Pharm Chapter 50: Antineoplastic Drugs and Targeted Therapies

A client received an injection of doxorubicin and is now observing a reddish urine. The client reports blood in the urine to the nurse. How should the nurse respond?

"The reddish urine is an expected response to the drug."

The patient's family shares they have heard that "pot will help with nausea and lack of appetite". What can you teach the family about medical marijuana?

- Dronabinol and nabilone= medically marijuana - ADRs: increased HR, lower RR, potential addiction - DO NOT drink alcohol

Some short-term adverse drug reactions to antineoplastic agents are:

1. Bone marrow suppression (anemia, leukopenia, thrombocytopenia) 2. diarrhea, dehydration, drowsiness 3. fluid and electrolyte imbalance 4. stomatitis (inflammation of lining tissues) 5. hair loss

Your patient has experienced severe nausea and vomiting due to their chemotherapy that they can no longer tolerate eating or drinking. The provider has prescribed TPN. List 4 essential RN considerations.

1. Change bag and tubing every 24 hours. 2. Infuse for 24 hours, 12 hours for lipids. 3. Verify at bedside with 2 nurses 4. Always use micron filter and monitor patient/site diligently

A client has chosen to be placed on hospice. Which is acceptable chemotherapy for a client on hospice?

682

A client is prescribed cyclophosphamide as part of her treatment for non-Hodgkin's lymphoma. Which symptoms should the client be instructed to report to her health care provider immediately?

Pain and burning with urination

A client is prescribed cyclophosphamide as part of her treatment for non-Hodgkin's lymphoma. Which symptoms should the client be instructed to report to her health care provider immediately? Nasal congestion Nausea and vomiting Pain and burning with urination Alopecia

Pain and burning with urination

A client with a pancreatic tumor will be starting on chemotherapy to decrease the size of the tumor, give the client a better quality of life, and reduce discomfort. What is this form of therapy called?

Palliative therapy

Who can administer antineoplastic drugs?

Specially trained/certified RN- outpatient settings

Podophyllotoxins action?

Stop the S and G2 phases and thus are unable to divide

What are patient signs and symptoms of LEUKOPENIA and what diagnostic labs can confirm it?

fever, chills, mouth sores, immunosuppression WBC < 5,000/uL

Which herbal product has the benefits of overall well-being, cancer prevention, dental health, and maintenance of heart and liver health as a result of being loaded with antioxidants?

green tea

Doxorubicin is an antibiotic associated with what ADR?

severe hair loss

Do targeted therapy agents or antineoplastic drugs have less ADRs?

targeted therapy agents

A mother has just been told that her child has cancer and will need chemotherapy. The mother is worried about side effects. What is the nurse's best response?

"An immediate side effect of many chemotherapy agents is nausea and vomiting. There are medications that can be given prior to chemotherapy to lessen these side effects."

A client being treated with an antineoplastic medication is being discharged from the hospital. Which of the following teaching instructions is appropriate for this client?

"You will be excreting the antineoplastic medications in your stool and urine. As a precaution, double-flush the toilet with the lid closed so the chances of contact with the drug will be lessened."

Which of the following adverse reactions to the antineoplastic drugs is most likely to affect the client's body image? 1. Hematuria 2. Alopecia 3. Nausea 4. Diarrhea

2. Alopecia

The 3 categories of cell cycle-specific drugs are?

Antimetabolites Vinca alkaloids Podophyllotoxins

A client with leukemia is being treated with a combination of antineoplastics, including methotrexate. The client's most recent laboratory results indicate the client is experiencing bone marrow suppression. What is the nurse's priority action? Encourage the client to limit physical activity in order to reduce the risk of bleeding. Ensure that all staff and visitors adhere to infection control precautions. Space out the client's care to preserve energy and prevent fatigue. Provide small quantities of food several times per day, as tolerated.

Ensure that all staff and visitors adhere to infection control precautions.

how are antineoplastic drugs given?

Given systemically- circulate through entire body- other rapidly growing cells also affected

A 39-year-old client has begun taking tamoxifen to reduce the risk of contralateral breast cancer. The client is now reporting hot flashes and dysmenorrhea. What is the nurse's best action? Encourage the client to ask her provider about the possible use of dexrazoxane to relieve these effects. Tell the client to stop taking the drug immediately and contact the prescriber. Encourage the client to speak with her care provider about hormone therapy. Inform the client that these are likely adverse effects of drug therapy.

Inform the client that these are likely adverse effects of drug therapy.

