Chemotherapy and Supportive Drug Quiz

Antineoplastics Chemotherapy

• Antineoplastics Chemotherapy is used for the treatment of cancer.
• The course covers the different types of chemotherapy drugs.
• The study includes types of drugs used in chemotherapy.
• The course covers different types of hormonal therapies.
• There is also discussion about targeted drug therapies.
• The course includes supportive drugs to offset any side effects of the chemo treatment.

Chemotherapy

• Mechanism of Action (Cytotoxic):
  • Kills cells, including cancer cells.
  • May stop cancer cells from dividing and growing.
  • May cause tumors to shrink.
• Mechanism of Action (Tumoricidal):
  • Kills only tumor cells.
  • More specificity in the way it works.
• Effects and Pharmacokinetics:
  • Most effective on rapidly dividing cells.
  • Narrow margin between therapeutic effects and toxicity.
  • Many adverse effects.
  • Drug combinations are usually more effective.
  • Resistance to drugs can develop.
  • Dosage varies depending on the patient.
  • Body surface area (m²) is often used in calculating dosages.
• Adverse Effects (Dose-limiting):
  • Side effects of a drug or treatment that are serious enough
    • To prevent increasing the dose or level of the treatment.
  • Drugs may also target normal health rapidly dividing cells.
  • Examples of many adverse effects:
    • Bone marrow suppression: neutropenia, thrombocytopenia, anemia.
    • Hair loss.
    • GI tract problems: diarrhea, mucositis, nausea, vomiting.
    • Teratogenic risks and infertility concerns.
    • Risk of extravasation during IV procedures.

Chemotherapy – Cell Cycle Specific

• Drugs that are cytotoxic during a specific phase of the cell cycle.
• Often used for solid tumours and circulating tumors.
• Cell cycle-specific agents do not work in the resting or dormant phase of tumors.
• Types of Chemotherapy Drugs
  • Antimetabolites
  • Mitotic inhibitors
  • Topoisomerase inhibitors
  • Antineoplastic enzymes

Chemotherapy – Antimetabolites

• Drugs like Methotrexate, Pemetrexed, and Raltitrexed are used to treat different types of cancers.
• These drugs mimic normal cellular metabolites.
• Interfere with cell reproduction.
• Falsely substitute purines, pyrimidines and folic acid.
• Inhibit crucial enzymes involved in synthesis of purines, pyrimidines, and folic acid.
• Result in inhibition for components needed for cellular survival.
• The target phase is the S phase (DNA synthesis).
• Indication for use: solid tumors, hematological cancers, in combination with other drug therapies for amplified effect.
• Administration: Mostly IV but some are PO form.
• Adverse effects include bone marrow depression, and drug interactions.

Chemotherapy – Mitotic Inhibitors

• Plant-derived compounds that target various phases of the cell cycle, including mitosis.
• Used for variety of solid tumours and some hematological cancers.
• MOA (Mechanism of Action): Interferes with mitotic spindle structures and inhibits cell reproduction, causing cell death.
• Types : - Vinca Alkaloids (Vinblastine, Vincristine, Vinorelbine) - Taxanes (Paclitaxel, Docetaxel)
• Vincristine is neurotoxic but lacks bone marrow suppression.
• Paclitaxel has high risk adverse effects during infusion.
• Adverse Effects: Hair loss, Nausea, vomiting, Bone marrow depression, Nephrotoxic, Hepatotoxic, High risk of extravasation, and requires antidote Hyaluronidase.

Chemotherapy – Topoisomerase Inhibitors

• Two main types of Topoisomerase inhibitors: Topoisomerase II Inhibitors (Etoposide, Teniposide); and Topoisomerase I Inhibitors (Topotecan, Irinotecan).
• Semi-synthetic drugs derived from Chinese shrub.
• MOA (Mechanism of Action): Inhibit enzyme topoisomerase to slow and break down DNA strands.
• Common uses for Topoisomerase I Inhibitors are Ovarian, Colorectal, and Small Cell Lung Cancers.
• Administration: Injectable- intravenous.
• Adverse Effects: Stomatitis, Hair loss, GI distress and diarrhea, Lacrimation, Sweating –Bone marrow depression, Cardiovascular, pulmonary embolism, Cerebral Vascular Accident, Myocardial Infraction, orthostatic hypotension.

Chemotherapy – Antineoplastic Enzymes

• Drugs that synthesize Asparaginase.
• They make cells unable to synthesize asparagine, which is needed for DNA synthesis and cell survival.
• Pegasparagase is one such drug.
• Indication: Lymphocytic leukemia.
• Administration: Injectable only.
• Adverse effects include allergic reactions, impaired pancreatic function, hyperglycemia, and pancreatitis.

