Immune System Drugs

• conferred by infection
• patients body produces antibodies against active infection
• confers limited and lifetime protection against re-infection

• conferred by vaccine or toxoid
• stimulates an antibody-antigen response
• confers temp or lifelong immunity against certain communicable diseases
• hepatitis, chicken pox, tetanus, etc

• antibodies
• directly transfers antibodies to fetus via placenta
• directly transfers antibodies via breastmilk

• antitoxin or immunoglobulin
• directly injects antibodies or immunoglobulin
• occurs after exposure to communicable disease, confers temp defense against that disease until bodies defense mobilize
• confers temp defense against communicable disease in a immuno-compromised patient

• antimetabolites
• alkylating agents
• platinum compounds
• anti-tumor antibiotics
• antimitotics
• topoisomerase inhibitors
• hormonal agents
• biologic response agents
• targeted antineoplastic agents

• folic acid analog
• pyrimidine analog
• purine analog

S phase of the cell cycle, where DNA is being synthesized

results in a number of normal cells being killed along side cancer cells

normal cells grow back more quickly than cancer cells

must be available in the body for an extended period of time

• more cancer cells are killed with each round of chemotherapy
• not able to grow back  or repopulate as quickly as normal cells before the next treatment.

• To kill more cancer cells more effectively
• to prevent resistance to a single drug

methotrexate (Trexall)

used when disorders have not responded to other types of treatment

used in smaller doses

• acute lymphocytic leukemia in children
• lymphomas (non-hodgkins)
• choriocarcinoma (uterine associated with pregnancy)
• inoperable sarcomas of the head, neck and pelvis

• rheumatoid arthritis
• psoriasis

• methotrexate (Trexall)
• pemetrexed (Alimta)

• blocks the folic acid synthesis by:
• -inhibiting the enzyme dihydrofolate reductase that is responsible for the activation of folic acid

disrupts the DNA synthesis that occurs in the S phase of cell formation

thus the Folic acid analog kills cancer cells during the S phase

• 1. Severe bone marrow suppression:
• -decreased thrombocytes (Platelets),leukocytes (WBC), and erythrocytes (RBC)
• 2. Liver Damage
• 3. Oral + Gastrointestinal ulceration
• 4. Pulmonary Fibrosis (lung damage)

• 1. Monitor CBC before, during and after treatment
• 2. monitor for fever and infection
• 3. Monitor for bleeding, bruising and petichiae (thrombocytopenia)
• 4. Monitor Liver Function Test
• 5. Monitor for Respiratory Distress and decreased oxygenation

can cause a decrease in Thrombocytes (platelets), Leukocyte (WBC) and erythrocytes (RBC)

b/c patient is at risk for infection if leukocytes drop and neutropenia develops

filgrastim may be ordered to minimize the decrease of WBCs

• the patient is at risk for bleeding so
• --use measures to minimize bruising such as:
• apply prolong pressure to puncture sites 
• use small gauge needles if necessary

• patient is at risk for bleeding:
• -monitor common sites such as the gums, blood in vomit or in stool

it may cause bleeding + discomfort in patient

Monitor patients Liver Function Test for jaundice, yellowing of the skin.

Monitor patients breathing b/c folic acid analog drugs may cause pulmonary fibrosis which cause patient to experience respiratory distress and decrease in oxygenation

b/c the drugs that kill cancer cells also kill blood cell forming cells of the bone marrow (WBC, RBC, and Platelets)

decrease in neutrocytes is the most common form of leukocytes.

• neutropenia, 2500 or less
• below 500 can make patient susceptible to infection

• When the patients neutrophil count is 500 or less. This lets the nurse know that the patient is at extreme risk for getting an infection or disease.
• The nurse would take neutropenia percautions

• 1. place patient in private room
• 2. limit the # of HCP who enter the room
• 3. restrict those who are sick from providing care
• 4. limit the # of invasive procedures such as Blood draws
• 5. using aseptic techniques when necessary

• notify HCP immediately when patient shows signs of fever
• assess patient for source of infection

Orally, IM, IV, and preservative free intrathecal form.

Leukovorin, a reduced form of folic acid

also given as a anecdote for severe bone marrow depression associated with folic acid analogs.

both, it may be given to a patient with food or without.

b/c methotrexate is incompatible with other drug solutions

To protect the Health Care Personel

Get special training and certification in order to admin IV anticancer drugs

• report fever, sorethroat, bruising, and unusual fatigue
• wash fresh fruits, vegetables, and cook food well done

Stomatitis, yeast supra infection in the mouth

Infection

• use soft bristle tooth brush to prevent bleeding of the gums
• use electric razor to prevent bruising

patient is at risk for bleeding caused by bone marrow supression a common side effect of anti cancer drug administration

• to avoid drinking any alcoholic beverages
• report jaundice of the skin or eyes immediately

report any ulceration in the mouth (stomatitis), blood in the vomit or in their stool

They may be having pulmonary fibrosis or damage which respiratory distress and decreased oxygenation are s/s

its considered to be a pregnancy category X drug

if the patient has any history of liver disease or hepatitis, or renal insufficiency: the drug should not be given

• ask the patient if had any history of oral or GI ulcerations
• ask patient if has any active bacterial or viral infections

concurrent use of methotrexate and digoxin can lower the digoxin levels

use with NSAIDS, salicylates and sulfonamides may cause toxic levels when taking concurrently with methotrexate.

it may increase the risk of hepatitis toxicity

It may change the patients response in taking methotrexate

• acute myeloctyic and acute lymphocytic leukemia
• non-hodgkins lymphoma
• prevents and treats meningitis caused by leukemia
• maintains the remission of all of the above

• cytarabine (Cytosar-U via subQ, IV)
• cytarabine (DepoCyt via intrathecal)

• other drugs:
• flourouracil (Adrucil)
• floxuridine (FUDR)
• gemcitibine (Gemzar)

• after pyrimidine analog, cytarabine in the body changes into its active form:araCTP.
• the drug becomes incorporated into the DNA of the cells during the S phase:
• when the cells are changing rapidly
• supresses both RNA and DNA synthesis by destroying both cancer and normal cells

• lymphocytic and acute myelogenous leukemia in both adults and children
• may cause temporary remission in chronic granulocytic leukemia

mercaptopurine (Purinethol)

• other drugs:
• thioguanine (Tabloid)
• fludarabine (Fludara)
• cladribine (Leustatin)

Blocks the purine creation during the S-phase of cell life cycle

DNA can't form due to it s inability of the cell to synthesize the necessary nucleic acids

necessary to produce nucleic acids, which purine analogs convert to its active form after administration

• broad spectrum chemotherapy agent that may be used alone or with other agents to treat:
• leukemias
• multiple myeloma
• lymphomas
• solid tumors (adenocarcinomas) of head, ovary or breast
• lung cancer