Medications - Neoplasia.doc - 1 Medications for Neoplasia...

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Medications for Neoplasia Classification Examples Mechanism of Action Side Effects Nursing Considerations Alkylating Agents ***Drugs that form bonds or linkages with DNA , a process called alkylation Nitrogen mustards : -bendamustine (Treanda) -busulfan (Myleran) -chlorambucil (Leukeran) -cyclophosphamide (Cytoxan) -estramustine (Emcyt) -ifosfamide (Ifex) -mechlorethamine (Mustargen) -melphalan (Alkeran) Nitrosoureas : -carmustine (BiCNU, Gliadel) -lomustine (CeeNU) -streptozocin (Zanosar) Platinum drugs: -carboplatin (Paraplatin) -cisplatin (Platinol-AQ), oxaliplatin (Eloxatin) Cell cycle phase---nonspecific. DNA damaged by causing breaks in the double-stranded helix. Cancer cell may die immediately (cytocidal) or when attempting to divide (cytostatic) Bone marrow suppression: ↓ erythrocytes, leukocytes, and platelets. GI lining damage: nausea, vomiting, diarrhea. Stomatitis. Alopecia. Nitrosoureas and mechlorethamine are strong vesicants. About 5% patients develop acute nonlymphocytic leukemia 4 years or more after chemo completed. -May cause sterility in some patients. Nadir 6 to 10 days. May cause hemorrhagic cystitis if the urine becomes concentrated----patients should be advised to maintain high fluid intake during therapy. Antimetabolites ***Drugs that chemically resemble essential building blocks of cells Folic acid analogs : -methotrexate (Rheumatrex, Trexall) -pemetrexed (Alimta) -pralatrexate (Folotyn) Purine analogs : -cladribine (Leustatin) -clofarabine (Clolar) -fludarabine (Fludara) -mercaptopurine (6-MP, Purinethol) -nelarabine (Arranon) -pentostatin (Nipent) -thioguanine (6-TG, Tabloid) Cell cycle phase – specific agents Cancer cells attempt to synthesize proteins, RNA, DNA, using the antimetabolites metabolic pathways are disrupted and the cancer cells die or their growth is slowed. Primarily acting during S phase. Prescribed for leukemias and solid tumors. -Bone marrow toxicity. -GI toxicity, including ulcerations of the mucosa. -Alopecia. -Mercaptopurine and thioguanine can cause hepatotoxicity, including cholestatic jaundice. -Neurotoxicity: cytarabine, fluorouracil, fludarabine, cladribine 1
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Pyrimidine analogs : -capecitabine (Xeloda) -cytarabine (Cytosar, Cytosine arabinoside, Depot-Cyt) -floxuridine (FUDR) -fluorouracil (5-FU, Adrucil, Carac, Efudex) -gemcitabine (Gemzar) Interference with DNA synthesis: -hydroxyurea (Hydrea, Droxia) Antitumor antibiotics ***Drugs obtained from bacteria that have the ability to kill cancer cells -bleomycin (Blenoxane) -dactinomycin (Cosmegen, Actinomycin-D) -daunorubicin (Cerubidine, DaunoXome) -doxorubicin (Adriamycin, Rubex, Doxil)
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