Chapter 12: Drug Therapy for the Treatment of Cancer
QSEN Safety Alert #6
Wear gloves when handling patient's clothing, bed linens, or excreta. Blood and body fluids are contaminated with drugs or metabolites for about 3-5 days after a dose
QSEN Safety Alert #2
When cytotoxic drugs are combined, it is essential to monitor the complete blood cell count (CBC) before and after each treatment to allow time for bone marrow recovery before the next treatment.
Major problem of chemotherapy
drug resistance
Chemotherapy is administered ___________________
in cycles (medication followed by recovery) Overseen by medical oncologists/specialty trained nurses
Why does Tumor Lysis Syndrome develop?
when large numbers of cancer cells are killed or damaged simultaneously and release their intracellular contents into the bloodstream
Safety Precautions With Cytotoxic Antineoplastic Medications
**Most are carcinogenic, mutagenic, and teratogenic. >Avoid exposure while pregnant. Parenteral solutions are irritating to skin, mucous membranes—>avoid direct contact with skin or respiratory tract; wash hands thoroughly after administration.
Common Adverse Effects of Traditional Cytotoxic Antineoplastic Drugs
-Alopecia, anemia, bleeding -Fatigue, mucositis -N/V -neutropenia -thrombocytopenia -Possible damage to heart, liver/kidneys, and nerves
Management of Hand Foot Syndrome
-Avoid increased pressure -Apply ice packs for 15-20 minutes at a time -Acetaminophen may be used for discomfort
Solid neoplasms
-Carcinomas (epithelial tissue) -Sarcomas (connective tissue)
Indications for Use of Traditional Cytotoxic Antineoplastic Drugs
-Cure neoplastic disease -Relieve neoplastic disease symptoms -Induce/maintain remissions -Treatment of nonmalignant conditions >>Rheumatoid arthritis >>Psoriasis
Hematologic malignancies
-Invade bone marrow and lymphoid tissue -Leukemias, lymphomas, multiple myeloma
General Characteristics of Traditional Cytotoxic Antineoplastic Drugs
-Most kill malignant cells by interfering with cell replication in some manner. -Act during the cell's reproductive cycle -Most active against rapidly dividing cells, both normal and malignant -Each dose kills a specific % of cells. -May induce drug-resistant malignant cells -Differing routes of administration
Antineoplastic Drug Selection/Dosage Depends on
-Type, stage of cancer -Drug efficacy in specific cancer -Patient's age, health status->Including liver, kidney function
Signs/Symptoms/Effects of Tumor Lysis Syndrome
-hyperkalemia -hyperphosphatemia -hyperuricemia -hypomagnesemia -hypocalcemia -acidosis
Cytotic Antineoplastic Drugs & Prototypes
1. Alkylating Drugs - Cyclophosphamide (Cytoxan) 2. Antimetabolites - Methotrexate (Trexall) 3. Antitumor Antibiotics - Bleomycin (Blenoxane) 4. Plant Alkaloids - Vincristine (Oncovin)
Adjuvant Medication Used to Treat Cancer
1. Biologic Antineoplastic Drugs -Monoclonal Antibodies -Growth Factor & Tyrosine Kinase Inhibitors -Proteasome Inhibitors 2. Antineoplastic Hormone Inhibitor Drugs -Antiestrogens For breast cancer or prevention in high risk patients -Aromatase Inhibitors -Antiandrogens -Luteinizing Hormone-Releasing Hormone Analogs
Cytoprotectant Drugs
1. Erythropoietin (Epogen, Procrit) - anemia 2. Filgrastin (Neupogen) - neutropenia 3. Oprelvekin (Neumega) - thrombocytopenia
Malignant Neoplasms Classifications
1. Hematologic malignancies -Invade bone marrow and lymphoid tissue -Leukemias, lymphomas, multiple myeloma 2. Solid neoplasms -Carcinomas (epithelial tissue) -Sarcomas (connective tissue)
Oncologic Medication Groups
1. Traditional cytotoxic agents 2. Biologic targeted therapies (cytotoxic) 3. Hormone inhibitors (noncytotoxic) 4. Medications that reduce adverse effects of cytotoxic medications
Hand Foot Syndrome
Aka Palmar-Plantar Erythema A sunburn type of skin reaction with redness, tenderness, & possibly peeling, numbness & tingling of palms & soles. Associated with some traditional cytotoxic dugs
Aromatase Inhibitors
Anastrozole (Armidenx) Indication=breast cancer
QSEN Safety Alert #8
Antineoplastic Hormone Inhibitor Drugs= use effective nonhormonal barrier contraception during therapy and for 2 months after the drug is discontinued.
