Antineoplastic Drugs Flashcards Preview

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Flashcards in Antineoplastic Drugs Deck (53):
0

Asparaginase
(Functional Classification)

Antineoplastic

1

Asparaginase
(Chemical Classification)

Escherichia coli enzyme

2

Asparaginase
(Uses)

Acute lymphocytic leukemia in combination with other antineoplastics

3

Asparaginase
(Contraindications)

Hypersensitivity to product or E. coli protein, thromboembolic disease, infants, breastfeeding, pancreatitis

4

Cytarabine
(Functional Classification)

Antineoplastic, antimetabolite

5

Cytarabine
(Chemical Classification)

Pyrimidine nucleoside analog

6

Cytarabine
(Mechanism of Action)

Competes with physiologic substrate of DNA synthesis, thus interfering with cell replication in the S phase of the cell cycle (before mitosis)

7

Cytarabine
(Uses)

Acute myelocytic leukemia, acute nonlymphocytic leukemia, chronic myelocytic leukemia; lymphomatous meningitis (intrathecal/intraventricular)

8

Cytarabine
(Contraindications)

Pregnancy (D), hypersensitivity

9

Cytarabine
(Side Effects)

CNS: neuritis, dizziness, headache, cerebellar syndrome, personality changes, ataxia, mechanical dysphagia, COMA; CHEMICAL ARACHNOIDITIS (IT)
CV: chest pain, CARDIOPATHY
CYTARABINE SYNDROME: Fever, myalgia, bone pain, chest pain, Rash, conjunctivitis, malaise (6-12 hr after administration)
EENT: sore throat, conjunctivitis
GI: Nausea, Vomiting, Anorexia, Diarrhea, Stomatitis, HEPATOTOXICITY, abdominal pain, hematemesis, GI HEMORRHAGE
GU: urinary retention, RENAL FAILURE, HYPERURICEMIA
HEMA: THROMBOPHLEBITIS, BLEEDING, THROMBOCYTOPENIA, LEUKOPENIA, MYELOSUPPRESSION, ANEMIA
INTEG: Rash, Fever, freckling, cellulitis
META: hyperuricemia
RESP: PNEUMONIA, dyspnea, PULMONARY EDEMA (high doses)
SYST: ANAPHYLAXIS

10

Cytarabine
(Nursing Considerations)

ASSESS:
-BONE MARROW SUPPRESSION: CBC (RBC, Hct, Hgb), differential, platelet count weekly; withhold product if WBC is <30ml/hr
-Monitor temp q4hr; fever may indicate beginning infection; no rectal temps
-HEPATOTOXICITY: hepatic studies before and during therapy: bilirubin, ALT. AST, alk phos, as needed or monthly; check for jaundice of skin, sclera; dark urine; clay-colored stools; pruritus; abdominal pain; fever; diarrhea
-blood uric acid therapy
-For anaphylaxis: rash, pruritus, facial swelling, dyspnea; resuscitation equipment should be nearby
-Chemical arachnoiditis (IT): headache, nausea, vomiting, fever; neck rigidity pain, meningism, CSF pleocytosis; may be decreased by dexamethasone
-Cytarabine syndrome 6-12hr after inf: fever, myalgia, bone pain, chest pain, rash, conjunctivitis, malaise; corticosteroids may be ordered
-Bleeding: hematuria, heme-positive stools, bruising or petechiae, mucosa or orifices q8hr
-Dyspnea, crackles, unproductive cough, chest pain, tachypnea, fatigue, increased pulse, pallor, lethargy; personality changes, with high doses; pulmonary edema may be fatal (rare)
-Buccal cavity q8hr for dryness, sores or ulceration, white patches, oral pain, bleeding, dysphagia
-Local irritation, pain, burning, discoloration at inj site
-GI symptoms: frequency of stools, cramping; antispasmodic may be used
-Acidosis, signs of dehydration: rapid respirations, poor skin turgor, decreased urine output, dry skin, restlessness, weakness

PERFORM/PROVIDE:
-Increased fluid intake to 2-3L/day to prevent urate deposits and calculi formation unless contraindicated
-Diet low in purines: absence of organ meats (kidney, liver), dried beans, peas to prevent increased urate deposits
-Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss

11

Etoposide
(Functional Classification)

Antineoplastic-miscellaneous

12

Etoposide
(Chemical Classification)

Semisynthetic podophyllotoxin

13

Etoposide
(Mechanism of Action)

Inhibits mitotic activity through metaphase to mitosis; also inhibits cells from entering mitosis, depresses DNA/RNA synthesis, cell-cycle-specific S and G2; binds to a complex of DNA and topoisomerase II

14

Etoposide
(Uses)

Testicular cancer, small-cell carcinoma of the lung

15

Etoposide
(Contraindications)

Pregnancy (D), breastfeeding, hypersensitivity, severe renal/hepatic disease

16

Etoposide
(Side Effects)

CNS: headache, Fever, peripheral neuropathy, paresthesias, confusion, chills, fever
CV: Hypotension, MI, DYSRHYTHMIAS
GI: Nausea, Vomiting, Anorexia, HEPATOTOXICITY, dyspepsia, diarrhea, constipation
GU: NEPHROTOXICITY
HEMA: THROMBOCYTOPENIA, LEUKOPENIA, MYELOSUPPRESSION, ANEMIA
INTEG: Rash, Alopecia, phlebitis at IV site, radiation recall, STEVENS-JOHNSON SYNDROME
RESP: BRONCHOSPASM, pleural effusion
SYST: ANAPHYLAXIS

17

Etoposide
(Nursing Considerations)

ASSESS:
-BONE MARROW DEPRESSION: CBC, differential, platelet count weekly; withhold product if WBC is <90mmHg, discontinue inf, notify prescriber
-Buccal cavity q8hr for dryness, sores or ulceration, white patches, oral pain, bleeding dysphagia
-Local irritation, pain, burning, discoloration at inj site
-SYMPTOMS INDICATING SEVERE ALLERGIC REACTION: rash, pruritus, urticaria, purpuric skin lesions, itching, flushing, restlessness, coughing, difficulty breathing
-FREQUENCY OF STOOLS, CHARACTERISTICS: cramping, acidosis; SIGNS OF DEHYDRATION: rapid respirations, poor skin turgor, decreased urine output, dry skin, restlessness, weakness
-GERIATRIC PATIENTS: increased alopecia, GI effects, infection, nephrotoxicity, myelosuppression

PERFORM/PROVIDE:
-Increased fluid intake to 2-3L/day to prevent urate deposits, calculi formation

18

Methotrexate
(Functional Classification)

Antineoplastic-antimetabolite (Vesicant)

19

Methotrexate
(Chemical Classification)

Folic Acid Antagonist

20

Methotrexate
(Mechanism of Action)

Inhibits an enzyme that reduces folic acid, which is needed for nucleic acid synthesis in all cells; specific to S phase of cell cycle' immunosuppressive

21

Methotrexate
(Uses)

Acute lymphocytic leukemia; in combination for breast, lung, head, neck carcinoma; lymphosarcoma, gestational choriocarcinoma, hydatidiform mole, psoriasis, RA, mycosis fungoides, osteosarcoma

22

Methotrexate
(Contraindications)

Hypersensitivity, leukopenia (<100,000/mm3), anemia; psoriatic patients with severe renal disease, alcoholism, HIV
Pregnancy (X), hepatic disease

23

Methotrexate
(Side Effects)

CNS: dizziness, SEIZURES, LEUKOENCEPHALOPATHY, headache, confusion, hemiparesis, malaise, fatigue, chills, fever; arachnoiditis (intrathecal)
EENT: blurred vision, optic neuropathy
GI: Nausea, Vomiting, Anorexia, Diarrhea, Ulcerative Stomatitis, HEPATOTOXICITY, cramps, ulcer, gastritis, GI HEMORRHAGE, abdominal pain, hematemesis, HEPATIC FIBROSIS, ACUTE TOXICITY
GU: urinary retention, RENAL FAILURE, menstrual irregularities, defective spermatogenesis, HEMATURIA, AZOTEMIA, URIC ACID NEPHROPATHY
HEMA: LEUKOPENIA, THROMBOCYTOPENIA, MYELOSUPPRESSION, ANEMIA
INTEG: Rash, Alopecia, dry skin, urticaria, photosensitivity, folliculitis, vasculitis, petechiae, ecchymosis, acne, alopecia, SEVERE FATAL SKIN REACTION
RESP: METHOTREXATE-INDUCED LUNG DISEASE
SYST: SUDDEN DEATH, Pneumocystis Jiroveci, TUMOR LYSIS SYNDROME

