Pharm ch. 46 – Antineoplastic Drugs Part 2 – Flashcards
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Cell cycle-nonspecific (CCNS) antineoplastic drugs
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1. Alkylating drugs. 2. Cytotoxic antibiotics.
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Alkylating Drugs
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1. Classic alkylators. (nitrogen mustards). 2. Nitrosoureas. 3. Miscellaneous alkylators.
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Alkylating Drugs: Mechanism of Action
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1. Work by preventing cancer cells from reproducing. 2. Alter the chemical structure of the cells' deoxyribonucleic acid (DNA). 3. Bifunctional or polyfunctional.
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Alkylating Drugs: Indications
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-Used in combination with other drugs to treat various types of cancer. -Such as: Recurrent ovarian cancer, Brain tumors, Lymphomas, Leukemias, Breast cancer, Bladder cancer, Others.
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Alkylating Drugs: Adverse Effects
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-Alopecia. -Nephrotoxicity, peripheral neuropathy, ototoxicity. ---Hydration can prevent nephrotoxicity. -Extravasation causes tissue damage and necrosis.
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Alkylating Drugs: Dose-limiting Adverse Effects
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Nausea and vomiting, myelosuppression.
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Alkylating Drugs: Examples
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-cisplatin (Platinol). -cyclophosphamide (Cytoxan). -mechlorethamine (Mustine, nitrogen mustard). -carmustine (BiCNU). -Others.
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Cytotoxic Antibiotics
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-Natural substances produced by the mold Streptomyces. -Synthetic substances also used. -Used to treat cancer; too toxic to treat infections.
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Anthracycline antibiotics
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Cytotoxic Antibiotics. 1. daunorubicin, 2. doxorubicin, 3. epirubicin, 4. idarubicin, 5. valrubicin.
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Other cytotoxic antibiotics
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1. bleomycin, 2. dactinomycin, 3. mitomycin, 4. mitoxantrone, 5. plicamycin
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Cytotoxic Antibiotics: Mechanism of Action
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1. CCNS drugs are active in all phases of the cell cycle. 2. Act by intercalation, resulting in blockade of DNA synthesis.
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Cytotoxic Antibiotics: Indications
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1. Used in combination chemotherapy regimens 2. Used to treat a variety of solid tumors and some hematologic malignancies. -Such as: Leukemia, ovarian, breast, bone, others. Squamous cell carcinomas. AIDS-related Kaposi's sarcoma (when intolerant to other treatments).
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Cytotoxic Antibiotics: Adverse Effects
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1. All can produce bone marrow suppression, except bleomycin. 2. Hair loss, nausea and vomiting, myelosuppression. 3. Heart failure (daunorubicin). 4. Acute left ventricular failure (doxorubicin). 5. Pulmonary fibrosis and pneumonitis (bleomycin). 6. Liver, kidney, and cardiovascular toxicities.
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Cytotoxic Antibiotics: Adverse Effect Cardiomyopathy is associated with large amounts of
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doxorubicin
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Cardiomyopathy from doxorubicin prevention
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-Routine monitoring of cardiac ejection fraction with multiple-gated acquisition (MUGA) scans. -Cumulative dose limitations. -Cytoprotective drugs such as dexrazoxane can decrease the incidence of this devastating toxicity.
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Which cytotoxic antibiotic does the nurse identify as most likely to cause pulmonary fibrosis? A. plicamycin B. mitoxantrone C. mitomycin D. bleomycin
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D. Bleomycin is most likely to cause pulmonary fibrosis and pneumonitis. Plicamycin is most likely to cause tissue damage in the event of extravasation. Mitoxantrone is most likely to cause cardiovascular toxicity, and mitomycin is most likely to cause liver, kidney, and lung toxicities.
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Miscellaneous Antineoplastics
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-bevacizumab (Avastin), -hydroxyurea (Hydrea, Droxia), -imatinib (Gleevec), -mitotane (Lysodren),
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bevacizumab (Avastin)
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-Angiogenesis inhibitor
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bevacizumab (Avastin) : Mechanism of Action
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-Blocks blood supply to the growing tumor.
