Episode 299: Pharmacology 101: Plant Alkaloids

“I can't stress enough how often I get questions about, ‘Is this the paclitaxel doing this? Is this the docetaxel doing this?’ And coming up with strategies to kind of help get our patients through with supportive care is important. It's a really big opportunity for pharmacists and our nurses to really provide it and help our patients get through and show the knowledge that we have and to help them,” Dane Fritzsche, PharmD, BCOP, oncology informatics pharmacist at the Fred Hutchinson Cancer Center and University of Washington Medicine in Seattle, WA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about the plant alkaloid drug class. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below. Music Credit: “Fireflies and Stardust” by Kevin MacLeod  Licensed under Creative Commons by Attribution 3.0  Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by February 16, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center’s Commission on Accreditation.  Learning outcome:  Learners will report an increase in knowledge related to plant alkaloids. Episode Notes  Complete this evaluation for free NCPD. Oncology Nursing Podcast series: Pharmacology 101 Cancer Symptom Management Basics Oncologic Emergencies 101 ONS courses: ONS/ONCC Chemotherapy Immunotherapy Administration Certificate™ ONS Fundamentals of Chemotherapy and Immunotherapy Administration™ ONS books: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook Clinical Journal of Oncology Nursing articles: Vincristine Minibag Administration: A Quality Improvement Project to Minimize Medical Errors Taxane-Induced Peripheral Neuropathy: Objective and Subjective Comparison Between Paclitaxel and Docetaxel in Patients With Breast Cancer Liposomal Irinotecan: Nursing Considerations in an Outpatient Cancer Center Extremity Cooling: A Synthesis of Cryotherapy Interventions to Reduce Peripheral Neuropathy and Nail Changes From Taxane-Based Chemotherapy ONS Huddle Card: Plant Alkaloids ONS Symptom Interventions and Guidelines ONS Voice article: Chemo-Induced Peripheral Neuropathy May Have a Link With Vitamin D Deficiency Hematology/Oncology Pharmacy Association patient education IV Cancer Treatment Education Sheets ChemoCare To discuss the information in this episode with other oncology nurses, visit the ONS Communities.   To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.  To provide feedback or otherwise reach ONS about the podcast, email [email protected].  Highlights From This Episode “An alkaloid is an organic compound, so think carbon-based ring structure. The only thing special about alkaloid is that it has to contain at least one nitrogen atom.” TS 1:43 “Plant alkaloids are just alkaloids derived from plants itself, so think like the roots, stems, leaves, bark, and things like that. Each of these agents we'll discuss today are unique, but broadly speaking, all of them are extracted, at least when they were first discovered, from a plant source. And they are typically biosynthesized by these plants for defensive purposes.” TS 2:01 “Broadly speaking, [plant alkaloids] are cell cycle–specific agents. They do, depending on the compound, impact different parts of the cell cycle. Topoisomerase inhibitors is an example, so think irinotecan, which is a topoisomerase I inhibitor. There's topoisomerase II inhibitors, like etoposide being a good example. These impact the S phase in your cell cycle, so the synthesis of the DNA. Topoisomerase kind of helps unwind DNA and stabilize that as it's being replicated.” TS 3:36 “Again, these plant alkaloids kind of fall into your typical chemotherapy side effects, so we’re thinking rapidly dividing cells. Our bone marrow—so is it lowering our red blood cells, our white blood cells, our platelets? And then it can also affect our GI [gastrointestinal] tract, whether it causes diarrhea in some cases; in some other cases, it can actually cause the other way and cause severe constipation. And then a lot of these agents do lead to hair loss.” TS 5:28 “The last thing I want to touch on with paclitaxel is neuropathy, or your pins and needles, tingling in the tips of your hands and toes. That is the most common one. That's a sensory neuropathy. But we also can see motor neuropathies with this agent, where the patients start to struggle with their fine motor skills, like buttoning shirts, using pencils, things like that. This is a cumulative dose effect with paclitaxel. So if patients are on multiple, multiple, multiple cycles, we definitely start to ask, you know, how that's going. And we expect at some point this is going to become an issue as therapy continues.” TS 9:26 “The last class we are going to touch on for more agent specifics is our vinca alkaloids. I think the biggest takeaway and something that was just kind of hammered into my brain during residency and during pharmacy school is that these agents should never be in a syringe, and that's because they are fatal if they're accidentally given intrathecally.” TS 11:41 Neuropathy-wise, it’s challenging, and it's something that throughout my whole career with patient care, it constantly comes up. And there's really no one great solution to it. There's many different guidelines out there and papers out there that recommend some stepwise approaches. At the end of the day, too, we have to think about, what are our goals with our patients? How much is this limiting? TS 16:44 “Unfortunately, these hypersensitivity reactions are somewhat routine because we have lots of patients getting these medications, and they're not uncommon, like you said. It's really just that team-based approach. And since they are routine, we're all pretty comfortable at handling these.” TS 22:51 “I've always appreciated just our team-based collaboration. My clinical nurse coordinators that I worked with very closely are all kind of our number-one go-to for our patients. So I mentioned anything that's happening, any questions you have, reach out to your doctors or nurse here. They know everything. And when they don't know everything, then they know who to reach out to.” TS 28:59 “You have to remember a lot of these agents have very agent-specific side effects. So don't just think you know them all just because you know it's a plant alkaloid. Remember and do your due diligence and dive into each drug.” TS 33:27