Med-Surg: Chemotherapy Agents Flashcards Preview

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Flashcards in Med-Surg: Chemotherapy Agents Deck (12)
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1
Q

Cytotoxic Chemotherapy Agents

A

toxic to cancer cells

  • kill fast-growing cancer cells as well a healthy cells, including skin, hair, intestinal mucosa, and hematopoietic cells
  • many adverse effects are r/t the unintentional harm done to rapidly proliferating cells (those found in the GI tract, hair follicles, and bone marrow)

> Adverse Effects:

  • nausea, vomiting, myelosuppression, and alopecia
  • vesicants: cause severe damage if there is leakage into tissue
2
Q

Antimetabolite (Methotrexate)

A

kill cancer cells by interrupting a specific phase of cell reproduction

  • Folic acid analog
  • stops cell reproduction needed for the synthesis of DNA by inhibiting folic acid conversion
  • can be used for rheumatoid arthritis

> Complications:

  • Mucositis (GI tract), gastric ulcers, perforation
  • Reproductive toxicities
  • Renal Damage due to hyperuricemia or elevated levels of uric acid

> Nursing:

  • monitor for GI bleed (coffee ground emesis or tarry black stools)
  • assess mouth for sores
  • provide frequent oral hygiene using soft tooth brush and avoid alcohol mouthwashes
  • monitor kidney function, BUN, Creatinine, and I’s and O’s
  • fluid intake of 2/3 L per day
  • administer Allopurinol if uric acid level elevated
  • administer with leucovorin rescue to reduce toxicity to healthy cells

> Education:
-avoid becoming pregnant while on this medication and for 6 months after

3
Q

Antitumor (cytotoxic) Antibiotics: Doxorubicin (IV)

A

kills cancer cells by stopping the synthesis of RNA, DNA, or proteins
-binds to DNA, altering its structure; therefore inhibits synthesis of DNA and RNA

> Complications:

  • Cardiac changes: acute toxicity can cause dysrhythmias and ECG changes; HF secondary to cardiomyopathy can occur months to years after treatment
  • Red coloration to urine and sweat; not harmful

> Nursing Actions:

  • monitor ECH and echocardiogram
  • for acute changes the client can be treated with dexrazoxane, but this can increase myelosuppression
4
Q

Alkylating Agents: Cyclophosphamide

A

kill fast-growing cancer cells by altering DNA structure and preventing cell reproduction
-crosses blood-brain barrier; useful against primary and metastatic tumors of brain

> Complications

  • Acute hemorrhagic cystitis: increase fluids to 3 L/day; monitor for blood in urine, Mesna can be given if needed (a uroprotectant agent that detoxifies metabolites to reduce hematuria)
  • can cause sterility or decreased immune response
  • alopecia; can occur 7 to 10 days after beginning of treatment and will last 2 months after the last administration of chemotherapeutic agent; select hair piece before occurrence of hair loss
5
Q

Alkylating Agents: Cisplatin

A

platinum compounds
-kills rapidly growing cells by interrupting DNA and RNA synthesis

> Complications:

  • Highly emetogenic: nausea, vomiting begin within one hour after dosing and can persist for several days
  • Renal toxicity: monitor kidney function; increase fluids; give diuretics if indicated
  • Hearing loss: monitor for tinnitus and hearing loss
6
Q

Complications for Alkylating Agents

A

(Cyclophosphamide, Cisplatin)

> Bone marrow Suppression: low WBC count or neutropenia, bleeding caused by thrombocytopenia or low platelet count, and anemia or low RBCs

  • monitor WBC, absolute neutrophil count, platelet count, Hgb, Hct
  • assess for bruising and bleeding gums
  • avoid crowds and contact with infectious individuals

> GI discomfort (nausea and vomiting)
-administer an antiemetic (ondansetron in combination with dexamethasone, granisetron, or metoclopramide0 before chemotherapy

> Cyclophosphamide

  • Acute hemorrhagic cystitis
  • Sterility or decreased immune response
  • Alopecia

> Cisplatin

  • Highly emetogenic
  • Renal toxicity
  • Hearing Loss
7
Q

Alkylating Agents: Nursing Administration

A

(Cyclophosphamide, Cisplatin)

  • adequate fluid intake of 2-3 L/day
  • monitor for blood in urine; Mesna may be indicated
  • reduce dose for clients who have liver disease
  • monitor for bleeding (bruising) or infection (fever, sore throat)
  • monitor CBC, uric acid level, and liver enzymes
  • give antiemetic for nausea and vomiting
  • stop chemotherapeutic medications if extravasation occurs
  • assess hearing prior to treatment with cisplatin
8
Q

Alkylating Agents: Client Education

A
  • good oral hygiene

- use birth control during treatment

9
Q

Hormonal Agents: Leuprolide

A

gonadotropin-releasing hormone (GnRH) agonist

  • for prostate cancer
  • prevents the release of luteinizing and follicle-stimulating hormones to prevent testosterone production by the testicles

> Complications:

  • hot flashes, decreased libido, erectile dysfunction, and gynecomastia
  • decreased bone density: increase calcium and vitamin D intake, increase bone mass with weight-bearing exercises
  • dysrhythmias, pulmonary edema
  • disease flare

> Nursing:
-warn clients about adverse effects
-perform bone density testing
-monitor for dysrhythmias and assess breath sounds
-monitor PSA and testosterone levels, which both should decrease with treatment
-
Education:
-increase calcium and vitamin D intake
-minimize bone loss with weight-bearing exercises
-monitor for bone pain
-prostate manifestations can worsen at beginning of treatment (disease flare) and can be prevented by adding flutamide to treatment

10
Q

Hormonal Agents: Tamoxifen (oral)

A

stops growth of breast cancer cells, which are estrogen-dependent cancers
-used to treat or prevent breast cancer

> Complications:

  • Endometrial cancer: monitor for abnormal bleeding; yearly gynecological exam and Pap smear
  • Hypercalcemia (bone pain): monitor calcium level
  • Nausea and Vomiting: monitor fluid status, administer fluids and antiemetics
  • Thromboembolic events (DVT, PE, stroke): assess breath sounds; report chest pain, edema of the leg or calf, SOB
  • Hot flashes
  • Vaginal Discharge or bleeding; monitor bleeding and discharge, have yearly gynecological exam and Pap smear

> Education:
-increase calcium and vitamin D intake

11
Q

Monoclonal Antibody: Belimumab or Trastuzumab

A

targets breast cancer cells, prevents cell growth, and causes cell death

  • only effective against tumors that are HER2-positive
  • used to treat metastatic breast cancer
12
Q

Biologic Response Modifiers: Interferon alfa-2b

A

increases immune response and decreases production of cancer cells

> complications:

  • flu-like manifestations
  • bone marrow suppression, alopecia, cardiotoxicity, thyroid dysfunction, and neurotoxicity with prolonged therapy
  • depression, anxiety, insomnia, altered mental states

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