPY

ADJUVANT
CHEMOTHERAPY
- Given after surgery or
irradiation to destroy micro
metastasis & prevent
development of secondary
neoplasm.
NEO-ADJUVANT
CHEMOTHERAPY
- Given before surgery or
radiotherapy in order to
diminished the volume of
large primary neoplasm.
 RELATED DRUGS DRUG
CLASSIFICATION
Busulfan (Myleran)
ANTINEOPLASTIC Carboplatin (Paraplatin)
AGENT Carmustine (BiCNU)
Chlorambucil (Leukeran)
Cisplatin (Platinol-AQ)
Ifosfamide (ifex) Alkylating
PROTOTYPE Iomustine (CeeNu) Agents
Mechlorethamine
DRUG (Mustargen)
CYCLOPHOSPHAMIDE Melphalan ( Alkeran)
(CYTOXAN) Oxaliplatin (Eloxatin)
Streptozocin (Zanosar)
Thiotepa ( Thioplex)
 RELATED DRUGS DRUG
CLASSIFICATION
ANTINEOPLASTIC Capecitabine (Xeloda)
Cladribine (Leustatin)
AGENT Clofarabine (Clolar)
Cytarabine (Ara-C)
Floxuridine ( FUDR)
Fludarabine (Fludara)
Mercaptopurine (Purinethol) Antimetabolites
FLUOROURACIL Methotrexate (Folex)
Pemetrexed (Alimta)
(ADRUCIL) Pentostatin (Nipent)
Tioguanine (Lanvis)
 RELATED DRUGS DRUG
CLASSIFICATION

ANTINEOPLASTIC Bleomycin (Blenoxane)

AGENT Dactinomycin(Cosmeg
en)
Daunorubicin
(DaunoXome)
Epirubicin (Ellence) Antibiotics
DOXORUBICIN Idarubicin (Idamycin)
(ADRIAMYCIN) Mitoxantrone
(Novantrone)
Plicamycin ( Mithracin)
Valrubicin (Valstar)
 RELATED DRUGS DRUG
CLASSIFICATION
ANTINEOPLASTIC
AGENT Docetaxel (Taxotere)
Etoposide (Toposar)
Paclitaxel (Taxol) Plant
Teniposide (Vumon) Alkaloids
Vinblastine (Velban)
VINCRISTINE Vinorelbine (Navelbine)
(ONCOVIN)
 RELATED DRUGS DRUG
CLASSIFICATION

ANTINEOPLASTIC Anastrozole (Arimidex)

Bicalutamide (Casodex)
AGENT Estramustine (Emcyt)
Exemestane (Aromasine)
Flutamide (Eulexin)
Fulvestrant (Faslodex) Hormone
Letrozole (Femara) Modulators
TAMOXIFEN Leuprolide (Lupron)
Megestrol (Megace)
(NOLVADEX) Nilatamide (Nilandron)
Testolactone (Teslac)
Toremifene (Fareston)
Triptorelin pamoate
(Trelstar Depot)
 RELATED DRUGS DRUG
CLASSIFICATION

ANTINEOPLASTIC Asparaginase
AGENT (Elspar)
Hydroxyurea Miscellaneous
(Hydrea) Agents
NO Procarbazine
(Matulane)
PROTOTYPE
DRUG
 RELATED DRUGS DRUG CLASSIFICATION

ANTINEOPLASTIC Amifostine (Ethyol)

AGENT Dexrazoxane
(Zinecard) Cytoprotectant
Leucovorin Agents
NO (Wellcovorin)
Mesna (Mesnex)
PROTOTYPE Rasburicase
DRUG (Elitek)
CLIENT TEACHING
 CLIENT TEACHING (ANTINEOPLASTICS)
 Do not become pregnant
 Do not breast-feed
 All health care providers need to
know you are taking an
antineoplastic agent.
 If hair loss occurs, it will be
temporary.
 Use soft-bristled toothbrush.
 Inspect mouth daily for sores.
 Avoid crowds and those who are ill.
 Wash hands frequently.
 Attend all physician visit and
get blood test done as
ordered.
 Eat nutritious diet
 Do not alter dosing
 Report all side effects
 No OTC drugs unless approved
by physician.
ALKYLATING AGENTS ANTI METABOLITES

Stay out of the sun.

Menstrual period may not
return for 1 year.
If unable to take dose,
physician must be notified
Report bloody urine.
Problems with balance
and ambulation must
be reported to
physician.
ANTIBIOTICS PLANT ALKALOIDS

If taking doxorubicin

(Adriamycin), Prevent constipation
by increasing fiber
Urine will be red for up to
2 days after receiving
and fluids.
drug.
HORMONE MODULATORS MISCELLANEOUS AGENTS

1.ASPARAGINASE ( ELSPAR)
Stay out of the sun.
 No activities requiring
Mentrual period may concentration
become irregular
 Toxic effects will be
experienced
2. HYDROXYUREA (HYDREA)
Toxic effects will be experienced.
3. PROCARBAZINE (MATULANE)
 NO FOODS HIGH IN TYRAMINES
 NO ALCOHOL
 NO ACTIVITIES REQUIRING
CONCENTRATION
 STAY OUT OF THE SUN
 REPORT ANY SIGHS OF
BLEEDING
 ACTION
ALKYLATING AGENTS ANTIMETABOLITES
Interfere with processes Interfere with creation
that affect DNA, causing of DNA or help
the cell to die. produce faculty DNA.
They are cell cycle They act in the S phase
nonspecific. of the cell cycle
 ANTIBIOTICS PLANT ALKALOIDS
Bring about cell death Bring about cell death
by preventing cell by preventing cell
division or interfering division or interfering
with DNA synthesis. with DNA synthesis.
They are cell cycle They are cell cycle
specific. specific.
 HORMONES MISCELLANEOUS AGENTS
MODULATORS ASPARAGINASE (ELSPAR)
Stop cancer growth in  Removes an amino acid needed in the
synthesis of DNA
hormone-dependent
HYDROXYUREA (HYDREA)
tissues by preventing  Prevents formation of DNA by hindering
protein synthesis. the presence of the mocleoside,
thymidine.

PROCARBAZINE (MATULANE)
 Action is unknown. This drug acts in the S
phase of cell cycle.
 ALKYLATING AGENTS
USE
 CANCER OF THE BREAST,  ANTIMETABOLITES
UTERUS, BLADDER,  LEUKEMIA
PANCREAS, OVARY, LUNGS ,
BRAIN & TESTICLES.  GI AND BREAST CANCER
 MULTIPLE MYELOMA  BASAL CELL CARCINOMA
 HODGKIN’S DISEASE  PSORIASIS
 LEUKEMIA  RHEUMATOID ARTHRITIS
 LYMPHOMA
 ANTIBIOTICS PLANT ALKALOIDS

 CANCER OF BLADDER,  CANCER OF LUNG, TESTICLE,

TESTICLE, PANCREAS, OVARY, BREAST
STOMACHS  LEUKEMIA
 LEUKEMIA  SARCOMA
 MULTIPLE SCLEROSIS  LYMPHOMA
 BONE PAIN IN PROSTATE  HODGKIN’S DISEASE
CANCER
 KAPOSI’S SARCOMA
 LYMPHOMA
HORMONE MODULATORS MISCELLANEOUS AGENTS
1. ASPARAGINASE (ELSPAR)
 ACUTE LYMPHOCYTIC LEUKEMIA
 CANCER OF BREAST, PROSTATE
2. HYDROXYUREA ( HYDREA)
 SICKLE CELL ANEMIA
 SQUAMOUS CELL CARCINOMA OF HEAD
AND NECK
 MYELOCYTIC LEUKEMIA
 MELANOMA
 CANCER OF OVARY
3. PROCARBAZINE (MATULANE)
 HODGKIN’S DISEASE
ADVERSE EFFECTS AND
SIDE EFFECTS
 ALKYLATING AGENTS

PREGNANCY CATEGORY D: Except for cyclophosphamide (Cytoxan) and streptozocin (Zanosar), which are category C

CNS: Dizziness

Derm: Hair loss, increased pigmentation in skin and nails, facial flushing

F&E: Decreased sodium, Increased uric acid, decreased potassium

GI: Anorexia, nausea, vomiting

GU: Kidney toxicity, hemorrhagic cystitis

Hematologic: Neutropenia
ANTI METABOLITES

PREGNANCY CATEGORY D

CNS: EUPHORIA

CV: ANGINA

DERM: HAIRLOSS, PHOTOSENSITIVITY, SYSTEMIC LUPUS ERYTHEMATOSUS LIKE DERMATITIS, ERYTHEMA

GI: DIARRHEA, NAUSEA, VOMITING, STOMATITIS

HEMATOLOGIC: THROMBOCYTOPENIA,ANEMIA, LEUKOPENIA

OTHER: EDEMA OF LEGS, FACE, EYES AND TONGUE; HYPERSENSITIVITY REACTION; TOPICAL APPLICATION CAN
CAUSE ITCHING, BURNING, PAIN, SWELLING, AND SCARRING
 ANTIBIOTICS

