Oncology-Antineoplastic

• rate of growth matched to cell death
• Growth fraction: measure of the number of cells undergoing mitosis in a tissue.

Cell death

• Tumor cells escape signal to die and achieve immortality.
• don't contribute to function of a organ
• Proliferate despite lack of growth initiating signals.

• grows slowly
• rarely have necrosis
• function similar to host organ

• grow rapidly
• have necrotic areas
• dysfunctional

• Cure: free of cancer for a period of time
• Palliation: measurement of the patients quality of life.

• Antineoplastic: cell cycle specific
• cell cycle non-specific
• adjuvant chemotherapy: antineoplastics after surgery or radiation.
• myeloablation: complete destruction of hematopoietic bone marrow cells

• They're adaptive-mutate to resist drugs
• Cells can repair DNA damage from chemo
• Cell membrane prevent drugs from working.
• Gene amplification leading to overproduction of protein-making drug less effective.

• Number of cells undergoing mitosis in a tissue
• Dependent on location of cancerous cells. Some cells proliferate faster then others.

• dosing schedules
• combination chemo
• route of admin: Po, IV, Intrathecal, intrarterial, intraperitoneal, intravesicular.

• anemia
• neutropenia
• thrombocytopenia
• N/V
• constipation or diarrhea
• hair loss
• stomatitis
• pain
• anxiety

• hematologic: myelosuppression: bone marrow suppression-Nadir: lowest point of RBC and WBC/platelets.
• gastrointestinal: emetic potential, Mucositis, cachexia
• Cardiopulmonary: doxorubicin/bleomycin.
• urinary: may lead to renal failure
• Reproductive: infertility

• Prevent skin absorption
• prevent inhalation by wearing masks
• appropriate management of pt.s bodily fluids.

• alkylating agents: cyclophosphamide (Cytoxan)
• antimetabolites: methotrexate (Rheumatrex)
• antitumor antibiotics: doxorubicin (adriamycin)
• Hormones: tamoxifen
• plant alkaloids: vincristine (Oncovin)
• biologic response modifiers and monoclonal antibodies.

• Alters the shape of DNA double helix
• prevent DNA from duplicating
• kills cancer cells when they divide
• myelosuppression
• alpecia
• strong vessicant
• secondary malignancy: increased risk of causing other cancer. 
• broad spectrum: lymphomas, myelomas, leukemias, pancreatic, testicular, ovarian, breast.

• Therapeutic class: alkylating agent
• Preg cat: D
• MOA: Cell cycle non specific- causes cross linking of DNA strands-prevents cell division.
• Indications: Cancers...
• Contraindications: Many, but mainly hepatic impairment or other impairments of your body that this drug will effect. 
• Adverse effects: alopecia, disorder of ksin pigmentation, N/V, cardiotoxicity, CHF, many...
• Alert: Void frequently to prevent bladder irritation.

• fatal bone marrow toxicity at high dose
• hemorrhage, nausea, vomiting, anorexia, GI ulcerations, intestinal bleeding.
• Contraindicated in pregnancy, hepatic, cardiac, renal insufficiency, myelosuppression and blood dyscrasia. 
• Avoid preg. for 6 months after therapy.

• Therapeutic class: antimetabolite 
• Preg cat: x
• MOA: blocks synthesis of folic acid Vitamin B)=powerful immunosuppressive.
• Indications: Used for cancers and diseases that have an over-reactive immune system. 
• Contraindications: hepatic impairment, blood dyscrasias, severe COPD
• Adverse: N/V, myelosuppression, pulmonary toxicity.

• bleomycin, adriamycin, actinomycin
• bind to DNA, preventing DNA-RNA synthesis

• Therapeutic class: Antitumor antibiotics
• Preg cat: 
• MOA: Bind to DNA-preventing DNA-RNA synthesis. decreasing cell replication.
• Indications: acute lymphoid leukemia, AML, Aids related kaposi, breast cancer.....antineoplastic...many cancers.
• contraindications: hepatic impairment, myelosuppression, MI-insufficiency.
• adverse: Turns urine/tears red, temporary infertility, secondary malignancy, N/V, rash, mucositis, excessive lacrimation, cardiotoxic.
• Alerts: neutropenic precaution, monitor cardiac function-3lead, observe s/s hepatic dysfunction, very good oral hygiene.
• alerts:

• Cell-cycle specific
• Vincristine: derivative of periwinkle plant-vinca alkaloids.
• MOA: blocks formation of mitotic spindle during mitosis( prevents cell division) 
• Indications: hodgkin/ non-hodgkin lymphomas, leukemia, kaposi sarcoma, wilms tumor(found on kidneys-young children), bladder carcinoma, breast carcinoma.
• Contraindications: charcot-marie-tooth syndrome. Intrathecal use
• Alert: Very toxic and therapeutic doses have serious side effects.
• Adverse: Neurotoxic: paraesthesia/neuropathies-major dose limiting effect.
• myelosuppression 
• N/V, Stomatitis, abdominal pain, vesicant.

• treat hormone sensitive tumors
• Block substanes neccessary for tumor growth
• corticosteroids
• gonadal hormones
• estrogen hormones
• androgen hormones

• therapeutic class: estrogen receptor blocker
• MOA: blocks estrogen receptor on the breast, but activates estrogen receptors elsewhere. increases mineral density of bone and lowers LDL levels.
• Indications: Breast cancers that require estrogen to grow.
• Contraindications: concomitant use of anticoagulant therapy. increases risk of ductal carcinoma. DVT, PE. 
• Adverse: hot flashes, fluid retention, increases rates of endometrial cancer.
• Also approved for prophylaxis of breast cancer....

• Stimulates bodys immune system to kill tumor cells.
• BRM: Immunostimulant (interferon, interleukins). 
• some dampen immune system (monoclonal antibodies)

• Interferon: natural protein produced by T-cells in response to a viral infection.
• interferon alfa 2-A and 2-B used to treat hepatitis B and C, kaposi sarcoma, hairy cell leukemia, chronic myelogenous leukemia
• Interleukin 2: activates cytotoxic lymphocytes and promotes action of the immune response. adesleukin is an example.

• molecularly targeted agents
• require that the tumor cells have specific protein receptors.
• Binds to CD20 cell surface antigen of B-lymphocytes. 
• Adverse: myelosuppression, pancytopenia, tumor lysis syndrome(ARF), hypotension, night sweats, joint and muscle aches.

• Antiemetics (zofran)
• RBC stimulates: Epotein/epogen
• neutrophil stimulates: neupogen 
• platelet stimulates: neumega
• Laxatives and stool softeners.
• Granulocyte-macrophage colony stim factor-increases production of macrophages.

• —cyclophosphamide, (Cytoxan)
• doxorubicin (Adriamycin)
• methotrexate (Rheumatrex)
• vincristine (oncovin)
• tamoxifen

Are able to kill a cell during any phase of cell cycle replication. these are usually given in a bolus over 20 mins.

are only able to kill a cell during a specific phase, not during the resting phase. These are usually given in divided doses to increase efficacy