Oncological and Hematological Medications Flashcards Preview

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Flashcards in Oncological and Hematological Medications Deck (12)
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1
Q

Antineoplastic Medications

A
  • kill or inhibit the reproduction of neoplastic cells and are used to cure, increase survival time, and decrease life-threatening complications.
  • effect may not be limited to neoplastic cells and normal cells also are affected.
  • can be phase-specific or non-specific, usually used in combination to increase response.
  • IV, oral, intra-arterial, isolated limb perfusion, or intracavity route with dose usually based on BSA and type of cancer.
  • side and adverse effects: mucositis, alopecia, anorexia, nausea, vomiting, diarrhea, anemia, low WBC count (neutropenia), thrombocytopenia, infertility, sexual alterations, neuropathy.
    Important:
  • withhold med and initiate neutropenic precautions if the segmented neutrophil count decreases below 18%
  • fluid intake of at least 2L/day to maintain adequate renal function.
  • chemo should be prepared in a air-vented space (pregnant nurses should avoid preparation and adm).
  • reduce IV site pain by altering IV rates or warming the injection site to distend the vein.
  • in case of extravasation, heat or ice is applied depending on the med and an antidote may be injected into the site.
  • new hair growth will occur several months after the final treatment.
  • need for contraception because of teratogenic effects
2
Q

Alkylating Medications

  • Nitrogen mustards: Bendamustine, Chlorambucil, Cyclophosphamide, Ifosfamide, Estramustine, Mechlorethamine, Melphalan.
  • Nitrosoureas: Carmustine, Lomustine, Streptozocin.
  • Alkylating-Like Meds: Altretamine, Busulfan, Carboplatin, Cisplatin, Dacarbazine, Oxaliplatin, Temozolomide, Thiotepa.
A
  • break the DNA helix, thereby interfering with DNA replication; cell cycle phase nonspecific med.
    Side and adverse effects:
  • anorexia, nausea, vomiting, stomatitis, rash, IV site pain.
  • Busulfan may cause hyperuricemia;
  • Chlorambucil and mechlorethamine may cause gonadal suppression and hyperuricemia.
  • Cisplatin, a platinum compound, may cause ototoxicity, tinnitus, hypokalemia, hypocalcemia, hypomagnesemia, and nephrotoxicity.
  • Cyclophosphamide may cause alopecia, gonadal suppression, hemorrhagic cystitis, and hematuria.
  • Ifosfamide may cause hemorrhagic cystitis and neurotoxicity.
3
Q

Alkylating Medications: important interventions

A
  • when adm cisplatin, assess client for dizziness, tinnitus, hearing loss, incoordination, and numbness or tingling of extremities.
  • Mesna may be adm with ifosfamide to reduce the potencial for ifosfamide-induced cystitis.
  • instruct client that oral cyclophosphamide is adm without food.
  • instruct client to follow a diet low in purines to alkalinize the urine and lower uric acid blood levels.
  • encourage increase in fluid intake (2-3L/day) when taking cyclophosphamide and ifosfamide because can cause hemorrhagic cystitis.
4
Q

Antitumor Antibiotic Medications

A
  • interfere with DNA and RNA synthesis; cell cycle phase-nonspecific med.
    Side and adverse effects:
  • nausea, vomiting, fever, bone marrow depression, rash, alopecia, stomatitis, gonadal suppression, hyperuricemia, vesication (at IV site).
  • Daunorubicin may cause heart failure and dysrhythmias.
  • Doxorubicin and Idarubicin may cause cardiotoxicity, cardiomyopathy, and ECG changes (dexrazoxane may be used in combination to reduce cardiomyopathy).
  • pulmonary toxicity can occur with Bleomycin.
    Med names:
  • Bleomycin sulfate; Dactinomycin; Daunorubicin; Doxorubicin; Epirubicin; Idarubicin; Mitomycin; Mitoxantrone; Valrubicin.
5
Q

Antimetabolite Medications

  • Azacitidine, Capecitabine, Cladribine, Clofarabine, Cytarabine, Decitabine, Floxuridine, Fludarabine, Fluorouracil, Gemcitabine, Hydroxyurea, Mercaptopurine, Methotrexate, Nelarabine, Pemetrexed, Pentostatin, Pralatrexate, Thioguanine, Uracil.
A
  • halt the synthesis of cell protein and impairs cell division; cell cycle phase-specific (S phase).
    Side and adverse effects:
  • anorexia, nausea, vomiting, diarrhea, alopecia, stomatitis, depression of bone marrow.
  • Cytarabine and Mercaptopurine may cause hyperuricemia and hepatotoxicity.
  • Fluorouracil may cause phototoxicity reactions and cerebellar dysfunction.
  • Methotrexate may cause hyperuricemia, photosensitivity, hepatotoxicity; hematological, GI, and skin toxicity.
    Important:
  • when adm fluorouracil or methotrexate, instruct the client to use sunscreen and protective clothing.
  • when adm fluorouracil assess for signs of cerebellar dysfunction, stomatitis and diarrhea, which may necessitate med discontinuation.
  • when adm large doses of methotrexate, prepare to adm leucovorin to prevent toxicity (known as leucovorin rescue).
6
Q

