Skip to content

Plant extracts for chemotherapy: Nursing Pharmacology

Notes

Notes

PLANT EXTRACTS FOR CHEMOTHERAPY
DRUG NAME & CLASS
*High Alert Medications*
vinblastine, vincristine, vinorelbine (Navelbine)
docetaxel (Taxotere), paclitaxel
etoposide (Etopopos), teniposide
bexarotene (Targretin)
thalidomide (Thalomid)
Vinca alkaloids
Antimicrotubule agents;  taxane derivatives
Podophyllotoxins
Retinoids
Angiogenesis inhibitors
MECHANISM OF ACTION
Stop replication and kill cancer cells
INDICATIONS
  • Leukemia
  • Hodgkin disease
  • non-Hodgkin lymphoma
  • Rhabdomyosarcoma
  • Neuroblastoma
  • Wilms’ tumor
ROUTE(S) OF ADMINISTRATION
  • IV
  • IV
  • IV
  • PO (etoposide)
  • IV
  • IV
SIDE EFFECTS
  • Alopecia, skin rash, photosensitivity
  • Nausea, vomiting, diarrhea, constipation, gastrointestinal bleeding
  • Hepatotoxicity (boxed warning for taxanes)
  • Vesication, phlebitis
  • Boxed warning: extravasation → tissue necrosis
  • Tumor lysis syndrome
  • Myelosuppression → pancytopenia
  • Vinorelbine, docetaxel, paclitaxel → Boxed warning: severe neutropenia
  • Taxanes, podophyllotoxins → Boxed warning: bone marrow suppression, hypersensitivity reactions
  • Vincristine, vinorelbine → Neurotoxicity: headaches, seizures, peripheral neuropathy
  • Bexarotene: Visual disturbances, lipid abnormalities, pancreatitis
CONTRAINDICATIONS AND CAUTIONS
  • Pregnancy (boxed warning for bexarotene) and breastfeeding
  • Infants
  • Bone marrow suppression
  • Vinblastine: significant granulocytopenia, bacterial infection
  • Taxanes: severe neutropenia
  • Podophyllotoxins: neutropenia, thrombocytopenia, infection, bleeding
NURSING CONSIDERATIONS:
PLANT EXTRACTS FOR CHEMOTHERAPY
ASSESSMENT AND MONITORING
  • Symptoms: fever, night sweats, weight loss, and fatigue
  • Vital signs, lymph nodes, neurological status, gastrointestinal status, pain
  • Laboratory test results: CBC with differential, renal and liver function, electrolytes, uric acid, ESR, pregnancy status
  • Diagnostic test results: X-rays, CT and PET scans, biopsy

Administration
  • Ensure adequate hydration
  • Patent IV, port-a-cath, or PICC line
  • Administer antiemetic 30–60 min before administration
  • Wear gloves and protective clothing when handling medication
  • Have extravasation antidote hyaluronidase readily available

Monitor
  • Vital signs, CBC, liver function, and renal function
  • Side effects
  • Therapeutic response: improvement in non-Hodgkin lymphoma symptoms
CLIENT EDUCATION
  • Purpose of medication: to stop the replication of the cancer cells
  • Weekly appointments for medication administration
  • Use reliable contraception during treatment
  • Report side effects
    • Increased risk of infection
    • Constipation
    • Impaired renal function
    • Neurotoxicity
    • Stomatitis
Memory Anchors and Partner Content
Transcript

Plant extracts used for chemotherapy are medications obtained from plants that can be used to treat various types of cancer, including leukemia and lymphoma, as well as rhabdomyosarcoma, neuroblastoma, and Wilms’ tumor.

These medications can be broadly divided into vinca alkaloids, which includes vinblastine, vincristine, and vinorelbine; taxanes, which include docetaxel and paclitaxel; podophyllotoxins, such as etoposide and teniposide; as well as retinoids like bexarotene; and angiogenesis inhibitors like thalidomide.

All of these medications can be administered intravenously, and etoposide can be taken orally too. Once administered, these medications stop the replication of the rapidly dividing cancer cells, and ultimately cause their death.

Unfortunately, plant extracts also act on healthy rapidly dividing cells, including those in the skin, bone marrow, and gastrointestinal tract. As a result, these medications can often cause several side effects, such as alopecia, skin rash, and photosensitivity, as well as nausea, vomiting, diarrhea, constipation, and even gastrointestinal bleeding.

Additionally, some clients may experience vesication, phlebitis, and there’s a boxed warning for extravasation, which can cause tissue necrosis.

A very dangerous complication is tumor lysis syndrome, where rapidly killing large numbers of tumor cells results in severe metabolic and electrolyte abnormalities. Another very important side effect is myelosuppression, which can lead to pancytopenia.

In fact, vinorelbine, docetaxel, and paclitaxel have a boxed warning for severe neutropenia; while taxanes and podophyllotoxins have a boxed warning for bone marrow suppression, as well as hypersensitivity reactions, such as Stevens Johnson syndrome, toxic epidermal necrolysis, and anaphylaxis.

Plant extracts can also cause hepatotoxicity, which is a boxed warning for taxanes. On the other hand, vincristine and vinorelbine can also cause neurotoxicity, which may result in headaches, seizures, and peripheral neuropathy. Finally, the retinoid bexarotene may cause side effects like visual disturbances, lipid abnormalities, and pancreatitis.

Now, contraindications of plant extracts include pregnancy, which is a boxed warning for bexarotene. Plants extracts are also contraindicated for clients who are breastfeeding, as well as for infants, and in clients with bone marrow suppression or leukopenia; while precaution should be taken in clients with thrombocytopenia, anemia, or infection.

Additionally, the vinca alkaloid vinblastine is contraindicated in clients with significant granulocytopenia or a bacterial infection. On the other hand, taxanes are contraindicated for use in clients with severe neutropenia.

Podophyllotoxins must be used with caution in clients with neutropenia or thrombocytopenia, as well as infection or bleeding.

Now, when administering a plant extract like vincristine to a client with non-Hodgkin lymphoma, first, assess their current symptoms, including fever, night sweats, weight loss, and fatigue.

Next, perform a baseline assessment, including weight, vital signs, lymph node examination, current peripheral neurological and gastrointestinal status; as well as pain location, type, quality, severity, onset, and duration.

Then, review their recent laboratory test results, specifically CBC with differential, renal and liver function, electrolytes, uric acid, ESR, and be sure to confirm a negative pregnancy test for female clients of childbearing age.

Lastly, review diagnostic test results, including X-rays, CT and PET scans, as well as biopsy results.

Sources
  1. "Adult Non-Hodgkin Lymphoma Treatment (PDQ®)–Patient Version"  (9 July 2021)
  2. "Pathophysiology of Chemotherapy-Induced Peripheral Neuropathy"  (9 July 2021)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  4. "Pharmacology" Elsevier Health Sciences (2014)
  5. "Focus on Nursing Pharmacology" LWW (2019)
  6. "Nursing Care Plans" F A Davis Company (2013)
  7. "Medical-Surgical Nursing - E-Book" Elsevier Health Sciences (2016)
  8. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)