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Pharmacology I NURS 1950 1.  Objective 1: Describe the general factors utilized to select the therapy used to treat cancer 2.

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Presentation on theme: "Pharmacology I NURS 1950 1.  Objective 1: Describe the general factors utilized to select the therapy used to treat cancer 2."— Presentation transcript:

1 Pharmacology I NURS 1950 1

2  Objective 1: Describe the general factors utilized to select the therapy used to treat cancer 2

3  Objective 2: Describe the general uses of chemotherapy in the treatment of cancer 3

4  Objective 3: Identify the basic types of antineoplastic drugs 4

5 5

6 6

7  Alkylating agents  Antimetabolites  Natural products  Antineoplastic antibiotics  Hormones  Biologic response modifiers & Misc. 7

8  Bond with DNA so it can’t separate = no replication  Cell-cycle nonspecific ◦ Resistance can be a problem  Creates cross resistance with other alkylating agents 8

9  Alkylating agents: non cell cycle specific drugs ◦ Activity occurs when the cell tries to replicate and the DNA can not separate 9

10  Busulfan (Myleran)  Carboplatin (Paraplatin)  Carmustine (BCNU)  Chloramubil (Leukeran)  Cisplatin (Platinol)  Cyclophosphamide (Cytoxan) 10

11  Fudarabine (Fludara)  Lomustine (CCNU, CeeNU)  Mechlorethamine (Nitrogen mustard, Mustargen)  Melphalan (Alkeran)  Streptozocin (Zanosar)  Thiotepa 11

12  In general, toxicities include ◦ N/V, anorexia ◦ Bone marrow depression ◦ Anemia ◦ Nephrotoxicity ◦ Hepatic and renal toxicity ◦ Alopecia ◦ Cystitis 12

13  Each drug may have specific toxicities ◦ Example: Zanosar causes hypoglycemia 13

14  Drugs included ◦ Capecitabine (Xeloda) ◦ Cytarabine hydrochloride (Cytosar) ◦ Fludarabine (Fludara) ◦ Flurouracil (5-FU, FU) ◦ Gemcitabine (Gemzar) 14

15  Mercaptopurine (6-MP, Purinethol)  Methotrexate (MTX)  Thioguanine (Lanvis) 15

16  Antimetabolites are subclassed as folic acid, purine, and pyrimidine antagonists ◦ Inhibit key enzymes in biosynthetic pathways of DNA and RNA synthesis  Many are cell-cycle specific (S phase) 16

17  In general, toxicities include ◦ N/V, diarrhea, constipation, fatigue ◦ Bone marrow depression, dermatitis ◦ Oral and GI ulceration 17

18  Come from periwinkle plant, specific yews  Cell-cycle specific: block mitotic spindle during mitosis 18

19  Drugs include ◦ Etoposide (VePesid) ◦ Docetaxel (Taxotere) ◦ Paclitaxel ◦ Vinblastine sulfate (Velban, Velbe) ◦ Vincristine sulfate (Oncovin) ◦ Vinorelbine (Navelbine) 19

20  General toxicities ◦ N/V, stomatitis ◦ Leukopenia with VePesid: nadir in 10-14 days, recovery 3 weeks ◦ Bone marrow suppression, alopecia, peripheral neuritis, hepatotoxicity, bronchospasm 20

21  Bind to DNA, inhibit DNA, RNA synthesis  Cell-cycle nonspecific 21

22  Drugs include ◦ Bleomycin (Blenoxane) ◦ Dactinomycin (Actinomycin D, Cosmegen) ◦ Daunorubicin (Cerubidine) ◦ Doxorubicin (Adriamycin) ◦ Epirubicin (Ellence) 22

23  Idarubicin  Mitomycin C  Mitoxantrone  Plicamycin  Valrubicin 23

24  Generally, toxicities include ◦ N/V, red tinged urine with some ◦ Bone marrow depression ◦ Cardiotoxicity ◦ Pulmonary fibrosis (Bleomycin) ◦ GI bleeding, CNS effects with some 24

