Oncological And Hematological Medications Process

Oncological And Hematological Medications Process

PYRAMID POINTS

I. Antineoplastic Medications

–Description

•Kill or inhibit reproduction of neoplastic cells

•Used to cure, increase survival time, and decrease life-threatening complications; normal cells affected by medication also

•Usually several medications used in combination

–Side/adverse effects

•Mucositis, alopecia, anorexia, nausea, vomiting, diarrhea, anemia

•Low white blood cell (WBC) count (neutropenia)

•Thrombocytopenia

•Infertility, neuropathy

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ADULT HEALTH:

Oncological and

Hematological Medications

PYRAMID POINTS

I. Antineoplastic Medications (continued)

–Interventions

•Monitor complete blood cell (CBC) count including WBC, platelets, electrolytes, uric acid level.

•Initiate bleeding precautions if thrombocytopenia occurs; use soft toothbrushes and electric razor to minimize risk of bleeding.

•Initiate neutropenic precautions if neutropenia occurs; monitor for fever, sore throat, unusual bleeding, and signs/symptoms of infection.

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ADULT HEALTH:

Oncological and

Hematological Medications

PYRAMID POINTS

I. Antineoplastic Medications (continued)

–Interventions (continued)

•Monitor for petechiae, ecchymosis, bleeding gums, epistaxis.

•Avoid intramuscular (IM) injections, venipuncture.

•Administer antiemetics several hours before chemotherapy.

•Pregnant nurses should avoid chemotherapy preparation, administration.

•Encourage hydration, promoting at least 2000 mL/day.

•Administer allopurinol (Zyloprim) as prescribed.

•Prepare IV chemotherapy in air-vented space per agency protocol.

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ADULT HEALTH:

Oncological and

Hematological Medications

PYRAMID POINTS

I. Antineoplastic Medications (continued)

–Interventions (continued)

•Discard intravenous (IV) equipment in designated containers.

•Monitor for extravasation.

•Instruct client about need for contraception during treatment.

•Live vaccinations should not be administered.

–Anaphylactic reactions

•Obtain allergy history.

•Stay with client during administration of medication.

•Monitor for signs of anaphylactic reactions.

•Dyspnea, chest tightness or pain, urticaria, tachycardia, dizziness, anxiety, flushed appearance, hypotension

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Slide 5

ADULT HEALTH:

Oncological and

Hematological Medications

PYRAMID POINTS

II. Alkylating Medications

–Description

•Interferes with DNA replication, breaks the DNA helix

–Side/adverse effects

•Busulfan may cause hyperuricemia.

•Chlorambucil and mechlorethamine may cause gonadal suppression and hyperuricemia.

•Cisplatin may cause ototoxicity, tinnitus, hypokalemia, hypocalcemia, hypomagnesemia, nephrotoxicity.

•Cyclophosphamide may cause alopecia, gonadal suppression, hemorrhagic cystitis, hematuria.

•Ifosfamide may cause neurotoxicity.

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Slide 6

ADULT HEALTH:

Oncological and

Hematological Medications

PYRAMID POINTS

II. Alkylating Medications (continued)

–Interventions

•Administer antiemetic 30 minutes before antineoplastic medication as prescribed.

•Instruct client to follow diet low in purines, avoid infection, report signs of infection or bleeding.

•Instruct client about good oral hygiene and use of soft toothbrush.

•Encourage client to drink increased fluids during therapy, unless contraindicated.

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ADULT HEALTH:

Oncological and

Hematological Medications

PYRAMID POINTS

III. Antitumor Antibiotic Medications

–Description

•Interfere with DNA, RNA synthesis

–Side/adverse effects

•Vesication

•Doxorubicin and idarubicin may cause cardiotoxicity.

•Pulmonary toxicity can occur with bleomycin.

–Interventions

•Assess for heart failure.

•Assess for myocardial toxicity, dyspnea, dysrhythmias, hypotension when administering doxorubicin, idarubicin.

•Monitor pulmonary status when administering bleomycin.

