ANTHELMINTICS
 Group of drugs that affect various systems
within the worms, causing them to die
 Most of these drugs are poorly absorbed in
the gastrointestinal tract
 Approximately 98% of the drug remains
effective as it passes through the GI tract and is
excreted in the feces
Pyrantel
Action: paralyzes intestinal tract of worm
Use: roundworm, pinworm, hookworm
Adverse Effects: n/v, anorexia, abdominal cramping,
diarrhea
Nursing Implications:
1.) give with milk or fruit juice
2.) entire dose must be taken at once
3.) offer small frequent meals
Mebendazole
Action: inhibits glucose and other nutrient uptake of
helminth
Use: roundworm, pinworm, threadworm, hookworm
Adverse Effects: abdominal cramping
ANTINEOPLASTIC AGENTS
 Destroy cancer cells and may also kill
normal cells
 Clients must be closely monitors due to
many toxic adverse effects
 General Adverse Effects: n/v, anorexia,
diarrhea and constipation, stomatitis, alopecia,
bone marrow depression (leucopenia, anemia
and thrombocytopenia), hepatic toxicity,
hyperuricemia, fatigue
 Nursing Implications:
1.) Handle antineoplastic agents carefully –
mutagenic and possibly carcinogenic
2.) Nurses should wear gloves, long-sleeved
cover gown, protective goggles and mask as
appropriate
3.) Monitor IV site closely to assess for
extravasation and stop IV if it occurs
4.) Treat used equipment as hazardous waste
5.) Administer antiemetic if ordered as prior to
chemotherapy and up to 48 hours afterwards
6.) Inspect oral cavity daily
ALKYLATING AGENTS
Prototype: Cyclophosphamide (Cytoxan)
Action: produces cytotoxic effects by damaging DNA
and interfering with cell replication
Thiabendazole
Action: interferes with parasitic metabolism
Use: threadworm, pinworm
Adverse Effects: dizziness, drowsiness, headache,
n/v, malodor of urine
Nursing Implications:
1.) give with food
2.) chew tablets before swallow
3.) avoid activities such as driving and working with
machineries
Praziquantel
Action: enhances permeability of the cell membranes
of the parasite to calcium
Use: schistosomes and flukes
Adverse Effects: headache, dizziness, abdominal
pain, increased liver enzymes
Nursing Implications:
1.) give with food or liquids
2.) do not chew
3.) do not breastfeed
7.) Monitor CBC, I & O, liver and renal function
tests
 Discharge Teaching:
1.) Eat frequent small portions of high-calorie,
high protein, bland, low-residue foods
2.) Avoid highly seasoned foods, drink clear
liquids if nauseated
3.) Frequent rest periods
4.) Expect alopecia and purchase scarves and
wigs
5.) Repeat fever, use good hand-washing
technique, avoid individuals with URTI
6.) Use soft toothbrush and baking soda, rinse
to minimize stomatitis
7.) Use progressive relaxation exercises or
liquid imagery to help cope with nausea
Use: leukemias, multiple myeloma, neuroblastoma,
ovarian, breast, lung cancers, Hodgkin’s disease,
Ewing’s sarcoma
Adverse Effects: hemorrhagic & nonhemorrhagic
cystitis, gonodal suppression
Nursing Implications: Related Drugs:
1.) force fluids 1.) Cisplatin
2.) assess for signs & symptoms of unexplained 2.) Busulfan
bleeding 3.) Chlorambuc
3.) assess leukocyte count frequently
4.) instruct client to report hematuria or dysuria
immediately

ANTIMETABOLITES

Prototype: Methotrexate with Leucovorin Adverse Effects: hemorrhagic & nonhemorrhagic

Action: Leucovorin calcium is a folic acid analog that cystitis, gonodal suppression
interferes with mitotic process by blocking folinic acid Nursing Implications: Leucovorin calcium is frequently
Use: acute lymphoblastic leukemia, cancer of breast, given to prevent toxicity when high doses of
lung, testes, ovary, head and neck, choriocarcinoma methotrexate are given

ANTIBIOTIC ANTINEOPLASTIC AGENTS

Prototype: Doxorubicin HCl (Adriamycin) 3.) do not mix with other drugs
Action: attaches to DNA and prevents DNA synthesis 4.) frequent mouth care
in vulnerable cells 5.) client needs sufficient fluids to prevent
Use: cancer of thyroid, lung, bladder, breast and hyperuricemia
ovary, acute leukemia, sarcoma, Ewing’s sarcoma, 6.) urine is red colored for 1-2 days after
neuroblastoma, lymphomas administration – clears within 48 hrs.
Adverse Effects: n/v, hyperpigmnetation of skin and Related Drugs:
nails, alopecia, stomatitis, agranulocytosis 1.) Bleomycin
Nursing Implications: 2.) Dactinomycin
1.) do not give SC or IM – local reaction & skin 3.) Daunorubicin
necrosis can occur 4.) Mitomycin
2.) IV use: reconstitute with normal saline or sterile 5.) Plicamycin
water; protect from sunlight; red steaking over vein
and facial flushing are signs of too rapid
administration

