NURS 211: Week 2 Drugs Used in Cancer Treatment

Describe what cancer is.

- Uncontrolled cellular growth, tissue invasion, distant metastases

State the 5 types of cancer treatments.

- Adjuvant therapy

- Neoadjuvant therapy

- Salvage therapy

- Targeted therapy

- Biological therapy

What is adjuvant therapy?

- Given AFTER treatment with surgery to destroy leftover cells

What is neoadjuvant therapy?

- Initial treatment given to shrink the cancer BEFORE surgery

What is salvage therapy

- Second-line therapy is administered when first-line therapy is unsuccessful

What is targeted therapy?

- "Targets" cancerous cells and spares normal cells

What is biological therapy?

- used to enable the immune system to better target and kill cancerous cells

Describe each of the phases of cancer treatment.

- Induction: induce remission

- Consolidation: eradication of remaining cells after remission

- Maintenance phase: prevent recurrence of cancer

Describe Cell-Cycle Specific vs. Nonspecific treatment.

- Specific: Only active in certain phases (e.g., S or M phase).

- Nonspecific: Act in all phases, including resting (G₀).

Describe Alkylating Agents.

- Type: Cell-cycle nonspecific

- Action: Cross-links DNA → prevents replication

- Examples: Cyclophosphamide, Ifosfamide

Describe Antimetabolites.

- Type: Cell-cycle specific (S phase)

- Action: Mimic natural metabolites → disrupt DNA/RNA synthesis

- Examples: Methotrexate, 5-FU

Describe antitumor antibiotics.

- Type: Mostly nonspecific

- Action: Intercalate DNA, inhibit RNA synthesis, generate free radicals

- Examples: Doxorubicin, Bleomycin

Describe plant alkaloids (vinca alkaloids).

- Type: Cell-cycle specific (M phase)

- Action: Inhibit microtubule formation → block mitosis

- Examples: Vincristine, Vinblastine

Describe Taxanes.

- Type: Cell-cycle specific (M phase)

- Action: Stabilize microtubules → prevent breakdown, stop mitosis

- Examples: Paclitaxel, Docetaxel

Describe supportive therapies.

- Purpose: Reduce chemo side effects & protect normal tissues

- Examples:

Filgrastim → boosts WBCs

Ondansetron → controls nausea

Epoetin alfa → stimulates RBC production

What are the ASCO/ONS standards for safe handling and administration of chemotherapy? (Lowkey extra hehe)

- Ensure trained/competent staff, informed consent, patient education, standardized orders, double-checks in prep/admin, proper labeling, safeguards for intrathecal/vinca drugs, and ongoing monitoring of toxicity, labs, and cumulative doses.

What does "cytotoxic" mean?

- Toxic to cells; kills or damages cells.

What are vesicants in chemotherapy?

Medications that cause severe tissue damage if they leak from the vein.

What is extravasation?

- Leakage of IV chemotherapy into surrounding tissue.

What happens if a vesicant extravasates?

- Pain, swelling, inflammation, blistering, tissue breakdown/necrosis.

What are the emergency steps if vesicant extravasation occurs (SAE)?

- Stop infusion

- Aspirate drug

- Elevate limb.

( think SAE frat hehe)

What are alkylating agents in chemotherapy?

- Cell-cycle nonspecific drugs that damage DNA by forming cross-links; very toxic with many side effects.

What are nitrogen mustards?

- A class of alkylating agents (different from mustard gas)

- 5 in use

- e.g. Cyclophosphamide

What are nitrosoureas?

- Alkylating agents that can cross the blood-brain barrier;

- example: Carmustine.

What are alkyl sulfonates?

- Alkylating agents

- example: Busulfan.

What is a key drawback of alkylating agents?

- Super toxic

- Numerous side effects

What is the mechanism of action of Cyclophosphamide (Cytoxan)?

- Causes DNA crosslinking during mitosis → nucleic acid chain breakage → cell destruction.

What cancers is Cyclophosphamide used to treat?

- Lymphomas

- Multiple myeloma

- Leukemias

- Ovarian cancer

- Breast cancer.

What are the major adverse effects of Cyclophosphamide?

- Myelosuppression

- Sepsis

- Nephrotoxicity

- Pulmonary toxicity

- Cardiotoxicity

- Infertility

- Hyponatremia

- Hemorrhagic cystitis.

What precautionary drug is given to prevent hemorrhagic cystitis with Cyclophosphamide?

- Mesna

What is the general mechanism of antimetabolites in cancer therapy?

- Prevent cancer cell growth by imitating metabolites needed for DNA/RNA synthesis.

What do folate antimetabolites inhibit?

- Folic acid synthesis

What toxicities are associated with folate antimetabolites?

- Myelosuppression

- Mucositis

- Hepatotoxicity

- Nephrotoxicity.

Give an example of a folate antimetabolite.

- Methotrexate

How do pyrimidine antimetabolites work?

- Mimic DNA/RNA bases to block synthesis.

What unique adverse effect can pyrimidine antimetabolites cause?

- Hand-foot syndrome (palmar-plantar erythrodysesthesia)

Give an example of a pyrimidine antimetabolite.

- Fluorouracil (5-FU)

What do purine antimetabolites mimic?

- Purine bases of DNA and RNA

What is the mechanism of action of Methotrexate (MTX)

- Imitates folic acid → inhibits DNA synthesis.

What cancers and conditions is Methotrexate used to treat?

