antineoplastic agents

Antineoplastic Drugs

Submitted to:

Zanita Glenda Plaga, R.N.

Submitted by:

Karizza Zoette Ann F. Alcarde

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BSN 2-A

ANTINEOPLASTIC AGENTS

ALKYLATING DRUGS

Nitrogen Mustards

Classification/Drug GroupTrade Name/Brand

NameBenefits

chlorambucil Leukeran Treats Lymphocytic leukemia, lymphomas, and cancer of the breast

and ovaries.cyclophosphamide Cytoxan Treats Breast, lung, ovarian cancers;

Hodgkin’s disease; leukemia; lymphomas. An immunosuppressant

agent.estramustine phosphate

sodiumEmeyt Progressive carcinoma of prostate

ifosfamide Ifex Testicular Cancer, Lymphoma, Lung cancer and sarcomas. Mesna, an unprotective agent, is added to prevent hemmorhagic cystitis

mechorethamine hydrochloride

Mustargen Hodgkin’s disease, solid tumors, and pleural effusion caused by cancer of

the lung.melphalan Alkeran Multiple myeloma, melanoma, and

cancer of the breast, ovary and testes.

temozolomide Temodar Refractory anaplastic astrocytomauracil mustard Uracil Mustrad Chronic Lymphocyticand myelocytic

leukemia; Non-Hodgkin’s; Cervix, ovary and lung cancer

Nitrosoareas


NameBenefits

carmustin BiCNU Hodgkin’s Disease, multiple myeloma, melanoma, and brain tumors

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carmustine with polifeprosan

Cliadel Wafer Chemotherapeutic Wafer implant used in addition to surgery for

recurrent glioblastoma multiformto improve survival.

lomustine CeeNU Advanced Hodgkin’s disease and brain tumors

streptozocin Zanosar Pancreatic islet cell tumor and cancer of the lung. May also be used for Hodgkin’s disease and colorectal

cancer.

Alkyl Sulfonates

Classification/Drug Group Trade Name/Brand Name

Benefits

busulfanMyleran Myelocytic Leukemia. May be used as

a preparation agent in bone marrow transplant

Akylating-Like Drugs


NameBenefits

altretamine Hexalen Ovarian Cancer. Also Used for breast, cervix, colon, endometrium,

head/neck, and lung cancers; lymphomas

carboplatin Paraplatin Recurrent Ovarian Cancer. May be used as a preparation agent in bone

marrow transplantcisplatin Platinol, CDDP Ovarian testicular cancer. Used as

adjunctive treatment. Has been used for cancer of the bladder, head and

neck, and endometrium.oxalipatin Eloxatin Metastatic colorectal cancer. Used

with 5-FU and leucovorin. Ovarian cancer, Head and neck cancer, and

malignant melanoma.dacarbazine DTIC Metastatic malignant melanoma,

sarcomas, neuroblastoma, and refractory Hodgkin’s disease.

pipobroman Vercyte Polycythemia and chronic myelocytic leukemia

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thiotepa Thioplex Palliative therapy, especially breast and ovarian cancer

NURSING PROCESS

Assessment

Assess complete blood count (CBC), differential, and platelet count weekly. Drug may be withheld if RBC, WBC or platelet counts drop below predetermined level.

Conduct thorough physical assessment; document findings.

Assess results of pulmonary function tests, chest radiographs, and renal and liver function studies during therapy

Assess temperature; fever may be an early sign of infection

Monitor adequate intake and output.

Nursing Diagnosis

Risk for infection R/T bone marrow depression.

Risk for imbalanced nutrition; less than body requirements R/T gastrointestinal side effects of chemotherapy.

Risk for impaired urinary elimination R/T hemorrhagic cystitis caused by chemotherapy.

Risk for abdominal bleeding R/T effects of the chemotherapy on the lining of the bladder and/or bone marrow depression.

Deficient knowledge (patient/family/caregivers) R/T chemotherapeutic protocol.

