NURS 211 - Drugs used in Cancer Treatment

cancer cells are characterized by

uncontrolled cellular growth, tissue invasion, and distant metastases

adjuvant therapy

given after the initial treatment with surgery to destroy leftover cells

neoadjuvant therapy

initial treatment given to shrink the cancer before surgery

salvage therapy

second line therapy administered when the first-line therapy is unsuccessful

targeted therapy

targets cancerous cells and spares normal cells, often through medications

biologic therapy

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

what are the three phases of cancer treatments?

induction, consolidation, and maintenance phase

induction phase

induce remission

consolidation phase

eradication of remaining cells after remission

maintenance phase

prevent recurrence of cancer

what does it mean for chemo to be cell-cycle specific?

the chemo is only effective in ONE phase of mitosis

what does it mean for chemo to be cell-cycle nonspecific?

the chemo is effective in ALL phases of mitosis

alkylating drugs

drugs used to treat cancer by breaking DNA strands in the cancerous cell

taxanes

Inhibit the function of microtubules during M phase

supportive therapies

cognitive therapy, brief strategic therapy, family therapy, group therapy

combination therapy

uses cell cycle specific and cell cycle nonspecific to eliminate cancer cells more completely

vesicant

medications that cause severe tissue damage if they leak from the vein

extravasate

to escape from a vessel into tissue

vesicants cause ______ when they extravasate

necrosis

symptoms of extravasate

pain, swelling, tissue breakdown, inflammation, and blistering

what does SAE stand for?

stop, aspirate, and elevate

three types of alkylating agents

nitrogen mustards, nitrosoureas, and alkyl sulfonates

nitrogen mustards

Cyclophosphamide, ifosfamide

nitrosoureas

cross the blood brain barrier, such as carmustine

alkyl sulfonates

busulfan

alkylating agents are cell cycle....

non specific

Cyclophosphamide (Cytoxan) MOA

causes the crosslinking of DNA during mitosis to cause nucleic acid chain breakage, resulting in apoptosis

Cyclophosphamide indications

lymphomas, multiple myelomas, leukemia, ovarian and breast cancers - can also be used for autoimmune disorders

Cyclophosphamide adverse effects

myelosuppression, sepsis, nephrotoxicity, pulmonary toxicity, cardiotoxicity, infertility, hyponatremia, hemorrhagic cystitis

what is myelosuppression?

Decrease in bone marrow activity resulting in fewer RBC, WBC, and platelets

what is typically a precaution that we can take to reduce the risk of hemorrhagic cystitis?

administer mesna

antimetabolites

prevent cancer cell growth by imitating metabolites

what are the three kinds of antimetabolites?

folate antimetabolites, pyrimidine antimetabolites, and purine antimetabolites

folate antimetabolites function

inhibit the synthesis of folic acid

folate antimetabolites adverse effects

myelosuppression, mucositis, hepatotoxicity, and nephrotoxicity

methotrexate MOA

prevents DNA synthesis by imitating folic acid, preventing cell proliferation

methotrexate is a _______ antimetabolite

folate

methotrexate indications

breast cancer, non-Hodgkin lymphoma, refractory psoriasis, RA, osteosarcoma, eczema, and sarcoidosis

methotrexate adverse effects

anorexia, hepatotoxicity, folate deficiency, mucosal ulceration, alopecia, fatigue, fever, increased risk of infection, GIB, pancreatitis, and renal failure

what is special about MTX for those who are pregnant or are engaging in sexual activity?

can NOT be given to those who are pregnant. for those who are engaging in sexual activity, double contraception must be used

pyrimidine antimetabolites

mimics the bases of DNA and RNA

pryimidine antimetabolites adverse effects

hand-foot syndrome (skin rxn causing redness, swelling, pain, peeling, and cracking along the palms and soles)

fluorouracil is a ________ antimetabolite

pyrimidine

anthracyclines

also called antitumor antibiotics; they are very strong vesicants that inhibit the ability of DNA strands to unwind/replicate by inhibiting topoisomerase

adverse effects of anthracyclines

cardiotoxicity and red/orange urine

what must be monitored if a patient is on any anthracycline medication?

heart must be monitored

what must the ejaction fracture be greater than for a patient to be able to receive anthracyclines?

55% or greater

doxorubicin is what kind of antibiotic?

antitumor antibiotic

doxorubicin MOA

inhibits topoiseomerase to prevent DNA replication and cause apoptosis

doxorubicin indications

breast and thyroid cancers, leukemia, lymphoma, sarcoma, and Wilms tumor

side effects of doxorubicin

myelosuppression, alopecia, oral sores, hyperpigmentation of skin/nails, red/orange/pink urine

adverse effects of doxorubicin

cardiotoxicity, extravasation necrosis, secondary cancers

plant alkaloids

derived from plants and cause the misalignment of chromosomes, causing apoptosis (inhibiting cell division)

plant alkaloids are often named with what prefix?

vin-

general adverse effect of plant alkaloids?

neurological symptoms

vincristine (Oncovin) MOA

causes chromosomal link errors, leading to apoptosis

vincristine indications

lymphoma, leukemia, Kaposi sarcoma, squamous cell carcinoma, lung cancer, bladder cancer

vincristine side effects

myelosuppression, alopecia, oral sores, constipation

vincristine adverse effects

neuropathy, paralytic ileus, hearing loss

food interaction of vincristine

GRAPEFRUIT!

what is the only way that vincristine can be administered?

IV

taxanes are developed from what tree bark

Yew tree bark

what can taxanes help treat?

breast, ovarian, prostate, gastric, esophageal, and pancreatic cancers

what is the most common reaction to taxanes?

hypersensitivity reactions

side effects of taxanes

fluid retention, myelosuppression, alopecia

adverse effects of taxanes

cardiotoxicity, hepatotoxicity, and peripheral neuropathy

what are three common things that can be treated with supportive therapies?

myelosuppression, nausea, and vomiting