McKenna's Pharmacology for Nursing, 2e

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P A R T 2  Chemotherapeutic agents

Implementation Ensure safe administration of the drug.

originally. It may help to purchase a wig before you lose your hair so that you can match appearance if you would like to. Hats and scarves may also be worn. It is very important to keep your head covered in extremes of temperature and to protect yourself from sun, heat and cold. Because much of the body’s heat can be lost through the head, not protecting yourself could cause serious problems. • Mouth sores . Frequent mouth care is very helpful. Try to avoid very hot or spicy foods. • Fatigue, malaise . Frequent rest periods and careful planning of your day’s activities can be very helpful. • Bleeding . You may bruise more easily than you normally do and your gums may bleed while you are brushing your teeth. Special care should be taken when shaving or brushing your teeth. Avoid activities that might cause an injury and avoid medications that contain aspirin. • Susceptibility to infection . Avoid people with infections or colds, and avoid crowded, public places. In some cases, the people who are caring for you may wear gowns and masks to protect you from their germs. Avoid working in your garden because soil can be full of bacteria. • Report any of the following to your healthcare provider: bruising and bleeding, fever, chills, sore throat, difficulty breathing, flank pain, and swelling in your ankles or fingers. • Take the full course of your prescription. It is very important to take the complete regimen that has been ordered for you. Cancer cells grow at different rates, and they go through rest periods during which they are not susceptible to the drugs. The disease must be attacked over time to eradicate the problem. • Tell any doctor, nurse or other healthcare provider that you are taking this drug. • Try to maintain a balanced diet while you are taking this drug. Drink 10 to 12 glasses of water each day during the drug therapy. • Use a barrier contraceptive while you are taking this drug. These drugs can cause serious effects to a developing fetus, and precautions must be taken to avoid pregnancy. If you think that you are pregnant, consult your healthcare provider immediately. • You need to have periodic blood tests and examinations while you are taking this drug. These tests help to guard against serious adverse effects and may be needed to determine the next dose of your drug.

Provide comfort and safety measures: mouth and skin care, rest periods, safety precautions, antiemetics as needed, maintenance of nutrition and head covering. Provide support and reassurance to deal with drug effects, body image changes, discomfort and diagnosis. Provide teaching regarding drug name, dosage, adverse effects, precautions to take, signs and symptoms to report and comfort measures to observe. Evaluation Evaluate drug effects: resolution of cancer. Monitor for adverse effects: GI toxicity, bone marrow suppression, CNS changes, renal and hepatic damage, alopecia, extravasation of drug. Monitor for drug–drug interactions as listed. Evaluate effectiveness of teaching program. Evaluate effectiveness of comfort and safety measures. TEACHING FOR B.P. Antineoplastic agents work to destroy cells at various phases of their life cycle. The drugs are given in combination to affect the cells at these various stages. These drugs are prescribed to kill cancer cells that are growing in the body. Because these drugs also affect normal cells, they sometimes cause many adverse effects. Your drug combination includes doxorubicin, cyclophosphamide and paclitaxel. • These drugs are given in a 21-day cycle, followed by a rest period. You will need to mark your calendar with the treatment days and rest days. You will need to have regular blood tests to follow the effects of these drugs on your blood cells. • Common adverse effects of these drugs include the following: • Nausea and vomiting . Antiemetic drugs and sedatives may help. Your healthcare provider will be with you to help if these effects occur. • Loss of appetite . It is very important to keep up your strength. Tell people if there is something that you would be interested in eating—anything that appeals to you. Alert someone if you feel hungry, regardless of the time of day. • Loss of hair . Your hair will grow back, although its colour or consistency may be different from what it was

CANCER CELL–SPECIFIC AGENTS The goal of much of the current antineoplastic drug research is directed at finding drugs that are cancer cell specific. These drugs would not have the devastat­ ing effects on healthy cells in the body and would be

more effective against particular cancer cells. Three groups of drugs are available for cancer cell–specific actions: protein tyrosine kinase inhibitors, an epidermal growth factor inhibitor and a proteasome inhibitor (see Table 14.6).