Pharmacology Final Exam
Cancer Treatments: Hormonal Manipulation
Block hormone receptors on hormone-sensitive tumors to stop or slow cancer growth rate
Used in treatment of breast cancer, prostate cancer, etc.
Hormone Modulators Prototype: Tamoxifen
MOA: Competes with estrogen binding site in target tissue; antiestrogen
Indications: Breast cancer; prophylactic breast cancer
Route: Oral (may take for years)
AE: Antiestrogen effects (hot flashes, menstrual irregularities); masculinizing effects in women; risk DVT
Contraindications: Pregnancy; breastfeeding, anticoagulants; hx blood clots
Nursing: Comfort measures to help client cope with menopausal signs and symptoms such as hygiene measures,
temperature control, and stress reduction
Antineoplastic Agents**
General
- Harmful to all rapidly growing cells
- Narrow therapeutic index:
o Fine line between toxic and therapeutic levels
Goals of treatment
- Limit cancer cells to degree that immune system can then eliminate without causing too much toxicity to the
host
Caution:
- Pregnancy/lactation
- Bone marrow suppression
- Hepatic or renal impairment
- CNS disorders
Routes:
- Oral, SQ, IM, IV, topically, intracavity, intrathecal
- Central vascular access devices are common
- Nurse requires certification to administer chemotherapy
Antineoplastics Across the Lifespan
Children
- Monitor and intervene AE, hydration/nutritional/labs
- Needs support, comfort, to explore and learn like other children
o Body image, lack of energy, parental need to protect child-isolate
Adults
- Monitor and intervene AE, hydration/nutritional/labs/status
- Body image; fear of diagnosis, treatment, job, financial strains, social issues
- Need networking support systems, teaching, reassurance, and comfort
,Older Adults
- Monitor and intervene AE, hydration/nutritional/labs
- More susceptible to the CNS, GI, renal, liver effects – may need reduced dose
Alkylating Agents Prototype: Cyclophosphamide (Cytoxan)
AE: Toxic increase in uric acid level, CNS toxicity, hemorrhagic cystitis
Nursing: Encourage hydration to prevent cystitis
Antimetabolites Prototype: Methotrexate (Rheumatrex)
AE: Gastrointestinal ulceration, bone marrow suppression
Nursing: See general
Antitumor Antibiotics Prototype: Doxorubicin (Adriamycin)
AE: Injection site extravasation; cardiotoxic
Nursing: See general
General Antineoplastic Adverse Effects
Alopecia – hair loss
CNS/PNS – neuropathy/cognitive dysfunction, headache, dizziness
CV/Pulmonary – risk toxicity
Myelosuppression – leukopenia, anemia, thrombocytopenia
GI – N/V, anorexia, diarrhea/constipation; mucous membrane deterioration (stomatitis)
Liver/renal – risk toxicity
Skin reactions – rashes, blisters, photosensitivity
GU/reproductive – cystitis, dysfunction
Nursing: Antineoplastic Assessment/Diagnosis/Outcome
Assessment:
- H&P, contraindications (pregnancy/lactation, etc.), monitor labs: CBC, renal/liver functions; respiratory or
cardiac disease
Nursing Diagnosis
- Fatigue r/t drug effects (anemia) disease effects
- Disturbed body image related to alopecia, skin effects
- Risk for injury
Outcomes: The client will receive:
- Best therapeutic effects
- Limited adverse effects
- Understanding or drug therapy, AE, comfort measures
Nursing: Antineoplastic General Implementation
Schedule blood tests to monitor bone marrow function, liver, renal
Monitor AE, pt. response
Administer meds (anti-nausea, antidiarrheal, etc.)
Ensure hydration to decrease risk of renal toxicity
Provide small frequent meals, mouth care, dietary consult to maintain nutrition
Arrange for proper head covering for alopecia-temp. control
Avoid exposure to infection
Observe for signs of bleeding
, Energy conservation
Barrier contraception
Nursing Management: Alopecia/Skin
Alopecia
- Begins 2-3 weeks after start of treatment
- Obtain wig/scarves/caps/hats
- Avoid vigorous brushing hair
o Shave head once hair loss begins
- Regrowth begins 2-3 months after treatment; may be different thickness and texture
Skin
- Rashes/blisters
- Protective clothing
- No sunburn easily
Nursing Management GI Effects: Treatment Induced Nausea
Chemotherapy pattern of nausea
- Early: first 12 hours
- Delayed: 2-5 days
- Anticipatory (goal: no nausea from first dose)
Prevention
- Bland diet before and after chemo; hydrate
- Pre-medication 30 min prior to chemo: ondansetron
- Around the clock dosing for 48 hours after
Nursing Management GI Effects: Anorexia
Causes: n/v/d, constipation, fatigue, pain
Individualize plan to address all contributing factors
- Control N&V
- Good oral care
- Pain meds prior to eating
- Conserve energy so not too tired to eat.
- Small frequent meals high in calories and protein
- Avoid noxious stimuli (odors/visual/conversations)
- Supplements – ensure; high protein/calorie milkshakes
- Treat constipation/diarrhea
- Appetite stimulants
- Last resort – PEG tube/NG tube enteral feedings/TPN
Cancer Treatments: Hormonal Manipulation
Block hormone receptors on hormone-sensitive tumors to stop or slow cancer growth rate
Used in treatment of breast cancer, prostate cancer, etc.
