Textbook of Medical-Surgical Nursing 3e

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Chapter 11

Oncology: Nursing management in cancer care

Table 11-7  Antineoplastic Agents Drug class and examples

Mechanism of action

Cell cycle specificity Common side effects

Alkylating agents Busulfan, carboplatin, chlorambucil, cisplatin, cyclophosphamide, dacarbazine, fotemustine, ifosfamide, melphalan, temozolomide, thiotepa Nitrosureas Carmustine (BCNU), lomustine (CCNU), semustine (methyl CCNU), streptozotocin (Zanosar)

Alter DNA structure by misreading   DNA code, initiating breaks in   the DNA molecule, cross-linking

Cell cycle—non-specific Bone marrow suppression, nausea,

  vomiting, cystitis (cyclophosphamide,   ifosfamide), stomatitis, alopecia,   gonadal suppression, renal toxicity   (cisplatin)

  DNA strands

Similar to the alkylating agents;   cross the blood–brain barrier

Cell cycle—non-specific Delayed and cumulative

  myelosuppression, especially   thrombocytopenia; nausea, vomiting

Topoisomerase I inhibitors Irinotecan, topotecan

Induce breaks in the DNA strand   by binding to enzyme   topoisomerase I, preventing   cells from dividing

Cell cycle—specific

Bone marrow suppression, diarrhoea,   nausea, vomiting, hepatotoxicity

Antimetabolites 5-azacytadine, cytarabine, edatrexate fludarabine,

Interfere with the biosynthesis of   metabolites or nucleic acids   necessary for RNA and DNA

Cell cycle—specific

Nausea, vomiting, diarrhoea, bone   marrow suppression, proctitis,   stomatitis, renal toxicity   (methotrexate), hepatotoxicity

  (S phase)

5-fluorouracil (5-FU), FUDR, gemcitabine, hydroxyurea, leustatin, 6-mercaptopurine, methotrexate, pentostatin, 6-thioguanine

  synthesis

Antitumour antibiotics Bleomycin, dactinomycin, daunorubicin, doxorubicin

Interfere with DNA synthesis by   binding DNA; prevent RNA

Cell cycle—non-specific Bone marrow suppression, nausea,

  vomiting, alopecia, anorexia, cardiac   toxicity (daunorubicin, doxorubicin)

(Caelyx), epirubucin, idarubicin, mitomycin, mitoxantrone, plicamycin Mitotic spindle poisons Plant alkaloids : etoposide, teniposide, vinblastine, vincristine (Oncovin), Taxanes : paclitaxel, docetaxel Hormonal agents Androgens and antiandrogens, oestrogens and antioestrogens, progestins and antiprogestins, aromatase inhibitors, luteinising hormone–releasing hormone analogues, steroids Miscellaneous agents Asparaginase, procarbazine vindesine, vinorelbine

  synthesis

Arrest metaphase by inhibiting   mitotic tubular formation   (spindle); inhibit DNA and

Cell cycle—specific

Bone marrow suppression (mild with   VCR), neuropathies (VCR),

  (M phase)

  stomatitis

  protein synthesis

Arrest metaphase by inhibiting   tubulin depolymerisation

Cell cycle—specific

Bradycardia, hypersensitivity   reactions, bone marrow   suppression, alopecia,

(M phase)

  neuropathies

Bind to hormone receptor sites   that alter cellular growth; block   binding of oestrogens to receptor   sites (antioestrogens); inhibit   aromatase of P450 system, which   decreases oestrogen level Unknown or too complex   RNA synthesis; suppress

Cell cycle—non-specific Hypercalcaemia, jaundice, increased

  appetite, masculinisation,   feminisation, sodium and fluid   retention, nausea, vomiting, hot

  flushes, vaginal dryness

Varies

Anorexia, nausea, vomiting, bone   marrow suppression, hepatotoxicity,   anaphylaxis, hypotension, altered   glucose metabolism

  to categorise

Dosage Dosage of antineoplastic agents is based primarily on the patient’s total body surface area, previous response to chemo­ therapy or radiation therapy, and function of major organ systems. Dosages are determined to maximise cell kill while minimising impact on healthy tissues and subsequent toxici- ties. The therapeutic effect may be compromised if inadequate dosing is required due to toxicities. Modification of dosage

is often required if critical laboratory values or the patient’s symptoms indicate unacceptable or dangerous toxicities or if the patient’s weight and therefore body surface area has changed since commencing chemotherapy treatment. Various laboratory tests, in addition to daily to weekly weights, are per- formed prior to, during and after chemotherapy to determine optimal treatment options, evaluate the patient’s response and monitor toxicity. Laboratory and physical assessments of the