Risk for sexual dysfunction R/T interference with normal menstrual cycle (in females) or lack of sperm production (in males).

Disturbed body image R/T hair thinning and/or loss.

Planning

Client will have WBC, RBC, and platelet counts at desired range

Client will remain free of infection Client will maintain nutritional status

(adequate fluid intake and output, sufficient caloric intake, stable weight)

Client will maintain adequate urinary output

Client will remain free of symptoms of hemorrhagic cystitis

Client/family/caregiver will demonstrate understanding f chemotherapeutic protocol (e.g dose, administration, side effects, adverse reactions)

Nursing Interventions

Monitor blood counts and laboratory values Handle drug with care during preparation and

administration; avoid direct skin, eye, and mucous membrane contact with anticancer drugs. Follow protocols.

Monitor IV site frequently for irritation and phlebitis.

Administer antiemetic 30-60 mins before giving drug.

Hydrate client with IV and/or oral fluids before chemotherapy is administered

Monitor blood, urea, nitrogen (BUN), and creatinine prior to administration

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Assess for sign and symptoms of hematuria, urinary frequency, or dysuria. Teah client to empty bladder every 2-3 hours.

Increase fluids 2-3 L/day to reduce the risk of hemorrhagic cystitis, ureate deposition, or calculus formation.

Monitor fluid intake and output and nutritional intake

Maintain strict medical asepsis during dressing changes and invasive procedures.

Evaluation

Client was free from infection Client maintained target weight Client maintained nutritional status Client did not develop hemorrhagic cystitis

Client/Family/Caregiver education need were met

Question related to sexuality were answered.

ANTIMETABOLITES

Folic Acid Antagonist

Classification/Drug Group Trade Name/Brand Name Benefits

methotrexate AmethopterineSolid Tumors, sarcomas,

leukemia.

pemetrexed disodium AlimtaA multitargeted antifolateto

treat mesothelioma and small lung cancer

Pyrimidine Analogues

Classification/Drug GroupTrade Name/Brand Name Benefits

capecitabine XelodaSolid Tumors, sarcoma,

choriocarcinoma, leukemia

cytarabine HCl Cytosar-U, ARA-C

Acute Leukemias and Lymphomas. Also used as an

immunosuppressive drug after organ transplant. May be used in

combination with other anticancer drugs.

floxuridine FUDRMetastatic colon cancer and

hematomas.5-Fluorouracil 5-FU, Adrucil Cancer of breast, cervix colon,

liver, ovary, pancreas, stomach, and rectum. Given in

combination with levamisole

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after surgical resection in client’s with Duke’s stage C colon cancer

gemcitabine HCl Gemzar

Advanced or metastatic adenocarcinoma of the

pancreas, non-small cell lung cancer and bladder cancer and

bladder cancer.

nelarabine Arranon

Treatment for refractory or relapsed T-cell lymphoblastic

leukemia and T-cell lymphoblastic lymphoma.

procarbazine HCl Mutalane

Palliative treatment for advanced Hodgkin’s disease and

for solid tumors. May be used with other anti-cancer drugs.

azacitidine VidazaTreatment for chronic

myelomonocytic leukemia.

Purine analogues


cladribine LeustatinFor treatment of hairy cell

leukemia and chronic lymphocyte leukemia.

clofarabine ClolarTo treat refractory or relapse

acute lymphoblastic leukemia in children.

fludarabine Fludara

Chronic lymphocytic leukemia in clients who have not responded to other alkylating drugs; low-

grade non-hodgkin’s lymphoma.

6-Mercaptopurine PurinetholFirst used in 1952 for treatuing acute leukemia. Also used as

immunosuppressive drug.

thioguanine LanvisAcute and chronic myelogous

leukemia.

Ribonucleotide Reductase Inhibitor


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hydroxyurea HydreaMelanoma, resistant chronic

myelocytic leukemia and ovarian cancer.

trimetrexate gluconate Neutrexin

Alternative drug therapy for pneumocystis carinii pneumonia; treatment for clients with AIDS.

