Inhibits protein synthesis (S phase) Azathioprine (Imuran) Fluorouracil (5-FU) Methotrexate (Mexate) given with leucovorin to protect normal cells Antibiotics Inhibit RNA Doxorubicin HCl (Adriamycin) Mithramycin (Mithracin)
Antimetabolites Inhibits protein synthesis (S phase) Azathioprine (Imuran) Fluorouracil (5-FU) Methotrexate (Mexate) given with leucovorin to protect normal cells Antibiotics Inhibit RNA Doxorubicin HCl (Adriamycin) Mithramycin (Mithracin) Hormone Inhibit RNA and protein synthesis in tissues that are dependent on the opposite sex Androgens, Estrogens, Progestins, Steroids (Analogue, Exogenous) Hormone Antagonist: Mitotane (Lysodren) cortisol antagonist, Tamoxifen Citrate (Nolvadex) estrogen antagonist Immune Agents Introduction of an agent to stimulate production of antibodies Bacillus Calmette-Guerin (BCG) C&R Goal: Destroy all malignant cells without excessive destruction of normal cell Control growth of tumor when cure is not possible Note: all rapid dividing cells (GI mucosa, hair follicles and bone marrow) are susceptible to the action of chemo and radiation therapy. Reasons of Combining Drugs Synergy - two or more agents works together to enhance the effect Adjuvant - an additional treatment ’s malignant cell destructions, ¯ ’s the SE Principle of MDT is instituted to avoid and prevent the SE C&R SIDE EFFECTS Common : nausea and vomiting Stomatitis Alopecia (2-3 weeks to occur) Bone marrow depression Neurologic/Sensory/Perceptual Meningeal irritation CN and peripheral neuropathy Cerebellar toxicity Ototoxicity Cardiac Pericardial Effusion Arrhythmias CHF Pulmonary Pleural Effusion Pneumonitis GIT Stomatitis Esophagitis Pharyngitis Taste alteration Anorexia Nausea and vomiting Constipation and diarrhea Weight loss C&R SIDE EFFECTS GUT Nephrotoxicity Hemorrhagic cystitis Hyperuricemia Urine color changes Reproductive Loss of libido Impotence Amenorrhea Irregular menses Menopausal symptoms Azoospermia Sterility Gynecomastia Hepatic Hepatotoxicity Integumentary Alopecia Dermatitis and ulcers Hematopoietic ¯ bone marrow activity anemia, prone to infection and bleeding tendency Metabolic TLS and Hyperkalemia
Perceived Change in Body Image Obvious reminder of disability need for prosthesis (breast, leg and eye) • need for hardware (wheel chair, crutches) • need for medication (CR therapy) • extent of disability or limitation Type of loss symbols of sexuality social acceptability (colostomy) ability to communicate (laryngectomy, aphasia) anatomic changes (amputation) Terminally Ill 50% die from the disease time from diagnosis to death ranges from weeks- years not all clients become terminally ill others die during initial treatment; others die from complications of treatment Endpoint: no response to treatment and progressions cannot be controlled HOSPICE CARE standard of care for terminally ill cancer clients symptom control pain management providing comfort and dignity 24 hour – 7 day coverage services are given based on client’s need not on its ability to pay Ethical Issues
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- Spring '19
- Chest xray, Denial Rational inquiry