Chapter 14:
Antineoplastic Agents
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Possible Causes of Cancer
Genetic Predisposition
Viral Infection
Constant Irritation and Cell Turnover
Stress
Lifestyle Factors
Environmental Factors
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Neoplasm Cancer — Mechanisms of
Growth #1
As the abnormal cells continue to divide, they lose more
and more of their original cell characteristics and they
exhibit the following:
Anaplasia
o Cancerous cells lose cellular differentiation and
organization; unable to function normally
Autonomy
o Cancerous cells grow without the usual homeostatic
restrictions that regulate cell growth
o This allows the cells to form a tumor
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Neoplasm Cancer — Mechanisms of
Growth #2
Metastasis
o Cancer cells travel from the place of origin to develop
new tumors in other areas of the body
Angiogenesis
o Abnormal cells release enzymes to generate blood
vessels and supply oxygen and nutrients to the cells,
generating growth
o Cancerous cells rob the host cells of energy and
nutrients and block normal lymph
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Types of cancer
Carcinomas-
o tumors that originate in epithelial cells
Sarcomas –
o tumors that originate in the mesenchyme and are
made up of embryonic connective tissue cells
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FIGURE 14.1 Malignant tumors develop from one cell, with
somatic mutations occurring during cell division as the tumor
grows.
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Goal of Cancer Treatment
Destroying cancer cells through several methods:
o Surgery to remove them
o Stimulation of the immune system to destroy them
o Radiation therapy to destroy them
o Drug therapy to kill them during various phases of
the cell cycle
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Classifications of Tumors
Solid Tumors
o May originate in any body organ
o Carcinomas (originate in epithelial cells)
o Sarcomas (originate in the mesenchyma)
Hematological Malignancies
o Leukemias and lymphomas; occur in the blood-
forming organs
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Antineoplastic agents
Antineoplastic drugs
o Alter human cells in a variety of ways. Their action is
intended to target the abnormal cells that compose
the neoplasm or cancer, having a greater impact on
them than on normal cells. Unfortunately, normal
cells also are affected by antineoplastic agents.
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Use of Antineoplastic Across the Life Span
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Sites of Action of Non–Cell Cycle–Specific
Antineoplastic Agents
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Sites of Action of Cell Cycle–Specific
Antineoplastic Agents
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Categories of Antineoplastic Agents #1
Alkylating Agents
o React chemically with portions of the RNA, DNA, or
other cellular proteins
Antimetabolites
o Have chemical structures similar to those of natural
metabolites
Antineoplastic Antibiotics
o Not selective only for bacterial cells; toxic to human
cells
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Categories of Antineoplastic Agents #2
Mitotic Inhibitors
o Drugs that kill cells as the process of mitosis begins
Hormones and Hormone Modulators
o Used in cancers that are sensitive to estrogen
stimulation
Cancer Cell Specific Agents
o Treat chronic myeloid leukemia (CML) and CD117-
positive unresectable or metastatic malignant GI
stromal tumors (GIST)
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Question #1
Which term is used to describe the process that occurs
when cells lose their cellular differentiation and
organization?
A. Autonomy
B. Neoplasm
C. Anaplasia
D. Angiogenesis
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Answer to Question #1
C. Anaplasia
Rationale: The cancerous cells exhibit anaplasia, a loss of
cellular differentiation and organization, which leads to a
loss of their ability to function normally.
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Alkylating Agents
Actions- React chemically with portions of the RNA, DNA, or
other cellular proteins
Pharmacokinetics - Vary in their degree of absorption, and
little is known about their distribution in the tissues. They are
metabolized and sometimes activated in the liver and excreted
in the urine
Contraindications- Known allergy, pregnancy, lactation, bone
marrow suppression and suppressed renal and hepatic function
Adverse Reactions- Many- See table 14.1
Drug-to-Drug Interactions- Many drugs that cause hepatic,
renal and kidney toxicity
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Nursing Considerations for
Alkylating Agents
Assess:
o History of allergy to any of the alkylating agents
o Bone marrow suppression, CBC
o Renal or hepatic dysfunction
o Pregnancy or lactation
o Physical status
o Orientation and reflexes
o Respiratory rate, adventitious sounds and VS
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Prototype Alkylating Agent
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Antimetabolites
Actions- Inhibit DNA production in cells that depend on certain
natural metabolites to produce their DNA.
