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Chapter 35
Anticancer Drugs

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Influences
 Influences
 Genetic mutations
 Inflammation
 Infectious organisms
 Environmental
 Unhealthy diet

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Cell-Cycle–Nonspecific and Cell-
Cycle–Specific Anticancer Drugs
 Cell-cycle–nonspecific
 Alkylating agents
 Antitumor antibiotics
 Hormones
 Cell-cycle–specific
 Antimetabolites
 Alkylating agents
 Vinca alkaloids

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Cancer Chemotherapy (1 of 3)
 Adjuvant therapy
 Neoadjuvant therapy
 Palliative chemotherapy
 Protocols

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Cancer Chemotherapy (2 of 3)
 Combination chemotherapy
 Enhances tumoricidal activity
 Increases chance of affecting cancer cells in all
phases of cell cycle
 Increases synergistic effects to kill cancer cells
 Decreases drug resistance

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Cancer Chemotherapy (3 of 3)
 General side effects and adverse reactions
 Affects normal cells
• Skin and hair
• GI tract, mucous membranes
• Bone marrow, reproductive system
 Anticancer therapy in outpatient settings
 Homes
 Oncology clinics
 Occupational exposure precautions

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Alkylating Agents (1 of 2)
 Action
 Damage cell’s DNA preventing reproduction of
cancer cells
 Uses
 Classes
 Nitrogen mustards
 Nitrosoureas
 Alkyl sulfonates
 Triazines
 Ethylenimines

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Alkylating Agents (2 of 2)
 Alkylating agents
 Cyclophosphamide
• Nitrogen mustard analogue
• Severe vesicant that causes tissue necrosis
• Administered orally and IV
• Patient must be well hydrated while taking this drug to prevent
hemorrhagic cystitis.
 Side effects and adverse reactions
• Anaphylaxis, hemorrhagic cystitis, cardiotoxicity
• Syndrome of inappropriate antidiuretic hormone
• Increased skin pigmentation, GI distress, stomatitis
• Fever, alopecia, weight loss, amenorrhea
• Neutropenia, pneumonitis,
• Tumor lysis syndrome, nephrotoxicity, hepatotoxicity

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Clinical Judgment: Alkylating Drugs:
Cyclophosphamide (1 of 2)
 Concept
 Immunity
 Recognize cues
 Assess baseline lab values.
 Obtain baseline data about patient’s physical
status.
 Analyze cues and prioritize hypothesis
 Decreased immunity, need for patient teaching
 Generate solutions
 The patient will remain free from infection and
hemorrhagic cystitis.

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Clinical Judgment: Alkylating
Drugs: Cyclophosphamide (2 of 2)
 Take action
 Monitor lab results.
 Monitor patient’s IV site frequently for irritation and
phlebitis.
 Maintain strict medical asepsis during dressing
changes and invasive procedures.
 Encourage small, frequent meals high in calories
and protein.
 Maintain hydration before and during
chemotherapy.
 Evaluate outcomes

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Antimetabolites (1 of 2)
 Methotrexate
 Action
 Affect cells with high metabolic rates, such as hair
follicles, endothelium, GI tract cells, bone marrow,
causes apoptosis to fetal cells
 Uses
 Treat malignant and nonmalignant conditions,
such as rheumatoid arthritis, psoriasis, leukemias,
cancers of GI tract, head, neck, breast, ovaries

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Antimetabolites (2 of 2)
 Fluorouracil
 Action
 Affect cells with high metabolic rates, such as hair
follicles, endothelium, GI tract cells, bone marrow;
causes apoptosis to fetal cells
 Uses
 Treat cancers of GI tract, head, neck, breast
 Side effects/adverse reactions
 Stomatitis, GI distress and bleeding, weight loss
 Bone marrow suppression, fever, amenorrhea
 Dry, cracked skin, alopecia, cardiac toxicity
 Hand and foot syndrome, renal failure

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Clinical Judgment: Antimetabolites:
Fluorouracil (1 of 2)
 Concept
 Immunity
 Recognize cues
 Conduct detailed current medication history.
 Obtain a list of drug and food allergies.
 Obtain baseline lab values.
 Analyze cues and prioritize hypothesis
 Decreased immunity, need for patient teaching
 Generate solutions
 The patient will remain free from signs and
symptoms of bleeding.

