NURSING

PHARAMCOLOGY
ANTIFUNGAL AGENTS
• Mycosis - infection caused by fungus

• Fungi differ from bacteria in that the fungus has a

rigid cell wall that is made up of chitin and various
polysaccharides and a cell membrane that contains
ergosterol

• Because of their cellular makeup, bacteria are

resistant to antifungal drugs
CELL STRUCTURE: BACTERIA VS
FUNGI
CANDIDA
fungus that is normally
found on mucous
membranes, can cause
yeast infections or
"thrush" in the GI tract
and yeast infections or
"vaginitis" in the vagina
 AZOLE ANTIFUNGALS
• -Large group of antifungals used to treat systemic
and topical fungal infections
• -MECHANISM OF ACTION: these drugs bind to
sterols and can cause cell death (a fungicidal
effect) or interfere with cell replications (a
fungistatic effect)
AZOLE
ANTIFUNGALS
• Fluconazole
• Treatment of
candidiasis,
cryptococcal
meningitis, other
systemic fungal
infections
AZOLE
ANTIFUNGALS
• itraconazole,
ketoconazole,
posaconazole
• One of the newest
antifungals
 AZOLE
ANTIFUNGALS
•terbinafine [inhibits cytochrome P450
2D6 (CYP2D6) enzyme]
•voriconazole and posaconazole – one of
the newest antifungals
 ECHINOCANDIN
Click icon to add
ANTIFUNGALS
picture

-inhibit glucan synthesis

-glucan is an enzyme present in the fungal cell wall but not in
human cell wall
-if this enzyme is inhibited, the fungal cell wall cannot form,
leading to death of the cell wall
-example: anidulafungin (excreted in the feces), caspofungin
acetate, micafungin
 OTHER ANTIFUNGALS
• -they work to cause fungal cell death or to prevent fungal cell
reproduction

• -example: amphotericin B (use is reserved for progressive,

potential fatal infections due to many associated adverse
effects), flucytosine, griseofulvin, nystatin (ttt or oral
candidiasis; swish, swirl, swallow; NOT absorbed from the GI
tract and passes unchanged in the stool)
 NYSTATIN
• This medication is used to treat fungal
infections of the mouth.
• Swish and swallow/spit (depending on the
doctor’s instructions)
• Do not eat or drink anything for 20
minutes after using nystatin oral
suspension in order to increase contact
time with the mouth surface.
CONTRAINDICATIONS
• avoid in patients
with hepatic
dysfunction; to
prevent serious
hepatic toxicity
CONTRAINDICATIONS

-avoid in patients with renal

impairment; could cause
renal toxicity
 Click icon to add
CONTRAINDICATION picture

pregnancy/lactatio
n because of
potential adverse
effects to the
fetus/infant
CONTRAINDICATIONS
• voriconazole
• should not be combined with ergots (a herb frequently used to treat
migraine headache and menstrual problems)
• can cause ergotism (convulsions/seizures, paresthesias, mental
effects including mania [mental illness marked by periods of great
excitement or euphoria, delusions, and overactivity] or psychosis
[severe mental disorder in which thought and emotions are so
impaired that contact is lost with external reality], gangrene)
CONTRAINDICATIONS
 NURSING CONSIDERATIONS
assess history of
allergy to
antifungals to
prevent potential
hypersensitivity
reactions
NURSING
CONSIDERATIONS
• Liver/renal dysfunction that might
interfere with metabolism and
excretion of the drug
• Evaluate renal and hepatic function
tests
• Check for the complete blood count
(WBC, neutrophils, lymphocytes,
monocytes)
NURSING
CONSIDERATIONS
obtain culture of the
infected area to make an
accurate determination
of the type and
responsiveness of the
fungus
 NURSING CONSIDERATIONS
Click icon to add
picture
monitor IV sites to
ensure that
infiltration (when
the IV fluid leaks
into the surrounding
tissue) or phlebitis
(see picture) does
not occur
 NURSING CONSIDERATIONS
• provide comfort or safety
provisions if CNS effects
occur (e.g., side rails and
assistance with ambulation
for dizziness and weakness,
analgesics for headache,
antipyretics for fever and
chills, temperature regulation
for fever) to protect the
patient from injury
 NURSING CONSIDERATIONS
• provide small, frequent
nutritious meals if GI
upset is severe; GI upset
may be decreased by
taking an oral drug with
food and try small,
frequent feedings
 NURSING CONSIDERATIONS
• report to a health care provider if with any of the
following: sore throat, unusual bruising and
bleeding, or yellowing of the eyes or skin, all of
which could indicate hepatic toxicity; or severe
nausea and vomiting which could interfere with
nutritional state and slow recovery
 NURSING CONSIDERATIONS
•monitor patient response to the drug
(resolution of fungal infection)
•monitor for adverse effects (orientation
and affect, nutritional state, skin color and
lesions, renal and hepatic function)
 SAMPLE NURSING DIAGNOSES
• acute pain r/t GI, CNS, and local effects of the
drug
• disturbed sensory perception
(kinesthetic/tactile) r/t CNS effects
• deficient knowledge regarding drug therapy
 TOPICAL ANTIFUNGALS
• dermatophytes is the collective term/broad term
for all organisms that causes mycoses (fungal
infection of animals/humans)
• mycoses include tinea pedis (athlete's foot),
tinea cruris (jock itch), and yeast infection of
the mouth and vagina often caused by Candida
 TOPICAL ANTIFUNGALS
• care is necessary when using these topical
antifungals near open or draining wounds
because the antifungals drugs are too toxic for
systemic administration
 MECHANISM OF ACTION
• alter the cell permeability of the fungus,
causing prevention of replication and fungal
death
• they are indicated only for local treatment of
mycoses, including tinea infections
TINEA PEDIS, TINEA CRURIS
NURSING CONSIDERATIONS
• Assess for known allergy to any topical
antifungal agent
• Perform a physical assessment
 NURSING CONSIDERATIONS
• Perform culture and sensitivity testing of
the affected area
• Inspect the area of application for color,
temperature, and evidence of lesions
 NURSING CONSIDERATIONS
• Culture the affected area before beginning
therapy
• Ensure that the patient takes the complete
course of the drug regimen
• Instruct the patient in the correct method of
administration, depending on the route
 NURSING CONSIDERATIONS
• Advise the patient to stop the drug if a severe rash
occurs, especially if it is accompanied by blisters or if
local irritation and pain are very severe. This
development may indicate a sensitivity to the drug or
worsening of the condition being treated.
• Provide patient instruction to enhance patient
knowledge about drug therapy and to promote
compliance.
 NURSING CONSIDERATIONS
•Monitor patient response to the drug
•Evaluate the effectiveness of the teaching
plan
•Monitor the effectiveness of comfort and
safety measures and compliance with the
regimen.
PROTOZOA
-single-celled Click icon to add
organisms that pass picture
through several stages
in their life cycles,
including at least one
phase as a human
parasite
- are very common in
several parts of the
world
OTHER PROTOZOAL
INFECTIONS
 AMEBIASIS
• intestinal infection caused by Entamoeba histolytica,
often known as amebic dysentery
• mode of transmission is during the cystic stage
(dormant stage) in fecal matter; can be passed to
humans when drinking infected water or eat infected
food that was grown in the ground of the protozoa
(where the fecal matter is located)
 LEISHMANIASIS
• protozoal diseased passed from sand flies to
humans
• the sand fly injects promastigote (an
asexual form of the flagellated protozoan)
into the human body
 s/s include serious skin
lesions, viscera, or
mucous membranes of
the host
 TRYPANOSOMIASIS
• caused by Trypanosoma
• has 2 species
• African sleeping sickness - caused by Trypanosoma
brucei gambiense and transmitted by the tsetse fly
(this organism invades the CNS leasing to an acute
inflammation that results in lethargy, prolonged
sleep, and even death)
TSETSE FLY
 CHAGAS’ DISEASE
• caused by
Trypanosoma cruzi
and is passed to
humans by the
common housefly;
causes severe
cardiomyopathy
 TRICHOMONIASIS
• caused by Trichomonas vaginalis
• usually spread during sexual intercourse by men
who have no s/s of infection
• in women, this protozoan causes reddened,
inflamed vaginal mucosa, itching, burning, and
a yellowish-green discharge
TRICHOMONIASIS: S/S
 GIARDIASIS
• caused by Giardia lamblia
• this protozoan forms cysts which survive outside
the body and allow transmission through
contaminated water/food
• diarrhea, rotten egg-smelling stool, pale and
mucus-filled stool are commonly seen, along
with epigastric distress, weight loss,
malnutrition
PNEUMOCYSTIS JIROVECI PNEUMONIA
• Caused by Pneumocystis jiroveci
• an endemic protozoan that does not usually cause
illness in humans
• when an individual's immune system becomes
suppressed because of AIDS or AIDS-related
complex, use of immunosuppressant drugs, or
advanced age, this parasite is able to invade the lungs
leading to severe inflammation; most common
opportunistic infection in patients with AIDS
MALARIA
-known method of
transmission is through
the bite of the female
Anopheles mosquito, an
insect that harbors the
protozoal parasite and
carries it to humans
 ANTIMALARIALS
• quinine – 1st
drug found to be
effective in the
ttt of malaria
• chloroquine (Aralen) – mainstay antimalarial therapy

