Chemotherapy Meds

Antimetabolites

a class of drugs that interfere with DNA and RNA growth by substituting for the normal building blocks of RNA and DNA. These agents damage cells during the S phase.

Cyclophosphamide

causes hemorrhagic cystitis. Give dose early in the day. Ensure adequate hydration. Have patient empty bladder frequently. An indwelling catheter may be necessary with high doses. When giving a high dose, administer with Mesna. Pelvic irradiation potentiates hemorrhagic cystitis. May cause a hypersensitivity reaction and can be toxic to the kidneys. To prevent nasal stuffiness and facial flushing, slow infusion.

Taxanes

complex terpenes produced by the plants of the genus Taxus (yews). Originally derived from the Pacific yew tree, they are now synthesized artificially. Their principal mechanism is the disruption of the cell's microtubule function by stabilizing microtubule formation. Microtubules are essential to mitotic reproduction, so through the inactivation of the microtubule function of a cell, taxanes inhibit the cell's division.

Methotrexate

follow high doses with Leucovorin & vigorous hydration. Monitor serum methotrexate levels. Instruct patient on strict mouth care and photosensitivity precautions. Patient should not take multivitamins with folic acid. Causes nail changes, hand-foot syndrome and radiation recall. Can be toxic to the liver and kidneys and can cause pneumonitis. Can be given intrathecally.

Examples of targeted therapies

imatinib (Gleevec®), gefitinib (Iressa®), and bortezomib (Velcade®). Targeted therapies are a huge research focus and probably many more will be developed in the future.

Topoisomerase II inhibitors

increases the risk of a second cancer — acute myelogenous leukemia (AML). With this type of drug, a secondary leukemia can be seen as early as 2 to 3 years after the drug is given.

Example of topoisomerase inhibitor

irinotecan (CPT-11)

Mitotic inhibitors

often plant alkaloids and other compounds derived from natural products. They can stop mitosis or inhibit enzymes from making proteins needed for cell reproduction. These drugs work during the M phase of the cell cycle but can damage cells in all phases. They are used to treat many different types of cancer including breast, lung, myelomas, lymphomas, and leukemias. These drugs are known for their potential to cause peripheral nerve damage, which can be a dose-limiting side effect.

Examples of corticosteroids

prednisone, methylprednisolone (Solumedrol®), and dexamethasone (Decadron®).

The platinum drugs (cisplatin), are sometimes grouped with alkylating agents because

they kill cells in a similar way. These drugs are less likely than the alkylating agents to cause leukemia later on.

Interferon-alfa

• Approved for use in hairy cell leukemia, malignant melanoma, AIDS-related Kaposi's sarcoma, follicular non-Hodgkin's lymphoma. • Other uses: Chronic myelogenous leukemia (CML), renal cell cancer, cervical cancer, carcinoid syndrome, medullary thyroid cancer, multiple myeloma, basal and squamous cell skin cancers, low-grade non-Hodgkin's lymphoma, cutaneous T-cell lymphoma (mycosis fungoides). • Blood disorders such as: polycythemia vera, essential thrombocytopenia, thrombocytopenia purpura. (NCI)

There are different classes of alkylating agents, including

• Nitrogen mustards: cyclophosphamide (Cytoxan®)

Tamoxifen

(Nolvadex) has been used for over 30 years to treat breast cancers that are hormone-receptor positive. It attaches to the hormone receptor in the cancer cell, blocking estrogen from attaching to the receptor. Since hormone-receptor positive cells need estrogen to grow, tamoxifen can slow or stop the growth of cancer cells. Unlike aromatase inhibitors, tamoxifen can be used to treat breast cancer in both premenopausal and postmenopausal women. Tamoxifen is also used to treat breast cancer in men

Examples of antimetabolites include

5-fluorouracil (5-FU) Methotrexate

Side Effects-Alkylating Agents

Alopecia, Anorexia, Stomatitis, diarrhea, N&V, Hepatotoxicity, Hyperuricemia, Ototoxicity, Hemorrhagic cystitis

Anti-tumor antibiotics

Anthracyclines

Anthracyclines

Anthracyclines are anti-tumor antibiotics that interfere with enzymes involved in DNA replication. These drugs work in all phases of the cell cycle. They are widely used for a variety of cancers. A major consideration when giving these drugs is that they can permanently damage the heart if given in high doses. For this reason, lifetime dose limits are often placed on these drugs

Targeted therapies

As researchers have learned more about the inner workings of cancer cells, they have begun to create new drugs that attack cancer cells more specifically than traditional chemotherapy drugs. Most attack cells with mutant versions of certain genes, or cells that express too many copies of a particular gene. These drugs can be used as part of the main treatment, or they may be used after treatment to maintain remission or decrease the chance of recurrence.

