Chemotherapeutic Agents, Immunosuppressive

Drugs

LEILANI O. ESTACIO , MAN RN

• At the end of the course unit (CM), learners will be able to:
• Cognitive:
• 1. Describe chemotherapy, its goal and treatment plan.

• 2. Familiarize with different chemotherapeutic agent and its effect.

• Affective:
• 1. Show concerns and develop trusting relationship to the patient and family
regarding treatment plan.
• 2. Listen attentively during class discussions.
• 3. Demonstrate tact and respect when challenging other people’s opinions and
ideas.
• 4. Accept comments and reactions of classmates on one’s opinions openly and
graciously.
• Psychomotor:
• 1. Apply safety risk and nursing process during administration of
Chemotherapeutic agents

• 2. Participate actively during class discussions.

• 3. Confidently express personal opinion and thoughts in front of the class.

 Cancer cells differ from normal cells in many ways.
For instance, cancer cells:
•grow in the absence of signals telling them to grow. Normal cells only grow
when they receive such signals.
•ignore signals that normally tell cells to stop dividing or to die (a process
known as programmed cell death, or apoptosis).
•invade into nearby areas and spread to other areas of the body. Normal cells
stop growing when they encounter other cells, and most normal cells do not
move around the body.
•tell blood vessels to grow toward tumors. These blood vessels supply tumors
with oxygen and nutrients and remove waste products from tumors.
•hide from the immune system. The immune system normally eliminates
damaged or abnormal cells.
•trick the immune system into helping cancer cells stay alive and grow. For
instance, some cancer cells convince immune cells to protect the tumor
instead of attacking it.
•accumulate multiple changes in their chromosomes, such as duplications and
deletions of chromosome parts. Some cancer cells have double the normal
number of chromosomes.
•rely on different kinds of nutrients than normal cells. In addition, some cancer
cells make energy from nutrients in a different way than most normal cells.
This lets cancer cells grow more quickly.
 Common Side Effects of Chemotherapy
Ø Fatigue
Ø Hair loss
Ø Easy bruising and bleeding
• Chemotherapy- is the treatment of cancer Ø Infection
Ø Anemia (low red blood cell counts)
by means of chemicals that kill cancer cells.
Ø Nausea and vomiting
These “anti-cancer” drugs destroy cancer Ø Appetite changes
cells by stopping their growth and Ø Constipation
reproduction. Unfortunately, normal Ø Diarrhea
healthy cells are also affected and this Ø Mouth, tongue, and throat problems such as sores
causes the well-known side effects of and pain with swallowing
chemotherapy. Ø Nerve and muscle problems such as numbness,
tingling, and pain
Ø Skin and nail changes such as dry skin and color
change
• Chemotherapeutic Agents- also Ø Urine and bladder changes and kidney problems
referred to as antineoplastic agents, are Ø Weight changes
Ø Chemo brain, which can affect concentration and
used to directly or indirectly inhibit the
focus
proliferation of rapidly growing cells, Ø Mood changes
typically in the context of malignancy Ø Changes in libido and sexual function
Ø Fertility problem
 1) Intravenous administration
This is the most common method of administration. A thin needle is
inserted into a vein on the hand or
lower arm. This needle is removed once the chemotherapy has been
Anti-tumor antibiotics- These completed.
drugs are not like the 2) Oral administration: The chemotherapy comes in pills, capsules, or
antibiotics used to treat liquids that is swallowed.
infections. They work 3) Topical: The chemotherapy comes in a cream that you rubs the skin.
by changing the DNA inside 4) Injection: A needle and syringe deliver the chemotherapy drug either
cancer cells to keep them intramuscularly (into a muscle)
from growing and multiplying. or subcutaneously (just below the skin).
Examples of 5) Intra-arterial (IA): The chemotherapy goes directly into the artery that
include: Daunorubicin, is feeding the cancer.
Doxorubicin (Adriamycin), 6) Intraperitoneal (IP): The chemotherapy goes directly into the
Doxorubicin liposomal, peritoneal cavity (the area that
Epirubicin, contains organs such as your intestines, stomach, liver, and ovaries).
Idarubicin,Valrubicin.
 The History of Chemotherapy: Overview
• ● Paul Ehrlich developed the concept of chemotherapy to treat microbial
diseases; he predicted the development of chemotherapeutic agents, which
would kill pathogens without harming the host.
• ● Sulfa drugs came into prominence in the late 1930s.
• ● Alexander Fleming discovered the first antibiotic, penicillin, in 1929; its
first clinical
• trials were done in 1940.
• Obtain special training for drug administration.
• Use two pairs of powder-free, dispensable
chemotherapy gloves, and a disposable,
closed, long-sleeved gown with outer pair of gloves
covering gown cuff whenever there
is risk of exposure to hazardous drugs.
• Provide syringes and IV sets with Luer lock fittings
for preparing and administering
hazardous drugs. Also provide containers for their
disposal.
• Use a closed-system drug-transfer device and
needleless system to protect nursing
personnel during drug administration.
• Label all prepared drugs appropriately.
• Double-bag chemotherapy drugs once prepared,
before transport.
• Have equipment ready to clean up any accidental
spill (spill kit).
• Dispose of all materials in marked containers
labeled hazardous waste.
• Dispose of all needles and syringes intact.
• Follow facility’s policies and procedures when
preparing to administer chemotherapy
Double-check chemotherapy orders with another oncology nurse.
• Read material safety data sheets (MSDS) prior to administration.
• Use personal protective equipment (PPE).
• Wash your hands both before you put on and after you take off
gloves.
• After infusion is complete, promptly dispose of any equipment
that contained the drug in
a puncture-proof container that is clearly marked.
• Chemotherapy agents may be excreted in body fluids; these may
be contaminated for
48 hours after the last drug dose. Wear PPE when handling such
excreta, and wash
your hands after removing gloves.
• Check facility’s policies about handling linen that’s been
contaminated with
chemotherapy.
• If a chemotherapy drug comes into contact with your skin or a
client’s skin, thoroughly
wash the affected area with soap and water, but don’t abrade the
skin with a scrub
brush.
• If the drug gets in your eyes, flush with copious amounts of water
for at least 15 minutes
while holding back your eyelids. Then get evaluated by employee
health or the
emergency department (ED).
• When infusing vesicant drugs, monitor
IV carefully—at first sign of
extravasation, remove IV and
implement Rx protocol
Chemotherapy
• Treatment of a disease by a chemical compound selectively directed against
invading microbes or abnormal cells.

