Antineoplast ic Drugs

Submitted to: Zanita Glenda Plaga, R.N. Submitted by: Karizza Zoette Ann F. Alcarde BSN 2-A

ANTINEOPLASTIC AGENTS ALKYLATING DRUGS 1

Nitrogen Mustards Classification/Drug Group chlorambucil Trade Name/Brand Name Leukeran Benefits Treats Lymphocytic leukemia, lymphomas, and cancer of the breast and ovaries. Treats Breast, lung, ovarian cancers; Hodgkins disease; leukemia; lymphomas. An immunosuppressant agent. Progressive carcinoma of prostate Testicular Cancer, Lymphoma, Lung cancer and sarcomas. Mesna, an unprotective agent, is added to prevent hemmorhagic cystitis Hodgkins disease, solid tumors, and pleural effusion caused by cancer of the lung. Multiple myeloma, melanoma, and cancer of the breast, ovary and testes. Refractory anaplastic astrocytoma Chronic Lymphocyticand myelocytic leukemia; Non-Hodgkins; Cervix, ovary and lung cancer

cyclophosphamide

Cytoxan

estramustine phosphate sodium ifosfamide

Emeyt Ifex

mechorethamine hydrochloride melphalan

Mustargen

Alkeran

temozolomide uracil mustard

Temodar Uracil Mustrad

Nitrosoareas Classification/Drug Group carmustin carmustine with polifeprosan Trade Name/Brand Name BiCNU Cliadel Wafer Benefits Hodgkins Disease, multiple myeloma, melanoma, and brain tumors Chemotherapeutic Wafer implant used in addition to surgery for recurrent glioblastoma multiformto improve survival. Advanced Hodgkins disease and brain tumors Pancreatic islet cell tumor and cancer of the lung. May also be used for 2

lomustine streptozocin

CeeNU Zanosar

Hodgkins disease and colorectal cancer. Alkyl Sulfonates Classification/Drug Group Trade Name/Brand Name Myleran Benefits Myelocytic Leukemia. May be used as a preparation agent in bone marrow transplant

busulfan

Akylating-Like Drugs Trade Name/Brand Name Hexalen Benefits Ovarian Cancer. Also Used for breast, cervix, colon, endometrium, head/neck, and lung cancers; lymphomas Recurrent Ovarian Cancer. May be used as a preparation agent in bone marrow transplant Ovarian testicular cancer. Used as adjunctive treatment. Has been used for cancer of the bladder, head and neck, and endometrium. Metastatic colorectal cancer. Used with 5-FU and leucovorin. Ovarian cancer, Head and neck cancer, and malignant melanoma. Metastatic malignant melanoma, sarcomas, neuroblastoma, and refractory Hodgkins disease. Polycythemia and chronic myelocytic leukemia Palliative therapy, especially breast and ovarian cancer

Classification/Drug Group altretamine

carboplatin

Paraplatin

cisplatin

Platinol, CDDP

oxalipatin

Eloxatin

dacarbazine

DTIC

pipobroman thiotepa

Vercyte Thioplex

NURSING PROCESS Assessment

 Assess complete blood count (CBC), differential, and platelet count weekly. Drug may be withheld if RBC, WBC or platelet counts drop below predetermined level. Conduct thorough physical assessment; document findings. Nursing Diagnosis Risk for infection R/T bone marrow depression. Risk for imbalanced nutrition; less than body requirements R/T gastrointestinal side effects of chemotherapy. Risk for impaired urinary elimination R/T hemorrhagic cystitis caused by chemotherapy. Risk for abdominal bleeding R/T effects of the chemotherapy on the lining of the bladder and/or bone marrow depression. Planning Client will have WBC, RBC, and platelet counts at desired range Client will remain free of infection Client will maintain nutritional status (adequate fluid intake and output, sufficient caloric intake, stable weight) Client will maintain adequate urinary output Nursing Interventions Monitor blood counts and laboratory values Handle drug with care during preparation and administration; avoid direct skin, eye, and mucous membrane contact with anticancer drugs. Follow protocols. Monitor IV site frequently for irritation and phlebitis. Administer antiemetic 30-60 mins before giving drug. Hydrate client with IV and/or oral fluids before chemotherapy is administered Monitor blood, urea, nitrogen (BUN), and creatinine prior to administration Evaluation Client was free from infection Client maintained target weight Client maintained nutritional status Client did not develop hemorrhagic cystitis

Assess results of pulmonary function tests, chest radiographs, and renal and liver function studies during therapy Assess temperature; fever may be an early sign of infection Monitor adequate intake and output.