Hormone Modulators Prototype: Tamoxifen
MOA: Competes with estrogen binding site in target tissue; antiestrogen
Indications: Breast cancer; prophylactic breast cancer
Route: Oral (may take for years)
AE: Antiestrogen effects (hot flashes, menstrual irregularities); masculinizing effects in women; risk DVT
Contraindications: Pregnancy; breastfeeding, anticoagulants; hx blood clots
Nursing: Comfort measures to help client cope with menopausal signs and symptoms such as hygiene measures,
temperature control, and stress reduction
Antineoplastic Agents**
General
- Harmful to all rapidly growing cells
- Narrow therapeutic index:
o Fine line between toxic and therapeutic levels
Goals of treatment
- Limit cancer cells to degree that immune system can then eliminate without causing too much toxicity to the
host
Caution:
- Pregnancy/lactation
- Bone marrow suppression
- Hepatic or renal impairment
- CNS disorders
Routes:
- Oral, SQ, IM, IV, topically, intracavity, intrathecal
- Central vascular access devices are common
- Nurse requires certification to administer chemotherapy
Antineoplastics Across the Lifespan
Children
- Monitor and intervene AE, hydration/nutritional/labs
- Needs support, comfort, to explore and learn like other children
o Body image, lack of energy, parental need to protect child-isolate
Adults
- Monitor and intervene AE, hydration/nutritional/labs/status
- Body image; fear of diagnosis, treatment, job, financial strains, social issues
- Need networking support systems, teaching, reassurance, and comfort
,Older Adults
- Monitor and intervene AE, hydration/nutritional/labs
- More susceptible to the CNS, GI, renal, liver effects – may need reduced dose
Alkylating Agents Prototype: Cyclophosphamide (Cytoxan)
AE: Toxic increase in uric acid level, CNS toxicity, hemorrhagic cystitis
Nursing: Encourage hydration to prevent cystitis
Antimetabolites Prototype: Methotrexate (Rheumatrex)
AE: Gastrointestinal ulceration, bone marrow suppression
Nursing: See general
Antitumor Antibiotics Prototype: Doxorubicin (Adriamycin)
AE: Injection site extravasation; cardiotoxic
Nursing: See general
General Antineoplastic Adverse Effects
Alopecia – hair loss
CNS/PNS – neuropathy/cognitive dysfunction, headache, dizziness
CV/Pulmonary – risk toxicity
Myelosuppression – leukopenia, anemia, thrombocytopenia
GI – N/V, anorexia, diarrhea/constipation; mucous membrane deterioration (stomatitis)
Liver/renal – risk toxicity
Skin reactions – rashes, blisters, photosensitivity
GU/reproductive – cystitis, dysfunction
Nursing: Antineoplastic Assessment/Diagnosis/Outcome
Assessment:
- H&P, contraindications (pregnancy/lactation, etc.), monitor labs: CBC, renal/liver functions; respiratory or
cardiac disease
Nursing Diagnosis
- Fatigue r/t drug effects (anemia) disease effects
- Disturbed body image related to alopecia, skin effects
- Risk for injury
Outcomes: The client will receive:
- Best therapeutic effects
- Limited adverse effects
- Understanding or drug therapy, AE, comfort measures
Nursing: Antineoplastic General Implementation
Schedule blood tests to monitor bone marrow function, liver, renal
Monitor AE, pt. response
Administer meds (anti-nausea, antidiarrheal, etc.)
Ensure hydration to decrease risk of renal toxicity
Provide small frequent meals, mouth care, dietary consult to maintain nutrition
Arrange for proper head covering for alopecia-temp. control
Avoid exposure to infection
Observe for signs of bleeding
, Energy conservation
Barrier contraception
Nursing Management: Alopecia/Skin
Alopecia
- Begins 2-3 weeks after start of treatment
- Obtain wig/scarves/caps/hats
- Avoid vigorous brushing hair
o Shave head once hair loss begins
- Regrowth begins 2-3 months after treatment; may be different thickness and texture
Skin
- Rashes/blisters
- Protective clothing
- No sunburn easily
Nursing Management GI Effects: Treatment Induced Nausea
Chemotherapy pattern of nausea
- Early: first 12 hours
- Delayed: 2-5 days
- Anticipatory (goal: no nausea from first dose)
Prevention
- Bland diet before and after chemo; hydrate
- Pre-medication 30 min prior to chemo: ondansetron
- Around the clock dosing for 48 hours after
Nursing Management GI Effects: Anorexia
Causes: n/v/d, constipation, fatigue, pain
Individualize plan to address all contributing factors
- Control N&V
- Good oral care
- Pain meds prior to eating
- Conserve energy so not too tired to eat.
- Small frequent meals high in calories and protein
- Avoid noxious stimuli (odors/visual/conversations)
- Supplements – ensure; high protein/calorie milkshakes
- Treat constipation/diarrhea
- Appetite stimulants
- Last resort – PEG tube/NG tube enteral feedings/TPN
