McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 1 4  Antineoplastic agents

TABLE 14.7

DRUGS IN FOCUS Miscellaneous antineoplastics (continued)

Drug name

Dosage/route

Usual indications

tretinoin (Vesanoid)

45 mg/m 2 per day PO for 30–120 days

Used to induce remission in APL; can cause severe respiratory and cardiac toxicity, including myocardial infarction and cardiac arrest Actions: promotes cell differentiation and the repopulation of the bone marrow with normal cells in people with APL Special considerations: GI toxicity, pseudotumour cerebri (papilloedema, headache, nausea, vomiting, visual changes), skin rash and fragility may limit use in some people; discontinue drug at first sign of toxic effects; use for induction of remission only—then other chemotherapeutic agents should be used

information about each drug may be obtained in a nursing drug guide. (See Figure 14.4 for sites of action of the miscellaneous antineoplastic agents.)

multiplying cells, such as bone marrow suppression, which may limit the drug use; GI toxicity, with nausea, vomiting, mouth sores and diarrhoea; and alopecia (hair loss). ■■ Chemotherapeutic agents should not be used during pregnancy or breastfeeding because they may result in potentially serious adverse effects on the rapidly multiplying cells of the fetus and neonate. ■■ The newest drugs developed as antineoplastic agents target very specific enzyme systems or processes used by the cancer cells but not by healthy human cells. These drugs are not as toxic to the person as traditional antineoplastic drugs. Knowing your strengths and weaknesses helps you to study more effectively. Take a PrepU Practice Quiz to find out how you measure up!

CHAPTER SUMMARY

■■ Cancers arise from a single abnormal cell that multiplies and grows. ■■ Cancers can manifest as diseases of the blood and lymph tissue or as growth of tumours arising from epithelial cells (carcinomas) or from mesenchymal cells and connective tissue (sarcomas). ■■ Cancer cells lose their normal function (anaplasia), develop characteristics that allow them to grow in an uninhibited way (autonomy), have the ability to travel to other sites in the body that are conducive to their growth (metastasis) and can stimulate the production of blood vessels to bring nutrients to the growing tumour (angiogenesis). ■■ Antineoplastic drugs affect both normal cells and cancer cells by disrupting cell function and division at various points in the cell cycle; new drugs are being developed, such as protein kinase inhibitors, to target cancer cell–specific functions. ■■ Cancer drugs are usually most effective against cells that multiply rapidly (i.e. proceed through the cell cycle quickly). These cells include most neoplasms, bone marrow cells, cells in the GI tract and cells in the skin or hair follicles. ■■ The goal of cancer chemotherapy is to decrease the size of the neoplasm so that the human immune system can deal with it. ■■ Antineoplastic drugs are often given in combination so that they can affect cells in various stages of the cell cycle, including cells that are emerging from rest or moving to a phase of the cycle that is disrupted by these drugs. ■■ Adverse effects associated with antineoplastic therapy include effects caused by damage to the rapidly

ONLINE RESOURCES

An extensive range of additional resources to enhance teaching and learning and to facilitate understanding of this chapter may be found online at the text’s accompanying website, located on thePoint at http://thepoint.lww.com. These include Watch and Learn videos, Concepts in Action animations, journal articles, review questions, case studies, discussion topics and quizzes.

WEB LINKS

Healthcare providers and students may want to consult the following Internet sources: www.cancer.org.au Home page of the Cancer Council Australia. Information on cancer including research, protocols and new information. http://canceraustralia.gov.au Home page of Cancer Australia, Australian Government.