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Clinical Judgment: Antimetabolites:
Fluorouracil (2 of 2)
 Take action
 Monitor patient’s IV site frequently.
 Maintain strict medical asepsis during dressing
changes and invasive procedures.
 Administer an antiemetic 30 to 60 min before drug
administration.
 Monitor fluid intake and output and nutritional
status.
 Advise patient to promptly report signs of infection.
 Evaluate outcomes

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Antitumor Antibiotics
 Doxorubicin
 Action
 Interfere with DNA replication and RNA transcription of
cancer cells
 Uses
 Solid tumors, leukemias
 Side effects/adverse reactions
 Alopecia, stomatitis, GI distress, rash, fever, chills
 Reddish colored urine, myelosuppression, blisters
 Hyperpigmentation of nail beds
 Cardiotoxicity, dysrhythmias

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Clinical Judgment: Antitumor
Antibiotics: Doxorubicin (1 of 2)
 Concept
 Perfusion
 Recognize cues
 Conduct a detailed medication history.
 Obtain baseline data regarding patient’s physical
status.
 Analyze cues and prioritize hypothesis
 Decreased tissue perfusion
 Generate solutions
 The patient will be free from cardiac abnormalities.
 The patient will have intact skin.

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Clinical Judgment: Antitumor
Antibiotics: Doxorubicin (2 of 2)
 Take action
 Maintain strict medical asepsis during dressing
changes and invasive procedures.
 Assess cardiac status and check for any ECG
abnormalities before and during treatment.
 Monitor IV site frequently and stop infusion
immediately if signs of extravasation are apparent.
 Handle the drug with care during preparation and
avoid direct skin contact with the drug.
 Evaluate outcomes

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Plant Alkaloids
 Vincristine
 Action
 Block cell division at the M phase of the cell cycle
 Uses
 Leukemias, breast cancer, multiple myeloma,
sarcomas, brain tumors, non-Hodgkin’s lymphoma
 Side effects/adverse reactions
 Loss of deep tendon reflexes, phlebitis, alopecia
 GI distress, constipation, muscle weakness, seizures
 Neurotoxicity, visual disturbances, ileus, fever
 SIADH, hyponatremia, hyperuricemia, bladder atony
 Extravasation, paresthesia, blindness
 Difficulty walking, hypotension

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Clinical Judgment:
Plant Alkaloids: Vincristine (1 of 2)
 Concept
 Sensory perception
 Recognize cues
 Obtain baseline data about patient’s physical
status.
 Assess bowel and urinary function.
 Analyze cues and prioritize hypothesis
 Reduced sensory perception
 Generate solutions
 The patient will be free from neuropathic
dysfunction.
 The patient will maintain adequate bowel function.

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Clinical Judgment:
Plant Alkaloids: Vincristine (2 of 2)
 Take action
 Assess for signs of respiratory distress during and
after drug administration.
 Monitor for signs of peripheral neuropathy.
 Assess patient’s IV site frequently.
 Administer stool softener or laxative as prescribed.
 Advise patient to promptly report signs of infection.
 Teach patient the signs of drug extravasation into
tissue.
 Evaluate outcomes

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Liposomal Chemotherapy
 Liposomal chemotherapy
 Action
 Fatty coating helps drug remain in system longer
 Increase duration of therapeutic effects
 Help decrease side effects (alopecia, nausea,
cardiotoxicity)
 Encapsulated form examples
 Doxorubicin
 Daunorubicin
 Vincristine
 Cytarabine

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Hormones and Hormonal
Agonists and Antagonists
 Hormones and hormonal agonists and
antagonists
 Corticosteroids
 Sex hormones
 Antiandrogens
 Selective estrogen receptor modulators
 Luteinizing hormone–releasing hormone agonists
 Aromatase inhibitors

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Hormones: Agonists/Antagonists:
Corticosteroids
 Corticosteroids
 Action
 Suppress inflammatory process associated with
tumor growth
 Use
 Treat leukemias, multiple myeloma, inflammatory
bowel disease, transplant rejection
 Side effects/adverse reactions
 Insomnia, irritability, delirium, psychosis
 Hyperglycemia, fluid retention, weakness

