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30.05 Plant Alkaloids Topoisomerase and Mitotic Inhibitors

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Overview

  1. Plank alkaloids are derived from plants
    1. Often a combination of natural and synthetic ingredients
  2. They are a type of chemotherapy
    1. Chemo precautions are maintained
    2. Administered by chemo certified nurses
  3. They can be broken down into several classifications based on the plant they come from
    1. Taxanes → from yew trees
      1. Docetaxel
      2. Paclitaxel
    2. Vinca alkaloids → from the periwinkle plant
      1. Vincristine
      2. Vinblastine
    3. Camptothecins → tree found in China
      1. Irinotecan
    4. Epipodophyllotoxins → from the mandrake plant
      1. Etoposide

Nursing Points

General

  1. These chemos work at different times during the cell cycle to prevent duplication of the cell resulting in cell destruction

Assessment

  1. Side effects → rapidly dividing cells more susceptible to side effects during the cell cycle
    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 → can be severe!
    3. Neuropathy
      1. Can be dose-limiting
    4. Hypersensitivity reaction
      1. Overwhelming immune response
        1. Can progress to an anaphylactic response
        2. Pre-medicate to prevent
      2. Can be a delayed reaction

Therapeutic Management

  1. Used to treat MANY cancers and often as part of a combination of different therapies
    1. Some examples → leukemias, lung cancer, pancreatic cancer

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. Managing side effects
    1. Nausea
    2. Diarrhea
  3. Signs of hypersensitivity reaction
    1. Rash
    2. Fever
    3. Edema
    4. Shortness of breath
    5. Tachycardia

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Video Transcript

All right. Hi guys. Today, we’re talking about plant alkaloids which is a classification of chemotherapy. You’ll also hear many sub classifications within this broad category of chemotherapies. And two of those names I want to mention are miotic inhibitors and topoisomerase. I’m sorry. I don’t even know how to say that appropriately- inhibitors. And those are just different ways to classify this broad category of chemotherapies. So these are chemos, right. So we need to make sure we’re adhering to chemotherapy precautions: with that includes making sure your chemo certified nurse, if you’re giving these meds. And I mentioned that specifically with these particular chemos, I mean, all chemotherapies fall within this category, but you really want someone with experience giving these meds because they have a high risk of hypersensitivity reaction. And we’re going to talk about that later, but you definitely want to have some experience with these meds before you give them.

And for other chemotherapy precautions, I encourage you to check out the antineoplastic lesson for considerations with administering chemo. Okay. So the cool thing about these types of chemotherapy or that they’re all derived from plants, which makes sense, they’re called plant alkaloids, right? So they’re a semi-synthetic derivative. So of course there’s other things in them, this isn’t, you know, straight plant extract that we’re giving these patients, but they’re derivatives from these plants. So taxanes are one of the classifications of these meds and these ones actually come from yew tree- just so fascinating. Right? And some of those meds you’ll hear is doxataxal and paclitaxel. Okay. Vinca alkaloids are another type and those are actually from the Perry Winkle plant and you’ll hear vincristine or vinblastine remember that VIN. Camptothecans- I’m sorry if I’m saying wrong, these ones actually come from a tree in China with the same name, and one of those is iranotecan. I’ll talk more about that one specifically later. And then the last one is at  podophyllotoxins toxins. Again, I might be butchering that name, but these ones are derived from the mandrake plant. And this is a picture of that plant there. The medication that I’m referring to here is etoposide. So there’s several chemos within this category and they all work a little bit different. These plants don’t always work in this same waybut the thing that they all have in common is they inhibit cell division. So they most often work within the M phase of the cell cycle. Not always, but usually it’s in that M phase. So their cell cycle specific. And that’s really important when we’re giving chemotherapy to know that, because we need to know that it works at a specific point within the cell cycle. 

