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Chemotherapy

This document provides information on chemotherapy including its primary focus of preventing cancer cell growth and spread, definitions, types of chemotherapy such as adjuvant and neoadjuvant therapy, factors that influence drug selection and administration like blood brain barriers and cytoprotectants, classifications of drugs, cell kill hypotheses, and guidelines for safe handling and administration.
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100% found this document useful (2 votes)
603 views44 pages

Chemotherapy

This document provides information on chemotherapy including its primary focus of preventing cancer cell growth and spread, definitions, types of chemotherapy such as adjuvant and neoadjuvant therapy, factors that influence drug selection and administration like blood brain barriers and cytoprotectants, classifications of drugs, cell kill hypotheses, and guidelines for safe handling and administration.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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CHEMOTHERAPY

Prepared by:
JEFFREY A. GALLO, RN, MSN

Chemotherapy
Primary focus:
prevent cancer cells from multiplying, invading adjacent
tissues, or developing metastasis
Provides systematic treatment for cure, control, or palliation
of cancer
Definition:
the use of cytotoxic drugs in the treatment of cancer

CHEMOTHERAPY
Adjuvant therapy:
a course of chemotherapy in conjunction with another treatment modality aimed
at treating metastasis
Neoadjuvant:
administration of chemotherapy to shrink a tumor before it is surgically removed
Primary therapy
: the treatment for patients who have localized cancer for which an alternative but
less than completely effective treatment is available
Induction:
drug therapy given as the primary treatment for patients who have cancer for
which no other alternative exists
Combination Chemotherapy:
administration of two or more chemotherapeutic agents to treat cancer; this
allows each medication to enhance the action of the other or to act synergistically
Myeloblative therapy:
dose-intensive therapy used in preparation for peripheral blood stem cell
transplantation

CHEMOTHERAPY
Historcial perspective
1900s
Paul Ehlrich used rodent models of infectious diseases to
develop antibiotics
Further developments led to the use of rodents to test
potential cancer chemotherapeutic agents
World War I and II
Servicemen exposure to mustard gas
led to effects of alkylating agents
1940
1946
1950s
1970s

CHEMOTHERAPY
Principles of Chemotherapy
Cell generation cycle
Tumor growth

Factors influencing Chemotherapy


Selection and Administration
Blood-Brain Barrier(BBB)
Chemoprevention
Chronotherapy or circadian rhythm
Cytoprotectants
Liposomes
radiosensitizers

Blood-brain Barrier
Made up of cellular structures that can inhibit certain
substances from entering the brain or CNS and acts as a
screening device , thereby protecting the brain and CSF from
harmful agents.
Formed by continuous supporting cells
Astrocytres and endothelial cells

Chemotherapy drug adminstration via intrathecal route


(Ommaya Resrvior) effectively bypasses the BBB and
permits delivery of drug directlyt into the CSF

Chemoprevention
Refers to the concept of reducing cancer risk in indivuals
who are highly susceptible to certain cancers by prescribing
certain natural or chemical synthetic products or
chemotherapeutic agents that may reduce or suppress the
process of carcinogenesis
Seeks to arrest the process of carcinogenesis before tumor
develops
Selective Estrogen Receptor Modulator
Aromatase inhibitors
Finasteride

Chronotherapy or circadian rhythm


Used to describe a regular repeated fluctuation in biologic
functions during a 24 hour period
Diurnal
Events happening in day time
Influences the drug absorption, metabolism, distribution and
elimination
Allows dose intensification and reduction of side effects
Circadian variations are evident in DNA synthesis in the
intestinal mucosa, skin, bone marrow, spleen, testis, and
thymus tissue.

Cytoprotectants
Are used to prevent or decrease specific system effects
related to certain drug therapies
These drugs selectively protect normal tissues from the
cytotoxic effects of drugs or irradiation while preserving their
antitumor effects
Usual administration and monitoring guidelines:
Follow specific manufacturers guidelines related to..
Administer the cytoprotectant 30 to 60 minutes before the
chemotherapy and radiation therapy
Side effects:
n/v, hypotension, warm flushed feeling, diarrhea and joint
pain

Cytoprotectants
Carvedilol(Coreg)
anthracycline associated cardiotoxicity
Dextrazoxane(Zinecard)
doxorubicin associated cadiotoxicity
Mesna(Mesnex)
hemorrhagic cystitis induced by ifosfamide or
cyclophosfamide(Cytoxan)
Amifostine(Ethyol)
Pancytoprotectant and decreases cumulative renal toxicity
associated with repeated administration of Cisplatin

Liposomes

Manipulate chemotherapeutic drugs and tailor them to


penetrate specific targets
Examples:
Doxil/ Doxorubicin HCL Liposome
Daunoxome/ daunorubicin liposome
DepoCyt/ cytarabine liposome
Side effects:
Mucositis, n/v, skin rash, headache
Reduction of myelosuppression and vesicant extravasation
Adminstration guidelines;
Do not administer or mix with other drugs
Use an in-line filter
If any untoward clinical event occurs during drug adminstration,
stop the infusion immediately

