Antineoplastic Flashcards
(157 cards)
1
Q
The branch of medicine concerned with the study of malignancy-development, dx, tx, and prevention is defined as:
A
Oncology
2
Q
Pertaining to a substance, procedure, or measure that prevents proliferation of cells is defined as:
A
antineoplastic
3
Q
The pharmaceutical agents used to destroy CA cells are defined as:
A
antineoplastics or cytoxic drugs
4
Q
What phase of the cell cycle is not as sensitive to antineoplastic Tx as the other phases of the cell:
A
Go
5
Q
What type of cells arise from a single abnormal cell that multiplies and grows:
A
CA cells
6
Q
What happens as abnormal cells continue to divide:
A
They lose some of their original characteristics
7
Q
What are the characteristics of CA cells:
A
anaplasia; autonomy; metastasis; angiogenesis
8
Q
The loss of cellular differentiation and organization is defined as what type of CA characteristic:
A
anaplasia
9
Q
To grow in an uninhibited way/manner is defined as what type of CA characteristic:
A
autonomy
10
Q
The ability to travel to other sites of the body is defined as what type of CA characteristic:
A
metastasis
11
Q
The ability to grow new bld vessels to feed a tumor is defined as what type of CA characteristic:
A
angiogenesis
12
Q
What are the specific protocols used before giving chemotherapy to pts:
A
type/extent of malignancy; type of chemo given; side effects; amount of time normal cells need to recover=giving the chemo in cycles
13
Q
What are the major factors that affect the CA cells response to chemotherapy:
A
Growth fraction and doubling time
14
Q
The percent of actively dividing cells is defined as:
A
growth fraction
15
Q
The time it take the cell to double in size is defined as:
A
Doubling time/growth rate
16
Q
Anticancer drugs are most effective on CA cells d/t what major factor:
A
Cells with high growth fraction
17
Q
Antineoplastic/Anticancer drugs treat malignancies by directly killing tumor cells how:
A
Damaging the DNA; inhibiting DNA synthesis from replication; stoping mitosis
18
Q
Antineoplastic drugs destroy CA cells by inhibiting cell division but also affect normal cells. What type of normal cells do they affect the most:
A
Rapidly multiplying cells or cells that replaces themselves quickly; thus, causing side effects
19
Q
This type of chemotherapy is used to relieve S/S associated with advanced CA (pain, breathing…) and improve quality of life is defined as:
A
palliative chemotherapy
20
Q
This category of antineoplastic drugs exert their influence during a specific phase of the cell cycle; are the most effective against rapidly growing CA cells is defined as and what are the examples:
A
CCS (cell-cycle specific or cell-cycle dependent); antimetabolites and mitotic inhibitors
21
Q
This category of antineoplastic drugs exert their influence during any phase of the cell cycle, especially the Go phase is defined as and what are the examples:
A
CCNS (Cell-cycle nonspecific or cell- cycle independent); alkylating; anti-tumor antibiotics; hormones
22
Q
The combined use of CCS and CCNS drugs maximize cell death is defined as:
A
synergistic effect
23
Q
The synergistic effect of the combination of CCS and CCNS is:
A
Kills cells in all phases of the cell cycle, especially the cells that have a high fraction rate; decreases drug resistance and increases destruction of CA cells
24
Q
What are the causes of MDRL:
A
Cell mutation; natural resistance; gene amplification; repair DNA damage
25
What are the specific classes of chemotherapy drugs:
alkylating agents; antimetabolites; anti-tumor antibiotics; plant alkaloids; Miscellaneous agents
26
Alkylating agents are of the CCNS category, but what phase are they most effective on:
Go phase d/t slow-growing CA which may have cells in the resting phase
27
What is the mechanism of action brought upon by alkylating agents:
Inhibits DNA synthesis by binding and damaging the DNA which prevents the cell from dividing
28
What is the main type of alkylating agent given for Tx:
Cytoxan (cyclophosphamide)
29
What are the pharmacokinetics of Cytoxan:
50 PERCENT IS EXCRETED UNCHANGED IN THE URINE; onset =2-3 hrs; therapeutic effect takes several days
30
What are the adverse effects of Cytoxan:
HEMORRHAGIC CYSTITIS (give >500 mL of fluid prior); BONE MARROW SUPPRESSION; 2dary malignancies (secondary neoplasm), sterility
31
What are the Cytoxan major dose-limiting toxicities:
Hematopoietic system and urinary system
32
Cytoxan is contraindicated to pts with:
pregnant; bone marrow suppression; impaired renal/hepatic function
33
What may occur if I take Allopurinol or HTCZ w/Cytoxan?