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bevacizumab (Avastin) : Indications
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metastatic colon cancer, rectal cancer in combination with 5-fluorouracil, non-small cell lung cancer, and malignant glioblastoma
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bevacizumab (Avastin) : Adverse Effects
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Many adverse effects, including nephrotoxicity
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Bevacizumab (Avastin) is an angiogenesis inhibitor. Which statement correctly describes the mechanism of action of an angiogenesis inhibitor? A. It inhibits the formation of blood cells. B. It inhibits the creation of new blood vessels in the tumor mass. C. It interferes with the synthesis of DNA in the cancer tumor. D. It causes cell death by inhibiting enzymes.
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B.Bevacizumab (Avastin) is the first approved angiogenesis inhibitor. Angiogenesis is the creation of new blood vessels that supply oxygen and other blood nutrients to growing tissues. In the case of malignant tumors, angiogenesis that occurs within the tumor mass promotes continued tumor growth. As a tumor enlarges, its central tissues gradually die off (necrosis). However, its outer portion continues to grow, often to fatal proportions, with blood supplied through angiogenesis. Thus, inhibiting this process offers a promising new mechanism for antineoplastic drug action.
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hydroxyurea (Hydrea, Droxia) : Mechanism of Action
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Action similar to antimetabolites
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hydroxyurea (Hydrea, Droxia) : Indications
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Used to treat squamous cell carcinoma and some leukemias
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hydroxyurea (Hydrea, Droxia) : Adverse Effects
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edema, drowsiness, headache, rash, hyperuricemia, nausea, vomiting, dysuria, myelosuppression, nephrotoxicity, pulmonary fibrosis.
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imatinib (Gleevec) : Mechanism of Action
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-Works by inhibiting an enzyme that is active in the CML process. -Use with other hepatic-metabolized drugs may cause severe interactions.
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imatinib (Gleevec) : Adverse Effects
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fatigue, headache, rash, fluid retention, GI and hematologic effects, musculoskeletal pain, cough, and dyspnea.
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imatinib (Gleevec) : Indications
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Used to treat chronic myeloid leukemia (CML).
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mitotane (Lysodren)
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Adrenal cytotoxic drug. Oral form only.
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mitotane (Lysodren) : Indications
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Inoperable adrenal corticoid carcinoma
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Hormonal Drugs
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-Used to treat a variety of neoplasms in men and women. -Used most commonly as adjuvant and palliative therapy. ---But may be a drug of first choice for some cancers.
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Hormonal therapy is used to
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-Oppose effects of hormones. -Block the body's sex hormone receptors.
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Hormonal Drugs for Female-Specific Neoplasms
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-Aromatase inhibitors. -Selective estrogen receptor modulators. -Progestins. -Androgens. -Estrogen receptor antagonist.
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Aromatase inhibitors examples
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-anastrozole, -aminoglutethimide
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Selective estrogen receptor modulators examples
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-tamoxifen, -toremifene
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Progestins examples
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-megestrol (Megace), -medroxyprogesterone
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Androgens examples
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-fluoxymesterone, -testolactone
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Estrogen receptor antagonist example
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fulvestrant
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Hormonal Drugs for Male-Specific Neoplasms
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-Antiandrogens. -Gonadotropin-releasing hormone antagonists. -Antineoplastic hormone.
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Antiandrogens examples
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-bicalutamide, -flutamide, -nilutamide
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Gonadotropin-releasing hormone antagonists examples
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-leuprolide, -goserelin
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Antineoplastic hormone example
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estramustine
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Porfimer sodium
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Used to treat esophageal and bronchial tumors in combination with laser light therapy.
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Radiopharmaceuticals
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-Used to treat a variety of cancers, or symptoms caused by cancers. -Administered by nuclear medicine specialists. ---Ex. samarium SM 153 lexidronam, sodium iodide I 131, sodium phosphate P 32
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Extravasation
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-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 amputation may be necessary.
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What to do if extravasation is suspected?
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-stop the infusion immediately and contact the prescriber, but leave the intravenous catheter in place. -Aspirate any residual drug and/or blood from the catheter. -Consult guidelines or the pharmacist regarding antidotes, application of hot or cold packs and/or sterile occlusive dressings, and elevation and rest of the affected limb.
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When handling and administering vesicant drugs the nurse will: A. double-flush the patient's bodily secretions in the commode. B. use sterile towels to clean up after chemotherapy spills. C. mix chemotherapeutic drugs in the patient's room. D. teach the patient how to administer parenteral chemotherapeutic drugs.