Deficient knowledge (patient/family/caregivers) R/T chemotherapeutic protocol. Risk for sexual dysfunction R/T interference with normal menstrual cycle (in females) or lack of sperm production (in males). Disturbed body image R/T hair thinning and/or loss.

Client will remain free of symptoms of hemorrhagic cystitis Client/family/caregiver will demonstrate understanding f chemotherapeutic protocol (e.g dose, administration, side effects, adverse reactions)

Assess for sign and symptoms of hematuria, urinary frequency, or dysuria. Teah client to empty bladder every 2-3 hours. Increase fluids 2-3 L/day to reduce the risk of hemorrhagic cystitis, ureate deposition, or calculus formation. Monitor fluid intake and output and nutritional intake Maintain strict medical asepsis during dressing changes and invasive procedures.

Client/Family/Caregiver education need were met Question related to sexuality were answered. 4

ANTIMETABOLITES Folic Acid Antagonist Trade Name/Brand Name Amethopterine Benefits Solid Tumors, sarcomas, leukemia. A multitargeted antifolateto treat mesothelioma and small lung cancer

Classification/Drug Group methotrexate pemetrexed disodium

Alimta

Pyrimidine Analogues Trade Name/Brand Name Benefits Solid Tumors, sarcoma, choriocarcinoma, leukemia Acute Leukemias and Lymphomas. Also used as an immunosuppressive drug after organ transplant. May be used in combination with other anticancer drugs. Metastatic colon cancer and hematomas. Cancer of breast, cervix colon, liver, ovary, pancreas, stomach, and rectum. Given in combination with levamisole after surgical resection in clients with Dukes stage C colon cancer Advanced or metastatic adenocarcinoma of the pancreas, non-small cell lung cancer and bladder cancer and bladder cancer. Treatment for refractory or relapsed T-cell lymphoblastic leukemia and T-cell lymphoblastic lymphoma. Palliative treatment for 5

Classification/Drug Group capecitabine Xeloda

cytarabine HCl

Cytosar-U, ARA-C

floxuridine

FUDR

5-Fluorouracil

5-FU, Adrucil

gemcitabine HCl

Gemzar

nelarabine

Arranon

procarbazine HCl

Mutalane

azacitidine Purine analogues

Vidaza

advanced Hodgkins disease and for solid tumors. May be used with other anti-cancer drugs. Treatment for chronic myelomonocytic leukemia.

Classification/Drug Group cladribine

Trade Name/Brand Name Leustatin

Benefits For treatment of hairy cell leukemia and chronic lymphocyte leukemia. To treat refractory or relapse acute lymphoblastic leukemia in children. Chronic lymphocytic leukemia in clients who have not responded to other alkylating drugs; lowgrade non-hodgkins lymphoma. First used in 1952 for treatuing acute leukemia. Also used as immunosuppressive drug. Acute and chronic myelogous leukemia.

clofarabine

Clolar

fludarabine

Fludara

6-Mercaptopurine

Purinethol

thioguanine Ribonucleotide Reductase Inhibitor

Lanvis

Classification/Drug Group hydroxyurea

Trade Name/Brand Name Hydrea

Benefits Melanoma, resistant chronic myelocytic leukemia and ovarian cancer. Alternative drug therapy for pneumocystis carinii pneumonia; treatment for clients with AIDS. May be used or colorectal cancer.

trimetrexate gluconate

Neutrexin

Enzyme inhibitor Trade Name/Brand Name Benefits 6

Classification/Drug Group

pentostatin

Nipent

Hairy cell leukemia refractory to alpha-interferon.

