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APHON:12 Principles of Cancer Chemotherapy ppt 12

Two drugs origionally designed as antibiotic's that are antimetabolites (anti cancer drugs)? Actinomycin (second antibiotic ever developed) & Daunorubicin
Class of dDrugs developed specifically for cancer treatment? ANTIMETABOLITES: interfere with metabolic pathways or disrupt DNA synthesis
NCI formed in what decade? 1930's
Clinical trials on 1st chemo (nitrogen mustard) completed in what decade? 1940's
Def: Pharmacokinetics Pharmacokinetics:drug absorption, metabolism, and excretion. How the body processes drugs.
Def: Pharmocodynamics CONCENTRATION of Rx in vivo BIOPHYSICAL MECHANISM. Principles of pharmacokinetics and pharmocodynamics are used to develop drug dose and schedules, which will maximize tumor cell kill and minimize toxicity.
Def: Multimodal Therapy Use of several forms of therapy in the course of treatment. Chemotherapy, surgery, hematopoietic cell transplant (HCT),radiation (XRT).
Def Adjuvant chemotherapy use of chemotherapy following another form of therapy, such as surgery, to treat residual disease or undetectable metastasis.
Def: Neoadjuvant chemotheapy Neoadjuvant chemotherapy is used preoperatively to decrease tumor bulk in order to make it easier to remove the tumor surgically.
Def Sanctuary site places within the body that tumor cells can hide. Sites not easily reached by systemic chemotherapy. Ex: CNS in leukemia.
How does chemo work "indiscriminately kills rapidly dividing cells". Malignant & normal cells (BM, oral mucosa, GI tract, hair folicles)
Goals of chemo cure dx, control dx or palliation
Cell cycle: what is G 0 (gap 0)? RESTING PHASE: cells not dividing. length extremely variable. (not "in cell cycle")
Cell cycle: what is G 1 (gap 1)? Second phase. POST-MITOTIC PHASE; cells enter cell cycle. Production of enzymes needed for DNA synthesis, proteins and RNA synthesis occurs. The length 18 hours.
Cell cycle: what is S (synthesis) phaze? DNA DUPLICATION PHASE in preparation for cellular division. Length 20 hours.
Cell cycle: what is G2 (gap 2)? PREMITOTIC PHASE. Both protein and RNA synthesis occur and the precursors to the mitotic spindle apparatus are produced. This phase is very short.
Cell cycle: what is M (Mitosis) phaze? CELL DEVISION. Four phases: Prophase: nuclear membrane breaks down chromosomes clump. Metaphase chromosomes align in middle of the cell. Anaphase chromosomes separate move to centriole. Telophase cell division two identical “daughter” cells. one hour.
Cell cycle: what is Prophase? phase 1 of Mitosis: . During prophase the nuclear membrane breaks down and chromosomes clump
Cell cycle: what is metaphase? Phase 2 of Mitosis: In metaphase the chromosomes align in the middle of the cell.
Cell cycle: what is Anaphase? Phase 3 of Mitosis: During anaphase the chromosomes separate and move to the centriole
Cell cycle: what is Telophase? Phase 4 of mitosis:Telophase results in actual cell division and the production of two identical “daughter” cells. This process takes approximately one hour.
Cell cycle: what is cell cycle time? Significance? time for cell to move from one mitotic episode to another. Length dependent on cell type & time in GO. Short cycle= higher kill with cycle specific agents. Continuous infusion of these Rx => higher cell kill in tumors with short cell cycle times.
What is the Cell Kill Hypothesis Sates that a percent of CA cells are killed with each cycle of chemo. ultimately only a few cells remain and the immune system destroys them. Rational for multiple cycles of chemo. Peds Ca high growth fraction so are suseptible to tx.
Def: Growth Fraction % of cells actively dividing at a given point in time - higher growth fraction ->higher cell kill with cycle specific agents - tumors with greater fraction of cells in G0 will be more sensitive to cell cycle nonspecific agents
Def: Tumor burden # of cells in tumor - ca with small tumor burden more responsive to antienoplastic tx. - Higher cell burden -> Rx resistance
Def: Gompertzian function Tumor burden growth is initially exponential but levels off as blood, O2 & nutrient supply is limits. Center of tumor becomes necrotic.