May be used or colorectal cancer.

Enzyme inhibitor


pentostatin NipentHairy cell leukemia refractory to

alpha-interferon.

NURSING PROCESS

Assessment

Assess complete blood count (CBC), differential and platelet count weekly. Chemotherapy may be held if RBC, WBC or platelet counts drop below predetermined levels


Assess renal function studies before and during drug therapy

Assess temperature; fever may be an early sign for infection

Nursing Diagnosis

Risk for infection R/T bone marrow depression

Risk for imbalanced nutrition: less than body requirements R/T GI side effects of chemotherapy

Risk for acute pain (mucositis/stomatitis) R/T GI side effect of chemotherapy

Risk for impaired perianal skinintegrity R/T diarrhea cause by chemotherapy

Deficient knowledge (client/family) R/T chemotherapeutic protocol

Planning

Client blood counts will remain in the desired range

Client will maintain nutritional status (adequate fluid intake and output, adequate caloric intake, stable weight)

Client will have adequate client pain control

Client will limit exposure to sunlight Client/family/caregiver will

demonstrate understanding of 7

chemotherapeutic protocol (dose, administration, side effects and adverse reactions)

Nursing interventions

Monitor blood glucose and laboratory values

Handle drug with care during preparation and administration; avoid direct skinc contact with anticancer drugs. Follow protocols.

Monitor IV site frequently. Extravasation produces severe pain. If this occurs, apply ice pack and notify health care providers.

Administer 30-6o mins before drug to prevent vomiting.

Assess for hyperpigmentation along the vein in which 5-FU was administered.

Offer client food and fluids that my decrease nausea (e.g cola, crackers, ginger ale)

Plan small, frequent meals. Maintain strict medical asepsis during

dressing changes and invasive procedures

Support good oral hygiene; brush teeth with soft toothbrush and use waxed dental floss

Encourage mouth rinsesevery 2 hours with normal saline

Monitor fluid intake and output and nutritional intake. GI effects are common on the fourth day of treatment.

Evaluation

Client was free of infection Oral mucosa was free of erythema and

swelling Pain was controlled

Skin integrity remained intact Questions regarding sexuality were

answered

ANTITUMOR ANTIBIOTICS


bleomycin Blenoxane

Squamous cell canrcinomas, testicular tumor (when used

with viniblastine and cisplatin) and lymhpomas.

dactinomycin Actinomycin D, CosmegenTesticular tumors, Wilms Tumor,

choriocarcinoma, and rhabdomyosarcoma.

daunorobicin HCl CerubidinLeukemia, Ewing’s sarcoma,

Wilms tumor, neurobalstoma, and non-Hodgkin’s lymphoma

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doxorubicin AdriamycinBreast, bladder, ovarian and lung cancers; leukemias, lymphomas,

soft tissue and bone sarcoma.

epirubicin Eilence

Cancers of breast, lung and lymph system, stomach, and

ovaries. Metastatic node-positive breast cancer; adjuvant with anticancer therapy. May be

used in combination therapy with cyclophosphamide and fluorouracil (CEF) for breast

cancer; improved survival rate over cyclohposphamide,

methotrexate, and fluorouracil (CMF)

Idarubicin IdamycinAcute monocytic leukemia and solid tumors. More potent than daunorobicin and doxorubicin.

mitomycin Mutamycin

Dessimenated adenocarcinoma of breast, stomach and pancreas. Also used for cancer of the head,

neck, cervix and lung.

mitoxantrone NovantroneAcute nonlymphocytic leukemia;

may be used for breast cancer

plicamycin MithracinTesticular cancer. May be used

to treat hypercalemiavalrubicin Valstar Bladder cancer

NURSING PROCESS

Assessment

Assess complete blood count (CBC), differential and platelet count weekly. Chemotheraopy may be held if RBC, WBC or platelet counts drop below predetermined levels.


