ANTINEOPLASTIC MEDICATIONS

JAMILA JANE UY BORLAGDAN, RN

ANTINEOPLASTIC MEDICATIONS
Antineoplastic medications kill or inhibit the reproduction of neoplastic cells.
Antineoplastic medications are used to cure, increase survival time, and decrease
life-threatening complications.
Cell cycle phase-specific medications affect cells only during a certain phase of the
reproductive cycle
Cell cycle phase-nonspecific medications affect cells during any phase of the
reproductive cycle
Several medications used in combination to increase therapeutic response

Chemotherapy dosing is usually based on TBSA which requires a current, accurate

weight and height for BSA calculation to ensure that the client receives optimal doses
of chemotherapy medications

ANTINEOPLASTIC MEDICATIONS
Cell cycle phase-nonspecific agents:
Alkylating agents
Antitumor antibiotics
Cell cycle phase-specific agents:

Antimetabolites (S phase)
Mitotic inhibitors (M phase)
Topoisomerase inhibitors (G2 and S phase)

SIDE EFFECTS
Mucositis
Alopecia
Anorexia, nausea, and vomiting

Diarrhea
Anemia
Neutropenia

Thrombocytopenia
Infertility, sexual alterations

GENERAL INTERVENTIONS
Physiological integrity
Monitor CBC, WBC count, platelet count, uric acid level, and electrolytes
Initiate bleeding precautions if thrombocytopenia occurs

When the platelet count is less than 50,000 cells/mm3, minor trauma can lead to
episodes of prolonged bleeding; when less than 20,000 cells/mm3, spontaneous and
uncontrollable bleeding can occur
Monitor for petechiae, ecchymosis, bleeding of the gums, and nosebleeds

Avoid IM injections and venipunctures as much as possible to prevent bleeding

Initiate neutropenic precautions if the WBC count decreases

GENERAL INTERVENTIONS
Monitor for fever, sore throat, unusual bleeding, or signs and symptoms of
infection
Inform the client that loss of appetite also may be the result of taste changes
or a bitter taste in the mouth from the medications
Monitor for nausea and vomiting and provide a high-calorie diet with protein
supplements
Administer antiemetics several hours before chemotherapy and for 12-48
hours after
Encourage hydration: IV fluids before and after; at least 2L of fluid intake per
day

GENERAL INTERVENTIONS
Safe and effective care environment
Prepare IV chemo in an air-vented space (biohazard cabinet area)
Wear gloves, gown, eye protectors, and mask when handling IV medications
Pregnant nurses should avoid chemo preparation and administration

Discard IV equipment in designated containers

Administer medications precisely as prescribed
Monitor for phlebitis, extravasation with IV administration; heat or ice may be
applied to the site and an antidote may be injectednotify MD

GENERAL INTERVENTIONS
Psychosocial Integrity
Discuss possibility of hair loss (occurs at varying degrees) and options
(wearing a wig)

Inform client that new hair growth will occur several months after the final
treatment
Instruct client about need for contraceptionmedications have teratogenic
effects
Discuss possibility of infertility, which may be irreversible

GENERAL INTERVENTIONS
Health promotion and maintenance
Instruct pt to avoid hot foods and high-fiber foods if diarrhea is a problem
Inspect the oral mucosa frequently for ulcers and erythema, rinse mouth after meals,
and maintain good oral hygiene---mouth rinses for mouth sores and antifungal agents
for fungal infections
Instruct pt to avoid crowds and persons with infections and to report s/sx of infxn such
as low-grade fever, chills, or sore throat
Instruct individuals with colds and infections to wear a mask when visiting the pt

Instruct the pt to use a soft toothbrush and electric razor and avoid aspirin
Consult a doctor before receiving vaccinations

ANAPHYLACTIC REACTIONS
Precautions:
Obtain an allergy history
Administer a test dose when prescribed by the MD
Stay with the client during the administration of medication