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A. When providing care to patients receiving vesicant drugs as well as handling and administering these drugs the nurse should double-flush the patient's bodily secretions in the commode and use special hampers for the disposal of all items that come in contact with the patient, including used personal protective equipment. If a spill should occur, the nurse should use special spill kits to clean up even the smallest chemotherapy spills. Nurses who are specially trained, current and certified should administer chemotherapeutic agents.
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What lab values to assess before starting therapy?
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baseline blood counts.
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Alkylating drugs : Nursing implications.
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-Monitor for expected effects of bone marrow suppression. -Hydration is important to prevent nephrotoxicity.
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Which adverse effects should you expect when giving Alkylating drugs?
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-nausea, vomiting, diarrhea, stomatitis. -ringing/roaring in the ears = possible ototoxicity. -tingling, numbness, or pain in extremities = peripheral neuropathies may occur.
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Cytotoxic antibiotics : Nursing Implications
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-Daunorubicin may turn the urine a reddish color. -Monitor cardiovascular status. -Monitor for nephrotoxicity, liver toxicity. -Monitor pulmonary status, since pulmonary fibrosis may occur.
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Which adverse effects should you expect when giving Cytotoxic antibiotics?
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bone marrow suppression, nausea, vomiting, diarrhea, stomatitis.
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Nursing Implications in general
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-Monitor closely for anaphylactic reactions. -Keep epinephrine, antihistamines, and antiinflammatory drugs on hand. -Monitor closely for complications associated with bone marrow suppression.
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IV amifostine is to reduce?
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renal toxicity associated with cisplatin.
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IV or PO allopurinol is to reduce?
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hyperuricemia
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Monitor for oncologic emergencies:
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-Infections, -Pulmonary toxicity, -Allergic reactions, -Stomatitis with severe ulcerations, -Bleeding, -Metabolic aberrations, -Bowel irritability with diarrhea, -Renal, liver, cardiac toxicity
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Aromatase inhibitors : Adverse Effects
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Vasodilation, hypertension, hot flushes, mood disorders, weakness, arthritis.
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Selective estrogen receptor modulators : Adverse Effects
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Hypertension, peripheral edema, mood disorders, depression, hot flushes, nausea, and weakness.
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Progestins: Adverse Effects
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Hypertension, chest pain, headache, weight gain, hepatotoxicity, dizziness, abdominal pain.
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Androgens : Adverse Effects
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Menstrual irregularities, virilization of female, gynecomastia, hirsutism, acne, anxiety, headache, nausea.
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Estrogen receptor antagonist : Adverse Effects
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Vasodilation, pain, headache, hot flushes, nausea, vomiting, pharyngitis.
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Antiandrogens : Adverse Effects
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Peripheral edema, pain, hot flushes, gynecomastia, anemia, nausea, diarrhea.
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Gonadotropin-releasing hormone antagonists : Adverse Effects
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Rash, pain on injection, alopecia, body odor.
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Antineoplastic hormone : Adverse Effects
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Edema, dyspnea, leg cramps, breast tenderness, nausea, anorexia, diarrhea.
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cisplatin (Platinol) : Adverse Effects
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Nephrotoxicity, peripheral neuropathy, otoxicity.
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cyclophosphamide (Cytoxan) : Adverse Effects
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hemorrhagic cystitis.
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A patient who is receiving chemotherapy with cisplatin (Platinol) has developed pneumonia. The nurse would be concerned about nephrotoxicity if which antibiotic was ordered as treament for the pneumonia at this time? A. Penicillin. B. Sulfa drug. C. Fluoroquinolone. D. Aminoglycoside.
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D. Aminoglycoside
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During treatment with doxorubicin (Adriamycin), the nurse must monitor closely for which potentially life-threatening adverse effect? A. Nephrotoxicity. B. Peripheral neuritis. C. Cardiomyopathy. D. Ototoxicity.
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C. Cardiomyopathy
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While teaching a patient who is about to receive cyclophosphamide (Cytoxan) chemotherapy, the nurse will instruct the patient to watch for potential adverse effects, such as A. Cholinergic diarrhea. B. Hemorrhagic cystitis. C. Peripheral neuropathy. D. Ototoxicity.