• the drug enters the human RBCs and changes the

metabolic pathways necessary for the reproduction of
the Plasmodium, this agent is directly toxic to
parasites that absorb it, is acidic, and decreases the
ability of the parasite to synthesize DNA, leading to a
blockage of reproduction
• hydroxychloroquine (Plaquenil)
• mefloquine (Lariam) - increases the acidity of
plasmodial food vacuoles causing cell rupture and
death; also used in malarial prevention and
treatment when used in combination therapy
• primaquine - very old drug to treat malaria; similar
to quinine; disrupts the mitochondria of the
Plasmodium
• primaquine - very old drug to treat malaria;
similar to quinine; disrupts the mitochondria
of the Plasmodium
• pyrimethamine (Daraprim) - used in
combination with agents that act more rapidly
to suppress malaria; acts by blocking the use
of folic acid in protein synthesis by the
Plasmodium, eventually leading to inability to
reproduce and cell death
• fansidar (Sulfadoxine and Pyrimethamine) - ttt of
acute, uncomplicated P. falciparum malaria when
chloroquine resistance is suspected
• malarone (atovaquone and proguanil)
 MECHANISM OF ACTION
• inhibit DNA synthesis in susceptible
protozoa, interfering with the cell's ability to
reproduce, subsequently leading to cell death
 OTHER ANTIPROTOZOAL AGENTS

• Atovaquone (Mepron)
• Metronidazole (Flagyl)
• Nitazoxanide (Alinia)
• Pentamidine (Pentam 300)
• Tinidazole (Tindamax)
 MECHANISM OF ACTION
•inhibit DNA synthesis in susceptible
protozoa, leading to the inability of
the cell to reproduce and subsequent
cell death
 INDICATION

•Treatment of protozoal (malaria)

