Introduction to Clinical Pharmacology Chapter 51- Antineoplastic Drugs

1. Introduction to Clinical PharmacologyChapter 51-Antineoplastic Drugs

2. Cell Cycle Specific Drugs: Actions and Uses • Plant Alkaloids: • Vinca alkaloids: Interfere with amino acid production in S phase and formation of microtubules in M phase • Taxanes: Interfere in M-phase with microtubules • Podophyllotoxins: Cells are unable to divide since cells are stopped during S and G2 phases by the podophyllotoxins

3. Cell Cycle Specific Drugs: Actions and Uses (cont’d) • Antimetabolites: • Interfere with synthesis of RNA and DNA, make it impossible for cancerous cell to divide into two daughter cells • Drugs are used to treat: • Leukemia, lymphoma, solid tumors, autoimmune diseases

4. Cell Cycle Nonspecific Drugs: Actions and Uses • Alkylating agents: • Change cell to more alkaline environment, which in turn damages the cell • Antineoplastic antibiotics: • Interfere with DNA and RNA synthesis, delaying or inhibiting cell division • Miscellaneous antineoplastic arugs: • Number of drugs are used for antineoplastic actions, do not belong to any one category

5. Cell Cycle Nonspecific Drugs: Adverse Reactions • Nausea and vomiting from highly emetic drugs or potential of IV extravasation of irritating solutions • Adverse reactions common to antineoplastic drugs: • Bone marrow suppression; Stomatitis; Diarrhea; Hair loss • Leukopenia and thrombocytopenia may cause cycles of chemotherapy to be delayed until blood cell counts can be raised • Damage gonads causing fertility problems

6. Cell Cycle Nonspecific Drugs: Contraindications and Precautions • Antineoplastic drugs are contraindicated in patients with: • Leukopenia; Thrombocytopenia; Anemia; Serious infections; Renal disease; Hypersensitivity to drug; During pregnancy or lactation • Used cautiously in patients with: • Renal or hepatic impairment; Active infection; Debilitating illnesses; Those who have completed treatment with other antineoplastic drugs or radiation therapy

7. Cell Cycle Nonspecific Drugs: Interactions

8. Cell Cycle Nonspecific Drugs: Interactions (cont’d)

9. Cell Cycle Nonspecific Drugs: Interactions (cont’d)

10. Cell Cycle Nonspecific Drugs: Interactions (cont’d)

11. Cell Cycle Nonspecific Drugs: Interactions (cont’d)

12. Nursing Process:Assessment • Preadministration assessment: • Initial assessment: • The type and location of the neoplastic lesion • The stage of the disease • Patient’s general physical condition, emotional response to the disease • Anxiety or fears the patient may have regarding chemotherapy treatments

13. Nursing Process:Assessment • Preadministration assessment: • Initial assessment (cont’d): • Previous, concurrent treatments • Current nonmalignant disease or disorder • The patient’s knowledge or understanding of the proposed chemotherapy regimen • Other factors

14. Nursing Process:Assessment (cont’d) • Ongoing assessment: • The patient’s general condition • The patient’s individual response to the drug • Adverse reactions that may occur • Guidelines established by the primary health care provider or hospital • Results of periodic laboratory tests and radiographic scans

15. Nursing Process: Nursing Diagnoses • Imbalanced nutrition: Less than body requirements • Fatigue • Risk for injury • Risk for infection • Disturbed body image • Anxiety • Impaired tissue integrity

16. Nursing Process: Planning • Expected outcomes: • An optimal response to therapy • Support of patient needs related to the management of adverse reactions • Understanding of prescribed treatment modalities

17. Nursing Process: Implementation • Promoting an optimal response to therapy: • Guidelines established by the setting for care: • Increase frequency of monitoring vital signs, if patient’s condition changes • Incorporate guidelines into nursing care plan with nursing observations and assessments geared to individual • Add further assessments to nursing care plan when patient’s condition changes