So we need to make sure that this chemotherapy is in the bloodstream when the cancer cells are in this point of the cell cycle. So we give these chemotherapies more often than other chemos to try to hit the cancers when they’re in the right point of the cell cycle. Okay. And this picture here is just a reminder of all the steps that are within the M phase of cell replication. So there’s several processes within that phase and these target different parts  of that cell duplication.
Okay. So side effects, like most chemotherapies, these are targeting rapidly dividing cells, right? So we’re going to have toxicity related to healthy rapidly dividing cells also being destroyed in the process. So we have bone marrow suppression. You’re going to hear also bone marrow suppression or pancytopenia that comes with that. So I’ve written this so many times in these chemo lectures, sorry if you’re seeing it so many times, but Hey, we hear it a lot of times and it sticks, right? 

So that’s low white blood cells, low platelets and low red blood cells, which equals low hemoglobin. So we’re at risk of infection, risk of bleeding and pretty severe fatigue. We might need some blood transfusions for that low hemoglobin, right. GI toxicities are pretty significant with these ones, all chemos have this a little bit, right then nausea, vomiting, diarrhea. Diarrhea is a really big one, especially with the chemotherapy.Yyou heard me say earlier Iranotecan- And you know what I remember this medication as: I run to the can, which is kind of gross to think about, but it causes a very severe diarrhea. So in addition to things like lomotil that you would give, you know, everyone with diarrhea, we even give atropine for the severe diarrhea for these patients. So it can be pretty bad. And then neuropathy is a pretty big one with this medication. So that’s the numbness and tingling to the extremities. And it can be so severe that it is dose limiting 

Make sure we’re always assessing our patients for that numbness and tingling. And this is huge. I mentioned this at the beginning: hypersensitivity reaction. So the toxins released by these plants can cause the immune system to respond overwhelmingly to these medications. So it’s an overwhelming immune response. What does that sound like? An anaphylactic reaction, right. And that’s what can happen with these meds. So we often pre-medicate with something like Tylenol and Benadryl, even Claritin and H two blockers too. So we hit them with all of these meds to try to prevent a hypersensitivity reaction. Cause of course that would also be dose limiting. Right? And then I just want to mention it doesn’t always happen during the infusion. This hypersensitivity reaction can be delayed, which is pretty scary, right? You think that if they’re not going to have an allergic reaction, it’s going to happen right away, but that’s not always the case. It can happen even days later with some of these meds.
So what do they treat? Like most chemotherapies, they treat many different cancers and they are given as a combination therapy. So many people are given different chemos within one regimen to hit the cancer at all kinds of different angles, right? But some of the cancers they treat are leukemias, lung cancer, and pancreatic cancer, along with other ones.
Patient education is important with all chemos, right? And we need to talk to your patients about preventing infection, of course. And what are those neutropenic precautions, if their neutrophils or their absolute neutrophil count is low. So hand hygiene preparing their food appropriately, avoiding large crowds, all of that sort of stuff. Managing side effects are really important with these ones. Because, remember, those severe GI toxicities. And the signs of hypersensitivity reaction, especially because it can occur delayed, right? 
So what are those signs? We can have a rash, we can have a fever. We can have edema- that fluid is escaping, right? We can have shortness of breath and tachycardia or a high heart rate.
So nursing concepts with plant alkaloids: cellular regulation with all chemo, right? Working to prevent the cell from dividing indifferent ways. Right? Lab values are super important here because they’re talking about that pancytopenia. And then patient education always so, so important with patients who are receiving chemotherapy.
Okay. So some key points here to wrap up the lesson, this is a chemo, right? So we need to make sure we’re adhering to all chemo precautions. They are plant derivatives, which is just pretty fascinating, right? How we discovered these sort of things can treat cancer. Semi-synthetic compounds, right? There is a risk of hypersensitivity reaction. This is a really important one with these types of medications. So we pre-medicate and educate, right? And they are a cell cycle specific. So they’re given over a longer time and more frequent dosing to make sure that they’re within the bloodstream at the right time to treat the cancer. 

All right, guys, we love you, 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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