Miotic Inhibitor Medications (Vinca Alkaloids)

A
  • prevent mitosis, causing cell death; cell cycle phase-specific (act on M phase).
    Side and adverse effects:
  • leukopenia, ptosis, hoarseness, motor instability, anorexia, nausea, vomiting, peripheral neuropathy, alopecia, stomatitis, hyperuricemia, phlebitis (IV site).
  • neurotoxicity with vincristine, manifested as numbness and tingling in the fingers and toes; constipation and paralytic ileus can also occur.
    Med names:
  • Vinblastine sulfate; Vincristine sulfate; Vinorelbine.
  • Docetaxel; Paclitaxel (Taxanes)
7
Q

Topoisomerase Inhibitors

A
  • block an enzyme needed for DNA synthesis and cell division; cell cycle phase-specific (G2 and S phases).
    Side and adverse effects:
  • leukopenia, thrombocytopenia, anemia, anorexia, nausea, vomiting, diarrhea, alopecia, orthostatic hypotension, hypersensitivity reaction.
    Med names:
  • Etoposide; Irinotecan; Teniposide; Topotecan.
8
Q

Hormonal Medications and Enzymes

  • Estrogens: Estramustine, Ethinyl estradiol.
  • Antiestrogens: Anastrozole, Exemestane, Fulvestrant, Letrozole, Raloxifene, Tamoxinfen citrate, Toremifene.
  • Antiandrogens: Bicalutamide, Enzalutamide, Flutamide, Goserelin acetate, Histrelin, Nilutamide, Triptorelin.
  • Progestins: Medroxyprogesterone, Megestrol acetate.
  • Other hormonal antagonists and enzymes: Asperaginase, Leuprolide acetate, Mitotane.
A
  • suppress the immune system and block normal hormones in hormone-sensitive tumors; change the hormonal balance and slow the growth rates of certain tumors.
    Side and adverse effects:
  • anorexia, nausea, vomiting, leukopenia, impaired pancreatic function with asparaginase, breast swelling, hot flashes, weight gain, hypertension, thromboembolic disorders, edema, electrolyte imbalances.
  • sex alterations: masculinizing effect in women (chest and facial hair, menses stops); feminine manifestations in men (gynecomastia).
  • hemorrhagic cystitis, hypouricemia, and hypercholesterolemia with mitotane.
  • tamoxifen citrate decreases the effects of estrogen.
9
Q

Immunomodulator (immunotherapy) agents: biological response modifiers

A
  • stimulate the immune system to recognize cancer cells and take action to eliminate or destroy them.
  • interleukins help various immune system cells to recognize and destroy abnormal body cells.
  • interferons slow tumor cell division, stimulate proliferation, and cause cancer cells to differentiate into nonproliferative forms.
  • colony-stimulating factors induce more rapid bone marrow recovery after suppression by chemotherapy (Sangramostim, Filgrastim, Pegfilgrastin, Epoetin a, Darbepoetin a, Oprelvekin).
  • interleukins and interferons meds: Aldesleukin, Interferon a-2a, Interferon a-2b, Interferon a-n3, Recombinant Interferon a-2a, Recombinant Interferon a-2b.
10
Q

Target Therapy

A
  • medications used as targeted therapies are monoclonal antibodies and small molecule inhibitors that target a cellular element of the cancer cell or antisense medications that work at the gene level.
  • adverse effects: allergic reactions.
  • common monoclonal antibodies med: Bevacizumab, Cetuximab, Ibritumomab, Infliximab, Panitumumab, Pembrolizumab, Rituximab, Trastuzumab.
  • small molecule inhibitors: Bortezomib, Desatinib, Erlotinib, Gefitinib, Imatinib, Lapatinib, Nilotinib, Sorafenib, Sunitinib, Temsirolimus.
11
Q

Other Antineoplastic Medications

A
  • Altretamine: cytotoxic agent used to treat ovarian canver.
  • Denileukin Diftitox: recombinant DNA-derived med used to treat cutaneous T-cell Lymphoma.
  • Pegaspargase: used in combination chemotherapies for acute lymphoblastic leukemia in clients unable to take asparaginase.
  • Bexarotene: used to treat advanced-stage cutaneous T-cell lymphoma.
12
Q

Medications to Treat Anemia

A
  • iron-deficiency anemia: iron, oral or IV.
  • vit B12-deficiency anemia: vit B12, oral or IM.
  • folate-deficiency anemia: folate, oral.
  • acute blood loss anemia: blood transfusion, packed red blood cells, platelets, or frozen plasma depending on cause.
  • anmeia of chronic disease: iron (oral or IV), erythropoietic growth factors, leukopoietic growth factors, and thrombopoietic growth factors.