DH206: Pharmacology CH 23: Antineoplastic Drugs Lisa Mayo, RDH, BSDH Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved

DH206: PharmacologyCH 23: Antineoplastic Drugs

Lisa Mayo, RDH, BSDH

Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.


Antineoplastic Drugs Outline

Antineoplastic Agents Classification Adverse Drug Effects Dental Implications Bisphosphates


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)


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


Classification


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


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)


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)


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


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


NBQCisplatin and cyclosphamide are classified as what type of cancer chemotherapy drug?

a. Alkylating agents

b. Anthrecyclines

c. Antimetabolites

d. Vinca alkaloids


NBQCisplatin and cyclosphamide are classified as what type of cancer chemotherapy drug?

a. Alkylating agents

b. Anthrecyclines

c. Antimetabolites

d. Vinca alkaloids


Adverse Drug Effects


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


NBQWhich of the following is the most likely complication seen with chemotherapy treatment?

a. Renal failure

b. Alopecia

c. Peripheral neuropathy

d. Glaucoma


NBQWhich of the following is the most likely complication seen with chemotherapy treatment?

a. Renal failure

b. Alopecia

c. Peripheral neuropathy

d. Glaucoma


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


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


Dental Implications


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


Dental Implications


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


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


BisphosphonatesBisphosphonates

Clondronate(Bonefos)

Pamidronate(Acredia)

Zoledronate(Zometa)

Ibandronate(Boniva)

Risedronate(Actonel)

Alendronate(Fosamax)

Tiludronate(Skelid)

Etidronate(Didronel)

End in ~ronate


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


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


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


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

Documents

DH206: Pharmacology CH 23: Antineoplastic Drugs Lisa Mayo, RDH, BSDH Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved