Week 13:

Course Unit 11: Chemotherapeutic Agents, Antibiotics,

Immunosuppressive Drugs
• At the end of the course unit (CM), learners will be able to:
• Cognitive:
• 1. Describe chemotherapy, its goal and treatment plan.
• 2. Familiarize with different chemotherapeutic agent and its effect.
• Affective:
• 1. Show concerns and develop trusting relationship to the patient and family
regarding treatment plan.
• 2. Listen attentively during class discussions.
• 3. Demonstrate tact and respect when challenging other people’s opinions and ideas.
• 4. Accept comments and reactions of classmates on one’s opinions openly and
graciously.
• Psychomotor:
• 1. Apply safety risk and nursing process during administration of
Chemotherapeutic agents
• 2. Participate actively during class discussions.
• 3. Confidently express personal opinion and thoughts in front of the class.
• Chemotherapy- is the treatment of cancer by means of chemicals that kill
cancer cells. These “anti-cancer” drugs destroy cancer cells by stopping their
growth and reproduction. Unfortunately, normal healthy cells are also
affected and this causes the well-known side effects of chemotherapy.
• Chemotherapeutic Agents- also referred to as antineoplastic agents, are
used to directly or indirectly inhibit the proliferation of rapidly growing cells,
typically in the context of malignancy
 The History of Chemotherapy: Overview
• ● Paul Ehrlich developed the concept of chemotherapy to treat microbial
diseases; he predicted the development of chemotherapeutic agents, which
would kill pathogens without harming the host.
• ● Sulfa drugs came into prominence in the late 1930s.
• ● Alexander Fleming discovered the first antibiotic, penicillin, in 1929; its
first clinical
• trials were done in 1940.
 Chemotherapy
• Treatment of a disease by a chemical compound selectively directed against
invading microbes or abnormal cells.
•  The chemical substance is called a chemotherapeutic agent.
 
CHEMOTHERAPEUTIC AGENTS:
Alkylating agents
• Alkylating agents keep the cell from reproducing (making copies of itself) by
damaging its DNA.
• Treated cancers: lung, breast, ovary, leukemia, lymphoma, Hodgkin disease,
multiple myeloma, and sarcoma.
• Examples of alkylating agents include: Altretamine, Bendamustine,
Busulfan, Carboplatin, Carmustine, Chlorambucil
 
 Antimetabolites
• Antimetabolites interfere with DNA and RNA by acting as a substitute for the normal
building blocks of RNA and DNA. When this happens, the DNA cannot make copies
of itself, and a cell cannot reproduce.
• Treatment for: leukemias, cancers of the breast, ovary, intestinal tract, other types of
cancer.
• Examples of antimetabolites include:
• Azacitidine, 5-fluorouracil (5-FU), 6-mercaptopurine (6-MP),Capecitabine (Xeloda),
Cladribine, Clofarabine.
Topoisomerase inhibitors

• These drugs are also called plant alkaloids (organic basis). They interfere
with enzymes called topoisomerases, which help separate the strands of
DNA so they can be copied. (Enzymes are proteins that cause chemical
reactions in living cells.)
• Topoisomerase inhibitors are used to treat certain leukemias, as well as
lung, ovarian, gastrointestinal, colorectal, and pancreatic cancers.
Topoisomerase inhibitors are grouped according to which type of enzyme they affect:

• Topoisomerase I inhibitors (also called camptothecins) include: Irinotecan,

Irinotecan liposomal, Topotecan

• Topoisomerase II inhibitors (also called epipodophyllotoxins) include: Etoposide

(VP-16), Mitoxantrone (also acts as an anti-tumor antibiotic), Teniposide.

• Topoisomerase II inhibitors can increase the risk of a second cancer.