6 characteristics of malignant cells 1)Mutated DNA alters function 2) Parasitic to host 3)Uncontrolled reproduction 4) Invade surrounding tissues and metastasize 5)immortal (no apoptosis) 6)cell birth> cell death
6 mechanisms of Rx resistance -decreased drug uptake by cell -increased excretion out of cell -detoxification of drug by cell -increased DNA repair -alterations in structure of Rx receptor sites -decreased apoptosis
3 reasons for multidrug resistance gene (MDR) - intrinsic (MDR present in tumor prior to tx) - acuired (resullt from genetic mutation following chemo) -Results from P-glycoprotein (rapidly eliminates Rx from cell eg anthracycline, vinca alkaloids)
3 reasons for multidrug resistance gene (MDR) - intrinsic (MDR present in tumor prior to tx) - acuired (resullt from genetic mutation following chemo) -Results from P-glycoprotein (rapidly eliminates Rx from cell eg anthracycline, vinca alkaloids)
4 principles of combination chemotherapy - 2+ Rx have greater response (act in diff phases of cycle, vary toxicities) - each Rx has independent action - synergistic effects -decreased Rx resistance
4 characterists of cell cycle specific chemo -greatest effect on actively deviding cells -not active in G0 -best as in divided doses or as continuous infusion -cytotoxic effects occur when cell repair or devision attempted
4 characteristics of cell cycle non-specific chemo -work in any phase -active in G0 - best as bolus -cytotoxic effects when cell division attempted
5 classificaitons of chemo agents - Rx interfere with DNA (alkylating agents/ antitumor abx, antimetabloites/nitrosureas) - Rx that cause cell cycle arrest (plant alkaloids) -Rx that interfere with protein synthesis (hormonal agents) -Antiangiogenesis -Biological response modifiers
Major toxicities of Alkylating Agents Hematopoiectic, GI tract (n/v), Reproductive
Are alkylating agents specific or non-speific? cell cycle non-specific, most active in G0 Phase
MOA of alkylating agents? -may cause DNA strand breakage or uncoiling -interfere with DNA replication, transcription & synthesis - variation in onset & duration of action
7 catagories of alkylating agents -mustartd derivatives -aziridines -hydrozines -alkyl sulfonates -triazenes -heavy metals -topisomerase I inhibitors
Alkylating Agents: list 3 mustard derivatives - Cyclophosphamide/ ifosfamide -Melphalan -Mechlorethamine (nitrogen mustard)
Alkylating Agents: list 2 azurudubes -Thiotepa -mitomycin
Alkylating Agents: list a hydrozine Procarbazine
Alkylating Agents: list a Alkyl Sulfonates Busulfan
Alkylating Agents: list 2 Triazenes - Dacarbazine (DTIC) - Temozolomide
Alkylating Agents: list a Heavy mental - Carboplatin/cisplatin
Alkylating Agents: list 2 Topisomerase I inhibitors -Topotecan -Irinotecan
What cell cycle specific are antimetabolities most active in? S phase
MOA of antimetabolites Structurally similar to normal cellular metabolites. Inhibits production or replacement of a specific enzyme so that a nonfunctioning end product is produced. This causes an interruption in protein, RNA, and DNA synthesis.
Major toxicities of antimetabolites - bone marrow suppression - GI tract (n/v, mucositis, injury to the liver)
3 catagories of antimetabolites - Folic Acid Antagonists - Pyrimidine Antagonists - Purine Antagonists
Antimetabolites: list 2 Folic Acid Antagoinists - Methotrexate - Trimetrexate
Antimetabolites: list 4 Pyrimidine Antagonists - 5 Azacytidine - 5 Flurouracil - cytosine arabinoside (Cytarabine) - Gemcitabine
Antimetabolites: list 4 Purine Antagonists - 6 Mercaptopurine (6-MP) - 6 Thioguanine (6-TG) - Fazarabine - Fludarabine
MOA of antitumor antibiotics Usually cell cycle non specific. bind to DNA and impede its replication, transcription, and repair by interfering with RNA and nucleic acid synthesis and function
Major toxicities of antitumor antibiotics Cardiac, BM suppression, mucositis, n/v, reproductive effects
3 catagories of antitumor antibiotics Anthracyclines, Chromomycin, Miscellaneous
Antitumor antibiotics: list 4 Anthracyclines Daunorubicin, Doxorubicin, Idarubicin, Mitoxantrone
Antitumor antibiotics: list 1 Chromoycin Dactinomycin
Antitumor antibiotics: list 2 miscellaeous Bleomycin, Mitomycin
Largest category of antitumor antibiotics used in pediatric cancers Anthracyclines (daunorubicin, doxorubicin, idarubicin, methoxantrone)
MOA of anthracyclines (antitumor abx) inhibition of topoisomerase II (enzyme associated with uncoiling of DNA)
What causes the cardiac tissue damage associated with anthracyclines (antitumor antibiotics) Free radical formation, involving O2 & it's conversion to hydrogen peroxide.
