Pharm, part 45: Immune Medications - Cancer

by Cathy Parkes September 24, 2021 Updated: March 13, 2022 9 min read

In this article, we continue our coverage of immune system medications, specifically medications used for the treatment of cancer.

The Nursing Pharmacology video series follows along with our Pharmacology Second Edition Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

Cool Chicken When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!

Common side effects of cancer medications

There are hundreds and hundreds of medications that could be used to treat cancer. We are going to focus on six specific medications that are among the most important to know: doxorubicin, vincristine, cyclophosphamide, leuprolide, tamoxifen, and interferon.

These medications share many, if not all of side effects, including:

  • Gastrointestinal upset (nausea and vomiting). This side effect is common to every single one of these medications. It is important to provide antiemetics to the patient prior to administration of these medications. Do not wait until nausea and vomiting is happening — proactively administer antiemetics for a patient prescribed these drugs.
  • Alopecia (hair loss).
  • Bone marrow suppression. Many of these medications have a side effect of bone marrow suppression, which can cause anemia, neutropenia, and thrombocytopenia (decreased red blood cells, white blood cells, and platelets, respectively).
    • A patient with anemia may have shortness of breath and experience fatigue. They may also have pallor.
    • A patient with neutropenia will have decreased white blood cells, which means they will be at a higher risk for infection.
    • A patient with thrombocytopenia will have decreased platelets, which puts them at risk for bleeding.

doxorubicin (Adriamycin)

Cool Chicken Ruby = red; Red discoloration of secretions. Heart = red (cardiac toxicity).

Doxorubicin is used to treat solid tumors.

As noted in the Cool Chicken mnemonic, ruby means red, which will help you remember that this medication causes red discoloration of secretions. Red can also help you remember that this medication can affect the heart and cause cardiac toxicity (when a side effect of treatment leads to damage to the heart muscle or valves).

Mode of action of doxorubicin

The mode of action of doxorubicin is to bind to the patient's DNA, inhibiting DNA and RNA synthesis. This causes the death of rapidly replicating cells, like cancer cells.

Side effects of doxorubicin

Doxorubicin is a potent medication with some very serious side effects, including GI upset, alopecia, bone marrow suppression (anemia, neutropenia, thrombocytopenia), cardiac toxicity, and red discoloration of the patient’s urine, sweat, and tears.

This medication carries a black box warning due to the risk for bone marrow suppression and cardiac toxicity. It may also cause leukemia in the patient.

Nursing care for patients receiving doxorubicin

In terms of nursing care, administer antiemetics for nausea and vomiting, monitor the patient for infection. It's also important to monitor the patient's cardiac function and CBC levels.

Vincristine

Cool Chicken Vin = wine in French. If you drink too much wine, you can’t feel your arms and legs (neuropathy).

Vincristine is used to treat a variety of tumors and cancers.

Mode of action of vincristine

The mode of action of vincristine is to stop cell division during mitosis (M phase specific). It does not cause bone marrow suppression, unlike other cancer medications.

Side effects of vincristine

Although vincristine does not cause bone marrow suppression, it does cause peripheral neuropathy, phlebitis (inflammation of the vein at the administration site), GI upset, and alopecia.

Vincristine also carries a black box warning due to the risk for phlebitis.

cyclophosphamide (Cytoxan)

Cyclophosphamide is another medication used to treat a variety of tumors and cancers. Note that unlike vincristine, cyclophosphamide may cause bone marrow suppression.

Mode of action of cyclophosphamide

The mode of action of cyclophosphamide is to inhibit protein synthesis by interfering with DNA and RNA synthesis.

Side effects of cyclophosphamide

Side effects of cyclophosphamide include GI upset and alopecia. A unique side effect with this medication is that it causes hemorrhagic cystitis, which is inflammation and bleeding from the bladder.

Nursing care for patients receiving cyclophosphamide

In terms of nursing care, advise the patient to increase their fluid intake to help counteract the risk for hemorrhagic cystitis.

Monitor the patient's CBC levels.