What is the two most common adverse reactions to antineoplastic agents?

Leukopenia and thrombocytopenia

A nurse is caring for a client who is undergoing chemotherapy. The client has experienced several episodes of vomiting. Which would be most appropriate for the nurse to do for this client as part of the ongoing assessment?

Measure all fluid intake and output

What can the oncology nurse do to minimize the exposure risk to chemotherapeutic agents? Only administer chemotherapy agents that are not toxic. Recognize the dangers of administering chemotherapeutic agents. Review institutional policies and procedures related to chemotherapy Attend in-service education on chemotherapeutic agents

Review institutional policies and procedures related to chemotherapy

What do antineoplastic agents do to malignant cells?

Slows growth

What are signs and symptoms of extravasation?

Swelling, stinging burning or pain at site, erythema, altered flow rate.

A nurse educator who coordinates the staff education on an oncology unit is conducting an inservice on targeted therapies. What potential benefit of targeted therapies should the nurse highlight in this education session?

Targeted therapies have the potential to damage cancerous cells while leaving normal body cells less affected.

What potential benefit is unique to biologic agent therapies?

They may affect cancer cells while leaving normal body cells unaffected.

Why are antineoplastic drugs administered in series of cycles?

To allow for recovery of normal cells & to destroy more malignant cells

The dosages of the chemotherapy agents that will be administered are based primarily on what client variable? comorbidities body surface area (BSA) percentage of body water weight

Weight

A 25-year-old female client is prescribed methotrexate to treat rheumatoid arthritis (RA). The nurse should teach the client to:

Women of childbearing age should use an effective contraceptive during therapy with methotrexate. When taking methotrexate, the client should be instructed to notify the primary health care provider immediately at first sign of a rash or sore throat.

Cisplatin cannot be prepared or administered with needles or IV administration sets containing what?

aluminum

What is the action of antineoplastic agents?

attack a cell during a phase of cell division (growing & dividing)

Antimetabolites work by:

attacking the cells in the S period of reproduction

The oncology nurse understands that chemotherapeutic agents are most effective during a particular phase of the cell cycle. This means the agents are:

cell cycle-specific

Antineoplastic Antibiotics drug prototype?

doxorubicin

Some long-term adverse drug reactions to antineoplastic agents are:

fertility, nuero/cardiac/pulmonary, secondary cancers

Antimetabolites are used for what conditions?

many of the leukemias lymphomas solid tumors autoimmune diseases

A 39-year-old woman is receiving doxorubicin for the treatment of cancer. After each treatment, the client has acute nausea and vomiting accompanied by a slightly increased heart rate. The nurse will advise her to:

perform relaxation techniques after the treatments.

A client asks the nurse what cancer cell growth is called. What would the nurse tell the client? anaplasia proliferation pleomorphism neoplasm

proliferation

Vinca Alkaloids drug prototype?

vincristine

Which of the following is the most common symptom of extravasation? 1. Swelling around the injection site 2. Redness along the vein and around the injection site 3. Pain at the injection site 4. Tenderness along the path of the vein

1. Swelling around the injection site

When assessing the client for leukopenia, the nurse ______. 1. checks the client every 8 hours for hematuria 2. monitors the client for fever, sore throat, and chills 3. checks female clients for increased menstrual bleeding 4. reports a white blood cell count of 5000/mm3

2. monitors the client for fever, sore throat, and chills

*Which of the drugs listed is most likely to cause nausea or vomiting? 1. Temozolomide 2. Cetuximab 3. Cisplatin 4. Vincristine

3. Cisplatin

Targeted therapy is use rarely used in which clients?

children

Which of the following interventions would be most helpful for a client with stomatitis? 1. Mouth care should be provided at least once daily 2. Swab the mouth with lemon glycerin swabs every 4 hours 3. Provide frequent mouth care with normal saline 4. Use a hard bristle toothbrush to cleanse the mouth and teeth of debris

3. Provide frequent mouth care with normal saline

What are patient signs and symptoms of ANEMIA and what diagnostic labs can confirm it?

Irregular heart rate, pallor, SOB, dizziness Hct and Hbg

A client asks the nurse why he has to have several courses of a chemotherapy drug instead of just one dose. The nurse states that it is based on the cell kill theory. Which of the following statements describes the cell kill theory? The cell kill theory describes the phenomenon that occurs during the life cycle of a cancer cell as it is treated with a chemotherapy medication. The cell kill theory describes the ways that different chemotherapy medications work to kill both healthy and cancerous cells within the human body. The cell kill theory describes the process of giving multiple doses of chemotherapy with each dose, killing approximately 90% of the cancer cells. The body's own immune system will kill the few cancer cells that are left. The cell kill theory is based on the premise that one dose of a chemotherapy drug will kill all the cancer cells if enough of the medication is given to a client.

