Sie sind auf Seite 1von 8

CHEMOTHERAPY DRUG POSSIBLE SIDE EFFECTS

 Decrease in blood cell counts


Carboplatin (Paraplatin)
 Hair loss (reversible)
 Usually given intravenously (IV)
 Confusion
 Used for cancers of the ovary, head
and neck, and lung  Nausea, vomiting, and/or diarrhea (usually a short-term
side effect occurring the first 24 to 72 hours following treatment)

Cisplatin (Platinol, Platinol-AQ)  Decrease in blood cell counts


 Usually given intravenously (IV)  Allergic reaction, including a rash &/or labored breathing
 Used for cancers of the bladder,  Nausea and vomiting usually occurs for 24 hours or longer
ovary, and testicles
 Ringing in ears and hearing loss
 Fluctuations in blood electrolytes
 Kidney damage

Cyclophosphamide (Cytoxan, Neosar)  Decrease in blood cell counts


 Can be given IV or orally  Nausea, vomiting, abdominal pain
 Used for lymphoma, breast cancer,  Decreased appetite
and ovarian carcinoma
 Hair loss (reversible)
 Bladder damage
 Fertility impairment
 Lung or heart damage (with high doses)
 Secondary malignancies (rare)

Doxorubicin (Adriamycin)  Decrease in blood cell counts


 Given intravenously (IV)  Mouth ulcers
 Used for breast cancer, lymphoma,  Hair loss (reversible)
and multiple myeloma
 Nausea and vomiting
 Heart damage

Etoposide (VePesid)  Decrease in blood cell counts


 Can be given intravenously (IV) or  Hair loss (reversible)
orally
 Nausea and vomiting
 Used for cancers of the lung,
 Allergic reaction
testicles, leukemia, and lymphoma
 Mouth ulcers
 Low blood pressure (during administration)
 Decreased appetite
 Diarrhea and abdominal pain
 Bronchospasm
 Flu-like symptoms

Fluorouracil (5-FU)  Decrease in blood cell counts


 Given intravenously (IV)  Diarrhea
CHEMOTHERAPY DRUG POSSIBLE SIDE EFFECTS
 Used for cancers of the colon,  Mouth ulcers
breast, stomach, and head and neck
 Photosensitivity
 Dry skin

Gemcitabine (Gemzar)  Decrease in blood cell counts


 Given intravenously (IV)  Nausea and vomiting
 Used for cancers of the pancreas,  Fever and flu-like symptoms
breast, ovary, and lung
 Rash

Irinotecan (Camptosar)  Decrease in blood cell counts


 Given intravenously (IV)  Diarrhea
 Used for cancers of the colon and  Hair loss (reversible)
rectum

Methotrexate (Folex, Mexate,  Decrease in blood cell counts


Amethopterin)
 Nausea and vomiting
 May be given intravenously (IV),
 Mouth ulcers
intrathecally (into the spinal column), or
orally  Skin rashes and photosensitivity
 Used for cancers of the breast,  Dizziness, headache, or drowsiness
lung, blood, bone, and lymph system
 Kidney damage (with a high-dose therapy)
 Liver damage
 Hair loss (reversible)
 Seizures

Paclitaxel (Taxol)  Decrease in blood cell counts


 Given intravenously (IV)  Allergic reaction
 Used with cancers of the breast,  Nausea and vomiting
ovary, and lung
 Loss of appetite
 Change in taste
 Thin or brittle hair
 Joint pain (short term)
 Numbness or tingling in the fingers or toes

Topotecan (Hycamtin)  Decrease in blood cell counts


 Given intravenously (IV)  Diarrhea
 Used for cancers of the ovary and  Hair loss (reversible)
lung
 Nausea and vomiting

Vincristine (Oncovin, Vincasar PFS)  Numbness or tingling in the fingers or toes


 Usually given intravenously (IV)  Weakness
 Used for leukemia and lymphoma  Loss of reflexes
 Jaw pain
CHEMOTHERAPY DRUG POSSIBLE SIDE EFFECTS
 Hair loss (reversible)
 Constipation or abdominal cramping

Vinblastine (Velban)  Decrease in blood cell counts


 Given intravenously (IV)  Hair loss (reversible)
 Used for lymphoma and cancers of  Constipation or abdominal cramping
the testis and head and neck
 Jaw pain
 Numbness or tingling in the fingers or toes

Alkylating Agents

 Alkylating agents are non-cell cycle specific antineoplastics drugs. They can affect cells even in the resting
phase.

