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APHON XII
APHON:12 Principles of Cancer Chemotherapy ppt 12
| Question | Answer |
|---|---|
| Two drugs origionally designed as antibiotic's that are antimetabolites (anti cancer drugs)? | Actinomycin (second antibiotic ever developed) & Daunorubicin |
| Class of dDrugs developed specifically for cancer treatment? | ANTIMETABOLITES: interfere with metabolic pathways or disrupt DNA synthesis |
| NCI formed in what decade? | 1930's |
| Clinical trials on 1st chemo (nitrogen mustard) completed in what decade? | 1940's |
| Def: Pharmacokinetics | Pharmacokinetics:drug absorption, metabolism, and excretion. How the body processes drugs. |
| Def: Pharmocodynamics | CONCENTRATION of Rx in vivo BIOPHYSICAL MECHANISM. Principles of pharmacokinetics and pharmocodynamics are used to develop drug dose and schedules, which will maximize tumor cell kill and minimize toxicity. |
| Def: Multimodal Therapy | Use of several forms of therapy in the course of treatment. Chemotherapy, surgery, hematopoietic cell transplant (HCT),radiation (XRT). |
| Def Adjuvant chemotherapy | use of chemotherapy following another form of therapy, such as surgery, to treat residual disease or undetectable metastasis. |
| Def: Neoadjuvant chemotheapy | Neoadjuvant chemotherapy is used preoperatively to decrease tumor bulk in order to make it easier to remove the tumor surgically. |
| Def Sanctuary site | places within the body that tumor cells can hide. Sites not easily reached by systemic chemotherapy. Ex: CNS in leukemia. |
| How does chemo work | "indiscriminately kills rapidly dividing cells". Malignant & normal cells (BM, oral mucosa, GI tract, hair folicles) |
| Goals of chemo | cure dx, control dx or palliation |
| Cell cycle: what is G 0 (gap 0)? | RESTING PHASE: cells not dividing. length extremely variable. (not "in cell cycle") |
| Cell cycle: what is G 1 (gap 1)? | Second phase. POST-MITOTIC PHASE; cells enter cell cycle. Production of enzymes needed for DNA synthesis, proteins and RNA synthesis occurs. The length 18 hours. |
| Cell cycle: what is S (synthesis) phaze? | DNA DUPLICATION PHASE in preparation for cellular division. Length 20 hours. |
| Cell cycle: what is G2 (gap 2)? | PREMITOTIC PHASE. Both protein and RNA synthesis occur and the precursors to the mitotic spindle apparatus are produced. This phase is very short. |
| Cell cycle: what is M (Mitosis) phaze? | CELL DEVISION. Four phases: Prophase: nuclear membrane breaks down chromosomes clump. Metaphase chromosomes align in middle of the cell. Anaphase chromosomes separate move to centriole. Telophase cell division two identical “daughter” cells. one hour. |
| Cell cycle: what is Prophase? | phase 1 of Mitosis: . During prophase the nuclear membrane breaks down and chromosomes clump |
| Cell cycle: what is metaphase? | Phase 2 of Mitosis: In metaphase the chromosomes align in the middle of the cell. |
| Cell cycle: what is Anaphase? | Phase 3 of Mitosis: During anaphase the chromosomes separate and move to the centriole |
| Cell cycle: what is Telophase? | Phase 4 of mitosis:Telophase results in actual cell division and the production of two identical “daughter” cells. This process takes approximately one hour. |
| Cell cycle: what is cell cycle time? Significance? | time for cell to move from one mitotic episode to another. Length dependent on cell type & time in GO. Short cycle= higher kill with cycle specific agents. Continuous infusion of these Rx => higher cell kill in tumors with short cell cycle times. |
| What is the Cell Kill Hypothesis | Sates that a percent of CA cells are killed with each cycle of chemo. ultimately only a few cells remain and the immune system destroys them. Rational for multiple cycles of chemo. Peds Ca high growth fraction so are suseptible to tx. |
| Def: Growth Fraction | % of cells actively dividing at a given point in time - higher growth fraction ->higher cell kill with cycle specific agents - tumors with greater fraction of cells in G0 will be more sensitive to cell cycle nonspecific agents |
| Def: Tumor burden | # of cells in tumor - ca with small tumor burden more responsive to antienoplastic tx. - Higher cell burden -> Rx resistance |