What phase of the cell cycle does Bleomycin (antitumor abx) work in G2 & M phases.
What phase of the cell cycle do plant alkaloids work in Predominatly M, some G1 & S
MOA of plant Alkaloids They interfere with the development of the mitotic spindle, preventing cell replication. Cause arrest during mitosis, DNA strand breakage/ death
Major toxicities of plant alkaloids Link with secondary maligant neoplasms. Neurological (peripheral neuropathies -> constipation & ambulation problems) GI (n/v/diarrhea), reproductive (amenorrhea, infertility. BM suppression minimal in standard doses.
3 catagories of Plant Alkaloids Vinca Alkaloids, Epipodophyllotoxins, Taxanes
Plant Alkaloids: list 2 vinca alkaloids Vinblastine, Vincristine
Plant Alkaloids: list 4 Epipodophyllotoxins Etoposide (VP-16), Teniposide (VM-26), Vindesine, Vinorelbine
Plant Alkaloids: list 2 Taxanes Paclitaxel, Docetaxel
What part of the cell cycle do Nitrosureas work in & MOA? Trick question!! primarily cell cycle non-specific. Interfere with DNA replication and repair.
Nature of relationships b/t nitrosureas & BBB Cross BBB
Nature of nadir with nitrosureas Delayed nadir (usually 30-45 days)
Major toxicities of nitrosureas Liver & GI (short term n/v which can be decreased if medications are taken with antiemetic at bedtime)
List 2 Nitrosureas Carmustine (BCNU), Lomustine (CCNU)
Miscellaneous Agents: List 2 Lipid Soluble agents Hydroxyurea, Procarbazine
Miscellaneous Agents: List Enzyme agents Asparaginase (Erwinia, Escherichia coli, Pegaspraginase)
Miscellaneous Agents: List 2 Retinoids 13-cis-retinoic acid (accutane), All-tras retinoic acid (ATRA)
What phase of the cell cycle does hydroxyurea work in? S phase: inhibits DNA synthesis
What phase of the cell cycle do Asparaginase drugs work in? Trick question! cell cycle non-specific
What is the significance of hydroxurea and procarbazine being lipid soluable? Cross the BBB
Special conciderations of Asparaginases? 1) interfere with metabolic functions=> hyperglycemia 2)higher incidences of allergic reactions than other chemo's
Which class of miscellaneous agents are vitman A derivatives? the retinoids: 13-cis-retinoic acid (accutane), All-tras retinoic acid (ATRA)
MOA of antiangiogenic agents? prevent growth of new microvessels from capillary endothelial cells to tumor
List 2 antiangiogenic agents Thalidomide, Anti-bascular endothelial growth facotr (VEGF)
Major toxicities of antiagiogenic agents GI (constipation), Neurologic (peripheral neuropathy)
Major toxicities of Biological Response Modifiers 1) Capillary leak syndrome 2) Flu-like syndrome: fever/chills/ bone pain 3) Dependent on agent adn dose
How to biologic response modifiers treat cancer (5 ways) Direct antitumor activity: cytotoxic, antiproliferation mechanism, affect differentiation/maturarion of tumor cell, prevent metastiasis. Supportive: initate, modify, resore immune system
List 6 Biological Response Modifiers Alpha interferon (a-IFN), Interleukin-2 (IL-2), Granulocyte-colony stimulating factor (G-CSF), Granulocyte-macrophage colony stimulating factor (GM-CSF), Erythropoietin (EPO), Monoclonal Antibodies.
Biological Response Modifiers: Clinical use of Alpha interferon (a-IFN)? Modulate immune responses
Biological Response Modifiers: Clinical use of Interleukin-2 (IL-2)? Supports growth/maturation of T-cells
Biological Response Modifiers: Clinical use of GCSF? Stimulates proliferation/ differentiation of neutrophils
Biological Response Modifiers: Clinical use of GM-CSF? Enhances function of granulocyte and macrophage lineages (remembering that neutrophils are granulocytes)
Biological Response Modifiers: Clinical use of Erythropoietin (EPO)? Stimulates production/ differentiation of RBC's
Biological Response Modifiers: Clinical use of Monocolnal Antibodies? Causes cell death through interaction with immune responses/ recognize tumor-asociated antigens
Hormonal Agents: list the 1 category of hormonal agents commonly used in children corticosteroids (prednisone & Dexamethasone)
MOA of steroids? directly lyse lymphoblasts (lymphoid maligancies) may indirectly effect other malignancies. Supportive care: antiemetic, potentiate anti serotonins, decrease cerebral edema.