Radiosensitizers
Enhances sensitivity of tumors to the effects of radiation, but
not to normal tissues
Allows better control of micrometastases
Examples:
Amifostine
Cisplatin
Docetaxel
Fludarabine
5-flourouracil
Gemcitabine
Hydroxyurea
placlitaxel

Chemotherapy drug classification


Drugs are classified according to their pharmacologic action
and their interference with the cellular reproduction
Cell cycle phase specific
Cell cycle phase on-specific

Cell cycle phase specific


Antimetabolites; block essential enzymes necessary for
DNS synthesis or by becoming incorporated into the DNA
and RNA so that a false message is transmitted
Vinca Plant alkaloids exerts cytotoxic effects during
metaphase

Cell cycle phase-nonspecific


Alkylating agents: act primarily to form a nuclear bond with nucleic
acids, which interferes with nucleic acid duplication. Two peaks of
lethal activity:
G2 to M and G1 to S

Antibiotics: disrupt DNA transcription and inhibit DNA and RNA


synthesis
Hormones: alter the environment of the cell and affects the cell
membrane permeability
Antihormones: derive their antineoplastic effect from their ability to
neutralize the effect of or inhibit the production of natural hormones
Nitrosureas: have the ability to cross the BBB. Has similar effects
with Alkylating agents

Cell Kill Hypothesis


Every tumor cell must be killed to cure cancer. With each
course of the drug therapy, a given dose of
chemotherapeutic drug kills only a fraction, not all, of all the
cancer cells present.
Repeated course of chemotherapy must be used to reduce
the total number of cancer cells
Cardinal rule of chemotherapy: inverse relationship between
cell number and curability

Factors considered in Drug


selection
Patients eligibility for chemotherapy
Cancer cell type
Rate of drug absorption
Tumor location
Tumor load
Tumor resistance

Chemotherapy dose listings


Standard dose therapy
High dose therapy
Dose intensity
Dose density

Chemotherapy administration
Body Surface area (m2)
Nomogram
Nurse responsibility:
Ensure accurate patient height and weight
The drug dose is ordered in mg per square meter
All drug calculations must be verified by a second person

Drug Reconstitution
Class II Biologic Safety
when drugs are prepared and reconstituted, aseptic
technique must be used in accordance with the
manufacturers current recommendations
All syringes of reconstituted drugs are immediately labeled
with the name of the drug

Special Considerations for


Intrathecal Drugs
Preparation of medications should be done in the pharmacy as close
as possible to the time of administration
Drugs should be labeled with appropriate short expiration time, time
delivered, and administered in a designated location, and at specified
time of the day or week
Wrap drugs with sterile bag and sterile towel or container and
labeled: FOR INTRATHECAL USE ONLY.
Establish a list of drugs that can be administered intrathecally
At least 2 qualified health care professionals should independently
verify and document drug:
dose
Route
date
time of pharmacy drug preparation
and verify correct patient identification

Administration Guidelines
Oral:
Emphasize importance of the patients complying with the
prescribed schedule
Plan for the drugs with emetic potential to be taken with
meals
Drugs that require hydration must be taken early in the
morning

Administration Guidelines
Subcutaneous and intramuscular
Injections sites must be rotated for each dose and a log kept
of the drug dosing schedule
Demonstration and return demonstration may be needed if
patient is giving self injection

Administration Guidelines
Intraarterial
Throughout the infusion, monitor:
vital signs,
color and temperature of the extremity,
and the site for potential bleeding

Administration Guidelines
Topical Administration
Cover surface area with a thin film of medication
Instruct the patient to wear loose-ftting cotton clothing
Wear gloves
Wash hands thoroughly after the procedure
Caution the patient not to touch the patient

Administration Guidelines
Intracavity
Follow prescribed medication dosage to minimize irritation

Administration Guidelines
Intraperitoneal
Tenckhoff catheter
Use dry heat to warm the infusate solution to body
temperature before administration
Monitor patient for:
Abdominal pressure
Pain
Fever
Electrolyte imbalance
Measure abdominal girth

Administration Guidelines
Intravenous
Are given through:
central venous catheter
peripheral venous access
Methods:
IV push
Piggyback
Continuous infusion

Administration Guidelines
Vein selection and venipuncture (Basilic, cephalic,
metacarpal veins)
Sites must be changed on a planned basis every 48 hours
to reduce phlebitis or infiltration
Peripheral sites must be changed daily for administration of
vesicants
veins suitable for venipuncture should:
feel smooth and pliable
Large enough to allow adequate blood flow
Use distal veins first,
Should be above areas of flexion
Subsequent changes should be done proximal to previous
sites

Safe handling of Chemotherapeutic


Agents
Drug Preparation
All chemotherapeutic agents should be prepared according to
package insert in class II Biologic Safety Cabinet
PPE:
Disposable surgical gloves
Gown made of lint-free, low permeability fabric with a closed
front, long sleeves, and elastic or knit-cuffs
Eye protective splash goggles or a face shield must be worn
when these drugs are prepared if a BSF is not used
Gloves should be changed between preparation and
administration of the drug at least every 30 minutes

