ANTITUMOR ANTIBIOTICS
·
Interferes
with DNA synthesis by binding DNA; prevents RNA synthesis
·
Indication:
o
Target
malignancies: Leukemias, Neuroblastoma, Nephroblastoma, breast caner, ovarian
cancer, thyroid cancer and lung cancer
·
Contraindication:
o
Lung
disease, renal and hepatic disorders, ulcers, and gastrointestinal disease
Example:
|
bleomycin (Blenoxane®)
|
dactinomycin (Actinomycin D®,
Cosmegan®)
|
daunorubicin (DaunoXome®,
Cerubidine®)
|
doxorubicin (Adriamycin®)
|
idarubicin (Idamycin®)
|
mitomycin (Mutamycin®)
|
mitoxantrone (Novantorone®)
|
plicamycin (Mithracin®)
|
valrubicin (Valstar®)
|
Side Effects:
·
Bone
marrow suppression
·
Nausea
and vomiting
·
Alopecia
·
Anorexia
·
Vesication
·
Daunorubicin
(DaunoXome), Idarubicin (Idamycin) and Doxorubicin (Adriamycin): cardiotoxicity
·
Bleomycin
(Blenoxane): pulmonary toxicity
·
Plicamycin
(Mithracin): affects bleeding time
Nursing Considerations:
ü Assess vital signs and temperature for signs
of infection.
ü Withhold medication if platelet count is
<75,000 cells/µL or WBC is <4000 cells/ µL and notify the physician.
ü Monitor ECG; assess for arrhythmias, gallops
and CHF (during dactinomycin [Actinomycin D], daunorubicin [DaunoXome,
Cerubidine], Doxorubicin [Adriamycin] therapy.
ü Monitor CBC with differential, BUN and uric
acid.
ü Assess pulmonary function studies (during
Bleomycin [Blenoxane] therapy).
ü Assess for bleeding; check stool for occult
blood. Avoid use of aspirin, anticoagulants and thrombolytic agents (during
Plicamycin [Mithracin] therapy).
ü May see delayed cardiotoxicity months to
years after administration of doxorubicin.
ü To prevent heart failure related to
doxorubicin, do not administer more than 550 mg/m2 in a lifetime
ü Evaluate hydration and nutrition status.
ü Monitor IV site for vesication.
ü Instruct oral care for stomatitis.
ü
Teach
care for hair loss.
MITOTIC SPINDLE POISONS (Mitotic
Inhibitors, Vinca Alkaloids)
·
Arrests
metaphase by inhibiting mitotic tubular formation (spindle); inhibit DNA and
protein synthesis
·
Indication:
o
Target
malignancies: Leukemias, Hodgkin’s and Non-Hodgkin’s lymphomas,lymphocytic and
histocytic lymphoma, neuroblastoma, nephroblastoma, Kaposi’s sarcoma, advanced
testicular cancer and unresponsive breast cancer
·
Contraindication: Cardiovascular, hepatic, nerve, and muscle
disease
Example:
|
Plant Alkaloids
o etoposide
(VePesid®)
o teniposide
(Vumon®)
o vinblastine
(Velban®)
o vincristine
(Oncovin®)
o vinorelbine
(Navelbine®)
|
Taxanes
o paclitaxel
(Nov-Onxol®, Taxol®, Paclitaxel Novaplus®)
o docetaxel
(Txotere®)
|
Side Effects:
·
Alopecia
·
Hoarseness
·
Ptosis
·
Anorexia,
nausea and vomiting
·
Stomatitis
·
Hyperuricemia
·
Constipation,
paralytic ileus
·
Vinblastine(Velban®):
bone marrow suppression
·
Vincristine
(Oncovin®): Neorotoxicity/ neuropathies
·
Taxanes:
Bradycardia, hypersensitivity reactions and neuropathies
·
Areflexia
Nursing Considerations:
ü
Assess vital
signs.
ü
Monitor
CBC with differential.
ü
Assess
neuromuscular function.
ü
Evaluate
gastrointestinal function; manage constipation.
ü
Administer
antiemetics prn as ordered.
ü
Monitor
eyes for ptosis; monitor for hoarseness.
ü
Teach
ways to manage hair loss.
HORMONAL AGENTS
·
Binds
to hormone receptor sites that alter cellular growth; block binding of
estrogens to receptor sites (antiestrogens); inhibit RNA synthesis
·
Indication:
o
Target
malignancies: Advanced breast and prostate cancer
·
Contraindication:
o
Pregnancy,
hepatic and renal disease, osteoporosis, hypertension, hypercholesterolemia
Example:
|
diethylstilbestrol (DES, Stilphostrol®)
|
letrozole (Femara®)
|
raloxifene (Evista®)
|
tamoxifen (Nolvadex®)
|
goserilin acetate (Zoladex®)
|
Testosterone
|
medroxyprogesterone (Depo- Provera®)
|
asparaginase (Elspar®)
|
mitotane (Lysodren®)
|
megestrol acetate (Megace®)
|
Side Effects:
·
Hypercalcemia
·
Hypertension
·
Jaundice
·
Increased
appetite, weight gain
·
Masculinization
·
Feminization
·
Sodium
and fluid retention
·
Hot
flashes
·
Vaginal
dryness
·
Nausea
and vomiting
·
Asparaginase
(Eslpar): impaired pancreatic function
·
Mitotane
(Lysodren): Hemorrhagic cystitis, hyperuricemia and hypercholesterolemia
·
Tamoxifen
(Nolvadex): Edema, hypercalcemia, elevated cholesterol and triglyceride levels,
decreased effects of estrogen
·
Diethylstilbestrol
(DES, Stilphostrol):
§ Female: Fluid retention, feminization and
uterine bleeding
§ Male: impotence and masculinization
Nursing Considerations:
ü
Monitor
vital signs.
ü
Administer
diuretics prn as ordered.
ü
Monitor
for bleeding.
ü
Monitor
electrolytes, uric acid and cholesterol levels.
ü
Monitor
pancreatic function.
ü
Explain
reason for sex characteristic alterations.
ü
Provide
patient teachings for managing hot flashes.
