Chapter 46: Antineoplastic Drugs Part 2: Cell Cycle - Nonspecific Drugs and Miscellaneous Drugs

How does hydroxyurea (Hydrea, Droxia) work?

-Action similar to antimetabolites

What is mitotane (Lysodren)?

-Adrenal cytotoxic drug -Used specifically for inoperable adrenal corticoid carcinoma -Oral form only

What are types of cell cycle-nonspecific (CCNS) antineoplastic drugs?

-Alkylating drugs -Cytotoxic antibiotics

What are adverse effects of cytotoxic antibiotics?

-All can produce bone marrow suppression, except bleomycin -Hair loss, nausea and vomiting, myelosuppression -Heart failure (daunorubicin) -Acute left ventricular failure (doxorubicin) -Pulmonary fibrosis and pneumonitis (bleomycin) -Liver, kidney, and cardiovascular toxicities -Many others -Cardiomyopathy is associated with large amounts of doxorubicin: 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

How does bevacizumab (Avastin) work?

-Angiogenesis inhibitor -Blocks blood supply to the growing tumor

What are examples of hormonal drugs for male-specific neoplasms?

-Antiandrogens: bicalutamide, flutamide, nilutamide -Gonadotropin-releasing hormone antagonists: leuprolide, goserelin -Antineoplastic hormone: estramustine

What are examples of hormonal drugs for female-specific neoplasms?

-Aromatase inhibitors: anastrozole, aminoglutethimide -Selective estrogen receptor modulators: tamoxifen, toremifene -Progestins: megestrol (Megace), medroxyprogesterone -Androgens: fluoxymesterone, testolactone -Estrogen receptor antagonist: fulvestrant

What are nursing implications of antineoplastic drugs?

-Assess baseline blood counts before administering antineoplastic drugs -Follow specific administration guidelines for each antineoplastic drug -Monitor closely for anaphylactic reactions -Keep epinephrine, antihistamines, and antiinflammatory drugs on hand -Monitor closely for complications associated with bone marrow suppression: Anemia, thrombocytopenia, neutropenia

What is the difference between bifunctional and polyfunctional alkylating drugs?

-Bifunctional alkylating drugs have two reactive alkyl groups that are able to alkylate two sites on the DNA molecule. -Polyfunctional alkylating drugs can participate in several alkylation reactions.

What is the mechanism of action of cytotoxic antibiotics?

-CCNS drugs are active in all phases of the cell cycle -Act by intercalation, resulting in blockade of DNA synthesis

What are the three types of alkylating drugs?

-Classic alkylators (nitrogen mustards) -Nitrosoureas -Miscellaneous alkylators

Which cytotoxic antibiotic does the nurse identify as most likely to cause pulmonary fibrosis? A. plicamycin B. mitoxantrone C. mitomycin D. bleomycin

-Correct answer: D -Rationale: 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.

What are adverse effects of alkylating drugs?

-Dose-limiting adverse effects: Nausea and vomiting, myelosuppression -Alopecia -Nephrotoxicity, peripheral neuropathy, ototoxicity (Hydration can prevent nephrotoxicity) -Extravasation causes tissue damage and necrosis

What are nursing implications for cytotoxic antibiotics?

-Expect bone marrow suppression, nausea, vomiting, diarrhea, stomatitis -Monitor pulmonary status, since pulmonary fibrosis may occur -Monitor for nephrotoxicity, liver toxicity -Monitor cardiovascular status -Daunorubicin may turn the urine a reddish color

How are cytoprotective drugs used to reduce toxicities?

-IV amifostine to reduce renal toxicity associated with cisplatin -IV or PO allopurinol to reduce hyperuricemia

How is extravasation treated?

-If suspected, 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 -Thoroughly document the extravasation incident -Consult facility protocol and guidelines

What things should a nurse monitor for an oncologic emergencies?

-Infections -Pulmonary toxicity -Allergic reactions -Stomatitis with severe ulcerations -Bleeding -Metabolic aberrations -Bowel irritability with diarrhea -Renal, liver, cardiac toxicity

What is extravasation?

