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Topoisomerase Inhibitors | 마이메르시 MyMerci
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Topoisomerase Inhibitors

NCLEX Review Guide: Topoisomerase Inhibitors

Overview of Topoisomerase Inhibitors

Mechanism of Action

  • Topoisomerase inhibitors block enzymes that relieve tension in DNA strands during replication, causing DNA damage and cell death in rapidly dividing cancer cells.
  • These medications are cell cycle-specific, targeting cells in S-phase (DNA synthesis) and G2-phase of mitosis.

Memory Aid: "TOP-o the Morning"

Topoisomerase inhibitors Obstruct DNA Process

Key Points

  • Two main types: Topoisomerase I inhibitors (irinotecan, topotecan) and Topoisomerase II inhibitors (etoposide, teniposide)
  • Primary use in colorectal, ovarian, lung, and hematological cancers

Major Drug Classifications

Topoisomerase I Inhibitors

  • Irinotecan (Camptosar): Used primarily for colorectal cancer, causes severe delayed diarrhea that can be life-threatening.
  • Topotecan (Hycamtin): Indicated for ovarian and small cell lung cancer, associated with significant myelosuppression.

Topoisomerase II Inhibitors

  • Etoposide (VePesid): Used for testicular cancer, lung cancer, and lymphomas, can cause hypotension with rapid IV infusion.
  • Teniposide (Vumon): Primarily for pediatric acute lymphoblastic leukemia, requires careful monitoring for hypersensitivity reactions.

Critical Nursing Considerations

Major Side Effects

  • Severe myelosuppression: Monitor CBC with differential, platelet count, and absolute neutrophil count before each cycle.
  • Delayed diarrhea with irinotecan: Can occur 24-48 hours after administration and may require hospitalization for fluid replacement.
  • Nausea and vomiting are common but manageable with appropriate antiemetic protocols.
  • Alopecia occurs in most patients and is usually reversible after treatment completion.

Immediate vs. Delayed Diarrhea (Irinotecan)

Immediate (During infusion)Delayed (24-48 hours later)
Treat with atropine 0.25-1mg IVTreat with loperamide aggressively
Cholinergic responseMore severe, life-threatening

    Irinotecan Diarrhea Management Protocol

  1. First loose stool: Start loperamide 4mg immediately
  2. Continue loperamide 2mg every 2 hours until diarrhea-free for 12 hours
  3. If diarrhea persists >24 hours, consider hospitalization for IV fluids
  4. Monitor for signs of dehydration and electrolyte imbalances

Administration Guidelines

Pre-administration Assessment

  • Verify adequate bone marrow function: ANC >1500/mm³, platelets >100,000/mm³
  • Assess baseline liver and kidney function as these drugs require dose adjustments in organ dysfunction.
  • Obtain baseline vital signs and weight for fluid balance monitoring.

During Administration

  • Etoposide must be infused slowly (over 30-60 minutes minimum) to prevent hypotension and bronchospasm.
  • Use non-PVC tubing and containers as etoposide can leach plasticizers from PVC.
  • Monitor for hypersensitivity reactions, especially with first dose of teniposide.

Clinical Scenario

A patient receiving irinotecan develops severe diarrhea 36 hours post-infusion with 8 loose stools in 12 hours. Priority nursing actions include: immediate loperamide administration, IV fluid replacement, electrolyte monitoring, and physician notification for possible hospitalization.

Patient Education & Monitoring

Essential Patient Teaching

  • Teach patients to report diarrhea immediately, especially with irinotecan therapy, as delayed treatment can be life-threatening.
  • Emphasize infection precautions due to immunosuppression: avoid crowds, wash hands frequently, report fever >100.4°F immediately.
  • Instruct on bleeding precautions: use soft toothbrush, electric razor, avoid NSAIDs and aspirin.
  • Advise patients that hair loss is temporary and typically begins 2-3 weeks after first treatment.

Memory Aid: "DIME" for Topoisomerase Monitoring

Diarrhea management
Infection prevention
Myelosuppression monitoring
Electrolyte balance

Key Points

  • Delayed diarrhea with irinotecan is dose-limiting and potentially fatal
  • Etoposide infusion rate is critical - too fast causes hypotension
  • All topoisomerase inhibitors cause significant myelosuppression

Commonly Confused Points

Topoisomerase I vs II Inhibitors

Topoisomerase ITopoisomerase II
Irinotecan, TopotecanEtoposide, Teniposide
Severe delayed diarrheaHypotension with rapid infusion
Colorectal, ovarian cancersTesticular, lung, lymphomas

Common Pitfalls

  • Don't confuse immediate vs delayed diarrhea with irinotecan - treatments are different
  • Never give etoposide as IV push - always infuse slowly over 30-60 minutes
  • Don't forget to use non-PVC tubing with etoposide

Quick Check Self-Assessment

  • ☐ I can identify the two main types of topoisomerase inhibitors
  • ☐ I understand the difference between immediate and delayed diarrhea with irinotecan
  • ☐ I know the proper infusion rate for etoposide and why it matters
  • ☐ I can list the major side effects requiring monitoring
  • ☐ I understand key patient teaching points for infection and bleeding precautions

Remember: You're preparing to save lives and provide compassionate care. Every concept you master brings you closer to becoming the excellent nurse your patients will depend on. Stay focused, stay positive, and trust in your preparation!

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