Mitotic inhibitor
• Mitotic inhibitor - are also called plant alkaloids. They are compounds
derived from natural products, such as plants.
• They work by stopping cells from dividing to form new cells, but can
damage cells in all phases by keeping enzymes from making proteins
needed for cell reproduction.
Anti-tumor antibiotics
• These drugs are not like the antibiotics used to treat infections. They work
by changing the DNA inside cancer cells to keep them from growing and
multiplying.
• Examples of anthracyclines include: Daunorubicin, Doxorubicin
(Adriamycin), Doxorubicin liposomal, Epirubicin, Idarubicin,Valrubicin.
Antibiotic
• ● Antibiotic is the discovery of a new and potent class of antibacterial active
chemotherapeutic agent. Some antibiotics are prepared synthetically, but
most of them are prepared commercially by microbial biosynthesis.
• To be useful as a chemotherapeutic agent a substance must have selective
toxicity for the parasite, which means a low toxicity for host cells and high
toxicity for the parasite.
 EFFECTS OF CHEMOTHERAPHY
• The treatment of cancer by means of chemicals that kill cancer cells. These “anti-cancer” drugs destroy
cancer cells by stopping their growth and reproduction. Unfortunately, normal healthy cells are also
affected and this causes the well-known side effects of chemotherapy.

• The normal healthy cells have an organized cell structure and repair mechanisms in place. This results in
them being able to reproduce new normal tissue after chemotherapy.
 
• Often, two or more drugs are given. This is called combination chemotherapy and forms the basis of
most of chemotherapy today. The rationale is that the different drugs enhance each other’s effect and
create a better effect combined than if they were used as single agents.

• Different chemotherapy drugs are chosen so that they do not have the same side effects on
tissue, in order for the side effects to be minimized.
Goals of Chemotherapy

• ● To cure cancer.
• ●To control the growth of cancer.
• ● To alleviate symptoms such as pain caused by cancer.
• 
TREATMENT MODALITY
Chemotherapy can be used as a single treatment modality, but is also commonly
used in combination with surgery, radiotherapy and biological treatment in order to:
● Shrink a tumor before radiotherapy or surgery. This is called neo-adjuvant therapy.
● Destroy any remaining cancer cells after surgery or radiotherapy. This is called
adjuvant therapy.
● Enhance the effect of radiotherapy and biological therapy.
● Destroy recurring cancer or destroy cancer that has spread to other parts of the
body.
 
Chemotherapy Treatment Plan

• Each treatment plan is tailor-made to suit every individual and will

depend on:
●The type of cancer.
● The area of the body where the cancer is.
● The stage of the development of the cancer, eg. The size of the tumor in
the affected organ.
● Spread of CA to the rest of the body
● How the cancer influences the functioning of your body.
● The general health of the patient.
●The purpose of the treatment, either curative or to relieve symptoms.
Administration of Chemotherapy

1) Intravenous administration
• This is the most common method of administration. A thin needle is
inserted into a vein on the hand or lower arm. This needle is removed once
the chemotherapy has been completed.

• Chemotherapy can also be given intravenously by means of catheters, ports

and pumps. A port is a round plastic or metal chamber that is placed under
the skin. It is connected via a thin tube to one of the major vessels in the
chest cavity. This method is more permanent and can be used for as long as
necessary.
 
Administration of Chemotherapy
2) Oral administration: The chemotherapy comes in pills, capsules, or liquids
that is swallowed.
3) Topical: The chemotherapy comes in a cream that you rubs the skin.
4) Injection: A needle and syringe deliver the chemotherapy drug either
intramuscularly (into a muscle) or subcutaneously (just below the skin).
5) Intra-arterial (IA): The chemotherapy goes directly into the artery that is
feeding the cancer.
6) Intraperitoneal (IP): The chemotherapy goes directly into the peritoneal
cavity (the area that contains organs such as your intestines, stomach, liver,
and ovaries).
Common Side Effects of Chemotherapy

• Fatigue
• Hair loss
• Easy bruising and bleeding
• Infection
• Anemia (low red blood cell counts)
• Nausea and vomiting
• Appetite changes
• Constipation
• Diarrhea
• Mouth, tongue, and throat problems such as sores and pain with swallowing
Common Side Effects of Chemotherapy
• Nerve and muscle problems such as numbness, tingling, and pain
• Skin and nail changes such as dry skin and color change
• Urine and bladder changes and kidney problems
• Weight changes
• Chemo brain, which can affect concentration and focus
• Mood changes
• Changes in libido and sexual function
• Fertility problems
Chemotherapy Safety Guidelines