NURSING PROCESS Assessment Assess complete blood count (CBC), differential and platelet count weekly. Chemotherapy may be held if RBC, WBC or platelet counts drop below predetermined levels Conduct thorough physical assessment; document findings. Assess renal function studies before and during drug therapy Assess temperature; fever may be an early sign for infection

Nursing Diagnosis Risk for infection R/T bone marrow depression Risk for imbalanced nutrition: less than body requirements R/T GI side effects of chemotherapy Risk for acute pain (mucositis/stomatitis) R/T GI side effect of chemotherapy Risk for impaired perianal skinintegrity R/T diarrhea cause by chemotherapy Deficient knowledge (client/family) R/T chemotherapeutic protocol

Planning Client blood counts will remain in the desired range Client will maintain nutritional status (adequate fluid intake and output, adequate caloric intake, stable weight) Client will have adequate client pain control Nursing interventions Monitor blood glucose and laboratory values Handle drug with care during preparation and administration; avoid direct skinc contact with anticancer drugs. Follow protocols. Monitor IV site frequently. Extravasation produces severe pain. If this occurs, apply ice pack and notify health care providers. Client will limit exposure to sunlight Client/family/caregiver will demonstrate understanding of chemotherapeutic protocol (dose, administration, side effects and adverse reactions)

Administer 30-6o mins before drug to prevent vomiting. Assess for hyperpigmentation along the vein in which 5-FU was administered. Offer client food and fluids that my decrease nausea (e.g cola, crackers, ginger ale) Plan small, frequent meals.

Maintain strict medical asepsis during dressing changes and invasive procedures Support good oral hygiene; brush teeth with soft toothbrush and use waxed dental floss

Encourage mouth rinsesevery 2 hours with normal saline Monitor fluid intake and output and nutritional intake. GI effects are common on the fourth day of treatment.

Evaluation Client was free of infection Oral mucosa was free of erythema and swelling Pain was controlled Skin integrity remained intact Questions regarding sexuality were answered

ANTITUMOR ANTIBIOTICS Classification/Drug Group Trade Name/Brand Name Benefits Squamous cell canrcinomas, testicular tumor (when used with viniblastine and cisplatin) and lymhpomas. Testicular tumors, Wilms Tumor, choriocarcinoma, and rhabdomyosarcoma. Leukemia, Ewings sarcoma, Wilms tumor, neurobalstoma, and non-Hodgkins lymphoma Breast, bladder, ovarian and lung cancers; leukemias, lymphomas, soft tissue and bone sarcoma. Cancers of breast, lung and lymph system, stomach, and ovaries. Metastatic nodepositive breast cancer; adjuvant with anticancer therapy. May be used in combination therapy with cyclophosphamide and fluorouracil (CEF) for breast cancer; improved survival rate over cyclohposphamide, methotrexate, and fluorouracil (CMF) 8

bleomycin

Blenoxane

dactinomycin

Actinomycin D, Cosmegen

daunorobicin HCl

Cerubidin

doxorubicin

Adriamycin

epirubicin

Eilence

Idarubicin

Idamycin

mitomycin

Mutamycin

mitoxantrone plicamycin valrubicin

Novantrone Mithracin Valstar NURSING PROCESS

Acute monocytic leukemia and solid tumors. More potent than daunorobicin and doxorubicin. Dessimenated adenocarcinoma of breast, stomach and pancreas. Also used for cancer of the head, neck, cervix and lung. Acute nonlymphocytic leukemia; may be used for breast cancer Testicular cancer. May be used to treat hypercalemia Bladder cancer

Assessment Assess complete blood count (CBC), differential and platelet count weekly. Chemotheraopy may be held if RBC, WBC or platelet counts drop below predetermined levels. Conduct thorough physical assessment; document findings. Assess temperature; fever may be an early sign for infection Assess plans for pregnancy (if appropriate)

