# Chemotherapy --- **chemotherapy** need to be given through a [[central line]] Most effective in treating fast growing cancers • Multiple drug therapy is possible usually done this way, to target different cell cycles • Decreases cell resistance to single drug • Impacts cell at different points of cell cycle • Dose is determined by the body surface area • Nadir is the point of therapy at which toxicity is at its maximum Alkylating Agents • For example Cyclophosphamide • Nitrogen mustard derivatives • Administered po or IV • Alters cell DNA • Cell cycle nonspecific • Vesicant — no • Uses: Cancer of head and neck, breast, ovary, or lung; lymphomas; leukemias; multiple myeloma • Toxicity includes bone marrow depression, alopecia and hemorrhagic cystitis Antimetabolites 5-FU fluorouracil (Adrucil) • Administered IV • Interferes with synthesis of nucleic acids • Cell cycle specific- S-phase • Vesicant — no • Uses: Carcinomas of pancreas, breast, stomach, colon and basal cell • Toxicity includes bone marrow depression, nausea, vomiting, diarrhea, stomatitis, alopecia Miotic Inhibitors For example Paclitaxel (Taxol) Administered IV (24 hour infusion) Arrest metaphase and inhibit DNA synthesis Cell cycle specific- G2/M phase Vesicant — no Uses: Cancer of breast, ovarian, and non-small cell lung Toxicity includes severe hypersensitivity reactions, bradycardia, bone marrow suppression Anti-tumor Antibiotics • Doxorubicin (Adriamycin) • Administered IV • Interfere with DNA/ RNA synthesis • Cell cycle nonspecific • Vesicant — yes • Uses: acute leukemias; lymphomas; cancer of breast, lung and ovary • Toxicity includes cardiotoxicity, neutropenia Anti-Estrogens [[antiestrogen]] • Tamoxifen (Nolvadex) • Antineoplastic • Binds to the estrogen receptors on estrogen sensitive tumors • Used to treat breast cancer and pt remains on it for several years after cancer treatment • Administered po • Cell-cycle nonspecific • Toxicity includes increased risk of thromboembolism and endometrial cancer, hot flashes (pt goes into menopause), fluid retention Aromatase inhibitors • Arimidex (Anastrozole) • Action: block estrogen production in postmenopausal women to treat breast cancer • Route: oral • SE: muscle weakness, fatigue, nausea, headache, hot flashes • Increased r/o osteoporosis, use calcium + Vit D supplement • May be used if tamoxifen did not work ## Potential Complications of Chemo -Extravasation -Alopecia -Mucositis -Bone Marrow Suppression-(BMS) -Nutritional Considerations anorexia -Nausea and Vomiting often given [[ondansetron]] ## Nursing Considerations SAFETY in Handling Chemotherapeutics • Extra precautions for pregnant, breast feeding, and those trying to conceive (both biologic genders) • Communicate reproductive status to leader to develop a safety plan to reduce exposure • Alternative assignment, Appropriate PPE, Collaborate with PCP & 0B • Beware of possible surface contaminants • Improper handling of hazardous drugs can lead to contamination on: Computer, keyboards, phones, doorknobs, bedside tables, call light, side rails ## Examples Cisplatin (Platinol) Class: Cytotoxic Platinum Compound Indications: Anti-Cancer Route: IV Central line Expected Action: Disrupt cell cycle DNA cross-links Expected Outcome: Stop cancer growth Common Adverse Effects: Nephrotoxic, N/V, neuropathy, bone marrow suppression, ototoxicity Nursing Implications: hydration/diuretics, antiemetics, monitor kidney function, nutrition, monitor blood counts (anemia, immunosuppression, thrombocytopenia) filgastrim ___