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PREPARING
CHEMOTHERAPEUTIC
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DRUGS

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SUBMITTED TO: Ms. Ivy Jade
Castaos,RN,MAN
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SUBMITTED BY: Capendit,
Sunshine BSN IV

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IV
Nuez, Mary Joy BSN

pasdfghjklzxcvbnmqwertyuio June 15, 2016

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 OBJECTIVES
After 8 hours of classroom discussion and demonstration, the Level IV
students will be able to:

1. define the following terms:

1.1 chemotherapy
1.2 radiation
1.3 metastasis
1.4 proliferation
1.5 benign
1.6 malignant
1.7 neoplasm
2. review the anatomy and physiology of the normal cell cycle
3. state the purpose of chemotherapy
4. discuss the different types of chemotherapy
5. identify the indications and contraindications of chemotherapy
6. differentiate the different classifications of chemotherapeutic agents
7. explain the guidelines in preparation and administration of
chemotherapeutic drugs
8. discuss the nursing roles and responsibilities in the management of
common side effects of chemotherapy
9. explain the possible complications of chemotherapy
10. enumerate the safety precautions of internal radiation therapy
11. list down the materials needed for the procedure
12. enumerate the nursing responsibilities before, during and after
the procedure
13. demonstrate beginning skills in preparing chemotherapeutic
drugs

Chemotherapy- use of medications to kill tumor cells by interfering with

cellular functions and reproduction
Radiation- the emission of energy as electromagnetic waves or as moving
subatomic particles, especially high-energy particles that cause ionization

Metastasis- spread of cancer cells from the primary tumor to distant sites

Proliferation- the growth or production of cells by multiplication of parts

Benign- not cancerous; benign tumors may grow but are unable to spread to
other areas

Malignant- having cells or processes that are characteristic of cancer

Neoplasm- is an abnormal growth of tissue and when it also forms a mass is

commonly referred to as a tumor

ANATOMY & PHYSIOLOGY OF THE NORMAL CELL CYCLE

Cell Life Cycle- is the series of changes a cell goes through from the time it
is formed until it divides

Two Major Periods

Interphase- the cell grows and carries on its usual metabolic activities

Cell division- cell reproduction

Events of Cell Division

Mitosis- division of the nucleus

Cytokinesis- division of cytoplasm

Mitosis results in the formation of two daughter nuclei with exactly the
same genes as the mother nucleus

Stages of Mitosis
 Prophase- Chromatin in the nucleus begins to condense and becomes
visible in the light microscope as chromosomes. The nucleolus disappears.
Centrioles begin moving to opposite ends of the cell and fibers extend from
the centromeres. Some fibers cross the cell to form the mitotic spindle.

Metaphase- Spindle fibers align the chromosomes along the middle of

the cell nucleus. This line is referred to as the metaphase plate. This
organization helps to ensure that in the next phase, when the chromosomes
are separated, each new nucleus will receive one copy of each chromosome

Anaphase- The paired chromosomes separate at the kinetochores and

move to opposite sides of the cell. Motion results from a combination of
kinetochore movement along the spindle microtubules and through the
physical interaction of polar microtubules.

Telophase- Chromatids arrive at opposite poles of cell, and new

membranes form around the daughter nuclei. The chromosomes disperse
and are no longer visible under the light microscope. The spindle fibers
disperse, and cytokinesis or the partitioning of the cell may also begin during
this stage.

PURPOSE OF CHEMOTHERAPY
Cure cancer

when chemotherapy destroys cancer cells to the point that your doctor
can no longer detect them in your body and they will not grow back

Control cancer

when chemotherapy keeps cancer from spreading, slows its growth, or

destroys cancer cells that have spread to other parts of your body.

Ease cancer symptoms (also called palliative care)

when chemotherapy shrinks tumors that are causing pain or pressure.

Types of Chemotherapy

1. Single-agent chemotherapy

Treatment with one type of chemotherapy drug, rather than with a

combination of different chemotherapy drugs.

2. Combination chemotherapy

Means the use of two or more chemotherapy drugs for the purpose of
treating cancer. It is the most effective method used for treating
various types of cancer and also helps to relieve the symptoms of this
disease.

