CA (Cellular Alterations)

Alkalyting agents

- Cell cycle non-specific

- -direct damage to DNA(chromatin)
o Clyclophospamide (Cytoxan)
 a/e:
 hemorrhagic cystitis
 leukemia
o Cysplatin
 a/e:
 tinnitus (ototoxic)
 inhibit RNA/protein synthesis
 stop RNA-DNA conversion (S-phase)
o Methotrexate (Rheumatrex)
 a/e:
 hepatotoxic
 antagonistic to vit B9 (folic acid)
o 5-FU (5-Fluorouracil)
 a/e:
 potent teratogen
 commonly associated with Hand Foot Syndrome a.k.a palmar-
plantar erythrodysesthesia
o 6-Mercaptopurine
 a/e:
 gouty arthritis
o Gemcitabine (Gemzar)
 a/e:
 gradual deterioration of immune system
o Antibiotic anti-tumors
 CCNS drugs
 Bleomycin
o least associated with myelosuppression
 Doxorubicin (Adriamycin)
o s/e:
 alopecia
 diarrhea
 red discoloration (urine)
 indigestion
 anemia
 myocardial toxicity
CA (Cellular Alterations)

 yeast infection
 CHF
 infiltration – stop or d/c
 nausea/ vomiting
o Mitotic inhibitors
 CSS drugs – disrupts cell division (M-phase)
 Paclitaxel/Doxotaxel (Taxol)
o a/e:
 xeroderma
o Plant alkaloids
 Vinblastine/Vincristine (Oncovin)
 s/e:
o neurotoxic - neutitis
o constipation

Side Effects of Chemotherapy

- administer antiemetic (alternative: ginger)

- avoid obnoxious stimuli
- hair follicles
o 14th day temporary alopecia
- Mucus membrane
o Canker sores – (mgt: lidocaine/saline mouth wash)
- Bone marrow depression
o anemia
o leukopenia
o thrombocytopenia
- reproductive or gonadal complications

Main adverse effect:

- tumor lysis syndrome (TLS)

o cytotoxic – RBC breakdown – (uric acid) hyperuricemia, (bilirubin)
hyperbilirubinemia, (potassium) hyperkalemia
- mgt
o mannitol
o osmotic laxative - lactulose

Other anti-tumors

- steroid (Prednisone)
CA (Cellular Alterations)

o glucocorticoids
 weight gain (moon face)
- anti-hormonal
o finasteride (poscar/Propecia)
 blocks testosterone
o tamoxifen (Nolvadex)
 blocks estrogen
 s/e:
 menopause
 bone pain
- immunotherapy – increase sensitivity/response of immune system
o interleukin
 increase cytokine response/production – inflammatory overdrive
 increases blood flow – reddish skin
 increased temperature – fever
 attracts WBC – leukocytosis
 increase capillary permeability – plasma leaks out (Capillary Leak
Syndrome) = discontinue
o crackles/rales
o dyspnea
o altered LOC
o IV interferon
 Decreases severity of s/sx
 Imbalance in neurotransmitters – decrease serotonin
o Targeted therapy – target specific portions of cancer cells
 Highly neurotoxic – permanent nerve damage
 Herceptin
 Adalimumab
 Monoclonal
- Transplantation
o Compatibility
 Self (autograft)
 Twin (isograft) – no rejection
 Cadaver (allograft)
 Animal (xenograft) – temporary
 Post-surgery
o Immunosuppressants to prevent organ rejection
 Cyclosporine (Sandimmune)
 Immuran
 Methylprednisolone
CA (Cellular Alterations)

- Palliative Care
o Abaquin Theory (“Prepare Me”)
 Holistic approach to care of clients with terminal conditions especially
cancer
 Pain relief – narcotics except Meperidine (Demerol)
 Stimulation to prevent sensory deprivation
- Alternative medicine – slow progression of cancer by minimizing cell damage
o Glutathione
o Vitamin E
o Green tea
o Plant alternatives
 Thistle – silimarine
 Noni
 Cranberry
 Dragon fruit
- Cryoablation (surgical tumor excision)
o Advantage:
 decreased hemorrhage
 decreased infection
- Hyperthemia therapy
o Use of HF (high frequency) ultrasound or transducer to induce heat (103 F –
113F); 45 min/session
o Non-invasive
o a/e: thermal injury/burns