Questions and Answers
What is cancer?
Cancer is a group of disorders characterized by the abnormal growth of cells.
What do anticancer drugs do?
Anticancer drugs cause cell death by interfering with cell replication.
What are cell-cycle nonspecific drugs?
Cell cycle-nonspecific drugs act during any phase of the cell cycle, including the G0 phase.
What are cell-cycle specific drugs?
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The four main classes of anticancer drugs are: ________, hormones and hormone antagonists, immunomodulating agents, and targeted drugs.
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Chemotherapy refers only to cytotoxic drugs.
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What is the most common route of administration for chemotherapy?
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Match the following anticancer drugs with their characteristics:
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What type of cancer is gefitinib used to treat?
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How does imatinib suppress cell proliferation?
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What is a common adverse effect of gefitinib?
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What are some contraindications for gefitinib?
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What is the preferred drug for treating chronic myeloid leukemia (CML)?
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What should be included in the pre-administration assessment for gefitinib?
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What affects the absorption of gefitinib?
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What are the usual dosages for gefitinib?
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What precautions should nurses take when administering chemotherapy agents?
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What should patients seek immediate medical attention for while on gefitinib?
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What is a recommended dietary consideration while taking imatinib?
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What is a potential interaction between targeted drugs and CYP3A4 inhibiting drugs?
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Prior to administering gefitinib, the nurse should obtain which information?
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If Mr. Williams experiences diarrhea while on gefitinib, which condition should prompt him to seek immediate medical attention?
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What is a priority nursing assessment prior to administration of anticancer drugs?
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Why is it important to encourage patients taking anticancer drugs to take the medications with fluids?
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Which statement regarding breastfeeding while on anticancer medication requires nurse intervention?
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If a patient with chronic myeloid leukemia (CML) does not respond to imatinib, what is the most likely reason?
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Which patient should a nurse assess first in the oncology unit?
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What is the appropriate scheduling for monitoring a cancer patient's complete blood count (CBC) after starting anticancer medication?
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What health assessment items should be reported immediately before administering imatinib?
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What should a patient taking imatinib be advised regarding potential symptoms of fever, chills, and a persistent sore throat?
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What class of anticancer drugs does chemotherapy fall into?
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What drug class is most commonly used for the treatment of prostate cancer?
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To which class of anticancer drugs do hematopoietic drugs and immunomodulating drugs belong?
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How do monoclonal antibodies halt proliferation of cells?
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When will maximum levels of gefitinib be present in the blood after administration?
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What should a nurse instruct a patient regarding alcohol intake while taking imatinib?
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What adverse response to gefitinib should a patient report immediately?
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What does tamoxifen do?
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What is the worst risk associated with tamoxifen?
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Study Notes
Cancer Overview
- Cancer is a collection of diseases characterized by uncontrolled cell growth; it is a leading cause of death in the U.S., second only to heart disease.
- In 2016, an estimated 1,685,210 new cancer cases and 595,690 cancer-related deaths were expected in the U.S.
- Treatment must be individualized based on the specific cancer type, cellular behavior, and patient response.
Anticancer Drug Classes
- Four primary classes of anticancer drugs:
- Cytotoxic agents: Kill cells directly.
- Hormones and hormone antagonists: Modify hormone action.
- Biologic response modifiers (BRMs): Alter immune response.
- Targeted drugs: Attack specific molecules involved in cancer growth.
Mechanism of Action
- Anticancer drugs work by interfering with cell replication, leading to cell death.
- Cytotoxic drugs (chemotherapy) are the most common and are administered intravenously.
Drug Types
- Cell-cycle nonspecific (CCNS) drugs: Effective in any cell cycle phase, including the G0 phase (e.g., alkylating agents, antitumor antibiotics).
- Cell-cycle specific (CCS) drugs: Target specific phases of the cell cycle, particularly effective against rapidly dividing cells (e.g., antimetabolites, vinca alkaloids).
Cytotoxic Agents
- Largest class of anticancer drugs, targeting DNA or RNA and disrupting cell division.
- Particularly toxic to rapidly dividing tissues like hair and skin.
Hormonal Agents
- Used mainly for hormonally sensitive cancers like prostate and breast cancer.
- Often have fewer side effects compared to cytotoxic agents, such as less severe nausea and bone marrow suppression.
Biologic Response Modifiers (BRMs)
- Include hematopoietic and immunomodulating drugs, enhancing the body's response to cancer.
- Examples include cytokines, monoclonal antibodies, and vaccines.
Targeted Anticancer Drugs
- Designed to bind specific molecules in cancer cells, suppressing tumor growth while sparing normal cells.
- Examples include imatinib and gefitinib; both demonstrate selectivity and milder side effects in some patients.
Tyrosine Kinase Inhibitors
- EGFR Tyrosine Kinase Inhibitors: Inhibit signaling pathways regulating cell growth and survival, promoting apoptosis (e.g., gefitinib).
