Taxing, taxiing, tacksing, talcing, talking

Mainly tax, yes, you have to say talking with an accent to make it work but since when did I care? Does it relate to the topic at hand? Nope. What is that topic you ask? Ok I guess cause I like you, paclitaxel, docetaxil, and cabazitaxel. The first two are quite ubiquitous in cancer treatments for a wide range of cancer types. They belong to the taxane family and were originally derived from the yew tree. Which is good for my family since I just planted one. Oh? It doesn’t work that way? Damn. 

On a tangent (oh no you would never!) it is incredible to me how many medications originally derived from nature. Ok it makes sense that they might appear somewhere. But the evolutionary process to have a yew create a compound like paclitaxel? I didn’t do any research but I would guess that’s not why the tree has it but it is just an incidental compound. Either way. Nature = cool. 

Why do you care? For me, it goes beyond interest and into the repercussions these medications have on patients that I care for. Post chemo, some of the taxane recipients need lots of medical support, the same can be said for many others. As a nurse, it is critical to know what to look out for, what is expected, and what are the worst adverse events. 

As mentioned in the intro paragraph, taxanes are used for a laundry list of malignancies: ovarian, breast, kung, endometrial, cervical, and prostate cancers as well as lymphoma, leukemia, and Kapok's sarcoma to name a few. As I understand the mechanism of action, thanks to PubMed, taxanes broadly inhibit the division of cells, paclitaxel prevents chromosomes from aligning for cell division, and docetaxil causes the buildup of microtubules which kills the cell. All this is done via the stabilization of microtubules, and I am still not sure what they are other than needed for cell division. 

Both paclitaxel and docetaxel cause the generic chemo adverse events like nausea, vomiting, blood dyscrasia, mucositis, rash, and myalgia (not comprehensive). Paclitaxel is more likely to cause neuropathiesand alopecia. Docetaxel is more likely to cause febrile neutropenia, diarrhea, and cardiovascular problems. Why do I bring this up? I’m not going to be giving these (until I’m chemo certified) but I will be there after if the patient has these effects. 

I’m starting to come more into what nurses do, and the key focus areas for us. What do I need to watch for? How do I keep this patient on docetaxel from going into acidosis or hypokalemia from diarrhea? These are the questions I have to think of. I’m watching for palpitations, cramps, tachypnea, confusion, etc… Knowing what is common helps us know what is likely. Understanding the underlying reasons are beneficial to those of us who carry out the care plan. It is better to know that a patient on antibiotics is at risk for CDAD that to just treat diarrhea as diarrhea and miss the reason behind it. Treat the disease if possible, of course, at times we have to just treat the symptoms. 

Anyway, two patients, one with throat cancer and another with metastatic ovarian cancer got me thinking about this topic. I look forward to doing more of these as I get more experience. And I would like to be more regimented in putting these out, but it’s also summer and every minute inside typing is one not spent outside so, it’s not much of a choice. 

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Love y’all, bye. 


References
Docetaxel, paclitaxel, and taxanes from the NIH: National Library of Medicine 

Image of the Pacific Yew from which paclitaxel was first obtained from News-Medical.net

How Taxel/paclitaxel kills cancer cells by Beth Weaver in Molecular Biology of the Cell in 2017 

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