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drugs
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Antineoplastic Drugs
Adams et al Chapter 37
Cancer
STAGES
Anaplasia Loss of cellular
differentiation & organization
Autonomy Grow without rules or
boundaries Metastasis
Leaves “home”, travels from place of origin▪ Breast tissue found in
lung mass
CAUSES
Genetic predisposition Viral infection Constant irritation and
cell turnover Stress (suppresses
immune system) Pipe smokers Exposure to
carcinogens
Types of Cancer
Solid Carcinomas▪ Originate in epithelial cells; breast, bronchial
tubes, skin Sarcomas▪ Originate in mesenchyme and made of
embryonic connective tissue; bone, cartilage, blood, lymphatic system
Hematological Leukemias (bone marrow) Lymphomas (lymphatic system)
Goal of cancer treatment
Destroying cancer cells through several methods: Surgery to remove them Stimulation of the immune system to
destroy them Radiation therapy to destroy them Drug therapy to kill them during various
phases of the cell cycle (replication phase)
Categories of Antineoplastics
Alkylating Agents React chemically with portions of the
RNA, DNA, or other cellular proteins Antimetabolites
Have chemical structures similar to those of natural metabolites
Antineoplastic Antibiotics Not selective only for bacterial cells;
toxic to human cells
Categories of Antineoplastics Mitotic Inhibitors
Drugs that kill cells as the process of mitosis begins
Hormones and Hormone Modulators Used in cancers that are sensitive to
estrogen and androgen stimulation Cancer Cell Specific Agents (Biologics)
Treat chronic myeloid leukemia (CML) and CD117-positive unresectable or metastatic malignant GI stromal tumors (GIST)
Nursing Considerations for all Antineoplastics
Do not administer during pregnancy Do not administer during lactation Assess renal/hepatic function tests Assess all drugs metabolized by liver GI effects
N/V/D, anorexia, mucous membrane deterioration
Administer allopurinol (Zyloprim) as drug causes ↑ uric acid levels
Alopecia major concern for patients
Nursing Assessments
Assess allergies Perform baseline physical assessment
Anthropometrics (height, weight, BMI) Orientation and reflexes CBC
Before, during, 3 weeks after last treatment Maintain proper hydration Protect patient from infection
Protective environment, isolation during hospital stay
Nursing Assessments
Small, frequent meals Frequent mouth care Dietary consult PRN Proper head covering Patient teaching regarding
Refraining from eating harsh foods if experiencing mouth/throat pain, no fresh fruits/veggies
Plan rest periods Barrier contraceptives
Bone Marrow Suppression Patient
experiences fatigue d/t low RBC
Space activities to allow rest periods
Inform pt. this is normal experience
↑ bruising d/t ↓ PLT Protect from infection
d/t ↓ WBC
Antiemetics with Cancer Chemotherapy
Antihistamines, corticosteroids adjuvant therapy
Ice chips, mouth care, environmental control with emetics
Marinol Zofran Emend Xanax, Ativan Reglan Haldol
Extravasation
Alkylating Agents
Non-cell specific Treat slow growing
cancer Cisplatin most
common medication Adverse effects
Bone marrow suppression
Thrombocytopenia, anemia, pancytopenia, leukopenia
Antimetabolites
Inhibit DNA synthesis in S phase thus preventing cell replication
Treat leukemias, some GI, basal cell cancers
Used as combo drugs as cells develop resistance
Leucovorin to help normal cells
Antineoplastic Antibiotics Treat leukemias
and AIDS associated Kaposi sarcoma
Does not cross blood- brain barrier
Zinecard as a cardioprotective drug
Mitotic Inhibitors (Natural Products)
Kill cells at beginning of mitosis
effect rapidly dividing cells
Treat leukemias, tumors
Hormone Modulators
Breast, ovaries, uterus, prostate, testes=all sensitive to estrogen stimulation
Can mimic s/s menopause
Hypercalcemia ↑ CVD ↑ risk of bleeding with
anticoagulants
Cancer cell specific: Gleevec Treats CML Treat cells specific to the cancer type
without interfering with normal cell growth&function
1st line of defense drug, given PO Expensive, $30,000-$35,000/year Administer with a meal, full glass of water Small, frequent meals; analgesics for
headache/muscle pain CBC, edema Oral administration
Across the Lifespan