Cancer Drugs Overview of Antineoplastic Medications PDF

Overview of Antineoplastic Medications (sources: NCLEX review Kaplan, Cleveland Clinic, NIH, medical news, NSNA review, NCI) Property of Philadelphia Community College Not for Public Dissemination...

Overview of Antineoplastic Medications (sources: NCLEX review Kaplan, Cleveland Clinic, NIH, medical news, NSNA review, NCI) Property of Philadelphia Community College Not for Public Dissemination Carol Moriarity DPM, APRN, AGNP-C, PMHRN-BC Note: this is not all-inclusive, new medications and treatments are being developed on a regular basis, this is a general overview Antineoplastic agents: destroy cancer cells, but also can kill normal cells. Sometime used in combination. Require close monitoring. General Adverse Effects: nausea, vomiting, diarrhea, constipation, fatigue, mucositis (stomatitis), alopecia, bone marrow depression, hepatic toxicity, hyperuricemia. Nursing: When appropriate wear gloves, long sleeved cover gown, protective goggles, and mask. Handle these agents carefully, they can be mutagenic and possibly carcinogenic. Monitor CBC monitor. I & O monitor Liver function and renal function Inspect oral cavity daily. Monitor IV sites closely assess for extravasation and stop if it occurs. Teaching (follow protocol, procedure & institutional care team): Nutrition: eat frequent small portions of high calorie high protein bland low residual food. Alopecia purchase wigs or scarves. Avoid highly seasoned food. If nauseated drink clear liquids Use a soft toothbrush, (sometimes baking soda rinse is suggested, check with Care team) Rest frequently. Progressive relaxation and guided imagery maybe useful techniques. Antineoplastic Medication: Nursing Implications for Adverse Events Bone Marrow Suppression Monito Bleeding: bleeding gums, bruising, petechiae, guaiac stool, urine and emesis Nausea, vomiting Monitor intake and output ratios, appetite, and nutritional intake. Prophylactic antiemetics may be used. Smaller, more frequent meals Altered Immunologic Response Prevent infection by hand washing. Timely reporting of alterations in vital signs or symptoms indicating possible infection. Impaired mucous membrane: stomatitis (oral) Oral hygiene measures. (See: mucositis & stomatitis at end of notes) Fatigue encourage rest and discuss measures to conserve energy use relaxation techniques, mental imagery. Antineoplastics Alkylating agents Antimetabolites Antibiotic-Antineoplastics Vinca Alkaloids Hormonal agents Medication Adverse Effects Nursing Considerations Alkylating Agents Cyclophosphamide Hemorrhagic cystitis or Check CBC (applies to all drugs in this table). (Damages DNA and interferes with cell replication) non-hemorrhagic cystitis, Report hematuria, unexplained gonadal suppression, bleeding, force fluids. amenorrhea, alopecia, bone marrow Monitor for infection. depression, hypoglycemia, Give antiemetics. Monitor thrombocytes, uric acid, elytes, hepatic & renal function. Cisplatin Ototoxicity and nephrotoxicity Ensure adequate hydration and give diuretics prior to therapy. Have client void every hour or insert Foley catheter before initiating treatment. Assess for hearing loss. Chlorambucil Nausea vomiting bone marrow Monitor for infection. depression, sterility Avoid IM injections when platelet count is low to minimize bleeding Busulfan Bone marrow depression Most chemotherapy causes stomatitis and requires extra fluids to flush the system. Medications Adverse Effects Nursing Considerations Antimetabolites Methotrexate Oral and GI ulceration, liver damage, Good mouth care. Avoid alcohol (folic acid antagonist, used for DNA synthesis. Cells bone marrow depression, stomatitis, increase risk of liver damage. die because DNA is not produced.) alopecia, bloody diarrhea, fatigue. Concomitant use with NSAIDs may increase methotrexate toxicity. Monitor hepatic and renal function test. Give (folate analog) Leucovorin rescue med, 24 hours after methotrexate treatment course. Counteracts toxic effects of methotrexate causing (folic acid) folate deficiency. Teach do not self-medicate with OTC vitamins. Fluorouracil Nausea, stomatitis, GI ulceration, Monitor for infection. diarrhea bone marrow depression Avoid extravasation. liver dysfunction, alopecia Cytarabine Hematologic abnormalities, Force fluids good oral