| Def: Gompertzian function | Tumor burden growth is initially exponential but levels off as blood, O2 & nutrient supply is limits. Center of tumor becomes necrotic. |
| 6 characteristics of malignant cells | 1)Mutated DNA alters function 2) Parasitic to host 3)Uncontrolled reproduction 4) Invade surrounding tissues and metastasize 5)immortal (no apoptosis) 6)cell birth> cell death |
| 6 mechanisms of Rx resistance | -decreased drug uptake by cell -increased excretion out of cell -detoxification of drug by cell -increased DNA repair -alterations in structure of Rx receptor sites -decreased apoptosis |
| 3 reasons for multidrug resistance gene (MDR) | - intrinsic (MDR present in tumor prior to tx) - acuired (resullt from genetic mutation following chemo) -Results from P-glycoprotein (rapidly eliminates Rx from cell eg anthracycline, vinca alkaloids) |
| 3 reasons for multidrug resistance gene (MDR) | - intrinsic (MDR present in tumor prior to tx) - acuired (resullt from genetic mutation following chemo) -Results from P-glycoprotein (rapidly eliminates Rx from cell eg anthracycline, vinca alkaloids) |
| 4 principles of combination chemotherapy | - 2+ Rx have greater response (act in diff phases of cycle, vary toxicities) - each Rx has independent action - synergistic effects -decreased Rx resistance |
| 4 characterists of cell cycle specific chemo | -greatest effect on actively deviding cells -not active in G0 -best as in divided doses or as continuous infusion -cytotoxic effects occur when cell repair or devision attempted |
| 4 characteristics of cell cycle non-specific chemo | -work in any phase -active in G0 - best as bolus -cytotoxic effects when cell division attempted |
| 5 classificaitons of chemo agents | - Rx interfere with DNA (alkylating agents/ antitumor abx, antimetabloites/nitrosureas) - Rx that cause cell cycle arrest (plant alkaloids) -Rx that interfere with protein synthesis (hormonal agents) -Antiangiogenesis -Biological response modifiers |
| Major toxicities of Alkylating Agents | Hematopoiectic, GI tract (n/v), Reproductive |
| Are alkylating agents specific or non-speific? | cell cycle non-specific, most active in G0 Phase |
| MOA of alkylating agents? | -may cause DNA strand breakage or uncoiling -interfere with DNA replication, transcription & synthesis - variation in onset & duration of action |
| 7 catagories of alkylating agents | -mustartd derivatives -aziridines -hydrozines -alkyl sulfonates -triazenes -heavy metals -topisomerase I inhibitors |
| Alkylating Agents: list 3 mustard derivatives | - Cyclophosphamide/ ifosfamide -Melphalan -Mechlorethamine (nitrogen mustard) |
| Alkylating Agents: list 2 azurudubes | -Thiotepa -mitomycin |
| Alkylating Agents: list a hydrozine | Procarbazine |
| Alkylating Agents: list a Alkyl Sulfonates | Busulfan |
| Alkylating Agents: list 2 Triazenes | - Dacarbazine (DTIC) - Temozolomide |
| Alkylating Agents: list a Heavy mental | - Carboplatin/cisplatin |
| Alkylating Agents: list 2 Topisomerase I inhibitors | -Topotecan -Irinotecan |
| What cell cycle specific are antimetabolities most active in? | S phase |
| MOA of antimetabolites | Structurally similar to normal cellular metabolites. Inhibits production or replacement of a specific enzyme so that a nonfunctioning end product is produced. This causes an interruption in protein, RNA, and DNA synthesis. |
| Major toxicities of antimetabolites | - bone marrow suppression - GI tract (n/v, mucositis, injury to the liver) |
| 3 catagories of antimetabolites | - Folic Acid Antagonists - Pyrimidine Antagonists - Purine Antagonists |
| Antimetabolites: list 2 Folic Acid Antagoinists | - Methotrexate - Trimetrexate |
| Antimetabolites: list 4 Pyrimidine Antagonists | - 5 Azacytidine - 5 Flurouracil - cytosine arabinoside (Cytarabine) - Gemcitabine |
| Antimetabolites: list 4 Purine Antagonists | - 6 Mercaptopurine (6-MP) - 6 Thioguanine (6-TG) - Fazarabine - Fludarabine |
| MOA of antitumor antibiotics | Usually cell cycle non specific. bind to DNA and impede its replication, transcription, and repair by interfering with RNA and nucleic acid synthesis and function |
| Major toxicities of antitumor antibiotics | Cardiac, BM suppression, mucositis, n/v, reproductive effects |
| 3 catagories of antitumor antibiotics | Anthracyclines, Chromomycin, Miscellaneous |