-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 -Prevention is essential -Continuous monitoring of the IV site is essential

What are adverse effects of hydroxyurea (Hydrea, Droxia)?

-Many adverse effects (e.g., edema, drowsiness, headache, rash, hyperuricemia, nausea, vomiting, dysuria, myelosuppression, nephrotoxicity, pulmonary fibrosis)

What is an adverse effect of bevacizumab (Avastin)?

-Many adverse effects, including nephrotoxicity

What are nursing implications of alkylating drugs?

-Monitor for expected effects of bone marrow suppression -Expect nausea, vomiting, diarrhea, stomatitis -Hydration is important to prevent nephrotoxicity -Report ringing/roaring in the ears—possible ototoxicity -Report tingling, numbness, or pain in extremities— peripheral neuropathies may occur

What are cytotoxic antibiotics?

-Natural substances produced by the mold Streptomyces -Synthetic substances also used -Used to treat cancer; too toxic to treat infections

What happens when imatinib (Gleevec) is used with other hepatic-metabolized drugs?

-SEVERE INTERACTIONS

How does imatinib (Gleevec) work?

-Targeted therapy, but it is NOT a monoclonal antibody -Works by inhibiting an enzyme that is active in the CML process

What are hormonal drugs used to treat?

-Used to treat a variety of neoplasms in men and women -Hormonal therapy used to oppose effects of hormones and block the body's sex hormone receptors -Used most commonly as adjuvant and palliative therapy, but may be a drug of first choice for some cancers

What is imatinib (Gleevec) used for?

-Used to treat chronic myeloid leukemia (CML)

What is porfimer sodium used for?

-Used to treat esophageal and bronchial tumors in combination with laser light therapy

What are indications for bevacizumab (Avastin)?

-Used to treat metastatic colon cancer, rectal cancer in combination with 5-fluorouracil, non-small cell lung cancer, and malignant glioblastoma

What are indications for hydroxyurea (Hydrea, Droxia)?

-Used to treat squamous cell carcinoma and some leukemias

What is the mechanism of action of alkylating drugs?

-Work by preventing cancer cells from reproducing -Alter the chemical structure of the cells' deoxyribonucleic acid (DNA) -Bifunctional or polyfunctional

What are other types of cytotoxic antibiotics?

-bleomycin -dactinomycin -mitomycin -mitoxantrone -plicamycin

What are examples of alkylating drugs?

-cisplatin (Platinol) -cyclophosphamide (Cytoxan) -mechlorethamine (Mustine, nitrogen mustard) -carmustine (BiCNU) -Others

What are examples of anthracycline antibiotics?

-daunorubicin -doxorubicin -epirubicin -idarubicin -valrubicin

How are cell cycle-specific and cell cycle-nonspecific drugs different?

-The cell cycle-nonspecific drugs have antineoplastic activity regardless of the phase of the cell cycle in contrast, cell cycle-specific drugs kill cancer cells during specific phases of the cell growth cycle.

When were the first alkylating drugs developed and what were they used for?

-The first alkylating drugs were developed in the 1940s were from mustard gas agents that were used for chemical warfare before and during World War I. The first drug to be developed was mechlorethamine, which is also known as nitrogen mustard. It is the prototypical drug of this class and is still used today for cancer treatment.

What is the rationale behind why hormonal drugs are used?

-The rationale is that sex hormones act to accelerate the growth of some common types of malignant tumors, especially certain types of breast and prostate cancer. Therefore, therapy may involve administration of hormones with opposing effects (i.e., male versus female hormones) or drugs that block the body's sex hormone receptors

What are indications of cytotoxic antibiotics?

-Used in combination chemotherapy regimens -Used to treat a variety of solid tumors and some hematologic malignancies: -Leukemia, ovarian, breast, bone, others -Squamous cell carcinomas -AIDS-related Kaposi's sarcoma (when intolerant to other treatments)

What are indications for alkylating drugs?

-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

What are radiopharmaceuticals used for?

-Used to treat a variety of cancers, or symptoms caused by cancers -Administered by nuclear medicine specialists -samarium SM 153 lexidronam -sodium iodide I 131 -sodium phosphate P 32 -Others