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Cancer Drugs: Antineoplastic Medications

Pharmacology in Nursing Antineoplastic Drugs Part 2: Cell Cycle – Nonspecific Drugs and Miscellaneous Drugs. Cancer Drugs: Antineoplastic Medications. Cell cycle – nonspecific (CCNS) drugs Alkylating drugs Cytotoxic antibiotics. Alkylating Drugs. Classic alkylators (nitrogen mustards)

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Cancer Drugs: Antineoplastic Medications

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  1. Pharmacology in NursingAntineoplastic Drugs Part 2:Cell Cycle–Nonspecific Drugs and Miscellaneous Drugs

  2. Cancer Drugs:Antineoplastic Medications • Cell cycle–nonspecific (CCNS) drugs • Alkylating drugs • Cytotoxic antibiotics

  3. Alkylating Drugs • Classic alkylators (nitrogen mustards) • Nitrosoureas • Probable alkylators

  4. Alkylating Drugs (cont’d) • CCNS antineoplastics • Effective at any stage in the growth cycle of cancer cells • Prevent cancer cells from reproducing with the process of alkylation

  5. Alkylating Drugs: Indications • Used in combination with other drugs to treat various types of cancer, such as: • Recurrent ovarian cancer • Brain tumors • Lymphomas • Leukemias • Various forms of cancer (breast, ovarian, bladder) • Others

  6. Alkylating Drugs: Adverse Effects • Dose-limiting adverse effects • Nausea and vomiting, myelosuppresion • Alopecia • Nephrotoxicity, peripheral neuropathy, ototoxicity • Hydration can prevent nephrotoxicity • Extravasation causes tissue damage and necrosis

  7. Alkylating Drugs: Examples • cisplatin (Platinol-AQ) • cyclophosphamide (Cytoxan) • altretamine (Hexalen) • carmustine (BiCNU) • mechlorethamine (Mustargen) • temozolomide (Temodar) • thiotepa (Thioplex)

  8. Cytotoxic Antibiotics • Natural substances produced by the mold Streptomyces • Synthetic substances also used • Used to treat cancer–too toxic to treat infections

  9. Cytotoxic Antibiotics (cont’d) • All can produce BMS (except bleomycin) • Pulmonary toxicity (bleomycin) • Heart failure (daunorubicin)

  10. Cytotoxic Antibiotics (cont’d) • Anthracycline antibiotics • daunorubicin, doxorubicin, idarubicin, others • Anthracenedione antibiotics • mitoxantrone • Other cytotoxic antibiotics • bleomycin, dactinomycin, mitomycin, plicamycin, others

  11. Cytotoxic Antibiotics (cont’d) • Most are CCNS drugs, and are active in all phases of the cell cycle • Most act by the process of alkylation and resulting in blocking DNA synthesis • Some act by intercalation, resulting in blockade of DNA, RNA, and protein synthesis

  12. Cytotoxic Antibiotics: Indications • 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)

  13. Cytotoxic Antibiotics: Adverse Effects • Hair loss, nausea and vomiting, myelosuppression • Pulmonary fibrosis (bleomycin) • Liver, kidney, and cardiovascular toxicities • Many others

  14. Cytotoxic Antibiotics: Adverse Effects (cont’d) • Cardiomyopathy is associated with large amounts of doxorubicin • Dexrazoxane can be used as a cytoprotective drug • Monitor cardiac ejection fractions

  15. Miscellaneous Antineoplastics • bevacizumab (Avastin) • hydroxyurea (Hydrea) • imatinib (Gleevec) • mitotane (Lysodren) • Hormonal antineoplastic drugs • Radiopharmaceuticals

  16. Miscellaneous Antineoplastics (cont’d) • bevacizumab (Avastin) • Angiogenesis inhibitor • Blocks the blood supply to the growing tumor • Many adverse effects, including nephrotoxicity

  17. Miscellaneous Antineoplastics (cont’d) • hydroxyurea (Hydrea) • Action similar to antimetabolites • Used to treat squamous cell carcinoma and some leukemias • Oral form only • Many adverse effects

  18. Miscellaneous Antineoplastics (cont’d) • imatinib (Gleevec) • Used to treat chronic myeloid leukemia (CML), especially in cases where interferon alfa therapy failed • It is NOT a monoclonal antibody • Works by inhibiting an enzyme that is active in the CML process • Use with other hepatic-metabolized drugs may cause severe interactions