24

Methotrexate
(Nursing Considerations)

ASSESS:
-Make sure product is taken weekly in RA, JRA
-CBC, differential, platelet count weekly; withhold product if WBC is <30ml/hr
-Monitor temp; fever may indicate beginning infection; no rectal temp
-Hepatic studies before and during therapy: bilirubin, alk phos, AST, ALT; liver biopsy should be done before start of therapy (psoriasis)
-Bleeding time, coagulation time during treatment; bleeding: hematuria, guaiac, bruising, or petechiae in mucosa or orifices
-Effects of alopecia on body image; discuss feelings about body changes
-PULMONARY TOXICITY: those with ascites or pleural effusion at greater risk for toxicity; fluid should be removed before treatment; monitor plasma methotrexate levels
-TUMOR LYSIS SYNDROME: hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalemia, decreased urine output; use aggressive hydration, allopurinol to correct severe electrolyte imbalances, renal toxicity
-Hepatotoxicity: jaundiced skin and sclera, dark urine, clay-colored stools, pruritus, abdominal pain, fever, diarrhea
-Monitor methotrexate levels, adjust leucovorin dose based on level
-Buccal cavity for dryness, sores, ulceration, white patches, oral pain, bleeding, dysphagia
-SEVERE ALLERGIC REACTION: rash, urticaria, itching, flushing
-RHEUMATOID ARTHRITIS: ROM, pain, joint swelling before, during treatment
-PSORIASIS: skin lesions before, during treatment

PERFORM/PROVIDE:
-Increased fluid intake to 2-3L/day to precent urate deposits, calculi formation unless contraindicated
-Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft brush or cotton-tipped applicators for stomatitis; use unwaxed dental floss
-Storage in tightly closed container in cool environment; store injection, powder for inj in dark, dry are

25

Paclitaxel
(Functional Classification)

Antineoplastic-miscellaneous

26

Paclitaxel
(Chemical Classification)

Taxane

27

Paclitaxel
(Mechanism of Action)

Inhibits reorganization of microtubule network needed for interphase and mitotic cellular functions; causes abnormal bundles of microtubules during cell cycle and multiple esters of microtubules during mitosis

28

Paclitaxel
(Uses)

Taxol: metastatic carcinoma of the ovary, breast; AIDS-related Kaposi's sarcoma (2nd-line), non-small-cell lung cancer (1st-line), adjuvant treatment for node-positive breast cancer

29

Paclitaxel
(Contraindications):

Pregnancy (D); hypersensitivity to paclitaxel or other products with polyoxyethylated castor oil, albumin, Neutropenia of <1500/mm3

30

Paclitaxel
(Side Effects)

CNS: Peripheral Neuropathy
CV: bradycardia, Hypotension, abnormal ECG, SUPRAVENTRICULAR TACHYCARDIA (SVT)
GI: Nausea, Vomiting, Diarrhea, Mucositis, Stomatitis, Increased Bilirubin, Alk Pho, AST
HEMA: NEUTROPENIA, LEUKOPENIA, THROMBOCYTOPENIA, ANEMIA, bleeding, infections
INTEG: Alopecia, TISSUE NECROSIS, generalized urticaria, Flushing
MS: Arthralgia, Myalgia
RESP: PULMONARY EMBOLISM, dyspnea
SYST: Hypersensitivity Reactions, ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, ANGIOEDEMA

31

Paclitaxel
(Nursing Considerations)

ASSESS:
-CBC, differential, platelet count before treatment and weekly; withhold product if WBC is -Effects of alopecia on body image; discuss feelings about body changes

PERFORM/PROVIDE:
-Confirmation that dexamethasone was given 12hr and 6hr before inf begins

32

Vincristine
(Functional Classification)

Anti-neoplastic-miscellaneous

33

Vincristine
(Chemical Classification)

Vinca alkaloid

34

Vincristine
(Mechanism of Action)

