PYRAMID POINTS CHAPTER 52: ANTINEOPLASTIC MEDICATIONS

PYRAMID POINTSPYRAMID POINTS

CHAPTER 52: CHAPTER 52:

ANTINEOPLASTIC ANTINEOPLASTIC MEDICATIONSMEDICATIONS

Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

ADULT HEALTH: Antineoplastic Medications

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I. Antineoplastic MedicationsI. Antineoplastic Medications DescriptionDescription

• Kill or inhibit reproduction of neoplastic cellsKill or inhibit reproduction of neoplastic cells

Side effectsSide effects• Low white blood cell (WBC) count (neutropenia)Low white blood cell (WBC) count (neutropenia)

• ThrombocytopeniaThrombocytopenia

• Fatigue, nausea, vomitingFatigue, nausea, vomiting



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I. Antineoplastic Medications (continued)I. Antineoplastic Medications (continued) InterventionsInterventions

• Monitor complete blood cell (CBC) count, including Monitor complete blood cell (CBC) count, including WBC, platelets, electrolytesWBC, platelets, electrolytes

• Initiate bleeding precautions if thrombocytopenia occurs, Initiate bleeding precautions if thrombocytopenia occurs, including use of soft toothbrush, electric razorincluding use of soft toothbrush, electric razor

• Initiate neutropenic precautions if neutropenia occurs, Initiate neutropenic precautions if neutropenia occurs, including no fresh fruits and vegetables, no uncooked including no fresh fruits and vegetables, no uncooked fish, protective isolationfish, protective isolation



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I. Antineoplastic Medications (continued)I. Antineoplastic Medications (continued) Interventions (continued) Interventions (continued)

• Monitor for petechiae, ecchymosis, bleeding gums, epistaxisMonitor for petechiae, ecchymosis, bleeding gums, epistaxis

• Avoid intramuscular (IM) injections, venipunctureAvoid intramuscular (IM) injections, venipuncture

• Administer antiemetics several hours prior to chemotherapyAdminister antiemetics several hours prior to chemotherapy

• Pregnant nurses should avoid chemotherapy preparation, Pregnant nurses should avoid chemotherapy preparation, administrationadministration

• Encourage hydration, promoting at least 2000 mL/dayEncourage hydration, promoting at least 2000 mL/day

• Administer allopurinol (Zyloprim) as prescribedAdminister allopurinol (Zyloprim) as prescribed

• Prepare IV chemotherapy in air-vented space per agency Prepare IV chemotherapy in air-vented space per agency protocolprotocol



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I. Antineoplastic Medications (continued)I. Antineoplastic Medications (continued) Interventions (continued)Interventions (continued)

• Discard intravenous (IV) equipment in designated containersDiscard intravenous (IV) equipment in designated containers• Monitor for extravasationMonitor for extravasation• Instruct client in potential side effects, including hair loss, Instruct client in potential side effects, including hair loss,

mucositis, infection, bleeding episodesmucositis, infection, bleeding episodes• Instruct client about need for contraception during treatmentInstruct client about need for contraception during treatment• Live vaccinations should not be administered.Live vaccinations should not be administered.

Anaphylactic reactionsAnaphylactic reactions• Obtain allergy historyObtain allergy history• Monitor for signs of anaphylactic reactionsMonitor for signs of anaphylactic reactions• Airway first priority if anaphylaxis occursAirway first priority if anaphylaxis occurs



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II. Alkylating and Alkylating-like MedicationsII. Alkylating and Alkylating-like Medications DescriptionDescription

• Affects synthesis of DNA by causing cross-linking of Affects synthesis of DNA by causing cross-linking of DNA to inhibit cell reproductionDNA to inhibit cell reproduction

Side effectsSide effects• Cisplatin (Platinol) may cause ototoxicity, tinnitus, Cisplatin (Platinol) may cause ototoxicity, tinnitus,

hypokalemia, hypocalcemia, hypomagnesemia, hypokalemia, hypocalcemia, hypomagnesemia, nephrotoxicitynephrotoxicity

• Cyclophosphamide (Cytoxan, Neosar) may cause Cyclophosphamide (Cytoxan, Neosar) may cause alopecia, gonadal suppression, hemorrhagic cystitis, alopecia, gonadal suppression, hemorrhagic cystitis, hematuriahematuria



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II. Alkylating and Alkylating-like Medications II. Alkylating and Alkylating-like Medications (continued)(continued) InterventionsInterventions

