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Anticancer Drugs Flashcards

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1
Q

Types of Cancer

A

Genetic and environmental/diet

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2
Q

Genetic Cancers

A

Breast, ovarian, prostate, endometrial/ovarian, colon, pancreatic, lung, malignant melanoma

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3
Q

Environmental/diet Cancers

A

Lung (tobacco/asbestos, arsenic), liver (Hep B+C, aflatoxin), AML (Benzene), sarcoma (vinyl chloride), colon/rectal (animal fat), stomach (smoked meats), mouth/throat/esophagus (ETOH)

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4
Q

Types of Anticancer Drugs

A

Cell cycle-nonspecific (CCNS) and cell cycle-specific (CCS)

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5
Q

Cell Cycle-nonspecific (CCNS)

A

Act during any phase of the cell cycle
Alkylating drugs
Anti-tumor antibiotics
Hormones

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6
Q

Cell Cycle-specific (CCS)

A

Act during a specific phase/phases
Effective for rapidly growing cancer cells
Anti-metabolites
Miotic inhibitors

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7
Q

General Sxs of Anticancer Drugs

A

Immunocompromised, N/V/D, loss of appetite, fatigue, low platelet count, low blood count, elevated BUN, elevated creatinine, alopecia, HA, dizziness, dermatitis

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8
Q

All Anticancer Drugs Are What Pregnancy Category?

A

Pregnancy category D

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9
Q

Most Anticancer Onset Times?

A

Between 7-10 days

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10
Q

General Adverse Reactions of Anticancer Drugs

A

Secondary neoplasm, bone marrow depression, anemia, reactivation of dormant viruses, cardiac dysrhythmias, HF

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11
Q

General Life-threatening Reactions of Anticancer Drugs

A

Leukopenia, thrombocytopenia, severe myelosuppression, anaphylaxis

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12
Q

General Contraindications of Anticancer Drugs

A

Hypersensitivity, severe bone marrow depression. pregnancy, liver or kidney disease, severe HF?, may increase INR, smoking?, dehydration

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13
Q

General Drug Interactions of Anticancer Drugs

A

Increase action of barbituates, chloramphenicol, AC
Bone marrow depressants increase toxicity
Avoid live virus vaccines
Thiasized diuretics may increase myelosuppression
Reduces effectiveness of vaccines

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14
Q

General Nursing Considerations of Anticancer Drugs

A

Assess CBC, plts (may hold med if levels are too low)
Handle drug with care (avoid direct contact with skin, eyes, mucous)
Monitor IV site frequently for irritation and phlebitis
Administer anti-emetic 30-60 minutes before giving drug
Hydrate pt with IV and oral fluids prior to administration
Monitor BUN and creatinine
Strict asepsis techniques during dressing changes or invasive procedures
Maintain good hygiene
Consult with oncologist before getting vaccines
Testicular atrophy and reversible oligospermia/azoospermia may occur in men
Avoid pregnancy for 3-4 months after completing treatment
Avoid others with respiratory infections
Report signs of infection immediately
Monitor I and O
Monitor electrolytes (serum K+)
Avoid ETOH or other hepatotoxic substances
Avoid live virus vaccines (2 months after therapy)

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15
Q

Mustard Gas Derivative Prototype

A

Cyclophosphamide (Cytoxan)

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16
Q

Cyclophosphamide (Cytoxan) Routes and Onset?

A

PO/IV onset 7 days

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17
Q

Sxs Specific to Cyclophosphamide (Cytoxan)

A

Hematuria, impotence, sterility

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18
Q

Adverse Reaction Specific to Cyclophosphamide (Cytoxan)

A

Hemorrhagic cystitis

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19
Q

Life-threatening Reaction Specific to Cyclophosphamide (Cytoxan)

A

Cardio toxicity (high doses), hepatotoxicity (long-term)

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20
Q

Drug Interactions Specific to Cyclophosphamide (Cytoxan)

A

Decrease digoxin level
Prolonged leukopenia with thiazide diuretics
Potentiates cardiomyopathy with Adriamycin
Potentiates action and toxicity of allopurinol, probenicid, colchicine, AC
Toxicity increases if given with corticosteroids, phenytoin or sulfonamides

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21
Q

Nursing Considerations Specific to Cyclophosphamide (Cytoxan)

A

Assess for sxs of hematuria, polyuria, dysuria
Teach client to empty bladder every 2-3 hours
Increase fluid intake to 2-3 L/day to reduce risk of hemorrhagic cystitis
Monitor I and O
Take drug early in the day to prevent accumulation of drug in bladder at night
Drug is excreted in breast milk

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22
Q

Antitumor Antibiotic Prototype

A

Anthracyclines ex: doxorubicin (Adriamycin)

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23
Q

Doxorubicin (Adriamycin) Route and Onset

A

IV 7-10 days

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24
Q

Sxs Specific to Doxorubicin (Adriamycin)

