DH206: Pharmacology CH 23: Antineoplastic Drugs Lisa Mayo, RDH, BSDH Copyright © 2011, 2007 Mosby,...
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Transcript of DH206: Pharmacology CH 23: Antineoplastic Drugs Lisa Mayo, RDH, BSDH Copyright © 2011, 2007 Mosby,...
DH206: PharmacologyCH 23: Antineoplastic Drugs
Lisa Mayo, RDH, BSDH
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Antineoplastic Drugs Outline
Antineoplastic Agents Classification Adverse Drug Effects Dental Implications Bisphosphates
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Antineoplastic Drugs
Designed to treat neoplasms that cannot be treated with surgery
Can be used in combo with surgery & radiation Called “Cancer chemotherapeutic agents” Most TOXIC drugs on market – interfere with
cellular DNA (healthy & cancer cells)
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Antineoplastic Drugs
Some cancers resistant to chemo by:1. De novo resistance: neoplams was ALWAYS resistant
to drugs
2. Acquired resistance: Resistance occurs through mutation of neoplasms
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Classification
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ClassificationAntineoplastic agents divided into 2 categories
1. Cell-cycle-specific (CCS) antineoplastic agentsAffect cells that are actively multiplying
2. Cell-cycle-nonspecific (CCNS) antineoplastic agentsKill cells that are actively multiplying or at restMore toxic than CCS
CCS DRUGS ACTION
Antimetabolites DNA synthesis inhibitors
CCNS DRUGS ACTION
Alkylating Agents DNA alkylating drugs
Antitumor ABX
Plant Alkaloids
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ClassificationCCS DRUGS
ANTIMETABOLITIES
Cladribine(Leustatin)
Cytarabine(Cytosar-U)
Floxuridine(FUDR)
Fludarabine phosphate(Fludara)
Fluorouracil Gemcitabine(Gemsar)
Meracaptopurine(Purinethol)
Methotrexate(Mexate)
Pentostatin(Nipent)
CCNS DRUGS: ALKYLATING AGENTS
Altretamine(Hexalen)
Busulfan(Myleran)
Chloramubucil(Leukeran)
Carboplatin(Paraplatin)
Cisplatin(Plantinol)
Cyclophosphamide(Cytoxan)
Ifofamide(Ifex)
Lomustine(CeeNU)
Melphalan(Alkeran)
Mitomycin(Mutamycin)
Mechlorethamine HCl(Mustargen)
Procarbazine HCl(Matulane)
Streptozocin(Zanosar)
Thiotepa(Thioplex)
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ClassificationCCNS DRUGS: ANTITUMOR ABX
Bleomycin(Blenoxane)
Danunorubicin HCl(Cerubidine)
Doxorubicin HCl(Adriamycin)
Idaribicin HCl(Idamycin)
CCNS DRUGS: PLANT ALKALOIDS
Mitotic Inhibitors Vinblastine(Velban) Vincristine(Oncovin)Vinorelbine(Navelbine)
Taxanes Docetaxel(Taxotere)Paclitaxel(Taxol)
Topoisomerase Inhibitors
Topotecan(Hycamtin)Etoposide(VePesid)Teniposide(Vumon)Irinotecan(Camptosar)
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ClassificationOther agents used in tx:
DRUG CLASS USESFlutamide(Eulexin)
Leuprolide(Lupron)
Prednisone Systemic steroid Lymphomas & Leukemia
Tamoxifen(Novadex) Antiestrogen Breast cancer
IMMUNOMODULATORS(CYTOKINES)
Aldesleukin(Proleukin)
Interferon alfa
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Classification
Oncologists “hit hard and fast” with drug therapyMany drugs have to stopped due to side effects
(infection, decrease WBC)Cancer cells become resistant to drugs with time
so “hit hard” with high doses cetuximab(Erbitux) FDA approved in 2006 for tx
squamous cell carcinoma head/neck + radiation
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NBQCisplatin and cyclosphamide are classified as what type of cancer chemotherapy drug?
a. Alkylating agents
b. Anthrecyclines
c. Antimetabolites
d. Vinca alkaloids
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NBQCisplatin and cyclosphamide are classified as what type of cancer chemotherapy drug?