Specific concerns with steriods Strengthen BBB blocking chemo (??) Effect metabolic function: increase appetite, redistribute body fat, hyperglycemia, acne, striae, behavior changes, mood swings, irritablity, avascular necrosis of humoral and femoral heads (LT use)
BSA formula Square root of (ht(cm)x wt (kg)/3600)
Dose calculations for child <1yr or <10kg Use KG not BSA. BSA (M2) give approx 1/3 greater amoung of drug than calculated by KG. Infants have different pharmokenitics
When would dose modifications be used? For pt's very thin or very obese (ideal body wt may be used) For pt's with decrease renal or hepatic function, ascities or other significant toxicities modified dosing maybe used.
Methods of IV administration of Chemo? Bolus (IV push) or Infusion
Dose category of Chemo administration (4)? STANDARD DOSE: SE mild. HIGH DOSE: increase dosing & SE. > supportive care(G-CSF, blood products) DOSE INTENSIFICATION (DI):higher than standard dose, shorter interval. Often to consolidate. ABLATIVE THERAPY:large dose ablate tumor & BM must have SCT
7 routes of Chemo administration? PO, IV, IV push, intraarterial (IVA), intrathecal (IT), IM, SQ
Def irritant Rx? causes local inflammatory rxn along venous tract and surrounding skin.
IV irritant Rx: list 5 Carmustine, Cisplatin, Dacarbazine, Docetaxel, Etoposide
Def Vesicant Rx? has potential to cause tissue necrosis if drug leaks out of the vein into surrounding tissue.
IV vesicant Rx: list 7? Actinomycin, Daunorubicin, Doxorubicin, Idarubicin, Mechlorethamine, Vinblastine, Vincristine
Def: flare reaction SE of IV admin of chemo (Central OR PIV)inflammation, no pain, along the venous tract 2ndry to histamine. Wheals may occur, usually a blood return; and it almost always resolves in 30 minutes, or less, without treatment. Occur with any RX esp irratant.
Def: infiltration leadage of drug/fluid out of vein into surrounding tissue. Can occur with + blood return, but IV fluids should always be discontinued. If the infiltration is along the tunnel of a VAD a radiographic or dye study might be indicated.
Def: extravasation leakage of Rx/fluids into surrounding tissue causing a chemical burn. + Pain, +inflammation, + ulceration. Stop Rx, Necrosis may take 4wk to appear & progress for 6 mth.
Rx that causes neuro SE of mood alterations (1) steroids
2 Rx's that causes neurotoxicity SE: Vincristine, cisplatin
2 Rx's that causes neuro SE of Ototoxicity: Cisplatin, carboplatin
3 Rx's that cause Cardiomyopathy: Dauorubicin/doxorubicin, Cyclophosphamide (high dose)
3 Rx's that cause pulmonary fibrosis: Bleomycin, mitomycin, carmustine
2 Rx's that have infertility as SE: Mustard, Cyclophosphmide
7 Teratogenic Rx/ Rx classes: Retinoids, thalidomide, antimetabolites, alkylating agents, vinca alkaloids, topoisomerase II inhibitors
Classes of Rx's that do not cause Alopecia steroids, retinoids, antiangiogenics (nearly every other chemo does)
2 Rx with SE of Acne Steroids, actinomycin
one drug know to cause rash Cytosine arabinoside
Specific SE associated with specific Rx: (INTEGUMENTARY)Striae (1) Steroids
Specific SE associated with specific Rx: (INTEGUMENTARY)photosensitivity (2) methotrexate, retinoids
Specific SE associated with specific Rx: (INTEGUMENTARY)Radiomimetic (3) Actinomycin, daunorubicin, doxorubicin
Specific SE associated with specific Rx: (INTEGUMENTARY)hyperpigmentation (2) Bleomycin, busulfan
Specific SE associated with specific Rx: (INTEGUMENTARY)Extravasation by vesicants (8) Actinomycin, daunorubicin, doxorubicin, mechlorethamine, mitomycin, vinblastine, vincristine, vinorelbine
Specific SE associated with specific Rx: (GI)N/V, Dose related anorexia Many Rx esp cisplatins, cytosine arabinoside, cyclophosphamides, anthracyclines
Specific SE associated with specific Rx: (GI) Diarrhea (2) Irinotecan, cisplatin
Specific SE associated with specific Rx: (GI)Constipation (2) Vincristine, thalidomide
Specific SE associated with specific Rx: (GI)Mucositis (3) Methotrexate, daunorubicin, doxorubicin
Specific SE associated with specific Rx: (GI)Hepatoxicity (4) 6-MP, 6-TG, VP-16, cytosine arabinoside
Specific SE associated with specific Rx: (GI)pancreatitis (2) Asparaginase, steroids
Specific SE associated with specific Rx: (GU)Hemorrhagic cystitis (2) Cyclophosphamide, Ifosfamide
Specific SE associated with specific Rx: (GU)Renal (2) Cisplatin, carboplatin