infections
 CONTRAINDICATIONS
• hepatic dysfunction/liver disease/alcoholism =
because of the parasitic invasion of the liver and
because of the need for the hepatic metabolism to
prevent toxicity
• renal impairment
• pregnancy = associated with birth defects
 CONTRAINDICATIONS
• lactation = drug can enter breastmilk and
could be toxic to the infant
• allergy
• retinal disease/damage = many of these drugs
can affect vision and the retina, and the
likelihood of problems increases if the retina
is already damaged
 ADVERSE EFFECTS
•CNS effects: headache, dizziness
•Immune reaction (related to release of
merozoites): fever, shaking, chills, malaise
•GI effects: nausea, vomiting, diarrhea,
unpleasant taste, cramps, changes in liver
function
 ADVERSE EFFECTS
•hepatic dysfunction (related to toxic
effects of the drug and the disease on the
liver)
•dermatological effects: rash, pruritus
(itching), and loss of hair associated with
changes in protein synthesis of the hair
follicles
 ADVERSE EFFECTS
• ototoxicity related to other nerve damage
• cinchonism (nausea, vomiting, tinnitus, vertigo)
may occur with high levels of quinine/primaquine
 ADVERSE EFFECTS
• superinfections (the process by which a cell that
has been previously been infected by one virus
gets co-infected with a different strain of the virus
or another virus at a later point in time) occur
when the normal flora is disrupted
 NURSING
CONSIDERATIONS
INTESTINE-INVADING
WORM INFECTIONS
NEMATODES/ROUNDWORMS
• Pinworm infection
• the most common helminthic infection among
school-aged children
• Transmitted through ingestion or inhalation of
eggs that become airborne and are then
swallowed
• Remain in the intestine, can cause perianal
itching and occasional vaginal itching
COLONOSCOPY FINDING OF PINWORM INFECTION
• Whipworm infection
• Transmitted when eggs found in the soil are
ingested
• Attach to the wall of the colon
• Cause abdominal discomfort, bloody diarrhea,
anemia; also rectal prolapse (telescoping of the
anus/turning the anus inside-out) in severe cases
• Threadworm infection
• Cause more damage to humans than other
helminths
• Transmitted as larvae found in the soil and are
inadvertently ingested
• The mature female worms lay eggs and burrows
into the wall of the small intestine
• The eggs hatch into larvae and invade many body
tissues including the lungs, liver, and heart
• Ascaris
• Most prevalent helmintic infection worldwide;
occurs in poor sanitation
• Eggs in the soil are ingested with vegetables or
other improperly washed foods
• Many individuals are unaware that they have this
manifestation unless they see a worm in their stool
• Causes abdominal distention and pain; intestinal
obstruction in severe cases
• Hookworm infection
• Penetrate the skin, enter the bloodstream, and
attaches to the small intestine
• The worms suck blood from the walls of the
intestine leading to severe anemia with
lethargy (a lack of energy), weakness, fatigue,
and malabsorption problems
• Platyhelminths/flatworms
• Cestodes (segmented flatworms)
• Enter the body as larvae that are found in
undercooked meat/fish
• May cause abdominal distention and discomfort,
and also weight loss (because worm eats ingested
nutrients)
TISSUE-INVADING WORM
INFECTIONS
•Trichinosis
•Caused by Trichinella spiralis in
undercooked pork
•Penetrate skeletal muscle and can
cause inflammatory reaction in the
cardiac muscle and brain
•Fatal pneumonia, heart failure, and
encephalitis may occur
•Filariasis
• Enter the body via insect (mosquito) bite
• Caused by Wuchereria bancrofti, Brugia
malayi, Brugia timori
• They overwhelm the lymphatic system
and can cause massive inflammatory
reactions
• Elephantiasis=severe swelling of hands,
feet, legs, arms, scrotum, or breast
• Schistosomiasis/bilharzia
• A platyhelmintic infection caused by a freshwater
snail
• Caused by Schistosoma mansoni, S. haematobium,
S. japonicum
• Cercariae=infectious form of the parasite
• Eggs that are excreted in the urine and feces of the
infected individuals hatch in the fresh water into a
form that infects the freshwater snail
• The larvae attach in the skin and quickly burrow in
the bloodstream and lymphatics
 ANTIHELMINTICS
• mebendazole (Vermox) – ttt of pinworms,
roundworms, whipworms and hookworms
• pyrantel (Antiminth)
• tiabendazole (Mintezol)
