Chapter 14: Antineoplastic Agents PDF

**Chapter 14:\ \ Antineoplastic Agents** **Possible Causes of Cancer** - Genetic Predisposition - Viral Infection - Constant Irritation and Cell Turnover - Stress - Lifestyle Factors - Environmental Factors **Neoplasm Cancer --- Mechanisms of Growth \#1** - As the abnormal cel...

**Chapter 14:\ \ Antineoplastic Agents** **Possible Causes of Cancer** - Genetic Predisposition - Viral Infection - Constant Irritation and Cell Turnover - Stress - Lifestyle Factors - Environmental Factors **Neoplasm Cancer --- Mechanisms of Growth \#1** - As the abnormal cells continue to divide, they lose more and more of their original cell characteristics and they exhibit the following: - Anaplasia - Cancerous cells lose cellular differentiation and organization; unable to function normally - Autonomy - Cancerous cells grow without the usual homeostatic restrictions that regulate cell growth - This allows the cells to form a tumor - Metastasis - Cancer cells travel from the place of origin to develop new tumors in other areas of the body - Angiogenesis - Abnormal cells release enzymes to generate blood vessels and supply oxygen and nutrients to the cells, generating growth - Cancerous cells rob the host cells of energy and nutrients and block normal lymph **Types of cancer** - Carcinomas- - tumors that originate in epithelial cells - Sarcomas -- - tumors that originate in the mesenchyme and are made up of embryonic connective tissue cells **FIGURE 14.1** Malignant tumors develop from one cell, with somatic mutations occurring during cell division as the tumor grows. This image explains Malignant tumors develop from one cell, with somatic mutations occurring during cell division as the tumor grows. **Goal of Cancer Treatment** - Destroying cancer cells through several methods: - Surgery to remove them - Stimulation of the immune system to destroy them - Radiation therapy to destroy them - Drug therapy to kill them during various phases of the cell cycle **Classifications of Tumors** - **Solid Tumors** - **May originate in any body organ** - **Carcinomas (originate in epithelial cells)** - **Sarcomas (originate in the mesenchyma)** - **Hematological Malignancies** - **Leukemias and lymphomas; occur in the blood-forming organs** **Antineoplastic agents** - **Antineoplastic drugs** - **Alter human cells in a variety of ways. Their action is intended to target the abnormal cells that compose the neoplasm or cancer, having a greater impact on them than on normal cells. Unfortunately, normal cells also are affected by antineoplastic agents.** **Use of Antineoplastic Across the Life Span**  **Sites of Action of Non--Cell Cycle--Specific Antineoplastic Agents** This image explains Sites of Action of Non--Cell Cycle--Specific Antineoplastic Agents **Sites of Action of Cell Cycle--Specific Antineoplastic Agents**  **Categories of Antineoplastic Agents \#1** - Alkylating Agents - React chemically with portions of the RNA, DNA, or other cellular proteins - Antimetabolites - Have chemical structures similar to those of natural metabolites - Antineoplastic Antibiotics - Not selective only for bacterial cells; toxic to human cells **Categories of Antineoplastic Agents \#2** - Mitotic Inhibitors - Drugs that kill cells as the process of mitosis begins - Hormones and Hormone Modulators - Used in cancers that are sensitive to estrogen stimulation - Cancer Cell Specific Agents - Treat chronic myeloid leukemia (CML) and CD117-positive unresectable or metastatic malignant GI stromal tumors (GIST) **Alkylating Agents** - Actions- React chemically with portions of the RNA, DNA, or other cellular proteins - Pharmacokinetics - Vary in their degree of absorption, and little is known about their distribution in the tissues. They are metabolized and sometimes activated in the liver and excreted in the urine - Contraindications- Known allergy, pregnancy, lactation, bone marrow suppression and suppressed renal and hepatic function - Adverse Reactions- Many- See table 14.1 - Drug-to-Drug Interactions- Many drugs that cause hepatic, renal and kidney toxicity **Nursing Considerations for Alkylating Agents** - Assess: - History of allergy to any of the alkylating agents - Bone marrow suppression, CBC - Renal or hepatic dysfunction - Pregnancy or lactation - Physical status - Orientation and reflexes - Respiratory