Specific SE associated with specific Rx: (Hypersensitivity)Anaphylaxis (1) Asparaginase
Specific SE associated with specific Rx: (Hypersensitivity) Allergic Rxn (3) Carboplatin, Etoposide, Belomycin
Specific SE associated with specific Rx: (Hypersensitivity)Hypotension (1) Etoposide
3 catagories of suppotive care meds 1) protect from specific SE (eg leucovorin, mesna) 2) halt/minimize immediate SE (eg antiemetics) 3) assist in recovery (eg growth factors)
Busulfan/ myleran: class of RX & Route Class: Alkylating agent. Subclass: alkyl sulfonates. PO/ IT in clinical trials
Busulfan/ myleran: SE (9) N/V, anorexia (@ high dose), BM suppression, Alopecia, hyperpigmentation, hyperuricemia, seizures, gynecomastia, sperm/ovarian faliure
Busulfan/ myleran: Nursing implications Seizure precautions
Busulfan/ myleran: main use prep for HCT
Carboplatin/ paraplatin: class of RX & Route Class: Alkylating agent. Sub class: heavy metal. IV
Carboplatin/ paraplatin: SE (7) N&V (mild) Bone marrow suppression (severe) Renal/hepatotoxic (rare) Hypersensitivity Ototoxic Hypomagnesaemia
Carboplatin/ paraplatin: nursing implications Bone marrow suppression Monitor hearing, renal, & liver function Other than bone marrow suppression, side effects milder than cisplatin
Cisplatin/ platinol: class of Rx & route Class: Alkylating agent. Subclass: heavy metal. IV
Cisplatin/ platinol: SE (7) N&V/anorexia (severe) Bone marrow suppression (mild) Renal/hepatotoxic (severe) Hypersensitivity (rare) Ototoxic (severe) Hypomagnesaemia Neurotoxic/peripheral neuropathies
Cisplatin/ platinol: Nursing implications Rigorous hydration/I&0 Long term need for antiemetics Monitor hearing/renal function
Cyclophosphamide/ cytoxan: Class of Rx & route Class: Alkylating agent. Subclass: mustard derivative. IV/PO
Cyclophosphamide/ cytoxan: SE (6) N&V/anorexia Bone marrow suppression Alopecia Hemorrhagic cystitis Cardiomyopathy (high dose) Infertility
Cyclophosphamide/ cytoxan: Nursing implications Give with MESNA (high dose) Hyperhydration/I&0
Dacarbazine (DTIC): Class of Rx & route Class: Alkylating agent. Subclass: Triazene. IV (irritant)
Dacarbazine (DTIC): SE (7) N&V/severe up to 12 hours Anorexia Fever/flu-like syndrome (up to 7 days) Bone marrow suppression (nadir 2-3 wks) Alopecia/rash/photosensitivity Hypotension/hypersensitivity Hepatic dysfunction
Dacarbazine (DTIC): Nursing implications Severe pain along vein if in peripheral IV Protect solution from light
Ifosfamide: Class of Rx & route Class: Alkylating agent. Subclass: mustard derivatives. IV
Ifosfamide: SE (7) N&V/anorexia Diarrhea Bone marrow suppression Alopecia Hemorrhagic cystitis Encephalopathy/peripheral neuropathy Fanconi’s syndrome
Ifosfamide: Nursing Implications Give with MESNA Hyperhydration/I&0
Irinotecan/ camptosar: Class & route Class: Alkylating agent. Subclass: Topisomerase II inhibitors. IV
Irinotecan/ comptosar: SE (3) Diarrhea (usually cholinergic) Bone marrow suppression Alopecia
Irinotecan/ comptosar: Nursing Implications Monitor for diarrhea Antidiarrhea medications may be given prophylactally or they need to be given immediately if symptoms occur Atropine may be given to control diarrhea
Temazolamide: class & route Class: Alkylating agent. Subclass: Triazene. PO
Temazolamide: SE N&V Bone marrow suppression Hepatotoxicity Allergy/anaphylaxis (uncommon) Second malignant neoplasms
Temazolamide: Nursing Implications teach to take at bedtime to decrease N/V
Thiotepa: Class & route Class: Alkylating agent, Subclass: Aziridines IV, IT in trials
Thiotepa: SE N&V Bone marrow suppression Rash/skin burn Fever Pain at infusion site if peripheral Testicular/ovarian failure
Thiotepa: Nursing implications Often used with hematopoietic stem cell support Closely monitor renal function
Topotecan: Class & Route Class: Alkylating agent. Subclass: Topisomerase II inhibitor, IV
Topotecan: SE (5) Diarrhea Bone marrow suppression Alopecia Renal toxic
Topotecan: Nursing Implications Monitor for diarrhea Dilute with either 0.9% normal saline or D5W
Cytosine arabinoside (ARA-C, cytarabine): Class & Route Class: Antimetabolite. Subclass: ? IV/SQ/IM/IT
Cytosine arabinoside (ARA-C, cytarabine): SE (6) N/V/anorexia, Diarrhea, BM suppression, mucositits, Rash (esp hands), Flu-like syndrome/fever, conjunctivitis (high dose)
Cytosine arabinoside (ARA-C, cytarabine): Nursing implications Dexametasone eye drops for high dose. N/V directly related to high dose.