The cell kill theory describes the process of giving multiple doses of chemotherapy with each dose, killing approximately 90% of the cancer cells. The body's own immune system will kill the few cancer cells that are left.

Antineoplastic agents are also known as?

chemotherapeutic agents (chemotherapy)

Targeted therapy agents do what?

these drugs interfere with specific cellular activity associated with certain types of cancers.

Why do targeted therapy agents have less systemic ADRs?

they leave healthy cells alone

The nurse is caring for a client who is receiving a combination of antineoplastic agents. The client has been told that alopecia is likely to occur, and the client is tearful and distraught about this. What is the nurse's best response? Reassure the client that other people who are treated with cancer also experience this. Validate the client's sense of impending loss and offer guidance for getting a wig. Encourage the client to view the hair loss as something that indicates cancer is being eradicated. Reassure the client that the hair loss will be temporary rather than permanent.

Validate the client's sense of impending loss and offer guidance for getting a wig

A male client on 5-FU calls the clinic and reports that he has between five and seven loose bowel movements daily. The nurse will instruct the client to: treat the diarrhea with OTC medications. avoid grapefruit and grapefruit juice. avoid protein-rich foods. notify the clinic if the stools are black or if there is evidence of blood.

If the client has more than three bowel movements daily, the nurse should instruct the client to observe the stools and notify the prescriber if stools are black or if there is evidence of blood.

Some immediate adverse drug reactions to antineoplastic agents are:

N/V, extravasation

Vinca Alkaloids work by?

- M-phase specific: inhibit microtubule function - S phase: interfere with amino acid production

*In what way might the nurse accidentally be exposed to chemotherapy? Select all that apply. 1. Direct skin contact 2. Ingestion 3. Inhalation 4. Needle stick

1. Direct skin contact 2. Ingestion 3. Inhalation 4. Needle stick

Antineoplastic drugs are contraindicated in patients with:

1. leukopenia 2. thrombocytopenia 3. anemia (reduced red blood cells), 4. serious infections 5. serious renal disease 6. known hypersensitivity to the drug 7. during pregnancy

Which of the following findings would be most indicative to the nurse that the client has thrombocytopenia? 1. Nausea 2. Blurred vision 3. Headaches 4. Easy bruising

4. Easy bruising

The major ADRs of all chemotherapy is pancytopenia. Pancytopenia occurs when you have a combination of three different blood disorders:

ANEMIA LEUKOPENIA THROMBOCYTOPENIA

A client has been diagnosed with a brain tumor and is dealing with this diagnosis by seeking detailed information about cancer. The nurse would explain to the client that cancer is essentially a result of the disruption of what?

cell cycle

Antineoplastic Antibiotics are used in the treatment of what?

many solid tumors

What are patient signs and symptoms of THROMBOCYTOPENIA and what diagnostic labs can confirm it?

prolonged bleeding time, petechiae, purpura, blood in urine or stool, bleeding of gums, heavy periods decrease in the platelet count (less than 100,000/mm^3)

Cytoprotective agents are drugs used with the antineoplastic drug to do what?

protect the normal cells or organs of the body. In this way, enough of the chemotherapeutic drug can be given to eradicate the cancer without irreversible harm to the patient.

A nurse is providing education to a client who is preparing to begin chemotherapy for the treatment of cancer. What action should the nurse encourage the client to implement to minimize the effects of chemotherapy-triggered mucositis?

thoroughly rinse the mouth often, especially before and after meals

Cell Cycle-Nonspecific Drugs are used for what?

used to cure, control, or provide palliation in the treatment of leukemias, lymphomas, and many different solid tumors, and are also used in the treatment of certain autoimmune diseases.

Targeted therapy agent ADRs?

• Skin problems (acne rash, dry skin, nail changes, hair depigmentation) • Photosensitivity • Thinning, brittle, yellowish dry hair, increased facial hair

How do cell cycle specific antineoplastic agents work ?

•Act on the cell in one specific phase of the process of cell division •Affects both malignant and normal cells

Antineoplastic Antibiotics action?