When administering this medication, always wear gloves and immediately wash hands after administration.

leuprolide (Lupron)

Cool Chicken Dr. Lou lied to me about the side effects of leuprolide! He didn’t tell me about hot flashes, gynecomastia (an increase in the amount of breast gland tissue in boys or men), etc.

Leuprolide is used to treat prostate cancer and endometriosis.

Mode of action of leuprolide

The mode of action of leuprolide is to act as a synthetic form of LHRH (luteinizing hormone releasing hormone, which facilitates reproductive behavior). This decreases the level of testosterone in the testes. It also reduces pain and lesions in endometriosis.

Side effects of leuprolide

Side effects of leuprolide include hot flashes, gynecomastia, bone pain, decreased libido, GI upset, and dysrhythmias (irregular heart beats).

Nursing care for patients receiving leuprolide

It is important that the patient increase their intake of calcium and vitamin D. Monitor the patient's PSA (it should be < 4.0ng/mL) and testosterone levels during therapy.

You can learn more about PSA lab values and more with our Lab Values Study Guide & Flashcard Index, a list of lab values covered in our Lab Values Flashcards for nursing students.

tamoxifen (Nolvadex)

Cool Chicken Tammy is a foxy lady who is fighting breast cancer.

Tamoxifen is used for the prevention and treatment of breast cancer.

Mode of action of tamoxifen

The mode of action of tamoxifen is to compete with estrogen for binding sites in the breasts, stopping the growth of estrogen-dependent cancer.

Side effects of tamoxifen

The side effects of tamoxifen include hot flashes, vaginal bleeding, increased risk of thromboembolism (PE, DVT, stroke), hypercalcemia, bone pain, and the increased risk of uterine and endometrial cancer.

Tamoxifen comes with a black box warning, due to its many serious side effects.

Nursing care for patients receiving tamoxifen

Monitor the patient's CBC and calcium levels during therapy. Also, advise the patient to report bone pain.

interferon alpha-2b (Intron A)

Cool Chicken Interferon Interferes with cancer by enhancing the body’s immune response.

Interferon alpha-2b is a medication used to treat cancers as well as viral infections like hepatitis.

Mode of action of interferon alpha-2b

Interferons are proteins that enhance the body's immune response to tumors or viruses. Interferon alpha-2b also helps to slow cancer proliferation.

Side effects of interferon alpha-2b

There are many side effects of interferon alpha-2b, including flu-like symptoms (fever, muscle aches, chills, lethargy).

It can cause bone marrow suppression, cardiotoxicity (heart toxicity), hepatotoxicity (liver toxicity), dyspnea (difficulty breathing), alopecia, and GI upset.

Interferon alpha-2b carries a black box warning due to psychiatric, autoimmune, ischemic (reduction in blood flow), and infectious disorders.

Nursing care for patients receiving interferon alpha-2b

Monitor the patient's liver function, their cardiac function, and their blood levels.

For in-depth studying on ABGs and to learn how to interpret ABGs, please check out ourArterial Blood Gas Interpretation Flashcards and video series onABG Interpretation.


Full Transcript

Hi, I'm Cathy, with Level Up RN. In this video, I'm going to continue my coverage of immune system medications.

Specifically, I will be talking about medications used for cancer. Be sure to stay till the end of the video because I'm going to give you guys a quiz to test your knowledge of some of the key concepts I'll be covering in this video. Also, if you have our pharmacology flashcards, pull those out so you can follow along with me. It definitely takes repetition to learn this information. And before I get started into talking about specific medications for cancer, I wanted to go over some side effects that are common across many or all of the medications I'm about to cover.

So one side effect common to every single one of these medications I'm going to cover is gastrointestinal upset. So nausea and vomiting. So as a nurse, you're going to want to provide antiemetics to your patient prior to administration of these medications. You don't want to wait until nausea and vomiting is happening. Also, many of these medications have a side effect of alopecia, which is hair loss. And then also, many of these medications have a side effect of bone marrow suppression, and this bone marrow suppression causes anemia, neutropenia, and thrombocytopenia. So we're going to have decreased red blood cells, white blood cells, and platelets. So what does this mean for your patient? Well, that anemia may cause them to have shortness of breath and be fatigued. They may have pallor.

