1. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 21 Antineoplastic Drugs

2. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antineoplastic Drugs  Antineoplastic drugs are sometimes called cancer chemotherapeutic agents and are primarily used to treat cancer.  These drugs are also used to treat inflammatory disorders such as psoriasis, rheumatoid arthritis, and systemic lupus erythematosus.  More often than not, multiple drug therapy is used to treat the different types of cancers. 2

3. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Antineoplastic Drugs  These drugs exert their pharmacologic effects by interfering with the metabolism or reproductive cycle of the tumor cells and thereby destroying them.  Antineoplastic drugs are classified as either cell cycle specific or cell cycle nonspecific.  Antineoplastic drugs target rapid dividing tumor cells.  However, they also affect rapidly dividing normal cells that leads to their many adverse effects. 3

4. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Drug Effects  Bone Marrow Suppression  Bone marrow suppression leads to leukopenia, agranulocytosis, thrombocytopenia, or anemia.  This puts the patient at risk for serious infection because of the lack of white blood cells.  Osteonecrosis  Osteonecrosis of the jaw bone is a recently recognized adverse effect of the bisphosphonates.  The majority of cases (94%) have been reported in patients receiving intravenous bisphosphonates to treat multiple myeloma or metastatic carcinomas. 4

5. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Drug Effects  Osteonecrosis  Most of the cases have been reported after tooth extractions and other dental procedures that traumatize the jaw.  It is very difficult to treat once it is diagnosed.  Good home oral hygiene can help to minimize the risk of osteonecrosis.  Maintenance of oral health exams and other dental procedures should be performed prior to starting therapy or within 3 months of beginning therapy. 5

6. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Drug Effects  Osteonecrosis  If osteonecrosis is present, then dead bone should be removed as necessary with minimal trauma to the adjacent tissue.  Chlorhexidrine rinses, systemic antibiotics, and analgesics should be used if clinically necessary.  Bisphosphonates are normally stopped until the bone heals or the patient requires it to treat the cancer. 6

7. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Drug Effects  Gastrointestinal  These drugs are known for causing significant nausea, vomiting, diarrhea, stomatitis, and oral ulcerations.  Patients should rinse with a dilution of lukewarm water and baking soda after vomiting.  Aspirin and NSAIDs should be avoided because of the increased risk for GI adverse effects. 7

8. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Drug Effects  Immunosuppression  Patients are at higher risk for bacterial, viral, and fungal infections.  Oral Effects  Antineoplastic drugs can cause oral discomfort, sensitivity of the teeth and gums, mucosal pain and ulceration, gingival hemorrhage, xerostomia, and impaired taste sensation.  Ice chips and nonalcohol mouth rinses can help with the dry mouth. 8

9. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Managing Patients Receiving Antineoplastic Drugs 9

10. Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Managing Patients Receiving Antineoplastic Drugs 10