PREGNANCY CATEGORY D, EXCEPT FOR DACTINOMYCIN ( COSMEGEN), PLICAMYCIN (MITHRACIN), AND

VALUBICIN (VALSTAR), WHICH ARE CATEGORY C

CNS: SLEEPINESS

CV: IRREVERSIBLE CARDIAC DAMAGE

DERM: HAIRLOSS , INCREASED PIGMENTATION OF BUCCAL MUCOSA, TONGUE AND NAILS, FACIAL FLUSHING WITH QUICK IV ADMINISTRATION AND RASH;
EXTRAVASATION FROM IV ADMINISTRATION CAN CAUSE SEVERE TISSUE RASH; EXTRAVASATION FROM IV ADMINISTRATION CAN CAUSE SEVERE TISSUE
DAMAGE FROM CELLULITIS TO TISSUE NECROSIS.

F&E: INCREASED URIC ACID

GI: DIARRHEA, STOMATITIS, NAUSEA, VOMITING, ANOREXIA

GU: BLOOD IN THE URINE

PLANT ALKALOIDS

PREGNANCY CATEGORY D, EXCEPT FOR PACLITAXEL (TAXOL), WHICH IS CATEGORY X

CNS: HIGH OR LOW BLOOD PRESSURE

DERM: HAIRLOSS

EENT: DOUBLE VISION, INTOLERANCE TO LIGHT, BLINDNESS

F&E: INCREASED POTASSIUM AND URIC ACID

GI: DYSURIA, POLYURIA, URINE RETENTION

RESP: BRONCHOSPASM
HORMONE MODULATORS

PREGNANCY C

CNS: HEADACHE, DIZZINESS, SLEEPINESS, CONFUSION

CV: THROMBOSIS

DERM: RASH, PHOTOSENSITIVITY, HAIRLOSS

EENT: BLURRED VISION, RETINOPATHY

F&E: INCREASED CALCIUM

GI: MENTRUAL CHANGES , LEAKING OF MILK FROM BREASTS

 MISCELLANEOUS AGENTS
• PREGNANCY CATEGORY C
• CNS: AGITATION,CONFUSION, HALLUCINATION,
DEPRESSION
• ENDOCRINE: ELEVATED BLOOD GLUCOSE
• F&E: INCREASED URIC ACID, DECREASED CALCIUM
AND ALBUMIN
• GI: PANCREATITIS, NAUSEA, VOMITING, ANOREXIA
ASPARAGINASE • GU: KIDNEY FAILURE
(ELSPAR)
• HEMATOLOGIC: LEUKOPENIA, DECREASED
FIBRINOGEN,PLATELETS AND CLOTTING FACTORS
• OTHERS: INFECTION,ALLERGIC REACTION, WEIGHTLOSS,
INCREASED SWEATING
 HYDROXYUREA (HYDREA)

•PREGNANCY CATEGORY D
•DERM: RASH, RED FACE
•F&E : INCREASED URIC ACID
•GI: NAUSEA, VOMITING, DIARRHEA
•GU: KIDNEY DYSFUNCTION; INCREASED BUN AND
HYDROXYUREA CREATITINE
(HYDREA) •HEMATOLOGIC: DECREASED BONE MARROW
FUNCTION
•OTHER: FEVER, CHILLS
 PROCARBAZINE (MATULANE)

• PREGNANCY CATEGORY D
• CNS: SEIZURES,PARESTHESIAS, HEADACHE, DIZZINESS,
HALICINATIONS
• CV: LOW BLOOD PRESSURE, ELEVATED HEART RATE
• DERM: HAIRLOSS, FLUSHING, ITCHING, DERMATITIS,
INCREASED PIGMENTATION, PHOTOSENSITIVITY
• ENDOCRINE: GROWTH OF BREAST TISSUE IN MALES
PROCARBAZINE • GI: NAUSEA, VOMITTING
(MATULANE) • GU: SHRINKING OF TESTICLES
• HEMATOLOGIC: DECREASED BONE MARROW FUNCTION
• RESP: COUGH, PLEURAL EFFUSION
• OTHER: FEVER, CHILLS, INCREASED PERSPIRATION
NURSING IMPLICATIONS