With neutropenia, because we have decreased white blood cells, your patient is going to be at higher risk for infection.

And with thrombocytopenia, your patient will have decreased platelets, which puts them at risk for bleeding. So I just wanted you to keep these things in mind so I didn't go through the same information over and over when we go through these specific medications.

There are obviously hundreds and hundreds of medications that could be used to treat cancer. I'm going to go through six specific medications that I think are most important to know. I'm not going to go through all the details that you can find on our flashcards, but I will definitely try to hit some of the highlights. The first medication I want to go over is doxorubicin.

Doxorubicin would be used to treat solid tumors.

Side effects of doxorubicin include GI upset, alopecia, and red discoloration of the patient's urine, sweat, and tears.

This medication also carries a black box warning due to the risk for bone marrow suppression, cardiac toxicity, and it could also cause the patient to get leukemia. So definitely a potent medication with some very serious side effects.

In terms of nursing care, you're going to want to monitor the patient for infection. You're definitely going to want to monitor their cardiac function as well as their CBC levels.

In terms of our cool chicken hint for how to remember this medication and some of the key side effects, if you look at doxorubicin, it's got that ruba like ruby, which is red. And if you remember that ruby means red, then that will help you remember that this medication causes red discoloration of secretions. Red can also help you remember that this medication can affect the heart and cause cardiac toxicity.

Our next medication is vincristine, which is used to treat a variety of tumors and cancers. It does not cause bone marrow suppression, unlike a lot of other cancer medications.

However, it does cause peripheral neuropathy, as well as GI upset, and alopecia.

It also carries a black box warning due to the risk for phlebitis, which is inflammation of the vein at the administration site.

So our little cool chicken hint for remembering this medication and a key side effect of this medication, if you look at vincristine, it starts with vin, it means wine in French. So if you drink too much wine, you won't be able to feel your arms and legs. So that helps you remember vincristine causes peripheral neuropathy.

Okay. Next, we have cyclophosphamide.

This is also used to treat a variety of tumors and cancers. It does cause bone marrow suppression.

Other side effects include GI upset as well as alopecia. And the unique side effect with this medication is that it causes hemorrhagic cystitis, which is inflammation and bleeding from the bladder.

So in terms of nursing care, you're going to want to advise your patient to increase their fluid intake to help counteract that risk for hemorrhagic cystitis. Also, you're going to want to monitor the patient's CBC levels. At any time you're administering this medication, you want to wear gloves and immediately wash your hands after administration. So I don't have a little trick for remembering cyclophosphamide. So if you do have a trick, then definitely leave it in the comments.

The last medication I want to cover in this video is interferon alpha-2b, which is a medication that is used to treat cancers, as well as viral infections such as hepatitis.

It works by enhancing the body's immune response to tumors or viruses, and it helps to slow cancer proliferation as well.

This medication has many, many side effects, including flu-like symptoms, which includes fever, chills, malaise, fatigue, and body aches. It can also cause bone marrow suppression, cardiotoxicity, hepatotoxicity, dyspnea, so difficulty breathing, alopecia, and GI upset.

As if that wasn't enough, it also carries a black box warning due to psychiatric, autoimmune, ischemic, and infectious disorders. So very serious medication with some very serious side effects.

So nursing care will include monitoring the patient's liver function, their cardiac function, and their blood levels as well.

A little cool chicken hint for remembering this medication is that interferon interferes with cancer by enhancing the body's immune response.

All right. Time for Quiz. I have three questions for you. First question, what cancer medication causes red discoloration of the urine, sweat, and tears? The answer is doxorubicin. Question number two, what cancer medication causes peripheral neuropathy? The answer is vincristine. Question number three, what cancer medication causes hemorrhagic cystitis? The answer is cyclophosphamide.

Okay. I hope you did well on that quiz. Hope you're enjoying these little quiz questions. If you need to review the material again, it's totally okay. Just go back and look at the flashcards, take them on a walk. With a little repetition, you got this. Take care and good luck studying.


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