• The chemical substance is called a chemotherapeutic agent.

CHEMOTHERAPEUTIC AGENTS:
Alkylating agents
• Alkylating agents keep the cell from reproducing (making copies of itself) by
damaging its DNA.
• Treated cancers: lung, breast, ovary, leukemia, lymphoma, Hodgkin disease,
multiple myeloma, and sarcoma.
• Examples of alkylating agents include: Altretamine, Bendamustine,
Busulfan, Carboplatin, Carmustine, Chlorambucil
Antimetabolites
• Antimetabolites interfere with DNA and RNA by acting as a substitute for the
normal building blocks of RNA and DNA. When this happens, the DNA cannot
make copies of itself, and a cell cannot reproduce.
• Treatment for: leukemias, cancers of the breast, ovary, intestinal tract, other types
of cancer.
• Examples of antimetabolites include:
• Azacitidine, 5-fluorouracil (5-FU), 6-mercaptopurine (6-MP),Capecitabine
(Xeloda), Cladribine, Clofarabine.
Topoisomerase inhibitors

• These drugs are also called plant alkaloids (organic basis). They interfere
with enzymes called topoisomerases, which help separate the strands of
DNA so they can be copied. (Enzymes are proteins that cause chemical
reactions in living cells.)

• Topoisomerase inhibitors are used to treat certain leukemias, as well as

lung, ovarian, gastrointestinal, colorectal, and pancreatic cancers.
Topoisomerase inhibitors are grouped according to
which type of enzyme they affect:
• Topoisomerase I inhibitors (also called camptothecins) include: Irinotecan,
Irinotecan liposomal, Topotecan

• Topoisomerase II inhibitors (also called epipodophyllotoxins) include: Etoposide

(VP-16), Mitoxantrone (also acts as an anti-tumor antibiotic), Teniposide.

• Topoisomerase II inhibitors can increase the risk of a second cancer.

Mitotic inhibitor
• Mitotic inhibitor - are also called plant alkaloids. They are compounds
derived from natural products, such as plants.

• Theywork by stopping cells from dividing to form new cells, but can
damage cells in all phases by keeping enzymes from making proteins
needed for cell reproduction.
Anti-tumor antibiotics
• These drugs are not like the antibiotics used to treat infections. They work
by changing the DNA inside cancer cells to keep them from growing and
multiplying.

• Examples of anthracyclines include: Daunorubicin, Doxorubicin

(Adriamycin), Doxorubicin liposomal, Epirubicin, Idarubicin,Valrubicin.
 EFFECTS OF CHEMOTHERAPHY
• The treatment of cancer by means of chemicals that kill cancer cells. These “anti-cancer” drugs
destroy cancer cells by stopping their growth and reproduction. Unfortunately, normal healthy
cells are also affected and this causes the well-known side effects of chemotherapy.

