Antineoplastic Agents

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Antineoplastic Agents

• Pharmacology II
• NUR 312

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Principles of Chemotherapy

• The goal is to eliminate all malignant cells
  without excessive destruction of normal cells
• Antineoplastic agents do not directly kill tumor
  cells they act by interfering with cell
  reproduction or replication at some point in the
  cell cycle

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Principles, cont

• Because chemo drugs are non-selective and affect
  all cells in the body ass they replicate, there
  is always some degree of injury to normal cells
• Particularly susceptible to chemo are those with
  a high rate of growth (bone marrow, GI track,
  epithelium, hair folicles)

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Principles, cont

• For cells to proliferate, the genetic material
  DNA must be replicated once every cell cycle

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Chemotherapy may be used for

• Cure
• Control of tumor growth
• Palliation
• Adjuvant therapy

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Use of Combination Chemotherapy

• The effectiveness of chemo will be more
  successful if combination chemo is given
• Different chemo agents, each of which works best
  at a different point in the cell division cycle,
  will be used
• This provides a better chance of cure, or gives
  longer remissions if cure not possible

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MOPP Regimen

• For Hodgkins Lymphoma, the MOPP regimen may be
  used
• M nitrogen Mustard
• O Oncovin
• P Procarbazine
• P Prednisone

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Alkylating Agents

• Cisplatin (Platinol), Mechlorethamine
  (Mustargen) and Cytoxan are commonly used agents
  in this category
• Action substitutes an alkyl chemical structure
  for a hydrogen atom in the DNA
• This results in a cross-linking of each strand of
  DNA, thus preventing cell division

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Alkylating Agents, cont

• Effective against lymphomas, leukemias, myelomas,
  ovarian, testicular, breast, and pancreatic
  cancers
• Cause bone marrow suppression, alteration in
  mucous membranes, severe NV, alopecia
• Cytoxan can cause hemorrhagic cystitis (give
  MESNA to protect the bladder)

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Alkylating Agents, cont

• Can also cause ototoxicity and nephrotoxicity.
  Be sure the patient is well hydrated before
  receiving these agents

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Antimetabolites

• These drugs have a structure similar to a
  necessary building block for the formation of
  DNA.
• These drugs are accepted by the cell as the
  necessary ingredient for cell growth, but because
  it is an imposter, it interferes with the
  production of DNA.

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Antimetabolites, cont

• Actually interferes with the synthesis of DNA and
  RNA
• Examples Fluorouracil (5-FU) , Methotrexate,
  and ARA-C
• Side effects include bone marrow depression,
  alteration in mucous membranes, NV, diarrhea,
  thrombocytopenia, alopecia.

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Antimetabolites

• Be sure the patient has at least 3 liters/day of
  fluids to minimize nephrotoxicity
• After Methotrexate administration, Leukovorin
  will be given. This is a form of folic acid that
  will prevent severe anemia from developing

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Antibiotic Antineoplastic Agents

• These agents actually bind DNA, thus inhibiting
  DNA and RNA synthesis and therefore inhibiting
  cell growth.
• Sadly, these drugs have great potential to cause
  irreversible cardiomyopathies.
• Doxorubicin (Adriamycin) is used for acute
  leukemias, soft tissue/bone cancers, lymphomas,
  and breast cancer

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Antibiotic Agents, cont

• Adriamycin is also a potent vessicant (will cause
  tissue necrosis if it infiltrates)
• Most dangerous side effect is decreased ejection
  fraction (normal is 70). Must do baseline CV
  assessment prior to beginning Adriamycin (EKG,
  echo, angiography).
• Must reduce the dose of chemo at the first sign
  of heart failure

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Antibiotic agents, cont

• Other side effects include stomatitis, alopecia,
  bone marrow suppression, hepatic impairment.

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Mitotic Inhibitors

• These drugs are also called Vinca-Alkaloids
• Work by inhibiting mitosis during cell division
• Vinblastine (Velban) and Vincristine (Oncovin)
  are commonly used agents for ALL, lymphomas,
  rhabdomyosarcoma)

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Mitotic Inhibitors, cont

• Neurotoxicity is a specific side effect for this
  classification of drugs. Peripheral neuropathy,
  alteration in bowel and bladder tone (including
  paralytic ileus), headache, tingling of
  fingers/hands/toes, ataxia.
• Constipation is common due to effects on the
  autonomic nervous system

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Other Drugs Used to Treat Cancer
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Hormonal Agents

• Used to treat neoplasms that are sensitive to
  hormonal growth controls of the body.
• They interfere with growth-stimulating receptors
  on target tissues.
• Corticosteroids are considered hormonal agents.
  They retard lymphocytic proliferation, so they
  help with lymphocytic leukemias and lymphomas.

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Hormonal Agents, cont

• Corticosteroids also decrease edema associated
  with tumor growth, especially in or around the
  brain, spinal cord, and mediastinum. Will
  decrease cerebral edema.
• Androgens (testosterone) may be used to treat
  advanced breast cancer

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Hormonal Agents, cont

• Anti-Estrogen drugs (Tamoxifen) block the uptake
  of estrogen and therefore are good for tumors
  that contain high concentrations of estrogen
  receptors
• Estrogen may be used to treat androgen-sensitive
  cancers, such as prostate cancer
• Progestins (Depo-Provera and Megace) are used to
  treat endometrial cancer

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Administration of Chemo

• IV is the most common route (peripheral
  administration is risky because many drugs are
  vesicants. Ports/central lines preferred)
• Oral
• Topical (some skin cancers)
• Intrathecal (through Omaya reservoir into
  ventricle of brain)

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Administration, cont

• Intracavity (directly into the bladder)
• Intra-arterial (for hepatic lesions)

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Allergic Reactions to Chemo

• Be prepared to totally STOP the infusion if any
  sign of allergic reaction develops. Give NS wide
  open, monitor rhythm, assure airway
• Dyspnea, wheezing, chest tightness, pain,
  pruritis, urticaria, tachycardia, dizziness,
  sudden anxiety, inability to speak, hypotension,
  decreased LOC, flushed skin

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Safety Issues with Chemo

• Nurses must be chemotherapy certified prior to
  administration of any chemotherapy agents
• Double checking the chemo with another nurse is
  required
• Wear special protective gloves, aprons
• Special spill precautions are taken

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Safety, cont

• Chemo bags, tubing, any chemo-soiled linens are
  discarded in special red hazardous material
  bags
• Chemo is excreted through urine, stool, and
  vomitus, so special precautions must be taken to
  avoid contact exposure
• Pregnant health care workers should not
  administer chemo

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Special Nursing Care

• Patient teaching is a priority
• Anticipatory guidance concerning body changes and
  the expected treatment regimen
• Assure hydration to avoid nephrotoxic effects of
  chemo

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Nursing Care, cont

• Teach about all side effects and how they can be
  managed (loss of appetite, mouth sores, fatigue
  and malaise, bleeding tendencies, constipation
  and diarrhea, susceptibility to infection)

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Management of Nausea and Vomiting

• Antineoplastic drugs directly stimulate the
  chemo-receptor trigger zone in the medulla of the
  brain. This is what causes the nausea and
  vomiting
• Cell death releases many toxins into the system
  which also stimulates the chemo-receptor trigger
  zone

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NV, cont

• Because patients expect and often experience NV
  with the administration of chemo, the higher
  cortical centers of the brain can stimulate the
  CTZ to induce vomiting just at the thought of
  chemo!

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Drugs that are Helpful for Chemo-Induced NV

• Marinol is a synthetic derivative of marijuana
• Zofran and Kytril block serotonin receptors in
  the CTZ and are among the most effective
  antiemetics, especially if combined with a
  corticosteroid
• Xanax and Ativan (Benzodiazepines) directly block
  the CTZ

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NV Drugs, cont

• Reglan calms activity of the GI track and is
  especially helpful if combined with a
  corticosteroid, an antihistamine, or a centrally
  acting drug like Ativan or Haldol
• Compazine is a phenothiazine that has a strong
  antiemetic effect in the CNS
• Treat for NV BEFORE it occurs!