| Antitumor antibiotics: list 4 Anthracyclines | Daunorubicin, Doxorubicin, Idarubicin, Mitoxantrone |
| Antitumor antibiotics: list 1 Chromoycin | Dactinomycin |
| Antitumor antibiotics: list 2 miscellaeous | Bleomycin, Mitomycin |
| Largest category of antitumor antibiotics used in pediatric cancers | Anthracyclines (daunorubicin, doxorubicin, idarubicin, methoxantrone) |
| MOA of anthracyclines (antitumor abx) | inhibition of topoisomerase II (enzyme associated with uncoiling of DNA) |
| What causes the cardiac tissue damage associated with anthracyclines (antitumor antibiotics) | Free radical formation, involving O2 & it's conversion to hydrogen peroxide. |
| What phase of the cell cycle does Bleomycin (antitumor abx) work in | G2 & M phases. |
| What phase of the cell cycle do plant alkaloids work in | Predominatly M, some G1 & S |
| MOA of plant Alkaloids | They interfere with the development of the mitotic spindle, preventing cell replication. Cause arrest during mitosis, DNA strand breakage/ death |
| Major toxicities of plant alkaloids | Link with secondary maligant neoplasms. Neurological (peripheral neuropathies -> constipation & ambulation problems) GI (n/v/diarrhea), reproductive (amenorrhea, infertility. BM suppression minimal in standard doses. |
| 3 catagories of Plant Alkaloids | Vinca Alkaloids, Epipodophyllotoxins, Taxanes |
| Plant Alkaloids: list 2 vinca alkaloids | Vinblastine, Vincristine |
| Plant Alkaloids: list 4 Epipodophyllotoxins | Etoposide (VP-16), Teniposide (VM-26), Vindesine, Vinorelbine |
| Plant Alkaloids: list 2 Taxanes | Paclitaxel, Docetaxel |
| What part of the cell cycle do Nitrosureas work in & MOA? | Trick question!! primarily cell cycle non-specific. Interfere with DNA replication and repair. |
| Nature of relationships b/t nitrosureas & BBB | Cross BBB |
| Nature of nadir with nitrosureas | Delayed nadir (usually 30-45 days) |
| Major toxicities of nitrosureas | Liver & GI (short term n/v which can be decreased if medications are taken with antiemetic at bedtime) |
| List 2 Nitrosureas | Carmustine (BCNU), Lomustine (CCNU) |
| Miscellaneous Agents: List 2 Lipid Soluble agents | Hydroxyurea, Procarbazine |
| Miscellaneous Agents: List Enzyme agents | Asparaginase (Erwinia, Escherichia coli, Pegaspraginase) |
| Miscellaneous Agents: List 2 Retinoids | 13-cis-retinoic acid (accutane), All-tras retinoic acid (ATRA) |
| What phase of the cell cycle does hydroxyurea work in? | S phase: inhibits DNA synthesis |
| What phase of the cell cycle do Asparaginase drugs work in? | Trick question! cell cycle non-specific |
| What is the significance of hydroxurea and procarbazine being lipid soluable? | Cross the BBB |
| Special conciderations of Asparaginases? | 1) interfere with metabolic functions=> hyperglycemia 2)higher incidences of allergic reactions than other chemo's |
| Which class of miscellaneous agents are vitman A derivatives? | the retinoids: 13-cis-retinoic acid (accutane), All-tras retinoic acid (ATRA) |
| MOA of antiangiogenic agents? | prevent growth of new microvessels from capillary endothelial cells to tumor |
| List 2 antiangiogenic agents | Thalidomide, Anti-bascular endothelial growth facotr (VEGF) |
| Major toxicities of antiagiogenic agents | GI (constipation), Neurologic (peripheral neuropathy) |
| Major toxicities of Biological Response Modifiers | 1) Capillary leak syndrome 2) Flu-like syndrome: fever/chills/ bone pain 3) Dependent on agent adn dose |
| How to biologic response modifiers treat cancer (5 ways) | Direct antitumor activity: cytotoxic, antiproliferation mechanism, affect differentiation/maturarion of tumor cell, prevent metastiasis. Supportive: initate, modify, resore immune system |
| List 6 Biological Response Modifiers | Alpha interferon (a-IFN), Interleukin-2 (IL-2), Granulocyte-colony stimulating factor (G-CSF), Granulocyte-macrophage colony stimulating factor (GM-CSF), Erythropoietin (EPO), Monoclonal Antibodies. |
| Biological Response Modifiers: Clinical use of Alpha interferon (a-IFN)? | Modulate immune responses |
| Biological Response Modifiers: Clinical use of Interleukin-2 (IL-2)? | Supports growth/maturation of T-cells |
| Biological Response Modifiers: Clinical use of GCSF? | Stimulates proliferation/ differentiation of neutrophils |
