Pharmacology in Nursing Antineoplastic Drugs Part 2 Cell

Pharmacology in Nursing Antineoplastic Drugs Part 2: Cell Cycle–Nonspecific Drugs and Miscellaneous Drugs Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Cancer Drugs: Antineoplastic Medications Cell cycle–nonspecific (CCNS) drugs Alkylating drugs Ø Cytotoxic antibiotics Ø Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Alkylating Drugs Classic alkylators (nitrogen mustards) Nitrosoureas Probable alkylators Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Alkylating Drugs (cont’d) CCNS antineoplastics Effective at any stage in the growth cycle of cancer cells Prevent cancer cells from reproducing with the process of alkylation Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Alkylating Drugs: Indications Used in combination with other drugs to treat various types of cancer, such as: Ø Ø Ø Recurrent ovarian cancer Brain tumors Lymphomas Leukemias Various forms of cancer (breast, ovarian, bladder) Others Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Alkylating Drugs: Adverse Effects Dose-limiting adverse effects Ø Alopecia Nephrotoxicity, peripheral neuropathy, ototoxicity Ø Nausea and vomiting, myelosuppresion Hydration can prevent nephrotoxicity Extravasation causes tissue damage and necrosis Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Alkylating Drugs: Examples cisplatin (Platinol-AQ) cyclophosphamide (Cytoxan) altretamine (Hexalen) carmustine (Bi. CNU) mechlorethamine (Mustargen) temozolomide (Temodar) thiotepa (Thioplex) Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Cytotoxic Antibiotics Natural substances produced by the mold Streptomyces Synthetic substances also used Used to treat cancer–too toxic to treat infections Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Cytotoxic Antibiotics (cont’d) All can produce BMS (except bleomycin) Pulmonary toxicity (bleomycin) Heart failure (daunorubicin) Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Cytotoxic Antibiotics (cont’d) Anthracycline antibiotics Ø Anthracenedione antibiotics Ø daunorubicin, doxorubicin, idarubicin, others mitoxantrone Other cytotoxic antibiotics bleomycin, dactinomycin, mitomycin, plicamycin, others Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Cytotoxic Antibiotics (cont’d) Most are CCNS drugs, and are active in all phases of the cell cycle Most act by the process of alkylation and resulting in blocking DNA synthesis Some act by intercalation, resulting in blockade of DNA, RNA, and protein synthesis Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Cytotoxic Antibiotics: Indications Used in combination chemotherapy regimens Used to treat a variety of solid tumors and some hematologic malignancies Leukemia, ovarian, breast, bone, others Ø Squamous cell carcinomas Ø AIDS-related Kaposi’s sarcoma (when intolerant to other treatments) Ø Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Cytotoxic Antibiotics: Adverse Effects Hair loss, nausea and vomiting, myelosuppression Pulmonary fibrosis (bleomycin) Liver, kidney, and cardiovascular toxicities Many others Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Cytotoxic Antibiotics: Adverse Effects (cont’d) Cardiomyopathy is associated with large amounts of doxorubicin Dexrazoxane can be used as a cytoprotective drug Monitor cardiac ejection fractions Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Miscellaneous Antineoplastics bevacizumab (Avastin) hydroxyurea (Hydrea) imatinib (Gleevec) mitotane (Lysodren) Hormonal antineoplastic drugs Radiopharmaceuticals Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Miscellaneous Antineoplastics (cont’d) bevacizumab (Avastin) Angiogenesis inhibitor Ø Blocks the blood supply to the growing tumor Ø Many adverse effects, including nephrotoxicity Ø Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Miscellaneous Antineoplastics (cont’d) hydroxyurea (Hydrea) Action similar to antimetabolites Ø Used to treat squamous cell carcinoma and some leukemias Ø Oral form only Ø Many adverse effects Ø Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Miscellaneous Antineoplastics (cont’d) imatinib (Gleevec) Used to treat chronic myeloid leukemia (CML), especially in cases where interferon alfa therapy failed Ø It is NOT a monoclonal antibody Ø Works by inhibiting an enzyme that is active in the CML process Ø Use with other hepatic-metabolized drugs may cause severe interactions Ø Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Miscellaneous Antineoplastics (cont’d) mitotane (Lysodren) Adrenal cytotoxic drug Ø Used specifically for adrenal corticoid carcinoma Ø Oral form only Ø Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Hormonal Drugs Used to treat a variety of neoplasms in males and females Hormonal therapy used To oppose effects of hormones Ø To block the body’s sex hormone receptors Ø Used most commonly as adjuvant and palliative therapy Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Hormonal Drugs (cont’d) Drugs for female-specific neoplasms anastrozole (Arimidex) Ø tamoxifen (Nolvadex) Ø megestrol (Megace) Ø medroxyprogesterone (Provera) Ø fluoxymesterone (Halotestin) Ø fulvestrant (Faslodex) Ø Several others Ø Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Hormonal Drugs (cont’d) Drugs for male-specific neoplasms (prostate cancer) bicalutamide (Casodex) Ø flutamide (Eulexin) Ø nilutamide (Nilandron) Ø leuprolide (Lupron) Ø goserelin (Zoladex) Ø estramustine (Emcyt) Ø Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Miscellaneous Antineoplastics (cont’d) Radiopharmaceuticals Ø Used to treat a variety of cancers, or symptoms caused by cancers • Porfimer sodium • Chromic phosphate P 32 • Samarium SM 153 lexidronam • Sodium iodide I 131 • Sodium phosphate P 32 • Strontium Sr 89 Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Extravasation Leaking of an antineoplastic drug into surrounding tissues during IV administration Can result in permanent damage to nerves, tendons, muscles, loss of limbs Skin grafting or amputations may be necessary Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Extravasation (cont’d) Prevention is essential Continuous monitoring of the IV site is essential Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Extravasation (cont’d) If suspected, stop the IV infusion immediately but do not remove the IV tube If possible, aspirate remaining drug or blood from the tube Follow instructions for giving the appropriate antidote through the existing IV tube, then remove the catheter Some antidotes are not given through the IV catheter Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Extravasation (cont’d) Cover area with sterile, occlusive dressing if ordered Apply warm or cold compresses, depending on the extravasated drug Rest and elevate the affected limb PREVENTION is the best approach! Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

