Chemotherapy medication

Question 1

Alkylating Agents

Answer 1

Non-phase specific and act by interfering with DNA replication.
Examples: Cyclophosphamide (Cytoxan)
Cisplatin (Platinol)
Ifosfamide (Ifex)

Question 2

Alkylating Agents

General assessment parameters

Answer 2

• Bone Marrow Suppression-monitor complete blood count before , during and up to 6 weeks after drug:Notify physician if WBC below 2000 mm3 or platelet count is below 50,000 mm3
• Severe N/V, diarrhea
• Stomatitis, anorexia and alopecia

Question 3

Cyclophosphamide

Answer 3

• Obtain baseline and periodic liver & kidney function studies and serum electrolytes
• Hemorrhagic Cystitis
• Cardiotoxicity, acute cardiomegaly with high dose-prior radiation treatment increases this risk
• Acral erythema(palm redness) & Sloughing of skin of palms and sole of feet
• Metallic taste on administration

Question 4

Cisplatin

Answer 4

• Need pre-treatment EKG because of myocarditis or focal irritation
• Anaphylactic reactions occur with in minutes of drug administration
• Monitor BUN, serum creatinine, and urinary creatinine clearance-Nephrotoxicity can occur in 2 weeks
• Monitor for ototoxicity-8th cranial nerve damage
• Assess BP, mental status and pupils-possible increased ICP
• Metallic taste on administration

Question 5

Ifosfamide

Answer 5

• Monitor urine before and during for hematuria
• Hydrate with at least 3000 ml fluid daily to reduce risk of hemorrhagic cystitis
• Report any unusual bleeding or bruising
• A chemo protectant agent, Mesna (Mesenex) may be given to bind acrolein in bladder, inactivating it & allowing excretion from bladder-comes as a part of a combination product with Ifex.

Question 6

Antimetabolites

Answer 6

- Interfere with metabolites or nucleic acids necessary for RNA and DNA synthesis;Most agents are cellcycle specific
   Examples:
Gemcitabine (Gemzar)
Fluorouracil
Methotrexate

Question 7

Antimetabolites

General Assessment parameters

Answer 7

• Assess baseline CBC, WBC differential and platelet count prior to administration
• General adverse effects for group include: myelosuppression, N/V. mucosal inflammation or stomatitis, alopecia, photosensitivity with or without hyperpigmentation and diarrhea
• Assess for signs & symptoms of infection or bleeding

Question 8

Fluorouracil (5-FU)

Answer 8

• Cardiotoxicity resembling acute myocardial infarction, angina, cardiogenic shock
• Cerebellar toxicity

Question 9

Antitumor Antibiotics

Answer 9

• Certain substances from bacteria that are able to kill cancer cells
• Were originally intended to be antibiotics, but were too cytotoxic for this use.
• Interfere with nucleic acid synthesis and function, inhibit RNA synthesis and inhibit DNA synthesis
• Most agents are cell cycle-nonspecific-

Question 10

Antitumor Antibiotics (cont’d) Types

Answer 10

Divided into two groups:
- Anthracyclines(More cardiotoxic) & Non anthracyclines
- Most toxicities occur in hematopoietic , GI, reproductive, and cardiac systems (cummulative doses)
Examples:
Doxorubricin (Adriamycin)
Bleomycin(Blenoxane)

Question 11

Doxorubicin

Answer 11

• Anthracycline
• Assess hepatic, renal, hematopoietic & cardiac function prior to administration and at regular intervals
• Need baseline vitals , weight, I & O and ejection fraction
• Vesicant-flare reaction common& hard to distinguish from extravasation
• Cardiotoxicity- cardiomyopathy
• Stomatitis is greatest at 2 weeks following therapy, begins with burning sensation
• Nadir(Lowest level of blood count) usually occurs 10-14 days after administration

THINK: RUB in doxorubicin-ruby red =think of heart & cardiotoxicity

Question 12

Bleomycin

Answer 12

• Nonanthracycline
• Test for anaphylactic response with test dose IM before IV administration
• Febrile reaction is relatively common
• Pulmonary toxicity occurs in 10% patients(usually over 70 yrs age and when dose reaches 400 units cumulative)
• Diffuse alopecia, hyperpigmentation of skin, acne, thickening of skin & nailbeds