Principles of Chemotherapy

Objectives At the completion of this session the participant will be able to: ◦ Define combination chemotherapy ◦ Recognize classifications for chemotherapeutic agents ◦ Identify common side effects for selected agents ◦ Describe nursing interventions for selected agents 2

Factors Affecting Response to Medication Pharmacogenetics Diet Kidney Function Liver Function Infections 3

Classes of Chemotherapeutic Agents

Classifications Cell-cycle-specific ◦ Cell-cycle specific drugs kill cells that are actively dividing during specific phases of the cell life cycle Cell-cycle-nonspecific ◦ Affects cells equally regardless of the cell phase 5

Alkylating Agents Either inaccurately replicate or inhibit the replication of DNA causing cell mutation or death They are most active in the resting (G o ) phase Examples: ◦ cyclophosphamide ◦ ifosfamide ◦ platinum complexes ◦ topoisomerase I inhibitors 6

Antitumor Antibiotics Bind to DNA and interfere with further replication of DNA, and transcription of RNA They are active in all phases Examples: ◦ doxorubicin ◦ daunorubicin ◦ idarubicin ◦ dactinomycin 7

Antimetabolites Resemble essential metabolic elements needed for cell growth and are altered so that synthesis of RNA and DNA is inhibited Examples: ◦ cytarabine ◦ methotrexate ◦ 6-mercaptopurine 8

Plant Alkaloids Arrest cells in metaphase and prevent spindle formation by binding to the microtubules Examples: ◦ vincristine ◦ vinblastine ◦ etoposide 9

Hormones Act in a variety of ways and their mechanism of action is not fully understood Have a “direct lytic action” on cells in certain diseases such as leukemia and lymphoma They inhibit tumor proliferation by blocking naturally occurring substances that stimulate tumor growth Examples: ◦ dexamethasone ◦ prednisone 10

Immunosuppressants Class of drugs capable of inhibiting the body’s immune system Decrease the body’s own natural defense to foreign bodies and is useful in treating non-cancer diseases and organ rejection Examples: ◦ Cellcept ◦ Rapamycin ◦ Tacrolimus ◦ Imuran ◦ Cyclosporin 11

Miscellaneous Wide variety of agents which do not fit into any other category or whose mechanism of action is not fully understood Example: ◦ asparaginase ◦ hydroxyurea 12

Combination Chemotherapy The use of two or more drugs given simultaneously or in sequence, in an effort to achieve the best therapeutic response within a range of toxicity 13

Chemotherapy Used For Non-Cancer Diseases Cyclophosphamide (Cytoxan) Methotrexate (Mexate) Mercaptopurine (6-MP) Vincristine (Oncovin®) Daunorubicin Doxorubicin (Adriamycin PFS®) Mitoxantrone(Novantrone®) Pentostatin (Nipent®) Hydroxurea(Hydrea®) 14

Immunosupressant Agents Used For Non-Cancer Diseases Sirolimus (Rapamycin) Tacrolimus (Prograf®) Mycophenolate Mofetil (CellCept®) Imuran (Azathioprine) Cyclosporin (Neoral, Sandimmune) 15

QUESTIONS?