ANTINEOPLASTICS AFFECTING HORMONAL BALANCE

Estrogen Nursing Implications: monitor WBC count

1.) Diethylstilbestrol (DES) – for breast & prostate
cancer
2.) Ethinyl Estradiol – for breast & prostate cancer
– monitor males for signs & symptoms of
feminization
Androgen
1.) Fluoxymesterone – for breast & renal cancer
2.) Testosterone Cypionate – for breast cancer
Antihormonal Agents
1.) Antiestrogen – Tamoxifen (Nolvadex)
Use: advanced breast cancer in pre & post
menopausal women
Adverse Effects: most common are similar to signs
& symptoms of menopause (not flashes & flushing),
n/v, decreased WBC
MITOTIC INHIBITORS
2.) Antiadrenal - Aminoglutethamide
Use: adrenal & metastatic breast cancer
Adverse Effects: adrenal insufficiency, severe
pancytopenia
Nursing Implications: may cause drowsiness,
orthostatic hypotension
3.) Gonadotropin Releasing Hormone – Leuprolide
(Lupron)
Use: prostate cancer
Adverse Effects: hot flashes, hematuria
Nursing Implications: monitor & rotate injection
sites
Prototype: Vincristine (Oncovin) Nursing Implications:
Action: acts on cells undergoing mitosis thus stopping 1.) do not give IM or SC
cell division 2.) can be given through direct IV over 1 minute
Use: acute leukemia, lymphoma, cancer of breast, 3.) monitor bowel function & neurochecks
brain, cervix, testes, Wilm’s tumor Related Drugs:
Adverse Effects: peripheral neuropathy, paresthesias, 1.) Etoposide
loss of deep tendon reflex, jaw pain, cramps, 2.) Vinblastine
constipation, stomatitis, n/v, phlebitis, hyponatremia, 3.) Pacitaxel
leucopenia, alopecia, photosensitivity

MISCELLANEOUS ANTINEOPLASTIC AGENTS

A. L - Asparaginase C. Procarbazine
Action: enzyme that destroys aspagise, an amino acid - similar to alkylating agents
necessary for protein synthesis of leukemia cells Use: Hodgkin’s disease, multiple myeloma, malignant
Use: acute lymphocytic leukemia melanoma
Adverse Effects: anorexia, n/v, anaphylaxis, Adverse Effects: altered reproductive potential,
hepatotoxicity, hemorrhagic pancreatitis anorexia,n/v, leukopenia
Nursing Implications: don’t shake vial Nursing Implications: drug is a MAO-inhibitor; avoid
* only give drug in a clear solution tyramines

B. Hydroxyurea
Action: urea derivative that kills granulocytes;
prevents DNA synthesis in cell cycle
Use: chronic myelogenous leukemia, malignant
melanoma, cancers of head, neck, ovary

IMMNOSUPPRESSANTS

Prototype1: Azathioprine
Action: not fully understood
Use: adjunct to prevent rejection of renal
transplants,severe rheumatoid arthritis
Adverse Effects: hypersensitivity, pancreatitis,
hypotwension, pulmonary edema, hepatoxicity,
secondary infection, alopecia, n/v, anorexia
Nursing Implications: monitor for signs & symptoms of
infection and rejection; take with food
Related Drug:
Mycophenolate – Used to prevent and treat
rejection of renal transplants
Prototype 2: Cyclosporine
Use: Prophylaxis for recipients of kidney, heart and
liver transplants to prevent organ rejection
Adverse Effects: Anaphylaxis in IV use, nephrotoxicity
hepatoxicity, hypertension, infections, tremors and
hyperplasia.
Nursing Implications:
1. With IV use epinephrine
2. Protect IV infusion from light
3. Mix PO medication in milk or orange juice at room
temperature
Related Drug:
Tacrolimus - Used to prevent rejection with kidney,
heart and liver transplants; given orally or IV.

HEAVY METAL ANTAGONISTS

1.) Deferoxamine Mesylate

- for iron intoxication
- may turn urine red 2.) Edetate Calcium Disodium (Calcium EDTA)
- use infusion - for renal poisoning
pump - can cause renal toxicity
- may cause - may increase ICP; do not give IV if with
hypotension, tachycardia, allergic reaction and pain encephalopathy.
on injection.
3.) Dimercaprol (BAL in Oil) 4.) Edetate Disodium (Disodium EDTA)
- given IM in combination with Ca EDTA to treat lead - for hypercalcemic crisis
poisoning
- also used to treat arsenic, mercury, and gold toxicity
- painful on injection and can cause hypertension and
tachycardia in large doses

HERBAL DRUGS

1.) Gingko Biloba 9.) Saw Palmetto

- improves memory - for enlarge prostate and urinary inflammation
- increase blood pressure - mild diuretic
- increase risk of bleeding - contraindicated in pregnancy and lactation

2.) St. John’s Wort 10.) Valerian

- antianxiety, anti-inflammatory, antidepressive and - Mild sleep aid
sedative agent - muscle relaxant
- decrease effectiveness of Digoxin - for relieve of nervous stomach
- intensity or prolong effects of narcotics and - for stress relief
anesthetic agents - contraindicated in infants and pregnant women

3.) Ginseng
- increase physical stamina and mental concentration
- potential for bleeding in post-menopausal females
- contraindicated in pregnancy and lactation

4.) Garlic
- lower cholesterol & triglyceride level and blood
pressure
- fibrinolytic
- antimicrobial
- potential for increase bleeding especially for
individuals taking anti-clotting medications

5.) Feverfew
- prevent migraine, headaches, arthritis, and
rheumatic diseases
- contraindicated in pregnancy and lactation

6.) Kava-Kava
- for nervousness, anxiety or restlessness
- used as muscle relaxant
- antispasmodic, anticonvulsant
- potential for increase effects of certain antiseizure
medications, intensifying psychoacting agents
- contraindicated in pregnancy and lactation

7.) Licorice
- expectorant, anti-inflammatory, anti-allergic, for
stomach ulcers

8.) Ginger
- for motion sickness, n/v, vertigo, stomach aches, aid
in digestion
- potential for increased bleeding in clients already
taking anti-clotting medication