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CHEMOTHERAPY

Antineoplastic Drugs
Cancer is a disease in which cell multiply without
control, destroy healthy tissue and could lead to
death.
Anticancer drugs, also called chemotherapeutic
drugs, or antineoplastic therapy.
The treatment of cancer is generally successful
when the cancerous cells are localized and have
not been disseminated throughout the body. The
optimal treatment is surgical removal of the
affected tissue or exposure by area by means of
radiation or cobalt

Chemotherapy of cancer is generally used


when the cancerous cells are widely
disseminated in the body, when the use of
surgery or radiation is not feasible or practical.
Chemotherapy is the most effective means of
treatment. Anti cancer drugs cause cancer cell
death by interfering with cancer cell replication

CAUTION US

C - Changes in bathroom habits.


A - A sore that does not heal.
U - Unusual discharge and bleeding.
T - Thickness or lumps in the breast or
other places.
I - Indigestion and difficulty in swallowing.
O - Obvious changes in moles or warts.
N - Nagging cough and hoarseness.

Factors that influence CA


development

1. Environmental Factors
Chemical Carcinogen
Physical Carcinogen
Viral Carcinogen
2. Dietary factors
3. Genetic predisposition
4. Immune function

Prevention
Early detection
1. Mammography
2. PAP test
3. Stools for occult
4. Sigmoidoscopy/Colonoscopy
5. Breast Self Exam
6. Testicular Self Exam
7. Skin inspection

Diagnostic Test

Biopsy
Bone marrow Examination
Chest Radiograph
Complete Blood Count
CT scan
Liver function studies
MRI

Management for Cancer

2 types of Anti cancer drugs


1.

2.

(CCNS) Cell cycle non specific drugs


Alkylating drugs
Anti tumor antibiotic
Nitrosureas
Steroids
(CCS) Cell cycle Specific Drugs
Antimetabolites
Alkaloids
some anti tumor antibiotic

Adverse Reaction to anti


cancer drugs

Bone marrow suppression


Low WBC susceptibility to infection with
a decreased WBC count

Low platelet count petechiae, bleeding of


gums, nosebleeds are signs of low
platelet count and should be reported

GI Disturbances
Anorexia because of bitter taste in
the mouth from drugs

Nausea and vomiting because


antineoplastic drugs stimulates
vomiting centers
Granisetron (Kytril)
Ondasentron (Zofran)

Anti emetics are given several hours before


chemo., and for 12 to 48 hours after treatment.
Diarrhea hydration should be maintained, hot
foods and high fibers should be avoided
because it increase peristalsis.
Others
Stomatitis good mouth care is necessary to
minimize mouth ulcers. If superinfection occurs
antifungal drug is necessary.
alopecia a wig should be purchased before
treatment. Some hair growth is apparent after
several months.
Infertility it could be irreversible. Pre
treatment counseling is advise


1.

2.
3.
4.

5.
6.
7.
8.

Nursing Consideration in chemotherapy


Discuss with the client and family the anticancer
drug to be administered, length of time per
administration, signs and symptoms that should
be reported.
Emphasize the importance of taking adequate
fluids.
Check if the I.V. line is patent and intact.
To reduce the exposure to anti cancer drugs the
health care provider should use latex gloves,
gown, and mask.
Regulate the chemotherapeutic drugs accurately.
Cover it if it is necessary, use I.V. tag.
Monitor vital signs closely
Disposed the materials according to agency policy.

Alkylating Agents
Kills cell by forming cross links on the
DNA strands causing abnormal chemical
bonding between the adjacent DNA
molecules. This belongs to CCNS
category. Effective against may type of
cancer.
Acute and chronic leukemia
Lymphoma
Multiple myeloma
Solid tumors (breast, ovaries, uterus,
lungs)

Cyclophosphamide
(Cytoxan)
Axn: Inhibition of
protein synthesis through

interference with DNA replication by alkylation


of DNA.
Route: oral or I.V.
Side Effect: nausea and vomiting, bone marrow
depression, alopecia, hemmorhagic cystitis
Nursing Implication:
1. Provide adequate daily fluid intake to avoid
hemmorhagic cystitis.
2. Monitor client for signs of hematological
changes.
3. Administer in the morning so that the kidneys

Carboplatin (Paraplatin)
Route: IV infusion up to 360 mg/ m2, every 4
weeks interval
Side effect: bone marrow depression
Nausea and vomiting
Electrolyte loss
Hemolytic anemia
Nursing Implication:
1. Monitor for signs of hematological disorder.
2. Discard solution 8 hours after dilution.
3. Anaphylactic like reaction may occur within
minutes of administration. Have epinephrine,
corticosteroids and antihistamine available at
bedside.