Indications of Chemotherapy

1. Patient with cancer

Chemotherapy is used to kill cancer cells in people with cancer.
2. Patient who will undergo surgery or radiation therapy
Chemotherapy can make a tumor smaller before surgery or radiation
therapy
3. Patient with Bone marrow diseases.
Diseases that affect the bone marrow and blood cells may be treated
with a bone marrow stem cell transplant. Chemotherapy is often used
to prepare for a bone marrow stem cell transplant.
4. Patient with Immune system disorders.
Lower doses of chemotherapy drugs can help control an overactive
immune system in certain diseases, such as lupus and rheumatoid
arthritis.
Contraindications of Chemotherapy

1. First trimester pregnancy

Chemotherapy has high potential of birth defects and other adverse
events. Some types of chemotherapy drugs are safe to administer
during the second and third trimester of pregnancy, although there is
still an increased risk of stillbirth and intrauterine growth restriction.
2. Thrombocytopenia
Chemotherapy drugs can cause low blood counts. Any pre-existing
blood count issues need to be managed before initiation of
chemotherapy
3. Liver or kidney impairment
Since most chemotherapy drugs are metabolized by the liver or
kidneys, liver or kidney impairment or failure is contraindication to
chemotherapy. Some drugs can be given in patients with decreased
liver or kidney function, but the dosage needs to be adjusted for the
amount of function that is present
4. Recent Surgery
Chemotherapy can interfere with the healing of any wounds. Once the
surgical wound has healed, chemotherapy can be started
5. Infection
Chemotherapy lowers blood cell counts so that the body would have a
difficult time fighting the infection. Overwhelming sepsis could occur,
which would pose a more immediate risk to the patient than the
cancer.

Different Classification of Chemotherapeutic Drugs

1. Cell Cycle-Specific Agent- chemotherapeutic agents that are specific to

certain phases of the cell cycle. These agents destroy cells that are actively
reproducing by means of the cell cycle.

2. Cell Cycle- Nonspecific Agent-chemotherapeutic agents that act

independently of the cell cycle phase. These agents usually have a
prolonged effect on cells, leading to cellular damage or death.
Drug Class & Mechanism of Cell Common Side
Examples Action Cycle Effects
Specificit
y

Alkylating Agents Alter DNA Cell cycle- Bone marrow

Busulfan, carboplatin, structure by nonspecifi suppression,
chlorambucil, cisplatin, misreading DNA c nausea,
cyclophosphamide, code, initiating vomiting, cystitis
dacarbazine, hexamethyl breaks in the (cyclophosphami
melamine, ifosfamide, DNA molecule, de, ifosfamide),
melphalan, nitrogen cross-linking DNA stomatitis,
mustard, oxiliplatin, strands alopecia,
thiotepa gonadal
suppression,
renal toxicity
(cisplatin)

Nitrosureas Similar to Cell cycle- Delayed and

Carmustine(BCNU), alkylating nonspecifi cumulative
lomustine (CCNU), agents; cross the c myelosuppressio
semustine (methyl blood-brain n, especially
CCNU), steptozocin barrier thrombocytopeni
a; nausea,
vomiting

Topoisomerase I Induce breaks in Cell cycle- Bone marrow

Inhibitors the DNA strand nonspecifi suppression,
Irinotecan, topotecan by binding to c diarrhea,
enzyme (S phase) nausea,
topoisomerase I, vomiting,
preventing cells hepatotoxicity
from dividing

Antimetabolites Interfere with the Cell cycle- Nausea,

5-Azactadine, biosynthesis of nonspecifi vomiting,
capecitabine (Xeloda), metabolites or c diarrhea, bone
cytarabine, edatrexate nucleic acids (S phase) marrow
fludarabine, 5- necessary for suppression,
fluorouracil (5-FU), FUDR, RNA and DNA proctitis,
gemcitabine, synthesis stomatitis, renal
hydroxyurea, leustati, 6- toxicity
mercaptopurine, (methotrexate),
methotrexate, hepatotoxicity
pentostatin, 6-
thioguanine

Antitumor Antibiotics Interfere with Cell cycle- Bone marrow

Bleomycin, dactinomycin, DNA synthesisby nonspecifi suppression,
daunorubicin, binding DNA; c nausea,
doxorubicin (Adriamycin), prevent RNA vomiting,
idarubicin, mitomycin, synthesis alopecia,
mitoxantrone, plicamycin anorexia, cardiac
toxicity
(daunorubicin,
doxorubicin)