• Assess vital signs, CBC resultsAssess vital signs, CBC results

• Withhold medication if platelet count below Withhold medication if platelet count below

75,000 cells/µL or WBC count below 4,000 cells/µL as 75,000 cells/µL or WBC count below 4,000 cells/µL as prescribedprescribed

• Administer antiemetic 30 minutes before antineoplastic Administer antiemetic 30 minutes before antineoplastic medication as prescribedmedication as prescribed

• Monitor for side effects developmentMonitor for side effects development

• Instruct client to eat diet low in purinesInstruct client to eat diet low in purines



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III. Antitumor Antibiotic MedicationsIII. Antitumor Antibiotic Medications DescriptionDescription

• Interfere with DNA, RNA synthesisInterfere with DNA, RNA synthesis Side effectsSide effects

• VesicationVesication

• Doxorubicin (Adriamycin, Doxil) and idarubicin (Idamycin) may Doxorubicin (Adriamycin, Doxil) and idarubicin (Idamycin) may cause cardiotoxicitycause cardiotoxicity

• Pulmonary toxicity can occur with bleomycin (Blenoxane)Pulmonary toxicity can occur with bleomycin (Blenoxane) InterventionsInterventions

• Assess for myocardial toxicity, dyspnea, dysrhythmias, Assess for myocardial toxicity, dyspnea, dysrhythmias, hypotension when administering doxorubicin, idarubicinhypotension when administering doxorubicin, idarubicin

• Monitor pulmonary status when administering bleomycinMonitor pulmonary status when administering bleomycin



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IV. Antimetabolite MedicationsIV. Antimetabolite Medications DescriptionDescription

• Halt synthesis of cell protein Halt synthesis of cell protein • Replace normal proteins required for DNA synthesisReplace normal proteins required for DNA synthesis

Side effectsSide effects• Fluorouracil (Adrucil) may cause alopecia, stomatitis, Fluorouracil (Adrucil) may cause alopecia, stomatitis,

diarrhea, phototoxicitydiarrhea, phototoxicity• Methotrexate may cause alopecia, stomatitis, Methotrexate may cause alopecia, stomatitis,

hyperuricemia, photosensitivity, hepatoxicityhyperuricemia, photosensitivity, hepatoxicity InterventionsInterventions

• When administering fluorouracil, assess for signs of When administering fluorouracil, assess for signs of cerebellar dysfunction, stomatitis, diarrheacerebellar dysfunction, stomatitis, diarrhea



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IV. Antimetabolite Medications (continued) IV. Antimetabolite Medications (continued) Interventions (continued) Interventions (continued)

• When administering methotrexate in large doses, When administering methotrexate in large doses, prepare to administer leucovorin as prescribed to prevent prepare to administer leucovorin as prescribed to prevent toxicity (known as leucovorin rescue)toxicity (known as leucovorin rescue)

• When administering fluorouracil or methotrexate, instruct When administering fluorouracil or methotrexate, instruct client to wear sunscreen or protective clothingclient to wear sunscreen or protective clothing



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V. Antimitotic Medications (Vinca Alkaloids)V. Antimitotic Medications (Vinca Alkaloids) DescriptionDescription

• Prevent mitosis, causing cell death; Prevent mitosis, causing cell death;

• Prevent cell divisionPrevent cell division

Side effectsSide effects• Neurotoxicity with vincristine (Oncovin, Vincasar)Neurotoxicity with vincristine (Oncovin, Vincasar)

InterventionsInterventions• Monitor for neurotoxicity with vincristine including Monitor for neurotoxicity with vincristine including

numbness, tingling in fingers, toesnumbness, tingling in fingers, toes

• Monitor for constipation, paralytic ileusMonitor for constipation, paralytic ileus



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VI. Hormonal Medications and EnzymesVI. Hormonal Medications and Enzymes DescriptionDescription

• Suppress immune system; block normal hormones in hormone-Suppress immune system; block normal hormones in hormone-sensitive tumorssensitive tumors

Side effectsSide effects• Tamoxifen citrate decreases effects of estrogenTamoxifen citrate decreases effects of estrogen