18. Nursing Process: Implementation • Promoting an optimal response to therapy: • Guidelines established by the setting for care (cont’d): • Consult references to obtain information regarding preparation and administration of drug, average dose ranges, all adverse reactions, warnings and precautions given by manufacturer

19. Nursing Process: Implementation • Promoting an optimal response to therapy (cont’d): • Protection of the provider: • The Occupational Safety and Health Administration (OSHA) guidelines • Nurses need to beprotected during administration and cleanup from accidental ingestion, inhalation, or absorption of drugs

20. Nursing Process: Implementation • Promoting an optimal response to therapy (cont’d): • Oral Administration: • Administer antineoplastic drugs orally • GI tract functions normally whenoral drugs are well absorbed

21. Nursing Process: Implementation • Promoting an optimal response to therapy (cont’d): • Parenteral administration: • Give injection into large muscles using Z-track method • Sites should be rotated, charted appropriately if the injections are given frequently

22. Nursing Process: Implementation • Monitoring and managing patient needs: • Imbalanced nutrition: Less than body requirements • Assess nutritional status of patient before and during treatment • Provide small, frequent meals to coincide with patient’s tolerance for food to stimulate appetite • Stress importance of eating meals high in nutritive value, particularly protein

23. Nursing Process: Implementation • Monitoring and managing patient needs: • Imbalanced nutrition: Less than body requirements (cont’d): • Monitor patient’s body weight weekly and report any weight loss • Provide soft or liquid food high in nutritive value • Report white patches on tongue, throat, gums; Burning sensation; Bleeding from mouth or gums

24. Nursing Process: Implementation • Monitoring and managing patient needs (cont’d): • Fatigue, infection and injury: Myelosuppression • Help patient learn to prioritize activity to conserve energy • Monitor patients with thrombocytopenia for bleeding tendencies and take precautions to prevent bleeding

25. Nursing Process: Implementation • Monitoring and managing patient needs (cont’d): • Fatigue, infection and injury: Myelosuppression (cont’d): • Apply pressure to injection site for 3 to 5 minutes to prevent bleeding into tissue and formation of hematoma • Inform patient to avoid use of electric razors, nail trimmers, dental floss, firm toothbrushes, any sharp objects

26. Nursing Process: Implementation • Monitoring and managing patient needs (cont’d): • Disturbed body image: Inform patient that hair loss may occur if hair loss is associated with antineoplastic drug being given • Forewarn patient that hair loss may occur suddenly and in large amounts • Assist in making plans for purchase of wig or cap to disguise hair loss until hair grows back

27. Nursing Process: Implementation • Monitoring and managing patient needs (cont’d): • Anxiety: Offer empathetic, emotional support to patient, and family members • Impaired tissue integrity: Instruct patient about adverse reaction as it can be both surprising and painful • Ensure that extravasation protocol orders are signed and extravasation kit is on unit before vesicant drugs are administered

28. Nursing Process: Implementation • Monitoring and managing patient needs (cont’d): • Impaired tissue integrity (cont’d): • Monitor IV site continuously and check for blood return frequently during IV push procedures • Keep extravasation kit containing all materials necessary to manage extravasation available, along with extravasation policy and procedure guidelines

29. Nursing Process: Implementation • Educating the patient and family: • Take drug only as directed and do not alter the dose unless advised • All recommendations given by the primary health care provider are important • Effectiveness or action of the drug could be altered if these directions are ignored • Keep all appointments for chemotherapy

30. Nursing Process: Implementation • Educating the patient and family (cont’d): • Do not take nonprescription drug unless approved by primary healthcare provider • Avoid drinking alcoholic beverages unless approved by PCP • Inform physicians, dentists, medical personnel of therapy with this drug • Keep all appointments for laboratory tests ordered by the primary health care provider

31. Nursing Process: Evaluation • The therapeutic effect is achieved • Adverse reactions are identified, reported and managed • Anxiety is reduced • The patient verbalizes: • An understanding of the dosage regimen; Understanding of treatment modalities; Importance of continued follow-up care; Complying with the prescribed therapeutic regimen

32. End of Presentation