- Breast cancer

- Non-Hodgkin lymphoma

- Osteosarcoma

- Refractory psoriasis

- Rheumatoid arthritis. (Off-label: eczema, sarcoidosis)

What are the common adverse effects of Methotrexate?

- N/V/D

- Anorexia

- Hepatotoxicity

- Folate deficiency

- Mucosal ulceration

- Alopecia

- Fatigue

- Fever

- Infection risk

- GI bleed

- Pancreatitis

- Renal failure.

What pregnancy category is Methotrexate?

- Category X — requires double contraception.

What class of chemotherapy drugs are very strong vesicants and inhibit DNA replication by targeting topoisomerase?

- Anthracyclines / Antitumor antibiotics

What is the mechanism of action of anthracyclines?

- They inhibit topoisomerase, preventing DNA strands from unwinding and replicating.

What is a major cardiac side effect of anthracyclines?

- Cardiotoxicity, which can lead to heart failure.

What unique urine color change is associated with anthracyclines?

- Red or orange urine.

Why are anthracyclines considered dangerous if they leak outside the vein?

- They are very strong vesicants and can cause severe tissue damage (extravasation).

What is the mechanism of action (MOA) of doxorubicin?

- Inhibits topoisomerase to prevent DNA replication, leading to cell death.

What cancers is doxorubicin commonly indicated for?

- Breast cancer

- Thyroid cancer

- Leukemia

- Lymphoma

- Sarcoma

- Wilms tumor.

What are common side effects of doxorubicin?

- Myelosuppression,

- Alopecia

- Oral sores

- Hyperpigmentation of skin and nails

- Red/orange/pink urine.

What are serious adverse effects of doxorubicin?

- Cardiotoxicity

- Extravasation necrosis

- Risk of secondary cancers.

What is the source of plant alkaloid chemotherapy drugs?

- Derived from plants; most common are vinca alkaloids.

Name two common vinca alkaloids.

- Vincristine

- Vinblastine.

What is the mechanism of action of vinca alkaloids?

- They cause misalignment of chromosomes during mitosis, leading to apoptosis (cell death).

What is a major adverse effect of vinca alkaloids?

- Neurologic symptoms

-(e.g., peripheral neuropathy).

What is the mechanism of action (MOA) of vincristine?

- Causes chromosomal misalignment/errors during mitosis, leading to apoptosis of cancerous cells.

What cancers is vincristine indicated for?

- Lymphoma

- Leukemia

- Kaposi sarcoma

- Squamous cell carcinoma

- Lung cancer

- Bladder cancer.

What are common side effects of vincristine?

- Myelosuppression

- Alopecia

- Oral sores

- Constipation.

What are serious adverse effects of vincristine?

- Neuropathy

- Paralytic ileus

- Hearing loss.

What foods can interact with vincristine?

- Grapefruit

How must vincristine be administered?

- Intravenously (IV) only — never orally.

What is the source of taxane chemotherapy drugs?

- Developed from the bark of the yew tree.

Name two common taxanes.

- Docetaxel (Taxotere)

- Paclitaxel (Taxol).

What cancers are taxanes used to treat?

- Breast

- Ovarian

- Prostate,

- Gastric,

- Esophageal,

- Pancreatic cancers.

Can taxanes be used alone or in combination therapy?

- Monotherapy or in combination.

What is the most common reaction to taxanes?

- Hypersensitivity reactions.

What are common side effects of taxanes?

- Fluid retention

- Myelosuppression

- Alopecia,

- N/V/D

What are serious adverse effects of taxanes?

- Cardiotoxicity,

- Hepatotoxicity

- Peripheral neuropathy.

What are supportive therapies in cancer treatment?

- Medications used to prevent or mitigate side effects or adverse effects of cancer treatment.

What is another term often used for supportive therapy?

- Palliative therapy

Give examples of medications used in supportive therapy.

- Hormones

- Steroids

- Histamine agonists

- Bone marrow stimulants

- Chemoprotective agents.

What should nurses assess before, during, and after chemotherapy?

- Overall well-being

- Lab values.

What is important to monitor with IV chemotherapy?

- Ensure IV patency and monitor frequently during administration.

What safety measures should nurses follow with chemotherapy drugs?

- Proper handling

- Disposal procedures

- Familiarity with black box warnings.

What emergent situations must nurses be able to recognize and manage?

- Hypersensitivity reactions

- Bleeding

- Sepsis.

What educational and supportive needs should nurses provide?

- Educational, spiritual, and psychosocial support for patients and caregivers.

What should patients be monitored for during chemotherapy?

- Hematuria or other signs of bleeding and ensure proper hydration.

What are key long-term care considerations for patients with IV chemotherapy?

- Long-term IV access care and avoiding infection risks

Name lifestyle precautions chemotherapy patients should follow?

- Avoid contact with people who received live vaccines within 3 months

- Wear gloves while gardening

- Avoid uncooked meat

- Avoid new supplements

- Avoid becoming pregnant

- Avoid cleaning litter boxes

What mnemonic can help you remember Anthracyclines, Vinca alkaloids, Taxanes, and Supportive therapies?

- Alarming Villains Try Safely.

- A = Anthracyclines → MOA, cardiotoxicity, red urine

- V = Vinca alkaloids → MOA, neuropathy

- T = Taxanes → MOA, hypersensitivity, neuropathy

- S = Supportive therapies → Palliative, prevent side effects