• The normal healthy cells have an organized cell structure and repair mechanisms in place. This
results in them being able to reproduce new normal tissue after chemotherapy.

• Often, two or more drugs are given. This is called combination chemotherapy and forms the
basis of most of chemotherapy today. The rationale is that the different drugs enhance each
other’s effect and create a better effect combined than if they were used as single agents.

• Different chemotherapy drugs are chosen so that they do not have the same side effects on
tissue, in order for the side effects to be minimized.
Goals of Chemotherapy

• To cure cancer.
• To control the growth of cancer.
• To alleviate symptoms such as pain caused by cancer.
TREATMENT MODALITY
Chemotherapy can be used as a single treatment modality, but is also commonly
used in combination with surgery, radiotherapy and biological treatment in order to:
● Shrink a tumor before radiotherapy or surgery. This is called neo-adjuvant therapy.
● Destroy any remaining cancer cells after surgery or radiotherapy. This is called
adjuvant therapy.
● Enhance the effect of radiotherapy and biological therapy.
● Destroy recurring cancer or destroy cancer that has spread to other parts of the
body.
Chemotherapy Treatment Plan
• Each treatment plan is tailor-made to suit every individual and will
depend on:
●The type of cancer.
● The area of the body where the cancer is.
● The stage of the development of the cancer, eg. The size of the tumor in the
affected organ.
● Spread of CA to the rest of the body
● How the cancer influences the functioning of your body.
● The general health of the patient.
●The purpose of the treatment, either curative or to relieve symptoms.
Common Side Effects of Chemotherapy
• Nerve and muscle problems such as numbness, tingling, and pain
• Skin and nail changes such as dry skin and color change
• Urine and bladder changes and kidney problems
• Weight changes
• Chemo brain, which can affect concentration and focus
• Mood changes
• Changes in libido and sexual function
• Fertility problems
B. ANTIBIOTICS: Overview
• Definitions:
• Antibiotics are molecules that kill, or stop the growth of, microorganisms,
including both bacteria and fungi.

• Antibiotics that kill bacteria are called "bactericidal"

• Antibiotics that stop the growth of bacteria are called "bacteriostatic"
ANTIBIOTICS

• Antibiotics are substance produced by a microorganism [or a similar

product produced wholly (synthetic)

• partially (semi-synthetic) by chemical synthesis that is capable, in low

concentrations, of inhibiting the growth or killing other micro-organisms.

• Antibiotic medication represents a convenient and effective means of

treating certain specific disease conditions.
ANTIBIOTICS
Medical Uses:
• control approximately 50% of all disease
• The number of patients being rescued from surgery by antibiotic medicine is
increasing every day.
Non-Medical Uses:
• The application of antibiotics to animal was an outgrowth of the work in the
human disease field.
• Animal feed supplements to promote growth in livestock.
• Use in food preservation and spraying of crops to control specific crop diseases.
Antibiotics are classified as:
• a. The producing micro-organisms
• b. Activity spectrum
• c. Metabolic pathways of biosynthesis
• d. Chemical structure.
Garrod, Lambert and O’ Grady have classified Antibiotics on the
basis of general similarity of chemical structure

• 1. Penicillin and related Antibiotics:

• Any of several antibiotics of low toxicity, produced naturally by molds of the
genus Penicillium and also semi synthetically, having a bactericidal action on
many susceptible Gram-positive or Gram-negative cocci and bacilli, some
also being effective against certain spirochetes.
 General Similarity of Chemical
Structure of Antibiotics
• 2. Aminoglycoside Antibiotics:
• Aminoglycosides are used in the treatment of severe infections of the
abdomen and urinary tract, as well as bacteremia and endocarditis.

• They are also used for prophylaxis.

• This group comprises the streptomycin, neomycin, kanamycin,
paromonycinentamycin, tubramycin and amikacin.
 General Similarity of Chemical
Structure of Antibiotics

• 3. Macrolide Antibiotics
• Used to treat infections caused by Gram-positive bacteria (e.g.,
Streptococcus pneumoniae) and limited Gram-negative bacteria (e.g.,
Bordetella pertussis, Haemophilus influenzae), and some respiratory tract
and soft-tissue infections

• This group comprises erythromycin, oleandomycin and spiromycin

 General Similarity of Chemical
Structure of Antibiotics
4. Tetracycline Antibiotics:
• Tetracycline is used to treat a wide variety of infections, including acne. It is
an antibiotic that works by stopping the growth of bacteria.
• This antibiotic treats only bacterial infections. It will not work for viral
infections (such as common cold, flu).
• This group consists of tetracycline, chlortetracycline, demeclocycline,
oxytetracycline and minocycline
 General Similarity of Chemical
Structure of Antibiotics

5. Chloramphenicol

• Is an antibiotic useful for the treatment of a number of bacterial infections.