Safe handling of Chemotherapeutic


Agents
Disposal of supplies and unused drugs
Place all unused or drugs in containers in:
Leak-proof
Closeable
Puncture proof
Appropriately labeled container
keep these containers in every area where drugs are
prepared or administered so the waste materials need not be
moved from one to another
dispose hazardous wastes in a licensed sanitary landfill or
incinerate at 1832 F or 1000C

Safe handling of Chemotherapeutic


Agents
Drug Administration
Wear PPE
Place a plastic-backed absorbent pad under the tubing
during administration to catch any leakage

Safe handling of Chemotherapeutic


Agents
Spills on hard surface
Spill on linen
Spill on personnel or patient
Eye exposure
Recommended supplies:
Respirator mask
Plastic safety glasses or goggles
Heavy duty rubber gloves
Absorbent pads
Absorbent towels
Double bags
Protective disposable gown
Containers of detergent and tap water
Puncture-proof
Leak-proof closeable container approved for chemotherapy waste disposal
Approved, specially labeled impervious bags

Safe Handling of Chemotherapy


Agents
1. Restrict area of the spill
2. Put on protective gowns, gloves, and goggles, and if a
powder spill is involved, a respirator mask.
3. Open waste disposal bags

Safe Handling of Chemotherapy


Agents
Spill on hard Surface
1. Place absorbent pads gently on the spill, being careful not
to touch them.
2. Place the saturated pads on the waste bag
3. Clean the surface with absorbent towels , using detergent
solution
4. Rinse it clean with clean tap water and wipe dry.

Safe Handling of Chemotherapy


Agents
Spill on Linen
1. Remove soiled contaminated linen from the patients
bedside.
2. place the linen in an approved specially marked
impervious laundry bag.
3. clean the contaminated area with absorbent towels and
detergent solution
4. The Contaminated linen should be washed twice by the
laundry, and the laundry personnel should wear surgical
latex gloves and gown when handling this material

Safe Handling of Chemotherapy


Agents
Spill on personnel or linen
1. Immediately remove any contaminated protective
garments or linen.
2. Wash the affected area of skin with soap and water
3. Follow procedures for contaminated linen
4. notify the physician if the drug spills on the patient.
5. Place all contaminated materials in double bagged waste
disposal bags
6. Discard the waste bags in an approved container
7. Wash hands thoroughly with soap

Caring for Patients Receiving


Chemotherapeutic Drugs
Extravasation management
Vesicant extravasation: the accidental leakage of a drug into the
subcutaneous tissue that causes pain, necrosis, or sloughing of
tissue
Vesicant: an agent that can produce blister, tissue destruction or
both.
Irritant: an agent that can cause aching, tightness, and phlebitis
at the injection site or along the vein line with or without
inflammatory reaction
Flare: Local allergic reaction without pain that usually is
accompanied by red blotches along the vein line. Subsides within
30 minutes with or without treatment
Delayed extravasation: one in which symptoms occur 48 hours or
more after the drug is administered

Chemotherapeutic Drugs with


Vesicant Potential
Generic name

Trade name

Dactinomycin

Actinomycin

Daunorubicin

Cerubidine, Daunomycin

Doxorubicin

Adriamycin

epirubicin

Pharmorubicin

Esorubicin

4-deoxydorubicin

Idarubicin

Idamycin

Mecholrethamine

Nitrogen mustard, Mustargen

Mitomycin

Mutamycin

Menogaril

Tomosar

Caring for Patients Receiving


Chemotherapeutic Drugs
Extravasation Management
Prevention:
Know which drugs have vesicant potential
Test the vein or lumen patency with normal saline
Observe IV site before, during and after administration, and
validate a dark, brisk blood,before, during and after administration
of drug

Treatment: Administration of antidotes


Documentation:
Date and time, needle product,, catheter size, , insertion site, ,
or type of venous access, drug sequence, approximate amount
of extravasated drug, photographic documentation, patients
complaints or statements, appearance of site,. Notification of
physician, follow-up measures and nurses signature

Anaphylaxis
Emergency medications and supplies for managing
anaphylaxis:
Injectable aminophylline, dyphenhydramine HCL, Dopamine,
epinephrine, heparin, hydrocortisone
Oxygen set-up, tubing cannula, or mask and airway device
Suction equipment
IV fluids
IV tubings and supplies for venous access

Anaphylaxis
Signs and symptoms
Anxiety
Hypotension
Urticaria
Cyanosis
Respiratory distress
Abdominal cramping
Flushed appearance
chills

Anaphylaxis
Management
1. immediately stop the infusion
2. Maintain an IV line with Isotonic saline
3. Position the patient for comfort and to promote perfusion to vital
organs
4. Notify the physician, nursing agency, or emergency department
5. Maintain the airway, and anticipate the need for cardiopulmonary
resuscitation
6. monitor vital signs according to agency policy
7. Administer appropriate medications with an aproved physicians
order
8. follow the nursing agencys protocol for follow-up care
9. Document
Follow-up care and provide health education to patient and SO

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