1. Antineoplastic Medications
Chapter 11
Antineoplastic Medications

2. Overview Antineoplastic Medications
LPN’s do not usually play a direct role in giving medications
Most cells in the body grow slowly at a rate that can be predicted.
Cancer cells grow rapidly and uncontrolled
Neoplasms: abnormal growths or tumors-may be benign or malignant.
Metastasis: cancer cells travel throughout the body
Causes of cancer are many—chemical, physical, hereditary, or biologic.
Screening may help find and treat some cancers early.

3. Antineoplastic Agents (anticancer)
Chemotherapeutic agents: used to treat cancerous or malignant diseases.
Slow cell growth or delay the spread of the malignant cells
To achieve a cure, every malignant cell must be removed, destroyed, or crippled.
Antineoplastic agents are most often used with other forms of treatment such as surgery and radiation.
Drug therapy is rigorous, often requiring multiple drugs, intensive courses of high doses, and repeated courses of medicine if they are to be effective.

4. Antineoplastic Agents (anticancer)
The following types of medications are used to treat neoplastic diseases: alkylating agents, antibiotic preparations, antimetabolites, hormones, natural products, and biologic response modifiers.
Antineoplastic drugs affect rapidly growing tumor cells but also affect all other rapidly growing normal cells, thus producing many of the adverse reactions caused by these drugs (diarrhea, alopecia [hair loss], infertility, and the like).
Adverse reactions are common

5. Antineoplastic Agents (anticancer)
Strong and highly toxic: interferon, mitotane, asparaginase.
Many drugs require intravenous (IV) administration. (Even small dosage errors could have significant negative effects on the patient).
LPN: know institutional policy- stay within authorized scope of practice.
Safety is a particular issue with oncology drugs.

6. Older Adults Adverse Reactions
Older adult patients are especially prone to adverse effects from these drugs and must be monitored carefully.
Special care should be taken to give these patients plenty of water to drink (so they are hydrated). Adverse reactions such as nausea, anorexia, and diarrhea dehydrate patients.
The older individual often does not have a lot of energy, and procedures and adverse effects make them especially tired. Monitor their strength and watch that they do not become overly exhausted.
The LPN should follow institutional procedures for care of the IV or central line.

7. Pediatric Safety Measures
Neoplastic drugs are particularly toxic. Particular care must be made for accurate dosing because even small errors in children could create big problems.
Infants and small children may not be able to tell the nurse they are having problems with a drug. The nurse should watch the child carefully to notice any changes.

8. Antineoplastics
Antimetabolites disrupt normal cell functions by interfering with various metabolic functions of the cells and interrupt critical cell pathways in cells.
Hormones: rarely produce cures but may slow the growth of the cancer. An 192example is the use of tamoxifen to slow specific types of breast cancers that depend on estrogen for growth. Administration of the female hormone estrogen also slows the growth of prostate cancer.
Mitotic inhibitors: plant extracts or alkaloids- used as antineoplastics. common flowers and shrubs have the ability to stop cell division
Taxoids and topoisomerase inhibitors are other groups of medications that have biologic properties helpful in treating cancer. They often have significant adverse effects.

9. Antineoplastics
Biologic response modifiers: new immunologic drugs -do not kill tumor cells; stimulate the body's immune system to help it fight the cancer (quality of life)
Miscellaneous agents: largest category-developed in the last few years
Antineoplastic drug usage is carefully based on the best evidenced-based guidelines from extensive clinical trials.

10. Antineoplastic Alkylating Agents
Alkylating Agents: widely used to interfere with the normal process of cell division. Effects ALL cells anemia and higher risk of infection because of loss of important cells. The death or damage to cells lining the GI tract produces nausea, vomiting, and diarrhea.
Antibiotics not as antiinfectives; assist to delay or prevent cell division chemicals are more toxic than other antibiotics and their use is limited to treating very specific cancers.

11. Common Symptoms Following Chemotherapy
SYMPTOMS OR PROBLEM SUGGESTED TREATMENT
Nausea and/or vomiting Provide antiemetics. Drink liquids between meals
Stomatitis Practice good oral hygiene/soft toothbrush, water, or mild salt solution;
avoid alcohol-based mouthwash. Use mouth rinse such as Maalox,
Xylocaine, Benadryl (BMX). Avoid hot, cold, or other products that might
damage sensitive tissue. Increase fluid intake to decrease the risk of
kidney damage and the formation of uric acid crystals.
Skin breakdown Provide vitamin supplementation; keep skin clean and dry.
Pain at surgical site Provide analgesics or narcotics.
Dehydration Force fluids; provide IV hydration.

12. Common Symptoms Following Chemotherapy
SYMPTOMS OR PROBLEM SUGGESTED TREATMENT
Low WBC count (bone marrow suppression) Use neutropenic diet: avoid raw
foods. Watch for elevated TEMP
reverse isolation
Low platelet counts Report bruising/bleeding, fatigue, epigastric pain,
Anemia epoetin to help stimulate red blood cell production.
Anorexia Small frequent feedings. Megestrol stimulates appetite
Reduced fertility Chemotherapy may reduce sperm count or increase risk of
genetic damage to sperm.