 These are the agents of choice for slow-growing cancers.

Therapeutic Action

The desired and beneficial action of agents for alkylating agents is:

 Reacting chemically with portions of RNA, DNA, or other cellular proteins to produce their cytotoxic effects.

 Alkylating agents are most potent when binding with cellular DNA.

 The oldest drugs in this class are nitrogen mustards.

Indications

Alkylating agents are indicated for the following medical conditions:

 Treatment of slow-growing cancers, like lymphomas, leukemias, myelomas, some ovarian, testicular, and breast
cancers, and pancreatic cancers.

Here are some important aspects to remember for indication of antineoplastics in different age groups:

Children

 Treatment of pediatric cancers follow developed antineoplastic protocols and combination therapy is stressed to
eliminate as many of the mutant cells as possible. Checking the dosage for children is crucial because of possible
drug toxicity. In addition, the nutritional needs and hydration status of children should be included in the
considerations for formulating a care plan.

 Even under therapy, children must be allowed to explore and learn like any other children. They would need
extra support and comfort as body image problems, lack of energy, and risk for infection can isolate them.
Lastly, bone marrow activity should be monitored carefully and dose should be adjusted carefully.

Adults

 Adults are also challenged with changes in body image and activities that come with chemotherapy. It is usual
for this age group to fear the diagnosis too. Therefore, establishing a good support system is important.

 Antineoplastic agents are contraindicated to pregnant and nursing women. Education, support, and referrals to
appropriate specialists are important. Women of childbearing age should use barrier contraceptives when these
drugs are being taken.

Older adults

 Older patients are more susceptible to GI and CNS adverse effects of antineoplastic therapy, particularly those
with hepatic and renal dysfunctions. Precautions are used accordingly. Protection from infection and injury
should be the focus of nurses.

Contraindications and Cautions


The following are contraindications and cautions for the use of alkylating agents:

 Pregnancy and lactation. Severe effects to fetus and neonate.

 Known allergy to drugs. Caution is exercised to prevent hypersensitivity reactions.

 Bone marrow suppression. The index for redosing and dosing levels

 Suppressed renal or hepatic function. Interfere with drug metabolism and excretion.

Adverse Effects

Use of alkylating agents may result to these adverse effects:

 GI: nausea, vomiting, anorexia, diarrhea, and mucous membrane deterioration, hepatic toxicity

 GU: renal toxicity, potentially toxic increase in uric acid levels

 Hematological: bone marrow suppression

 Alopecia or hair loss

Antimetabolites

 Antimetabolites are drugs that have chemical structures similar to those of various natural metabolites that are
necessary for growth and division of rapidly growing neoplastic cells and normal cells.

Therapeutic Action

The desired and beneficial action of antimetabolites is:

 Inhibiting DNA production in cells that depend on certain natural metabolites to produce their DNA. They
replace these needed metabolites and thereby prevent normal cellular function.

 Inhibit thymidylate synthase, DNA polymerase, or folic acid reductase, all of which are needed for DNA
synthesis.

 Considered to be S phase specific in the cell cycle, they are most effective in rapidly dividing cells, preventing cell
replication, and leading to cell death.

Indications

Antimetabolites are indicated for the following medical conditions:

 Treatment of various leukemias and some GI and basal cell cancers

 Use has been somewhat limited because neoplastic cells rapidly develop resistance to these agents. Therefore,
they are commonly administered as part of combination therapy.

Contraindications and Cautions

The following are contraindications and cautions for the use of antimetabolites:

 Known allergy to drug. Prevent hypersensitivity reactions

 Pregnancy and lactation. Severe effects on the fetus and neonate

 Bone marrow suppression. Index of redosing and dosing levels

 Renal and hepatic dysfunction. Interfere with drug metabolism and excretion

 Known GI ulceration or ulcerative diseases. Can be exacerbated by the effects of the drug

Adverse Effects

Use of antimetabolites may result to these adverse effects:

 CNS: headache, drowsiness, aphasia, fatigue, malaise, dizziness

 Respiratory: pulmonary toxicity, interstitial pneumonitis

 Hematological: bone marrow suppression


 GI: nausea, vomiting, anorexia, diarrhea, mucous membrane deterioration, hepatic toxicity

 GU: renal toxicity

 Leucovorin is an active form of folic acid that is used to rescue normal cells from the adverse effects of
methotrexate therapy in the treatment of osteosarcoma.