Mitotic Spindle
Poisons Arrest Cell cycle- Bone marrow
Plant alkaloids: metaphase by nonspecifi suppression
etoposide, teniposide, inhibiting mitotic c (mild with VCR),
vinblastine, vincristine tubular formation (M phase) neuropathies
(VCR), vindesine, (spindle); inhibit (VCR), stomatitis
vinorelbine DNA and protein Bradycardia,
Cell cycle-
synthesis hypersensitivity
Taxanes: paclitaxel, nonspecifi
Arrest reactions, bone
docetaxel c
metaphase by marrow
(M phase)
inhibiting tubulin suppression,
depolymerization alopecia,
neuropathies

Hormonal Agents Bind to hormone Cell cycle- Hypercalcemia,

Androgens and receptor sites nonspecifi jaundice,
antiandrogens, estrogens that alter cellular c increased
and antiestrogens, growth; block appetite,
progestins and binding of masculinization,
antiprogestins, estrogens to feminization,
aromatase inhibitors, receptor sites sodium and fluid
luteinizing hormone- (antiestrogens); retention,
releasing hormone inhibit RNA nausea,
analogues, steroids synthesis; vomiting, hot
suppress flashes, vaginal
aromatase of dryness
P450 system,
which decreases
estrogen level

Miscellaneous Agents Unknown or too Varies Anorexia,

Asparaginase, complex to nausea,
procarbazine categorize vomiting, bone
marrow
suppression,
hepatotoxicity,
anaphylaxis,
hypotension,
altered glucose
metabolism

Safe Handling During the Preparation of Cytotoxic Drugs

Admix all chemotherapeutic agents in a biological safety cabinet

(laminar air flow with HEPA filtration) that meets standards and has
been inspected properly.
All admixing of chemotherapeutic agents must be done in the
pharmacy by a well-trained pharmacist.
Wear latex powder free long cuff gloves while preparing chemotherapy
drugs. Wear a gown that is non-permeable, long sleeve, cuffed and
solid fronted and use aerosols free mask.
Work over a suitable container to prevent the spread of any spillage.
Prevent high pressure being generated inside sealed vials. When fluids
are introduced an equivalent volume of air should be withdrawn or a
venting needle with a hydrophobic filter (to prevent aerosol formation)
may be used if available.
Ampules should be directed away from the face and covered with a
suitable pad or cotton when broken open.
Diluent fluids should be introduced slowly into open-ended ampules or
vials. Running it down the vessel wall and ensuring the drug powder is
moist before shaking.
 When excess air is expelled from a filled syringe it should be exhausted
into a pad and not straight into the atmosphere.
If excess drug is to be expelled from a filled syringe it should be
removed first and a sterile cotton wool placed over the end of the
syringe to prevent possible scatter of aerosol droplets.
Luer lock fittings should be used in preference to push connections on
syringes, tubing, and IV sets.
All labeled bottles should be labeled properly (it's mandatory).
Check the reconstitute or diluents for the particular drug and the
concentration in which it is to be reconstituted.

Safe Handling During Administration

Spill kits must be available in all areas that administer cytotoxic drugs.
The spill kit should include the following:
Spill Kit Content:
o Double latex gloves.
o water-proof gown.
o Mask & eye goggles.
o Shoes cover.
o Spill kit sign.
o Scupper & brush.
o Absorbent sheet.
o Double labeled plastic bag.
The person who transports cytotoxic drugs should be oriented to the
hazards of cytotoxic agents.
Transporting cytotoxic drugs from pharmacy to delivery area should be
in a leak-proof container.
Wash hands thoroughly before and after administration of cytotoxic
drugs.
Wear personal protective equipment (double disposable surgical latex
gloves, long sleeved non absorbent gown with elastic at the wrist,
mask, and eye goggles if required) when administering cytotoxic drugs
because splash may occur.
Explain to the patient and family that chemotherapy is harmful to
normal cells as well, so they should use protective measures to
minimize exposure to these agents.
Gloves should be changed and hands washed immediately after
obvious contamination of the gloves with chemotherapy or after any
patient contact.
Staff nurse should not eat, drink, chew gum, or store food in immediate
chemotherapy administration area during activities.
Place a plastic- backed absorbent pad under the tubing during
administration to catch any leakage.
 Flush IV lines and clear air from tubing with IV fluid (not chemotherapy)
to minimize aerosolizing or splashing.
When expelling bubbling from a syringe, cover the tip of the needle
with dry sterile gauze.
Dont dispose any supplies or unused cytotoxic drugs in patient care
area.

