antineoplastic drugs.ppt

8/10/2019 Antineoplastic Drugs.ppt

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CHEMOTHERAPYCHEMOTHERAPY


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Antineoplastic DrugsAntineoplastic Drugs

Cancer is a disease in which cell multiply withoutCancer is a disease in which cell multiply without

control destroy healthy tissue and could lead tocontrol destroy healthy tissue and could lead to

death!death!

Anticancer drugs also called chemotherapeuticAnticancer drugs also called chemotherapeuticdrugs or antineoplastic therapy!drugs or antineoplastic therapy!

The treatment o" cancer is generally success"ulThe treatment o" cancer is generally success"ul

when the cancerous cells are locali#ed and ha$ewhen the cancerous cells are locali#ed and ha$e

not %een disseminated throughout the %ody! Thenot %een disseminated throughout the %ody! The

optimal treatment is surgical remo$al o" theoptimal treatment is surgical remo$al o" the

a&ected tissue or e'posure %y area %y means o"a&ected tissue or e'posure %y area %y means o"

radiation or co%altradiation or co%alt


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Chemotherapy o" cancer is generally usedChemotherapy o" cancer is generally used

when the cancerous cells are widelywhen the cancerous cells are widely

disseminated in the %ody when the use o"disseminated in the %ody when the use o"

surgery or radiation is not "easi%le or practical!surgery or radiation is not "easi%le or practical!Chemotherapy is the most e&ecti$e means o"Chemotherapy is the most e&ecti$e means o"

treatment! Anti cancer drugs cause cancer celltreatment! Anti cancer drugs cause cancer cell

death %y inter"ering with cancer cell replicationdeath %y inter"ering with cancer cell replication


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CA(T)O* (+CA(T)O* (+ CC, Changes in %athroom ha%its!, Changes in %athroom ha%its! AA, A sore that does not heal!, A sore that does not heal!

UU , (nusual discharge and %leeding!, (nusual discharge and %leeding!

TT , Thic-ness or lumps in the %reast or, Thic-ness or lumps in the %reast orother places!other places!

II , )ndigestion and di.culty in swallowing!, )ndigestion and di.culty in swallowing!

OO , O%$ious changes in moles or warts!, O%$ious changes in moles or warts! NN, *agging cough and hoarseness!, *agging cough and hoarseness!


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/actors that in0uence CA/actors that in0uence CA

de$elopmentde$elopment

1! En$ironmental /actors1! En$ironmental /actors

Chemical CarcinogenChemical Carcinogen

Physical CarcinogenPhysical Carcinogen

2iral Carcinogen2iral Carcinogen

3! Dietary "actors3! Dietary "actors 4! 5enetic predisposition4! 5enetic predisposition

6! )mmune "unction6! )mmune "unction


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Pre$entionPre$ention

Early detectionEarly detection 1! Mammography1! Mammography

3! PAP test3! PAP test

4! +tools "or occult4! +tools "or occult 6! +igmoidoscopy7Colonoscopy6! +igmoidoscopy7Colonoscopy

8! 9reast +el" E'am8! 9reast +el" E'am

:! Testicular +el" E'am:! Testicular +el" E'am

;! +-in inspection;! +-in inspection


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Diagnostic TestDiagnostic Test

9iopsy9iopsy 9one marrow E'amination9one marrow E'amination

Chest RadiographChest Radiograph

Complete 9lood CountComplete 9lood Count

CT scanCT scan


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3 types o" Anti cancer drugs3 types o" Anti cancer drugs

1!1! =CC*+> Cell cycle non speci?c drugs=CC*+> Cell cycle non speci?c drugsAl-ylating drugsAl-ylating drugs

