Mitotic Inhibitors Drugs that kill cells as the process of mitosis begins.

These cell cycle inhibits DNA synthesis. Like other antineoplastics, the main adverse effects of mitotic inhibitors occur with cells that rapidly multiply: those in the bone marrow, GI tract, and skin.

Therapeutic Actions and Indications Mitotic Inhibitors interfere with the ability of a cell to divide, block, or alter DNA synthesis, thus causing cell death. They work in the M phase of the cell cycle. These drugs are used for the treatment of a variety of tumors and leukemias.

Mitotic Inhibitor Drugs Docetaxel ( Taxatore) 60-100mg IV over 1 hr every 3 wk Treatment of breast cancer and non-small lung cancer. Special Considerations: Monitor pt.closelydeaths have occuered during the use;severe fliud retention can occur premedicate with corticosteroids & monitor for weight gain; skin rash & nail disorders are usually reversible

Etoposide(Toposar,VePesid) 35-100mg per day IV for 4-5 days Treatment of testicular cancers refractory to other agents; non-small cell long carcinomas Special Considerations: Fatigue, GI toxicity, bone marrow depression & alopecia, avoid direct skin contact with the drug, monitor bone marrow function to adjust dosage, rapid fall in bp can occur during IV infusion

Paclitaxel (Taxol, Onxol) 135-175 mg per day IV over 3 hour every 3 weeks. Treatment of advanced ovarian cancer, breast cancer, non-small cell lung cancer, and AIDSrelated Kaposis sarcoma Special Considerations Anaphylaxis & severe hypersensitivity reactions have occurredmonitor very closely during administration; also monitor for bone marrow suppression; cardiovascular toxicity and neuropathies have occurred.

Teniposide (Vumon) 165-250 mg IV weekly in combinatiom with other drugs In combination with other drug for induction therapy in childhood acute lymphoblastic leukemia Special Considerations: GI toxicity, CNS effects, bone marrow suppression, alopecia, rapid fall in bp can occur during IV infusion

Vinblastine (Velban) Adult: 3.7 mg IV once weekly Pediatric: 2 mg IV once weekly Dosage may then be increased based on leukocyte count and patient response Tx of lymphomas & sarcomas, Hodgkins disease Special Considerations: GI toxicity, CNS effects, alopecia

Vincristine (Oncovin, Vincasar) Adult: 1.4mg IV at weekly intervals Pediatric: 2mg IV once weekly Tx of acute leukemia, various lymphomas, and sarcomas Special Considerations: Extensive CNS effects, GI toxicity, local irritation at injection site, alopecia, monitor urine output and arrange for fluid restriction and deuretics as needed

Vinorelbine(Navelbine) 30mg IV once weekly, based on granulocyte count First line treatment of unresectable advanced non-small cell lung cancer; stage IV non-small lung cancer and stage III non small cell lung cancer with cisplatin Special Considerations: GI & CNS toxicity, total hair loss, local reaction at injection site, bone marrow depression, antiemetics may be helpful if reaction is severe

Pharmacokinetics These drugs are not well absorbed from the GI tract and are given intravenously. They are metabolized in the liver and excreted primarily in the feces. Should not be used during pregnancy or lactation because of the potential risk to the neonate

Contraindications and Cautions To anyone with a known allergy to the drug. During pregnancy and lactation Bone marrow suppression Renal or hepatic dysfunction Known GI ulcerations or ulcerative diseases

Adverse Effects Bone marrow suppression: with leukopenia, thrombocytopenia, anemia, and pancytopenia GI effects include: N&V, anorexia, diarrhea,mucous membrane deterioration Alopecia may occur Necrosis & cellulitis if extrasavation occurs, so injection sites should be regularly monitored.

Drug-Drug Interaction Mitotic inhibitors that are known to be toxic in the liver or the CNS should be used with care with any other drugs known to have the same adverse effects.

Nursing Considerations for Patients Receiving Mitotic Inhibitors Assessment: History of allergy to the drug used Bone marrow suppression Renal or hepatic dysfunction Pregnancy or lactation GI ulcerative disease Evaluate the CBC with differential and renal and liver function test Regular evaluation of injection sites

Nursing Diagnoses Acute pain related to GI, CNS, local effects of drugs Disturbed body image related to alopecia, skin effects Fear, Anxiety related to diagnosis and treatment Deficient knowledge regarding drug therapy

Implementation Arrange for blood test to monitor bone marrow function before, periodically during, and for atleast 3 weeks after therapy Avoid direct skin or eye contact with the drug Administer medication according to scheduled protocol and combination with other drugs as indicated Monitor injection sites Provide small frequent meals, frequent mouth care and dietary consultation Arrange for proper head covering if alopecia occurs (eg. Wig, scarf or hat)

Evaluation Monitor pt. response to the drug Monitor for adverse effects