Roles and Responsibilities of Oncology Nurse

1. Direct caregiver- provide, guide and evaluate nursing practice

2. Educator- provides health teaching about chemotherapy to the patient

3. Consultant- provide expertise about oncology

Possible Complications of Chemotherapy

1. Extravasation- when vesicants are deposited into the subcutaneous tissue

that can cause tissue necrosis and damage to underlying tendons, nerves
and blood vessels.

Management

medication is stop immediately

ice is applied to the site (unless the extravasated vesicant is vinca
alkaloid)
physician may aspirate any infiltrated medication from the tissue and
inject neutralizing solution into the area to reduce tissue damage

2. Nausea, vomiting and diarrhea- most common side effects because the
vomiting centers in the brain are stimulated

Management

antiemetic medication
small frequent meals
bland foods
relaxation techniques and imagery

3. Myelosuppression ( depression of bone marrow resulting in decreased

production of blood cells which increases the risk of infection and bleeding)

Management
 frequent monitoring of blood cell count
protect patient from infection and injury
agents with colony stimulating factor(erythropoietin) can be
administered after chemotherapy

4. Kidney damage- chemotherapeutic agents can damage the kidney

because of their direct effect during excretion and the accumulation of end
products after cell lysis

Management

monitor BUN, creatinine and electrolyte levels

adequate hydration
alkalinization of urine
allopurinol

5. Early menopause, permanent sterility, azoospermia(men)

Management

inform the patient and their partner about potential changes in

reproductive functioning
advised reliable method of birth control
sperm banking before initiation of chemotherapy

6. Fatigue and Hair loss

Management

encourage several rest period

inform client that hair loss is expected

Internal radiation therapy (brachytherapy)

Internal radiation is also called brachytherapy. It uses a radioactive

source thats put inside the body in or near the tumor.

RADIATION SAFETY PRECAUTIONS

To minimize exposure, you need to take five routine precautions:

1. Recognize radiation sources.

Make sure you are aware of the source of the hazard.
 Be sure that you are authorized to be in the posted area (and if not,
do not enter it)
Take appropriate precautions to reduce exposure and avoid
contamination
Do not handle material labelled as radioactive unless you are
trained and authorized to do so
2. Reduce your exposure time.
o Make sure in advance that you have everything you need so that
you can complete necessary procedures near a radiation source
as quickly as possible.
3. Increase your distance from radiation.
o Radiation levels vary inversely with the square of the distance
from their source that is, levels decrease sharply with
distance. The farther away you place yourself, the less radiation
you are exposed to.
4. Shield yourself from radiation.
o Shielding will also reduce the level of radiation. Shielding is very
effective with x-rays. Wear a lead apron, where provided. If your
hands may be in the-ray beam, wear lead gloves unless doing so
would compromise patient care. Use lead shields when available.
5. Avoid radioactive contamination
Wear gloves, a gown, and shoe covers if indicated.
Avoid contact with objects or areas that maybe contaminated.
Dont eat, drink, or smoke in areas where radioactive materials are
in use.
Dont apply cosmetics or groom your hair while in the area.
Wash your hands when leaving the area.
Read and follow all signs and instructions.

And remember: Dont handle radioactive materials unless you are

trained and authorized to do so

Materials Needed in Chemotherapy

IV fluid ordered to be infused plaster

(D5LR or NaCD) scissors
IV Line disposable needles
2 pairs of gloves chemotherapeutic drugs
70% alcohol ampules of pre- meds

Nursing Responsibilities in Chemotherapy

 Before

read/ check doctors order: name of patient, drugs, equipment to be

prepared
inform the patient about the procedure. let the patient sign the
consent
prepare all the materials needed
do medical handwashing
provide privacy

During

put on gloves
disinfect drug with cotton ball with alcohol
prepare the drug
hand over the syringe to the doctor
close the IV line
monitor patient's reaction and vital sign while the doctor is infusing the
drug

After

discard the materials placing it in a plastic bag

assess the patients reaction
do documentation (reaction of the patient, time and drug given)