-alcohol (cancer of mouth, throat, esophagus, liver, breast)

-animal fats (cancer of colon, rectum, breast, uterus, prostate, ovary)

-act during any phase of cell cycle

-alkylating agents, antitumor antibiotics, hormones

-act during any phase of cell cycle

-antimetabolites, mitotic inhibitors

-not selective, kills cancer cells & normal cells

-side effects come from effect on normal cells

-amount of time to double

-clinically detectable at 1 cm (1 billion cells)

-have slow growth rate

-less sensitive to anticancer drugs

-have less blood supply

-slower growth rate

-need higher dose of chemo

-given in cycles to allow normal cells to recover

-can develop drug resistance (gene mutation against chemo agent)

-bone marrow suppression

-anemia (low RBC)

-neutropenia (low WBC)

-thrombocytopenia (low platelets)

-assess for fatigue, SOB, pallor, tachycardia, hypotension, LOC

-rest periods need to be planned (nap)

-elevate HOB

-O2 may be needed

-erythropoietin may be needed (stimulate RBC production)

-potential for infection

-limit visitors

-wear PPE

-monitor temp

-usual s/s of infection will be suppressed

-monitor breath sounds

-monitor WBC count

-bruising, petechaie, epistaxis (nose bleed, bleeding gums)

-avoid ASA

-avoid invasive procedures (rectal temp)

-hold pressure on injection sites

-anorexia

-N/V

-Diarrhea

-Stomatitis

-Alopecia

-fatigue

-Infertility

-small frequent meals

-altered taste due to chemo (metallic)

-ice chips, hard candy for bitter taste

-monitor weight

-chemo triggers vomitting center

-irritation of GI tract from chemo/radiation

-provide antiemetics (Ofran)

-minimize noise, odors, light

-provide mouth care (no mouthwash)

-diarrhea may be either osmotic (absorption defects), secretory (bacterial infection), or exudative (chemo-related)

-assess bowel sounds

-assess labs for dehydration

-small frequent meals

-low residue diet

-limit caffeine/carbonation, spicy, fatty, salty foods

-medicate prn

-monitor weight, electrolytes

-change in oral mucosa (redness, pain, white patches)

-frequent mouth rinses (no mouthwash)

-soft toothbrush

-ice chips/ice pops

-evaluate intake

-monitor weight

-soft foods

-thinning, patchy, baldness, complete

-gradual or rapid hair loss

-hair growth returns after chemo completed (texture, color may change)

-assess body image concerns

-multiple causes (stress, depression, pain)

-planning to conserve energy

-well-balanced diet

-encourage exercise

-stress reduction (relaxation, guided imagery)

-usually permanent

-may harvest eggs/sperm prior to chemo

-treat acute & chronic leukemia, lymphoma, multiple myeloma, solid tumors (breast, ovary, uterus, bladder, lung, stomach)

-SE: n/v, alopecia, hemorrhagic cystitis (bad bladder infection), anemia, neutropenia, thrombocytopenia, sterility,  secondary malignancies

Examples: Cytoxan, chlorambucil (Leukeran), estramustine (Emcyt)

-similar to nitrogen mustard

-severe vesicant (causes tissue necrosis)

-hepatotoxic

-need to be well-hydrated to prevent hemorrhagic cystitis; treated concurrently w/ Mesna (Mesnex) to prevent hem. cystitis

-SE: bone marrow suppression, alopecia, darkening of nail beds

-Oral or IV

-drug-drug: multiple interactions; warfarin, thiazides, digoxin, ginseng, Garlic, St. Johns wort, Echinacea

-cross blood-brain barrier, treat brain tumors

Example: carmustine (BiCNU) - treat Hodgkin's, multiple myeloma, brain tumors

-cell cycle specific

-treat leukemia, breast, lung, osteosarcoma, non-hodgkin's lymphoma

-SE: bone marrow suppression, stomatitis, n/v, alopecia, hepatic & renal toxicity

-antimetabolite drug

-folic acid antagonist (acts as substitute for folic acid)

-leucovoran given to rescue normal cells from adverse drug effects

-antimetabolite drug

-treat colorectal cancer initially, basal cell carcinoma

-IV or topical

-SE: Diarrhea may be severe

-cell cycle nonspecific

-SE: alopecia, n/v, stomatitis, leucopenia, thrombocytopenia, vesication (blistering of the skin)

Examples: Adriamycin, Bleomycin (Blenoxane), Mitomycin (Mutamycin)

-antitumor antibiotic

-treat lung, breast, ovarian, bladder, soft tissue & bone sarcoma

-Potent vesicant (very acidic)

-IV

-SE: pint-red urine for 48 hrs, n/v, stomatitis, irritation to prior irradiated skin, darkening of nails

-Adverse: cardiotoxic, CHF, myelosuppression, anaphylaxis

-drug-drug: CCB, other chemo agents, garlic, grape seed, St. John's wort

-derived from plant sources (periwinkle, yew)

-cell-cycle specific

-SE: partial to complete alopecia, allergic reactions, leucopenia, n/v/d, phlebitis, neurotoxic, joint pain, muscle weakness, loss of deep tendon reflexes

Examples: Oncovin, Vinblastice (Velban), Docetaxel (Taxotere), Paclitaxel (Taxol)

-Mitotic inhibitor, plant alkaloid

-treat Wilm's tumor, Ewing's sarcoma, brain tumors, luekemias, neuroblastoma

-severe extravasant (tissue necrosis if infiltrates)

-IV, never intrathecally (spinal)

-drug-drug: digoxin, phenytoin, Mutamycin

-SE: accute bronchospasm

-hormone that treats prostate cancer & certain types of breast cancer

Examples: diethylstilbesterol (DES), conjugated estrogens (Premarin)

-for women who have cancer w/ hotflashes

-for men who have cancer w/ prostate issues

-treat renal, breast, endometrial cancer

-shrink tumor

-SE: blood clots, fluid retention

Examples: Megestrol (Megace), Hydroxyprogesterone (Duralutin)

-male hormones that treat advanced breast cancer in premenopausal women

-shrink tumor

-can develop secondary male characteristics

-a.k.a. "anti-estrogens"

Examples: Tamoxifen (Nolvadex), Testolactone (Teslac)

-androgen that prevents tumor reoccurance

-SE: hot flashes, h/a, n/v

-androgen used as palliative tx of breast cancer

-monitor Ca+ levels

-treat hormone-responsive prostate cancer w/ metastasis

Example: Bicalutamide (Casodex)

-treat hormone sensitive breast cancer (no ovaries)

-blocks perpheral conversion of androgens to estrogens

Examples: Anastrozole (Arimidex), Letrozole (Femara)

-mediate immunity, inflammation, hematopoiesis

Examples: Interlukin, Tissue Necrosis Factor (TNF), Interferon (Intron)

-anti-inflammatory agents

-suppress inflammation on cancer cells

-suppress edema from brain tumors

-SE: euphoria, fluid retention, risk of infection, hyperglycemia, K+ loss, increased fat distribution, muscle weakness, increased bleeding tendency, suppress immune system

Examples: Cortastat, Deltasone, Solu-cortef

-corticosterioid for cancer

-IV

-corticosteroid for cancer

-IV or po

-corticosteroid for cancer

-IV