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Topoisomerase I and II inhibitors
- nuclear enzymes that alter the shape of DNA coils which are responsible for DNA replication and repair
- destroy the replication of DNA and cell structure
- Topoisomerase I: affects the S phase - inhibiting cellular reproduction
- Examples: topotecan and irinotecan
- SA: alopecia, constipation, N&V peripheral neuropathy, shomatitis, abdominal pain, headache
- Topoisomerase II: work on the G2 phase cellular reproduction of the cancer anc can also act on the S phase which is DNA systhesis
- Examples: etoptside, teniposide
- SA: alopecia, constipation, N&V, flusing, leukopenia, thrombocytopenia, bone marrow depression and anemia.
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Tyrosine Kinase Inhibitors
(Small Molecule)
- Protein tyrosine kinases regulate cellular growth, proliferation and angiogenesis - mediate signal transmission
- receptors are on surface of endothelial cells and tumor cells
- Tyrosine Kinase Inhibitors act on the tumor and tumor vasculature - block signaling pathways that are critical for tumor growth
- Downstream signal transduction
- Example: erlotinib, gefitinib, imatinib
- SA: hypertension, pruitus, dry skin with pustular acneiform rash, elevations in serum transaminases, asthenia, anorexia, N&V, mucositis, conjunctivitis, blepharitis, and corneal erosions, hemoptysis, GI hemorrhage, interstitial lung disease
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Proteasome Inhibitors
- intracellular multienzyme complexes that degrade proteins to eliminate the cells of proteins that are not needed.
- regulate transcription, cell adhesion, apoptosis, cell cycle progression and mitosis
- Disrupt aspects of cellular structure and promote apoptosis
- SA: malaise, fatigue, n&V, anorexia, diarrhea, constipation, headache, insomnia, leg pain, edema, rash. Thrombocytopenia, neutropenia, peripheral neuropathies, pyrexia, hypotension
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Multikinase Inhibitors (MKIs)
- block pathwasy for tumor angiogenesis
- each MKi has own unique dosing and formulation
- SA: N&V, diarrhea, tast disturbance, stomatitis, hair thinning or alopecia, rash, thickened or cracking skin on palms and soles, hypertension, electrolyte disturbances, neutropenia, thrombocytopenia, dyspnea, cough, fever and abnormal laboratoy values - hyperlipidemia, hyperglycemia
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Angiogenesis Inhibitors
- Angiogenisis is the process of new capillary formation from existing blood vessels
- Angiogenisis inhibitors inhibit the formation of blood vessels needed for tumor growth and metastaisi
- Example: bevacizumab - metastatic carcinoma of the colon and rectum
- SA: pain, headache, hypertension, diarrhea, N&V, anorexia, stomatitis, constipation, upper respiratory infection, nose bleed, dyspnea, exfolative dermatitis and proteinuria with nepfritic syndrome.
- AR: leukopenia, hypertension, bleeding, wound healing complications, GI perforation , atrerial thromblic events, reversible posterior encephalopathy syndrome, nasal septum perforation
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Monoclonal Antibodies
- produse in the lab and desinged to recognize and bind to specific antigens expressed on the surface of cancer cells
- work by blocking the growth of the tumor and/or alerting the body's immune system to attach the cancer cells
- inhibit human epidermal growth factor receptors 1 and 2 that are attached to the protein
- SA: N&V, anorexia, diarrhea, headaches, and vertigo, fever, paine , chills, diff. breathing, rashes
- RA: leukopenia, thrombocytopenia, neutropenia, anemia, anaphylaxix, urticaria, bronchospasm, angioedema
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Nursing Considerations for clients on targeted therapies
- Client / family education
- understanding the mechanism of action
- self administration drug issues
- access to therapy
- side effect management
- reproductive issues
- quality of live
- financial implications (drugs cost over $30,000 per dose)
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