PYRAMID POINTS
CHAPTER 52:
ANTINEOPLASTIC
MEDICATIONS
PYRAMID POINTS
I. Antineoplastic Medications


Description
• Kill or inhibit reproduction of neoplastic cells
Side effects
• Low white blood cell (WBC) count (neutropenia)
• Thrombocytopenia
• Fatigue, nausea, vomiting
ADULT HEALTH:
Antineoplastic Medications
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PYRAMID POINTS
I. Antineoplastic Medications (continued)

Interventions
• Monitor complete blood cell (CBC) count, including WBC,
platelets, electrolytes
• Initiate bleeding precautions if thrombocytopenia occurs,
including use of soft toothbrush, electric razor
• Initiate neutropenic precautions if neutropenia occurs,
including no fresh fruits and vegetables, no uncooked
fish, protective isolation
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Antineoplastic Medications
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PYRAMID POINTS
I. Antineoplastic Medications (continued)

Interventions (continued)
• Monitor for petechiae, ecchymosis, bleeding gums, epistaxis
• Avoid intramuscular (IM) injections, venipuncture
• Administer antiemetics several hours prior to chemotherapy
• Pregnant nurses should avoid chemotherapy preparation,
administration
• Encourage hydration, promoting at least 2000 mL/day
• Administer allopurinol (Zyloprim) as prescribed
• Prepare IV chemotherapy in air-vented space per agency
protocol
ADULT HEALTH:
Antineoplastic Medications
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PYRAMID POINTS
I. Antineoplastic Medications (continued)

Interventions (continued)
• Discard intravenous (IV) equipment in designated containers
• Monitor for extravasation
• Instruct client in potential side effects, including hair loss,
mucositis, infection, bleeding episodes
• Instruct client about need for contraception during treatment
• Live vaccinations should not be administered.

Anaphylactic reactions
• Obtain allergy history
• Monitor for signs of anaphylactic reactions
• Airway first priority if anaphylaxis occurs
ADULT HEALTH:
Antineoplastic Medications
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PYRAMID POINTS
II. Alkylating and Alkylating-like Medications

Description
• Affects synthesis of DNA by causing cross-linking of DNA
to inhibit cell reproduction

Side effects
• Cisplatin (Platinol) may cause ototoxicity, tinnitus,
hypokalemia, hypocalcemia, hypomagnesemia,
nephrotoxicity
• Cyclophosphamide (Cytoxan, Neosar) may cause
alopecia, gonadal suppression, hemorrhagic cystitis,
hematuria
ADULT HEALTH:
Antineoplastic Medications
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PYRAMID POINTS
II. Alkylating and Alkylating-like Medications
(continued)

Interventions
• Assess vital signs, CBC results
• Withhold medication if platelet count below
75,000 cells/µL or WBC count below 4,000 cells/µL as
prescribed
• Administer antiemetic 30 minutes before antineoplastic
medication as prescribed
• Monitor for side effects development
• Instruct client to eat diet low in purines
ADULT HEALTH:
Antineoplastic Medications
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PYRAMID POINTS
III. Antitumor Antibiotic Medications


Description
• Interfere with DNA, RNA synthesis
Side effects
• Vesication
• Doxorubicin (Adriamycin, Doxil) and idarubicin (Idamycin) may
cause cardiotoxicity
• Pulmonary toxicity can occur with bleomycin (Blenoxane)

Interventions
• Assess for myocardial toxicity, dyspnea, dysrhythmias,
hypotension when administering doxorubicin, idarubicin
• Monitor pulmonary status when administering bleomycin
ADULT HEALTH:
Antineoplastic Medications
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PYRAMID POINTS
IV. Antimetabolite Medications


Description
• Halt synthesis of cell protein
• Replace normal proteins required for DNA synthesis
Side effects
• Fluorouracil (Adrucil) may cause alopecia, stomatitis,
diarrhea, phototoxicity
• Methotrexate may cause alopecia, stomatitis,
hyperuricemia, photosensitivity, hepatoxicity

