CHEMOTHERAPY

Interfere will cell reproduction to destroy tumors During administration, a fixed percentage of cancer cells die, afterward the remaining cells continue reproducing Eradication of cancer cells depends on repeated antineoplastic doses. Because cancer cells are at various phases in the cell cycle, therapy usually combines drugs that act on different cell phases or that have different sites of action Although an antineoplastic kills cells as soon as they pass through a specific cell cycle, this action doesnt produce as immediate response in the patient. DRUG CLASSIFICATION:

Purine Analogues: inhibits RNA and DNA synthesis; S phase Pyrimidine Analogues: inhibits pyrimidine nucleotides needed for RNA synthesis ANTINEOPLASTIC ENZYMES (Asparaginase) Used to treat ALL. Catalyst for the conversion of the amino acid asparagine to aspartic acid and ammonia. Leukemic cells are unable to synthesis it for RNA synthesis C. TOPOISOMERASE I INHIBITOR Topotecan Irinotecan Used for metastatic ovarian Ca and Colorectal Ca

CELL CYCLE PHASE SPECIFIC GROUPS

active on the cells undergoing cell division in the cell cycle A. NATURAL ANTI NEOPLASTICS/ MITOTIC INHIBITORS NATURAL ANTI NEOPLASTICS (VINCA ALKALOIDS) Derived from the periwinkle plant M-phase Pharmacokinetics: well distributed, undergo mod. Liver metabolism, eliminated thru feces and small percentage in the urine Pharmacodynamics: cell division is arrested in metaphase. Pharmacotherapeutics: testicular carcinoma, lymphomas, kaposis sarcoma, neuroblastoma, breast, choriocarcinoma PODOPHYLLOTOXINS Acts during G2 and S phases of cell cycle. Etoposide and teniposide Break one of the strands of the DNA molecule Used to treat testicular cancer and small cell lung caner Lymphomas, leukemias (FDA has not yet approved these indications yet.)

CELL CYCLE NONSPECIFIC GROUPS are active on cells in either a dividing or resting state.G1-S, G2-M A. ALKYLATING AGENTS
CLASSIC ALKYLATORS

Chlorambucil Cyclophosphamide Ifosfamide Thiotepa Melphalan mechlorethamine

NITROSUREAS

Carmustine Lomustine Streptozocin

PROBABLE ALKYLATORS

TAXANES The taxanes are made from the bark of the Pacific Yew tree Paclitaxel (Taxol) B. ANTI METABOLITES Structurally resemble DNA base pairs Mainly affect cells that actively synthesis DNA s phase specific Folic Acid Analogues: inhibits the enzyme dihydrofolate reductase, blocking folic acid and inhibits DNA and RNA synthesis

Altretamine Busulfan Carboplatin Cisplatin Dacarbazine Oxaliplatin Procarbazine temozolomide

B. ANTITUMOR ANTIBIOTICS/ CYTOTOXIC ANTIBIOTICS ANTHRACYCLINES Daunorubicin Doxorubiciin Epirubicin Idarubicin valrubicin

OTHERS Bleomycin (cell cycle specific) Dactinomycin Mitomycin Mitoxantrone Pentostatin plicamycin

RADIATION THERAPY
C A T E G O R I E S: Electromagnetic Particulate FRACTIONATION Unit: The centiGray (cGy) is equivalent rad. Administration of Radiation: external beam radiation - delivered by a machine Internal radiation - place inside; ingested, intravenous Agents that alters tissue response: Radiosensitizers -5FU, Taxol Radioprotectors - aminfostine Nursing Management 1. Patient and family education 2. Assessment and management of symptoms 3. Coordination of care 4. Providing emotional support throughout ttt. METHODS: EXTERNAL / INTERNAL decide by oncologist, physician, dosimetrists. dosing depends on the stage, grade, loc imaging studies written consent METHODS: The typical ttt time is 2-5 mins. The lenght is approx 10 mins. The typical daily frac is 180- 300 cGy METHODS: - Avoid underwire - Avoid use of deo AFTER: - Erythema-hyperpigmentation-dry desquamation-moist desquamation - FATIGUE most common ttt related complaints BONE MARROW SUPPRESSION

a. b. c. a. b. c. d.

blood counts are monitored based on the pts risk factor. family and pt education about the possibility that could place them at risk for infection, bleeding or fatigue. - possible blood transfu -d/c til bld count is ok. Includes: implants - needles, seeds, wires, or catheters - Pregnancy should be prevented. - Body fluids are contaminated. - Flushed toilet 3x - Disposable plates and utensils should be used - INTERNAL - METHODS: SEALED SOURCES: Check for dislodgement of source Implants handled with long forceps placed in a lead container When implants is removed the patient is not active METHODS: UNSEALED: Body fluids are source of active radiation Toilet must be flush 3x Disposable utensils Surveyed at the safe level for discharge