Pharmacokinetics- Absorbed well in GI tract, metabolized in
the liver and excreted in the urine
Contraindications- Pregnancy, lactation, bone marrow
suppression and hepatic dysfunction
Adverse Reactions- Many- See table 14.1
Drug-to-Drug Interactions- Many drugs that cause hepatic,
renal and kidney toxicity
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Nursing Considerations for Antimetabolite
Assess:
o History of allergy to the specific antimetabolite
o Bone marrow suppression to prevent further suppression
o Renal or hepatic dysfunction
o Physical status
o Orientation and reflexes
o Respirations, adventitious sounds, VS, CBC,
o Renal and liver function tests
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Prototype Antimetabolite Agent
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Antineoplastic Antibiotics #1
Actions- Are cytotoxic and interfere with cellular DNA
synthesis by inserting themselves between base pairs in the
DNA chain
Pharmacokinetics – Not well absorbed in the GI tract,
metabolized by the liver and excreted in the urine. Long half
life (up to 5 days)
Contraindications- Known allergy, Pregnancy, lactation,
bone marrow suppression and hepatic dysfunction
Adverse Reactions- bone marrow suppression, with
leukopenia, thrombocytopenia, anemia, and pancytopenia
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Antineoplasic Antibiotics #2
Drug-to-Drug Interactions- Known to cause hepatic or renal
toxicity should be used with care with any other drugs known
to have the same effect
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Nursing Considerations for
Antineoplastic Antibiotics
Assess:
o History of allergy to the antibiotic in use
o Bone marrow suppression
o Renal and hepatic dysfunction, respiratory or cardiac
disease
o Pregnancy and lactation
o Physical assessment
o Orientation and reflexes, monitor the results of laboratory
tests such as complete blood count with differential
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Prototype Antineoplastic Antibiotics
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Mitotic Inhibitors #1
Actions- Kill cells as the process of mitosis begins which
inhibit DNA synthesis
Pharmacokinetics – Given IV since they are not well
absorbed in the GI tract, metabolized in the liver and excreted
primarily in the feces, making them safer for use in patients
with renal impairment than the antineoplastics that are cleared
through the kidney.
Contraindications- Known allergy, pregnancy, lactation, bone
marrow suppression and hepatic dysfunction
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Mitotic Inhibitors #2
Adverse Reactions- bone marrow suppression, with
leukopenia, thrombocytopenia, anemia, and pancytopenia,
secondary to the effects of the drugs on the rapidly multiplying
cells of the bone marrow. GI effects include nausea, vomiting,
anorexia, diarrhea, and mucous membrane deterioration
Drug-to-Drug Interactions- Known to be toxic to the liveror
the CNS should be used with care with any other drugs known
to have the same adverse effects
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Nursing Considerations for
Mitotic Inhibitors
Assess:
o History of allergy
o Bone marrow suppression
o Renal or hepatic dysfunction
o Pregnancy, lactation
o Physical status
o Orientation and reflexes
o Respiratory rate, adventitious sounds and CBC with
differential
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Prototype Mitotic Inhibitors
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Hormones and Hormone Modulators #1
Actions- Hormone modulators used as antineoplastics are
receptor site specific or hormone specific to block the
stimulation of growing cancer cells that are sensitive to
the presence of that hormone (IE: breast cancer)
Pharmacokinetics- Readily absorbed from the GI tract,
metabolizedin the liver, and excreted in the urine
Contraindications- Known allergy, hypercalcemia,
pregnancy, lactation, bone marrow suppression, renal
and liver dysfunction
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Hormones and Hormone Modulators #2
Adverse Reactions- Menopause-associated effects include hot
flashes, vaginal spotting, vaginal dryness, moodiness, and
depression. Other effects include bone marrow suppression
and GI toxicity, including hepatic dysfunction, hypercalcemia
and cardiovascular risks
Drug-to-Drug Interactions- Oral anticoagulants
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Nursing Considerations for Hormones and
Hormone Modulators
Assess:
o History of allergy to the drug in use or any related drugs
o Bone marrow suppression
o Renal or hepatic dysfunction
o Physical status
o Assess orientation and reflexes
o Laboratory tests such as complete blood count with
differential
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Prototype Hormones and Hormone
Modulators #1
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Prototype Hormones and Hormone
Modulators #2
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Question #2
You are caring for a patient with a Wilm’s tumor who is
receiving doxorubicin. What is an adverse effect of
doxorubicin that you would teach the patient and their
family about?
A. Brown urine
B. Red urine
C. Orange urine
D. Gold urine
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Answer to Question #2
B. Red urine
Rationale: Adverse effects: Cardiac toxicity, complete but
reversible alopecia, nausea, vomiting, mucositis, red
urine, myelosuppression, fever, chills, rash
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