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ANTINEOPLASTIC/ ANTICANCER DRUGS o Thrombocytopenia

o Leukopenia
 With antibacterial drugs, the client’s immune
defense mechanism aids in destroying the BONE MARROW SUPPRESSION
bacterially infected cells
 Leukopenia (low mature leukocuytes) -
 ANTICANCER DRUGS – compromise the
susceptible to infection
immune system and the drug fails to attack only
o Neutrophil count lower 500 mm3 – serious
cancer cells
infection
GOAL  Limit visitor and contact sports
 Proper hygiene
1. CURE – long term survival
 Food; thin skinned fruit
 Give large dose lethal (cytotoxic) to cancer
 Thrombocytopenia (low platelet count) –
cells but small enough – tolerable to normal
petechiae, ecchymoses, bleeding of gums,
cells
noseblleds – should be reported
2. PALLIATIVE – control of tumor growth
o Avoid contact sport
 Beyond control (alleviation of symptoms)
o S/Sx:
3. PROPHYLACTIC – if tumor is undetectable but
 Increase menstrual flow
with possible recurrence
 Coffee ground emesis
ANTINEOPLASTIC AGENTS  Pinpoint red rash
 Erythropenia (anemia) weakeness, easy
 Works well with actively dividing cells fatigability, pallor
CELL CYCLE AND ITS PHASES o Iron rich foods
o Rest
 G1 – enzyme production for DNA
 S or synthesis – DNA synthesis and replication BONE MARROW DEPRESSION
 G2 – RNA and CHON synthesis  Observe for signs of bleeding
 M or mitosis – cell division  Check sign of infection
 G0 – resting phase o Advice neutropenic diet = emphasize on
food handling
NEOPLASMS
 Cleaning leads of can before opening
 New or cancerous growth  Cook at right temperature
 Occurs when abnormal cells have the  Chilling and refrigerate food
opportunity to multiply and grow  Protective isolation (reverse isolation)

AUTONOMY INFERTILITY

 Loss of the normal controls and reactions that  Irreversible; pre treatment
inhibit growth and spreading  Counselling is advised

ANAPLASIA MUCOUS MEMBRANE

 Loss of organization and structure  Routine inspection of the oral cavity


 Routine mouth care (every 2-4 days)
METASTASIS
 Rinse mouth thoroughly after meals
 Ability to enter the circulatory or lymphatic  Assess or note for evidence of GI upset
system and travel to other areas of the body that
NAUSEA AND VOMITING
are conducive to growth and survival
 Provide foods that would decrease nausea and
GENERAL ADVERSE EFFECTS
vomiting = poor appetite due to food aversion
 Alopecia and changes in smell and taste (small frequent
 Bone marrow suppression diet, ice chips)
o Anemia  If persistent give antiemetic agents
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o Ordansetron (Zofran)  Reduced drug toxicity because use of several
o Granisteron (Kytril) drug at lower doses
o Dronabinol (Marinol) o Types of Cancer Cell drugs
o Metoclopramide (Reglan)  Cell Cycle Nonspecific – which act on
any phase; kill the cell during dividing
KIDNEY FUNCTION
and resting phase (AHA)
 Monitor intake and output  Alkylating
 Force oral fluids  Antitumor
 Hormones
ALOPECIA  Cell Cycle Specific – which act on a
 Counsel the client specific phase of the cell cycle; aka cell-
 Encourage use of wigs or any head ornaments cycle dependent; effective against
rapidly growing or proliferating cell
OTHER CONSIDERATIONS:  Antimetabolites
 Mitotic Inhibitors
 Pregnancy should be avoided
 Antitumor
 Avoid direct contact  hyperpigmentation
 Contraindication: infection, recent surgery, ALKYLATING
impaired renal/hepatic function, recent
radiotherapy, pregnancy, bone marrow  React chemically with portions of RNA,DNA or
depression other cellular proteins
 Kills both proliferating and non-proliferating cells
THE EFFECTIVENESS OF ANTINEOPLASTIC  Effective against many types of cancer
AGENTS DEPENDS ON THE FOLLOWING: o Drug interactions
1. Growth fraction  Thiazide (diuretics) and allopurinol ->
increase bone marrow depression
 Percentage of cancer cell that is actively dividing
 Digoxin -> effect is decreased, helps the
a. High growth – rapidly dividing =
heart pump faster
leukemia, lymphoma
b. Low growth – slowly dividing = breast  Insulin -> increased effect =
hypoglycaemia
cancer. colon CA
 Phenobarbital and rifampin -> toxicity
 Normal tissues with high rates of proliferation are
 Nitrogen mustard
susceptible = GI, hair follicles, cervical mucosa
a) Mechloretheamine (Mustargen)
2. Doubling time
b) Cyclophosphamide (Cytoxan) –
 Related to growth fraction, the time required
used as immunosuppressant drug
 As the tumor enlarges and ages growth fraction
for organ transplant; can cause
decreases but doubling time increases
hemorrhagic cystitis
 Ex: Breast CA 1% growth and 55 days doubling c) Mesna (Mesnex) – lower incidence
time of induced hemorrhagic cystitis,
Drug resistance – tumor’s location limits the drug antidote for cyclophosphamide
effectiveness; brain tumors respond poorly to (cellular protector)
anticancer; changes in DNA (major cause); mutation  Nitrosoureas = can pass brain barrier
of cancer cell a) Carmustin (Bicnu)
b) Lomustin (Cee Nu)
ADVANTAGES OF COMBINATION  Alkyl sulfonates
CHEMOTHERAPY a) Cisplatin – can cause renal toxicity
b) Amifostine (Ethyol) – antidote
 Decreases drug resistance and shortened and
intensified therapeutic effect ANTIMETABOLITES
 Increase destruction of cancer cells by
effectiveness  Inhibit DNA production in cells that depend on
certain natural metabolites to produce their DNA