Antineoplastic Antibiotics

 This group of drugs is selective for bacterial cells. However, they are also toxic to human cells.

 They are aimed towards rapidly-multiplying cells.

Therapeutic Action

The desired and beneficial action of antineoplastics antibiotic is:

 Either breaking up DNA links or preventing DNA synthesis

 They interfere with cellular DNA synthesis by inserting themselves between base pairs in the DNA chain. This
causes a mutant DNA molecule, leading to cell death.

Indications

Antineoplastic antibiotics are indicated for the following medical conditions:

 Treatment of various types of cancer, particularly those with rapidly-dividing nature.

 These drugs have potentially adverse effects which limit their usefulness in patients with pre-existing disease
and those who are debilitated.

Contraindications and Cautions

The following are contraindications and cautions for the use of antineoplastic antibiotics:

 Known allergy to drug. Prevent hypersensitivity reactions

 Pregnancy and lactation. Severe effects on the fetus and neonate

 Bone marrow suppression. Index of redosing and dosing levels

 Renal and hepatic dysfunction. Interfere with drug metabolism and excretion

 Known GI ulceration or ulcerative diseases. Can be exacerbated by the effects of the drug

 Pulmonary problems. Exacerbated by bleomycin or mitomycin

 Cardiac problems. Exacerbated by idarubicin or mitoxantrone

Adverse Effects

Use of antineoplastic antibiotics may result to these adverse effects:

 CNS: headache, drowsiness, aphasia, fatigue, malaise, dizziness

 Respiratory: pulmonary toxicity, interstitial pneumonitis

 Hematological: bone marrow suppression

 GI: nausea, vomiting, anorexia, diarrhea, mucous membrane deterioration, hepatic toxicity

 GU: renal toxicity

 Alopecia

Mitotic Inhibitors

 Drugs that kill cells as the process of mitosis begins.

 Mitotic inhibitors are cell cycle-specific agents that inhibit DNA synthesis.
Therapeutic Action

The desired and beneficial action of mitotic inhibitors is:

 Interfering with the ability of the cell to divide by blocking or altering the M phase of the cell cycle.

Indications

Mitotic inhibitors are indicated for the following medical conditions:

 Treatment of a variety of tumors and leukemias.

Contraindications and Cautions

The following are contraindications and cautions for the use of mitotic inhibitors:

 Known allergy to drug. Prevent hypersensitivity reactions

 Pregnancy and lactation. Severe effects on the fetus and neonate

 Bone marrow suppression. Index of redosing and dosing levels

 Renal and hepatic dysfunction. Interfere with drug metabolism and excretion

 Known GI ulceration or ulcerative diseases. Can be exacerbated by the effects of the drug

Adverse Effects

Use of mitotic inhibitors may result to these adverse effects:

 CNS: headache, drowsiness, aphasia, fatigue, malaise, dizziness

 Respiratory: pulmonary toxicity, interstitial pneumonitis

 Hematological: bone marrow suppression

 GI: nausea, vomiting, anorexia, diarrhea, mucous membrane deterioration, hepatic toxicity

 GU: renal toxicity

 Can cause necrosis and cellulitis if extravasation occurs

Hormones and Hormone Modulators

 Some cancers are sensitive to estrogen stimulation. Estrogen-receptor sites on the tumor react with
circulating estrogen, and this reaction stimulates the tumor cells to grow and divide.

 Hormones and hormone modulators block or interfere with these receptor sites to prevent growth of
the cancer and cause cell death.

 Some hormones are used to block the release of gonadotropic hormones in breast or prostate cancer if the
tumors are responsive to gonadotropic hormones. Others may block androgen-receptor sites directly.

Therapeutic Action

The desired and beneficial action of hormones and hormone modulators is:

 Blocking the stimulation of growing cancer cells that are sensitive to the presence of that hormone.

Indications

Hormones and hormone modulators are indicated for the following medical conditions:

 Treatment of breast cancer in postmenopausal women or in other women without ovarian function.

 Treatment of prostatic cancers that are sensitive to hormone manipulation.