Anti tumor anti%ioticAnti tumor anti%iotic

*itrosureas*itrosureas+teroids+teroids

3!3! =CC+> Cell cycle +peci?c Drugs=CC+> Cell cycle +peci?c Drugs

Antimeta%olitesAntimeta%olitesAl-aloidsAl-aloids

some anti tumor anti%ioticsome anti tumor anti%iotic


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Ad$erse Reaction to antiAd$erse Reaction to anti

cancer drugscancer drugs

9one marrow suppression9one marrow suppression


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5) Distur%ances5) Distur%ances

Anore'ia %ecause o" %itter taste inAnore'ia %ecause o" %itter taste in

the mouth "rom drugsthe mouth "rom drugs


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*ausea and $omiting %ecause*ausea and $omiting %ecause

antineoplastic drugs stimulatesantineoplastic drugs stimulates

$omiting centers$omiting centers

5ranisetron =ytril>5ranisetron =ytril>

Ondasentron =Bo"ran>Ondasentron =Bo"ran>


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Anti emetics are gi$en se$eral hours %e"oreAnti emetics are gi$en se$eral hours %e"orechemo! and "or 13 to 6 hours a"ter treatment!chemo! and "or 13 to 6 hours a"ter treatment!

Diarrhea hydration should %e maintained hotDiarrhea hydration should %e maintained hot"oods and high ?%ers should %e a$oided"oods and high ?%ers should %e a$oided%ecause it increase peristalsis!%ecause it increase peristalsis!

OthersOthers

+tomatitis good mouth care is necessary to+tomatitis good mouth care is necessary tominimi#e mouth ulcers! )" superin"ection occursminimi#e mouth ulcers! )" superin"ection occursanti"ungal drug is necessary!anti"ungal drug is necessary!

alopecia a wig should %e purchased %e"orealopecia a wig should %e purchased %e"ore

treatment! +ome hair growth is apparent a"tertreatment! +ome hair growth is apparent a"terse$eral months!se$eral months!

)n"ertility it could %e irre$ersi%le! Pre)n"ertility it could %e irre$ersi%le! Pretreatment counseling is ad$isetreatment counseling is ad$ise


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*ursing Consideration in chemotherapy*ursing Consideration in chemotherapy

1!1! Discuss with the client and "amily the anticancerDiscuss with the client and "amily the anticancerdrug to %e administered length o" time perdrug to %e administered length o" time per

administration signs and symptoms that shouldadministration signs and symptoms that should%e reported!%e reported!

3!3! Emphasi#e the importance o" ta-ing adeuateEmphasi#e the importance o" ta-ing adeuate0uids!0uids!

4!4! Chec- i" the )!2! line is patent and intact!Chec- i" the )!2! line is patent and intact!6!6! To reduce the e'posure to anti cancer drugs theTo reduce the e'posure to anti cancer drugs the

health care pro$ider should use late' glo$eshealth care pro$ider should use late' glo$esgown and mas-!gown and mas-!

8!8! Regulate the chemotherapeutic drugs accurately!Regulate the chemotherapeutic drugs accurately!

:!:! Co$er it i" it is necessary use )!2! tag!Co$er it i" it is necessary use )!2! tag!;!;! Monitor $ital signs closelyMonitor $ital signs closely

!! Disposed the materials according to agency policy!Disposed the materials according to agency policy!


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Al-ylating AgentsAl-ylating Agents

ills cell %y "orming cross lin-s on theills cell %y "orming cross lin-s on the

D*A strands causing a%normal chemicalD*A strands causing a%normal chemical%onding %etween the adacent D*A%onding %etween the adacent D*A

molecules! This %elongs to CC*+molecules! This %elongs to CC*+

category! E&ecti$e against may type o"category! E&ecti$e against may type o"cancer!cancer!

Acute and chronic leu-emiaAcute and chronic leu-emia


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l h h id


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CyclophosphamideCyclophosphamide

=Cyto'an>=Cyto'an> A'nF )nhi%ition o" protein synthesis throughA'nF )nhi%ition o" protein synthesis throughinter"erence with D*A replication %y al-ylationinter"erence with D*A replication %y al-ylationo" D*A!o" D*A!

