Medication
Class
MOA
Notable SE/ADR and Nursing
considerations
Traditional Cyclophosphamide (Cytoxan), Anticancer/CCNS/alkylation Damages DNA by cross linking strands thus
Severe vesicant- causes
therapy
Nitrogen mustard derivative
preventing cell growth. Effective at all stages extravasation and tissue
medications
of cell cycle but most effective during G 0
necrosis if infiltration occurs;
can cross BBB
Patient teaching
Mesnex (cytoprotective/chemoprotectant)protects against bladder toxicity by inactivating
urologic metabolites, administer 30-60min
before
Take early in the day; Sufficent hydration
required to prevent hemorrhagic cystitis;
encourage intake of fluids to promote
excretion; empty bladder every 2-3hrs;
sunblock SPF >50; avoid citric acid; restrict
purines (organ meats, beans, peas)
Doxorubicin (Adriamycin)
Anticancer/CCNS/antitumor Inhibits DNA and RNA synthesis.
antibiotic/anthracycline
Methotrexate
Anticancer/CCS/(Folate
Inhibits DNA synthesis by blocking reduction of Stomatitis (early sign),
Leucovorin given 12-24hrs after to reduce
antagonist) Antimetabolite folic acid. Effects the S phase.
alopecia, hepatotoxic, N/V,
toxicity
bone marrow suppression;
causes apoptosis in fetal cells,
used for ectopic pregnancy
(pregnancy category X); Lowprotein binding
NSAIDs, penicillins, probenecid, and
various other drugs can induce
methotrexate toxicity.
Vincristine
Anticancer/CCS/plant
alkaloid
Report signs of neurotoxicity, signs of
respiratory compromise, encourage high
fiber foods and adequate hydration
Liposomal drugs
Tamoxifen
Anastrozole
Leuprolide (Lupron)
Targeted
therapy
(Precision
medicine)
Combo medication
Bevacizumab (Avastin)
Rituximab
Anticancer/Estrogen
antagonist/selective
estrogen receptor
modulator
Anticancer/Aromatase
inhibitor
Erlotinib
Anticancer/small
molecule/Targeted
therapy/ EGFR inhibitor
Gefitinib (Iressa)
Anticancer/small
molecule/Targeted
therapy/EGFR inhibitor
Imatinib mesylate
Anticancer/small
molecule/Targeted
therapy/BCR-ABL TK
inhibitor
Anticancer/small
molecule/Targeted
therapy/Multikinase
inhibitor
Anticancer/small
molecule/Targeted
therapy/Multikinase
inhibitor
Anticancer/small
molecule/Targeted
therapy/Proteasome
inhibitor
Sorafenib
Sunitinib
Bortezomib
Inhibits microtubule formation, thus blocking
cell division (M phase)
Neurotoxicity (peripheral
neuropathy, "stocking glove
syndrome"), GI constipation,
vesicant, leukopenia, alopecia
anticancer meds packaged inside synthetic fat Decreases side effects such as
globules called liposomes. Ex. Liposomal
hair loss, nausea, and
forms of doxorubicin and vincristine
cardiotoxicity
Competes with estrogen for estrogen positive Increases risk of endometrial
breast cancer cells thereby preventing growth cancer, pulmonary edema, and
in both men and women
hypercalcemia
Inhibits the conversion of other hormones to
estrogen. Lowers estradiol levels which
inhibits breast cancer cell growth
Anticancer/GnRH analouge Inhibits the release of FSH and LH from the
pituitary gland, which suppresses testosterone
and estrogen levels. This in turn reduces the
size of the prostate gland in men and reduces
the size of the ovaries, uterus, and mammary
glands in women
Anticancer/Monoclonal
antibody/Targeted therapy
Anticancer/Monoclonal
antibody/Targeted therapy
Cardiotoxicity is a major
Dexrazoxane (cytoprotective/chemoprotectant)- Can cause urine to be pink or red; report
concern. Assess for preexisting administered 30min before anthracycline to
signs of cardiac abnormabilities
cardiac conditions that
prevent cardiotoxicity
immediately
increase risk of cardiotoxicity;
vesicant, can cause
extravasation; pnumonitis, may
progress to pulmonary fibrosis
Prevents angiogenesis by blocking vascular
endothelial growth hormone (VEGF)
Binds to CD20 positive B lymphocytes and
lymphoma cells causing cytotoxicity and
apoptosis
Selectively inhibits epidermal growth factor
receptor (EGFR) tyrosine kinase, thereby
blocking signal transduction pathways for
angiogenesis and cellular proliferation
Avoid with use of warfarin; SSRI can
decrease effectiveness; Regualr gyn
exams should be done
Increasingly being used before
tamoxifien. Cardiotoxicity and
angioedema can occur
Gyneocomastia, decreased
bone density, decreased libido.