- BCR-ABL Tyrosine Kinase Inhibitors: Specifically for chronic myeloid leukemia (CML), including imatinib; inhibit BCR-ABL tyrosine kinase activity.
Pharmacokinetics of Gefitinib
- Absorbed slowly from the GI tract; peak plasma levels in 3–7 hours.
- Extensive liver metabolism and excreted mainly through feces.
- Half-life of 48 hours.
Pharmacokinetics of Imatinib
- Rapid absorption with high bioavailability (98%).
- Metabolized in the liver, with elimination half-lives of 18 hours for imatinib and 40 hours for its primary metabolite.
Clinical Considerations
- Pre-administration assessments are crucial to avoid drug-drug interactions and monitor adverse effects.
- While administering these drugs, specific precautions should be taken to minimize nursing exposure to hazardous agents.
Contraindications
- Gefitinib: Contraindicated in severe hypersensitivity cases, requires liver function monitoring.
- Imatinib: Contraindicated during pregnancy/lactation; use cautiously in patients with renal/hepatic impairments.
Drug Interactions
- Gefitinib: Interactions with CYP3A4 inhibitors can increase levels; indducers may decrease them.
- Imatinib: Inhibitors can raise levels; inducers may lower them.
Dosing Guidelines
- Gefitinib: Typical dosage of 250 mg orally once a day. Adjustments may be needed based on tolerability and liver enzyme status.
- Imatinib: Administered with food; standard dosage for adults with CML is 400 mg daily.
Adverse Effects
- Gefitinib: Common side effects include diarrhea and rash; others include nausea, dry skin, and increased liver enzymes.
- Imatinib: Side effects often include nausea, vomiting, fluid retention, and potential hematological issues like neutropenia.
Patient Education
- Monitoring patient weight and reporting significant changes is crucial for both drugs.
- Patients should be warned about severe symptoms that require immediate medical attention.
- Female patients are advised to avoid pregnancy during and post-treatment.
Evaluation
- Regular assessments for skin reactions, signs of infection, and thromboembolic events are vital.
- Monitor organ function and report any serious side effects, ensuring thorough patient education on treatment protocols and potential side effects.### Medication Guidelines and Precautions
- Women of childbearing age should avoid pregnancy during imatinib treatment and for 12 months afterward.
- Breastfeeding must cease during imatinib treatment and for 60 days after completion.
- Grapefruit juice can elevate imatinib blood levels, intensifying side effects; it should be avoided.
- St. John's wort reduces imatinib's effectiveness; its use is discouraged.
- Avoid alcohol and drugs that stress the liver, like acetaminophen.
Adverse Effect Reporting
- Report symptoms like fever, chills, persistent sore throat, swelling, weight gain, or increasing shortness of breath immediately.
- Symptoms of bleeding, including black stools, coffee ground emesis, or easy bruising, require urgent reporting.
- Liver impairment signs—stomach pain, jaundice, dark urine, unusual fatigue—must be communicated right away.
Drug Interactions and Administration
- CYP3A4 inhibitors lower metabolism and effectiveness of targeted drugs; caution is required when combining these medications.
- Liver function tests are crucial assessments before administering anticancer drugs, prioritizing patient safety.
Nursing Assessments and Patient Education
- Baseline assessments for new patients on gefitinib include chest x-rays, allergies, skin evaluations, and medication history.
- Patients on anticancer therapy should maintain high fluid intake to prevent gastric irritation and promote drug metabolism.
- Educate breastfeeding mothers on the correct timelines for cessation and resumption of breastfeeding when taking imatinib.
Specific Patient Cases
- For Mr. Williams on gefitinib, immediate medical attention is warranted if chest pain occurs.
- If chronic myeloid leukemia (CML) does not respond to imatinib, it may indicate cancer cell resistance.
- Monitor complete blood count (CBC) weekly for the first month of anticancer therapy.
Side Effects and Interventions
- Patients on imatinib should report symptoms indicating adverse reactions such as dyspnea, fever, or chills.
- Tamoxifen is an estrogen receptor blocker used in breast cancer treatment; avoid if pregnant due to harm to unborn children.
Chemotherapy Drug Classes
- Cytotoxic drug therapy encompasses various chemotherapy agents, while hormone antagonists are pivotal in treating prostate cancer.
- Monoclonal antibodies inhibit cell proliferation by targeting EGFR tyrosine kinase activation.
Post-Administration Monitoring
- Peak blood levels of gefitinib occur 3-7 hours post oral administration; understanding this can guide monitoring efforts.
- Encourage patients to disclose any new symptoms or health changes during treatment, ensuring timely interventions.
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Test your knowledge on the second class of anticancer drugs with these flashcards. This quiz explores key definitions and concepts related to cancer treatment. Enhance your understanding of the different classes of anticancer medications and their effects on cancer cells.