• albendazole (Albenza) – ttt for pork tapeworm
• ivermectin (Stromectol)
• praziquantel (Biltricide) - drug of choice for
schistosomiasis
 MECHANISM OF ACTION
•interfere with the metabolic processes in
particular worms
 INDICATION
• Treatment of infections by susceptible worms
 CONTRAINDICATIONS
• allergy
• lactation
• pregnancy
• note: albendazole-should only be used after the causative
worm has been identified because of its adverse effects
on the liver, which could become problematic if the
patient has liver involvement
• renal/hepatic disease
 ADVERSE EFFECTS
• mebendazole and pyrantel-cause abdominal
discomfort/pain, and diarrhea
• antihelmintics that are not absorbed systematically may
cause the following effects: HA, dizziness, fever,
shaking, chills, malaise associated with an immune
reaction to the death of the worms; rash; pruritus; loss of
hair
 NURSING
CONSIDERATIONS
CANCER
 CHARACTERISTICS OF CANCER
CELLS
• Anaplasia – loss of cellular differentiation and
organization
• Autonomy – growing without the usual
homeostatic restrictions that regulate cell growth
and control
CHARACTERISTICS OF CANCER CELLS
• Metastasis – travelling of neoplastic cells from the
place of origin to develop new tumors in other
areas of the body favorable for cell growth
• Angiogenesis – abnormal cells release enzymes
that generate blood vessels in the area to supply
oxygen and nutrients to the cells
• Cell kill theory - a
set percentage of
cells is killed after
each dose of
chemotherapy; the
percentage killed is
dependent upon
the drug therapy
 GOAL OF CANCER THERAPY
• to limit the offending cells to the degree that the
immune system can then respond without too
much toxicity to the host (but this is difficult since
most antineoplastic agents affect normal human
cells as well; primarily affect human cells that are
rapidly multiplying such as hair follicles, GI tract,
and bone marrow).
 ALKYLATING AGENTS
• are non-cell cycle specific because these
agents can affect cells even in the resting
phase
• useful in the ttt of slow-growing cancers,
which have many cells in the resting phase
 ACTION
• work by disrupting cellular mechanisms that
affect DNA (being most potent), RNA, or
other cellular proteins causing cell death
 INDICATION
•lymphomas, leukemias, myelomas,
ovarian, testicular and breast cancer,
pancreatic cancer
 CONTRAINDICATION
• pregnancy
• lactation
• allergy
• bone marrow suppression
• renal/hepatic dysfunction
 ADVERSE EFFECTS
• Hematological effects: bone marrow suppression
including leukopenia, thrombocytopenia, anemia,
pancytopenia, secondary to the effects of the drugs
on the rapidly multiplying cells of the bone
marrow
 ADVERSE EFFECTS
•GI effects: N&V, anorexia, diarrhea,
mucous membrane deterioration
related to the drug’s effects on the
rapidly multiplying cells of the GI
tract
 ADVERSE EFFECTS
• Hepatic
and renal
toxicity
 ADVERSE EFFECTS
• Alopecia
 KEY POINTS
•Alkylating agents affect cellular RNA,
DNA or other cellular proteins, are cell-
cycle nonspecific, and are most effective
against slow-growing tumors
 KEY POINTS
•Patients receiving alkylating agents may
experience alopecia, N&V, and need to be
monitored for bone marrow suppression
and CNS toxicity
 SAMPLE
MEDICATIONS
 ANTIMETABOLITES
• have chemical structures similar to those of
various natural metabolites that are necessary
for the growth and division of rapidly
growing neoplastic and normal cells
• effective in rapidly dividing cells
 ACTION
• inhibit DNA production in cells that depend on
certain natural metabolites to produce their DNA
• inhibit thymidylate synthetase, DNA polymerase,
or folic acid reductase, all of which are needed for
DNA synthesis
• considered to be S-phase specific in the cell cycle
 INDICATION
• Leukemias, some GI and basal cell cancers
 CONTRAINDICATIONS
• pregnancy
• lactation
• allergy
• bone marrow suppression
• renal/hepatic dysfunction
• GI ulcerations
 ADVERSE EFFECTS
• Leucovorin-used to counteract the effects of
methrotrexate
• Hematological effects
 ADVERSE EFFECTS
•CNS effects: HA, drowsiness, aphasia
(problem w/ communication), fatigue,
malaise, dizziness
•Pulmonary toxicity, interstitial pneumonitis
or interstitial lung disease (thickening of the
supporting tissues between the air sacs of the
lungs)
 ADVERSE EFFECTS
• Hepatic/renal toxicity