• This includes use as an eye ointment to treat conjunctivitis, By mouth or by
injection into a vein

• it is used to treat meningitis, plague, cholera, and typhoid fever

 General Similarity of Chemical
Structure of Antibiotics

6. Peptide Antibiotics: are naturally synthesized structures built from amino

acids into chains.
The body produces peptides to aid in healing, fight infection and inflammation
and rebuild tissues.
This category includes bacitracin, gramicidin and the polymyxins.
 General Similarity of Chemical
Structure of Antibiotics

• 7. Antifungal Antibiotics:
• An antifungal medication, also known as an antimycotic (Fungus)
medication.

• is a pharmaceutical fungicide or fungistatic used to treat and prevent

mycosis such as athlete's foot, ringworm, candidiasis (thrush), serious
systemic infections such as cryptococcal meningitis
 General Similarity of Chemical
Structure of Antibiotics
• . Unclassified Antibiotics
• These antibiotics have varied structures. They are not classified among the
main groups described above Antibiotics

• This group include cycloserine, tusidic acid, novobiocin, prasinnomycin,

spectinomycin and vancomycin.

•
 In preparations of medicines, Antibiotics are
subdivided into the following seven groups:
● Penicillin's (including semi synthetic methicillin, oxacillin, ampicillin) and
cephalosporins.
● Broad-Spectrum antibiotics (tetracycline)
● Streptomycin group (streptomycin, neomycin etc.)
● Reverse antibiotics (erythromycin, chloramphenicol ristomycin, novobiocin)
● Antifungal (levorin, nystatin etc)
● Antituberculosis (streptomycin, kanamycin, phiorimycin, etc)
● Antineoplastic (bruneomycin, olivomycin etc)
 C. DRUGS ACTING ON IMMUNE SYSTEM
(Immunologic Agents)
What are Immunologic agents?
• Immunologic agents are drugs that can modify the immune response,
either by enhancing or suppressing the immune system. They are used to
fight infections, prevent and treat certain diseases.

• Immunologic agents include drugs used for immunosuppression to prevent

graft rejection. They can be used as cancer chemotherapy agents.

• Some immunologic agents can down-regulate the inflammatory process

and can be used to treat inflammatory conditions such as rheumatoid
arthritis, autoimmune conditions.
 Types
●Immune globulins of Immunologic agents
●Immunostimulants

• bacterial vaccines

• colony stimulating factors

• interferons

• interleukins

• therapeutic vaccines

• viral vaccines
Types of Immunologic Agents

● Immunosuppressive agents

• calcineurin inhibitors

• interleukin inhibitors
 immune globulin IV (BayGam, Flebogamma, Gammagard), immune globulin SC (BayGam,
DRUG NAME Cutaquig, Cuvitru, Hizentra), immune globulin IM (BayGam, Gammastan), hepatitis B immune
globulin (HBIG), tetanus immunoglobulin (TIG), botulism immune globulin (BIG), Rh(D) immune
IM globulin (RhoGAM, WinRho)

M CLASS Immunoglobulins
UN
•Increase antibody levels in individuals with immunodeficiency
OG MECHANISM OF ACTION •Help fight off infectious diseases
•Prevent the immune system from attacking the body’s own healthy cells
LO •Replacement therapy for immunodeficiency
BU •Prophylaxis of infectious diseases
•Treatment of inflammatory or autoimmune disorders (e.g., Kawasaki disease, idiopathic
INDICATIONS
LI thrombocytic purpura, Guillain-Barre syndrome, etc.)
•Prevention of Rh sensitization in pregnant Rh-negative clients
N
ROUTE(S) OF ADMINISTRATION •IV, SC, IM

•Headache
•Local injection site reactions
•Flu-like symptoms: fatigue, fever, chills, myalgia's, arthralgia's, nausea and vomiting
•Transfusion-associated cardiovascular overload (TACO)
SIDE EFFECTS •Delayed side effects: thrombotic events, skin reactions, renal impairment, hemolysis, neutropenia
•Rh(D) immune globulin: intravascular hemolysis (boxed warning)
•IVIG, SCIG, IMIG: thrombosis, renal impairment, acute renal failure (boxed warning)

•Coagulation disorders
CONTRAINDICATIONS AND CAUTIONS •Selective IgA deficiency
•THANK YOU……..