Antimetabolites
Have the ability to interfere with
various metabolic actions of the cells
results in the cell destruction or
inability to replicate. The
antimetabolites are single cell cycle
specific agents that appear on
dividing cells during the S phase of
the cell cycle.

Cytarabine Hcl (Cytosar U)


Route: I.V., S.Q., intrathecal
Dosage: 100 to 200 mg/m2 day for 5 days for
12 to 24 hours infusion
Side effects: bone marrow depression
NVD
hyperurucemia
Fever and rash
Nursing Implication
1. Monitor client for hematological changes.
2. Encourage increase oral fluid intake.
3. Allopurinol may be used to inhibit the
formation of
uric acid

Fluorouracil, 5 FU (Adrucil)
Inhibition of DNA and RNA synthesis
Route: I.V.
Dosage: 6 to 12 mg/kg/day (250mg/5ml
amp)
Side Effect: Bone marrow depression
Nausea, oral and G.I. ulceration
diarrhea, and alopecia
Nursing Implication
1. Monitor client for signs of hematologic
changes.
2. Do not refrigerate
3. Protect solution from light

Methotrexate
(Amethopterin)
Folic Acid Antagonist

Route: oral, IV, IM


Dosage: 10 to 30 mg/IV
Side Effects: ulcerative stomatitis
nausea and vomiting
bone marrow depression
diarrhea
For treating solid tumors, sarcomas,
leukemia
Higher dose require leucoverin as a rescue
dose for normal cells to neutralize the toxic
effects of methotrexate.

Anti Tumor Antibiotics

Inhibit protein and RNA synthesis and


bind DNA, causing fragmentation.
Interferes with the cells ability to grow
and reproduce normally. Because
antibiotic agents generally interfere with
several parts of cell cycle. They are
considered to be cell cycle non specific
antineoplastic drugs.

Doxurubucin (adriamycin)

Inhibits DNA and RNA synthesis


Route: IV
Dosage: 20 to 75 mg/m2
Side Effect: bone marrow depression
Cardiac toxicity
nausea and vomiting
Alopecia
Nursing Implication
1. Monitor development of bone marrow
depression and cardiac toxicity.
2. May produce red urine for 1 to 2 days
3. Refrigerated, reconstituted solution is stable
for 48 hours

Bleomycin Sulfate
(Blenoxane)

For treating squamous cell carcinoma,


testicular tumor, and lymphoma
Route: IV,IM,SQ
Dosage: 0.25 to 0.50 units/kg/day
Side Effect: pneumonitis
pulmonary fibrosis
Nausea and vomiting
Fever

Nursing Implication
1. Monitor client for development of
pulmonary toxicity.
2. Powder should be stored in ref.
3. Reconstituted solution is stable for 24
hours at room temperature.
Other anti-tumor antibiotic
Dactinomycin (cosmegen)
Plicamycin (mithracin)
Valrubicin (valstar)

Other anti tumor antibiotic


Dactinomycin (cosmegen)
Plicamycin (mithracin)
Valrubicin (valstar)
MITOTIC INHIBITORS
block cell division at the M phase of the
cell
cycle. This group of inhibitors
is extracted from various plants and tree
substances.
the vinca alkaloidssuch as vinblastine,

vincristine, are obtained from the


periwinkle plant
This group of drug is CCS.
ETOPOSIDE (Ve Pesid)
Route: oral, IV
Dosage: 35 to 100mg/m2/day
Side effect: bone marrow
depression,anorexia,vomiting, and
diarrhea, fatigue, hypotension.

Nursing Implication
1. Do not administer by IV push
2. Capsules should be kept refrigerated.
3. Monitor vital signs.
4. Monitor liver function
VINBLASTINE (Velsar)

Route: IV

Dosage: 3.7 to 11.1 mg/m2

Side effects: bone marrow


depression, nausea, vomiting, and
constipation

Neurotoxicity, Alopecia, irritation at


the injection site
Nursing Implication
1. Stop infusion if extravasation
occurs.
2. Stool softener may be use.
3. Reconstituted refrigerated solution
may be kept for 30 days.
4. Force fluid and encourage fiber in
the diet to help offset constipation.

VINCRISTINE (oncovin)

Route: IV

Dosage: 1.4 mg/m2

Side effect: peripheral neuropathy,


alopecia, irritation at injection site
Nursing Implication
1. Monitor client for development of
neuromuscular changes.
2. Do not mix with anything but
normal saline or dextrose in water.

Other Chemotherapeutic Drugs


-Corticosteroids
PREDNISONE
Route: Oral
Dosage: 40mg/m2 PO days 1 to 14
every 4 weeks
Primary indication: breast cancer,
acute and chronic lymphocytic
leukemia

DEXAMETHASONE
Route: IV
Dosage: initially 0.5mg-1.5mg/kg/day
in every 6 hours
Primary indication: Nausea and
vomiting with chemotherapy