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Cytotoxic Drugs – NCLEX Review (Nursing)

by Rhonda Lawes

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    00:00 Okay, good work.

    00:01 Now, I'm gonna breakdown these toxicities for you in a little more detail because you've got the framework, right? You already know where this information is gonna go because you remember, hair, GI, skin, reproductive, and bone marrow.

    00:13 Okay, I know that's quite a picture, isn't it? I love her personality. You can see it in there.

    00:19 Now, one of the major toxicities is obviously the high growth fraction cells of hair.

    00:25 So, goes after the hair follicles, you end up with alopecia and a significant loss of hair.

    00:30 Now, if I was experiencing this, this would be very traumatic as it would for anyone.

    00:36 But not most likely to be the highest area of question on an NCLEX exam.

    00:41 This is more of a psychosocial need and usually we deal little bit more with the physiological needs but just be aware, this is an issue with a real-life patient, we're gonna address this and help them.

    00:53 But not likely to be the hardest content on an NCLEX-type exam.

    00:57 So, you know that we lose hair.

    00:59 Patients will lose hair, but that's just one concept to be aware of.

    01:03 Here's where I want you to zero in, GI is gonna be a large percentage of what you see in patients who are on chemotherapy.

    01:11 Now, they did a fantastic job of that picture there.

    01:14 That's actually someone's open mouth.

    01:17 So, that is what used to be a healthy tongue. This is excruciating.

    01:22 We talk about GI effects, it's digestive track injury because those are high growth fraction cells.

    01:29 What you see on your screen is a picture of stomatitis, horribly intense mouth sores.

    01:36 So, how much you see this on a test? Well, if we know a patient's on chemotherapy, we know that all of these areas are at risk. 2 28 Stomatitis is a huge issue because it hurts to swallow their own spit, let alone acidic foods like tomatoes. So, they're gonna stay away from orange juice.

    01:53 Those types of things would be like acid on their tongue.

    01:56 Another area you wanna be aware of in questions, we want a patient on chemotherapy, we need them to eat.

    02:04 Their body needs nourishment to heal.

    02:06 So, where questions might come from is, do you know how to assess a patient's mouth for a patient who's on chemotherapy? That's gonna be an area where they could test you.

    02:16 So, by knowing that chemotherapy goes after the GI tract that can be stomatitis, it can be nausea and vomiting, diarrhea, any one of those adverse effects.

    02:27 I'm gonna watch for the fallout and for the signs in my patient.

    02:30 So, I'm gonna help them deal with the stomatitis and the mouth sores.

    02:33 I'm gonna recognize that it's difficult for them to eat.

    02:36 I'll look for possible fluid and electrolyte imbalances with diarrhea. For nausea and vomiting, I wanna be on top of that with medications and treatment options for them because we need to do whatever we can to help the patient eat as normally as possible so they can do the work of trying to recover from cancer.

    02:54 Now, there are certain drugs that are highly linked to causing nausea and vomiting.

    02:59 It's very common, sadly, way too common with chemotherapy drugs.

    03:04 Now, these drugs on this list, as you see them there, look they cause like a 90% or greater than 90% chance.

    03:12 So, this is a huge problem with these drugs.

    03:14 Look at the first one, are there any other lists that that drug has been on before this slide? Now, this is a moderate to severe list, so this has a 30% to 90% chance of causing nausea.

    03:27 So, just familiarize yourself with these names.

    03:30 We've put them here to help you recognize drugs that are mitogenic.

    03:33 That word, genic or genesis always means producing, right? And that is emesis producing drugs.

    03:40 Now, we talk about skin. Skin can be really sensitive.

    03:44 I really don't anticipate this would be a major area of NCLEX type of questions but know that it can happen. Really strange things happen to their skin, rashes, and redness, and peeling, and itching.

    03:55 What about this weird acne or even darkening along the vein.

    03:59 I had a friend who's Asian, whose palms turned maroon, it's really bizarre looking, but it was just a side effect of the chemotherapy that eventually went away.

    04:09 So far, hair, GI, remember, we think a lot of questions who come from there; stomatitis, nausea/vomiting, diarrhea, skin, all kinds of unpleasantness for the patient, but not necessarily likely the most intense areas for testing.

    04:24 Now, we talk about reproduction. Hey, the impact is severe.

    04:28 It's both males and females, could be temporary or permanent.

    04:32 So, it could reduce the number of sperm cells, and their ability to move.

    04:35 It can cause difficulty with an erection, with either getting one or keeping one.

    04:40 And it can also damage the chromosomes, which could lead to birth defects.

    04:45 So, this is obviously a huge issue for patients, not what I would anticipate to be a key area for testing.

    04:51 But if you're -- if you see a question one area, you might think about is that if the patient is still of reproductive age, they might consider harvesting eggs or sperm before they start the therapy.

    05:04 So as for the female side -- if we think we are very delicate hormonal creatures.

    05:12 You should see us on chemotherapy, okay, so they might also have some temporary and permanent changes but it might put them at risk for infertility.

    05:19 Your ovaries might not produce the same levels of hormones and it could throw them into menopause.

    05:25 So, besides dealing with everything that comes along with cancer, now, you're really messing with our hormone levels.

    05:31 So, we've done hair, GI, skin, reproduction, now, we're going to bone marrow.

    05:38 Now, I think the two areas I would really look for test questions to come from are GI, and bone marrow suppression.