InterventionsInterventions• Monitor vital signsMonitor vital signs• Monitor serum calcium levels with androgensMonitor serum calcium levels with androgens• Monitor pancreatic function with asparaginase (Elspar)Monitor pancreatic function with asparaginase (Elspar)• Encourage fluid intake of 2 to 3 L/day as prescribedEncourage fluid intake of 2 to 3 L/day as prescribed• Monitor uric acid, cholesterol serum levelsMonitor uric acid, cholesterol serum levels• Monitor for signs of hemorrhagic cystitisMonitor for signs of hemorrhagic cystitis• Instruct client about potential for alterations in sexual Instruct client about potential for alterations in sexual

characteristicscharacteristics



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VII. Immunomodulator Agents: Biological VII. Immunomodulator Agents: Biological Response ModifiersResponse Modifiers DescriptionDescription

• Stimulate immune system to recognize cancer cells and Stimulate immune system to recognize cancer cells and take action to eliminate or destroy themtake action to eliminate or destroy them

• Colony-stimulating factors induce more rapid bone Colony-stimulating factors induce more rapid bone marrow recovery after suppression by chemotherapymarrow recovery after suppression by chemotherapy



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VII. Immunomodulator Agents: Biological Response VII. Immunomodulator Agents: Biological Response Modifiers (continued) Modifiers (continued) Medications include interferon alfa-2a; recombinant Medications include interferon alfa-2a; recombinant

interferon-alfa-2b (Intron A); rituximab (Rituxan); interferon-alfa-2b (Intron A); rituximab (Rituxan); sargramostim (Leukine); filgrastim (Neupogen); epoetin alfa sargramostim (Leukine); filgrastim (Neupogen); epoetin alfa (Epogen)(Epogen)

Side effects include flu-like symptoms; nausea and vomiting; Side effects include flu-like symptoms; nausea and vomiting; nephrotoxicity (interferon alfa); edema and dyspnea (epoetin nephrotoxicity (interferon alfa); edema and dyspnea (epoetin alfa)alfa)

InterventionsInterventions• Monitor vital signs Monitor vital signs • Monitor liver and renal function tests Monitor liver and renal function tests • Teach clients to avoid persons who have received live Teach clients to avoid persons who have received live

immunizationsimmunizations• Monitor CBC resultsMonitor CBC results



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VIII. Gene TherapyVIII. Gene Therapy DescriptionDescription

• Allows the client’s immune system to be better able to Allows the client’s immune system to be better able to recognize cancer cells as non-selfrecognize cancer cells as non-self



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IX. Targeted TherapyIX. Targeted Therapy DescriptionDescription

• Monoclonal antibodies that target a cellular element of Monoclonal antibodies that target a cellular element of the cancer cell or medications that work at the gene levelthe cancer cell or medications that work at the gene level

Side effectsSide effects• Monoclonal antibodies can cause allergic reactionsMonoclonal antibodies can cause allergic reactions



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XI. Other Antineoplastic MedicationsXI. Other Antineoplastic Medications Altretamine (Hexalen)Altretamine (Hexalen) Denileukin diftitox (Ontak)Denileukin diftitox (Ontak) Gemcitabine (Gemzar)Gemcitabine (Gemzar) Irinotecan (Camptosar)Irinotecan (Camptosar) Paclitaxel (Abraxane, Taxol, Onxol)Paclitaxel (Abraxane, Taxol, Onxol) Pegaspargase (Oncaspar)Pegaspargase (Oncaspar) Topotecan (Hycamtin)Topotecan (Hycamtin) Trastuzumab (Herceptin)Trastuzumab (Herceptin) Bexarotene (Targretin)Bexarotene (Targretin)



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The client receiving antineoplastic medications by the The client receiving antineoplastic medications by the intravenous (IV) route has ongoing monitoring of serum intravenous (IV) route has ongoing monitoring of serum laboratory results to monitor for adverse medication effects. The laboratory results to monitor for adverse medication effects. The nurse should prepare to institute bleeding precautions if which nurse should prepare to institute bleeding precautions if which of the following results is telephoned to the nursing unit by the of the following results is telephoned to the nursing unit by the laboratory staff?laboratory staff?

1. Clotting time of 12 minutes1. Clotting time of 12 minutes2. Ammonia level of 28 mcg/dL2. Ammonia level of 28 mcg/dL3. White blood cell count (WBC) 4,500 cells/3. White blood cell count (WBC) 4,500 cells/mmmm³³4. Platelet count of 50,000 cells/4. Platelet count of 50,000 cells/mmmm³³

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PYRAMID POINTS CHAPTER 52: ANTINEOPLASTIC MEDICATIONS