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Antineoplastics and Antianemics

Antineoplastics and Antianemics. Pharmacology I NURS 1950. Objective 1: Describe the general factors utilized to select the therapy used to treat cancer. Objective 2: Describe the general uses of chemotherapy in the treatment of cancer.

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Antineoplastics and Antianemics

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  1. Antineoplastics and Antianemics Pharmacology I NURS 1950

  2. Objective 1: Describe the general factors utilized to select the therapy used to treat cancer

  3. Objective 2: Describe the general uses of chemotherapy in the treatment of cancer

  4. Objective 3: Identify the basic types of antineoplastic drugs

  5. Alkylating agents • Antimetabolites • Natural products • Antineoplastic antibiotics • Hormones • Biologic response modifiers & Misc.

  6. Alkylating Agents • Bond with DNA so it can’t separate = no replication • Cell-cycle nonspecific • Resistance can be a problem • Creates cross resistance with other alkylating agents

  7. Alkylating agents: non cell cycle specific drugs • Activity occurs when the cell tries to replicate and the DNA can not separate

  8. Drugs included • Busulfan (Myleran) • Carboplatin (Paraplatin) • Carmustine (BCNU) • Chloramubil (Leukeran) • Cisplatin (Platinol) • Cyclophosphamide (Cytoxan)

  9. Fudarabine (Fludara) • Lomustine (CCNU, CeeNU) • Mechlorethamine (Nitrogen mustard, Mustargen) • Melphalan (Alkeran) • Streptozocin (Zanosar) • Thiotepa

  10. In general, toxicities include • N/V, anorexia • Bone marrow depression • Anemia • Nephrotoxicity • Hepatic and renal toxicity • Alopecia • Cystitis

  11. Each drug may have specific toxicities • Example: Zanosar causes hypoglycemia

  12. Antimetabolites • Drugs included • Capecitabine (Xeloda) • Cytarabine hydrochloride (Cytosar) • Fludarabine (Fludara) • Flurouracil (5-FU, FU) • Gemcitabine (Gemzar)

  13. Mercaptopurine (6-MP, Purinethol) • Methotrexate (MTX) • Thioguanine (Lanvis)

  14. Antimetabolites are subclassed as folic acid, purine, and pyrimidine antagonists • Inhibit key enzymes in biosynthetic pathways of DNA and RNA synthesis • Many are cell-cycle specific (S phase)

  15. In general, toxicities include • N/V, diarrhea, constipation, fatigue • Bone marrow depression, dermatitis • Oral and GI ulceration

  16. Natural Products/mitotic inhibitors • Come from periwinkle plant, specific yews • Cell-cycle specific: block mitotic spindle during mitosis

  17. Drugs include • Etoposide (VePesid) • Docetaxel (Taxotere) • Paclitaxel • Vinblastine sulfate (Velban, Velbe) • Vincristine sulfate (Oncovin) • Vinorelbine (Navelbine)

  18. General toxicities • N/V, stomatitis • Leukopenia with VePesid: nadir in 10-14 days, recovery 3 weeks • Bone marrow suppression, alopecia, peripheral neuritis, hepatotoxicity, bronchospasm

  19. Antineoplastic Antibiotics • Bind to DNA, inhibit DNA, RNA synthesis • Cell-cycle nonspecific

  20. Drugs include • Bleomycin (Blenoxane) • Dactinomycin (Actinomycin D, Cosmegen) • Daunorubicin (Cerubidine) • Doxorubicin (Adriamycin) • Epirubicin (Ellence)

  21. Idarubicin • Mitomycin C • Mitoxantrone • Plicamycin • Valrubicin

  22. Generally, toxicities include • N/V, red tinged urine with some • Bone marrow depression • Cardiotoxicity • Pulmonary fibrosis (Bleomycin) • GI bleeding, CNS effects with some

  23. Hormones • Corticosteroids: lymphoma and acute leukemia as suppress mitosis in lymphocytes • Help restore sense of well being, decrease edema with radiation, increase appetite and strength

  24. Estrogens and androgens: malignancies of sexual organs • Use estrogen for prostate cancer (suppress the amount of androgen available) • Use androgens for breast cancer (suppress the amount of estrogen available)

  25. Drugs included • Anastrozole (Arimidex) • Diethylstilbestrol (DES) • Prednisone • Tamoxifen (Nolvadex) • Testolactone (Teslac) • Testosterone

  26. General toxicities • N/V, headache • Fluid retention, feminization or masculinization • Hot flashes • Some can cause thrombocytopenia, leukopenia, hypercalcemia, increased bone and tumor pain

  27. Biologic response modifiers • Drugs included • Altretamine (Hexalen) • Dacarbazine (DTIC-dome) • Hydroxyurea (Hydrea) • Interferon alfa-2b (Roferon-a) • Leuprolide acetate (Lupron)

  28. Toxicities in general • N/V, hot flashes, bone marrow depression, arrhythmias • Flulike syndrome • Anemia, leukopenia

  29. Immunomodulators • Drugs used as adjunct therapy • Epoetin alfa (Procrit) stimulates production of red blood cells • Used to treat anemia induced by chemotherapy

  30. Filgastim (Neupogen) stimulates the production of neutrophils (WBC)

  31. Oprelvekin (Neumega) stimulates platelet production at stem cell level

  32. Rituximab (Rituxan) binds to the surface of B lymphocytes • Used to treat relapsed B-cell non-Hodgkin’s lymphoma

  33. Sargramostim (Leukine) stimulates the production of granulocytes and macrophages • Also helpful in aplastic anemia

  34. Trastuzumab (Herceptin) inhibits growth of tumor cells (especially useful in metastatic breast cancer)

  35. Chemoprotective Agents • Amifostine (Ethyol) reduces toxic effects of cisplatin • Reduces renal toxicity

  36. Dexrazoxane (Zinecard) used with doxorubicin • Reduces cardiomyopathy

  37. Mesna (Mesnex) reduces toxic effects of Ifex and Cytoxan • Reduces hemorrhagic cystitis

  38. New class: antiangiogenesis • Prevent new blood vessels

  39. Objective 4: identify the 2 factors that play a major role in the response of the cancer cell to the antineoplastic drug • Tumor size • Rate of cell replication

  40. Objective 5: describe what “tumor resistance” means • Tumor cells are not as susceptible to antineoplastic agents as they should be • Cells escape damage from the drugs

  41. Objective 6: specify which normal cells are frequently affected by antineoplastic therapy; and signs and symptoms that result most frequently

  42. Normal cells responding to chemotherapy • Rapidly growing cells • GI tract • Hair follicles • RBCs, WBCs, platelets

  43. Side effects/toxicities to expect • GI tract: N/V, diarrhea or constipation, stomatitis • Take PRN medications as needed • Will have pre-treatment drugs for N/V • Stomatitis requires good oral hygiene, mouth wash with local anesthetic • Weekly weights

  44. Diarrhea: skin care a must • Avoid foods that stimulate bowel motility • Eat foods high in K+ (loose it with diarrhea)

  45. Alopecia • Hair will begin to fall out in clumps • Devastating—cut hair short; get wigs, caps, turbans

  46. Skin care: lukewarm water, mild soap • Keep skin clean and dry • If drugs cause photosensitivity, avoid sun • Skin creams available from MD to heal, protect • Especially important with radiation

  47. Decreased RBCs = decreased 02 transport • May receive Procrit • May have blood transfusion • Need to rest often • Avoid orthostatic hypotension

  48. Neutropenia: avoid crowds (infections) • Neupogen may be used • Meticulous care of central lines needed

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