Cardio, pulmonary, and
hepatotoxicity can occur.
Metabolized by CYP3A4
enzyme of the liver.
Avoid grapefruit which contains CYP3A4
inhibitors. Increase dose if taken with
CYP3A4 inducers which will increase drug
metabolism. Avoid antacids which change
gastric pH and decreases absorption.
CYP3A4 inhibitor
Avoid concomitant CYP3A4 inhibitors, such
as grapefruit.
Targets serine/threonine and receptor TKs.
Metabolized by CYP3A4
enzyme of the liver. Highly
protein bound (99.5%)
Don’t take with high fat meals which will
inhibits drug absorption and
bioavailability.
Selectively inhibits receptor TKs resulting in
regression of tumor growth
Metabolized by CYP3A4
enzyme of the liver. Highly
protein bound (95%)
Promotes the accumulation of proteins that
promote programmed cell death. Affects
cancer cells more than normal cells
Metabolized by CYP3A4
enzyme of the liver.
Selectively inhibits epidermal growth factor
receptor (EGFR) tyrosine kinase, thereby
blocking signal transduction pathways for
angiogenesis and cellular proliferation
Inhibits ATP binding site on BCR-ABL tyrosine
kinase thereby inhibiting proliferation and
inducing apoptosis in BCR-ABL positive cells
CYP3A4 inhibitors can increase the level or
effect of bortezomib
Common side effects for targeted therapies: Diarrhea, hepatitis, thrombus formation, poor wound healing, HTN, fatigue, stomatitis, skin changes
BRM
Aldesleukin (Proleukin)
BRM/Interleukin/Lymphoki Produced by WBCs (T-lymphocytes). Increases Capillary leak syndrome,
ne
the immune response and decreases
hypotension, N/V, bone
production of cancer cells
marrow suppression, flu like
symptoms, depression.
Discontinue if organ system
toxicity occurs
Interferon-⍺, β, ɣ
BRM
Erytrhopoietin (Epogen, EPO, BRM/Colony stimulating
procrit, epoietin alpha)
factor (CSF)/glycoprotein
hormone
Antibiotics
antiviral, anti-inflammatory, anti-proliferative, SEs: Rigors, GI upset, CV
Pre treat with meperidine and acetaminophen
immunomodulatory, activate NK cells
(tachycardia, pallor, cyanosis), for Rigors
CNS (confusion, irritability,
seizures), Renal
Stimulates production of red blood cells.
SEs: Increased BP due to
Only give to patients with Hgb <11g/dL
Endogenous EPO produced by kidneys in
increased RBCs in blood,
response to hypoxia. Decreased when theres increased clotting (may require
renal dysfunction
heparinization)
increases production and activation of
SEs: Skeletal pain.