A

IV reaction, potent vesicant may cause flare reaction, discolors urine pink-red for up to 48 hours, may cause radiation recall to previously radiated skin

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25
Adverse Reactions Specific to Doxorubicin (Adriamycin)
Esophagitis, hyperpigmentation of nails, tongue and oral mucosa may darken (more often in African Americans)
26
Life-threatening Reactions Specific to Doxorubicin (Adriamycin)
Cardio toxicity, CHF
27
Contraindications Specific to Doxorubicin (Adriamycin)
Severe cardiac disease (check EF prior to starting), do not exceed lifetime does of 550 mg/m2 or 450 mg/m2 if prior radiation, hepatic impairment
28
What is Used with Doxorubicin (Adriamycin) to Help Prevent/Decrease Cardiac Damage?
Dextazoxane (Zinecard)
29
Drug Interactions Specific to Doxorubicin (Adriamycin)
Increased risk of cardiotoxicity with CA+ blockers, Taxol, mitomycin Decreases phenytoin levels Increased risk of hemorrhage and cardiotoxicity with Cytoxan Retrovir may decrease effectiveness Increased hepatoxicity with mercaptopurine Green tea may enhance antitumor effect, use with caution w/ grape seed, garlic, and st. johns wort
30
Nursing Considerations Specific to Doxorubicin (Adriamycin)
Monitor IV site, severe tissue necrosis may occur 3-4 weeks after infiltration Monitor cardiac status
31
Plant Alkaloid Prototype
Vincristine (Oncovin)
32
Vincristine (Oncovin) Route and Onset
IV 7 days
33
Sxs Specific to Vincristine (Oncovin)
Peripheral neuropathy, loss of DTR (deep tendon reflex)
34
Adverse Reactions Specific to Vincristine (Oncovin)
Hypotension, visual disturbances, ileus, SIADH, hyponatremia, severe local reaction with extravasation, fever
35
Life-threatening Reaction Specific to Vincristine (Oncovin)
Intestinal necrosis
36
Contraindications Specific to Vincristine (Oncovin)
FATAL if given intrathecally, do not give to pts: receiving radiation through parts of liver, with Charcot-Marie-Tooth syndrome
37
Drug Interactions Specific to Vincristine (Oncovin)
Give 12-24 hours prior to L-asparaginase to minimize toxicity, bronchospasm may occur (especially if given with mitomycin), L-asparaginase (elspar) may reduce drug clearance, decreases the effect of phenytoin (monitor for seizures), mix only with NS or D5W
38
Nursing Considerations Specific to Vincristine (Oncovin)
Monitor bilirubin levels (decrease dose if > 1.5 mL), monitor for neurotoxicity, assess for neuropathy and loss of DTR's, monitor for paralytic ileus, monitor for bronchospasm
39
Liposomal Chemotherapy
Anticancer drugs packed into synthetic fat (liposomes) Stays in system longer with decreased sxs Increased therapeutic effects
40
Hormonal Agents
Corticosteroids Sex hormones (estrogen, progestins, androgens, antiadrogens, aromatase inhibitors)
41
Corticosteroids
Help slow the growth of tumor through anti-inflammatory effects Decreases cerebral edema in brain CA Gives pts sense of euphoria
42
Biotherapy Agents
Cytokinins Monoclonal antibodies Vaccines (prevents CA)
43
Antimetabolite Prototype
Fluorouracil, 5-Fluorouacil, 5-FU (Adrucil)
44
Fluorouracil (Adrucil) Pregnancy Category When Topical?
Pregnancy category X
45
Fluorouracil (Adrucil) Routes and Onset
IV 10-14 days, topical 2-3 days
46
Contraindications Specific to Fluorouracil (Adrucil)
Marginal nutritional status Decrease dose with patients with impaired renal or hepatic function, or impaired nutrition
47
Drug Interactions Specific to Fluorouracil (Adrucil)
Increased toxicity with leucoviron, flagyl Increased effects with cimetidine
48
Targeted Therapy Drugs
Interfere with cancer cell growth and division Monotherapy, combination therapy with chemo or radiation Can be orally administered at home or IV Ex: Tyrosine Kinase inhibitors
49
Tyrosine Kinase Inhibitor Prototype
Imatinib mesylate (Gleevec)
50
Sxs Specific to Imatinib Mesylate (Gleevec)
Gi sxs, diarrhea (most notable in this drug compared to the others), N/V, decreased appetite, upset stomach, muscle cramping, difficulty sleeping
51
Imatinib Mesylate (Gleevec) Route and Onset
PO rapid onset not affect by meals
52
Contraindications Specific to Imatinib Mesylate (Gleevec)
Drugs that inhibit the cytochrome P450 increase adverse reactions and reduce Gleevac effectiveness (ex: Amiodarone) Any drug metabolized by cytochrome P450 may have increase in drug levels
53