Specific Nursing Interventions for Alkylating Agents

Assess for infection, Monitor uric acid, Assess pulmonary function, Hydrate, Oral Cytoxan given without food, Diet low in purines to alkalize the urine, Withhold if platelet count below 75,000 or WBC below 4000

Anti-tumor Antibiotic Side Effects

Cardiotoxicity, Alopecia, Anorexia, Myelosuppression, N&V, Pulmonary fibrosis, Vesicants

Side effects of Tamoxifen

Hot flashes and night sweats, Vaginal discharge, Vaginal dryness or itching, Irregular periods or spotting (uterine bleeding), Loss of sex drive, Blood clots

Different types of chemotherapy drugs

Chemotherapy drugs can be divided into several groups based on factors such as how they work, their chemical structure, and their relationship to another drug. Because some drugs act in more than one way, they may belong to more than one group. Knowing how the drug works is important in predicting side effects. This helps oncologists decide which drugs are likely to work well together. If more than one drug will be used, this information also helps them plan exactly when each of the drugs should be given (in which order and how often).

Alkylating agents

Directly damage DNA to prevent the cancer cell from reproducing. As a class of drugs, these agents are not phase-specific; in other words, they work in all phases of the cell cycle. Alkylating agents are used to treat many different cancers, including leukemia, lymphoma, Hodgkin disease, multiple myeloma, and sarcoma, as well as cancers of the lung, breast, and ovary. Because these drugs damage DNA, they can cause long-term damage to the bone marrow. In rare cases, this can eventually lead to acute leukemia. The risk of leukemia from alkylating agents is "dose-dependent," meaning that the risk is small with lower doses, but goes up as the total amount of the drug used gets higher. The risk of leukemia after getting alkylating agents is highest about 5 to 10 years after treatment

Example of anthracycline

Doxorubicin (Adriamycin®)

Hormone therapy

Drugs in this category are sex hormones, or hormone-like drugs, that change the action or production of female or male hormones. They are used to slow the growth of breast, prostate, and endometrial (uterine) cancers, which normally grow in response to natural hormones in the body. These cancer treatment hormones do not work in the same ways as standard chemotherapy drugs, but rather by preventing the cancer cell from using the hormone it needs to grow, or by preventing the body from making the hormones

Topoisomerase inhibitors - Side Effects

Early onset diarrhea that is cholinergically mediated and managed with atropine, Late onset diarrhea treated with loperamide, Increased sweating and saliva production, Watery eyes, Abdominal cramping, S&S of immune suppression; sore throat, infection, fever, chills, Hematological changes; bleeding, bruising

Interferon-alfa side effects

Flu-like symptoms Tiredness (fatigue) Nausea, vomiting, anorexia Dizziness Depression and emotional changes Alopecia Temporary reduction in blood cell numbers Dysrhythmias

Side Effects of LH-RH (GnRH) analog Therapy

Fluid retention Hot flashes Headaches Osteoporosis

Interleukin-2 (IL-2)

Interleukin 2 (IL-2) is an interleukin, a type of cytokine signaling molecule in the immune system. It is a protein that regulates the activities of white blood cells (leukocytes, often lymphocytes) that are responsible for immunity. IL-2 is part of the body's natural response to microbial infection, and in discriminating between foreign ("non-self") and "self". It has been approved by the Food and Drug Administration (FDA) for the treatment of cancers (malignant melanoma, renal cell cancer) in large intermittent toxic doses, and is in clinical trials for the treatment of chronic viral infections, and as a booster (adjuvant) for vaccines. The use of large, toxic doses of IL-2 given every 6-8 weeks in HIV therapy, similar to its use in cancer therapy, has been found recently to be ineffective in preventing progression to an AIDS diagnosis in two large clinical trials. IL-2 is also effective in improving the T-cell count in the blood.