Do not dose within 24hrs of cytotoxic
neutorphils (increased ANC)
meds because the rapidly dividing cells
may be destroyed by the chemo
treatment. Report signs of weight loss,
infection, bleeding
Filgrastim (Neupogen)
BRM/Granulocyte-CSF
Oprelvekin (Neumega)
BRM/Platelet-CSF
Stimulates thrombocyte production
Use caution in those with heart
conditions. SEs: serious fluid
retention (peripheral edema,
pericardial effusions,
exertional dyspnea). Use
within 3hrs of reconstitution
Med Group
Penicillins (suffix: -cillin)
Meds
Amoxicillin, ampicillin,
pipercillin, ticarcillin
Action
Targets narrow spectrum gram+ bacteria
Effect
Bactericidal
Cephalosporins (prefix: cefor ceph-)
Ceftriaxone, cefixime,
cephalexin
Similar action to penicillins
Bactericidal
Aminoglycosides
Gentamycin, streptomycin, Inhibits bacterial protein synthesis
tobramycin, neomycin,
amikacin*
Bacteriostatic; bactericidal at
high doses
Macrolides
Azithromycin, erythromycin, Inhibits bacterial protein synthesis
clarithromycin
Bacteriostatic; bactericidal at
high doses
Quinolones (suffix: -floxacin) ciprofloxacin
Inhibits DNA synthesis
Bactericidal
Lincosamide
Glycopeptides
clindamycin
Vancomycin
Inhibits bacterial protein synthesis
Inhibits bacterial cell wall synthesis
bacteriostatic
Bactericidal
Tetracyclines
Tetracycline, doxycycline
Inhibits bacterial protein synthesis
bacteriostatic
Inhibits the folic acid synthesis required for
bacterial DNA synthesis
bacteriostatic
Sulfonamides (prefix: -sulfa) sulfamethoxazole,
Nitrofurantoin (Macrobid)
Peptides
Metronidazole
Antituberculars
Antifungals
Antimalarial
Antihelmintic
Antiviral
Bacitracin, polymyxin
Interfere with cell membrance and cell wall
synthesis
Antiprotozoal for T.
vaginalis, amebiasis, and
giardiasis
Isoniazid (INH), Rifampin
Interferes with DNA and cell wall synthesis
Amphotercin B, Nystatin,
fluconazole, miconazole
chloroquine
mebendazole, quinfamide
acyclovir
Do not take with dexamethasone which
can negate the effects of aldesleukin. Can
decrese the effectiveness of vaccines.
give with beta-lactamase inhibitor to target
If allergic to pencillin, substitute with a
penicillinase resistant bacteria; High doses of macrolide;
penicillin cause hyperkalemia and
dysrhythmias, monitor electrolytes; Penicillins
inactivate aminoglycosides, give 1hr apart;
Ampicillin decreases oral contraceptive
efficacy; Probenecid decreases renal excretion
of penicillin G;
give with beta-lactamase inhibitor to target
penicillinase resistant bacteria; Monitor PT and
consider vitamin K injection if bleeding occurs;
probenecid decreases renal excretion
*BBW: nephrotoxicity, ototoxicity, respiratory
paralysis, neuromuscular blockade resulting in
respiratory depression; inactivated by
penicillins; collect peaks 30min after dose;
collect troughs before the administration of 4th
dose;
5-10% cross sensitivity if PCN allergy;
discontinue if antibiotic
pseudomembranous colitis occurs
Closely monitory clients with other
respiratory depressants (anesthesia,
muscle relaxants, myasthenia gravis)
First alternative choice in those with PCN
allergy
BBW: tendon rupture
causes ototoxicity and nephrotoxicity; peak
should be between 30-40mcg;
Used for UTI because these drugs concentrate
in the urine before excretion. First choice for
UTI in non-pregnant women
Used for UTI treatment in pregnant women
Ineffective against some drug resistant
bacteria (VRE and VRSA)
Tetracycline: avoid milk products, expired
meds are poisonous; Doxycycline: stains
teeth gray, do not give to those younger
than 8 or who are pregnant
Administer w/ water and maintain high
fluid intake
Polymyxins: can cause renal and
nephrotoxicity; Bacitracin: can cause renal
damage and ototoxcity
STI treatment for trichomonas
INH is first choice for treatment.
Treatment for HSV
INH can cause hepatotoxicity and turn
fluids (urine, sweat, saliva) orange; oral
contraceptives decreased