Chap. 37

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Author:
av8girl
ID:
10872
Filename:
Chap. 37
Updated:
2010-03-16 21:49:50
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Cancer pharmacology
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Description:
Targeted Therapies to Treat Cancer
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  1. 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.
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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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