Chemo

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Cell cycle-specific drugs

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toxic to the cell at a particular phase of the cell cycle cause no significant harm during other phases

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Major toxicities of antineoplastic drugs seen on rapidly dividing cells

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bone marrow = decreased RBC, WBC, major reason for infection, GI mucosa = N&V, Gonadal cells = sperm banking, do not use during pregnancy

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Chemo routes

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central line is choice for vesicant but peripheral can be used for pushes no piggybacks with vesicants

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what is the most common side effect of chemo

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bone marrow toxicity we are killing both good and bad cells

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Antimetabolites 5 FU treats solid tumors especially GI, pallative care of carcinoma of colon, breast, liver, ovary, pancreas, rectum head & neck, stomach

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5FU: hepatic metabolism
dose limiting: myelosuppression, anemia, leukopenia, thrombocytopenia

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5FU is does dependant = N&V, anorexia, diarrhea adn stomatitis, GI ulceration, cardiac events occur during the firs 72hours

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5FU cutaneous does dependant : alopecia, hyperpigmentation, brittle and cracking nails, maculopapular rash painful erythematous desquamation, fissrues of the palms and soles so think 5 = hands and feet

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5FU is cardiotixic, acute cerebella syndrom and photophibia and ocular changes

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ALL CHEMOS
risk for infection, risk for injury, imbalanced nutrition - less than body requirements, distrubed body image, distrubed sensory perception,

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5fu daily dose s/n exceed 800 mg d/c drug if stomatitis, esophagopharyngitis, leukipenia, throbocytopenia, intractable vomiting, diarrhea, gi ulceration and bleeding do not use aspirin

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mitotic inhibitors - vinca alkaloids: vincristine the terrible v sisters = vesicant

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Vincristine used for acutre lymphoblastic and hodkgin disease, malignant lymphomas, sarcoma, breast cancer, small-cell lung cancer

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Vincristine bind to plasma proteins and poor bbb penetration

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Vincristine dose limiting is

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neurologic effects most common: motor, sensory and autonomic eruopathies

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nursing diagnosis for most chemo drugs are

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disturbed sensory perception
risk for constipation
risk for infection
impaired skin integrity
disturbed body image
ineffective sexuality patterns

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Vincristine mazimizing theraputic effects the nurse needs to do

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monitor cbc before each dose
protect drug from light
uses central venous access for continous IV infustion

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Vincristine minimizing adverse effects the nurse

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conducts neurologic evaluation before each cycle, report changes in sensory functioning and prevent extravasion

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with Vincristine ongoing assessments are

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measuring uric acid levels
assessing bowel, motor and sensory functions

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what to teach patients to limit infection:

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handwashing, avoid children / crowds,pet excretion, fresh fruit and veggies and fresh flowers

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Mitotic inhibitors Etoposide vespid vp16
used for

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testicula tumors and small lung cancer

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Etoposide vespid vp16
contraindications & precautions

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never IV push danger of hypotension insufed over 30 to 60 minutes or longer. if taking warfarin monitor prothrobin

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Etoposide vespid vp16
adverse side effects

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hypersensitivity or anaplyatic-like reactions
hypotension, chill, fever, facial flushing, bronchospasms, dyspnea tachycardia and radiation recall, secondary malignancies

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Etoposide vespid vp16
maximizing threaputic effects

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prevent crystallization via proper dilution

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Etoposide vespid vp16
minimizing adverse reactions

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apply warm compress to IV site, monitor hepatic and renal functinon and daily dose s/not exceed 8000 MG

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mitotic inhibitor - tanes
pacilataxel TAXOL treats ovarian and breast cancer and Karposi sarcoma
metabolized in hepatically

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mitotic inhibitor - tanes
pacilataxel TAXOL can cause hypersenstivity reaction, neurutoxic, cutaneous reactions and cardiotoxic

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mitotic inhibitor - tanes
pacilataxel TAXOL
neurotoxicity s/s

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numbness, tingling & pain to hands & feet

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what does nurse need with cardiotoxic

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baseline EKG and ejection fration MUGA SCAN

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mitotic inhibitor - tanes
pacilataxel TAXOL what does nurse need to to

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premedicate d/t hypersitivity

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camptothecines: topotecan

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treats metastic ovarian cancer, small cell lung and all
hepatic metabolism

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camptothecines: topotecan
contracindications and issues

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poor bone marrow reserves can cause head ache, fever and flu-like symptoms

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Hydroxyurea for hematologic cancers = bbb penetration donts use in severe anemia, severely depressed bone marrox

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hydroxyurea can cause renal problems, CNS effects are drowsiness, HA, dizziness, hallucinations
"think hydro = high= hallucinations"

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with hydroxyura use patients actual or ideal body weight for dosage pretreat will allopurinol if necessary

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Alkylating agents: Cytoxan ( cyclophoshamide) treats hematologic malignancies, acute and chronic leukemias, stem cell transplants and solid tumors, hepatic metabolism

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Cytoxan ( cyclophoshamide
precautions and complications are

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poor renal or hepatic function
dose limiting = leukopenia, sterile hemorrhagic cystitis, secondary malignicies, dizzy, nnasal stuffiness, rhinnorrhea with rapid infusion

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what is sterile hemorrhagic cystitis

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you will have pain, burning and hematuria give uroprotectant drug mensa (Mesnex) and hydrate patient well before, during and after treatment

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Cytoxan ( cyclophoshamide
what are adverse effects

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nephrotoxicty, neurotoxicity, ototoxicity, anaphylaxis like reaction and electrolyte imbalance

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Nitrosoureas: carmustine
pallative care threapy of brain tumors hodgkin - renal and respiratory excretion crosses bbb

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Carmustine can cause irreversible pulmonary fibrosis and need pulmonary assessments avoid aspirin

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anitumor antibiotics: doxorubicin red drug hepatic metabolism may turn urine red

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antitumor antibiotics: doxorubicin red drugcardiotoxicity is the dose-limiting toxicity it is cumulative and may manifest in weeks or months

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anitumor antibiotics: doxorubicin red drug
contraindications

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severe congestive heart failure, cardiomyopahty and myelosupression can cause renal insufficency

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hormones and hormone antagonists
used in lymphomas, squamous cell carcinoma ad testicular cancer high risk for pulmonary toxicity

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hormones and hormone antagonists treat neoplasma inhibit tumor proliferation alter cellular environment, affect permeability of cell membrane have pallative benefits, anti-inflammatory

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antiestrogens: tamoxifen
treats advanced breast cancer adjuvant therapy for axillary node-negative breast cancer

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Tamoxifen is well absorbed, highly protein bound, hepatic metabolised, competes with estrogen for binding sites

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tamoxifen
hypersensitvity, causes hot flashes, mild nausea, all s/s of menapause and bone and tumor pain is sign it is working

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tamoxifen
assess serum calcuim levels and corneal changes with decreased visual acutiy