Fludarabine: Class & Route Class: Antimetabolite. Subclass: purine antagonist. IV
Fludarabine: SE N/V/D, BM suppression, Mucositis, fatigue/ muscle aches, rash, neurotoxicity/ pulmonary toxicity
Fludarabline: nursing implicatons Monitor pulmonary function
Gemcitabine: Class & Route Class: Antimetabolite Subclass: pyrimidine antagonist IV
Gemcitabine: SE N/V, BM suppression (especially anemia), Rash, Fever/flu-like symptoms
Gemcitabine: nursing implications Infuse with NS, generally given over 30min, BM suppression is dose limiting
Mercaptopurine (6-MP): Class & Route Class: Antimetabolite. Subclass: purine antagonist. PO/IV
Mercaptopurine (6-MP): SE BM suppression, mucositis (rare), Rash, Hepatotoxic, Mild nausea
Mercaptopurine (6-MP): Nursing Implications Monitor liver function, Teach: take at bedtime on empty stomach to increase absorption. May need decreased dose if on allopurinol
Methotrexate (MTX): Class & Route Class: Antimetabolite. Subclass:Folic acid antagonist. PO/IV/IT/IM
Methotrexate (MTX): SE BM suppression, Mucositis/ GI ulceration, Rash/photosensitivity, Hepatic/renal toxic, Nausea (dose related)
Methotrexate (MTX): nursing implications Monitor liver function, Teach: PO at bedtime on empty stomach, avoid folic acid supplements. High dose needs aggressive hydration, urine alkalinization & leucovorin/ monitor levels
Thiguanine (6-TG): Class & Route Class: Antimetabolite. Subclass: Purine antagonist. PO
Thiguanine (6-TG): SE BM suppression, Mild nausea, mucositis (rare) Hepatotoxic
Thiguanine (6-TG): Nursing Implications Monitor liver function, Teach: take at bedtime on empty stomach
Daunorbubicin, Doxorubicin: class & route Class: Antitumor abx. Subclass: anthracyclines (vesicant)
Daunorbubicin, Doxorubicin: SE Alopecian, N/V, BM suppression, mucositis, cardiomyopathy, Radiomimetic
Daunorbubicin, Doxorubicin: Nursing implications Teach: red/orange urine Monitor: ECHO, photosensitivity. Cumulative max dose (450-550mg/M2)
Idarubicin: class & route Class:antitumor abx. Subclass: anthracycline. (vesicant) IV
Idarubicin: SE Alopecia, N/V, BM suppression, Mucositis, Cardiomyopathy (less common)
Idarubicin: nursing implications Teach: red/orange urine Monitor: ECHO, photosensitivity.