Assess temperature; fever may be an early sign for infection

Assess plans for pregnancy (if appropriate)

Planning

Client will maintain blood cell values in the desired range

Client will be free of cardiac dysfunction

Client’s skin integrity will remain intact Client/family/caregivers will

demonstrate understanding of the 9

chemotherapy regimen, including side effects.

Assess client/family/caregiver knowledge related to chemotherapeutic protocol

Nursing Intervention

Monitor blood counts and laboratory values

Assess cardiac status Handle drug with care during

preparation; avoid direct skin contact with drug

Monitor IV site frequently. Doxorubicin is a severe vesicant whose effects are not immediately apparent. Give drug through a large bore quickly running IV infusion

Tissue necrosis may occur 3-4 weeks after infiltration into tissue. Extravasation produces severe pain. If this occurs apply ice pack and notify health care provider

Administer antiemetic 30-60 mins before chemotherapy

Monitor for changes in urine color (pink-red). The drug is red and is excreted in the urine.

Offer client food and fluids that may decrease nausea (e.g cola, crackers, ginger ale)

Plan small frequent meals Administer prophylactic antibiotics to

prevent infection Offer analgesics for pain as prescribed Maintain strict medical asepsis during

dressing changes and invasive procedures

Support good oral hygiene, use soft oral toothbrush. Use waxed dental floss


Evaluation

Client was free from infection Cardiac function was maintained Client and family education need were

met

Side effects of therapy were controlled Client/family/caregiver education needs

were met

MITOTIC INHIBITORS

Mitotic Inhibitors


vinblastin SO4 Velban

Cancer of the testes, beast and kidnet and for treatment of

lymphomas, lymhosarcomas and neuroblastomas

vincristine SO4 Oncovin Cancer of the breast, lungs and

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cervix; multuiple myelomas, sarcoma, lymphomas and Wilms

tumor. Used for treating Hodgkin’s disease in

combination therapy , MOPP (mechlorethamine, vincristine, procarbazine, and prednizone)

vinorelbine Navelbine

First-line treatment for ambulatory clients with

advanced, unresectable non-small cell lung cancer (NSCLC).

Antimicrotubules


docetaxel TaxotereAdvanced or metastatic breast

cancer.

paclitaxel TaxolMetastatic ovarian and breast

cancer.

NURSING PROCESSAssessment

Assess baseline condition of patient before and during chemotherapy treatment

Assess CBC, differential, and platelet count weekly

Monitor bilurubin levels. Dose may be reduced if bilirubin levels are >1.5 mg/dl

Conduct thorough physical assessment and document findings. Be especially aware of evidence of neurotoxicity, because this is a dose limiting toxicity.

Assess for sign of peripheral neuropathy (numbness or tingling of toes or fingers), loss of deep tendon reflexes,

foot drop, slapping gait, difficulty walking.

Monitor bowel function. Automatic neuropathy may lead to constipation and paralytic ileus, th use of vincristine (Oncovin) and narcotic agents may increase the risk for constipation.

Assess temperature; fever may be an early sign of infection

Monitor acute bronchospasm Assess plans for pregnancy (if

appropriate) Evaluate patient/family/caregiver

knowledge of drug therapy

Nursing Diagnosis

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Risk for infection R/T bone marrow depression

Risk for constipation R/T neuropathic side effects of chemotherapy

Risk for injury R/T neuropathic side effects of chemotherapy

Deficient knowledge R/T antineoplastic therapy

Planning

Client will maintain blood cell values in the desired range

Client will maintain adequate bowel function

Client will be free of neuropathic dysfunction

Client/family/caregivers will demonstrate understanding of the chemotherapy regimen, including side effects.

Nursing Intervention

Monitor blood counts and laboratory values

Assess bowel function Administer stool softener or laxative as

prescribed. Monitor signs of peripheral neuropathy

(numbness and/or tingling of fingers and toes), sensory loss, loss of deep tendon reflexes, paresthesia, foot drop, wrist drop, and ataxia.