Increased bone marrow suppression
34
What may occur if I take Phenobarbital with Cytoxan:
Cytoxan toxicity increases
35
What may occur if I take Cytoxan with Warfarin or ASA (NSAIDs):
bleeding
36
What may occur if I take Digoxin with Cytoxan:
Cytoxan will decrease digoxin effects
37
An accumulation of toxic metabolites that causes inflammation of the bladder (may be painless) and bleeding in the urine is a result is defined as:
hemorrhagic cystitis (MUST HYDRATE BEFORE GIVING CYTOXAN)
38
Cytoxan should be taking early in the morning why and what should be avoided in the diet during Cytoxan Tx:
avoid accumulation in the bladder at night; avoid high purines (beans/peas/organ meats) to alkalinize the urine. avoid citric acid
39
Bone marrow suppression include:
Low RBC (anemia); low WBC (neutropenia); low platelet count (thrombocytopenia)
40
Antimetabolites are S phase specific with the exception of what type of antimetabolite drug:
5-FU adrucil (fluoroacil) is considered both CCNS and CCS
41
What is the therapeutic action of antimetabolite drugs:
Disrupts the metabolic process and inhibits enzyme synthesis which prevents normal cellular function
42
Antimetabolites are often given with other agents to...
help overcome MDR tumors
43
5-FU Adrucil is contraindicated in pts with:
GI ULCERATIONS/DISEASES; pregnant; bone marrow suppression; renal/hepatic disfunction
44
What are the adverse effects of antimetabolite drugs:
STOMATITIS; BONE MARROW SUPPRESSION (LIFE-THREATENING INFECTIONS/BLEEDING); hepatic/renal dysfunction
45
What is the action of 5-FU adrucil:
prevention of thymidine synthase production, thus inhibiting DNA/RNA synthesis
46
What are the adverse effects of 5-FU adrucil:
STOMATITIS: may be early sign of 5-FU toxicity
47
What may occur if I take Leucovorin calcium with 5-FU adrucil:
increases 5-FU toxicity
48
What may occur if I take Metronidazole with 5-FU adrucil:
increases 5-FU toxicity
49
What may occur if I take HTCZ with 5-FU adrucil:
increases myelosuppression (decrease in blood cell production)
50
Soreness, ulcerations, and white patches of the mouth is defined as:
stomatitis (Can use NS to rinse mouth out every 2 hrs/avoid mouthwashes)
51
Anti-tumor antibiotics are CCNS drugs with the exception of:
bleomycin (Blenoxane) EFFECTS G2 PHASE
52
What is the action of anti-tumor antibiotics:
inhibits protein/RNA synthesis and binds to DNA causing FRAGMENTATION
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What are the main two types of anti-tumor antibiotics:
bleomycin (G2 specific) and Doxorubicin (CCNS)
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What is the adverse effect of Doxorubicin:
CARDIOTOXIC EFFECTS
55
What are the common side effects of anti-tumor antibiotics:
mucositis, N/V; CARDIOTOXIC EFFECTS
56
How should anti-tumor antibiotics be given:
very slowly if pt has a congestive heart (pts' cardiovascular system-EKG- should be assessed prior to administering drug)
57
What other drug is given along with Doxorubicin to reduce cardiac symptoms:
Dextrazoxane (Zinecard)
58
Plant alkaloids are mitotic inhibitors CCS. What is their action:
Blocks cell division at the M phase of the cell cycle
59
What are the adverse reactions of plant alkaloids mitotic inhibitors:
NEUROTOXICITY=PERIPHERAL NEUROPATHY; leukopenia; loss of DTR
60
What are some examples of plant alkaloids mitotic inhibitors:
Vincristine (Oncovin)
61
What are the adverse reactions of Vincristine (oncovin):
SENSORY LOSS; NEUROPATHY=PERIPHERAL NEUROPATHY; extravasation; hypoNA; ILEUS
62
Wha are some life-threatening effects of Vincristine (Oncovin):
intestinal necrosis; SZ; coma; bronchospasm; bone marrow suppression
63
What may occur if I take digoxin and Vincristine (Oncovin) together:
Vincristine decreases the effects of digoxin
64
What may occur if I take Vincristine (Oncovin) with phenytonin (Dilantin):
Vincristine decrease effect of Phenytonin (Dilantin): MONITOR FOR SZ
65
What are miscellaneous cytotoxic agents:
A category that includes antineoplastic agents in which the mechanism of action is unclear, but is used in the combination of other drugs:
66
When are miscellaneous cytotoxic agents given:
Given for ACUTE LYMPHOCYTIC/LYMPHOBLASTIC LEUKEMIAS
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What are the examples of miscellaneous agents:
Elspar and Oncaspar
68
Elspar is used for what:
Lymphocytic leukemia
69
Oncaspar is used for what:
Lymphoblastic leukemia
70
Major toxicity of miscellaneous cytotoxic agents is:
hypersensitivity reactions
71
What are the adverse effects of taking Elspar and Oncaspar:
IMPAIRED PANCREATIC FUNCTION; hepatotoxicity; coagulopathy
72
Hormonal agents are CCNS; they are cytostatic, which means...
prevents the growth of the tumor instead of causing cell death
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What is the hormonal agent's mechanism of action :
Receptor-site specific or hormone specific that blocks the stimulation of growing CA cells that are sensitive to that specific hormone being given
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What are the examples of hormonal agents:
Corticosteroids; estrogen therapy; antiestrogens; SERMs; progestins; Gonadotropin-releasing Hormones
75
This hormonal agent decreases cerebral edema caused by malignant brain tumors; and suppresses the inflammatory process:
corticosteroids
76
What are the examples of corticosteroids given for CA:
prednisone and dexamethasone
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What are the adverse effects of prednisone or dexamethasone:
fluid retention; hypokalemia; hyperglycemia; risk of infection; muscle weakness; euphoria
78
These hormonal agents slow the growth of hormone dependent tumors:
sex hormones
79
What is estrogen therapy used for and what are some types of examples:
palliative treatment used to decrease the progression of prostate CA in men and breast CA in women; ESTINYL & PREMARIN
80
What types of estrogen therapy is given to pts with prostate/breast CA:
Estinyl or Premarin
81
This hormonal agent competes with estrogen for binding sites to target tissues of the breast:
Antiestrogen
82
What are the examples of antiestrogen:
tamoxifen (Nolvadex)
83
When or why is tamoxifen (Nolvadex) given:
Advance breast CA and prevents tumor recurrence
84
What are the adverse effects of tamoxifen (Novaldex):
endometrial CA; thrombosis; hot flashes
85
What could I give a pt with advance breast CA in place of tamoxifen (Nolvadex) to decrease side effects:
SERMs (selective estrogen receptor modulator)
86
What is an example of selective estrogen receptor modulator:
Raloxifene (EVISTA)
87
What hormonal agent is given to treat RENAL CA, endometrial and breast CA:
progestins
88
What are some examples of progestins that I could give a renal CA pt:
Megace and Depo-provera
89
These hormonal agents are primarily used for the treatment of prostate CA:
Gonadotropin-releasing hormone
90
What are the types of Gonadotropin-releasing Hormone used for prostate CA:
LH-RH (leutinizing) = leuprolide (LUPRON)
91
What is the mechanism of action of Lupron (leuprolide):
suppression of follicle hormone and luteinzing hormone from pituitary resulting is the suppression of testosterone that stimulates the growth of prostate CA cells
92
Long-term survivors of chemotherapy have an increased risk of developing what type of secondary malignancies:
acute leukemias and solid tumors
93
What are the antineoplastic drugs that commonly are associated with secondary malignancies:
alkylating agents: cytoxan and alkeran
94
Why do secondary malignancies occur:
D/t toxic damage effects on DNA, mutations, and chromosomal damage
95
Drugs that may be used to reduce toxicities are called:
cytoprotective drugs
96
What are some examples of cytoprotective drugs:
allopurina (zyloprim) reduces hyperuricemia; Mesna (mesnex) is given w/high doses of cytoxan to inactivate urotoxic metabolites in the bladder
97
What are some nsg measures for low RBC amount (anemia):
