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30.04 Anti Tumor Antibiotics

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Overview

  1. Anti-tumor antibiotics are different than antibiotics used for infections- they are a type of chemotherapy.
    1. Chemotherapy precautions must be taken
    2. Administered by chemo-certified nurses
  2. Examples of anti-tumor antibiotics
    1. Doxorubicin
    2. Bleomycin
    3. Idarubicin

Nursing Points

General

  1. Works by binding with DNA to keep it from multiplying leading to cell destruction
    1. Classification within this category is anthracyclines
      1.  Releases free radicals that damage cells.
      2. Has a max dose in a lifetime because of potentially irreversible damage 
      3. Doxorubicin is an example
        1. This one is known as the “red-devil-” it is red and very toxic 

Assessment

  1. Side effects → rapidly dividing cells more susceptible to side effects and free radical damage
    1. Bone marrow suppression
      1. Pancytopenia → low white blood cells, platelets, and low hemoglobin
      2. Risk of infection, bleeding, and anemia
    2. GI toxicities
      1. Nausea and vomiting
      2. Diarrhea
    3. Alopecia
      1. Hair loss common
    4. Organ-specific → free radical release can be toxic to organs
      1. Assess function before initiating therapy
      2. Cardiac toxicity
      3. Pulmonary toxicity

Therapeutic Management

  1. Used to treat MANY cancers and often as part of a combination of different therapies
    1. Some examples → Bladder cancer, breast cancer, and lymphomas

Nursing Concepts

  1. Cellular regulation
    1. Disrupts cell duplication by changing the DNA and releasing free radicals
  2. Lab Values
    1. WBC normal 5-10 x10-3/mL
    2. HGB normal 12-17 g/dL (depending on gender)
    3. Platelets normal 150-400 x10-3/mL
  3. Patient Education

Patient Education

  1. Infection prevention
    1. Neutropenic precautions
    2. Hand hygiene
    3. Food preparation
    4. Avoid large crowds
  2. Bleeding precautions
    1. Shaving with an electric razor
    2. Fall prevention
    3. Oral care
  3. Managing side effects
    1. Nausea
    2. Diarrhea
  4. Chemo-specific toxicities
    1. Monitor for weight gain and shortness of breath
    2. Max dose in lifetime

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Video Transcript

Okay. Hi guys. We are here today to talk about antitumor antibiotics, and these are a type of, it’s a classification of chemotherapy. Okay. So with that, we need to make sure we are adhering to chemo precautions, right? Anytime someone is on chemotherapy, there’s a lot of safety precautions that go into it. I encourage you to check out the antineoplastic lecture to learn more about precautions when administering chemotherapy, but one specific one we’re talking about with these medications is the fact that they are vesicant or a lot of them are vesicant. Not every chemo in this classification is. And that means that they are very, very damaging to the tissue if they get outside of the vein. So you just have to be very careful with administering these. These ones can cause massive cell damage tissue damage, like people needing plastic surgery if they get outside of the vein and we’re not talking about anti-infective antibiotics, so we’re treating a tumor or a cancer, right? Not an infection. And some names of these chemos you’ll hear is doxorubicin also called Adriamycin. That one’s actually also called the red devil. That’s another term for it. Bleomycin and Idarubicin. Okay. So how do these ones work? We’re talking about a general class here, right? The chemos within this classification do work a little bit differently, but basically what these chemos do is they bind to the DNA to keep it from multiplying and that leads to cell destruction. So this image here is showing how the doxarubicin will bind to this DNA strand and because it’s bound, it cannot duplicate. So that’s basically how this classification works. Anthracyclines are another sub classification of anti-metabolites and those ones release a lot of free radicals that cause damage to the tumors and the cancer cells and also damage to our organs So that has a lot to do with the side effects with this type of chemotherapy. One of those that does release a lot of free radicals is that red devil, that doxorubicin I mentioned, because it is so toxic actually to the heart. We’ll talk more about that in side effects. Also I just wanted to mention, since I said, it’s called the red devil that’s because it’s red, it’s a red medication  and that also can discolor the urine. So that’s kind of alarming to patients. Sometimes you just want to make sure we warn them. You know, there’s not something massive, huge happening. You’re not necessarily bleeding. It just might turn your urine red when you get this medication.
Okay. So side effects as with most chemotherapies, we have the bone marrow suppression and GI toxicities, and alopecia for that matter or hair loss, because these are fast growing cells, right? 