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Handling Antineoplastic Drugs Those preparing and administering these drugs may be exposed to negative consequences Most facilities have these drugs mixed under special environments in the pharmacy Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Handling Antineoplastic Drugs (cont’d) During care of a patient receiving these drugs, special precautions may be implemented, depending on facility policies Double flushing of bodily fluids in the commode Ø Special hampers for disposal of all objects that contact the patient’s body fluids Ø Personal protective equipment Ø Special concerns if chemotherapy liquid spills Ø Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Nursing Implications Assess baseline blood counts before giving any antineoplastic drugs Follow specific administration guidelines for each antineoplastic drug Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Nursing Implications (cont’d) Alkylating drugs Ø Ø Ø Monitor for expected effects of bone marrow suppression Expect nausea, vomiting, diarrhea, stomatitis Hydration is important to prevent nephrotoxicity Report ANY ringing/roaring in the ears—possible ototoxicity Peripheral neuropathies may occur—report tingling, numbness, pain in extremities Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Nursing Implications (cont’d) Cytotoxic antibiotics Expect bone marrow suppression, nausea, vomiting, diarrhea, stomatitis Ø Monitor pulmonary status Ø Monitor for nephrotoxicity, liver toxicity Ø Monitor cardiovascular status Ø Daunorubicin may turn the urine to a reddish color Ø Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Nursing Implications (cont’d) In general Monitor closely for anaphylactic reactions Ø Keep epinephrine, antihistamines, antiinflammatory drugs on hand Ø Monitor closely for complications associated with bone marrow suppression • Anemia, thrombocytopenia, neutropenia Ø Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Nursing Implications (cont’d) Cytoprotective drugs may be used to reduce toxicities IV amifostine (Ethyol) to reduce renal toxicity associated with cisplatin Ø IV or PO allopurinol (Zyloprim) to reduce hyperuricemia Ø Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.

Nursing Implications (cont’d) Monitor for oncologic emergencies Ø Ø Ø Ø Infections Pulmonary toxicity Allergic reactions Stomatitis with severe ulcerations Bleeding Metabolic aberrations Bowel irritability with diarrhea Renal, liver, cardiac toxicity Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc. , an affiliate of Elsevier Inc.