Cancer Heather Gates RN, BSN October 20, 2009

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Drug Therapy of Cancer - Aka Chemotherapy Transported through blood - potential to reach every cancer cell Some drugs cross blood-brain barrier - treat brain tumors Some drugs instilled directly into body cavities - treat bladder cancers

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Drug Therapy of Cancer - Aka Chemotherapy (cont’d) May be given To attempt to cure For palliation Prophylaxis - prevent cancer from occurring Often combined with surgery and radiation to increase chance of cure

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Malignant Cells Each must be destroyed One could reproduce Immune system eliminates only a small number of cancer cells

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Figure 24.2 Cell kill and chemotherapy

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Successful Treatment Treat tumors at an early stage Use multiple drugs Use several methods Chemotherapy Radiation Surgery

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Figure 24.3 Antineoplastic agents and the cell cycle

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Different Antineoplastic Classes Are Given Different classes affect different stages of the cancer’s life cycle Allows lower dosages of each agent Reducing toxicity Slowing development of resistance

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Specific Dosing Schedules/Cycles Increase Effectiveness Single or multiple doses over several days Gives normal cells a chance to recover Cancer cells may be more sensitive during the time of the next treatment

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Serious Toxicity Pushed to maximum possible dosage Greatest tumor cells killed Always result in adverse effects

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Table 24.1 Adverse Effects of Anticancer Drugs

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Drug Profile - Alkylating Agent Cyclophosphamide (Cytoxan), nitrogen mustard Actions and uses Adverse effects and interactions Mechanism in action

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Table 24.2 Alkylating Agents

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Table 24.2 (continued) Alkylating Agents

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Antimetabolites Chemically similar to essential building blocks of the cell Resemble purines or pyrimidines Building blocks of DNA and RNA Cancer cells use this drug to construct proteins or DNA Block DNA synthesis Kill cancer cells or slow growth

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Drug Profile - Antimetabolite Methotrexate (Mexate) Actions and uses Adverse effects and interactions Mechanism in action

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Table 24.3 Antimetabolites

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Table 24.3 (continued) Antimetabolites

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Antitumor Antibiotics Not widely prescribed Interact with DNA in a manner similar to alkylating agents

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Drug Profile - Antitumor Antibiotic Doxorubicin (Adriamycin) Actions and uses Adverse effects and interactions Mechanism in action

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Table 24.4 Antitumor Antibiotics

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Table 24.4 (continued) Antitumor Antibiotics

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Plant Alkaloids/Natural Products Structurally very different Common ability to arrest cell division Sometimes called mitotic inhibitors

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Plants Used: Common periwinkle (Vinca rosea) Vinca alkaloids - vincristine (Oncovin) and vinblastine (Velban) Mandrake plant (May apple) Teniposide (Vumon) and etoposide (VePesid) Pacific yew Taxoids - pacitaxel (Taxol) and docetaxel (Taxotere) Shrub Campothecus accuminata Topoisomerase inhibitors - topetecan (Hycamtin) and irinotecan (Camptosar)

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Drug Profile - Plant Alkaloids/Natural Product Vincristine (Oncovin) Actions and uses Adverse effects and interactions Mechanism in action

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Table 24.5 Plant Extracts/Natural Products

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Hormones and Hormone Blockers Used to slow the growth of hormone-dependant tumors Certain tumors stimulated by natural hormones Specific hormones or hormone blockers can block receptor sites Examples of hormones used in cancer chemotherapy Use of testosterone or antiestrogen to slow breast cancer (Tamoxifen) Estrogen to slow the growth of prostate cancer Other major class is corticosteroids

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Table 24.6 Hormones and Hormone Antagonists

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Table 24.6 (continued) Hormones and Hormone Antagonists

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Adverse Effects Doses are much larger than normally present in body Produce few of the typical cytotoxic side effects Can produce significant side effects when given at high doses for prolonged periods Normally given for palliation

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Drug Profile - Hormone Blocker Tamoxifen (Nolvadex) Actions and uses Adverse effects and interactions Mechanism in action

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Lab Monitoring CBC Temperature BUN, Creatinine LFT’s Glucose levels

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Nursing Interventions Encourage patient to report any fevers, sore throat, epigastric pain, coffee-ground vomit or stools, bruising, or frank bleeding Monitor vital signs Monitor cardiorespiratory status ( EKG changes, SOB, pitting edema) Monitor Renal Status (U.O. and weight) Monitor GI status (nutrition, anti-emetics, oral mucosa changes)

Core Concepts in Pharmacology, 2e By Norman Holland and Michael Patrick Adams © 2007 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Nursing Interventions Monitor for constipation Monitor neurosensory status (peripheral neuropathy, mental depression, vision changes) Monitor hair and skin (alopecia, peeling hands and feet, skin eruptions)