APHON Pediatric Chemotherapy-Biotherapy Renewal

Small Molecule Inhibitors Shelly Tolley, BSN RN CPHON® Ruth Anne Herring, MSN APRN CPNP CPHON®

Learner Outcomes Upon completion of this Pediatric Chemotherapy and Biotherapy Provider Program learning activity 1. the learner will be able to identify four small molecule inhibitors that can be given as extemporaneous liquid preparations 2. the learner will be able to demonstrate proper safe handling practices for administering small molecule inhibitors 3. the learner will be able to name four medications or foods that could increase serum concentrations of small molecule inhibitors, resulting in the possibility of increased side effects ***** Small molecule inhibitors are a class of targeted therapies that are becoming more common in pediatric oncology. Nurses can readily identify drugs in this category by their generic name, which ends in “-nib,” “-imus,” or “-stat.” Most small molecule inhibitors are administered orally (notable exceptions are bortezomib and temsirolimus, which are given intravenously). Oral small molecule inhibitors have a short half-life, so they must be administered daily. Small molecule inhibitors are classified by the intracellular pathway that they target (this will be discussed below).

Pathophysiology General Pathophysiology

Every cell in the human body has a set of internal regulatory pathways designed to control four cellular functions that are essential to the life of the cell: cell growth, cell proliferation, cell survival, and cell death. These basic functions are regulated by external signals sent from outside the cell. The external signal is a protein—a cytokine or a hormone, for example—and it carries a message that needs to be delivered to the nucleus within the cell. On the surface of the cell are receptors that are designed to receive specific signals. Once received, the signal is modified (transduced), and it unlocks a designated pathway in the interior of the cell that will transport the message to its destination. The signaling pathway includes a series of waypoints, like locked doors, that the message will need to pass through on the way to its destination in the nucleus of the cell. At each waypoint, the signal may be amplified or modified in a way that enhances its