Bleomycin: Class & route Class: Antitumor abx. Subclass: miscellaneous IV
Bleomycin: SE Fever/chills, Hyperpigmentation/ peeling of skin (palms), Hypersensitivity (rare), Renal/hepatic toxicity, pulmonary fibrosis
Bleomycin: Nursing implications test dose prior to first dose. Monitor PFT. Cumulative max dose (400 Units)
Dactinomycin (Actinomycin-D, AMD): Class & route Class:antitumor abx. Subclass: chromomycin (vesicant) IV
Dactinomycin (Actinomycin-D, AMD): SE Bone marrow suppression N/V Photosensitivity/radiomimetic Acne Mucositis
Dactinomycin (Actinomycin-D, AMD): nursing implications Teach: skin care, Dose often ordered in mcg not mg
Alpha interferon (a-IFN): Class & Route Biologic agent, SQ/IM/IV/ Intracavitary
Alpha interferon (a-IFN): SE Flu-like syndrome Fatigue Neurologic Anorexia/weight loss Pruritis Neutropenia/thrombocytopenia
Alpha interferon (a-IFN): Nursing implications Chills usually occur 3-6 hours following administration Fevers to 400 C may occur and last 24 hours
Erythropoientin (EPO): Class & route Biologic agent, IV, SQ
Erythropoientin (EPO): SE HTN, Diarrhea
Erythropoientin (EPO): Nursing implications Teach re: injection techniques Monitor BP Safety and efficacy have not been established in pediatrics
Interleukin-2 (IL-2): Class & Route Biologic agent, SQ, IVq
Interleukin-2 (IL-2): SE Capillary leak syndrome Flu-like syndrome/fevers CNS changes N&V, anorexia Skin changes
Interleukin-2 (IL-2): Nursing Implication Premedicate with acetaminophen Monitor BP Skin care
Granulocyte colony stimulating factor (G-CSF): Class & route biologic agent, SQ, IV
Granulocyte colony stimulating factor (G-CSF):SE Bone pain, fever
Granulocyte colony stimulating factor (G-CSF):nursing implications Teach re: injection techniques, and the development of bone pain as counts recover (more common in adolescents) May require analgesia Monitor WBC/ANC
Granulocyte-macrophage colony stimulating factor (GM-CSF): Class & route biologic agent
Granulocyte-macrophage colony stimulating factor (GM-CSF): SE Bone pain Local skin reaction Flu-like syndrome Third spacing at high dose
Granulocyte-macrophage colony stimulating factor (GM-CSF): Nursing implications Teach re: injection techniques and potential for bone pain as counts recover (more common in adolescents) Treat bone pain with acetaminophen Monitor WBC/ANC
Monoclonal Antibodies: Class & route Biologic agent, IV
Monoclonal Antibodies: SE Potential allergic reactions Flu-like syndrome Fever Achiness
Monoclonal Antibodies: Nursing Implications Keep emergency drugs/dosages available Monitor VS frequently during first hour of infusion
Glucorticoids (prednisone, hydrocortisone, dexamethasone): Class & Route Hormone, IV/PO
Glucorticoids (prednisone, hydrocortisone, dexamethasone): SE Sodium/fluid retention Excessive appetite/food cravings/weight gain Hyperglycemia/GI irritation Cushingoid appearance/acne/striae Cataracts/glaucoma Osteoporsis/avascular necrosis (AVN) Mood alteration/nightmares Restless sleep/night sweats
Glucorticoids (prednisone, hydrocortisone, dexamethasone): nursing implications Teach re: increased risk of infection/GI protection, diet Taper dose if on greater than 3-4 weeks Perineal burning with rapid IV infusion
Carmustine (BCNU): class & route Class: Nitrosoureas, IV, irritant
Carmustine (BCNU): SE N&V Bone marrow suppression Renal/hepatic toxicity Pulmonary fibrosis Ovarian/sperm suppression
Carmustine (BCNU): nursing implications Crosses the blood-brain barrier Delayed nadir (4-6 weeks) Cough & dyspnea initial symptoms of respiratory failure
Lomustine (CCNU): class & route Class: nitrosoureas, PO
Lomustine (CCNU):SE N&V Bone marrow suppression (severe) Renal/hepatic toxicity Mucositis Alopecia
Lomustine (CCNU): nursing implications crosses BBB, delayed nadir (4-6 weeks)
Etoposide (VP-16): class and route Class: Plant alkaloid. Subclass: Epipodophyllotoxins. (Irritant) IV, PO
Etoposide (VP-16):SE Mild N&V Bone marrow suppression Alopecia Hypotension/hypersensitivity Liver toxicity
Etoposide (VP-16):Nursing implications Precipitates easily Monitor for hypotension/hypersensitivity
Vinblastine: class & route Class: Plant alkaloid. Subclass: vinca alkolodis. (vesicant) IVP
Vinblastine: SE Alopecia Bone marrow suppression (mild) Peripheral neuropathy/foot drop (uncommon) Constipation/ileus Jaw pain Hepatotoxic
Vinblastine: Nursing implications Teach re: need for stool softeners, high fiber diet/fluids May need pain medication Neurotoxicities are cumulative
Vinorelbine (Navelbine): class & Route Class: Plant alkaloid. Sub class: epipodophyllotoxins.(vesicant) IV
Vinorelbine (navelbine): SE N&V Bone marrow suppression Neurotoxic/peripheral neuropathies
Vinorelbine (navelbine): nursing implications Given over 4-6 minutes as an IVP Observe for neurotoxicities
Arsenic: Class & route Miscellaneous IV
Arsenic: SE  Electrolyte imbalances Electrolyte imbalances Headache Rash/pruritis Cough/dyspnea N&V/anorexia
Arsenic: Nursing implications Concurrent use with antifungal, antihistamine, diuretic, and tricyclic antidepressant drugs can lead to life-threatening cardiac arrhythmias
Asparaginase (e-coli, erwinia, PEG): class & route Miscellaneous, IMq
Asparaginase (e-coli, erwinia, PEG): SE Skin reaction at injection site Systemic allergic reaction (may be delayed with PEG) Hyperglycemia Pancreatitis Coagulapathies
Asparaginase (e-coli, erwinia, PEG): (3) Monitor urine/serum glucose, Observe for 1 hour for allergic reaction, Teach patient that allergic reaction can be delayed especially with PEG.