Planning Client will maintain blood cell values in the desired range Client will be free of cardiac dysfunction Clients skin integrity will remain intact Client/family/caregivers will demonstrate understanding of the Nursing Intervention Monitor blood counts and laboratory values Assess cardiac status Handle drug with care during preparation; avoid direct skin contact with drug Monitor IV site frequently. Doxorubicin is a severe vesicant whose effects are not immediately apparent. Give drug chemotherapy regimen, including side effects. Assess client/family/caregiver knowledge related to chemotherapeutic protocol

through a large bore quickly running IV infusion Tissue necrosis may occur 3-4 weeks after infiltration into tissue. Extravasation produces severe pain. If this occurs apply ice pack and notify health care provider Administer antiemetic 30-60 mins before chemotherapy

Monitor for changes in urine color (pink-red). The drug is red and is excreted in the urine. Offer client food and fluids that may decrease nausea (e.g cola, crackers, ginger ale) Plan small frequent meals Administer prophylactic antibiotics to prevent infection Evaluation Client was free from infection Cardiac function was maintained Client and family education need were met

Offer analgesics for pain as prescribed Maintain strict medical asepsis during dressing changes and invasive procedures Support good oral hygiene, use soft oral toothbrush. Use waxed dental floss Monitor fluid intake and output and nutritional intake

Side effects of therapy were controlled Client/family/caregiver education needs were met

MITOTIC INHIBITORS Mitotic Inhibitors Trade Name/Brand Name Classification/Drug Group Cancer of the testes, beast and kidnet and for treatment of lymphomas, lymhosarcomas and neuroblastomas Cancer of the breast, lungs and cervix; multuiple myelomas, sarcoma, lymphomas and Wilms tumor. Used for treating Hodgkins disease in combination therapy , MOPP (mechlorethamine, vincristine, procarbazine, and prednizone) First-line treatment for ambulatory clients with advanced, unresectable nonsmall cell lung cancer (NSCLC). Benefits

vinblastin SO4

Velban

vincristine SO4

Oncovin

vinorelbine

Navelbine

Antimicrotubules Trade Name/Brand Name Benefits 10

Classification/Drug Group

docetaxel paclitaxel

Taxotere Taxol

Advanced or metastatic breast cancer. Metastatic ovarian and breast cancer.

NURSING PROCESS Assessment Assess baseline condition of patient before and during chemotherapy treatment Assess CBC, differential, and platelet count weekly Monitor bilurubin levels. Dose may be reduced if bilirubin levels are >1.5 mg/dl Conduct thorough physical assessment and document findings. Be especially aware of evidence of neurotoxicity, because this is a dose limiting toxicity. Assess for sign of peripheral neuropathy (numbness or tingling of toes or fingers), loss of deep tendon reflexes, foot drop, slapping gait, difficulty walking. Monitor bowel function. Automatic neuropathy may lead to constipation and paralytic ileus, th use of vincristine (Oncovin) and narcotic agents may increase the risk for constipation. Assess temperature; fever may be an early sign of infection Monitor acute bronchospasm Assess plans for pregnancy (if appropriate) Evaluate patient/family/caregiver knowledge of drug therapy

Nursing Diagnosis Risk for infection R/T bone marrow depression Risk for constipation R/T neuropathic side effects of chemotherapy Risk for injury R/T neuropathic side effects of chemotherapy Deficient knowledge R/T antineoplastic therapy

Planning Client will maintain blood cell values in the desired range Client will maintain adequate bowel function Client will be free of neuropathic dysfunction Nursing Intervention Monitor blood counts and laboratory values Assess bowel function Client/family/caregivers will demonstrate understanding of the chemotherapy regimen, including side effects.

