MAJOR DRUG GROUPS Neoplastic, Body Defenses. CYTOTOXIC AGENTS Act with a degree of selectivity against the uncontrolled proliferation of cancerous cells.

MAJOR DRUG GROUPS Neoplastic, Body Defenses

CYTOTOXIC AGENTS

Act with a degree of selectivity against the uncontrolled proliferation of cancerous cells.

Act directly or indirectly affecting DNA or DNA function to cause cell death.

Have a particular affinity for cells that are in the process of dividing.

2 Types

Cell cycle specific; these destroy proliferating (dividing) cells throughout the cycle, and phase specific agents that destroy or attest cells during a specific phase of the cell cycles

Cell – cycle non- specific agents that destroy both proliferating and resting cells

Increased susceptibility during cell division

Malignancies that respond best are the rapid growth or high growth fraction (testicular, lymphomas acute leuk)

Adverse reactions occur in the non-malignant tissue which has a high growth fraction

USES

1. Disease regression2. Palliative care 3. Pain relief

Administered

Orally Intramuscularly Intravenously Intrathecally Combination of the above High doses may by given

intermittently to allow normal cells to recover

Adverse affects

Bone marrow = myelo-supppression

Hair follicles = alopecia GIT mucosa = mucositis or

Diarrhoea Gonads = menstrual irregularities,

dec spermatogenesis, sterility

Adverse effects related to administration

Anorexia, Nausea & vomiting Fever headache, hypotension Fatigue/ weakness Anaphylaxis, Rah pruitus,erythema Pain / irritation / inflammation at

local site

Adverse effects related to later reactions

Bone marrow suppression (Peak 10 14 days post chemo)

Leucopenia = Infection Thrombocyopenia = haemorrhage Anaemia Alopecia & GIT ulcers (mouth) Kidney and liver toxicity

Precautions/Contraindications

Breast feeding Pregnancy Drug interactions Elderly and Paediatric have

increased effects

Nursing Interventions Patients fully informed re effects Staff use care re self protection, staff

blood tests Personal protection equipment (PPE)

Care handing pt excreta ( contaminated) Guidelines for spills, extravasation Neutopenic pt requires isolation (DAY 10

– 12) Temp >38 medical emergency

Nursing Interventions

Drugs should be prepared under a Bilogical Cabinet/Class Laminar flow to prevent breathing mists

Linen put in labeled bag (Purple)

Nursing Interventions Dietary modification Program of ant emetics Protection from general population

(infection) TLC re alopecia and changed

physical appearance Care and complete instructions re

complicated oral drug administration

Hormonal treatments

Tamoxifen (Common) Non steroidal, antioestrogen Precise mechanism of

controlling breast cancer unknown

S/E hot flushes, nausea pain headaches

Medical Devices

Hickman catheter Port a cath Pic line Portable drug pumps

Examples

Cisplatin Methotrexate Fluorouracil Bleomycin Vincristine Hydroxyurea Cyclophosphamide

Drugs affecting the Body Defenses

2 methods of resistance Specifically through developed

immunity Non-specifically through

barriers (skin, mucus membranes and gastric acidity

Anti inflammatory drugs

NSAIDs Inhibit the synthesis of

prostoglandins Symptomatic relief of pain and

inflammation and fever Arthritis, gout, bowel disease Oral, IV, IMI, Topical, PR,

Adverse effects

Bronchospasm (asthmatics) GIT upset Peptic ulceration Inhibition of platelet aggregation Mask S&S of infection Fluid retention

Precautions /Contraindications

Asthmatics Pts with history of GIT

bleeding Alcohol and anticoagulants Not used in pregnancy

Nursing intervention

Take with food Takes time to be effective Pt education re signs of bleeding

(Black stools) Protect skin (Photosensitivity) Regular blood screens (Renal

impairment)

Examples Aspirin =tinnitus, dizziness, bleeding Diflunisal (dolobid) = general Indomethacin = potent, blood

discrasias, headache, Ibuprofen, (brufen)= precaution with

liver and cardiac failure Naproxen = drowsiness, vertigo,

bleeding

Immunomodulation agents(immunosuppressants)

Modify the immune system (organ transplant immunosuppressants)

Pt is susceptible to various infections Adverse effects depends on drug Diarrhoea, N & V, Pancytopenia Depression, anxiety confusion Pg234

Nursing interventions

Pt education re long term therapy and compliance issues

Regular checks, blood, liver, renal. Panadol as pain relief, No NSAIDs Beware of minor infections Good mouth care

Examples

Steroids; prednisone Azathioprine; Imuran Cyclosporin; Sandimmun

Complications

Higher incidence of cancer, eg NHL, ca lip, skin, and urogenital tract.

Inc susceptibility to bacterial infection.

Inc susceptibility to opportunistic infections eg cytomegalovirus, herpes and fungal infections and Pneumocyctis carinii.

HISTAMINE AND ALLERGIES Histamine is a naturally occurring

substance Stored in mast cells (skin, nose,

lungs, GIT When damaged, (chemicals, drugs,

heat, trauma), large amts released = allergic reaction

Act on specific receptor sites, H1, H2, H3,

Antihistamines

Block the H1 receptor sites Decrease itching, depress CNS,

sedation, supression of nausea and vomiting.

Oral rapid absorption, 15-30 min S/E drowsiness, dry mouth, Promethazine, loratadine,

Drugs affecting the SKIN

Treat a variety of conditions E.g.Burns, Infections, Acne, Sunscreens, emollients,

antipruritics Systemic (oral), topical

Soothing and Protective

Calamine; zinc oxide in water Aqueous cream; sorbolene Oily glycerine; Barrier; dimethicone, silicon Soft parraffin; vaseline Woolfat; lanolin Bath oil; alpha-Keri, Q.V. Tar,

Pinetarsal

Cleansers and Keratolytics (cause flaking and scaling)

Soap Hydrogen Peroxide Benzol Perozide; acne Salicylic acid; (K) Warts Urea; promote hydration of the

skin,

Retinoids

Treatment with Vitamin A; Psoriasis & Acne; Retin-A, Airol, Tigason,

Rocaccutane is teratogenic Increases skin sensitivity to light

Application Bathoils; correct strength and temp Lotions; used sparingly Wet dressings; kept wet Powders; used sparingly, not on

wet or hairy areas Ointments; thin smear, not

removed between applications or over oozing lesions

Application

Creams; not on chronic scaling skin

Keratolytics; minimal use, healthy skin protected.

Retinoids, beware of side effects

Anti-infective preparations

Tricolsan; Clearasil, sapoderm Chlorhexidine; Hibitane Povidone iodine; Betadine Metronidazole; Rozex, Antibiotics; Neosporin, Sofra-Tulle,

Bactroban,

Nursing Implications Protect yourself from the medication Use sparingly SSD, 3-5cm thick, max 3 days, wash

off completely, between applications Protect pts clothes Discard expired creams and inc

concentration of medication. Prolonged use = superinfections