Hydroxyurea: class & route Class: miscellaneous. Subclass: lipid soluable. PO
Hydroxyurea: SE (5) Bone marrow suppression (primarily leukopenia, N&V, Skin rashes, Exacerbate mucous membrane inflammation in radiation field, Dysuria.
Hydroxyurea: nursing implications (2) Teach: Take at bed time to decreased N&V. Overall well tolerated with mild sedation.
Gleevac: Class & route Class: miscellaneous (targeted therapy) PO
Gleevac: SE (5) Edema/fluid retention, N&V, Neutropenia, thrombocytopenia, Hepatotoxicity.
Gleevac: Nursing implications (3) Teach: Take at bed time to decrease N&V. Observe for signs of fluid retention. Metabolism may be altered in patient is on some antifungal, antibiotics, or steroids.
Retinoids: Class & route Route: PO Class: Miscellaneous. Subclass: retinoids. Rx: All-trans retinoic acid (ATRA®),13-cis-retinoic acid (Accutane®)
Retinoids: SE (4) Teratogenic, Dry skin/photosensitivity, Conjunctivitis, Headache/pseudotumor cerebri
Retinoids: Nursing Implications (2) Teach: Take with food for better absorption. Monitor pregnancy tests on post menarchal females
Amifostine: class & route Protective agent, IV
Amifostine: SE (5) Hypotension, Rash, Hepatic toxicity, Bad taste in mouth, N&V,
Amifostine: nursing implications (4) Administer IV bolus dose over 15 minutes. Pretreat with antiemetics. Begin chemotherapy or radiation 15 minutes AFTER amifostine infusion completed. Patient should be well hydrated prior to infusion.
Mesna: class & route Protective agent, IV/ PO
Mesna: SE (5) Hypotension, Rash, Hepatic toxicity, renal toxicity, Bad taste in mouth,
Mesna: Nursing implications (4) May be mixed with cyclophosphamide or ifosphamide. False positive ketones. Administer IV bolus dose over 15 minutes. May mix oral form with small amount of juice or carbonated drink.
Leucovorin: class & route Protective agent, IV/PO
Leucovorin: SE Rash, pruritus, erythema
Leucovorin: nursing implication (3) Timing of doses crucial, IV solution should be diluted to 10 mg/ml, Do not infuse IV at > 160 mg/minute
Zinecard: Class & Route Protective agent/unclassified chemotherapeutic agent. IV.
Zinecard: SE (5) Alopecia, Mild N&V, Low grade fever, Myelosuppression, Hepatotoxic
Zinecard: nursing implications (1) Timing of doses crucial, Anthracyclines should be given within 30 minutes of start of Zinecard
What does zinecard do? protects heart from doxorubicin
What does mesna do? To prevent haemorrhagic cystitis and haematuria when a patient receives ifosfamide or cyclophosphamide for cancer chemotherapy which converts tp urotoxic metabolites such as acrolein. Increases excretion & binds to toxin.
What does amifostine do? reduce neutropenia-related fever and infection induced by DNA-binding chemo. alkylating agents (e.g. cyclophosphamide) and platinum-containing agents (e.g. cisplatin). It is also used to decrease the cumulative nephrotoxicity with platinum-containing rx.
Created by: jjenlouu
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