Contraindications and Cautions

The following are contraindications and cautions for the use of hormones and hormone modulators:

 Known allergy to drug. Prevent hypersensitivity reactions


 Hypercalcemia. Contraindication to the use of toremifene because the drug can increase serum calcium levels.

 Pregnancy and lactation. Severe effects on the fetus and neonate

 Bone marrow suppression. Index of redosing and dosing levels

 Renal and hepatic dysfunction. Interfere with drug metabolism and excretion

 Known GI ulceration or ulcerative diseases. Can be exacerbated by the effects of the drug

Adverse Effects

Use of hormones and hormone modulators may result to these adverse effects:

 Menopause-associated effects: hot flashes, vaginal spotting, vaginal dryness, moodiness, and depression

 Hematological: bone marrow suppression

 GI: hepatic toxicity

 GU: renal toxicity

 Hypercalcemia is encountered as the calcium is pulled out of the bones without estrogenactivity to
promote calcium deposition.

Cancer Cell-Specific Agents

 These agents are only specific to cancer cells and spare the healthy cells its devastating effects. Patients do not
experience the numerous adverse effects associated with antineoplastic chemotherapy.

 Three groups of drugs are cancer cell-specific: protein tyrosine kinase inhibitors, epidermal growth factor
inhibitor, and proteasome inhibitor.

Therapeutic Action

The desired and beneficial action of cancer cell-specific agents is:

 Protein tyrosine kinase inhibitors act on specific enzymes that are needed for protein building by specific tumor
cells. Blocking of these enzymes inhibits tumor cell growth and division.

 Epidermal growth factor inhibitors are drugs that act on epidermal growth factor receptors which are found in
both normal and cancerous cells but are more abundant on the latter.

 Proteasome inhibitors are drugs indicated for inhibition of proteasome in human cells, a large protein complex
that works to maintain cell homeostasis and protein production.

Indications

Cancer cell-specific agents are indicated for the following medical conditions:

 Imatinib, the first drug approved protein tyrosine kinase inhibitor, is given orally and is approved to treat
chronic myelocytic leukemia (CML). It selectively inhibits the Bcr-Abl tyrosine kinase created by the Philadelphia
chromosome abnormality in CML.

 Bortezomib is used for the treatment of multiple myeloma in patients whose disease had progressed after two
standard therapies.

Contraindications and Cautions

The following are contraindications and cautions for the use of cancer cell-specific agents:

 Pregnancy. All drugs in this class is pregnancy category D.

 Women of childbearing age. Must be advised to use barrier contraceptives while taking these drugs.

 Lactation. Can enter breastmilk and use is only justified if benefits outweigh the risks.

 Hepatic dysfunction. Increased risk of toxicity with imatinib and pazopanib.

 Risk for prolonged QT intervals (hypokalemia, hypomagnesia, taking drugs that can prolong QT
intervals). Contraindicated with nilotinib.
 Known allergy to the drug. Prevent hypersensitivity reactions.

Adverse Effects

Use of cancer cell-specific agents may result to these adverse effects:

 Imatinib: GI upset, muscle cramps, heart failure, fluid retention, skin rash. Severe adverse effects of traditional
antineoplastic therapy (severe bone marrow depression, alopecia, severe GI effects) do not occur.

 Gefitinib: potentially severe interstitial lung disease and various eye symptoms

 Pazopanib: some bone marrow depression, diarrhea, hypertension, and liver impairment, change in hair color

 Lapatinib: diarrhea, liver impairment, altered heart function

 Erlotinib and bortezomib: cardiovascular events, pulmonary toxicity

 Bortezomib: peripheral neuropathy, liver and kidney impairment

Interactions

The following are drug-drug interactions involved in the use of antineoplastic agents:

 Any drug that has potential for hepatic or renal toxicity

 Adversely affect drugs metabolized in the liver (e.g. oral anticoagulants)

 Antineoplastic antibiotics can increase toxicity of drugs that are toxic to the heart and lungs.

 Echinacea: increased risk of hepatotoxicity with antineoplastics

 Ginkgo: inhibits blood clotting, which can cause problems after surgery or with bleedingneoplasms

 Saw palmetto: increase the effects of various estrogen hormones and hormone modulators; advise patients
taking such drugs to avoid this herb

 St. John’s wort: can greatly increase photosensitivity, which can cause problems in patient who have received
radiation therapy or are taking drugs that cause other dermatological effects. In addition, it can decrease the
effectiveness of some antineoplastic agents.