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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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Key Drug Specific Points
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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Key Drug Specific Points
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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