| Biological Response Modifiers: Clinical use of GM-CSF? | Enhances function of granulocyte and macrophage lineages (remembering that neutrophils are granulocytes) |
| Biological Response Modifiers: Clinical use of Erythropoietin (EPO)? | Stimulates production/ differentiation of RBC's |
| Biological Response Modifiers: Clinical use of Monocolnal Antibodies? | Causes cell death through interaction with immune responses/ recognize tumor-asociated antigens |
| Hormonal Agents: list the 1 category of hormonal agents commonly used in children | corticosteroids (prednisone & Dexamethasone) |
| MOA of steroids? | directly lyse lymphoblasts (lymphoid maligancies) may indirectly effect other malignancies. Supportive care: antiemetic, potentiate anti serotonins, decrease cerebral edema. |
| Specific concerns with steriods | Strengthen BBB blocking chemo (??) Effect metabolic function: increase appetite, redistribute body fat, hyperglycemia, acne, striae, behavior changes, mood swings, irritablity, avascular necrosis of humoral and femoral heads (LT use) |
| BSA formula | Square root of (ht(cm)x wt (kg)/3600) |
| Dose calculations for child <1yr or <10kg | Use KG not BSA. BSA (M2) give approx 1/3 greater amoung of drug than calculated by KG. Infants have different pharmokenitics |
| When would dose modifications be used? | For pt's very thin or very obese (ideal body wt may be used) For pt's with decrease renal or hepatic function, ascities or other significant toxicities modified dosing maybe used. |
| Methods of IV administration of Chemo? | Bolus (IV push) or Infusion |
| Dose category of Chemo administration (4)? | STANDARD DOSE: SE mild. HIGH DOSE: increase dosing & SE. > supportive care(G-CSF, blood products) DOSE INTENSIFICATION (DI):higher than standard dose, shorter interval. Often to consolidate. ABLATIVE THERAPY:large dose ablate tumor & BM must have SCT |
| 7 routes of Chemo administration? | PO, IV, IV push, intraarterial (IVA), intrathecal (IT), IM, SQ |
| Def irritant Rx? | causes local inflammatory rxn along venous tract and surrounding skin. |
| IV irritant Rx: list 5 | Carmustine, Cisplatin, Dacarbazine, Docetaxel, Etoposide |
| Def Vesicant Rx? | has potential to cause tissue necrosis if drug leaks out of the vein into surrounding tissue. |
| IV vesicant Rx: list 7? | Actinomycin, Daunorubicin, Doxorubicin, Idarubicin, Mechlorethamine, Vinblastine, Vincristine |
| Def: flare reaction | SE of IV admin of chemo (Central OR PIV)inflammation, no pain, along the venous tract 2ndry to histamine. Wheals may occur, usually a blood return; and it almost always resolves in 30 minutes, or less, without treatment. Occur with any RX esp irratant. |
| Def: infiltration | leadage of drug/fluid out of vein into surrounding tissue. Can occur with + blood return, but IV fluids should always be discontinued. If the infiltration is along the tunnel of a VAD a radiographic or dye study might be indicated. |
| Def: extravasation | leakage of Rx/fluids into surrounding tissue causing a chemical burn. + Pain, +inflammation, + ulceration. Stop Rx, Necrosis may take 4wk to appear & progress for 6 mth. |
| Rx that causes neuro SE of mood alterations (1) | steroids |
| 2 Rx's that causes neurotoxicity SE: | Vincristine, cisplatin |
| 2 Rx's that causes neuro SE of Ototoxicity: | Cisplatin, carboplatin |
| 3 Rx's that cause Cardiomyopathy: | Dauorubicin/doxorubicin, Cyclophosphamide (high dose) |
| 3 Rx's that cause pulmonary fibrosis: | Bleomycin, mitomycin, carmustine |
| 2 Rx's that have infertility as SE: | Mustard, Cyclophosphmide |
| 7 Teratogenic Rx/ Rx classes: | Retinoids, thalidomide, antimetabolites, alkylating agents, vinca alkaloids, topoisomerase II inhibitors |
| Classes of Rx's that do not cause Alopecia | steroids, retinoids, antiangiogenics (nearly every other chemo does) |
| 2 Rx with SE of Acne | Steroids, actinomycin |
| one drug know to cause rash | Cytosine arabinoside |
| Specific SE associated with specific Rx: (INTEGUMENTARY)Striae (1) | Steroids |
| Specific SE associated with specific Rx: (INTEGUMENTARY)photosensitivity (2) | methotrexate, retinoids |
| Specific SE associated with specific Rx: (INTEGUMENTARY)Radiomimetic (3) | Actinomycin, daunorubicin, doxorubicin |