•Interfere with DNA and RNA synthesis, thereby delaying or inhibiting cell division and blocking the reproductive ability of malignant cells

Antimetabolites drug prototype?

•Prototype: methotrexate •Recognize fluorouracil (5-FU) •Recognize mercaptopurine (6-MP)

A patient who will begin chemotherapy voices concern to the nurse about the accompanying nausea and vomiting. What is the best response by the nurse? "Nausea and vomiting are an unfortunate side effect of the chemotherapy. We will do what we can but you may have it anyway." "We can relieve your nausea and vomiting with antiemetic drug therapy. You should ask for these medications whenever you need them." "We can relieve your nausea and vomiting with drugs but you can have them only before and after the chemotherapy." "Not everyone has nausea and vomiting. Just wait to see how you will react to the chemotherapy."

"We can relieve your nausea and vomiting with antiemetic drug therapy. You should ask for these medications whenever you need them."

Antineoplastic agents are used to treat?

Cancer

A client has been diagnosed with leukemia. Which alkylating agent is the only one that can be used for both acute and chronic leukemia? Streptozocin Carmustine Cyclophosphamide Chlorambucil

Cyclophosphamide

How can a nurse best prevent tissue damage caused by an antineoplastic extravasation? Inspect the site frequently for redness or swelling Use an infusion pump Administer through a hand vein, if possible Infuse into proximal veins whenever possible

Inspect the site frequently for redness or swelling

Cisplatin requires treatment measures before administration: hydration with 1 to 2 L because:

It has 60% chance or greater of causing N/V

During which phase of the cell cycle does a cell split into two daughter cells? 1. G1 2. S 3. G2 4. M

M

A 42-year-old female with breast cancer has had a radical mastectomy. She will have radiation therapy and then begin chemotherapy. Drug therapy will consist of a combination of doxorubicin, cyclophosphamide, and paclitaxel. What will the nurse include in the teaching plan concerning the drug therapy?

Take special care when shaving or brushing her teeth because she may bruise more easily than normal and gums may bleed

How do cell cycle NON specific antineoplastic agents work ?

Targets the cell at any phase of the cycle Interfere with the process of cell division of malignant and normal cells.

The nurse is describing the necessity of recovery periods between treatment cycles to a client receiving chemotherapy. How should the nurse best explain the need? Time is required for the successful application of radiotherapy between cycles of chemotherapy. Time is needed to replace many of the healthy body cells killed by chemotherapy. There is a need to restore a physiologic reserve of energy before further chemotherapy. The restoration of fluid balance and nutrition is needed before continuing with chemotherapy.

Time is needed to replace many of the healthy body cells killed by chemotherapy

A client is undergoing a cytotoxic chemotherapy regimen for the treatment of stage III lung cancer. What effect will this regimen likely have on the client's hemostatic function? The client will likely experience thrombocytosis. The client's platelet count will decline. The client will require prophylactic heparin. The client will be at increased risk of deep vein thrombosis (DVT).

The client's platelet count will decline

What should the oncology nurse understand when administering a cell cycle-nonspecific chemotherapeutic agent about its effect? The drug will be effective through specific areas of the cell cycle. The drug is ineffective throughout all phases of the cell cycle. The drug will be effective through all phases of the cell cycle. The drug has intermittent effectiveness throughout the cell cycle.

The drug will be effective through all phases of the cell cycle.

The nurse is preparing to administer doxorubicin for a client who has a diagnosis of neuroblastoma. What action should the nurse perform? Perform hand hygiene before administration to protect against cytotoxic effects. Assess the integrity of the client's deltoid sites. Wear personal protective equipment. Assess the integrity of the client's mucous membranes.

Wear personal protective equipment.

An adult client who has been diagnosed with a rectal tumor is scheduled to begin treatment with cisplatin. The nurse has conducted client teaching about the possibility of nausea and vomiting. In order to reduce the client's risk of severe nausea, the nurse should: encourage the client to request antiemetics if the nausea becomes unbearable. ensure that the client is NPO from midnight prior to receiving the drug. administer a combination of antiemetics prior to the administration of the drug. place the client on a low-residue diet.

administer a combination of antiemetics prior to the administration of the drug.

The nurse is caring for a client who has leukemia. What aspect of this client's health status should the nurse prioritize when confirming the appropriateness and dosing of antimetabolites? recent seizure activity longstanding diagnosis of type 2 diabetes mellitus bone marrow suppression blood pressure in the range of 140/90 mm Hg

bone marrow suppression

Podophyllotoxins drug prototype ?

etoposide