Nursing Considerations Specific to Imatinib Mesylate (Gleevec)
Monitor LFT's + renal function once a month Monitor electrolytes during and after for 8 weeks (especially ca+ and phosphorus for low levels) Monitor EF Monitor hands and feet for redness, swelling, pain, blisters Avoid grapefruit juice
54
Epidermal Growth Factor/Receptor Inhibitor Prototype
Erlotinib (Tarceva)
55
Erlotinib (Tarceva) Route and Onset
PO absorption enhanced w/ food
56
Adverse Reactions Specific to Erlotinib (Tarceva)
Ocular changes, GI perforation
57
Contraindications Specific to Erlotinib (Tarceva)
Pt with peptic ulcer disease or diverticulitis Grape juice increase blood levels and adverse effects Cigarette smoking decreases blood levels
58
Monoclonal Antibody Prototype
Rituximab (Rituxan)
59
Pregnancy Category Specific to Rituximab (Rituxan)
Pregnancy category C
60
Rituximab (Rituxan) Route
IV
61
Sxs Specific to Rituximab (Rituxan)
Night sweats, hypotension, joint and muscle aches
62
Contraindications Specific to Rituximab (Rituxan)
Preexisting pulmonary fibrosis
63
Drug Interaction Specific to Rituximab (Rituxan)
Hypotension with antihypertensives
64
Nursing Considerations Specific to Rituximab (Rituxan)
Infusion reactions are common (have resuscitation equipment nearby for 1st 15 mins of infusion Client is a radiation hazard 4-7 days post infusion, stay 6 ft away from children and pregnant women Sleep in a separate bed, use separate toilet, sit while urinating Separate eating utensils, wash hands frequently Wash laundry separately
65
Biological Response Modifiers
Enhance host immunologic function Destroy or interfere with tumor activities Promote differentiation of stem cells Ex: Procrit, Neupogen, Leukine
66
Erythropoietin-Stimulating Agents
Epoetin Alpha (Erythropoietin, trade names Epogen, Procrit, Eprex)
67
Epoetin Alpha (Erythropoietin, trade names Epogen, Procrit, Eprex) Pregnancy Category
Pregnancy Category C
68
Procrit Routes and Onset
SQ/IV 7-10 days
69
Procrit Sxs
Fatigue, SOB
70
Procrit Adverse Reactions
Seizures, hyperkalemia
71
Procrit Life-threatening Reactions
CVA, MI
72
Procrit Contraindications
Uncontrolled HTN, hypersensitivity to mammalian products or human albumin Caution: pregnancy, lactation, increased mortality/and tumor progression, not used for children Serious cardiovascular and thromboembolic events if target Hemoglobin of 12g/dl exceeded
73
Procrit Nursing Considerations
Do not shake bottle, shaking may denature (roll the bottle between hands) Only one use per vial (no preservatives) Use smallest amount per injection Do not use same needle to draw and inject medication (change needle in between)
74
Granulocyte Colony-stimulating Factor
Filgrastim (Neupogen)
75
Filgrastim (Neupogen) Pregnancy Category
Pregnancy Category C
76
Filgrastim (Neupogen) Routes
IV/SQ
77
Filgrastim (Neupogen) Sxs
Skeletal pain, general anticancer drug sxs
78
Filgrastim (Neupogen) Adverse Reactions
Neutropenia, SOB
79
Filgrastim (Neupogen) Life-threatening Reactions
Thrombocytopenia, ARDS with sepsis, splenic rupture
80
Filgrastim (Neupogen) Contraindications
Hypersensitivity to E. coli derived proteins, 24 hours before or after cytotoxic chemo, pregnancy, lactation Do not administer 14 days before and 24 hours after chemo Keep pre-filled syringes away from light and discard any unused medication May administer acetaminophen for bone pain Takes 2 weeks for Neupogen to become effective
81
Granulocyte Macrophage Colony Stimulating Factor
Sargramostim (Leukine)
82
Sargramostim (Leukine) Pregnancy Category
Pregnancy Category C
83
Sargramostim (Leukine) Routes
IV/SQ (SQ not as often)
84
Sargramostim (Leukine) Sxs
Chills, peripheral edema
85
Sargramostim (Leukine) Adverse Reactions
Pleural/pericardial effusion, SOB
86
Sargramostim (Leukine) Contraindications
Do not use within 24 hours of chemo or 12 hours of radiation therapy, pts sensitive to yeast products, hypersensitivity Caution: pregnancy, lactation, HF
87
Sargramostim (Leukine) Drug Interactions
Lithium/steroids may increase effects
88
Nursing Considerations for Biologic Response Modifiers
Monitor temperature, may give meperidine to decrease chills Pre-medicate with acetaminophen, diphenhydramine to reduce chills, fever, nausea Maintain hydration Only one dose per vial

Pharm Final (5 decks)

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