    05:46 Because bone marrow suppression, that's where the blood cells are made, right? So, it's gonna cause a decrease in those cells.

    05:52 I'm gonna show you in the order that they're impacted.

    05:55 So, if I have a patient on chemotherapy, I'm gonna be looking at their lab work and the clinical symptoms of being low.

    06:01 But first, the neutrophils are gonna take a hit.

    06:05 That's the first group of cells to take a hit.

    06:07 Now, sadly, they're what help keep us protected from infection.

    06:11 This is why people in chemotherapy have a hard time fighting off infection.

    06:15 Low white cells is leukopenia, that just means an all-over low white cell.

    06:20 Thrombocytes, thrombocytopenia, that means I'm gonna be at an increased risk for bleeding.

    06:26 And lastly, low red cells or erythrocytes will lead to anemia.

    06:32 So, when we look at all these areas, now I think, why do I need to know this? How would it help keep a patient safe? Why do I need to know that white cells are gonna be low? Because I know this patient's gonna need special precautions to not catch an infection.

    06:46 So, they shouldn't be around anyone who has something that's contagious.

    06:49 We want to make sure that we follow extreme precautions in what they eat.

    06:54 So, where I'm from, people like really rare meat, not an option for somebody with leukopenia.

    07:00 They're gonna need to have all their meat well-cooked.

    07:03 They shouldn't be gardening and digging around in the dirt.

    07:05 Shouldn't be really be exposed to fresh things.

    07:07 Sadly, they need to have more canned and processed things so they don't risk picking up some type of bug or contaminant that a normal immune system could fight off but their immune system is not normal.

    07:20 Because the thrombocytes, you might see some things about, hey, what I'm gonna teach them about shaving? You'd want to use an electric razor.

    07:27 They notice the extra bruising, they wanna pay attention to that.

    07:30 Low red cytes, applying that information, if they have low erythrocytes, low red cells.

    07:36 But I know they're gonna be really tired, right, because they don't have enough carrying oxygen ability in their body.

    07:42 So, I'm gonna help them have to conserve energy and pick what's most important for them to do.

    07:48 So, you see the difference between memorizing list, and going "Well, yeah, that makes sense." But thinking about how could this come at me in a test question, because that's the kinda nurse you wanna be.

    07:59 That's really the purpose of test, to help you look at this information from multiple different perspectives so you'll be a better nurse.

    08:07 Alright. Here's your chance. Supercharge your memory.

    08:10 It's your chance to study as you go, so don't look at your notes.

    08:14 Go ahead and do this, I want you to think and write down the toxicities we just discussed.

    08:20 Write them in the appropriate system.

    08:22 So please pause the video now and see what your brain can remember this is when you're gonna get the best bang for your buck.

    08:33 Okay. Now, they've got some additional toxicities.

    08:37 Good work doing the work, by pausing the video and writing them as you study as you go.

    08:42 But now I wanna talk about some others I want you to consider.

    08:45 Certain drugs are toxic to the heart and the kidneys.

    08:48 Also, if the carcinogens extravasates, it means it's meant to go in a vein but if it goes into the tissues around it, that can cause severe tissue damage.

    08:58 And this is gonna sound bizarre, but some chemotherapy agents can also cause cancer.

    09:06 Okay. So, it can be really hurt the heart and kidneys.

    09:08 We've had patients die cancer free because of heart damage or renal damage.

    09:13 They've had, if the drugs slides out of the vein into the tissues, that could cause severe tissue damage and the drug itself can be carcinogenic.

    09:22 So, sometimes you'll see cytotoxic drugs.

    09:26 Same thing, we use them to treat things like arthritis, but we use them in much smaller doses.

    09:32 So, I've listed them for you there, both the generic name and the brand name because all of us have the opportunity to be exposed to these drugs in our practice, no matter what type of unit you're in, in-patient or out-patient.

    09:44 Because I know for, in our area, methotrexate, is used a lot for patients with arthritis.

    09:50 So, you'll see this drug.

    09:52 Can you see, they've even gave it a brand name of Rheumatrex, to make it sound a little bit better than a chemotherapy drug.

    09:57 But at the end of the day, they're all cytotoxic drugs. Now, I've given you some names here.

    10:03 These are just some more for you to review, so write yourself a little note to follow up with these later.

    10:08 We've got drug names up there so you'll recognize them on an exam situation that these are cytotoxic drugs.


    About the Lecture

    The lecture Cytotoxic Drugs – NCLEX Review (Nursing) by Rhonda Lawes is from the course NCLEX Pharmacology Review (Nursing).


    Included Quiz Questions

    1. Alopecia
    2. Stomatitis
    3. Acne
    4. Glossitis
    1. Stomatitis
    2. Alopecia
    3. Psoriasis
    4. Atopic dermatitis
    1. Cisplatin
    2. Ifosfamide
    3. Doxorubicin
    4. Nitrosourea
    5. Dactinomycin
    1. Reduction in the number of sperm cells
    2. Reduction in the sperm cells' ability to move
    3. Erectile dysfunction
    4. Chromosome damage
    5. Increase in the number of sperm cells
    1. Neutrophils
    2. Thrombocytes
    3. Erythrocytes
    4. Osteocytes
    5. Oocytes

    Author of lecture Cytotoxic Drugs – NCLEX Review (Nursing)

     Rhonda Lawes

    Rhonda Lawes


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