Nursing Pharmacology: Miscellaneous Anticancer Drugs
Hepatic metabolism
Mechanism of Action:
DNA intercalation: produces single-and double-strand breaks
interaction with topoisomerase II-DNA complexes
Clinical Uses:
Anthracyclines- and cytarabine-resistant acute myelogenous leukemia
Advanced ovarian cancer
Lymphomas
Adverse Effects:
Does-limiting hepatic toxicity
Cardiac arrest has been noted with amsacrine infusion
Asparaginase (El-spar):
Mechanism of action: depletion of serum asparagine (forming aspartic acid and ammonia(
Decreased blood levels of asparagine and glutamine inhibit protein synthesis in those neoplastic cells that express decreased levels of asparagine synthase.
Most normal cells express sufficient levels of asparagine synthase to avoid toxicity.
Mechanism of action:
Inhibits ribonucleotide reductase; depletes deoxyribonucleoside triphosphate pools
Acts at S phase.
Clinical Uses:
Melanoma [secondary role]
Chronic myelogenous leukemia [secondary role]
Adverse Effects:
Bone marrow suppression
nausea
vomiting
diarrhea
Mitoxantrone (Novantrone):
Mechanism of action:
Induces DNA strand breaks
Inhibits RNA and DNA synthesis
Clinical Uses:
Refractory acute leukemia
Pediatric and adult acute myelogenous leukemia
non-Hodgkin's lymphoma's
breast cancer
Adverse Effects:
Dose-limiting: leukopenia
mild nausea
vomiting
stomatitis
alopecia
some cardiotoxicity (arrhythmias(
Mitotane (Lysodren):
Clinical Use:Single indication-- adrenal carcinoma
Reduces excessive steroid secretion
Adverse Effects:
diarrhea
mental depression
skin eruption
anorexia
nausea
somnolence
dermatitis
Clinical Uses:
Remissions -- acute promyelocytic leukemia
13-cis-Retinoic acid: chemopreventive -- second primary tumors in patients with hand and neck squamous cell carcinoma.
Adverse Effects:
skeletal effects
hepatic effects
teratogenic effects
mucocutaneous effects
Bone Marrow Growth Factors (sargramostim and filgrastim):
Reduces neutropenic sepsis and other complications of chemotherapy
Filgrastim shortens neutropenic state following induction chemotherapy for acute nonlymphocytic leukemia.
Cytoprotective from
effects of chemotherapy