| Specific SE associated with specific Rx: (INTEGUMENTARY)hyperpigmentation (2) | Bleomycin, busulfan |
| Specific SE associated with specific Rx: (INTEGUMENTARY)Extravasation by vesicants (8) | Actinomycin, daunorubicin, doxorubicin, mechlorethamine, mitomycin, vinblastine, vincristine, vinorelbine |
| Specific SE associated with specific Rx: (GI)N/V, Dose related anorexia | Many Rx esp cisplatins, cytosine arabinoside, cyclophosphamides, anthracyclines |
| Specific SE associated with specific Rx: (GI) Diarrhea (2) | Irinotecan, cisplatin |
| Specific SE associated with specific Rx: (GI)Constipation (2) | Vincristine, thalidomide |
| Specific SE associated with specific Rx: (GI)Mucositis (3) | Methotrexate, daunorubicin, doxorubicin |
| Specific SE associated with specific Rx: (GI)Hepatoxicity (4) | 6-MP, 6-TG, VP-16, cytosine arabinoside |
| Specific SE associated with specific Rx: (GI)pancreatitis (2) | Asparaginase, steroids |
| Specific SE associated with specific Rx: (GU)Hemorrhagic cystitis (2) | Cyclophosphamide, Ifosfamide |
| Specific SE associated with specific Rx: (GU)Renal (2) | Cisplatin, carboplatin |
| Specific SE associated with specific Rx: (Hypersensitivity)Anaphylaxis (1) | Asparaginase |
| Specific SE associated with specific Rx: (Hypersensitivity) Allergic Rxn (3) | Carboplatin, Etoposide, Belomycin |
| Specific SE associated with specific Rx: (Hypersensitivity)Hypotension (1) | Etoposide |
| 3 catagories of suppotive care meds | 1) protect from specific SE (eg leucovorin, mesna) 2) halt/minimize immediate SE (eg antiemetics) 3) assist in recovery (eg growth factors) |
| Busulfan/ myleran: class of RX & Route | Class: Alkylating agent. Subclass: alkyl sulfonates. PO/ IT in clinical trials |
| Busulfan/ myleran: SE (9) | N/V, anorexia (@ high dose), BM suppression, Alopecia, hyperpigmentation, hyperuricemia, seizures, gynecomastia, sperm/ovarian faliure |
| Busulfan/ myleran: Nursing implications | Seizure precautions |
| Busulfan/ myleran: main use | prep for HCT |
| Carboplatin/ paraplatin: class of RX & Route | Class: Alkylating agent. Sub class: heavy metal. IV |
| Carboplatin/ paraplatin: SE (7) | N&V (mild) Bone marrow suppression (severe) Renal/hepatotoxic (rare) Hypersensitivity Ototoxic Hypomagnesaemia |
| Carboplatin/ paraplatin: nursing implications | Bone marrow suppression Monitor hearing, renal, & liver function Other than bone marrow suppression, side effects milder than cisplatin |
| Cisplatin/ platinol: class of Rx & route | Class: Alkylating agent. Subclass: heavy metal. IV |
| Cisplatin/ platinol: SE (7) | N&V/anorexia (severe) Bone marrow suppression (mild) Renal/hepatotoxic (severe) Hypersensitivity (rare) Ototoxic (severe) Hypomagnesaemia Neurotoxic/peripheral neuropathies |
| Cisplatin/ platinol: Nursing implications | Rigorous hydration/I&0 Long term need for antiemetics Monitor hearing/renal function |
| Cyclophosphamide/ cytoxan: Class of Rx & route | Class: Alkylating agent. Subclass: mustard derivative. IV/PO |
| Cyclophosphamide/ cytoxan: SE (6) | N&V/anorexia Bone marrow suppression Alopecia Hemorrhagic cystitis Cardiomyopathy (high dose) Infertility |
| Cyclophosphamide/ cytoxan: Nursing implications | Give with MESNA (high dose) Hyperhydration/I&0 |
| Dacarbazine (DTIC): Class of Rx & route | Class: Alkylating agent. Subclass: Triazene. IV (irritant) |
| Dacarbazine (DTIC): SE (7) | N&V/severe up to 12 hours Anorexia Fever/flu-like syndrome (up to 7 days) Bone marrow suppression (nadir 2-3 wks) Alopecia/rash/photosensitivity Hypotension/hypersensitivity Hepatic dysfunction |
| Dacarbazine (DTIC): Nursing implications | Severe pain along vein if in peripheral IV Protect solution from light |
| Ifosfamide: Class of Rx & route | Class: Alkylating agent. Subclass: mustard derivatives. IV |
| Ifosfamide: SE (7) | N&V/anorexia Diarrhea Bone marrow suppression Alopecia Hemorrhagic cystitis Encephalopathy/peripheral neuropathy Fanconi’s syndrome |
| Ifosfamide: Nursing Implications | Give with MESNA Hyperhydration/I&0 |
| Irinotecan/ camptosar: Class & route | Class: Alkylating agent. Subclass: Topisomerase II inhibitors. IV |
| Irinotecan/ comptosar: SE (3) | Diarrhea (usually cholinergic) Bone marrow suppression Alopecia |
