Antineoplastics

• Antineoplastics

  • CCS -> Antimetabolites, Alkylating agents, Vinca Alkaloids
  • CCNS -> Antitumor antibiotic, Antitumor antibiotics, Hormones
• Cell Cycle Specific (CCS) antineoplastics


  • Exert their influence during a specific phase of the cell cycle and are most effective against rapidly growing cancer cells
  • Not effective in G0 phase (resting)
  • Work best in S phase and M phase
• Cell Cycle Nonspecific (CCNS) antineoplastics

  • Acts during any phase of the cell cycle including G0 phase (dormant phase)
  • Most effective against proliferation cells
  • More toxic, High dose= leukemia
• Combination therapy using multiple antineoplastic agents helps:

  1. increase ability to kill cell
  2. hit cells at different points synergistic effect
  3. overcome drug resistance
  4. increase cancer cell destruction
• Nursing interventions for patients receiving antineoplastic agents

  • Dose based on BSA (height and weight)
  • Multiple independent checks prior to administration
• Common side effects of antineoplastic drugs

  • Myelosuppression (decreased RBC, WBC, platelets)
  • GI disturbances (nausea, vomiting, constipation, diarrhea, anorexia, weight loss, stomatitis/ulcers, reflux)
  • Hair loss, fatigue, pain
  • Skin changes, infection, weakness
  • Dehydration
  • Cardiac, pulmonary issues
• Symptom management for antineoplastic side effects

  1. Antiemetic drugs + steroids 30-60 minutes prior

  2. Proton pump inhibitors to decrease acid/nausea

  3. Antidiarrheal or laxative medications

  4. Antibiotics for immunocompromised patients

  5. Nursing interventions: referral to specialist, monitor labs/bleeding/infection, monitor IV site
• Biologic response modifiers (BRMs)

  • Substances naturally produced by the body and those developed in the lab
  • Kill cancer cells directly and indirectly
  • Enhance immune system's ability to kill abnormal cells
  • Change cancer cells to act like healthy cells
  • Inhibit normal cells from changing into cancer cells
  • Enhance body's ability to repair/replace damaged cells
  • Prevent cancer from metastasizing
• Epoetin


  • Stimulates RBC production in the bone marrow
  • Used for anemia due to CRF or cancer chemotherapy, in patients with renal disease
• Filgrastim


  • Regulates production of neutrophils
  • Administered 24 hours after chemo
  • Used for myelodysplastic syndrome, myelosuppressive cancer chemo, severe aplastic anemia/neutropenia, bone marrow transplant
• Dosing:

  BSA = height and weight

  Multiple Independent Checks occur prior to administration of chemo

  • BSA, Vital signs, lab work, assess the patient

  HOLD Chemotherapy if:

  • S/S of severe dehydration
  • Fever (> 100.5 F of 38.0 C)
  • Presence of neutropenia or thrombocytopenia -> low no chemo
  • Tumor complications (PE, blood clot, DIC)
• Chemo SE: Myelosuppression:

  1. Decreased RBC (anemia)
  2. Decreased WBC (neutropenia)
• Chemo SE: GI

  1. N/V
  2. Constipation
  3. Diarrhea
  4. Anorexia
  5. Weight loss
  6. Stomatitis/ulcers
  7. Reflux
• Chemo SE: Thrombocytopenia

  1. decreased platelets
  2. Increase bleeding
• Other SE for chemo:

  1. Hair loss (alopecia), fatigue, pain
  2. Skin changes, infection, weakness
  3. Dehydration
  4. Cardiac (SOB), Pulmonary
• Side Effect Symptom Management

  Pharmacologic Intervention:

  1. Antiemetic drugs (Zofran) + steroid 

  • 30-60 minutes prior to chemo 

  1. Proton pump inhibitors 

  • decrease acid, nausea 

  1. Antidiarrheal or laxative medications 

  • If the patient is dehydrated they cannot get chemo 

  1. Antibiotics 

  • Patient are immunocompromised, you do not want them to get an infection 
• Fligrastim SE


  SE: CNS: HA/dizziness GI:anorexia, Other: alopecia, skin rash, flu-like symptoms
• Epstein Patient Education


  Patient education: monitor hemoglobin, do not shake vial, discard after single use
• When do you administer Fligrastim?

  24 hr AFTER chem0
• Epoetin SE

  CNS: HA, fatigue

  CV:HTN, thrombosis

  MS: myalgia, arthralgia
• Hold Chemo for signs of?

  severe dehydration, fever, neutropenia, thrombocytopenia, or tumor complications