• alopecia
 KEY POINTS
• Antimetabolites inhibit DNA production by
inhibiting metabolites needed for the
synthesis of DNA in susceptible cells
• Antimetabolites are S-phase cell cycle
specific and are used for some leukemias, as
well as some GI and basal cell cancers
 KEY POINTS
• Bone marrow suppression, alopecia, and toxic
GI effects are common adverse effects of
antimetabolites
SAMPLE MEDICATIONS
ANTINEOPLASTIC ANTIBIOTICS
• although selective to bacterial cells, are also
toxic to human cells
• more toxic to cells that are multiplying
rapidly
 ACTION
• break up DNA links and prevent DNA
synthesis by inserting themselves between
base pairs in the DNA chain, which causes a
mutant DNA molecule, leading to cell death
INDICATION
 CONTRAINDICATIONS
• pregnancy
• lactation
• allergy
• bone marrow suppression
• renal/hepatic dysfunction
 CONTRAINDICATIONS
• GI ulcerations
• Bleomycin, mitomycin=pulmonary problems
• Idarubicin, mitoxantrone- cardiac problems
 ADVERSE EFFECTS
•Hematological effects
•CNS effects: HA, drowsiness, aphasia
(problem w/ communication), fatigue,
malaise, dizziness
•Pulmonary toxicity, interstitial
pneumonitis
 ADVERSE EFFECTS
• Hepatic/renal toxicity
• alopecia
 KEY POINTS
• Antineoplastic antibiotics are toxic to rapidly
diving cells.
• These drugs are cell cycle specific, affecting
the S phase.
• Bone marrow suppression, alopecia, and toxic
GI effects are common adverse effects of
antineoplastic antibiotics.
SAMPLE MEDICATIONS
 MITOTIC INHIBITOR
•kill cells as the process of
mitosis begins
 ACTION
•interfere with the ability of the
cell to divide and block/alter
DNA synthesis
•work on the M-phase of the cell
cycle
INDICATION
 CONTRAINDICATION
•pregnancy
•lactation
•allergy
•bone marrow suppression
•renal/hepatic dysfunction
 CONTRAINDICATIONS
•GI ulcerations
•Eribulin=may prolong QT
interval leading to potentially
serious arrhythmias
 ADVERSE EFFECTS
•Hematological effects
•CNS effects: HA, drowsiness,
aphasia (problem w/
communication), fatigue, malaise,
dizziness
 ADVERSE EFFECTS
•Pulmonary toxicity, interstitial
pneumonitis
•Hepatic/renal toxicity
•Alopecia
•Necrosis and cellulitis if extravasation
occurs at IV sites
 KEY POINTS
• Mitotic inhibitors kill cells during the M phase and
care used to treat a variety of cancers.
• These drugs are usually given IV and
extravasation could be a serious problem.
• Bone marrow suppression, alopecia, and toxic GI
effects are common adverse effects of mitotic
inhibitors
SAMPLE MEDICATIONS
 HORMONES AND HORMONE
MODULATORS
• some cancers, particularly those involving the
breast tissue, ovaries, uterus, prostate, and
testes are sensitive to estrogen stimulation
• Estrogen receptor sites on the tumor react
with circulating estrogen, and this reaction
stimulates the tumor cells to grow and divide
 ACTION
• other hormonal agents are used to block the
release of gonadotropic hormones in
breast/prostate cancer if the tumors are
responsive to gonadotropic hormones
(hormone-site specific)
• other agents may block/interfere with the
receptor sites on the tumor/cancer (receptor-
site specific)
 INDICATIONS
•breast cancer in post menopausal women,
prostatic cancer
 CONTRAINDICATIONS
• pregnancy
• lactation
• allergy
• bone marrow suppression
• renal/hepatic dysfunction
• GI ulcerations
• Toremifene-hypercalcemia
 ADVERSE EFFECTS
• Menopause-associated effects: hot flashes,
vaginal spotting, vaginal dryness, moodiness,
depression
• Hypercalcemia is encountered as the calcium is
pulled out of the bones without estrogen
activity to promote calcium deposition
 ADVERSE EFFECTS
•Increase in risk for cardiovascular disease
•Abiraterone-increase risk of
adrenocortical insufficiency
 KEY POINTS
• Hormones and hormonal agents are used to
treat specific cancers that respond to hormone
stimulation such as breast cancer or prostate
cancer.
 KEY POINTS
• The adverse effects of hormone and hormonal
agent used to treat cancers are
increased/decreased effects of the hormones
on the body: virilization (when women
develop male-pattern hair growth and other
masculine physical traits), increased risk of
cardiovascular disease, and increased calcium
levels
SAMPLE MEDICATIONS
 CANCER-CELL SPECIFIC AGENTS:
PROTEIN TYROSINE KINASE INHIBITORS,
EPIDERMAL GROWTH FACTOR
INHIBITORS, PROTEASOME INHIBITORS