a. Alkylating agents
b. Anthrecyclines
c. Antimetabolites
d. Vinca alkaloids
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Adverse Drug Effects
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Adverse Drug Effects
Table 23-2, p.259 Side effects due to non-selectivity of drugs
○ Faster growing cells affected the most (GI tract, bone marrow, hair follicles)
○ Early side effects are seen in these tissues Most common
○ Nausea & vomiting○ Bone marrow suppression = leads to leukopenia = ↑ risk for
serious infections & thrombocytopenia○ Hair loss, dry skin
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NBQWhich of the following is the most likely complication seen with chemotherapy treatment?
a. Renal failure
b. Alopecia
c. Peripheral neuropathy
d. Glaucoma
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NBQWhich of the following is the most likely complication seen with chemotherapy treatment?
a. Renal failure
b. Alopecia
c. Peripheral neuropathy
d. Glaucoma
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NBQAll of the following are adverse effects of antineoplastic treatment EXCEPT which one?
a. Mucositis of dorsum of tongue
b. Gingival bleeding
c. Xerostomia
d. Stomatitis
e. Thrush
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQAll of the following are adverse effects of antineoplastic treatment EXCEPT which one?
a. Mucositis of dorsum of tongue
b. Gingival bleeding
c. Xerostomia
d. Stomatitis
e. Thrush
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
Dental Implications
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
40% patients on chemo drugs will have
oral side effectsDENTAL COMPLICATION
NOTATION
Xerostomia Preventive & Palliative Care
Caries Root caries
Oral mucositis Difficult to maintain oral hygiene at homeOccurs within 1wk starting chemoCHX should be recommended
Esophagitis Damage to mucosal lining leads to dysphagia (swallowing difficulty)
Oral candidiasis Due to leukopenia
Bacterial infections Premed may be necessary due to leukopenia
Taste Alterations: esp sweet & salty
Bleeding & Impaired healing
Result of thrombocytopenia & neutropenia
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Dental Implications
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Dental Implications Avoid working on patients right AFTER they stop drug therapy
Bone marrow depression still present, WBC count too lowRefer to Box 23-3 & 23-4 on page 260
ORAL CARE BEFORE TX
ORAL CARE DURING TX
ORAL CARE AFTER TX
Extract questionable teeth
Med consult Resume normal care
OHI Premed may be needed
Tx any infections Tx depends on neutrophil count
Monitor pt’s closely
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Bisphosphonates 1st developed as drugs as alternative for HRT &
osteoporosis1996: aldendronate(Fosamax)
Action: ↓ actions of osteoclasts Cancer patients: Excessive Ca is released in
the blood & bone is resorbedIV bisphos’s used to tx
OsteoradionecrosisIV bisphos’s + dental extractions, surgery, endo,
ortho, SCRP = Cause alterations to bone deposition & repair = osteoradionecrosis
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BisphosphonatesBisphosphonates
Clondronate(Bonefos)
Pamidronate(Acredia)
Zoledronate(Zometa)
Ibandronate(Boniva)
Risedronate(Actonel)
Alendronate(Fosamax)
Tiludronate(Skelid)
Etidronate(Didronel)
End in ~ronate
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NBQA patient is taking zolendronate(Zometa) for pain from multiple myeloma (a cancer.) Which of the following conditions can develop after periodontal debridement?
a. Orthostatic hypotension
b. Malignant hypertension
c. Osteoradionecrosis of the jaw
d. Multiple periodontal abscesses
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQA patient is taking zolendronate(Zometa) for pain from multiple myeloma (a cancer.) Which of the following conditions can develop after periodontal debridement?
a. Orthostatic hypotension
b. Malignant hypertension
c. Osteoradionecrosis of the jaw
d. Multiple periodontal abscesses
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQYour patient with a history of breast cancer is undergoing chemotherapy with a drug called cisplatin(Platinol). All of the following are expected adverse effects of cisplastin EXCEPT which one?
a. Nausea and vomiting
b. Hair loss
c. Xerostomia
d. Brain hemorrhages
e. Changes within the tissues of the oral cavity such as mucositis
Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.
NBQYour patient with a history of breast cancer is undergoing chemotherapy with a drug called cisplatin(Platinol). All of the following are expected adverse effects of cisplastin EXCEPT which one?
a. Nausea and vomiting
b. Hair loss
c. Xerostomia
d. Brain hemorrhages
e. Changes within the tissues of the oral cavity such as mucositis