| Irinotecan/ comptosar: Nursing Implications | Monitor for diarrhea Antidiarrhea medications may be given prophylactally or they need to be given immediately if symptoms occur Atropine may be given to control diarrhea |
| Temazolamide: class & route | Class: Alkylating agent. Subclass: Triazene. PO |
| Temazolamide: SE | N&V Bone marrow suppression Hepatotoxicity Allergy/anaphylaxis (uncommon) Second malignant neoplasms |
| Temazolamide: Nursing Implications | teach to take at bedtime to decrease N/V |
| Thiotepa: Class & route | Class: Alkylating agent, Subclass: Aziridines IV, IT in trials |
| Thiotepa: SE | N&V Bone marrow suppression Rash/skin burn Fever Pain at infusion site if peripheral Testicular/ovarian failure |
| Thiotepa: Nursing implications | Often used with hematopoietic stem cell support Closely monitor renal function |
| Topotecan: Class & Route | Class: Alkylating agent. Subclass: Topisomerase II inhibitor, IV |
| Topotecan: SE (5) | Diarrhea Bone marrow suppression Alopecia Renal toxic |
| Topotecan: Nursing Implications | Monitor for diarrhea Dilute with either 0.9% normal saline or D5W |
| Cytosine arabinoside (ARA-C, cytarabine): Class & Route | Class: Antimetabolite. Subclass: ? IV/SQ/IM/IT |
| Cytosine arabinoside (ARA-C, cytarabine): SE (6) | N/V/anorexia, Diarrhea, BM suppression, mucositits, Rash (esp hands), Flu-like syndrome/fever, conjunctivitis (high dose) |
| Cytosine arabinoside (ARA-C, cytarabine): Nursing implications | Dexametasone eye drops for high dose. N/V directly related to high dose. |
| Fludarabine: Class & Route | Class: Antimetabolite. Subclass: purine antagonist. IV |
| Fludarabine: SE | N/V/D, BM suppression, Mucositis, fatigue/ muscle aches, rash, neurotoxicity/ pulmonary toxicity |
| Fludarabline: nursing implicatons | Monitor pulmonary function |
| Gemcitabine: Class & Route | Class: Antimetabolite Subclass: pyrimidine antagonist IV |
| Gemcitabine: SE | N/V, BM suppression (especially anemia), Rash, Fever/flu-like symptoms |
| Gemcitabine: nursing implications | Infuse with NS, generally given over 30min, BM suppression is dose limiting |
| Mercaptopurine (6-MP): Class & Route | Class: Antimetabolite. Subclass: purine antagonist. PO/IV |
| Mercaptopurine (6-MP): SE | BM suppression, mucositis (rare), Rash, Hepatotoxic, Mild nausea |
| Mercaptopurine (6-MP): Nursing Implications | Monitor liver function, Teach: take at bedtime on empty stomach to increase absorption. May need decreased dose if on allopurinol |
| Methotrexate (MTX): Class & Route | Class: Antimetabolite. Subclass:Folic acid antagonist. PO/IV/IT/IM |
| Methotrexate (MTX): SE | BM suppression, Mucositis/ GI ulceration, Rash/photosensitivity, Hepatic/renal toxic, Nausea (dose related) |
| Methotrexate (MTX): nursing implications | Monitor liver function, Teach: PO at bedtime on empty stomach, avoid folic acid supplements. High dose needs aggressive hydration, urine alkalinization & leucovorin/ monitor levels |
| Thiguanine (6-TG): Class & Route | Class: Antimetabolite. Subclass: Purine antagonist. PO |
| Thiguanine (6-TG): SE | BM suppression, Mild nausea, mucositis (rare) Hepatotoxic |
| Thiguanine (6-TG): Nursing Implications | Monitor liver function, Teach: take at bedtime on empty stomach |
| Daunorbubicin, Doxorubicin: class & route | Class: Antitumor abx. Subclass: anthracyclines (vesicant) |
| Daunorbubicin, Doxorubicin: SE | Alopecian, N/V, BM suppression, mucositis, cardiomyopathy, Radiomimetic |
| Daunorbubicin, Doxorubicin: Nursing implications | Teach: red/orange urine Monitor: ECHO, photosensitivity. Cumulative max dose (450-550mg/M2) |
| Idarubicin: class & route | Class:antitumor abx. Subclass: anthracycline. (vesicant) IV |
| Idarubicin: SE | Alopecia, N/V, BM suppression, Mucositis, Cardiomyopathy (less common) |
| Idarubicin: nursing implications | Teach: red/orange urine Monitor: ECHO, photosensitivity. |
| Bleomycin: Class & route | Class: Antitumor abx. Subclass: miscellaneous IV |
| Bleomycin: SE | Fever/chills, Hyperpigmentation/ peeling of skin (palms), Hypersensitivity (rare), Renal/hepatic toxicity, pulmonary fibrosis |
| Bleomycin: Nursing implications | test dose prior to first dose. Monitor PFT. Cumulative max dose (400 Units) |
| Dactinomycin (Actinomycin-D, AMD): Class & route | Class:antitumor abx. Subclass: chromomycin (vesicant) IV |