Have emergency equipment and medications readily available

Provide an IV line for the administration of emergency medications if needed

ANAPHYLACTIC REACTIONS
Signs of an anaphylactic
reaction:
Dyspnea

Chest tightness or pain

Pruritus or urticaria
Tachycardia

Dizziness

Anxiety or agitation
Flushed appearance
Hypotension
Decreased sensorium

Cyanosis

ANAPHYLACTIC REACTIONS
Actions to take if an Anaphylactic Reaction Occurs From Medication:
Assess respiratory status
Stop the medication
Contact the MD
Administer oxygen
Maintain the IV access with normal saline
Raise the clients feet and legs if not contraindicated
Elevate HOB10 degrees if hypotensive; 45 degrees or more if BP normal
Administer prescribed emergency medications
Monitor vital signs
Document the event, actions taken and the clients response

ALKYLATING MEDICATIONS

Breaks DNA helix, thereby interfering with DNA replication

Cell cycle phase-nonspecific
Side effects: anorexia, nausea, and vomiting; stomatitis, rash, pain in IV site
Busulfan: hyperuricemia
Chlorambucil and mechlorethamine: gonadal suppression and
hyperuricemia
Cisplatin: ototoxicity, tinnitus, hypokalemia, hypocalcemia,
hypomagnesemia, and nephrotoxicity
Cyclophosphamide: alopecia, gonadal suppression, hemorrhagic cystitis
and hematuria

ALKYLATING MEDICATIONS
Nitrogen mustards
Bendamustine
Chlorambucil
Cyclophosphamide
Ifosfamide
Mechlorethamine
Melphalan
Nitrosureas

Carmustine
Lomustine
Streptozocin

Alkylating-Like Medications
Altretamine
Busulfan
Carboplatin
Cisplatin
Dacarbazine
Oxaliplatin
Temozolomide
Thiotepa

ALKYLATING MEDICATIONS: Interventions

Withhold medication if the platelet count is less than 75,000 cells/mm3 or the
neutrophil count is less than 2000 cells/mm3 and notify the MD
Assess results of pulmonary function tests
Assess results of CXR and renal and liver function tests
Hydrate the client with IV or oral fluids before administration
Reduce IV site pain by altering IV rates or warming injection site
Cisplatin: assess for dizziness, tinnitus, hearing loss, incoordination, and
numbness or tingling of extremities
Cyclophosphamide: administered without food; increase fluid intake to 23L/day
Low-purine diet to alkalinize urine and lower UA levels

ANTITUMOR ANTIBIOTIC MEDICATIONS

Interfere with DNA and RNA synthesis
Cell cycle phase-nonspecific medications
Bleomycin, Dactinomycin, Daunorubicin, Doxorubicin, Epirubicin, Idarubicin,
Mitomycin, Mitoxantrone
SE: N/V, fever, myelosuppression, rash, alopecia, stomatitis, gonadal
suppression, hyperuricemia, vesication
Daunorubicin: CHF, dysrhythmias
Doxorubicin: cardiotoxicity, cardiomyopathy, ECG changes
Bleomycin: pulmonary toxicity

ANTITUMOR ANTIBIOTIC MEDICATIONS:

Interventions
Withhold medication if the platelet count is less than 75,000 cells/mm3 or the
neutrophil count is less than 2000 cells/mm3 and notify the MD
Assess results of the pulmonary function tests
Monitor for ECG changes
Assess lung sounds for crackles
Assess for s/sx of CHF i.e. dyspnea, crackles, peripheral edema, and weight gain
Assess results of chest radiography and renal and liver function tests
Hydrate client with IV and oral fluids before administration
Reduce IV site pain by altering IV rates or warming injection site
Monitor IV site for irritation, phlebitis, and vesication, change site as needed
Bleomycin: assess pulmonary status
Doxorubicin/Idarubicin: assess for myocardial toxicity, dyspnea, arrhythmias,
hypotension, weight gain

ANTIMETABOLITE MEDICATIONS

Halt the synthesis of cell protein; their presence impairs cell division
Cell cycle specific: affects the S phase
Side effects: anorexia, N/V, diarrhea, alopecia, stomatitis, myelosuppression
Cytarabine: alopecia, stomatitis, hyperuricemia, hepatotoxicity
Fluorouracil: alopecia, stomatitis, diarrhea, phototoxicity, cerebellar
dysfunction
Mercaptopurine: hyperuricemia and hepatotoxicity
Methotrexate: alopecia, stomatitis, hyperuricemia, photosensitivity,
hepatotoxicity, haematological, gastrointestinal, and skin toxicity

