Cancer Drugs

uncontrolled cell growth, invasion, and metastasis

Cancer refers to _____.

Chemotherapy

_____ is the core treatment for cancer alongside surgery and radiation.

no

Are there any chemotherapy drugs that work for all types of cancer?

No, chemotherapy must be administered by specially trained nurses.

Can any registered nurse administer chemotherapy?

toxicity

Chemotherapy drugs have a narrow therapeutic index, therefore, the nurse must monitor for _____. 

myelosuppression

_____, aka bone marrow suppression, is a major complication of chemotherapy.

decreased production and maturation of RBCs, WBCs, and platelets

Myelosuppression result in ______.

fatigue, weakness, and dyspnea

Recall: dyspnea = shortness of breath

Low RBC count causes _____.

4,350 - 5,870 cells per microliter

What is the normal RBC range?

infection and neutropenia

Low WBC count puts the patient at a high risk for _____. 

4,500 - 11,000 cells per microliter

What is normal WBC range?

bleeding

Low platelet count increases the risk of _____.

150,000-400,000 platelets per microliter

What is normal platelet range?

(1) either cell cycle specific or non-specific

(2) further defined by mechanism of action

How are antineoplastic drugs classified?

A. Shortness of breath, fatigue, and weakness

A patient undergoing chemotherapy reports new symptoms. Which findings should lead the nurse to suspect a reduction in RBC levels?

A. Shortness of breath, fatigue, and weakness

B. Burning with urination and presence of hematuria

C. elevated temperature, chills, and sore throat

D. Irregular heart rhythm and palpitations

alkylating

Cisplatin and Cyclophosphamide are types of ______ drug.

damage cancer cell DNA/RNA to prevent replication

How do alkylating drugs work?

hemorrhagic cystitis (blood in urine)

Alkylating drugs may cause urotoxicity, including _____. 

liver and kidney functions

Alkylating drugs require assessment of which two functions?

ovarian and testicular cancer

Alkylating drugs are often used for what two types of cancer?

C. Blood present in the urine

A patient receiving cyclophosphamide begins reporting new symptoms. Which finding should the nurse recognize as a sign of toxicity associated with this medication?

A. Increased temperature

B. Irregular cardiac rhythm

C. Blood present in the urine

D. New onset abdominal cramping

nutrients

Antimetabolites, like Methotrexate, interfere with ______ needed for cancer cell reproduction. 

rapidly dividing cancers, such as leukemia and non-Hodgkin lymphoma

Antimetabolites, like Methotrexate, are most effective against _____.

prevent cancer cells from reading genetic information by binding to DNA/RNA

How do antitumor antibiotics, like Doxorubicin and Adriamycin, work?

cardiotoxicity 

Antitumor antibiotics, like Doxorubicin, are known for causing ______.  

dysrhythmias and heart failure (HF)

Because antitumor antibiotics are known for causing cardiotoxicity, the nurse must monitor for _____.

disrupting microtubules and mitosis

Plant alkaloids work by _____.

neurotoxicity

Plant alkaloids put patients at a high risk for _____.

tissue necrosis

Extravasation during IV administration of plant alkaloids can cause severe _____. 

vesicants

Some plant alkaloids are ______, meaning they cause skin damage, blistering, and necrosis.

B. Discontinue the infusion

A patient receiving an IV infusion of the plant alkaloid vincristine reports discomfort at the insertion site. The nurse observes a firm, reddish-purple area forming around the IV. What is the priority nursing action?

A. Notify the chemotherapy-certified nurse who started the line

B. Discontinue the infusion

C. Apply a warm compress to the affected site

D. Page the oncology provider immediately

• Nausea and Vomiting

• Alopecia: hair loss

• Mucositis: inflammation and sores of the lining of the digestive tract, including the mouth.

• Tumor Lysis Syndrome (TLS): occurs when cancer cells rapidly break down and release their contents into the bloodstream.

• Oral Candidiasis (oral thrush): yeast infection of the mouth resulting in white patches.

What are some adverse effects associated with chemotherapy?

C. Candidiasis

A patient is undergoing treatment with chemotherapy. He calls the nurse and states that his mouth hurts and there are white patches on his tongue. The nurse suspects the white patches are a symptom of what?

A. HIV Infection

B. Milk Residue

C. Candidiasis

D. Poor Oral Hygiene

Colony Stimulating Factors (CSFs), which are proteins that stimulate the production and function of blood cells

Myelosuppression can occur due to cancer invasion in bone marrow or after various anticancer therapies. What can you expect the provider to order to minimize the severity of neutropenia and reduce the risk of infection?

• Rinse your mouth several times a day, especially before and after meals.

• Drink plenty of fluids.

• Suggest soft, bland, cold, nonacidic foods. Although individual tolerances vary, it is usually better to avoid highly spiced or rough foods.

• If pain is present, local anesthetic solutions, such as “magic mouthwash” are commonly used in clinical practice. There are commercially available products, or a compound can be made often including ingredients of viscous lidocaine, diphenhydramine, and liquid antacid.

Due to rapid cellular turnover, the GI mucosa is a common site of toxicity associated with anticancer therapy. The subsequent inflammation (mucositis) can lead to painful ulcerations and an inability to eat, drink, or swallow. What suggestions can you make that would help your patient?

• Aggressive hydration with IV normal saline

• Alkalinization with IV sodium bicarbonate

• Allopurinol

Tumor lysis syndrome (TLS) is one of the most common oncologic emergencies. This condition develops when large numbers of cancer cells are killed or damaged simultaneously and release their intracellular contents into the bloodstream. To prevent or minimize this, what would the nurse expect to administer?

Effective antifungal therapy may be achieved with fluconazole, clotrimazole, or nystatin mouth rinses.

Oral candidiasis (thrush) is usually painful and looks like creamy-white, curd-like patches overlying the mucosa and is associated with systemic or local immunosuppression, such as recent corticosteroid, chemotherapy, or antibiotic use. What treatment will the nurse administer to the patient following a provider's orders?