RouteF oral or )!2!RouteF oral or )!2!

+ide E&ectF nausea and $omiting %one marrow+ide E&ectF nausea and $omiting %one marrowdepression alopecia hemmorhagic cystitisdepression alopecia hemmorhagic cystitis

*ursing )mplicationF*ursing )mplicationF

1! Pro$ide adeuate daily 0uid inta-e to a$oid1! Pro$ide adeuate daily 0uid inta-e to a$oid

hemmorhagic cystitis!hemmorhagic cystitis!

3! Monitor client "or signs o" hematological3! Monitor client "or signs o" hematological

changes!changes!

4! Administer in the morning so that the -idneys4! Administer in the morning so that the -idneys


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Car%oplatin =Paraplatin>Car%oplatin =Paraplatin> RouteF )2 in"usion up to 4:G mg7 m3 e$ery 6RouteF )2 in"usion up to 4:G mg7 m3 e$ery 6

wee-s inter$alwee-s inter$al+ide e&ectF %one marrow depression+ide e&ectF %one marrow depression

*ausea and $omiting*ausea and $omiting

Electrolyte lossElectrolyte loss

Hemolytic anemiaHemolytic anemia

*ursing )mplicationF*ursing )mplicationF

1! Monitor "or signs o" hematological disorder!1! Monitor "or signs o" hematological disorder!

3! Discard solution hours a"ter dilution!3! Discard solution hours a"ter dilution!4! Anaphylactic li-e reaction may occur within4! Anaphylactic li-e reaction may occur withinminutes o" administration! Ha$e epinephrineminutes o" administration! Ha$e epinephrinecorticosteroids and antihistamine a$aila%le atcorticosteroids and antihistamine a$aila%le at

%edside!%edside!


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Antimeta%olitesAntimeta%olites

Ha$e the a%ility to inter"ere withHa$e the a%ility to inter"ere with

$arious meta%olic actions o" the cells$arious meta%olic actions o" the cells

results in the cell destruction orresults in the cell destruction orina%ility to replicate! Theina%ility to replicate! The

antimeta%olites are single cell cycleantimeta%olites are single cell cycle

speci?c agents that appear onspeci?c agents that appear ondi$iding cells during the + phase o"di$iding cells during the + phase o"

the cell cycle!the cell cycle!


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C %i l =C >


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Cytara%ine Hcl =Cytosar (>Cytara%ine Hcl =Cytosar (> RouteF )!2! +!! intrathecalRouteF )!2! +!! intrathecal

DosageF 1GG to 3GG mg7m3 day "or 8 days "orDosageF 1GG to 3GG mg7m3 day "or 8 days "or13 to 36 hours in"usion13 to 36 hours in"usion

+ide e&ectsF %one marrow depression+ide e&ectsF %one marrow depression

*2D*2Dhyperurucemiahyperurucemia

/e$er and rash/e$er and rash

*ursing )mplication*ursing )mplication

1! Monitor client "or hematological changes!1! Monitor client "or hematological changes!

3! Encourage increase oral 0uid inta-e!3! Encourage increase oral 0uid inta-e!

4! Allopurinol may %e used to inhi%it the4! Allopurinol may %e used to inhi%it the

"ormation o" uric acid"ormation o" uric acid

l il = d il>


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/luorouracil 8 /( =Adrucil>/luorouracil 8 /( =Adrucil>

)nhi%ition o" D*A and R*A synthesis)nhi%ition o" D*A and R*A synthesis

RouteF )!2!RouteF )!2!DosageF : to 13 mg7-g7day =38Gmg78mlDosageF : to 13 mg7-g7day =38Gmg78mlamp>amp>

+ide E&ectF 9one marrow depression+ide E&ectF 9one marrow depression

*ausea oral and 5!)! ulceration*ausea oral and 5!)! ulceration

diarrhea and alopeciadiarrhea and alopecia


1! Monitor client "or signs o" hematologic1! Monitor client "or signs o" hematologicchanges!changes!