hygiene. nausea, vomiting, rash, weight loss. Mercaptopurine Liver damage, bone marrow Check liver function test. depression, infection, alopecia, abdominal bleeding. Hydroxyurea Bone marrow depression, Teach client to report toxic GI GI symptoms, rash symptoms promptly. Medication Adverse Effects Nursing Considerations Antibiotic Antineoplastic Doxorubicin Red urine, nausea, vomiting, Check EKG, avoid IV (prevents DNA synthesis in vulnerable cells) stomatitis, alopecia, cardiotoxicity, infiltration/extravasation. blisters, bone marrow depression. Do not mix with other drugs. Monitor vital signs closely. Wear gloves to prepare this drug, wash skin with soap & water if powder or solution touches skin. Do not give SC or IM skin necrosis can occur. Frequent mouth care. Bleomycin Nausea, vomiting, alopecia, edema of Observe for pulmonary hands, pulmonary fibrosis, fever, complications, treat fever with bone marrow depression. acetaminophen. Check breath sounds frequently. Dactinomycin Nausea, bone marrow depression Give antiemetic before administration Medication Adverse Effects Nursing Considerations Vinca Alkaloids Vincristine Peripheral neuritis, loss of reflexes, Avoid IV infiltration and (acts on cells undergoing mitosis thus stopping cell jaw pain, cramps, muscle weakness, extravasation. Do not give SC or IM, division) constipation, phlebitis, leukopenia, tissue necrosis can occur. photosensitivity, bone marrow Frequent neuro checks. depression, alopecia, GI symptoms, Monitor CBC and platelets. hyponatremia Check reflexes, motor, and sensory function. Allopurinol is given to increase excretion and decrease buildup of urates (uric acid). Advise client to avoid overexposure to the sun. Vinblastine Nausea, vomiting, stomatitis, Avoid IV infiltration and alopecia, loss of reflexes, bone extravasation. marrow depression. Give antiemetic before administration. Acute bronchospasms can occur if given IV. Allopurinol given to increase excretion and decrease buildup of urates (uric acid)  Medications Adverse Effects Nursing Considerations Hormonal Agents Antineoplastics affecting hormone balance. Hormonal agents mechanism action not completely understood. May keep cells in resting phase, decreasing tumor growth. They are unable to cure cancer. There are other hormonal therapies not list here. Tamoxifen Transient fall in WBCs or platelet. Check CBC. (selective estrogen receptor modulator {SERM} ) Hypercalcemia bone pain. Monitor serum calcium. (antiestrogen blocks the effects of estrogen and breast tissue but acts like estrogen in uterus.) Temporary bone pain, Non-steroidal antiestrogen. Menopause-like symptoms Teach premenopausal women to use (hot-flashes and flushing. contraception as short-term therapy Used in pre-menopausal and causes ovulation. post-menopausal women. Note: Mucositis & Stomatitis Damage to the mucosal lining of the Gastrointestinal tract Chemotherapy or Radiation. Mucositis: Painful inflammation or ulceration of the mucous membranes anywhere along the gastrointestinal tract. Stomatitis: can affect any structure in the mouth: roof, floor, cheeks, gums, tongue, throat, lips. Complex subject: there is no single answer. Needs a timed approach. Treatment involves managing symptoms and targeting infection. Stomatitis: Approaches to symptom management vary: Avoid Trauma: ill-fitting dentures, hard, spicy foods, hot drinks, smoking, alcohol. Cryotherapy (not with oxaliplatin tx.), Ice chips, popsicles, and other cold foods, mouthwashes, mouth coatings, antibiotics, analgesics, etc. Topical pain relief medication. Allergy medications, lozenges, corticosteroids, sprays for preventing dry mouth. Infection: frequent teeth brushing each day with a soft toothbrush to prevent gum bleeding, using an antiseptic mouthwash, frequent dental checkups, etc. Nausea & Vomiting Tx antiemetics e.g., granisetron, ondansetron, aprepitant, sometimes marijuana. Loss of appetite good nutrition, also several drugs that may increase appetite: dronabinol, megestrol, etc. Diarrhea Tx. loperamide Article: Evidence-Based Management of Oral Mucositis | JCO Oncology Practice (ascopubs.org) Evidence-Based Management of Oral Mucositis American Cancer Society www.cancer.org CancerCare www.cancercare.org Chemocare www.chemocare.com The Oral Cancer Foundation https://oralcancerfoundation.org