Inhibits mitotic activity, arrests cell cycle at metaphase; inhibits RNA synthesis, blocks cellular use of glutamic acid needed for purine synthesis; vesicant

35

Vincristine
(Uses)

Lymphomas, neuroblastoma, Hodgkin's disease, acute lymphoblastic and other leukemias, rhabdomyosarcoma, Wilms' tumor, non-Hodgkin's lymphoma, malignant glioma, soft-tissue sarcoma

36

Vincristine
(Contraindications)

Pregnancy (D), breastfeeding, infants, hypersensitivity, radiation therapy

37

Vincristine
(Side Effects)

CNS: Decreased Reflexes, Numbness, Weakness, Motor Difficulties, CNS depression, cranial nerve paralysis, SEIZURES, peripheral neuropathy
CV: orthostatic hypotension
EENT: Diplopia
GI: Nausea, Vomiting, Anorexia, Stomatitis, Constipation, PARALYTIC ILEUS, Abdominal Pain, HEPATOTOXICITY
GU: RENAL TUBULAR OBSTRUCTION
HEMA: THROMBOCYTOPENIA, LEUKOPENIA, MYELOSUPPRESSION, ANEMIA
INTEG: Alopecia, extravasation
SYST: TUMOR LYSIS SYNDROME (TLS)

38

Vincristine
(Nursing Considerations)

ASSESS:
-CBC, differential, platelet count before each dose; withhold product if WBC is <75,000/mm3, notify prescriber; RBC, Hct, Hgb; may be decreased
-Renal studies: BUN, serum uric acid, urine CCr, electrolytes before, during therapy; I&O ratio; report fall in urine output of 30ml/hr
-Monitor temp q4hr; may indicate beginning infection
-Hepatic studies before, during therapy (bilirubin, AST, ALT, LDH) as needed or monthly
-Deep Tendon Reflexes; product is neurotoxic
-Sensitivity of feet/hands, which precedes neuropathy
-TUMOR LYSIS SYNDROME: hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia
-EXTRAVASATION: pain swelling, poor blood return; if extravasation occurs, local inj of hyaluronidase and moderate heat to area may help disperse product
-INTRATHECAL ADMINISTRATION: BLEEDING: hematuria, guaiac, bruising, petechiae, mucosa or orifices q8hr. Effects of alopecia on body image discuss feelings about body changes. Jaundiced skin, sclera; dark urine, clay-colored stools, itchy skin, abdominal pain, fever, diarrhea. Buccal cavity q8hr for dryness, sores, ulcerations, white patches, oral pain, bleeding, dysphagia. Symptoms indicating severe allergic reaction: rash, pruritus, urticaria, purpuric skin lesions, itching, flushing

PERFORM/PROVIDE:
-Brushing of teeth bid-tid with soft brush or cotton-tipped applicator for stomatitis; use unwaxed dental floss

39

Cisplatin
(Functional Classification)

Antineoplastic alkylating agent

40

Cisplatin
(Chemical Classification)

Platinum Complex

41

Cisplatin
(Mechanism of Action)

Alkylates DNA, RNA; inhibits enzymes that allow for the sythesis of amino acids in proteins; activity not cell-cycle-phase specific

42

Cisplatin
(Uses)

Advanced bladder cancer; adjunct in metastatic testicular cancer; osteosarcoma; soft-tissue sarcomas; adjunct in metastatic ovarian cancer; head, neck cancer; esophagus, prostate, lung, cervical cancer; lymphoma

43

Cisplatin
(Contraindications)

Pregnancy (D), breastfeeding; radiation or chemotherapy within 1 mo; thrombocytopenia; recent smallpox vaccination; aluminum products used to prepare or administer CISplatin
Preexisting hearing impairment, bone marrow suppression, platinum compound hypersensitivity, renal disease/failure

44

Cisplatin
(Side Effects)

CNS: SEIZURES, peripheral neuropathy
CV: cardiac abnormalities
EENT: Tinnitus, Hearing Loss, Vestibular Toxicity, blurred vision, altered color perception
GI: Severe Nausea, Vomiting, Diarrhea, Weight Loss
GU: RENAL TUBULAR DAMAGE, renal insufficiency, impotence, sterility, amenorrhea, gynecomastia, hyperuremia
HEMA: THROMBOCYTOPENIA, LEUKOPENIA, PANCYTOPENIA
INTEG: Alopecia, dermatitis
META: hypomagnesemia, hypocalcemia, hypokalemia, hypophosphatemia
RESP: FIBROSIS
SYST: ANAPHYLAXIS