| Dactinomycin (Actinomycin-D, AMD): SE | Bone marrow suppression N/V Photosensitivity/radiomimetic Acne Mucositis |
| Dactinomycin (Actinomycin-D, AMD): nursing implications | Teach: skin care, Dose often ordered in mcg not mg |
| Alpha interferon (a-IFN): Class & Route | Biologic agent, SQ/IM/IV/ Intracavitary |
| Alpha interferon (a-IFN): SE | Flu-like syndrome Fatigue Neurologic Anorexia/weight loss Pruritis Neutropenia/thrombocytopenia |
| Alpha interferon (a-IFN): Nursing implications | Chills usually occur 3-6 hours following administration Fevers to 400 C may occur and last 24 hours |
| Erythropoientin (EPO): Class & route | Biologic agent, IV, SQ |
| Erythropoientin (EPO): SE | HTN, Diarrhea |
| Erythropoientin (EPO): Nursing implications | Teach re: injection techniques Monitor BP Safety and efficacy have not been established in pediatrics |
| Interleukin-2 (IL-2): Class & Route | Biologic agent, SQ, IVq |
| Interleukin-2 (IL-2): SE | Capillary leak syndrome Flu-like syndrome/fevers CNS changes N&V, anorexia Skin changes |
| Interleukin-2 (IL-2): Nursing Implication | Premedicate with acetaminophen Monitor BP Skin care |
| Granulocyte colony stimulating factor (G-CSF): Class & route | biologic agent, SQ, IV |
| Granulocyte colony stimulating factor (G-CSF):SE | Bone pain, fever |
| Granulocyte colony stimulating factor (G-CSF):nursing implications | Teach re: injection techniques, and the development of bone pain as counts recover (more common in adolescents) May require analgesia Monitor WBC/ANC |
| Granulocyte-macrophage colony stimulating factor (GM-CSF): Class & route | biologic agent |
| Granulocyte-macrophage colony stimulating factor (GM-CSF): SE | Bone pain Local skin reaction Flu-like syndrome Third spacing at high dose |
| Granulocyte-macrophage colony stimulating factor (GM-CSF): Nursing implications | Teach re: injection techniques and potential for bone pain as counts recover (more common in adolescents) Treat bone pain with acetaminophen Monitor WBC/ANC |
| Monoclonal Antibodies: Class & route | Biologic agent, IV |
| Monoclonal Antibodies: SE | Potential allergic reactions Flu-like syndrome Fever Achiness |
| Monoclonal Antibodies: Nursing Implications | Keep emergency drugs/dosages available Monitor VS frequently during first hour of infusion |
| Glucorticoids (prednisone, hydrocortisone, dexamethasone): Class & Route | Hormone, IV/PO |
| Glucorticoids (prednisone, hydrocortisone, dexamethasone): SE | Sodium/fluid retention Excessive appetite/food cravings/weight gain Hyperglycemia/GI irritation Cushingoid appearance/acne/striae Cataracts/glaucoma Osteoporsis/avascular necrosis (AVN) Mood alteration/nightmares Restless sleep/night sweats |
| Glucorticoids (prednisone, hydrocortisone, dexamethasone): nursing implications | Teach re: increased risk of infection/GI protection, diet Taper dose if on greater than 3-4 weeks Perineal burning with rapid IV infusion |
| Carmustine (BCNU): class & route | Class: Nitrosoureas, IV, irritant |
| Carmustine (BCNU): SE | N&V Bone marrow suppression Renal/hepatic toxicity Pulmonary fibrosis Ovarian/sperm suppression |
| Carmustine (BCNU): nursing implications | Crosses the blood-brain barrier Delayed nadir (4-6 weeks) Cough & dyspnea initial symptoms of respiratory failure |
| Lomustine (CCNU): class & route | Class: nitrosoureas, PO |
| Lomustine (CCNU):SE | N&V Bone marrow suppression (severe) Renal/hepatic toxicity Mucositis Alopecia |
| Lomustine (CCNU): nursing implications | crosses BBB, delayed nadir (4-6 weeks) |
| Etoposide (VP-16): class and route | Class: Plant alkaloid. Subclass: Epipodophyllotoxins. (Irritant) IV, PO |
| Etoposide (VP-16):SE | Mild N&V Bone marrow suppression Alopecia Hypotension/hypersensitivity Liver toxicity |
| Etoposide (VP-16):Nursing implications | Precipitates easily Monitor for hypotension/hypersensitivity |
| Vinblastine: class & route | Class: Plant alkaloid. Subclass: vinca alkolodis. (vesicant) IVP |
| Vinblastine: SE | Alopecia Bone marrow suppression (mild) Peripheral neuropathy/foot drop (uncommon) Constipation/ileus Jaw pain Hepatotoxic |
| Vinblastine: Nursing implications | Teach re: need for stool softeners, high fiber diet/fluids May need pain medication Neurotoxicities are cumulative |