3! Do not re"rigerate3! Do not re"rigerate

4! Protect solution "rom light4! Protect solution "rom light

M th t tM th t t


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Methotre'ateMethotre'ate

=Amethopterin>=Amethopterin> /olic Acid Antagonist/olic Acid Antagonist RouteF oral )2 )MRouteF oral )2 )M DosageF 1G to 4G mg7)2DosageF 1G to 4G mg7)2 +ide E&ectsF ulcerati$e stomatitis+ide E&ectsF ulcerati$e stomatitis

nausea and $omitingnausea and $omiting

%one marrow depression%one marrow depression

diarrheadiarrhea

/or treating solid tumors sarcomas/or treating solid tumors sarcomasleu-emialeu-emia

Higher dose reuire leuco$erin as a rescueHigher dose reuire leuco$erin as a rescuedose "or normal cells to neutrali#e the to'icdose "or normal cells to neutrali#e the to'ic

e&ects o" methotre'ate!e&ects o" methotre'ate!


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Anti Tumor Anti%ioticsAnti Tumor Anti%iotics

)nhi%it protein and R*A synthesis and)nhi%it protein and R*A synthesis and%ind D*A causing "ragmentation!%ind D*A causing "ragmentation!

)nter"eres with the cells a%ility to grow)nter"eres with the cells a%ility to grow

and reproduce normally! 9ecauseand reproduce normally! 9ecauseanti%iotic agents generally inter"ere withanti%iotic agents generally inter"ere with

se$eral parts o" cell cycle! They arese$eral parts o" cell cycle! They are

considered to %e cell cycle non speci?cconsidered to %e cell cycle non speci?c

antineoplastic drugs!antineoplastic drugs!


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Do'uru%ucin =adriamycin>Do'uru%ucin =adriamycin> )nhi%its D*A and R*A synthesis)nhi%its D*A and R*A synthesis

RouteF )2RouteF )2 DosageF 3G to ;8 mg7m3DosageF 3G to ;8 mg7m3 +ide E&ectF %one marrow depression+ide E&ectF %one marrow depression

Cardiac to'icityCardiac to'icity

nausea and $omitingnausea and $omiting

AlopeciaAlopecia *ursing )mplication*ursing )mplication

1! Monitor de$elopment o" %one marrow1! Monitor de$elopment o" %one marrowdepression and cardiac to'icity!depression and cardiac to'icity!

3! May produce red urine "or 1 to 3 days3! May produce red urine "or 1 to 3 days

4! Re"rigerated reconstituted solution is sta%le4! Re"rigerated reconstituted solution is sta%le"or 6 hours"or 6 hours


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=9leno'ane>=9leno'ane>

/or treating suamous cell carcinoma/or treating suamous cell carcinoma

testicular tumor and lymphomatesticular tumor and lymphoma RouteF )2)M+RouteF )2)M+

DosageF G!38 to G!8G units7-g7dayDosageF G!38 to G!8G units7-g7day

+ide E&ectF pneumonitis+ide E&ectF pneumonitis

pulmonary ?%rosispulmonary ?%rosis

*ausea and $omiting*ausea and $omiting /e$er/e$er


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1!1! Monitor client "or de$elopment o"Monitor client "or de$elopment o"

pulmonary to'icity!pulmonary to'icity!3!3! Powder should %e stored in re"!Powder should %e stored in re"!

4!4! Reconstituted solution is sta%le "or 36Reconstituted solution is sta%le "or 36

hours at room temperature!hours at room temperature!

