oncology medications chemotherapy agents. oncology medications key terms cancer – uncontrolled...
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Oncology Medications
Chemotherapy Agents
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Oncology Medications
Key Terms• Cancer – uncontrolled cell division and growth
• Malignant – invade other tissues
• Proliferation – multiply rapidly
• Metastasis – the spread of cancerous cells
• Antineoplastics – drugs used to control the growth of malignant cells
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Oncology Medications
• Proliferation– The purpose of antineoplastic drug therapy is to attack
cells that rapidly divide and reproduce
– Malignant cells usually proliferate rapidly
• Other Rapidly Growing Cells– Oral and GI mucosal lining
– Bone marrow
– Hair follicles
– Gonads
– Lymph
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Oncology Medications
• Cell Cycle– G1-RNA and proteins
are built– S-DNA is made– G2-RNA and protein
prepare for cell division
– M-Mitosis occurs– G3-Cell rests
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Oncology Medications
• Cell Cycle Specific Drugs– Attack cells
somewhere during mitosis
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Oncology Medications
• Cell Cycle Nonspecific Drugs– Attack cells anywhere
in the cell cycle
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Oncology Medications
Uses
• Cure – destroy all malignant cells
• Control – delay metastasis
• Control – slow tumor growth
• Palliative – provide comfort
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Oncology Medications
Cell Cycle Specific Drugs
• Plant Alkaloids– Prevent mitosis
• Antimetabolites– Prevent mitosis
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Oncology Medications
Cell Cycle Nonspecific Drugs
• Alkylating agents– Change to alkaline environment
• Antineoplastic antibiotics– Prevent or inhibit cell division
• Miscellaneous antineoplastics– Number of actions
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Oncology Medications
Combination Therapy
• Combination of one or more chemotherapy agents
• May include radiation as well
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Oncology Medications
Common Chemotherapy Agents
– paclitaxel (Taxol): ovarian, breast cancers– fluorourecil [5-FU] (Adrucil): breast, stomach,
pancreas, colon, rectum– cyclophosphamide (Cytoxan): Lymphomas,
Hodgkin’s disease, RA, SLE– methotrexate (Rheumatrex): Leukemia, non-
Hodgkin’s lymphoma, breast, RA
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Oncology Medications
Adverse Reactions
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Oncology Medications
Adverse Reactions
Hand and Foot Syndrome
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Oncology Medications
Adverse Reactions
Hyperuricemia
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Oncology Medications
Adverse Reactions
Urine Discoloration
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Oncology Medications
Adverse Reactions
Radiation Recall
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Oncology Medications
Adverse Reactions
NauseaDiarrhea
Extravasation
AlopeciaStomatitis - Mucositis
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Oncology Medications
Adverse ReactionsMyelosuppression (Bone Marrow Suppression)
ThrombocytopeniaPlatelet count less than 100,000 mm3
LeukopeniaNeutropenia
WBC less than 2,500 / mm3infection
AnemiaDecreased RBC and Hct
fatigue
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Oncology Medications
Adverse Reactions
– Inevitable
–Dose dependent
–May delay chemotherapy
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Lactation
Pregnancy
Renal or hepatic dysfunction
Previous allergic or hypersensitivity reactions
Oncology Medications
Use cautiously with
Infection or debillitating illness
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Oncology Medications
Precautions Protecting the Health Care
Provider
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Oncology Medications
Preparing the Medications
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Oncology Medications
Handling urine and
other bodily fluids
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Oncology Medications
InteractionsPlant Alkaloids
– Digoxin (decreased serum level of digoxin)– Phenytoin (increased risk of seizures)– Oral anticoagulants (prolonged bleeding)
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Oncology Medications
InteractionsAntimetabolites
– Digoxin (decreased serum level of digoxin)– Phenytoin (decreased need for antiseizure
medication)– NSAID’s (methotrexate toxicity)
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Oncology Medications
InteractionsAlkylating Drugs
– Aminoglycosides (increased risk of nephrotoxicity and ototoxicity)
– Loop Diuretics (increased risk of ototoxicity)– Phenytoin (increased risk of seizure)
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Oncology Medications
InteractionsAntineoplastic Antibiotics
– Digoxin (decreased serum level of digoxin)
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Oncology Medications
InteractionsMiscellaneous Antineoplastics
– Insulin and oral hypoglycemics (increased risk for hyperglycemia)
– Oral anticoagulants (prolonged bleeding times)– CNS depressants (increased CNS depression)
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Oncology Medications
Special CircumstancesExtravasation
• Is this a vesicant drug?• Is a vesicant protocol
in place?• What are the
symptoms?• What is the response?
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Oncology Medications
Special CircumstancesOral Mucositis - Stomatitis
• Good mouth care• Avoid strong or
alcohol-based mouthwashes
• Saline rinses• Offer ice cubes during
chemotherapy
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Oncology Medications
Special CircumstancesMyelosuppression
• Anemia (Decreased RBC, Hct)
• Leukopenia / Neutropenia (WBC < 2,500)
• Thrombocytopenia (Platelet Count < 100,000)
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Oncology MedicationsNursing Process
• Assessment
– Type and location of neoplasm– Stage of the disease– General physical condition– Emotional response to disease– Previous or concurrent therapies– Knowledge– Lab results
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Oncology MedicationsNursing Process
• Planning
– Adverse reactions– Premedicate for nausea (Zofran)– Oral complications (NS rinses, ice cubes)– Anemia (epoetin, blood transfusions)– Neutropenia (Neupogen)– Leukopenia (Leukogen)– Thrombocytopenia (platelet transfusions)
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Oncology MedicationsNursing Process
• Suggested Nursing Diagnoses
– Imbalanced nutrition: less than body requirements r/t adverse drug effects (e.g., anorexia, stomatitis)
– Fatigue r/t adverse drug effects (decreased RBC, Hct)
– Risk for injury r/t adverse drug effects (thrombocytopenia)
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Oncology MedicationsNursing Process
• Suggested Nursing Diagnoses (cont.)
– Risk for infection r/t adversedrug effects (leukopenia)
– Disturbed body image r/t drug effects (e.g., alopecia, weight loss, fluid retention)
– Anxiety r/t to diagnosis, anticipatory grieving– Impaired tissue integrity r/t adverse drug
effects (e.g., radiation recall, extravasation)
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Oncology MedicationsNursing Process
• Implementation
– Route of administration– Precautions for patient– Precautions for health care provider
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Oncology MedicationsNursing Process
• Evaluation
– Response to treatment– Evidence of adverse reactions– Pain management
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Oncology MedicationsNursing Process
• Patient Teaching
– Follow physician’s directions at all time– Good hygiene, stay away from crowds, sick
people– Contact primary physician before taking any
prescribed or OTC meds, herbs, etc.– Avoid alcohol– Keep radiated areas clean and dry
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Oncology MedicationsKey Points
• Why are antineoplastics used?• What are the adverse effects?– Benign– Potentially lethal
• What can nurses do to minimize these adverse effects?
• What precautions should be taken to protect the patient?
• What precautions should be taken to protect the health care provider?