  19. Miscellaneous Antineoplastics (cont’d) • mitotane (Lysodren) • Adrenal cytotoxic drug • Used specifically for adrenal corticoid carcinoma • Oral form only

  20. Hormonal Drugs • Used to treat a variety of neoplasms in males and females • Hormonal therapy used • To oppose effects of hormones • To block the body’s sex hormone receptors • Used most commonly as adjuvant and palliative therapy

  21. Hormonal Drugs (cont’d) • Drugs for female-specific neoplasms • anastrozole (Arimidex) • tamoxifen (Nolvadex) • megestrol (Megace) • medroxyprogesterone (Provera) • fluoxymesterone (Halotestin) • fulvestrant (Faslodex) • Several others

  22. Hormonal Drugs (cont’d) • Drugs for male-specific neoplasms (prostate cancer) • bicalutamide (Casodex) • flutamide (Eulexin) • nilutamide (Nilandron) • leuprolide (Lupron) • goserelin (Zoladex) • estramustine (Emcyt)

  23. Miscellaneous Antineoplastics (cont’d) • Radiopharmaceuticals • Used to treat a variety of cancers, or symptoms caused by cancers • Porfimer sodium • Chromic phosphate P 32 • Samarium SM 153 lexidronam • Sodium iodide I 131 • Sodium phosphate P 32 • Strontium Sr 89

  24. 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 amputations may be necessary

  25. Extravasation (cont’d) • Prevention is essential • Continuous monitoring of the IV site is essential

  26. Extravasation (cont’d) • If suspected, stop the IV infusion immediately but do not remove the IV tube • If possible, aspirate remaining drug or blood from the tube • Follow instructions for giving the appropriate antidote through the existing IV tube, then remove the catheter • Some antidotes are not given through the IV catheter

  27. Extravasation (cont’d) • Cover area with sterile, occlusive dressing if ordered • Apply warm or cold compresses, depending on the extravasated drug • Rest and elevate the affected limb • PREVENTION is the best approach!

  28. Handling Antineoplastic Drugs • Those preparing and administering these drugs may be exposed to negative consequences • Most facilities have these drugs mixed under special environments in the pharmacy

  29. Handling Antineoplastic Drugs (cont’d) • During care of a patient receiving these drugs, special precautions may be implemented, depending on facility policies • Double flushing of bodily fluids in the commode • Special hampers for disposal of all objects that contact the patient’s body fluids • Personal protective equipment • Special concerns if chemotherapy liquid spills

  30. Nursing Implications • Assess baseline blood counts before giving any antineoplastic drugs • Follow specific administration guidelines for each antineoplastic drug

  31. Nursing Implications (cont’d) • Alkylating drugs • Monitor for expected effects of bone marrow suppression • Expect nausea, vomiting, diarrhea, stomatitis • Hydration is important to prevent nephrotoxicity • Report ANY ringing/roaring in the ears—possible ototoxicity • Peripheral neuropathies may occur—report tingling, numbness, pain in extremities

  32. Nursing Implications (cont’d) • Cytotoxic antibiotics • Expect bone marrow suppression, nausea, vomiting, diarrhea, stomatitis • Monitor pulmonary status • Monitor for nephrotoxicity, liver toxicity • Monitor cardiovascular status • Daunorubicin may turn the urine to a reddish color

  33. Nursing Implications (cont’d) • In general • Monitor closely for anaphylactic reactions • Keep epinephrine, antihistamines, antiinflammatory drugs on hand • Monitor closely for complications associated with bone marrow suppression • Anemia, thrombocytopenia, neutropenia

  34. Nursing Implications (cont’d) • Cytoprotective drugs may be used to reduce toxicities • IV amifostine (Ethyol) to reduce renal toxicity associated with cisplatin • IV or PO allopurinol (Zyloprim) to reduce hyperuricemia

  35. Nursing Implications (cont’d) • Monitor for oncologic emergencies • Infections • Pulmonary toxicity • Allergic reactions • Stomatitis with severe ulcerations • Bleeding • Metabolic aberrations • Bowel irritability with diarrhea • Renal, liver, cardiac toxicity

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