FOR ALL ANTINEOPLASTIC AGENTS

•USE SAFE HANDLING PRECAUTIONS IF PREPARING IV FORM.
•MONITOR LAB TEST: CBC, KIDNEY AND LIVER FUNCTION
•MONITOR I&O
•WEIGH CLIENT
•PREVENT INFECTION
ALKYLATING AGENTS
• GIVE PO OR IV
• ADMINISTER PO FORM WITHOUT FOOD.
• GIVE ANTIEMETIC FOR NAUSEA/ VOMITTING
• REPORT ALL SIDE EFFECTS
• MONITOR LAB TESTS: PLATELETS, SERUM ELECTROLYTES
• LEUKOPENIA IS SIDE EFFCT TO BE MOST CONCERNED ABOUT. BLOOD
COUNT RECONVERTS TO NORMAL 7 TO 10 DAYS AFTER DRUG IS STOPPED.
• GRANULOCYTES COUNT LESS THAN 1000 IS CONSIDERED A MEDICAL
CRISIS.
ANTIMETABOLITES
•GIVE PO, IM, TOPICAL, OR IV.
•WEAR GLOVES FOR TOPICAL APPLICATION
•ASSESS CLIENT’S MOUTH
•STOP DRUG IF CLIENT IS CONFUSED OR DISORIENTED
•IF WBC IS LESS THAN 3500/mm3 , CLIENT WILL NEED TO BE
PUT IN PROTECTIVE ISOLATION.
ANTIBIOTICS
• GIVE SC, IM, IV, OR INTRAVESICALLY.
• ASSESS IV SITE AND TERMINATE INFUSION IF THERE IS
BURNING OR DISCOMFORT AT SITE
• ASSESS HEART FUNCTION BEFORE, DURING, AND AFTER
THERAPY.
• NO RECTAL TEMPERATURES OR MEDICATIONS
PLANT ALKALOIDS
• GIVE IV
• NO RECTAL TEMP. OR MEDICATIONS
• ASSESS WALKING
• PERIPHERAL NEUROPATHY AND PARESTHESIAS ARE
OFTEN SEEN IN CHILDREN AND STOP AFTER 6 WEEKS
OF TREATMENT.
HORMONES AND HORMONE
MODULATORS
• GIVE PO OR SC
• PAIN INDICATES CANCER IS RESPONDING TO DRUG.
• MEDICATE WITH ANALGESICS AS NEEDED.
• EFFECTS OF DRUGS MAY TAKE 4 TO 10 WEEKS TO
OCCUR.
 MISCELLANEOUS AGENTS
GIVE IV
ASPARAGINASE
(ELSPAR)

SKIN TEST IS DONE BEFORE IV ADMINISTRATION

IV ADMINISTRATION REQUIRES CONTINUOUS MONITORING BY
HEALTHCARE PROVIDER
ALLERGIC REACTIONS TYPICALLY HAPPEN 30 TO 60 MINUTES
AFTER IV DOSE
ASSESS FOR NEUROTOXIC REACTION (LEVEL OF
CONSCIOUSNESS CHANGE) IN INITIAL DAYS OF THERAPY
DIABETICS NEED CLOSE ASSESSMENT OF GLUCOSE LEVELS
MONITOR LAB TEST : SERUM URIC ACID, AMONIA, AMYLASE,
AND CALCIUM; COAGULATION STUDIES.
TOXICITY IS SEEN MORE IN ADULTS THAN CHILDREN.
 GIVE PO
(HYDREA)
HYDROXYUREA

CONTENTS OF CAPSULES CAN BE MIXED WITH

WATER IF CLIENT IS UNABLE TO SWALLOW
CAPSULE.
MONITOR LAB TESTS: PLATELET COUNT
IF CLIENT’S URIC ACID LEVEL IS ELEVATED,
INCREASE DAILY FLUID INTAKE TO 2 TO 3 L/DAY.
STOP DRUG IF WBC AND PLATELET LEVELS DROP.
 GIVE PO
(MATULANE)
PROCARBAZINE

STOP DRUG IF WBC COUNT AND PLATELET LEVELS

DROP.
MONITOR LAB TEST: PLATELETS
NAUSEA AND VOMITING ARE COMMON, AND
TOLERANCE WILL OCCUR AFTER INITIAL WEEK OF
THERAPY.
ASSESS FOR CNS EFFECTS AND REPORT TO PHYSICIAN.
 GUIDING PRINCIPLES IN CAREER
CHEMOTHERAPY
 TO ACHIEVE CURE A TOTAL CELL KILL MUST
BE TRIED
 EARLY DIAGNOSIS AND CLEARLY
INSTITUTION OF TREATMENT
 COMBINATION CHEMOTHERAPY
 INTERMITTENT REGIMENS
 ADJUVANT AND NEOADJUVANT
CHEMOTHERAPY
 INTERMITTENT REGIMENS
 ADJUVANT NEOADJUVANT
CHEMOTHERAPY OCCASIONALLY
 AIMED AT
TOTAL DESTROYING ALL THE
MALIGNANT

CELL KILL
CELLS,LEAVING NONE

THIS APPROACH 1. EARLY RECOVERY

ENSURES:
2.PREVENTS RELAPSE
3.PROLONGS SURVIVAL

PHARMACOLOGICAL
SANCTURIES
THANK YOU!