pharm II exam #5 - cancer

cytotoxic agents, noncytotoxic agents, pain medication for cancer

what are cytotoxic agents?

cytotoxic agents are chemicals that kill or damage cells and are most often used for chemotherapy. these drugs interfere with a certain part of the cell cycle, such as mitosis, DNA replication, and protein synthesis.

what are the many “chemotoxicities” of cytotoxic agents? (5)

(aka what can occur as a result of chemo)

1. bone marrow suppression → anemia, leukopenia, thrombocytopenia

2. GI tract injury → stomatitis (mucositis), N/V, diarrhea

3. alopecia

4. sex cell injury

5. local tissue injury → extravasation

what is dose limiting toxicity? why is it so important with chemotherapy drugs?

Dose-limiting toxicity (DLT) is the most severe side effect of a drug that prevents you from increasing the dose any further

DLT helps the healthcare team recognize when to reduce, delay, or stop treatment if this manifestation occurs.

cytotoxic agent category: alkylating agents

Alkylating agents are a type of cytotoxic chemotherapy drug that work by directly damaging DNA in cells. as a result, the cell eventually dies because it cannot replicate its DNA

ex) cyclophosphamide

cytotoxic agent: cyclophosphamide (class, use, DLT, S/E)

alkylating agent → disrupts DNA

use: treats a broad range of cancers

DLT: bone marrow suppression

S/E: acute hemorrhagic crisis (urinates blood), severe N/V, alopecia

cytotoxic agent category: platinum compounds

chemotherapy drugs made from platinum → this element disrupts DNA and stops the cell from replicating

ex) cisplatin

cytotoxic agent: cisplatin (class, use, DLT, S/E)

platinum compound → disrupts DNA

use: treats testicular, bladder, and ovarian cancers

DLT: kidney damage

S/E: severe N/V lasting days, peripheral neuropathy

cytotoxic agent category: antimetabolites

these medications work by mimicking molecules needed to grow, but they’re faulty. this medication tricks cancer cells into using it for DNA growth; instead, the DNA becomes injured

ex) methotrexate

cytotoxic agent: methotrexate (class, use, DLTs)

antimetabolite → mimicks molecules needed to grow

use: treats nonhodgkins lymphoma, cures choriocarcinomas (highly malignant cancer of cells that create the placenta)

DLT: bone marrow suppression and pulmonary infiltrates

cytotoxic agent category: anti-tumor antibiotics

both types of anti-tumor antibiotics work by damaging DNA and blocking cancer cell replication

two sub categories → anthracyclines and non-anthracyclines

ex) doxorubicin (anthracycline) and dactinomycin (non-anthracycline)

cytotoxic agent: doxorubicin (class, use, DLT, AS/E)

anti-tumor antibiotic, specifically an anthrocycline → damages DNA and blocks cancer cell replication

use: very common cancer drug used to treat a broad range of cancers

DLT: cardiotoxicity (delayed: CHF)

AS/E: this medication is a strong vesicant, turns urine and sweat red (why it is nicknamed the “red devil”)

cytotoxic agent: dactinomycin (class, use, DLT, AS/E)

anti-tumor antibiotic, specifically a non-anthrocycline → damages DNA and blocks cancer cell replication

use: wilm’s tumor, rhabdomyocarcinoma

DLT: bone marrow suppression

AS/E: strong vesicant! be careful of extravasation!

cytotoxic agent category: mitotic inhibitors

cytotoxic chemotherapy drugs that stop cells from dividing during mitosis by disrupting the structures needed to pull chromosomes apart (metaphase)

two subcategories → vinca alkaloids and taxanes

ex) vincristine and vinblastine (vinca alkaloids) and paclitaxel (taxane)

cytotoxic agent: vincristine (class, use, DLT)

mitotic inhibitor, specifically a vinca alkaloid → inhibits metaphase of mitosis

use: used as combination therapy for many cancers because it does not cause bone marrow suppression

DLT: peripheral neuropathy

cytotoxic agent: vinblastine (class, use, DLT)

mitotic inhibitor, specifically a vinca alkaloid → inhibits metaphase of mitosis

use: lymphomas, testicular cancer, SCLC, caposi sarcoma, and breast cancer

DLT: bone marrow suppression

cytotoxic agent: paclitaxel (taxol) (class, use, DLT, AS/E)

mitotic inhibitor, specifically a taxane → inhibits metaphase of mitosis

use: breast cancers

DLT: bone marrow suppression

AS/E: severe hypersensitivity reaction

paclitaxel (taxol) can cause a severe hypersensitivity reaction. what are some S/S that this is occurring? what meds can the nurse give to intervene?

S/S → sudden onset SOB, urticaria, angioedema, hypotension

meds → diphenhydramine (benadryl, H1 receptor antagonist), famotidine (pepcid, H2 receptor antagonist), and dexamethasone (glucocorticoid)

before giving any meds, what should the nurse do FIRST after noticing a hypersensitivity to ANY medication?

STOP THE MED

cytotoxic agent category: topoisomerase inhibitors

cytotoxic agent: irinotecan (class, use, DLT)

cytotoxic agent: asparaginase (class, use, toxicities)

what are noncytotoxic cancer agents?