rate, adventitious sounds and VS **Prototype Alkylating Agent** This image explains Prototype Alkylating Agent **Antimetabolites** - Actions- Inhibit DNA production in cells that depend on certain natural metabolites to produce their DNA. - Pharmacokinetics- Absorbed well in GI tract, metabolized in the liver and excreted in the urine - Contraindications- Pregnancy, lactation, bone marrow suppression and hepatic dysfunction - Adverse Reactions- Many- See table 14.1 - Drug-to-Drug Interactions- Many drugs that cause hepatic, renal and kidney toxicity **Nursing Considerations for Antimetabolite** - Assess: - History of allergy to the specific antimetabolite - Bone marrow suppression *to prevent further suppression* - Renal or hepatic dysfunction - Physical status - Orientation and reflexes - Respirations, adventitious sounds, VS, CBC, - Renal and liver function tests **Prototype Antimetabolite Agent**  **Antineoplastic Antibiotics \#1** - Actions- Are cytotoxic and interfere with cellular DNA synthesis by inserting themselves between base pairs in the DNA chain - Pharmacokinetics -- Not well absorbed in the GI tract, metabolized by the liver and excreted in the urine. Long half life (up to 5 days) - Contraindications- Known allergy, Pregnancy, lactation, bone marrow suppression and hepatic dysfunction - Adverse Reactions- bone marrow suppression, with leukopenia, thrombocytopenia, anemia, and pancytopenia - Drug-to-Drug Interactions- Known to cause hepatic or renal toxicity should be used with care with any other drugs known to have the same effect **Nursing Considerations for Antineoplastic Antibiotics** - Assess: - History of allergy to the antibiotic in use - Bone marrow suppression - Renal and hepatic dysfunction, respiratory or cardiac disease - Pregnancy and lactation - Physical assessment - Orientation and reflexes, monitor the results of laboratory tests such as complete blood count with differential **Prototype Antineoplastic Antibiotics** This image explains Prototype Antineoplastic Antibiotics **Mitotic Inhibitors \#1** - Actions- Kill cells as the process of mitosis begins which inhibit DNA synthesis - Pharmacokinetics -- Given IV since they are not well absorbed in the GI tract, metabolized in the liver and excreted primarily in the feces, making them safer for use in patients with renal impairment than the antineoplastics that are cleared through the kidney. - Contraindications- Known allergy, pregnancy, lactation, bone marrow suppression and hepatic dysfunction - Adverse Reactions- bone marrow suppression, with leukopenia, thrombocytopenia, anemia, and pancytopenia, secondary to the effects of the drugs on the rapidly multiplying cells of the bone marrow. GI effects include nausea, vomiting, anorexia, diarrhea, and mucous membrane deterioration - Drug-to-Drug Interactions- Known to be toxic to the liveror the CNS should be used with care with any other drugs known to have the same adverse effects - Assess: - History of allergy - Bone marrow suppression - Renal or hepatic dysfunction - Pregnancy, lactation - Physical status - Orientation and reflexes - Respiratory rate, adventitious sounds and CBC with differential **Prototype Mitotic Inhibitors**  **Hormones and Hormone Modulators \#1** - Actions- Hormone modulators used as antineoplastics are receptor site specific or hormone specific to block the stimulation of growing cancer cells that are sensitive to the presence of that hormone (IE: breast cancer) - Pharmacokinetics- Readily absorbed from the GI tract, metabolizedin the liver, and excreted in the urine - Contraindications- Known allergy, hypercalcemia, pregnancy, lactation, bone marrow suppression, renal and liver dysfunction - Adverse Reactions- Menopause-associated effects include hot flashes, vaginal spotting, vaginal dryness, moodiness, and depression. Other effects include bone marrow suppression and GI toxicity, including hepatic dysfunction, hypercalcemia and cardiovascular risks - Drug-to-Drug Interactions- Oral anticoagulants - Assess: - History of allergy to the drug in use or any related drugs - Bone marrow suppression - Renal or hepatic dysfunction - Physical status - Assess orientation and reflexes - Laboratory tests such as complete blood count with differential **Prototype Hormones and Hormone Modulators \#1** This image explains Prototype Hormones and Hormone Modulators