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Hormones Agonists/Antagonists: Sex
Hormones
 Sex hormones
 Use
 Estrogen, androgen—slow growth of hormone-
dependent tumors (breast and prostate cancer)
 Estrogen—improve bone metastasis
 Progestin—renal and endometrial cancers
 Side effects/adverse reactions
 Fluid retention, thrombosis, menstrual irregularity,
osteoporosis

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Antiandrogens and Selective Estrogen
Receptor Modulators
 Antiandrogens
 Action
• Block testosterone and estrogen effects slowing or
shrinking cancers
 Selective estrogen receptor modulators
 Action
• Produces estrogenic effects in bone and lipids
• Has antiestrogenic property in mammary tissues
 Use
• Breast cancer

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Luteinizing Hormone-Releasing
Hormone Agonists
 Luteinizing hormone–releasing hormone
agonists
 Action
• Suppress the secretion of follicle-stimulating hormone and
luteinizing hormone from pituitary gland
• Reduce size of sex organs
• Improves symptoms

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Hormones Agonists/Antagonists:
Aromatase Inhibitors
 Aromatase inhibitors
 Block peripheral conversion of androgens into
estrogen
 Suppress the postmenopausal synthesis of estrogen
and slows tumor growth
 Use
 Treat hormonally sensitive breast cancer in
postmenopausal females and premenopausal
females with ovaries removed

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Miscellaneous Chemotherapy Agents
 Vaccines
 Action
• Stimulates T-cell immunity
 Use
• Prevent hepatitis B virus, which can cause liver cancer
• Prevent human papillomavirus, which can lead to female
cervical cancer and genital warts in males

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Practice Question #1 (1 of 2)
A patient receiving chemotherapy for the treatment
of cancer experiences “stocking/glove” syndrome.
The nurse identifies which drug class as most
likely associated with this adverse effect?
A. Antitumor antibiotics
B. Plant alkaloids
C. Alkylating drugs
D. Hormonal agents

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Practice Question #1 (2 of 2)
Answer:
B. Plant alkaloids

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Practice Question #2 (1 of 2)
A patient is receiving the alkylating drug
cyclophosphamide. Which of the following is most
important for the nurse to provide?
A. IV hydration and assessment of fluid status
B. Vigilant skin care and cleaning with mild soap
C. Mouth care using half-strength hydrogen peroxide and a
soft toothbrush
D. Patient-controlled analgesia with meperidine

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Practice Question #2 (2 of 2)
Answer:
A. IV hydration and assessment of fluid status

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Practice Question #3 (1 of 2)
A patient being treated for cancer is receiving
medication for palliation. Which of the following
does the nurse understand what palliative therapy
is used for?
A. Relieve symptoms
B. Kill tumor cells
C. Decrease viral load
D. Increase body defenses

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Practice Question #3 (2 of 2)
Answer:
A. Relieve symptoms.

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Practice Question #4 (1 of 2)
A patient is receiving chemotherapy for the
treatment of cancer. Of the following choices,
which does the nurse anticipates nadir to occur?
A. 2 days
B. 8 days
C. 15 days
D. 30 days

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Practice Question #4 (2 of 2)
Answer:
B. 8 days

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Practice Question #5 (1 of 2)
A patient is receiving cyclophosphamide therapy.
Which statement by the patient indicates more
teaching is necessary?
A. “I will take the medication before bedtime.”
B. “I will eat a diet low in organ meats, beans, and peas.”
C. “I may experience hair loss.”
D. “I will not visit anyone who has a respiratory infection.”

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Practice Question #5 (2 of 2)
Answer:
A. “I will take the medication before bedtime.”

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Practice Question #6 (1 of 2)
The nurse assesses a patient who is receiving
doxorubicin intravenously. The nurse determines
extravasation has occurred. Which of the following
is the first action for the nurse to perform?
A. Attempt to aspirate residual doxorubicin from the
patient’s vein
B. Remove the intravenous catheter
C. Pack the intravenous site with ice
D. Stop the intravenous infusion of doxorubicin

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Practice Question #6 (2 of 2)
Answer:
D. Stop the intravenous infusion of doxorubicin.