ANTIMETABOLITE MEDICATIONS
Capecitabine

Hydroxyurea

Cladribine

Mercaptopurine

Clofarabine

Methotrexate

Cytarabine

Pemetrexed

Floxuridine

Pentostatin

Fludarabine

Thioguanine

Fluorouracil
Gemcitabine

ANTIMETABOLITE MEDICATIONS: Interventions

Withhold medication if the platelet count is less than 75,000 cells/mm3 or the
neutrophil count is less than 2000 cells/mm3 and notify the MD
Monitor renal function tests
Monitor for cerebellar dysfunction: dizziness, ataxia, weakness (Fluouracil)

Assess for photosensitivity (FU or MTX)use sunscreen and protective clothing

Monitor IV site for extravasation
Encourage fluid intake of 2-3L/day

Encourage good oral hygiene

Fluouracil: stomatitis and diarrhea warrant medication discontinuation

MITOTIC INHIBITORS (VINCA ALKALOIDS)

Prevent mitosis causing cell death; prevent cell division
Cell cycle phase-specific: act on M phase
SE: Leukopenia, neurotoxicity (vincristine), ptosis, hoarseness, motor
instability, anorexia, N/V, peripheral neuropathy, alopecia, stomatitis,
hyperuricemia, phlebitis at IV site

Vinca alkaloids: Vinblastine, Vincristine, Vinorelbine

Taxanes: Docetaxel, Paclitaxel

MITOTIC INHIBITORS: Interventions

Monitor for hoarseness
Assess eyes for ptosis
Assess motor stability and initiate safety precautons as necessary
Monitor for neurotoxicity with vincristine manifested as numbness and
tingling in the fingers and toes
Monitor for constipation and paralytic ileus

TOPOISOMERASE INHIBITORS
Blocks the enzyme needed for DNA synthesis and cell division
Cell cycle phase-specific; act on G2 and S phases
SE: pancytopenia, anorexia, N/V, diarrhea, alopecia, orthostatic hypotension,
hypersensitivity reaction
Etoposide, Irinotecan, Teniposide, Topotecan

HORMONAL MEDICATIONS AND ENZYMES

Suppress the immune system and block normal hormones in hormonesensitive tumors
Change the hormonal balance and slow the growth rates of certain tumors
SE: anorexia, N/V, leukopenia, impaired pancreatic function (asparaginase),
sexual alterations: feminizing effects in males, masculinization in females,
breast swelling, hot flashes, weight gain, hypertension, thromboembolic
disorders, edema, electrolyte imbalances
Tamoxifen: edema, hypercalcemia, elevated cholesterol and TG

Diethylstilbestrol: impotence, gynecomastia in men; may affect action of

insulin, oral anticoagulants, and OHA

HORMONAL MEDICATIONS AND ENZYMES

Estrogens
Diethylstilbestrol
Estramustine
Ethinyl estradiol
Antiestrogens
Anastrozole
Exemestane
Fulvestrant
Letrozole
Raloxifene
Tamoxifen
Toremifene

Antiandrogens
Bicalutamide
Flutamide
Goserelin
Nilutamide
Triptorelin
Progestins
Medroxyprogesterone
Megestrol acetate
Others
Asparaginase
Leuprolide acetate
Mitotane

HORMONAL MEDICATIONS AND ENZYMES:

interventions
Assess medications that are currently taken by client
Monitor serum calcium levels with androgens
Monitor for signs of sexual alterations
Monitor pancreatic fxn with asparaginase

Encourage oral fluid intake of 2-3 L/day

Monitor uric acid and cholesterol levels
Monitor for signs of hemorrhagic cystitis

IMMUNOMODULATORS: BIOLOGICAL
RESPONSE MODIFIERS
Immunomodulators stimulate the immune system to recognize cancer cells
and take action to eliminate and destroy them
Interleukins help different immune system cells recognize and destroy
abnormal body cells
Interferons slow tumor cell division, stimulate proliferation, and cause cancer
cells to differentiate into nonproliferative life forms
Colony-stimulating factors induce more rapid bone marrow recovery after
suppression by chemotherapy