Web Drugs for Neoplasia

8/6/2019 Web Drugs for Neoplasia

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Drugs for Neoplasia

Chapter 37


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Cancer: Basic Facts

CarcinomaAbnormal, uncontrolled cell division

Suppressor genesDamaged cells unresponsive to chemicalsignals

Cancer cells create tumorsCancer cells can metastasizeNamed according to tissue of origin


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Factors Causing or Associated with

Increased Cancer RiskChemical carcinogensExcess x-ray exposure

Ultraviolet light exposureVirusesImmune system suppression

Genetic componentEnvironmental component


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Lifestyle Risks

Inadequate/improper nutritionChemical risks

Noncompliance with screeningrecommendations

Discuss lifestyle factors important to cancerprevention or diagnosis.


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Curing Cancer

Discuss challenges to curing cancer.

Discuss treatment approaches: Surgery Radiation

Chemotherapy


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Antineoplastic Therapy

Describe the generalpurposes of antineoplastic

therapy.


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Cell Cycle

Figure 37.2 Antineoplastic agents and the cellcycle, p. 555

Important to pharmacodynamics of antineoplastic therapy Some drugs are specific to certain cell cycle

phases

Growth Fraction Ratio of # of replicating cells to # of resting cells


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Special Protocols and Strategies

Protocols: Therapy will be designed to optimize cancer cell

death. Specific dosing schedules

Strategies: Multiple drugs from different classes Combination therapy


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Toxicity

Antineoplastics also affect normal cellsReplicating cells most susceptible

Hair follicle, epithelial lining of gastric mucosaVomiting center triggeredPremedications may decrease toxic effects

Bone marrow toxicity is most frequent dose-limiting effect


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Bone Marrow Toxicity

Discuss strategies tominimize bone marrow

toxicity.


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Nadir and Absolute Neutrophil Count

Nadir: lowest point at which neutrophil countis depressed by the chemotherapeutic agent.p. 557

Describe the significance of monitoring theabsolute neutrophil count.


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Administration Considerations

Identify delivery strategies to minimizesystemic toxicity.

Discuss the practice implications of IVadministration of antineoplastics, most of which are vesicants.

What must a nurse know before administeringan antineoplastic IV?


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Q uestion

Antineoplastic agents are toxic to normal cellsas well as cancer cells and can cause long termconsequences such as infertility and inductionof secondary malignancies.

Why would drugs that could cause suchserious side effects and other cancers beadministered?


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Antineoplastic Drugs

Develop a table to include: MOA

Prototype and examples Indications for therapy Common adverse effects Nursing considerations Key teaching points


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General Nursing Considerations

Baseline: VS, CBC with Diff, RFTs, LFTs, I&O, wt. Hearing test with some drugs

Cautious:

hepatic, cardiac, renal impairment Recent steroids, leukopenia, thrombocytopenia

Well hydrated prior to therapyAvoid crowds/those with respiratory infections

Incorporate measures to facilitate respiratory functionBe alert for bruising and bleedingMonitor CBC and platelet count during therapy


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General Nursing Considerations

Anticipate side effects Premedicate with antiemetic

Monitor nutritional intake

Assess for n/v; medicate as appropriate Offer foods/fluids to minimize nausea/vomiting Small, frequent meals Avoid high purine and citric acid Ice chips/ice pops to decrease mouth pain

Assess skin integrityMonitor IV siteNo rectal temps or OTC suppositories


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General Teaching Points

Reliable contraceptionNo breast feeding

Hearing screening during therapyImmediately report s/s of ototoxicityImmediately report s/s of anemia, infection,

blood dyscrasias, gout/kidney stones, rashesAvoid crowds or anyone with respiratoryinfection


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General Teaching Points

Good oral careInform that hair loss is possible

Inform regarding: Women: amenorrhea, menstrual irregulrities,

sterility Men: impotence

Avoid citric acid and high purine foodsSmall frequent meals


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Key Drug Specific Points

Platinum alkylating agents: hearing lossAntimetabolites:

temperature monitoring Monitor IV site for extravasation

Antitumor Antibiotics: Weekly CBC with diff, platelet count May need prophylactic antibiotics Baseline assessment of cardiac status; ECG Potential for angioedema


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Doxorubicin (Adriamycin): Gloves and protective clothing Severe vesicant

Natural Products: Steroid therapy to ameliorate infusion hypersensitivity

Vincristine Contraindicated in obstructive jaundice and Charcot-

Marie-Tooth Cautiously: leukopenia, neuromuscular disease, HTN Prevent constipation Can cause severe mental depression


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Hormones and Hormone Antagonists: All but tamoxifen may be palliative, be sure

patient and family understand this Cross-gender secondary sex characteristics can

develop

Glucocorticoids: risk of STDs and infection glucose may need to adjust antidiabetic meds

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