Chemotherapy Agents

chemotherapy is dosed based on…

body surface area (height and weight)

Use of more than one chemo agent that act on different phases of the cell cycle

combination therapy

combination therapy is used to…
reduce ___ ___
increase _____
reduce ____ effects to ___ ___

medication resistance
effectiveness
toxic
healthy cells

Kills cancer cells as well as healthy cells

cytotoxic chemo

Chemo Targets fast growing cells, proliferating (healthy cells in gut, hair, and bone turn over quickly) causing…
N___
V___
A___
M_____
E______

nausea
vomiting
alopecia
myelosuppression
extravasation

Cause an increase in hormone and can be effective against tumors that require a specific hormone to grow

hormonal agonists

estrogen hormones for testosterone dependent cancer & suppress growth

leuprolide

Block certain hormones and can be effective against tumors that require a specific hormone for support

hormonal antagonists

leuprolide is a…

hormonal agonist

Antiestrogen hormone with estrogen dependent cancer & suppress growth

tamoxifen

tamoxifen is a…

hormonal antagonist

if a patient undergoing chemo treatment is experiencing GI discomfort, what do you give them and when?

antiemetic (e.g. ondansetron) before beginning chemo

bone marrow suppression causes…

neutropenia
thrombocytopenia
anemia

low rbc

anemia

low platelets

thrombocytopenia

low WBC

neutropenia

what are signs of infection?

fever and sore throat

see bruising first, monitor for s/s of bleeding

thrombocytopenia

what should you instruct chemo patients to do regarding going in public?

avoid crowds and contact with infectious individuals

when does alopecia begin when taking chemo?

7-10 days after beginning

how long does chemo-related alopecia last for?

2 months after last dose

what should you assess when a person is experiencing alopecia and how can you prevent it?

self-esteem issues
order wig prior to beginning chemo

what are the nursing implications for chemotherapy agents?

GI discomfort
Bone marrow suppression
alopecia
severe tissue damage

this is caused by extravasation of vesicants

severe tissue damage

what should you do if you’re taking a chemotherapy agent and experiencing severe tissue damage??

stop chemo immediately and administer neutralizing agent

who can administer a neutralizing agent?

trained personnel

how is a neutralizing agent administered?

central access device

What are the subcategories for antiretrovirals?

fusion entry inhibitors
nucleotide reverse transcriptase inhibitors (NRTI)

what is the prototype drug for fusion entry inhibitors?

enfuviritide

this antiretroviral drug blocks HIV from attaching to & entering CD4T cell

enfuvirtide

the side effect of this drug is localized reaction at injection site (occurs in 98% of clients)

enfuvirtide

what are the prototype drugs for nucleotide reverse transcriptase inhibitors (NRTI)?

zidovudine
delavirdine
ritonavir
raltegravir

this antiretroviral class prevents HIV replication within the cell

nucleoside reverse transcriptase inhibitors (NRTI)

this drug causes suppressed bone marrow leading to neutropenia and anemia

zidovudine

when does anemia occur when taking zidovudine?

2-4 weeks

when does neutropenia occur when taking zidovudine?

6 weeks

what should you monitor when taking zidovudine?

Hgb and neutrophil counts (obtain baseline and monitor periodically)

when taking this drug, a common reaction is a rash that usually 1-3 weeks after starting the drug

delavirdine

a client is taking delavirdine. They develop a rash. What should they do? Why?

stop medication and notify HCP
stevens-johnson syndrome can occur

adverse effects of ritonavir:
H____
F____ R_____
elevated serum ____ and ____

hyperglycemia
fat redistribution
lipids
cholesterol

thin arms and legs, abdominal fat, buffalo hump, gynecomastia

fat redistribution

side effects of this drug are depression and suicidal ideation

raltegravir

what are the two prototype antiviral drugs?

acyclovir
ganciclovir

this antiviral drug is used to Treat herpes simplex (HSV-1 & HSV-2) and varicella-zoster viruses (HSV-3)

acyclovir

do antiviral drugs work when the virus is dorment?

no

contraindication are renal impairment and use of nephrotic medication

acyclovir

adverse effects include nephrotoxicity, gingival hyperplasia, and headache

acyclovir

how do you administer acyclovir and why?

IV over 1 hour or longer to prevent nephrotoxicity

when taking acyclovir, what should they refrain from doing?

sexual contact when lesions are present
use condom even when herpetic lesions are healed

what is an adverse effect of ganciclovir?

bone marrow suppression

what are the contraindications for ganciclovir?

neutrophil count <500
platelet count <25,000

what is a normal neutrophil count?

2,500-7,500

what is a normal platelet count?

150,000-400,000

which drug class should you take exactly as prescribed, do not skip doses, or take decreased doses?

retrovirals

Take retrovirals at regular intervals to maintain ____ ____ in the ___; strains can ____ and change which adds to _____

therapeutic levels
blood
mutate
resistance

Use of 3-4 antiretrovirals to reduce medication resistance, adverse reactions, and dosages

highly active antiretroviral therapy (HAART)

which drug class should you always use barrier contraception

retrovirals

Notify HCP if suspected pregnancy; antiretroviral therapy can be given prophylactically to infected mom to reduce infant infection.

all retrovirals