Purpose of grading/staging classifications
Assist in determining treatment modalities.
QSEN Safety Alert #5
Avoid direct contact with solutions for injection by wearing gloves, face shields, an protective clothing
Antiandrogens
Bicalutamide (Casodex) - Indication=prostatic cancer
Antitumor Antibiotic Prototype
Bleomycin (Blenoxane)
Antineoplastic Drug Guidelines
Consider the patient's age, functional status, nutritional status, blood count, kidney and liver function High doses are usually most effective. Doses are usually calculated according to the body surface area. Doses may be reduced for impairments that reduce the ability to eliminate medications.
Alkylating Drug Prototype
Cyclophosphamide (Cytoxan)
QSEN Safety Alert #3
Cytotoxic drugs are potentially embryotoxic, teratogenic & carcinogenic
Cancer
Disease process characterized by uncontrolled cell growth, invasiveness and metastasis with numerous etiologies, clinical manifestations, and treatments
Luteinizing Hormone-Releasing Hormone Analogs
Goserelin (Zoladex) Indication=advanced prostatic or breast cancer
Grading/Staging Malignant Neoplasms
Grades 1 and 2=-Similar to normal tissue of origin; show cellular differentiation Grades 3 and 4=Unlike normal tissue of origin; less differentiated, more malignant Staging=Localized or metastasized; organ involvement
Purpose of Oncologic Medications
Kill, damage, or slow growth of cancer cells and prevent/treat adverse effects
Antimetabolite Prototype
Methotrexate (Trexall)
Normal Versus Malignant Cells
Normal Cells: -Reproduce in response to the need for tissue growth/repair -Stop reproduction when the need is met -Well differentiated in appearance and function -Have characteristic lifespan Malignant Cells: -Occupy space; serve no useful purpose -Steal blood and nutrients from normal tissue -Grow in uncontrolled fashion -Undifferentiated; loosely connected >>Break off and invade adjacent tissues or circulate throughout the body in bloodstream
QSEN Safety Alert #1
Nurses who administer IV cyotoxic chemotherapy receive special training and are certified in handling and administering the chemotherapy drugs safely & accurately
QSEN Safety Alert #7
Oral Tyrosine Kinase Inhibitors=No crushing or cutting tablets should occur and if necessary dissolve the tablet in water in accordance with the manufacturer's instructions and ingest it immediately
Purpose for Erythropoietin (Epogen, Procrit)
Protection against anemia
Purpose for Filgrastin (Neupogen)
Protection against neutropenia
Purpose for Oprelvekin (Neumega)
Protection against thrombocytopenia
Medical management of metastatic disease
Requires systemic chemotherapy alone
Tumor Lysis Syndrome
Serious life-threatening adverse effect from treatment of leukemias & lymphomas
Medical management of localized tumors
Surgery, radiation, or concurrent chemotherapy and radiation
Antiestrogens
Tamoxifen (Nolvadex) Indication=breast cancer or prevention in high risk patients
QSEN Safety Alert #4
Use of cytotoxic agents that cause bone marrow suppression is not appropriate in people with a white blood cell count less than 2000 cell/mm3, a neutrophil count less than 1500 cells/mm3, and/or platelet count less than 50,000/mm3
Chemotherapy
Use of medications to treat cancer (rather than surgery, radiation) Goal=Damage or kill cancer cells Most regimens involve combination of drugs with differing cellular action
Plant Alkaloid Prototype
Vincristine (Oncovin)