| Vinorelbine (Navelbine): class & Route | Class: Plant alkaloid. Sub class: epipodophyllotoxins.(vesicant) IV |
| Vinorelbine (navelbine): SE | N&V Bone marrow suppression Neurotoxic/peripheral neuropathies |
| Vinorelbine (navelbine): nursing implications | Given over 4-6 minutes as an IVP Observe for neurotoxicities |
| Arsenic: Class & route | Miscellaneous IV |
| Arsenic: SE | Electrolyte imbalances Electrolyte imbalances Headache Rash/pruritis Cough/dyspnea N&V/anorexia |
| Arsenic: Nursing implications | Concurrent use with antifungal, antihistamine, diuretic, and tricyclic antidepressant drugs can lead to life-threatening cardiac arrhythmias |
| Asparaginase (e-coli, erwinia, PEG): class & route | Miscellaneous, IMq |
| Asparaginase (e-coli, erwinia, PEG): SE | Skin reaction at injection site Systemic allergic reaction (may be delayed with PEG) Hyperglycemia Pancreatitis Coagulapathies |
| Asparaginase (e-coli, erwinia, PEG): (3) | Monitor urine/serum glucose, Observe for 1 hour for allergic reaction, Teach patient that allergic reaction can be delayed especially with PEG. |
| Hydroxyurea: class & route | Class: miscellaneous. Subclass: lipid soluable. PO |
| Hydroxyurea: SE (5) | Bone marrow suppression (primarily leukopenia, N&V, Skin rashes, Exacerbate mucous membrane inflammation in radiation field, Dysuria. |
| Hydroxyurea: nursing implications (2) | Teach: Take at bed time to decreased N&V. Overall well tolerated with mild sedation. |
| Gleevac: Class & route | Class: miscellaneous (targeted therapy) PO |
| Gleevac: SE (5) | Edema/fluid retention, N&V, Neutropenia, thrombocytopenia, Hepatotoxicity. |
| Gleevac: Nursing implications (3) | Teach: Take at bed time to decrease N&V. Observe for signs of fluid retention. Metabolism may be altered in patient is on some antifungal, antibiotics, or steroids. |
| Retinoids: Class & route | Route: PO Class: Miscellaneous. Subclass: retinoids. Rx: All-trans retinoic acid (ATRA®),13-cis-retinoic acid (Accutane®) |
| Retinoids: SE (4) | Teratogenic, Dry skin/photosensitivity, Conjunctivitis, Headache/pseudotumor cerebri |
| Retinoids: Nursing Implications (2) | Teach: Take with food for better absorption. Monitor pregnancy tests on post menarchal females |
| Amifostine: class & route | Protective agent, IV |
| Amifostine: SE (5) | Hypotension, Rash, Hepatic toxicity, Bad taste in mouth, N&V, |
| Amifostine: nursing implications (4) | Administer IV bolus dose over 15 minutes. Pretreat with antiemetics. Begin chemotherapy or radiation 15 minutes AFTER amifostine infusion completed. Patient should be well hydrated prior to infusion. |
| Mesna: class & route | Protective agent, IV/ PO |
| Mesna: SE (5) | Hypotension, Rash, Hepatic toxicity, renal toxicity, Bad taste in mouth, |
| Mesna: Nursing implications (4) | May be mixed with cyclophosphamide or ifosphamide. False positive ketones. Administer IV bolus dose over 15 minutes. May mix oral form with small amount of juice or carbonated drink. |
| Leucovorin: class & route | Protective agent, IV/PO |
| Leucovorin: SE | Rash, pruritus, erythema |
| Leucovorin: nursing implication (3) | Timing of doses crucial, IV solution should be diluted to 10 mg/ml, Do not infuse IV at > 160 mg/minute |
| Zinecard: Class & Route | Protective agent/unclassified chemotherapeutic agent. IV. |
| Zinecard: SE (5) | Alopecia, Mild N&V, Low grade fever, Myelosuppression, Hepatotoxic |
| Zinecard: nursing implications (1) | Timing of doses crucial, Anthracyclines should be given within 30 minutes of start of Zinecard |
| What does zinecard do? | protects heart from doxorubicin |
| What does mesna do? | To prevent haemorrhagic cystitis and haematuria when a patient receives ifosfamide or cyclophosphamide for cancer chemotherapy which converts tp urotoxic metabolites such as acrolein. Increases excretion & binds to toxin. |
| What does amifostine do? | reduce neutropenia-related fever and infection induced by DNA-binding chemo. alkylating agents (e.g. cyclophosphamide) and platinum-containing agents (e.g. cisplatin). It is also used to decrease the cumulative nephrotoxicity with platinum-containing rx. |
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jjenlouu
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