1. Slide 1 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 44 Drugs Affecting Neoplasms

2. Slide 2 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 44 Lesson 44.1

3. Slide 3 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Learning Objectives Explain the normal cycle for cell replication and describe the effects of the cell cycle– specific and cell cycle–nonspecific drugs within this process Cite the rationale for giving chemotherapeutic drugs on a precise time schedule Cite the goals of chemotherapy

4. Slide 4 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Learning Objectives (cont’d) Describe the role of targeted anticancer agents in treating cancer Describe the role of chemoprotective agents in treating cancer Describe the role of bone marrow stimulants in treating cancer

5. Slide 5 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Learning Objectives (cont’d) Describe the nursing assessments and interventions needed for people experiencing adverse effects from chemotherapy Develop patient education objectives for a patient receiving chemotherapy

6. Slide 6 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Cancer and the Use of Antineoplastic Agents Cancer: disorder of cellular growth Occurs when a group of abnormal cells proliferate more rapidly than normal cells, losing the ability to perform specialized functions They invade surrounding tissues and develop growths in other tissues distant to the original growth

7. Slide 7 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Cancer and the Use of Antineoplastic Agents (cont’d) Treatment requires a combination of surgery, radiation, chemotherapy, and immunotherapy Rapidly changing approaches to treatment Recent developments enhance role of antineoplastic agents in therapy

8. Slide 8 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Cancer and the Use of Antineoplastic Agents (cont’d) Mitosis: phase of cellular proliferation in which cells divide into two equal daughters  Cells either advance into a nonproliferative stage, G0, or advance to the first gap phase, G1  Stimulation is needed to enter the G1 phase  G1, presynthetic phase in which the cell manufactures the needed enzymes to prepare for DNA synthesis

9. Slide 9 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Cancer and the Use of Antineoplastic Agents (cont’d)  Phase G2, a postsynthetic phase, the cell prepares for mitosis by producing RNA, specialized proteins, and the foundations for the mitotic spindle apparatus needed for mitosis  Mitosis then divides the cell into two G1 daughter cells  G1 cells may advance again to S phase or pass into a nonproliferative stage known as G0  S phase is the stage of active synthesis of two sets of DNA Generation time: time required to complete a cycle

10. Slide 10 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Cancer and the Use of Antineoplastic Agents (cont’d) Cell cycle–specific: drug is selectively toxic when the cell is in a specific phase of growth—schedule dependent  Effective against malignancies that proliferate rapidly Cell cycle–nonspecific: active throughout the cell cycle  More effective against slowly proliferating neoplastic tissue

11. Slide 11 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Cancer and the Use of Antineoplastic Agents (cont’d) Cell cycle specificity means it is important to correlate the dosage schedule with the known cellular kinetics of that type of neoplasm Drugs usually administered when the cell is most susceptible to the cytotoxic effects of the agent for a greater “kill rate” of neoplastic cells

12. Slide 12 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Therapy for Cancer Goals for chemotherapy  Give a dose large enough to be lethal to the cancer cells but small enough to be tolerable for normal cells  Control of the disease (arresting of tumor) Goal for palliation: alleviation of symptoms if cancer is beyond control Goal for prophylaxis: prophylactic measures if patient is a known risk for developing cancer

13. Slide 13 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Therapy for Cancer (cont’d) Five chemotherapeutic agents are currently used, classified as:  Alkylating agents  Antimetabolites  Natural products  Antineoplastic antibiotics  Hormones

14. Slide 14 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Therapy for Cancer (cont’d) Three new types of medications to fight cancer from different directions  Targeted anticancer agents Noncytotoxic drugs that target key pathways that provide growth and survival for cancer cells  Chemoprotective agents Help reduce the toxicity of chemotherapeutic agents to normal cells  Bone marrow stimulants Trigger the recovery of bone marrow cells

15. Slide 15 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Therapy for Cancer (cont’d) Bone marrow stimulants change the way the body responds to cancer or strengthens the body’s defense mechanisms against cancer Chemoprotective agents help reduce the toxicity of chemotherapeutic agents to normal cells

16. Slide 16 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Bone Marrow Stimulants

17. Slide 17 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Chemoprotective Agents

18. Slide 18 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Process for Antineoplastic Drug Therapy Nurses play a crucial role in the treatment of patients with cancer  Contact between health care provider and family  Help patient adapt emotionally as well as physically  Often first to identify complications  Patient education important part of treatment

19. Slide 19 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Process for Antineoplastic Drug Therapy (cont’d) Assessments  History of risk factors  Dietary habits  Preexisting health problems  Adaptation to diagnosis  Psychomotor functions  Safety  Symptoms of pharmacologic side effects  Physical and sexual assessment  Pain

20. Slide 20 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Process for Antineoplastic Drug Therapy (cont’d) Medication administration Plan drug administration exactly at the time intervals prescribed Review orders for predication or hydration Schedule oral hygiene measures Chemotherapy administration performed only by qualified RNs or physicians

21. Slide 21 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Process for Antineoplastic Drug Therapy (cont’d) Side effects Monitor vital signs and watch for:  Hydration  Infection  Nausea, vomiting  Positioning Diarrhea  Constipation  Bleeding  Pain  Neurotoxicity  Anxiety

22. Slide 22 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 44 Lesson 44.2

23. Slide 23 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Learning Objectives State which types of chemotherapeutic agents are cell cycle–specific and those that are cell cycle–nonspecific

24. Slide 24 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Class: Alkylating Agents Highly reactive chemical compounds that bond with DNA molecules, causing cross- linking of DNA strands Binding prevents the separation of the double-coiled DNA molecules necessary for cellular division Cell cycle–nonspecific are capable of combining with cellular components at any phase of the cell cycle

25. Slide 25 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Class: Antimetabolites Inhibit key enzymes in the biosynthetic pathways of DNA and RNA synthesis Many antagonists are cell-specific, killing cells during the S phase of cell maturation

26. Slide 26 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Class: Natural Products Vinca alkaloids: vincristine and vinblastine  Natural derivatives of the periwinkle plant  Cell cycle–specific agents that block the formation of the mitotic spindle during mitosis, inhibiting cell division Antibiotics: bind with cellular DNA preventing its replication, as well as RNA synthesis, which is required for subsequent protein synthesis

27. Slide 27 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Class: Antineoplastic Antibiotics Bind to DNA, inhibiting DNA or RNA synthesis Inhibit protein synthesis and prevent cell replication

28. Slide 28 Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Drug Class: Hormones Corticosteroids (usually prednisone) may be beneficial for treating lymphomas and acute leukemia Reduce edema secondary to radiation therapy and act as palliative therapy as it temporarily suppresses fever, diaphoresis, and pain Uses: estrogens and androgens are used in malignancies of sexual organs