Assess IV site carefully, vincristine (Oncovin) is a sever vesicant whose effects are not immediately apparent. Give drug through a large bore, quickly running IV infusion over one minute.

Tissue necrosis may occur 3-4 weeks after infiltration into tissue. Extravasation produces severe pain. If this occurs apply ice pack and notify health care provider. Apply heat intermittently every two hours for 24 hours. Give hyaluronidase into infiltrated area, pre physician order.

Administer antiemetic 30-60 mins before chemotherapy, or as prescribed


Maintain strict medical asepsis during dressing changes and invasive procedures

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Evaluation

Client was free from infection Bowel function was maintained Peripheral neuropathy did not occur Side effects of therapy were controlled Extravasation and tissue necrosis did not occur Client/family/caregiver education needs were met

HORMONES, HORMONE ANTAGONIST and ENZYME

Androgen


testolactone TeslacPalliative treatment in

postmenopausal women

progesterone Gesterol 50Palliative treatment of

endometrial and breast carcinoma

Hormonal antagonist


aminoglutethimide Cytadren

Adrenal carcinoma, ectopic adrenocorticotropic hormone

(ACTH)-producing tumors. Suppresses adrenal activity. May be used in breast cancer therapy

anastrozole ArimidexAdvanced breast cancer in postmenopausal women.

bicalutamide Casodex

exemestane AromasinAdvanced metastatic prostatic

carcinoma

flutamide EulexinAdvanced breast cancer in postmenopausal women.

Prostate cancer

fulvestrant FaslodexMetastatic prostatic carcinoma,

usually in combination with other anticancer drugs

goserelin acetate Zoladex Treatment for hormone-receptor

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positive metastatic breast cancer in postmenopausal women

whose disease has progressed after antiestrogen therapy.

histrelin acetate implant Vantas Treatment for prostate cancer.

jetrozole FemaraMetastatic prostatic carcinoma.

May be used in breast cancer endometriosis.

leuprolide Lupron

Advanced breast cancer in post menopausal women. Used to slow the growth of prostate cancer. May be sued to treat

endometriosis.

megestrol acetate MegacePalliative treatment for

advanced carcinoma of breast and endometrium

mitotane LysodrenPalliative treatment of

inoperable adrenal cortical carcinoma.

nilutamide Nilandron Prostatic Carcinoma

polyestradiol PO4 EstrdurinPalliative treatment of

inoperable prostatic carcinoma.

tamoxifen citrate Nolvadex

Palliative treatment of advanced breast carcinoma with positive

lymph nodes in postmenopausal women

raloxifene Evista

Selective estrogen receptor modulator (SERM) originally

approved to fight osteoporosis in postmenopausal women

toremifene citrate FarestonAdvanced breast cancerin postmenopausal women.

Miscellaneous enzyme

Classification/Drug Group Trade Name/Brand Name BenefitsL-aspargine Elspar Acute lymphocytic leukemia.

pegaspargase OncasparAcute lymphocytic leukemia. Interferes with the DNA, RNA

and protein synthesis.

BIOLOGIC THERAPIES

Cytokines

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Interferon alpha 2a Roferon-A

Multiple myeloma, chronic leukemia, hairy cell leukemia,

malignant malenoma, AIDS related Kaposi sarcoma

Interferon alpha-2b Intron-A, IFN-alpha 2Hairy cell leukemia, AIDS relatred Kaposi sarcoma,

malignant melanomaInterleukin-2, aldesleuin Proleukin Merastatic

Vaccines


Hepatitis B Energix-B, Recombivax HB

First anticancer vaccine. Prevents hepatitis B disease and

its serious consequences like hepatocellular carcinoma

gardasilQuadrivalent human papiloma

virus [types 6, 11, 16, 18] recombivant vaccine

Used for prevention of human papiloma varus type 6, type 11

(genital warts), type 16, and type 18 (cervical cancer)

1cervarix cervarix

Prevent cervical cancer and precancerous lesions associated

with most common cancer-causing HPV types.

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antineoplastic agents

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