Plant extracts for chemotherapy: Nursing pharmacology

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. Next, explain to your client that vincristine will help to stop the replication of the cancer cells.

Provide them a schedule of weekly appointments for their medication to be administered. Then, let your client know that they can be at higher risk for an infection during treatment, and review infection control techniques, such as proper hand hygiene, avoiding people with infections, and large crowds; stress the importance of reporting to their healthcare provider if they develop symptoms of an infection, such as fever, sore throat, or other flu-like symptoms.

Lastly, be sure to caution your female clients to use reliable contraception during treatment, and to let their healthcare provider know right away if they become pregnant.

Then, review with your client common side effects they could experience during treatment and how to manage them. For constipation, encourage them to increase their intake of fluids and fiber, and instruct them to let the oncologist know if constipation becomes a problem.

Also, prompt them to report symptoms of impaired renal function, which can present with decreased urine output or urinary hesitancy; as well as symptoms of neurotoxicity, like numbness or tingling of the hands or feet, changes in gait, or the inability to button clothes or close zippers.

In addition, let your client know that you will be assessing these side effects at each visit. Lastly, if stomatitis develops, encourage them to avoid hot, acidic foods with rough textures and maintain good oral hygiene with gentle brushing of a soft toothbrush.Now, when preparing to administer vincristine intravenously, ensure that your client is adequately hydrated; and confirm that they have a patent large-bore IV, port-a-cath, or PICC line in place.

Be sure you have the antidote hyaluronidase readily available in case extravasation occurs. To reduce the likelihood of nausea and vomiting, administer the ordered antiemetic 30 to 60 minutes before you begin the infusion.

Lastly, be sure to always wear gloves or other protective clothing when handling the medication. During administration, and continuously throughout treatment, be sure to monitor your client’s vital signs, and watch out for the development of side effects.

In addition, instruct them to let you know right away if they experience pain at the infusion site or other symptoms.Finally, while caring for a client receiving a plant extract like vincristine, keep a close eye on their vital signs, CBC, liver function and renal function, neurological and gastrointestinal status; and monitor for the desired therapeutic response to the medication, such as an improvement in the symptoms associated with non-Hodgkin lymphoma.

Alright, as a quick recap… Plant extracts used for chemotherapy can be divided into five categories: vinca alkaloids, taxanes, retinoids, podophyllotoxins, and angiogenesis inhibitors.

All of these medications interrupt the cell cycle to stop replication of cancer cells. Side effects include nausea and vomiting, constipation, and alopecia; in addition, vincristine can also cause peripheral neuropathy and urinary problems.

When caring for a client taking a plant extract, nursing considerations include performing a baseline assessment, monitoring for the development of side effects, as well as for the desired therapeutic effect.

Client teaching is focused on recognition of and management of side effects and when to notify the healthcare provider.