Antineoplastics / Chemotherapeutic Agents Emphasize protective isolation

• Objectives:
1. to destroy all malignant cells without excessive destruction of normal cells.
2. to control tumor growth if cure is no longer possible.

• Affect neoplastic and normal cells

 INTERVENTIONS: (CANCER)
A. UNDESIRABLE effects: (BARFS) CBC, platelets, uric acid – monitor
Bone marrow depression ( WBC, RBC, Plt Ct.)  WBC < 4000 cells/ ul notify MD
 Avoid crowd, protect from infection.  Platelet Ct < 75,000
 Frequent rest periods.  Uric acid > 8 mg/dl (hyperuricemia due to massive cell destruction)
 Bleeding protocol, Avoid ASA • Tx: Allopurinol
 Consult MD before receiving vaccination. • Low purine diet --> help alkalinize urine

Alopecia Antiemetics before drug.

 Reassure its temporary • ondansetron, granisetron
 Wigs
• dronabinol, haloperidol
• alprazolam, lorazepam
Retching –- nausea / vomiting • prochlorperazine
 Antiemetics 30-60 min before chemo drug.
 Replace fluids & electrolyte losses
 Small, frequent meals
Nephrotoxicity / hemorrhagic cystitis – SE
 provide 2-3 L of fluids per day
Fear & anxiety
 pretreatment counseling.
Counselling regarding reproductive issues
 category X drugs ---> teratogenic effects
 gonadal suppression --> infertility
Stomatitis
 good oral hygiene
 avoid hot & spicy foods.
Encourage handwashing, avoid crowds.

Recommend wig for alopecia.

B. INTERVENTIONS: (METABOLITE)
Monitor CBC & platelets weekly
 Contraindications:
Evaluate renal function tests.
 Infection. -->Chemo drugs are immunosuppressives.
Temperature assessment q 4-6 hrs.  Recent surgery. --> They retard healing.
Asepsis – strict
 Impaired kidney/ liver function. --> nephrotoxic & hepatotoxic.
 Pregnancy.--> congenital defects
Bleeding, anemia, infection & nausea – report  Bone marrow depression --> aggravate blood dyscrasia
Oral hygiene – soft toothbrush

Lots of fluids (2 -3 L / day)

Intake & output, nutritional intake – monitor

The protocol for handling chemo drugs must be followed.

 SE: BARFS:
• cytarabine
• 5- Fluorouracil (5 FU) –cerebellar dysfunction photosensitivity reactions
CHEMOTHERAPEUTIC AGENTS: • methotrexate (MTX)
• Cell-cycle phase-specific --> affect cells only in certain phase of reproductive cycle. o Given with leucovorin (folinic acid or citrovorum factor)
o Antimetabolites (affect S phase) --> protect normal cells from damage from MTX
o Mitotic inhibitors / Vinca alkaloids (affect M phase)
• 6 mercaptopurine --> hyperuricemia & hepatotoxicity
• Cell cycle phase-nonspecific --> affect cells in any phase of cycle.
o Alkylating agents
o Antitumor antibiotics IV. Mitotic Inhibitors (Vinca alkaloids):
Action: prevent cell division: cell-cycle specific --> affect M phase
I. Alkylating Agents :
SE:
Action: alters DNA of cancer cells --> cell death
• vincristine (Oncovin) --> neurotoxicity (numbness & tingling in fingers & toes)
Indic: leukemia, lymphomas, breast, lung, ovarian CA
• vinblastine
1. Nitrogen mustards • etoposide
 chlorambucil (Leukeran)
 cyclophosphamide (Cytoxan) V. Hormonal medications:
 mechlorethamine (Mustargen) Action: block normal hormones in hormone-sensitive tumors.
 ifosfamide
Indic :metastatic breast CA
2. Alkylating-like
 busulfan (Myleran) SE:
 cisplatin (Platinol) • asparaginase --> pancreatic dysfunction
• tamoxifen --> hypercalcemia, elev. Cholesterol & triglyceride levels
SE: BARFS +
• diethylstilbestrol --> impotence, gynecomastia
• busulfan --> hyperuricemia
• cisplatin --> ototoxicity, nephrotoxicity, neurotoxicity
• cyclophoshamide hemorrhagic cystitis/ hematuria
• Ifosfamide Safe Handling of Chemo Drugs:
 given with MESNA to reduce cystitis 1. Wear mask, gloves & back-closing gown.
2. Skin contact with drug must be washed immediately with soap & water.
3. Sterile / alcohol-wet cotton pledgets should be used – wrapped around the neck of ampule
II. Antitumor Antibiotics or vial when breaking & withdrawing the drug.
Action: interfere with DNA & RNA synthesis 4. Expel air bubbles on wet cotton.
5. Wipe external surface of syringes & IV bottles.
Indic: leukemia, lymphoma, testicular CA 6. Clearly label the hanging IV bottle with ANTINEOPLASTIC CHEMOTHERAPY.
7. Contaminated needles & syringes must be disposed in a “leak-proof”, “puncture-proof”
SE: BARFS + container.
• bleomycin --> pulmonary toxicity 8. Dispose half-empty ampules & vials, IV bottles by putting into plastic bag, seal & then into
another plastic bag or box, clearly labeled as “HAZARDOUS waste”.
• dactinomycin (Actinomycin D)
9. Handwashing should be done before & after removal of gloves.
• daunorubicin cardiotoxic ( CHF, dysrhythmias) 10. Trained personnel only should be involved in use of drugs.
• doxorubicin (Adriamycin) 11. Prepare IV chemotherapy in an air-vented space (biohazard cabinet area).
• plicamycin --> prolongs bleeding time 12. Nurses who are pregnant should not prepare or administer IV chemotherapy.

III. Antimetabolites:
Action: interfere with DNA ; cell cycle phase-specific --> affect S phase
Good luck to everyone!