• A. Antineoplastic drugs are potentially hazardous to personnel and may

have teratogenic and/or carcinogenic effects.
• B.Safety guidelines have been issued by the Occupational Safety and
Health Administration (OSHA).
Chemotherapy Safety Guidelines
• Obtain special training for drug administration.
• Use two pairs of powder-free, dispensable chemotherapy gloves, and a
disposable, closed, long-sleeved gown with outer pair of gloves covering
gown cuff whenever there is risk of exposure to hazardous drugs.
• Provide syringes and IV sets with Luer lock fittings for preparing and
administering hazardous drugs. Also provide containers for their disposal.
• Use a closed-system drug-transfer device and needleless system to protect
nursing personnel during drug administration.
• Label all prepared drugs appropriately.
• Double-bag chemotherapy drugs once prepared, before transport.
Chemotherapy Safety Guidelines
• Have equipment ready to clean up any accidental spill (spill kit).
• Dispose of all materials in marked containers labeled hazardous waste.
• Dispose of all needles and syringes intact.
• Follow facility’s policies and procedures when preparing to administer
chemotherapy.
• Double-check chemotherapy orders with another oncology nurse.
• Read material safety data sheets (MSDS) prior to administration.
• Use personal protective equipment (PPE).
Chemotherapy Safety Guidelines

• Wash your hands both before you put on and after you take off gloves.
• After infusion is complete, promptly dispose of any equipment that
contained the drug in a puncture-proof container that is clearly marked.
• Chemotherapy agents may be excreted in body fluids; these may be
contaminated for 48 hours after the last drug dose. Wear PPE when
handling such excreta, and wash your hands after removing gloves.
• Check facility’s policies about handling linen that’s been contaminated with
chemotherapy.
Chemotherapy Safety Guidelines
• If a chemotherapy drug comes into contact with your skin or a client’s skin,
thoroughly wash the affected area with soap and water, but don’t abrade
the skin with a scrub brush.
• If the drug gets in your eyes, flush with copious amounts of water for at least
15 minutes while holding back your eyelids. Then get evaluated by
employee health or the emergency department (ED).
• When infusing vesicant drugs, monitor IV carefully—at first sign of
extravasation, remove IV and implement Rx protocol.
B. ANTIBIOTICS: Overview
• Definitions:
• Antibiotics are molecules that kill, or stop the growth of, microorganisms,
including both bacteria and fungi.
• Antibiotics that kill bacteria are called "bactericidal"
• Antibiotics that stop the growth of bacteria are called "bacteriostatic"
ANTIBIOTICS

• Antibiotics are substance produced by a microorganism [or a similar

product produced wholly (synthetic)
• partially (semi-synthetic) by chemical synthesis that is capable, in low
concentrations, of inhibiting the growth or killing other micro-organisms.
• Antibiotic medication represents a convenient and effective means of
treating certain specific disease conditions.
ANTIBIOTICS
Medical Uses:
• control approximately 50% of all disease
• The number of patients being rescued from surgery by antibiotic medicine is
increasing every day.
 Non-Medical Uses:
• Theapplication of antibiotics to animal was an outgrowth of the work in the
human disease field.
• Animal feed supplements to promote growth in livestock.
• Use in food preservation and spraying of crops to control specific crop diseases.
Antibiotics are classified as:
• a. The producing micro-organisms
• b. Activity spectrum
• c. Metabolic pathways of biosynthesis
• d. Chemical structure.
 Garrod, Lambert and O’ Grady have classified Antibiotics on the
basis of general similarity of chemical structure

• 1. Penicillin and related Antibiotics:

• Any of several antibiotics of low toxicity, produced naturally by molds of the
genus Penicillium and also semi synthetically, having a bactericidal action on
many susceptible Gram-positive or Gram-negative cocci and bacilli, some
also being effective against certain spirochetes.
 General Similarity of Chemical
Structure of Antibiotics
• 2. Aminoglycoside Antibiotics:
• Aminoglycosides are used in the treatment of severe infections of the
abdomen and urinary tract, as well as bacteremia and endocarditis.
• They are also used for prophylaxis.
• This group comprises the streptomycin, neomycin, kanamycin,
paromonycinentamycin, tubramycin and amikacin.
 General Similarity of Chemical
Structure of Antibiotics

• 3. Macrolide Antibiotics
• Used to treat infections caused by Gram-positive bacteria (e.g.,
Streptococcus pneumoniae) and limited Gram-negative bacteria (e.g.,
Bordetella pertussis, Haemophilus influenzae), and some respiratory tract
and soft-tissue infections
• This group comprises erythromycin, oleandomycin and spiromycin
 General Similarity of Chemical
Structure of Antibiotics
4. Tetracycline Antibiotics:
• Tetracycline is used to treat a wide variety of infections, including acne. It is
an antibiotic that works by stopping the growth of bacteria.
• This antibiotic treats only bacterial infections. It will not work for viral
infections (such as common cold, flu).
• This group consists of tetracycline, chlortetracycline, demeclocycline,
oxytetracycline and minocycline
 General Similarity of Chemical
Structure of Antibiotics

5. Chloramphenicol
• Is an antibiotic useful for the treatment of a number of bacterial infections.
• This includes use as an eye ointment to treat conjunctivitis, By mouth or by
injection into a vein
• it is used to treat meningitis, plague, cholera, and typhoid fever
 General Similarity of Chemical
Structure of Antibiotics

6. Peptide Antibiotics: are naturally synthesized structures built from amino

acids into chains.
The body produces peptides to aid in healing, fight infection and inflammation
and rebuild tissues.
This category includes bacitracin, gramicidin and the polymyxins.
 General Similarity of Chemical
Structure of Antibiotics

• 7. Antifungal Antibiotics:
• An antifungal medication, also known as an antimycotic (Fungus)
medication.
• is a pharmaceutical fungicide or fungistatic used to treat and prevent
mycosis such as athlete's foot, ringworm, candidiasis (thrush), serious
systemic infections such as cryptococcal meningitis
 General Similarity of Chemical
Structure of Antibiotics
• . Unclassified Antibiotics
• These antibiotics have varied structures. They are not classified among the
main groups described above Antibiotics
• This group include cycloserine, tusidic acid, novobiocin, prasinnomycin,
spectinomycin and vancomycin.
• 
 In preparations of medicines, Antibiotics are subdivided into the following seven groups:

● Penicillin's (including semi synthetic methicillin, oxacillin, ampicillin) and

cephalosporins.
● Broad-Spectrum antibiotics (tetracycline)
● Streptomycin group (streptomycin, neomycin etc.)
● Reverse antibiotics (erythromycin, chloramphenicol ristomycin, novobiocin)
● Antifungal (levorin, nystatin etc)
● Antituberculosis (streptomycin, kanamycin, phiorimycin, etc)
● Antineoplastic (bruneomycin, olivomycin etc)
 C. DRUGS ACTING ON IMMUNE SYSTEM (Immunologic Agents)
 

What are Immunologic agents?

• Immunologic agents are drugs that can modify the immune response,
either by enhancing or suppressing the immune system. They are used to
fight infections, prevent and treat certain diseases.
• Immunologic agents include drugs used for immunosuppression to prevent
graft rejection. They can be used as cancer chemotherapy agents.
• Some immunologic agents can down-regulate the inflammatory process
and can be used to treat inflammatory conditions such as rheumatoid
arthritis, autoimmune conditions.
 Types of Immunologic agents

●Immune globulins
●Immunostimulants
• bacterial vaccines
• colony stimulating factors
• interferons
• interleukins
• therapeutic vaccines
• viral vaccines
Types of Immunologic Agents

● Immunosuppressive agents
• calcineurin inhibitors
• interleukin inhibitors
• THANK YOU……..