Chemotherapy – Cell Cycle Non-Specific

• Drugs that are cytotoxic to neoplasms at any phase of the cell cycle.
• Include Alkylating drugs (Cyclophosphamide, Chlorambucil, Isofamide, Melphalan). Different types of Alkylating drugs: Classic alkylating drugs, Nitrosoureas, and miscellaneous alkylating drugs.
• These drugs cause abnormal chemical bonds in DNA and prevent cell reproduction, leading to cell death.
• Other drugs include Cytotoxic antibiotics (Daunorubicin, Doxorubicin, Epirubicin, Idarubicin, Valrubicin, Bleomycin, Dactinomycin, Mitomycin, Mitoxantrone).
• Some Adverse effects: bone marrow suppression, nephrotoxicity, neurotoxicity, ototoxicity, pulmonary fibrosis, and many drug interactions.

Hormonal Antineoplastics

• Drugs that target hormone receptors, or administer hormones with opposing effects to treat cancers like breast and prostate cancer.
• Some drugs are not considered chemotherapies.
• Not considered chemotherapy.
• Sex hormones in breast cancer accelerate growth.
• Mechanism of Action: Block body’s sex hormone receptors OR administer hormones with opposing effects.
• Breast Cancer: Blocking estrogen production or utilization. Effective for breast cancer affected by estrogen. Drugs include Tamoxifen (Nolvadex-D) and Toremifene (Fareston). Selective estrogen receptor modulators (SERMs) like Anastrozole, Exemestane, and Letrozole. Prevent formation of Aromatase or inhibit its action (required estrogen). Not used with Tamoxifen.
• Prostate Cancer: Interfering with testosterone production or competing with androgen receptors for treatment. Hormones that interfere with testosterone production or compete with androgen receptors e.g., Bicalutamide (Casodex), Flutamide (Eulexin), Emcyt (Estramustine).
• Common adverse effects include menopause-like symptoms, hot flashes, night sweats, irregular periods, osteoporosis, increased risk of endometrial cancer for tamoxifen, general fatigue, infertility and impotence in men, and CV risks (increased cholesterol).

Targeted Drug Therapy

• Major focus of cancer drug research.
• Drugs recognize specific molecules involved in cancer cell growth while sparing normal cells.
• Imatinib (tyrosine inhibitor) and Vorinostat (histone deacetylase inhibitor) are examples of these drugs.

Immunotherapy

• Use the body's immune system against the cancer.
• Interferons and Interleukin-2 are types of cytokines that improve immune system actions against cancer cells.
• Monoclonal Antibodies (MABs) trigger the immune system to attack/kill cancer cells.
• Hematopoietic or Colony Stimulating Factors: Increase immunity affected by chemotherapy.
• Inhibit the proliferation of cancer cells by blocking growth signals.
• Radioimmunotherapy: Using cancer drugs or radiation to target cancer cells.

CAR-T Cells

• Involves harvesting a patient’s own T-cells and modifying them in a lab, then reintroducing them to attack tumors.
• They become the standard of treatment for leukemia relapses.
• Trials are being carried out to see if they are effective in solid tumors.

Supportive Drugs

• Used to offset the damaging effects of cancer treatment (chemo and radiation).
• Helps protect cells and organs from side effects.
• Examples: Allopurinol (Zyloprim), Rasburicase (Fasturtec), Dexrazoxane (Zinecard), Folinic acid (leucovorin), Colony-stimulating factors (Filgrastim/Neupogen).
• Mechanism of action depends upon specific drug, but the goals are usually to mitigate side effects such as preventing uric acid buildup, preventing damage to kidneys/heart/nervous system, and protecting blood cells.

General Patient Education

• Understanding treatment protocols, adverse effects.
• Reporting signs of infection, bleeding, anemia.
• Anticipating hair loss, and mouth care.
• Avoiding others with infections or proper diarrhea management.
• Increasing fluid intake and avoiding inflammatory drugs.
• Reproductive counseling, contraception, and use of Canadian Cancer Society as a resource.

Nursing Considerations

• Establishing a therapeutic relationship with patients to offer support.
• Lab work to check electrolytes, minerals, uric acid levels, CBC, platelets, bleeding times, liver, and renal function.
• Checking for neutropenia, infection, and tumour markers.
• Monitoring oral mucosa, swallowing, weight, nutritional status, bowel patterns, N&V, signs of infection, bleeding, and anemia.
• Administering antiemetics before chemo for nausea or vomiting.
• Safe handling of drugs. Checking for look-alike and smell-alike medications, including training in PPE, and having spill kits.
• Carefully monitoring IV sites and having protocols for extravasation problems.
• Double-flushing bodily secretions and following requirements for reverse isolation protocols.
• Being aware and using the Canadian Association of Nurses in Oncology as a resource.

Test your knowledge on chemotherapy drugs and supportive medications. This quiz covers drug mechanisms, adverse effects, and their roles in cancer treatment. Get ready to match drugs with their protective capabilities and understand critical concepts related to drug therapies.