45

Cisplatin
(Nursing Considerations)

ASSESS:
-Bone marrow depression: CBC, differential, platelet count weekly; withhold product if WBC is <100,000/mm3
-Increase fluid intake to 2-3L/day to prevent urate deposits, calculi formation; promote elimination of product

46

Cyclophosphamide (Cytoxan)
(Functional Classification)

Antineoplastic alkylating agent

47

Cyclophosphamide (Cytoxan)
(Chemical Classification)

Nitrogen mustard

48

Cyclophosphamide (Cytoxan)
(Mechanism of Action)

Alkylates DNA is responsible for cross-linking DNA strands; activity is not cell-cycle-phase specific

49

Cyclophosphamide (Cytoxan)
(Use)

Hodgkin's disease; lymphomas; leukemia; cancer of female reproductive tract, breast, lung, prostate; multiple myeloma; neuroblastoma; retinoblastoma; Ewing's sarcoma; disseminated neuroblastoma, nephrotic syndrome

50

Cyclophosphamide (Cytoxan)
(Contraindications)

Pregnancy (D), breastfeeding, severely depressed bone marrow function, hypersensitivity, prostatic hypertrophy, bladder neck obstruction

51

Cyclophosphamide (Cytoxan)
(Side Effects)

CNS: headache, dizziness
CV: CARDIOTOXICITY (HIGH DOSES), MYOCARDIAL FIBROSIS
ENDO: SIADH, gonadal suppression
GI: Nausea, Vomiting, Diarrhea, Weight Loss, colitis, HEPATOTOXICITY
GU: HEMORRHAGIC CYSTITIS, Hematuria, Neoplasms, Amenorrhea, Azoospermia, Sterility, Ovarian Fibrosis
HEMA: THROMBOCYTOPENIA, LEUKOPENIA, PANCYTOPENIA, MYELOSUPPRESSION
INTEG: Alopecia, dermatitis
META: hyperuricemia
MISC: secondary neoplasms, ANAPHYLAXIS
RESP: PULMONARY FIBROSIS, INTERSTITIAL PNEUMONIA

52

Cyclophosphamide (Cytoxan)
(Nursing Considerations)

ASSESS:
-HEMORRHAGIC CYSTITIS: renal studies: BUN, serum uric acid, urine CCr before, during therapy; I&O ratio; report fall in urine output <75,000; notify prescriber of results
-Pulmonary function tests, chest x-ray films before, during therapy; chest film should be obtained 2qwk during treatment
-Monitor temp q4hr; elevated temp may indicated beginning infection
-HEPATOTOXICITY: hepatic studies before, during therapy (bilirubin, AST, ALT, LDH), as needed; jaundice of skin, sclera; dark urine, clay-colored stools; itchy skin; abdominal pain; fever; diarrhea
-BLEEDING: hematuria, guaiac, bruising or petechiae, mucosa or orifices q8hr
-Dyspnea, crackles, unproductive cough, chest pain, tachypnea
-Effects of alopecia on body image, discuss feelings about body changes
-Buccal cavity q8hr for dryness, sores or ulceration, white patches, oral pain, bleeding, dysphagia; obtain prescription for viscous lidocaine (Xylocaine)
-Symptoms that indicate severe allergic reaction: rash, pruritus, urticaria, purpuric skin lesions, itching, flushing

PERFORM/PROVIDE:
-Strict medical asepsis, protective isolation if WBC levels are low
-Increased fluid intake to 2-3L/day to precent urate deposits, calculi formation, reduce incidence of hemorrhagic cystitis
-Diet low in purines: organ meats(kidney,liver), dried beans, peas to maintain alkaline urine
-Rinsing of mouth tid-qid with water, club soda; brushing of teeth bid-tid with soft bursh or cotton-tipped applicators for stomatitis; used unwaxed dental floss
-Warm compresses at inj site for inflammation