Review Notes in Pharmacology: Drugs Used in Chemotherapy (Antineoplastic Drugs)

General Characteristics
• Destroy malignant cells by interfering with cell replication, with the supply and uptake of nutrients, or with the
DNA or RNA inside the nucleus.
• Affects both normal and malignant cells
• Commonly affected cells are the rapidly-dividing cells of the bone marrow, the gastrointestinal tract, and the
hair follicles.
• Potential teratogens (substances which can affect normal fetal growth resulting in physical defects in the
fetus)
• Side effects: Nausea, vomiting, diarrhea, constipation, stomatitis, alopecia, bone marrow, depression, fatigue,
increased uric acid levels, and hepatic toxicity (important: administer antiemetics as indicated, monitor CBC,
I&O, liver and renal function studies, and inspect oral cavity)
• Potentially mutagenic and carcinogenic (important: should be handled using gloves, goggles, long-sleeved
gown, mask; used equipment is considered hazardous waste, monitor IV site for extravasation)

Indications
• Used to cure malignant neoplasms, relieve symptoms, or maintain remissions
• Chemotherapy is the treatment of choice for conditions such as Hodgkin’s disease and Wilms’ tumor
• Some antineoplastic drugs such as Methotrexate (MTX) are used for nonmalignant conditions such as arthritis
and psoriasis

Classifications

alkylating agents- damages DNA and interferes with cell replication; includes nitrogen mustard derivatives
nitrosoureas, and platinum compounds

Some Alkylating Drugs Uses Adverse Effects

Cyclophosphamide (Cytoxan ) Hodgkin’s disease, non- Bone marrow depression, nausea,
Hodgkin’s lymphomas, vomiting, alopecia, hemorrhagic
leukemias, cancer of breast, cystitis, hypersensitivity reactions,
lung or ovary, multiple secondary leukemia or
myeloma, neuroblastoma bladder cancer
Cisplatin (Platinol) Advanced carcinomas of Nausea, vomiting, anaphylaxis,
testes, bladder, ovary nephrotoxicity, bone marrow
depression, ototoxicity
Chlorambucil (Leukeran) Chronic lymphocytic leukemia, Bone marrow depression, hepatotoxicity,
Hodgkin’s and non-Hodgkin’s secondary leukemia
lymphomas
Melphalan (Alkeran) Multiple myeloma, ovarian Bone marrow depression, nausea
cancer and vomiting, hypersensitivity
reactions

antimetabolites- deprive cells of substances needed for formation of cell DNA or cause formation of abnormal DNA by
competing with, replacing, or antagonizing normal metabolites; includes folic acid antagonists such as methotrexate,
purine antagonists like mercaptopurine, and pyrimidine antagonists such as fluouracil.

Some Antimetabolites Uses Adverse Effects

Capecitabine (Xeloda) Metastatic breast cancer, colorectal Bone marrow depression, nausea,
cancer vomiting, diarrhea, mucositis

Fluorouracil (5-FU) Carcinomas of the breast, Bone marrow depression, nausea,

(Adrucil, Efudex, colon, stomach, and vomiting, mucositis
Fluoroplex) pancreas Pain, pruritus, burning at site of
Solar keratoses, basal cell carcinoma application
Mercaptopurine Acute and chronic leukemias Bone marrow depression, nausea,
(Purinethol) vomiting, mucositis
Methotrexate (MTX) Leukemias, non-Hodgkin’s Bone marrow depression, nausea,
(Rheumatrex) lymphomas, osteosarcoma, vomiting, mucositis, diarrhea,
choriocarcinoma of testes, fever, alopecia
cancers of breast, lung, head, and neck

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antibiotic antineoplastic agents- antitumor antibiotics have effects similar to those of alkylating agents as they bind
with DNA and RNA transcription; includes drugs such as Doxorubicin (has a high potential for cardiotoxicity and tissue
necrosis) and Bleomycin (can cause pulmonary toxicity)

Some Antitumor Antibiotics Uses Adverse Effects

Bleomycin (Blenoxane) Squamous cell carcinoma, Pulmonary toxicity, mucositis,
Hodgkin’s and non- alopecia, nausea, vomiting,
Hodgkin’s lymphomas, testicular hypersensitivity reactions
carcinoma
Dactinomycin Rhabdomyosarcoma, Wilms’ Bone marrow depression, nausea,
(Actinomycin D) tumor, choriocarcinoma, Vomiting, extravasation may lead to
testicular carcinoma,Ewing’s sarcoma tissue necrosis
Daunorubicin (Daunomycin) Acute leukemias, lymphomas Bone marrow depression, alopecia,
mucositis, GI upset,
cardiomyopathy, extravasation may lead
to tissue necrosis
Mitomycin (Mutamycin) Metastatic carcinomas of stomach and Bone marrow depression, nausea,
pancreas Vomiting, extravasation may lead to tissue
necrosis.

antineoplastic agents affecting hormonal balance- includes hormones that interfere with tumor growth and are useful
in the palliative treatment of some cancers, adrenal corticosteroids used in the treatment of leukemia, and lymphoma,
and certain hormone inhibitors like Tamoxifen

Some Hormones and Hormone Uses Adverse Effects

Inhibitors
Diethylstilbestrol (DES) Breast and prostate cancer Headache, vertigo, insomnia, nausea,
weight changes, phlebitis, edema, uterine
bleeding, feminization in males, changes
in calcium and folic acid metabolism
Fluoxymesterone (Halotestin) Breast and renal cancer Nausea, vomiting, weight gain, edema,
fluid retention, vaginal dryness and
itching, fluid retention, hypercalcemia if
with bone cancer, masculinization of
females
Tamoxifen (Nolvadex) Breast cancer: after surgery or Hot flashes, nausea, vomiting, vaginal
radiation; prophylaxis in discharge, risk of endometrial cancer in
high-risk women; and treatment of nonhysterectomized women
metastatic disease

mitotic inhibitors- cell-cycle specific agents that stop mitosis; includes plant alkaloids such as taxanes, vinca alkaloids,
camptothecins, and podophyllotoxins