Administer stool softener or laxative as prescribed. Monitor signs of peripheral neuropathy (numbness and/or tingling of fingers 11

and toes), sensory loss, loss of deep tendon reflexes, paresthesia, foot drop, wrist drop, and ataxia. Assess IV site carefully, vincristine (Oncovin) is a sever vesicant whose effects are not immediately apparent. Give drug through a large bore, quickly running IV infusion over one minute. Tissue necrosis may occur 3-4 weeks after infiltration into tissue. Extravasation produces severe pain. If this occurs apply ice pack and notify Evaluation Client was free from infection Bowel function was maintained Peripheral neuropathy did not occur Side effects of therapy were controlled Extravasation and tissue necrosis did not occur Client/family/caregiver education needs were met

health care provider. Apply heat intermittently every two hours for 24 hours. Give hyaluronidase into infiltrated area, pre physician order. Administer antiemetic 30-60 mins before chemotherapy, or as prescribed Monitor fluid intake and output and nutritional intake Maintain strict medical asepsis during dressing changes and invasive procedures

HORMONES, HORMONE ANTAGONIST and ENZYME Androgen Trade Name/Brand Name Classification/Drug Group testolactone progesterone Teslac Palliative treatment in postmenopausal women Palliative treatment of endometrial and breast carcinoma Benefits

Gesterol 50

Hormonal antagonist Trade Name/Brand Name Benefits Adrenal carcinoma, ectopic adrenocorticotropic hormone (ACTH)-producing tumors. Suppresses adrenal activity. May be used in breast cancer therapy Advanced breast cancer in 12

Classification/Drug Group

aminoglutethimide

Cytadren

anastrozole

Arimidex

postmenopausal women. bicalutamide exemestane Casodex Aromasin Advanced metastatic prostatic carcinoma Advanced breast cancer in postmenopausal women. Prostate cancer Metastatic prostatic carcinoma, usually in combination with other anticancer drugs Treatment for hormone-receptor positive metastatic breast cancer in postmenopausal women whose disease has progressed after antiestrogen therapy. Treatment for prostate cancer. Metastatic prostatic carcinoma. May be used in breast cancer endometriosis. Advanced breast cancer in post menopausal women. Used to slow the growth of prostate cancer. May be sued to treat endometriosis. Palliative treatment for advanced carcinoma of breast and endometrium Palliative treatment of inoperable adrenal cortical carcinoma. Prostatic Carcinoma Palliative treatment of inoperable prostatic carcinoma. Palliative treatment of advanced breast carcinoma with positive lymph nodes in postmenopausal women Selective estrogen receptor modulator (SERM) originally approved to fight osteoporosis in postmenopausal women 13

flutamide

Eulexin

fulvestrant

Faslodex

goserelin acetate

Zoladex

histrelin acetate implant jetrozole

Vantas Femara

leuprolide

Lupron

megestrol acetate

Megace

mitotane nilutamide polyestradiol PO4

Lysodren Nilandron Estrdurin

tamoxifen citrate

Nolvadex

raloxifene

Evista

toremifene citrate Miscellaneous enzyme

Fareston

Advanced breast cancerin postmenopausal women.

Classification/Drug Group L-aspargine pegaspargase

Trade Name/Brand Name Elspar Oncaspar

Benefits Acute lymphocytic leukemia. Acute lymphocytic leukemia. Interferes with the DNA, RNA and protein synthesis.

BIOLOGIC THERAPIES Cytokines Trade Name/Brand Name Benefits Multiple myeloma, chronic leukemia, hairy cell leukemia, malignant malenoma, AIDS related Kaposi sarcoma Hairy cell leukemia, AIDS relatred Kaposi sarcoma, malignant melanoma Merastatic

Classification/Drug Group

Interferon alpha 2a

Roferon-A

Interferon alpha-2b Interleukin-2, aldesleuin Vaccines

Intron-A, IFN-alpha 2 Proleukin

Classification/Drug Group

Trade Name/Brand Name

Hepatitis B

Energix-B, Recombivax HB

gardasil

Quadrivalent human papiloma virus [types 6, 11, 16, 18] recombivant vaccine

cervarix

cervarix

Benefits First anticancer vaccine. Prevents hepatitis B disease and its serious consequences like hepatocellular carcinoma Used for prevention of human papiloma varus type 6, type 11 (genital warts), type 16, and type 18 (cervical cancer) Prevent cervical cancer and precancerous lesions associated with most common cancercausing HPV types.

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