25  Corticosteroids: lymphoma and acute leukemia as suppress mitosis in lymphocytes ◦ Help restore sense of well being, decrease edema with radiation, increase appetite and strength 25

26  Estrogens and androgens: malignancies of sexual organs ◦ Use estrogen for prostate cancer (suppress the amount of androgen available) ◦ Use androgens for breast cancer (suppress the amount of estrogen available) 26

27  Drugs included ◦ Anastrozole (Arimidex) ◦ Diethylstilbestrol (DES) ◦ Prednisone ◦ Tamoxifen (Nolvadex) ◦ Testolactone (Teslac) ◦ Testosterone 27

28  General toxicities ◦ N/V, headache ◦ Fluid retention, feminization or masculinization ◦ Hot flashes  Some can cause thrombocytopenia, leukopenia, hypercalcemia, increased bone and tumor pain 28

29  Drugs included ◦ Altretamine (Hexalen) ◦ Dacarbazine (DTIC-dome) ◦ Hydroxyurea (Hydrea) ◦ Interferon alfa-2b (Roferon-a) ◦ Leuprolide acetate (Lupron) 29

30  Toxicities in general ◦ N/V, hot flashes, bone marrow depression, arrhythmias ◦ Flulike syndrome ◦ Anemia, leukopenia 30

31  Drugs used as adjunct therapy ◦ Epoetin alfa (Procrit) stimulates production of red blood cells ◦ Used to treat anemia induced by chemotherapy 31

32  Filgastim (Neupogen) stimulates the production of neutrophils (WBC) 32

33  Oprelvekin (Neumega) stimulates platelet production at stem cell level 33

34  Rituximab (Rituxan) binds to the surface of B lymphocytes ◦ Used to treat relapsed B-cell non-Hodgkin’s lymphoma 34

35  Sargramostim (Leukine) stimulates the production of granulocytes and macrophages  Also helpful in aplastic anemia 35

36  Trastuzumab (Herceptin) inhibits growth of tumor cells (especially useful in metastatic breast cancer) 36

37  Amifostine (Ethyol) reduces toxic effects of cisplatin ◦ Reduces renal toxicity 37

38  Dexrazoxane (Zinecard) used with doxorubicin ◦ Reduces cardiomyopathy 38

39  Mesna (Mesnex) reduces toxic effects of Ifex and Cytoxan ◦ Reduces hemorrhagic cystitis 39

40  New class: antiangiogenesis ◦ Prevent new blood vessels 40

41  Objective 4: identify the 2 factors that play a major role in the response of the cancer cell to the antineoplastic drug ◦ Tumor size ◦ Rate of cell replication 41

42  Objective 5: describe what “tumor resistance” means ◦ Tumor cells are not as susceptible to antineoplastic agents as they should be  Cells escape damage from the drugs 42

43  Objective 6: specify which normal cells are frequently affected by antineoplastic therapy; and signs and symptoms that result most frequently 43

44  Normal cells responding to chemotherapy ◦ Rapidly growing cells  GI tract  Hair follicles  RBCs, WBCs, platelets 44

45  Side effects/toxicities to expect ◦ GI tract: N/V, diarrhea or constipation, stomatitis  Take PRN medications as needed  Will have pre-treatment drugs for N/V  Stomatitis requires good oral hygiene, mouth wash with local anesthetic  Weekly weights 45

46 ◦ Diarrhea: skin care a must ◦ Avoid foods that stimulate bowel motility ◦ Eat foods high in K+ (loose it with diarrhea) 46

47  Alopecia ◦ Hair will begin to fall out in clumps  Devastating—cut hair short; get wigs, caps, turbans 47

48  Skin care: lukewarm water, mild soap  Keep skin clean and dry  If drugs cause photosensitivity, avoid sun  Skin creams available from MD to heal, protect ◦ Especially important with radiation 48

