Module 6 - Antineoplastics

Carcinoma

Carcinoma

epithelial tissue cancer

Leukemia

blood cancer, replaces bone marrow cells and causes immature WBCs

Lymphoma

lymphoid tissue cancer

Sarcoma

connective tissue cancer (painless swelling)

cell-cycle non-specific

cytotoxic at any growth phase

cell-cycle specific

cytotoxic at specific phases of growth

tumor lysis syndrome

extracellular product accumulation

general adverse effects of chemo

alopecia, N/V/D, mucositis, myelosuppression, aplastic anemia

(effects areas with rapidly dividing cells like hair follicles, GI tract, and bone marrow cells)

Antimetabolites examples

methotrexate, cladribine, mercaptopurine, capecitabine, cytarabine

Antimetbolites MOA

inhibits critical enzymes

Antimetabolites

solid tumors, hematologic cancers, psoriasis, rheumatoid arthritis

Antimetabolites complications

tumor lysis syndrome, hair loss, N/V/D, myelosuppression, toxicity, fever, malaise, immunosuppression (methotrexate)

Tumor lysis syndrome treatment

allopurinol (for increased uric acid)

Patient education for antineoplastics

Avoid things that irritate the GI system (alcohol, tobacco, spicy, high fiber, citrus, too hot/cold, rough texture), mouth care (report sores, pain, white patches), fertility education (egg freezing, contraception), avoid OTC meds, pain control methods, infection prevention techniques

Miotic inhibitors

Vincristine

Vincristine MOA

binds to tubulin to inhibit mitosis

Vincristine adverse effects

NEUROTOXICITY, hair loss, N/V, myelosupression

Vincristine med administration

IV only, no intrathecal route

Vincristine nursing interventions

monitor hepatic and renal levels, uric acid levels, peripheral neuropathies

Antineoplastic enzyme drug examples

asparaginase, pegasparase

asparaginase adverse effects

impaired pancreatic functions resulting in hyperglycemia, severe pancreatitis

Alkylating drug xamples

cyclophosphamide (Cytoxan)

cyclophosphamide MOA

alters DNA

cyclophosphamide complications

GI toxicity, myelosuppression, hemorrhagic cystitis (s/s hematuria with bladder pain)

Patient education cyclophosphamide

hydration must be maintained to prevent hemorrhagic cystitis

erythropoietin stimulating agent example

epotein alfa

epoetin alfa

HEART ATTACK, STROKE, DEATH IF CONT AFTER HGB >11

epoetin alfa patient education

must receive with iron supplementation

Ferrous iron complications

N/V/D, constipation

Ferrous iron contraindications

hemolytic anemias, anemias without low iron

Ferrous iron interactions

antacids

Iron overdose interventions

give deferoxamine

Patient education ferrous iron

May darken stool, sit upright for 30 mins after taking, take with vitamin C to increase absorption, take with 4-6 oz of water, if liquid sip through straw to avoid discoloration

Iron dextran adverse effects

anaphylaxis (potentially fatal, give test dose), orthostatic hypotension

dietary sources of iron

meat, spinach, sweet potatoes, peas, broccoli, string beans, enriched grains, tofu, beans, lentils, strawberries, watermelon, raisins, dates, apricots

folic acid use

malabsorption syndromes, pregnancy

folic acid contraindications

pernicious anemia

dietary sources of folic acid

beans, peas, oranges, green vegetables

filgrastim MOA

stimulates progenitor cells to increase number of granulocytes (neutrophils)

filgrastim uses

increase ANC greater than 10,000

filgrastim adverse effects

edema, anorexia, N/V, alopecia, rash cough, dyspnea, bone pain

filgrastim contraindications

presence of more than 10% myeloid blasts

filgrastim interactions

myelosuppressive antineoplastics (don’t give w/i 24hours of myelosuppressive antineoplastics)

romiplostim MOA

stimulates platelet production

interferon uses

viral infection, cancer, autoimmune

interferon adverse effects

AGRIVATION OR PRECIPITATION OF CETAIN AUTOIMMUNE AND NEUROPSYCHIATRIC DISORDERS, fatigue (dose-limiting)

Monoclonal antibodies

adalimumab (Humira)

Monoclonal antibodies uses

cancer, rheumatoid arthritis, MS, organ transplant

adalimumab adverse effects

flu-like symptoms, infection

adalimumab contraundications

active infections, live infections

adalimumab patient teaching

takes weeks to take effect

Disease modifying antirheumatic arthritis drugs examples

abatacept, etanercept

abatacept uses

rheumatic arthritis (STOPS DISEASE PROGRESSION)

abatacept contraindications

active bacterial infection

abatacept patient education

make sure immunizations are up to date, slow onset over several weeks