• Are cancer-specific and would not affect

healthy cells on the body
 ACTIONS
• act on specific enzymes needed for protein
building by specific tumor cells, which inhibit
tumor cell growth and division
• work by inhibiting various kinases in specific
cancer cells
 ACTIONS
• Epidermal Growth Factor Inhibitor: Erlotinib
(Tarceva) inhibits cell epidermal growth factor
receptors which is found on normal and cancerous
cells but is more abundant on rapidly growing cells
• Proteasome Inhibitor: inhibits proteasome in human
cells, a large protein complex that works to maintain
cell homeostasis and protein production, without it
the cell loses homeostasis and dies
 INDICATION
• Protein Tyrosine Kinase Inhibitor: Imatinib
(Gleevec) – ttt of chronic myelocytic
leukemia
• Proteasome Inhibitor: bortezomib (Velcade)
for multiple myeloma
 CONTRAINDICATIONS
• pregnancy
• lactation
• allergy
• patients with arrhythmia (prolonged QT interval)
or at risk for arrhythmia
 ADVERSE EFFECTS
• Imatinib-GI upset, muscle cramps, heart
failure, fluid retention, skin rash
• Other adverse effects seen in other
antineoplastics do not occur in this type of
antineoplastic (e.g. bone marrow suppression,
alopecia, severe GI effects)
 KEY POINTS
• Cancer-cell specific drugs have been
developed to target processes that occur in
cancer cells but not in healthy cells
• This specificity results in fewer toxic effects
than with traditional antineoplastic therapy
 KEY POINTS
•Protein tyrosine kinase inhibitors,
epidermal growth factor inhibitors, and
proteasome inhibitors have been
developed to target cancer cells
specifically
SAMPLE MEDICATIONS
 MISCELLANEOUS
ANTINEOPLASTICS
•These do not fit into one of the previously
discussed groups
 ACTION
• Are used to cause cell death
INDICATION
 CONTRAINDICATION
• pregnancy
• lactation
• allergy
 ADVERSE EFFECTS
• Hematological effects
• CNS effects: HA, drowsiness, aphasia
(problem w/ communication), fatigue,
malaise, dizziness
 ADVERSE EFFECTS
•Hepatic/renal toxicity
•Alopecia
•Necrosis and cellulitis if extravasation
occurs at IV sites
SAMPLE MEDICATIONS
 NURSING
CONSIDERATIONS
• amifostine (Ethyol) – preserves healthy cells
from the toxic effects of cisplatin
• mesna (Mesnex) – cytoprotective drugs that
may be given to limit certain effects of
cisplatin & ifosfamide in order to decrease
hemorrhagic cystitis
• leucovorin is given to counter the effects of
methotrexate
• Tumor Lysis Syndrome – a complication
during cancer ttt where large amounts of
tumor cells are killed (lysed) releasing their
contents into the bloodstream
• Allopurinol (Zyloprim) lowers the serum uric
acid that results from the rapid destruction of
the cells
• Monitor for s/s of hemorrhagic cystitis (hematuria,
dysuria) during cyclophosphamide or ifosfamide
therapy; EOF