Interventions
• When administering fluorouracil, assess for signs of
cerebellar dysfunction, stomatitis, diarrhea
ADULT HEALTH:
Antineoplastic Medications
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PYRAMID POINTS
IV. Antimetabolite Medications (continued)

Interventions (continued)
• When administering methotrexate in large doses,
prepare to administer leucovorin as prescribed to prevent
toxicity (known as leucovorin rescue)
• When administering fluorouracil or methotrexate, instruct
client to wear sunscreen or protective clothing
ADULT HEALTH:
Antineoplastic Medications
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PYRAMID POINTS
V. Antimitotic Medications (Vinca Alkaloids)



Description
• Prevent mitosis, causing cell death;
• Prevent cell division
Side effects
• Neurotoxicity with vincristine (Oncovin, Vincasar)
Interventions
• Monitor for neurotoxicity with vincristine including
numbness, tingling in fingers, toes
• Monitor for constipation, paralytic ileus
ADULT HEALTH:
Antineoplastic Medications
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PYRAMID POINTS
VI. Hormonal Medications and Enzymes

Description
• Suppress immune system; block normal hormones in hormonesensitive tumors


Side effects
• Tamoxifen citrate decreases effects of estrogen
Interventions
• Monitor vital signs
• Monitor serum calcium levels with androgens
• Monitor pancreatic function with asparaginase (Elspar)
• Encourage fluid intake of 2 to 3 L/day as prescribed
• Monitor uric acid, cholesterol serum levels
• Monitor for signs of hemorrhagic cystitis
• Instruct client about potential for alterations in sexual
characteristics
ADULT HEALTH:
Antineoplastic Medications
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PYRAMID POINTS
VII. Immunomodulator Agents: Biological
Response Modifiers

Description
• Stimulate immune system to recognize cancer cells and
take action to eliminate or destroy them
• Colony-stimulating factors induce more rapid bone
marrow recovery after suppression by chemotherapy
ADULT HEALTH:
Antineoplastic Medications
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PYRAMID POINTS
VII. Immunomodulator Agents: Biological Response
Modifiers (continued)



Medications include interferon alfa-2a; recombinant
interferon-alfa-2b (Intron A); rituximab (Rituxan);
sargramostim (Leukine); filgrastim (Neupogen); epoetin alfa
(Epogen)
Side effects include flu-like symptoms; nausea and vomiting;
nephrotoxicity (interferon alfa); edema and dyspnea (epoetin
alfa)
Interventions
• Monitor vital signs
• Monitor liver and renal function tests
• Teach clients to avoid persons who have received live
immunizations
• Monitor CBC results
ADULT HEALTH:
Antineoplastic Medications
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PYRAMID POINTS
VIII. Gene Therapy

Description
• Allows the client’s immune system to be better able to
recognize cancer cells as non-self
ADULT HEALTH:
Antineoplastic Medications
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PYRAMID POINTS
IX. Targeted Therapy

Description
• Monoclonal antibodies that target a cellular element of
the cancer cell or medications that work at the gene level

Side effects
• Monoclonal antibodies can cause allergic reactions
ADULT HEALTH:
Antineoplastic Medications
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PYRAMID POINTS
XI. Other Antineoplastic Medications









Altretamine (Hexalen)
Denileukin diftitox (Ontak)
Gemcitabine (Gemzar)
Irinotecan (Camptosar)
Paclitaxel (Abraxane, Taxol, Onxol)
Pegaspargase (Oncaspar)
Topotecan (Hycamtin)
Trastuzumab (Herceptin)
Bexarotene (Targretin)
ADULT HEALTH:
Antineoplastic Medications
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The client receiving antineoplastic medications by the
intravenous (IV) route has ongoing monitoring of serum
laboratory results to monitor for adverse medication effects. The
nurse should prepare to institute bleeding precautions if which of
the following results is telephoned to the nursing unit by the
laboratory staff?
1.
2.
3.
4.
Clotting time of 12 minutes
Ammonia level of 28 mcg/dL
White blood cell count (WBC) 4,500 cells/mm³
Platelet count of 50,000 cells/mm³
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Antineoplastic Medications
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