Other anti,tumor anti%ioticOther anti,tumor anti%iotic

Dactinomycin =cosmegen>Dactinomycin =cosmegen>Plicamycin =mithracin>Plicamycin =mithracin>

2alru%icin =$alstar>2alru%icin =$alstar>

Other anti tumor anti%ioticOther anti tumor anti%iotic


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Other anti tumor anti%ioticOther anti tumor anti%iotic

Dactinomycin =cosmegen>Dactinomycin =cosmegen>

Plicamycin =mithracin>Plicamycin =mithracin>2alru%icin =$alstar>2alru%icin =$alstar>

M)TOT)C )*H)9)TOR+M)TOT)C )*H)9)TOR+%loc- cell di$ision at the M phase o" the%loc- cell di$ision at the M phase o" the

cell cycle! This group o" inhi%itorscell cycle! This group o" inhi%itors

is e'tracted "rom $arious plants and treeis e'tracted "rom $arious plants and treesu%stances!su%stances!

the $inca al-aloidssuch as $in%lastinethe $inca al-aloidssuch as $in%lastine


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$incristine are o%tained "rom the$incristine are o%tained "rom the

periwin-le plantperiwin-le plant

This group o" drug is CC+!This group o" drug is CC+!

ETOPO+)DE =2e Pesid>ETOPO+)DE =2e Pesid>

RouteF oral )2RouteF oral )2 DosageF 48 to 1GGmg7m37dayDosageF 48 to 1GGmg7m37day

+ide e&ectF %one marrow+ide e&ectF %one marrow

depressionanore'ia$omiting anddepressionanore'ia$omiting and

diarrhea "atigue hypotension!diarrhea "atigue hypotension!



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1!1! Do not administer %y )2 pushDo not administer %y )2 push

3!3!

Capsules should %e -ept re"rigerated!Capsules should %e -ept re"rigerated!4!4! Monitor $ital signs!Monitor $ital signs!

6!6! Monitor li$er "unctionMonitor li$er "unction

2)*92)*9

RouteF )2RouteF )2

DosageF 4!; to 11!1 mg7m3DosageF 4!; to 11!1 mg7m3 +ide e&ectsF %one marrow+ide e&ectsF %one marrow

depression nausea $omiting anddepression nausea $omiting and

constipationconstipation

*euroto'icity Alopecia irritation at*euroto'icity Alopecia irritation at


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*euroto'icity Alopecia irritation at*euroto'icity Alopecia irritation at

the inection sitethe inection site


1!1! +top in"usion i" e'tra$asation+top in"usion i" e'tra$asation

occurs!occurs!3!3! +tool so"tener may %e use!+tool so"tener may %e use!

4!4! Reconstituted re"rigerated solutionReconstituted re"rigerated solution

may %e -ept "or 4G days!may %e -ept "or 4G days!6!6! /orce 0uid and encourage ?%er in/orce 0uid and encourage ?%er in

the diet to help o&set constipation!the diet to help o&set constipation!

2)*CR)+T)*E =onco$in>2)*CR)+T)*E =onco$in>


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2)*CR)+T)*E =onco$in>2)*CR)+T)*E =onco$in>

RouteF )2RouteF )2

DosageF 1!6 mg7m3DosageF 1!6 mg7m3 +ide e&ectF peripheral neuropathy+ide e&ectF peripheral neuropathy

alopecia irritation at inection sitealopecia irritation at inection site


1!1! Monitor client "or de$elopment o"Monitor client "or de$elopment o"

neuromuscular changes!neuromuscular changes!3!3! Do not mi' with anything %utDo not mi' with anything %ut

normal saline or de'trose in water!normal saline or de'trose in water!


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DEIAMETHA+O*EDEIAMETHA+O*E

RouteF )2RouteF )2 DosageF initially G!8mg,1!8mg7-g7dayDosageF initially G!8mg,1!8mg7-g7day

in e$ery : hoursin e$ery : hours

Primary indicationF *ausea andPrimary indicationF *ausea and$omiting with chemotherapy$omiting with chemotherapy

antineoplastic drugs.ppt

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