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 Replace needed metabolites and prevent normal MITOTIC INHIBITORS
cellular function
 Cell cycle specific drugs
 Disrupt the balance inside a cancer cell
 Inhibit DNA synthesis
 Folic Acid Antagonist
 Kill cells as the process of mitosis begins
o Methotrexate (Mexate)
o Acts by substituting for folic acid which is  Vinka Alkaloid
needed for CHON & DNA synthesis o Vinblastine
o Used for organ transplant o Vincristine
o As treatment for psoriasis o Neurotoxic -> paresthesia and muscle
o Low dose – experimental for rheumatic weakness
arthritis o Leukopenia in 4-10 days
o High dose – renal failure (drug precipitates
in the renal tubules) HORMONES AND ANTAGONIST
o Leucovorin (wellcovorin) – antidote
“rescue” normal cells  Some cancer cells relies on presence of
 Pyrimidine Analogs receptors for endogenous hormones required for
o Fluorouracil (5 FU, Adrucil) – color RED na cell proliferation
vial  Suppress tumor growth by blocking the receptor
 Purine Analogs site
o Mercaptopurine  I.E.: estrogen-receptor site, androgen-receptor
site
ANTINEOPLASTIC ANTIBIOTICS  Estrogen (diethystilbestrol/ esthinyl
 Not selectively toxic to bacterial cells estradiol)
 Disrupts cellular function of human cells o Treatment for prostate cancer
o Utilization of female hormones and
 Inhibits one or more stages of RNA or DNA
decreased amount of male hormone
synthesis, or both
available or used by the cancer cell
 Interferes with cell’s ability to grow and
 Antiandrogen (flutamide)
reproduce normally
o Treatment for metastic ptostate cancer
 Drugs: (always force fluid, when not it will cause
o Prevents adrenal androgen from binging to
urinary damage)
androgen receptor
o Daunorubicin
o S/Sx: Gynecomastia, hepatitis
o Dactinomycin
 Tamoxifen
o Mitomycin
o Anti-estrogen
o Doxorubicin – cell cycle specific
o Blocks growth-promoting effect of estrogen
 Harmless reddish urine 1-2 days after
in estrogen dependent tumors
administration
o Breast and ovaries – concentrated estrogen
 AR: Cardiomyopathy (heart is no longer
receptors
pumping the way it was before)
o Note: tumors spread upon withdrawal
 Dexrazoxane (zinecard) – lower
o AR: hypercalcemia, hot flashes, mild fluid
incidence of cardiomyopathy
retention, nausea, with increased dose ->
o Plicamycin
cornea and retinal opacity
 Primary use: ↓ serum calcium levels for
patient with hypercalcemia as a result of  Androgen (fluoxymesterone, testosterone)
metastatic cancer of the bone o Treatment for breast cancer in menopausal
 Blocks parathyroid hormone activity → women
release of calcium into the blood. o s/sx: masculinization, fluid retention
o Bleomycin  Corticosteroids (hormone modulators)
 Increase RR and cough o Suppresses the inflammatory process
 Signs of developing CHF brought about by tumor growth
 May lead to pneumonia o Block steroid-specific receptors on the
surface of the cell -> inhibits cellular glucose
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transport -> decreasing the amount of o 1st dose should be given 6 – 24 hours after
energy needed for mitosis and CHON completion of chemotherapy; given via SC
synthesis -> cell death o S/E : fluid retention, cardiovascular events,
 Extravasation or Infiltration ophthalmologic events
o Stop infusion, aspirate as much of the drug  T/B Cell Modulators
as possible o Restores suppressed immune function
o Administer lidocaine into the area o Stimulates b-cells which stimulates antibody
o Apply ice pack for the first 24-36 hours, then formation
warm moist compress o Enhance t-cells which increase activity of
o Elevate the IV site above the level of the both monocytes and macrophages
heart o Night time is the best time to give this drug
to the patient
BIOLOGIC RESPONSE MODULATORS (BRMS) –
o Levamisole (Ergamisol)
IMMUNE MODULATORS
 Indicated for colon CA after resection
 Enhance immunologic function of the host and used with fluorouracil
(immunomodulation)  AE : flu like effects, GI upset,
 Destroy or interfere tumor activities (cytotoxic) dermatitis
 Promote differentiation of stem cells (biologic  Colony Stimulating Factor (CSF)
effects) o Are CHONs that stimulates growth,
 Stimulate the production of cells that were maturation, differentiation of bone marrow
