Pharma --Antineoplastics--Drugs and their classes
Most cells in the human body are in the
Cell cycle specific drugs are most effective against
rapidly growing cancers
The percent of rapidly dividing cells
Anticancer drugs are more effective against cancers with a high
Which cancers have a high growth fraction?
leukemias and lymphomas
solid tumors have a low growth fraction and therefore
respond poorly to anticancer drugs
Solid tumor cancers require
high dose chemo to overcome the low growth fraction
why do tumors slow in growth as they get larger?
the blood supply decreases
What is needed for anticancer cells to be effective and access their target?
Put the phases of the cell cycle in order
How can chemo be administered?
Benefits to multidrug therapy
-multiple cell cycle hits
-enhances tumoricidal activity
Anticancer drugs affect which healthy cells most
rapidly dividing--skin and hair
Myelosupression occurs when
bone marrow is supressed--RBC/WBC/platelets
What is cyclophosphamide (Cytoxan) used to treat?
WHat is fluorouracil (5-FU) used to treat?
Head & neck
basal cell carcinoma (Topical)
Fluororocil (5-FU) is NOT given
PO because bioavailability is unstable
What natural supplement promotes cancer growth?
What supplement has "blood fighting" properties that can increase bleeding risk?
What does doxorubicin treat?
Solid and hematogenous tumors
What type of solid tumor does doxorubicin not treat?
Acute myelogenous leukemia because of risk of stomatitis and cardiotoxicity
Doxorubicin is only given
What causes the dose limit is vincristine?
A major concern with vincristine?
numerous drug interactions
Why are corticosteroids used in cancer treatment?
To manage inflammation associated with tumor growth
Other than skin and hair, what tissues suffer during chemo treatment?
What is the NADIR?
The time at which blood counts are the lowest
When does the NADIR typically happen?
7-10 days after treatment
Ankylating drugs are effective in all phases, but they are MOST effective during
Ankylating drugs given in high doses can cause permanent damage to
bone marrow, causing acute leukemia
Low RBC resulting from chemo can manifest with
-mental status change
Anemic cancer patients should be provided with proper pain relief because
pain increases oxygen demand
What can be given to increase WBC counts in cancer pts?
Colony stimulating factors like filgrastim
How to prevent bleeding in thrombocytopenic cancer pts?
-Avoid invasion- like rectal temp
-monitor counts and signs of bleeding
What causes anorexia related to chemo?
Why do antineoplastics cause N/V?
they stimulate the CTZ
Which chemo drugs are most likely to cause diarrhea?
Other than cancer, what can cyclophosphamide treat?
When using IV cyclophosphamide, what must be assesses?
infiltration, as this drug is a severe vesicant that will cause tissue necrosis
The pt must be very well __________ while taking cyclophosphamide in order to avoid ______________
Pts on cyclophosphamide must be continually assessed for
How does cyclophosphamide affect the skin?
increased pigmentation of skin and nail beds
Antimetabolites are Cell cycle specific to which phase?
Which antimetabolite can be cytotoxic in multiple cell cycle phases?
Pts should take oral cyclophosphamide ___________- to avoid ____________
early in the day
accumulation in the bladder
If platelets arelower than 50,000 mm3
a soft toothbrush should be used
In order to alkalize urine, pts should eat diets low in
purines (which are found in organ meats, beans, peas)
Which herbs interfere with chemo?
st johns wort
Therapy should be stopped if which labs are present
How do antitumor antibiotics work?
by interfering with DNA replication and RNA transcription of cancer cells
Most Antitumor antibiotics works in which cell cycle phases?
Antitumor antibiotics may cause
vesication (tissue blistering)
Doxorubicin has a higher chance of causing what than other antitumor antibiotic anthracyclines?
Cardiotoxicity (especially IV)
What is the max dose of Doxorubicin due to cardiotoxicity?
Fluorouracil can do what?
Cross the BBB
Pts of Fluorouracil should avoid alcohol mouthwash and do what instead?
rinse with saline every two hours
Grapefruit should not be eaten/drank while on
Doxorubicin may discolor
urine to pink or red
Plant alkaloids are
cell cycle specific
How do plant alkaloids work?
interfere with cell functions during mitosis (antimicrotubules)--- leads to apoptosis
Doxorubicin causes complete
Drugs used as a cytoprotectant against doxorubicin?
Dexrazoxane-- prevents cardiotoxicity
Skin integrity is a concern with all antineoplastics, but especially
Doxorubicin must be given through a
large bore, quickly running IV infusion
What plant is Vincristine made from?
What is the dose limiting property of vincristine?
Does Vincristine cross the BBB?
Neuropathy occurs with ________ in as little as a weekly dose, but _________
it will resolve within a week
Vincristine side effects are different from other antineoplastics in that
it is mostly various neurological side effects
-deep tendon reflex loss
Nonneurological effects of Vincristine
-hepatic venoocclusive disease
-transient cortical blindness/optic atrophy
IV vincristine administration must include monitoring for
can occur 3-4 wks after administration!
Constipation and electrolyte imbalance are a major concern and must be avoided with
For a pt on vincristine, __________ must be monitored closely to avoid renal toxicity and electrolyte imbalances
Exogenous estrogen can do what for a cancer pt
slow the rate pf prostate cance
Exogenous androgen opposes the activity of
Epoetin alpha may cause
Most targeted therapies are either
small molecules or monoclonal antibodies
How do targeted therapies work
they clock signal transduction and stop cancer spread by causing cell death
Epoetin Alpha (Procrit, epogen) side effects
Erythropoietin stimulators (procrit/epogen) increases risk of death if hgb is
Filgastrim (Neupogen/neulasta) side effects
-elevated hepatic enzymes
Filgastrim stimulates what cells to proliferate?
T and B lymphocytes
Most pts on Erythropoietin colony stimulating factor will need _______- so monitor _______
Pts on biological response modifiers should have which systems evaluated
Risks of bio response modifiers
-anaphylaxis/allergies (MONITOR SKIN)
Bio response modifiers may cause
histamine effects--use tylenol and Benadryl to treat chills and fever resulting
Side effects of bevacizumab
__________ should be assessed before starting bevacizumab
SKIN--during treatment as well
--Clotting and immunity may be altered
All monoclonal antibodies (ie bevacizumab) are given
IV because the GI tract alters the structure
4 requirements for effective monoclonal antibodies
-target antigens are on tumor cell surface
-antigens do not spread into the blood stream
-antigens occur in high numbers
-antigens play a role in tumor cell survival
Side effects of monoclonal antibodies are related to
activation of the immune system
location of the antigen
type of MAb
Monoclonal antibodies are made from
mouse or human or mix
(human is more effective)
Side effects of MAB rituximab
bone marrow suppression/pancytopenia
tumor lysis syndrome
joint and muscle pain
Mab rituximab should not be used in patients with
-hx of hep B
Potential problems with the use of monoclonal antibodies
-fluid electrolyte imbalance
While on monoclonal antibodies, __________ should be avoided
pregnancy (for 12 months after treatment)
breastfeeding (for 60 days after)
Patients on monoclonal antibodies should immediately report
convulsions, persistent headache
reduced eyesight/blurred vision