49  Decreased RBCs = decreased 02 transport ◦ May receive Procrit ◦ May have blood transfusion ◦ Need to rest often ◦ Avoid orthostatic hypotension 49

50  Neutropenia: avoid crowds (infections) ◦ Neupogen may be used ◦ Meticulous care of central lines needed 50

51  Thrombocytopenia: client needs to watch for bleeding ◦ Nurse: use smallest needle when MUST give parenteral medication ◦ Neumega may be used ◦ Teach safety measures 51

52  Objective 7: discuss the nursing care for the client receiving antineoplastic therapy 52

53  Clients with cancer require holistic nursing ◦ Medications ◦ Physical assessment ◦ Psychosocial support ◦ Emotional support ◦ Growth and development support, esp. for kids 53

54  Care of the nurse ◦ Prevent inhalation of aerosols ◦ Prevent drug absorption through the skin ◦ Safe disposal ◦ Prevent contamination of body fluids 54

55 55

56  Objective 8: describe the types of anemias  Anemia is a condition in which the hemoglobin concentration or the number of circulating RBCs is decreased 56

57 ◦ Anemia occurs because of:  Blood loss  Hemolysis  Bone marrow dysfunction  Deficiencies of substances essential for hematopoiesis  Lack of iron, vitamin B12 or folic acid 57

58  Objective 9: identify drugs used to treat iron deficiency anemia  Drugs include ferrous sulfate, ferrous gluconate, ferrous fumarate and iron dextran (Imferon); iron polysaccharide 58

59  Objective 10: describe the nursing responsibilities associated with administering iron preparations 59

60  Ferrous sulfate ◦ Oral, usually tablet or capsule ◦ SE: usually GI—nausea, pyrosis, bloating, constipation or diarrhea ◦ If liquid prep: stains teeth  Dilute in water or juice  Administer with a straw  Rinse mouth after administration 60

61  High doses are toxic ◦ Usually accidental ◦ Children susceptible: >3 gms can be fatal 61

62  Ascorbic acid promotes absorption  Tetracycline and antacids decrease absorption  Iron (Fe) used for iron deficiency anemia or to prevent (pregnancy) 62

63  Ferrous gluconate and ferrous fumarate ◦ Same therapeutic effect as ferrous sulfate ◦ If no response to one drug form, no response to the others 63

64  Iron dextran: for parenteral administration ◦ Used when oral iron ineffective or intolerable ◦ Given IM or IV 64

65  Major adverse effect ◦ Anaphylactic shock ◦ Test doses given for IV before the dose  Have emergency drugs available STAT 65

66  IM iron ◦ Persistent pain and discoloration at site occur ◦ Can cause anaphylactic reactions ◦ Must use Z track method of administration 66

67  Objective 11: describe pernicious anemia and identify the drug used to treat it ◦ May see it called vitamin B12 deficiency anemia or megaloblastic anemia 67

68  Vitamin B12 deficiency occurs because of ◦ Lack of B12 in diet ◦ Lack of intrinsic factor in stomach  Causes oversized erythroblasts; can be fatal  Have CNS effects, neurological damage 68

69  Vitamin B12 can be oral or parenteral administration  Cyanocobalamin can be given IM or deep subq  Oral form usually as dietary supplement 69

70  Folic acid deficiency  Folic acid available as tablet and for IM, IV, or subq administration  Leucovorin: active form of folic acid used as a rescue drug in cancer therapy; may also see in rheumatoid arthritis clients taking methotrexate 70

71  Objective 12: apply the nursing process when caring for the client receiving antineoplastic and antianemic agents 71

72  Anxiety  Knowledge deficit  Disturbed body image  Anticipatory grieving  Risk for infection  Risk for injury 72

73  Nutrition: less than body requirements (or a risk for)  Impaired tissue integrity (or risk for)  Chronic pain (or acute, depending upon the situation) 73

74  Activity intolerance  Impaired oral mucous membranes  Self-care deficit  Nutrition: less than body requirements 74


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