stem cells
broken
o To enhance patient’s immune system during
IMMUNE STIMULANTS chemotherapy
o Triggers recovery of bone marrow cells
 Energize the immune system when it is several days earlier than the normal course
exhausted from fighting prolonged invasion of of recovery
specific pathogen or cancer cell. o Give it at night time after chemotherapy
 Interferons o It decreases the length of post treatment
o Produced by B and T cells in response to the neutropenia --- decrease incidence of
presence of viruses or tumor cells infection
o Inhibits intracellular replication of viral DNA o It decreases bone marrow recovery time
o Interferes with tumor cell growth after bone marrow transplant
o Enhances natural killer cell activity o It enhances macrophage destroying ability
(antitumor) (against tumor, virus and fungus)
o Roferon A, Intron-A o Prevents severe thrombocytopenia
o S/E: flu-like syndrome - lethargy, myalgia, o Should NOT be administered 24 hours
arthralgia, anorexia, nausea, headache, before or after administration of therapeutic
dizziness, photosensitivity, alopecia --- after agents
4 months o Erythropoietin - stimulates RBC
 Interleukins production --- decrease frequent blood
o Group of CHON produced by WBC – transfusion
lymphocytes  EPO, Procrit, Epogen
o Hormone-like glycoproteins also called  S/E: HPN, arthralgia (joint pain),
lymphokines thrombosis (clots), allergic reaction
o They are cytokins secreted by T-cells  Evaluation of “iron store” during EPO
o Oprelvekin (Neumega) -- stimulates therapy
megakaryocyte and thrombocyte production  Iron supplements may be used to
o --- resulting to functionally and support EPO-stimulated
morphologically normal circulating platelets erythropoiesis
o --- prevents chemo-induced o G-CSF (granulocyte stimulating factor) –
thrombocytopenia induces production of neutrophils (WBC)
 Filgrastim/ Neupogen
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 S/E: skeletal pain or bone pain o Muromonab = T cell specific antibody,
consistently observed disables cells
 Stimulate WBC production and o = used for treatment of acute allograft
maturation -> decreased infection rejection in renal transplants
o GM-CSF (granulocyte macrophage o AE : acute pulmonary edema
stimulating factor) – Induces parents cells  T/B Cell Suppressors
to divide and differentiate in the granulocyte o Blocks antibody production by B cells
macrophage o Inhibit suppressor and helper T cells
 Sargramostim// Leukine o Modify the release of interleukins and of T
 Caution to clients with pre-existing cell growth factor
pleural or pericardial effusion because o Cyclosporine (Sandimmune) =
it may increase fluid retention – suppresses rejection in transplants
dyspnea  most commonly used immune
 Caution with cortiscosteroids suppressant
o General consideration  AE : increased risk of infection and
 Assess CBC before therapy to avoid development of neoplasm
leukocytosis and thrombocytosis ---  Interleukin Receptors Antagonist
especially with filgrastim, o Antagonizes human interleukin-1
sargramostin and neumega receptors
 Give anti-emetic as necessary o (Ointerleukin-1 – are elevated in response
 Administer at bedtime to decrease to inflammation or immune reactions and
consequences of fatigue responsible for degeneration of cartilage
 Drug vials are for one-time use only in rheumatoid arthritis )
 Avoid shaking --- it will denature o Anakinra (Kineret)
 Most BRM’s side effects will disappear
within 72 – 96 hours after
discontinuation of therapy
 Women of childbearing age should be
advised to use barrier
contraceptives(bec. Oral
contraceptives may be altered by liver
changes or by changes in the body’s
immune response)
IMMUNE SUPPRESSANTS

 Monoclonal antibodies
 T/B Cell Suppressor
 Used in conjunction with corticosteroids to block
inflammatory process
 Drug used to block or suppress the actions of
the T cells and antibody production;
 Used to prevent transplant rejection and treat
autoimmune diseases
 NO giving of vaccines
 Monoclonal Antibody
o Muromonab-CD3 / Orthoclone OKT3
o Trastuzumab / Herceptin,
o Rituximab / Rituxan
o Antibodies that attach to specific receptor
sites

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