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B. Hemorrhagic cystitis
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When chemotherapy with alkylating drugs is planned, the nurse expects to implement which intervention to prevent nephrotoxicity? A. Hydrating the patient with intravenous fluids before chemotherapy. B. Limiting fluids before chemotherapy. C. Monitoring drug levels during chemotherapy. D. Assess creatinine clearance during chemotherapy.
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A. Hydrating the patient with intravenous fluids before chemotherapy.
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During therapy with the cytotoxic antibiotic bleomycin, the nurse will assess for potentially serious adverse effect by monitoring A. blood urea nitrogen and creatinine levels. B. cardiac ejection fraction. C. respiratory function. D. cranial nerve function.
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C. respiratory function.
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While administering bevacizumab (Avastin), what will the nurse assess to look for drug-related toxicities? (Select all that apply) A. Blood pressure. B. Color of the skin and sclera of the eye (for jaundice) C. Blood glucose level D. Urine protein level. E. Hearing
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A. Blood pressure, and D. Hearing
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A patient is receiving her third course of 5-fluorouracil therapy and knows that stomatitis is a potential adverse effect of antineoplastic therapy. What will the nurse teach her about this problem? A. Aspirin should be taken to prevent the development of stomatitis. B. She should watch for and report black, tarry stools immediately. C. She should increase her intake of foods containing fiber and citric acid. D. She should examine her mouth daily for bleeding, painful areas and ulcerations.
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D. Examine mouth daily for bleeding, painful areas and ulcerations.
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When a patient is receiving cyclophosphamide (Cytoxan), he or she should be advised to drink plenty of water/fluids to prevent which condition? A. Renal failure. B. Hemorrhagic cystitis. C. Liver dysfunction. D. Red blood cell count.
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B. Hemorrhagic cystitis
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What is considered a major dose-limiting side effect of doxorubicin (Adriamycin)? A. Hemorrhagic cystitis B. Cardiomyopathy C. Hepatoxicity D. Nephrotoxicity
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B. Cardiomyopathy
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Which laboratory test result would cause the nurse to question administration of hydroxyurea (Hydrea)? A. White blood cell count of 8000/mm3. B. Platelet count of 450,000/mm3. C. Hemoglobin of 15 g/dL. D. Thrombocyte count of 8000/mm3.
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D. Thrombocyte count of 8000/mm3.
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The nurse will suspect which type of cancer in a patient receiving tamoxifen (Soltamox)? A. Lung cancer. B. Renal cancer. C. Breast cancer. D. Colon cancer.
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C. Breast cancer.
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The nurse is discussing the use of alkylating drugs with the patient. What is the best way to describe the mechanism of action of alkylating drugs on cancer cells? A. They interact with the cell through intercalation. B. They alter the chemical structure of the DNA. C. They change the structure of the RNA. D. They stop the meiosis of the cell.
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B. They alter the chemical structure of the DNA.
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When assessing a patient for adverse effects related to cisplatin (Platinol), the nurse will monitor for which adverse effects? (Select all that apply.) A. Nephrotoxicity. B. Peripheral neuropathy. C. Pulmonary toxicity. D. Severe nausea/vomiting. E. Ototoxicity.
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A. Nephrotoxicity. B. Peripheral neuropathy. D. Severe nausea/vomiting. E. Ototoxicity.
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Which are known adverse effects of alkylating agents? (Select all that apply.) A. Nephrotoxicity. B. Neurotoxicity. C. Ototoxicity. D. Bone marrow suppression. E. Cardiotoxicity.
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A. Nephrotoxicity. B. Neurotoxicity. C. Ototoxicity. D. Bone marrow suppression.
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What are the major adverse effects specific to the cytotoxic antibiotics? A. Liver toxicity. B. Cardiovascular toxicity. C. Pneumonitis. D. Neurotoxicity. E. Nephrotoxicity.
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A. Liver toxicity. B. Cardiovascular toxicity. C. Pneumonitis. E. Nephrotoxicity.
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When providing education to a patient undergoing antineoplastic drug therapy, the nurse would teach the patient that which signs and symptoms indicate an oncologic emergency that requires immediate notification of the health care provider? (Select all that apply.) A. Swollen tongue. B. Bleeding gums. C. Difficulty sleeping. D. New and persistent cough. E. Nausea on the day of treatment. F. Blood in urine.
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A. Swollen tongue. B. Bleeding gums. D. New and persistent cough. F. Blood in urine.