So the chemos targeting the fast growing cancer cells, but then the healthy, fast growing cells are also impacted. So we’re going to have bone marrow suppression, which causes pancytopenia or decreased white blood cells, decreased platelets and decreased red blood cells, which equals a decrease in hemoglobin so low blood counts. Right? So a lot of our side effects will have to do with that. So risk of infection, risk of bleeding, and then significant fatigue if their hemoglobin is reduced, right. GI toxicities: that’s the nausea, vomiting, diarrhea with these medications. And then hair loss is a big one with these type of medications. It’s very common. It doesn’t happen immediately. That’s important to mention it surprises people, they think, Oh, I got chemo and I still have my hair. I’m so lucky. And unfortunately it takes about a week for the hair to start falling out. 

Okay. And then organ toxicities, this is huge with antitumor antibiotics because of the release of those free radicals. Those free radicals are damaging to organs. So I mentioned briefly the heart cardiac toxicities are big. And then also pulmonary toxicities with a medication called bleomycin is a big one. And I just wanted to mention those two because we actually do tests to test the function of these organs before initiating therapy with these medications, because they can be so toxic. And because they’re so toxic, we actually have a dose max for these meds for a lifetime. You can only receive so much of a certain chemo in your entire life, or it can cause,  it can be fatal. So what do: they treat, like many chemos, they treat many cancers. It’s hard to even make a list because it’s so many, some of them are breast cancer, bladder cancer and lymphomas, but there’s multiple. 

And they are given as combination therapy often they’re combined with other chemos or other types of antineoplastics, like hormone therapy or immunotherapy therapy, that sort of thing.
Okay. So patient education, we need to talk to them about infection prevention. And again, that’s because they have low white blood cell, right? So hand hygiene food preparation is a big one, avoiding large clouds wearing their mask out in public bleeding precautions because of the low platelets, right. Watching for signs of bleeding, using an electric razor, right. That sort of thing, preventing falls. Okay. And then managing side effects, the fatigue, the nausea, vomiting, diarrhea, that sort of thing. We can talk about ways that they can manage those side effects and chemo specific toxicities is a big one need to educate our patient about, so we need to monitor for these risks. So if we’re talking about the cardiac, what do you think they need to watch for- weight gain, r
ight? That would be a big one. If they’re having shortness of breath would show kind of that fluid building up that sort of thing. And then I did briefly mention this, but there is a max dose in a lifetime. So that can limit treatment options for people. If they failed one therapy, one regimen, they might not be eligible for another one because they’ve had too much of this classification of chemotherapy. Okay. So some concepts here similar to all chemos, we’re talking about cellular regulation, right? This one specifically disrupts the DNA, right. It binds to it and prevents it from duplicating and also the free radical damage. Lab values. We’re always talking about that pancytopenia, right? Low blood counts. And then patient education is huge specifically here with the max dose in a lifetime, and the organ toxicities.
And key points. We’re kind of reviewing similar to what we just talked about. Neutropenic precautions, right? They’re at risk of infection here.  We need to always adhere to chemo precautions specifically because a lot of these meds are vesicants. There’s a max dose in a lifetime which can limit treatment options. Unfortunately that’s devastating news for patients and then organ toxicities. So we test their function before using. So sometimes we test their lung function or their cardiac function. 

All right. That’s all I have for you about antitumor antibiotics. We love you guys. Go out and be your best self today. And as always happy nursing.

 

 

Module 0 – Pharmacology Course Introduction
Module 3 – Disease Specific Medications

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