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ANTINEOPLASTIC DRUGS (ALKYLATING AGENTS (NURSING CONSIDERATIONS (SIDE…
ANTINEOPLASTIC DRUGS
ALKYLATING AGENTS
MECHANISM OF ACTION
- Reacting chemically with portions of RNA,DNA, or other cellular proteins to produce their cytotoxic effect.
- Alkylating agents are most potent when binding with cellular DNA.
- The oldest drugs in this class are nitrogen mustards.
INDICATIONS
- treats slow-growing cancers like:
- Lymphomas
- Leukaemias
- Myelomas
- Some ovarian,testicular and breast cancers
- Pancreatic cancers
NURSING CONSIDERATIONS
SIDE EFFECTS
- Alopecia or hairloss
- Gastrointestinal: nausea, vomiting, diarrhoea, and mucous membrane deterioration, hepatic toxicity.
- Renal toxicity, potentially toxic increase in uric acid levels.
- Hematological: bone marrow suppression
CONTRAINDICATIONS
- Pregnancy and lactation: severe effects to fetus and neonate
- Known allergy to drugs: prevent hypersensitivity reactions
- Bone marrow suppression: the index for redosing and dosing levels
- Suppressed renal or hepatic function: interfere with drug metabolism and excretion
-
ROUTE OF ADMINISTRATION
- Administered orally and acts over a period of 15-20 hours.
EXAMPLES
- Cyclophosphamide (Endoxan)
- Chlorambucil (Leukeran)
- Melphelan (Alkeran)
- Ifosfamide (Holoxan)
ANTIMETABOLITES
MECHANISM OF ACTION
- Inhibiting DNA production in cells that depend on certain natural metabolites to produce their DNA. They replace these needed metabolites and thereby prevent normal cellular function.
- Inhibit thymidylate synthase, DNA polymerase, or folic acid reductase, all of which are needed for DNA synthesis.
- Considered to be S phase specific in the cell cycle, they are most effective in rapidly dividing cells, preventing cell replication, and leading to cell death.
INDICATIONS
- Treatment of various leukemias and some GI and basal cell cancers
- Use has been somewhat limited because neoplastic cells rapidly develop resistance to these agents. Therefore, they are commonly administered as part of combination therapy.
NURSING CONSIDERATIONS
CONTRAINDICATIONS
- Known allergy to drugs: prevent hypersensitivity reactions Pregnancy and lactation: severe effects on the fetus and neonate - Bone marrow suppression: index of redosing and dosing levels Renal and hepatic suppression: index of redosing and dosing levels
SIDE EFFECTS
- CNS headache, drowsiness, aphasia, fatigue, malaise, dizziness
- Respiratory: pulmonary toxicity, interstitial pneumonitis
- Hematological :bone marrow suppression
- GI : nausea, vomiting, anorexia, diarrhoea, mucous membrane deterioration, hepatic toxicity.
- An example of a drug used to manage side effects is Leucovorin.It is used to rescues normal cells from the adverse effects of methotrexate therapy in the treatment of osteosarcoma
ROUTE OF ADMINISTRATION
- Administered orally and acts within a period of 1-4 hours -
- Administered intravenously(IV) and acts within a period of half an hour to 2 hours.
EXAMPLES
- Pemetrexed (Alimta)
- Thioguanine(Lanvis)
- Cytarabine (Cytosar)
-
MITOTIC INHIBITORS
MECHANISM OF ACTION
- Interfering with the ability of the cell to divide by blocking or altering the metaphase of the cell cycle.
INDICATIONS
- Treatment of various types of tumours and leukemias
NURSING CONSIDERATIONS
CONTRAINDICATIONS
- Known allergy to drug: prevent hypersensitivity reactions
- Pregnancy and lactation: severe effects on the fetus and neonate
- Bone marrow suppression: index of redosing and dosing levels
- Known GI ulceration or ulcerative diseases: can be exacerbated by the effects of the drug
- Renal and hepatic dysfunction: interfere with drug metabolism ad excretion
SIDE EFFECTS
- CNS: headache, drowsiness, aphasia, fatigue malaise dizziness
- Respiratory: pulmonary toxicity, interstitial pneumonitis
- Hematological: bone marrow suppression
- GI: nausea and vomiting, anorexia,diarrhoea, mucous membrane deterioration, hepatic toxicity
- Renal toxicity
- Can cause necrosis and cellulitis if extravasation occurs
ROUTE OF ADMINISTRATION
- Administered intravenously(IV)
EXAMPLES
- Taxol (Paclitaxel) & Halaven (Eribulin)
REFERENCES
- Belleza M., Martin P., Paton F.,Saavdra S. M. & Wayne G. (2010), Nurselabs, viewed 01 March 2019, < https://nurseslabs.com >
- Dreyer A, Kharwa R, Moch S & Thandar Y. 2016, Pharmacology for nurses, 4th edition, Pearson South Africa (Pty) Ltd. Cape Town, pp.210-212