Some Mitotic Inhibitors Uses Adverse Effects

Vincristine (Oncovin) Hodgkin’s and other lymphomas, Peripheral neuropathy, extravasation may
acute leukemia, neuroblastoma, Wilms’ lead to tissue necrosis
tumor
Etoposide (VePesid) Testicular cancer, small-cell lung cancer Bone marrow depression, allergic
reactions, nausea, vomiting, alopecia
Vinblastine (Velban) Metastatic testicular carcinoma, Bone marrow depression, nausea,
Hodgkin’s disease vomiting., extravasation may lead to
tissue necrosis
Pacitaxel (Taxol) Advanced ovarian cancer, Bone marrow depression, allergic
advanced breast cancer, reactions, hypotension, bradycardia,
non–small cell lung cancer, nausea, vomiting
AIDS-related Kaposi’s sarcoma

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miscellaneous antineoplastic agents- Miscellaneous agents vary in their sources, mechanisms of action, indications for
use, and toxic effects; includes L- Asparaginase, Hydroxyurea, and Procarbazine

Miscellaneous Antineoplastic Agents Uses Adverse Effects

L-Asparaginase (Elspar) Non–small cell lung cancer Bone marrow depression, peripheral
Neuropathy, extravasation
may lead to tissue necrosis
Hydroxyurea (Hydrea) Chronic myelocytic leukemia, Bone marrow depression, nausea,
melanoma, ovarian cancer, vomiting, peripheral neuritis
head and neck cancer
Procarbazine (Matulane) Hodgkin’s disease Bone marrow depression, mucositis,
CNS depression

Major Side Effects and Nursing Interventions

• nausea and vomiting

o administer antiemetics (e.g. Plasil) routinely every 4-6 hours after as well as before chemotherapy is
started
o withhold food and fluids 4-6 hours before chemotherapy-->a light, dry snack may be allowed
o improve patient's appetite and minimize food aversion by:

providing 5-6 small meals per day

provide bland, non-greasy foods-->crackers, toast

serving foods at room temperature or slightly cooler-->less odor

• diarrhea
o administer antidiarrheals as ordered
o maintain perineal care-->to prevent infection and minimize discomfort; medicated creams may be
prescribed
o give clear liquids as tolerated-->apple juice, ginger ale, jello, broth
o instruct patient to avoid milk products, spicy foods, and hard to digest foods temporarily-->to rest the
bowel
o monitor potassium, sodium, and chloride levels
o measure I&O regularly

• stomatitis
o provide and instruct patient on good oral hygiene-->inspect mouth regularly, use non-alcoholic
mouthwash (e.g.)diluted hydrogen peroxide),removal of ill-fitting dentures, use of soft-brsitled
toothbrush
o provide health teachings on the importance of:

keeping mucous membranes moist-->let patients suck on popsicle

avoidance of hot and spicy foods-->pasta and tacos

avoidance of acidic and/or carbonated food and drinks-->cola, orange juice, grapefruit juice

keeping food at room temperature or slightly cool
o apply water-soluble lubricant such as KY jelly to dry, cracked lips
o offer viscous lidocaine before meals to minimize discomfort

• thrombocytopenia (low platelet count)

o monitor blood count
o observe for epistaxis, petechiae, and ecchymosis
o protect clients from injury-->no flossing, use of razor
o instruct clients to avoid bumping or bruising the skin
o avoid giving IM injections

• leukopenia (decrease in number of circulating WBCs)

o implement careful handwashing technique
o maintain reverse isolation as ordered
o monitor for signs of respiratory and other infections
o instruct patient to avoid crowds/person with infections
o provide patient teachings on the early signs of infection:

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Fever above 100.4°F (37.8°C)

Chills

New cough or production of sputum

Sore throat

More than three loose stools in a day

Pain or burning upon urination

• anemia
o monitor hemoglobin and hematocrit
o encourage adequate rest and sleep periods
o administer oxygen as needed
o provide health teachings on symptoms of anemia:

Fatigue, dizziness, lightheadedness

Shortness of breath

Difficulty staying warm

Chest pains

• alopecia
o inform patient that hair loss is not permanent
o encourage the patient to obtain bandana or wig before starting treatment
o administer scalp tourniquet or scalp hypothermia using ice pack as ordered-->to minimize hair loss
o offer support and encouragement
o provide health teachings on the importance of:

maintaining skin and scalp moisture-->limit shampooing to 3x a week with a mild shampoo and
conditioner

preventing damage to hair follicles-->avoid using hair dryers, irons, and dyes

avoid tangling hair-->wide-toothed comb; use of silk pillowcase when sleeping

• kidney damage
o encourage increased fluid intake and frequent voiding to prevent accumulation of metabolites in the
bladder
o administer Allopurinol (Zyloprim) as ordered-->prevents uric acid formation which is common among
patients on chemotherapy

• reproductive organ damage

o sperm banking is encouraged for men-->chemotherapy may cause infertility
o advise clients and partners to use reliable methods of contraception-->chemotherapy can cause
mutagenic damage to chromosomes leading to birth defect

• neurologic damage
o peripheral neuropathies and hearing losses may occur
o protect patient from injury

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