Gonadotropin-releasing hormone (GnRH) leuprolide (Lupron®)

Leuprolide acts as an agonist at pituitary GnRH receptors. By interrupting the normal pulsatile stimulation of, and thus desensitizing, the GnRH receptors, it indirectly downregulates the secretion of gonadotropins luteinizing hormone (LH) and follicle-stimulating hormone (FSH), leading to hypogonadism and thus a dramatic reduction in estradiol and testosterone levels in both sexes. An LH-RH (GnRH) analog, leuprolide (Lupron) may be used in the treatment of hormone-responsive cancers such as prostate cancer or breast cancer, estrogen-dependent conditions (such as endometriosis or uterine fibroids), to treat precocious puberty, and to control ovarian stimulation in In Vitro Fertilization (IVF).

Interleukin-2 (IL-2) side effects

Low blood pressure Capillary leak syndrome NVD Sores in the mouth or on the lips Drowsiness Allergic reactions

Specific Nursing Interventions for Mitotic inhibitors (plant alkaloids)

Moderate heat compress to area of extravasation Watch carefully for life-threatening bronchospasm after drug administration Assess for numbness and tingling in patient's hands and feet, foot drop, difficulty walking, decreased wrist and Achilles deep tendon reflexes Monitor bowel function, constipation may be an early sign of neuro toxicity

Specific Nursing Interventions Antitumor-Antibiotics

Monitor lung sounds for crackles, Assess cardiac/pulmonary toxicity, Avoid anticoagulants when giving Plicamycin

Specific Nursing Interventions - Topoisomerase inhibitors

Must be given IV slowly over at least ½ hour, Metabolized through the liver - monitor liver enzymes, Protect vials from light exposure

Side Effects of Plant Alkaloids

Neurotoxicities, Vesicants, Ptosis, Hoarseness, Motor Instability, NV, Stomatitis, Constipation, Alopecia

Examples of Immunotherapies

Non-specific immunotherapies and adjuvants (other substances or cells that boost the immune response), such as, interleukin-2 (IL-2), and interferon-alfa

Specific Nursing Care for Antimetabolites

Observe for cerebellar dysfunction (dizziness, weakness, ataxia), When Methotrexate administered in large doses leucovorin given to prevent fatal toxicity, Use sunscreen and wear protective clothing

Examples of taxanes

Paclitaxel—used to treat lung cancer, ovarian cancer, breast cancer, and advanced forms of Kaposi's sarcoma

Immunotherapy

Some drugs are given to people with cancer to stimulate their natural immune systems to recognize and attack cancer cells. These drugs offer a unique method of treatment, and are often considered to be separate from chemotherapy. Compared with other forms of cancer treatment such as surgery, radiation therapy, or chemotherapy, immunotherapy is still fairly new. There are different types of immunotherapy. Active immunotherapies stimulate the body's own immune system to fight the disease. Passive immunotherapies do not rely on the body to attack the disease; instead, they use immune system components (such as antibodies) created outside the body.

Corticosteroids

Steroids are natural hormones and hormone-like drugs that are useful in treating some types of cancer (lymphoma, leukemias, and multiple myeloma), as well as other illnesses. When these drugs are used to kill cancer cells or slow their growth, they are considered chemotherapy drugs. Corticosteroids are also commonly used as anti-emetics to help prevent nausea and vomiting caused by chemotherapy. They are used before chemotherapy to help prevent severe allergic reactions (hypersensitivity reactions), too. When a corticosteroid is used to prevent vomiting or allergic reactions, it's not considered chemotherapy

Side Effects of Antimetabolites

Stomatitis, anorexia, N&V, Myelosuppression, Changes in skin and nails, Phototoxicity, Cerebellar dysfunction

Examples of hormone therapy

The anti-estrogens: Tamoxifen

Topoisomerase inhibitors

These drugs interfere with enzymes which help separate the strands of DNA so they can be copied. They are used to treat certain leukemias, as well as lung, ovarian, gastrointestinal, and other cancers

Antimetabolites Treat...

They are commonly used to treat leukemias, cancers of the breast, ovary, and the intestinal tract, as well as other types of cancer.

Alkylating agents treat...

Used to treat many different cancers, including leukemia, lymphoma, Hodgkin disease, multiple myeloma, and sarcoma, as well as cancers of the lung, breast, and ovary.

Example of vinca alkaloids

Vincristine—used to treat lymphoma, breast cancer, lung cancer, and acute lymphoblastic leukemia.

Vinca alkaloids

amines produced by the hallucinogenic plant Catharanthus roseus (Madagascar Periwinkle). Vinca alkaloids inhibit microtubule polymerization, thereby inhibiting mitosis