Chapter 21 Antineoplastic Drugs Mosby items and derived

Antineoplastic Drugs Antineoplastic drugs are sometimes called cancer chemotherapeutic agents and are primarily used to treat cancer. These drugs are also used to treat inflammatory disorders such as psoriasis, rheumatoid arthritis, and systemic lupus erythematosus. More often than not, multiple drug therapy is used to treat the different types of cancers. Mosby items and derived items © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 2

Antineoplastic Drugs These drugs exert their pharmacologic effects by interfering with the metabolism or reproductive cycle of the tumor cells and thereby destroying them. Antineoplastic drugs are classified as either cell cycle specific or cell cycle nonspecific. Antineoplastic drugs target rapid dividing tumor cells. However, they also affect rapidly dividing normal cells that leads to their many adverse effects. Mosby items and derived items © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 3

Adverse Drug Effects Bone Marrow Suppression Bone marrow suppression leads to leukopenia, agranulocytosis, thrombocytopenia, or anemia. Ø This puts the patient at risk for serious infection because of the lack of white blood cells. Ø Osteonecrosis of the jaw bone is a recently recognized adverse effect of the bisphonates. Ø The majority of cases (94%) have been reported in patients receiving intravenous bisphonates to treat multiple myeloma or metastatic carcinomas. Ø Mosby items and derived items © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 4

Adverse Drug Effects Osteonecrosis Most of the cases have been reported after tooth extractions and other dental procedures that traumatize the jaw. Ø It is very difficult to treat once it is diagnosed. Ø Good home oral hygiene can help to minimize the risk of osteonecrosis. Ø Maintenance of oral health exams and other dental procedures should be performed prior to starting therapy or within 3 months of beginning therapy. Ø Mosby items and derived items © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 5

Adverse Drug Effects Osteonecrosis If osteonecrosis is present, then dead bone should be removed as necessary with minimal trauma to the adjacent tissue. Ø Chlorhexidrine rinses, systemic antibiotics, and analgesics should be used if clinically necessary. Ø Bisphonates are normally stopped until the bone heals or the patient requires it to treat the cancer. Ø Mosby items and derived items © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 6

Adverse Drug Effects Gastrointestinal These drugs are known for causing significant nausea, vomiting, diarrhea, stomatitis, and oral ulcerations. Ø Patients should rinse with a dilution of lukewarm water and baking soda after vomiting. Ø Aspirin and NSAIDs should be avoided because of the increased risk for GI adverse effects. Ø Mosby items and derived items © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 7

Adverse Drug Effects Immunosuppression Ø Patients are at higher risk for bacterial, viral, and fungal infections. Oral Effects Antineoplastic drugs can cause oral discomfort, sensitivity of the teeth and gums, mucosal pain and ulceration, gingival hemorrhage, xerostomia, and impaired taste sensation. Ø Ice chips and nonalcohol mouth rinses can help with the dry mouth. Ø Mosby items and derived items © 2007 by Mosby, Inc. , an affiliate of Elsevier Inc. 8