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Slide 8

ADULT HEALTH:

Oncological and

Hematological Medications

PYRAMID POINTS

IV. Antimetabolite Medications

–Description

•Halt synthesis of cell protein

•Presence impairs cell division

–Side/adverse effects

•Fluorouracil may cause alopecia, stomatitis, diarrhea, phototoxicity.

•Methotrexate may cause alopecia, stomatitis, hyperuricemia, photosensitivity, hepatoxicity.

–Interventions

•When administering fluorouracil, assess for signs of cerebellar dysfunction, stomatitis, diarrhea.

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ADULT HEALTH:

Oncological and

Hematological Medications

PYRAMID POINTS

IV. Antimetabolite Medications (continued)

–Interventions (continued)

•When administering methotrexate in large doses, prepare to administer leucovorin as prescribed to prevent toxicity (known as leucovorin rescue).

•When administering fluorouracil or methotrexate, instruct client to wear sunscreen or protective clothing.

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ADULT HEALTH:

Oncological and

Hematological Medications

PYRAMID POINTS

V. Mitotic Inhibitor Medications (Vinca Alkaloids)

–Description

•Prevent mitosis, causing cell death

•Prevent cell division

–Side/adverse effects

•Neurotoxicity with vincristine sulfate – numbness and tingling in fingers and toes, constipation, paralytic ileus

–Interventions

•Monitor for neurotoxicity with vincristine including numbness, tingling in fingers, toes.

•Monitor for constipation, paralytic ileus.

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ADULT HEALTH:

Oncological and

Hematological Medications

PYRAMID POINTS

VI. Topoisomerase Inhibitors

–Description

•Block enzyme needed for DNA synthesis and cell division

•Cell cycle phase–specific; act on the G2 and S phases

–Side/adverse effects

•Leukopenia, thrombocytopenia, anemia

•Anorexia, nausea, vomiting

•Diarrhea

•Alopecia

•Orthostatic hypotension

•Hypersensitivity reaction

–Interventions

•Refer to general interventions section under Oncological and Hematological Medications.

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ADULT HEALTH:

Oncological and

Hematological Medications

PYRAMID POINTS

VII. Hormonal Medications and Enzymes

–Description

•Suppress immune system; block normal hormones in hormone-sensitive tumors

–Side/adverse effects

•Tamoxifen citrate decreases effects of estrogen, may cause edema, hypercalcemia, and elevated cholesterol and triglyceride levels.

–Interventions

•Monitor vital signs.

•Monitor serum calcium levels with androgens.

•Monitor pancreatic function with asparaginase.

•Monitor uric acid, cholesterol serum levels.

•Monitor for signs of hemorrhagic cystitis.

•Instruct client about potential for alterations in sexual characteristics.

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Slide 13

ADULT HEALTH:

Oncological and

Hematological Medications

PYRAMID POINTS

VIII. Immunomodulator Agents: Biological Response Modifiers

–Description

•Stimulate immune system to recognize cancer cells and take action to eliminate or destroy them

•Colony-stimulating factors induce more rapid bone marrow recovery after suppression by chemotherapy.

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Slide 14

ADULT HEALTH:

Oncological and

Hematological Medications

PYRAMID POINTS

VIII. Immunomodulator Agents: Biological Response Modifiers (continued)

–Medications include rituximab, trastuzumab, alemtuzumab, bevacizumab, cetuximab.

–Adverse effects: allergic reactions (monoclonal antibodies)

–Interventions

•Monitor vital signs.

•Monitor liver and renal function tests.

•Teach clients to avoid persons who have received live immunizations.

•Monitor CBC results.

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Slide 15

ADULT HEALTH:

Oncological and

Hematological Medications

PYRAMID POINTS

IX. Targeted Therapy

–Description

•Monoclonal antibodies that target a cellular element of the cancer cell or medications that work at the gene level

–Side/adverse effects

•Monoclonal antibodies can cause allergic reactions.

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Slide 16

ADULT HEALTH:

Oncological and

Hematological Medications

PYRAMID POINTS

X. Other Antineoplastic Medications

–Altretamine

–Denileukin diftitox

–Pegaspargase

–Bexarotene

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