Anticancer Drugs

Question 1

Premedication Drugs

Answer 1

• Antiemetic: ondansetron & promethazine
• Antihistamine: diphenhydramine
• Glucocorticoid: dexamethasone
• H2 Receptor Blocker: famotidine
• Analgesic/Antipyretic: acetaminophen & NSAIDs

Question 2

Drugs to use for chemo allergic reaction

Answer 2

• Diphenhydramine
• Glucocorticoids
• Epinephrine
• Fluid resuscitation with IV NS

Question 3

Cytotoxic Agents

Answer 3

• Kill fast growing cells (both cancerous & healthy) –> mucous membranes, blood cells, hair cells & reproductive system
• The side effects are temporary because normal cells can repair themselves

Question 4

Mucositis (Cytotoxic Side Effect)

Answer 4

• Mucositis = inflammation of the mucous membranes of the GI/GU & respiratory tract

S/S:

• Pain
• Malnutrition
• Hematuria
• Upper/lower GI bleed
• Hemoptysis

Treatment = Magic Mouthwash

• Diphenhydramine = for inflammation & pain
• Lidocaine = for pain
• Aluminum hydroxide or Magnesium hydroxide = to reduce GI tract acidity
• Nystatin = to prevent opportunistic infections
• Hydrocortisone = to treat inflammation & pain

Question 5

Myelosuppression, Nadir (Cytotoxic Side Effect)

Answer 5

• Need to monitor blood cell count & treat as needed

S/S:

• Low HgB –> weakness, fatigue, SOB, activity intolerance, tachycardia, AMS –> treat with Epoetin Alfa
• Thrombocytopenia –> petechiae, purpura, ecchymosis, epistaxis, bleeding gums, GI bleed, hematuria –> treat with oprelvekin
• Leukocytopenia –> high infection rate –> treat with filgrastim –> need to prevent infection (hand washing, neutropenic precautions)

Question 6

Alopecia (Cytotoxic Side Effects)

Answer 6

• Educate that this is temporary
• Hair loss starts a week after the first dose & lasts up to 2 months after the last dose
• Support body image concerns
• This does not happen with every chemo drug

Question 7

Reproductive System Damage (Cytotoxic Side Effects)

Answer 7

• Infertility, amenorrhea, impotence
• Pretreatment counseling for permanent infertility
• Sperm banking
• Avoid conception 6 months to 2 years after chemo

Question 8

Nursing for Cytotoxic Agents

Answer 8

• Need specific training & certifications
• Ensure patency of IV to avoid extravasation (chemo drugs are usually a vesicant)
• Safe handling procedures to prevent absorption into the skin of the healthcare workers –> use PPE, hand washing, bodily fluids of pts still contain cytotoxic agents, specific method of IV tube priming

Question 9

Hormonal Agents (Non-cytotoxic Agents)

Answer 9

Hormone Agonists:

• Increases the effect of a specific hormone
• Androgenic hormone for estrogen-dependent cancer
• Estrogen hormone for testosterone dependent-cancer

Hormone Antagonists:

• Reducing the effects of specific hormone
• Anti-estrogen hormone for an estrogen-dependent hormone
• Anti-testosterone hormone for testosterone-dependent hormone

Indications:

• Prostate cancer, BPH
• Breast cancer
• Endometriosis
• Uterine fibroids
• Polycystic ovarian disease
• Precocious puberty
• IBS

Contraindications:
- Pregnancy

Side Effects:

• Hot flashes, libido & gynecomastia –> transient & worse at the beginning of the treatment
• Osteoporosis (Ca & vitamin D, weight-bearing exercises)
• Dysrhythmia & pulmonary edema