Assist for SOB/VS/LOC/O2 sat; rest periods; control pain/elevate HOB; Rx FeSO4 (Iron) and erythropoietin (stimulates RBCs from kidneys) or blood transfusion of PRBC
98
What are some nsg measures of Low WBC count (leukopenia:
assess for localized infections; hand/pt hygiene precautions; TEMPERATURE; Fever/chills/sore throat should be reported to HCP
99
A low absolute neutrophil count (ANC) is defined as and what is the normal range:
neutropenia; 1500-8000
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What value of neutropenia is considered to be severe and what is usually administered:
less than 500; Colony-stimulating factors filgrastin (Neupogen)
101
What shouldn't be brought into the room to a pt that has leukopenia or neutropenia:
fresh flowers/plants, or raw foods
102
For neutropenia or leukopenia pts, temps must be monitores why:
If they have a temp of 99 degreas, that is a fever. If they temp drops, may be d/t sepsis
103
What is given to pts with Anemia (low RBCs):
FeSO4 (iron) and erythropoietin
104
Where are pts kept if their neutrophils are below 200 (normal is 1500-8000):
reverse isolation/protective isolation
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What parts of the body should be checked every 8 hrs in pts with neutropenia:
Tiny ulcers in the mouth and anal fissures
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If a neutropenic pt has chills, how should it be handled:
As an emergency
107
A low platelet count is defined as:
thrombocytopenia
108
What should be avoided in pts with thrombocytopenia:
Meds that promote bleeding (NSAIDs); IM unless withdrawing blood in which case pressure should be applied for 10 minutes; rectal temps; use smaller gauge needles if starting an IV
109
What should be reported to HCP from a pt with thrombocytopenia:
Petechiae (rash like red dots that can be purple), bruising, bleeding gums, nosebleeds
110
What is the normal range for platelets and what should you do if a pt's platelet count is at 50 or less:
150-350; check to see if pt is bleeding in the urine;
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What may be given to thrombocytopenic pts:
Numega to stimulate platelet production
112
What drugs may cause cardiotoxicity:
Adriamycin (EKG or CHF), cytoxan (If high doses), Herceptin (cardiomyopathy)
113
What may cause Nephrotoxicity:
5-FU, mutamycin
114
What may cause Hepatoxicity:
Cytoxan (chronic use), Adriamycin (if pts are hepatic/renal impaired)
115
A complication of chemotherapy that occurs when there's an escape of a vesicant drug into surrounding tissue causing severe tissue damage or permanent damage to nerves/tendons/loss of limbs is defined as:
Extravasation
116
Extravasation typically occurs with what type of access:
peripheral access; seldom in central catheters
117
What is to be done if you see a pt with extravasation:
Stop IV; DONT REMOVE IV LINE; ASPIRATE REMAINING DRUG AND BLOOD IF POSSIBLE; give appropriate antidote according to policy in EXISTING IV SITE OR SUBQ AROUND INFILTRATED SITE; elevate affected extremity=PREVENTION IS THE BEST APPROACH
118
What is the most common and distressing symptoms of receiving CA treatment:
chemotherapy-induced nausea and vomiting (CINV)
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How is CINV stimulated:
antineoplastic drugs stimulate chemoreceptor trigger zone (CTZ) leading to N/V
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This type of CINV occurs within a few minutes to several hours of chemo, ends in 24 hrs:
acute CINV
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This type of CINV occurs more than 24 hr after chemo, lasts several days:
Delayed CINV
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This type of CINV is triggered by anything the pt associates w/N/V r/t previous chemo treatment, such as smell or taste:
anticipatory CINV
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This type of CINV occurs even though preventative measures have been taken:
breakthrough CINV
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What drug is given to pts with highly emetogenic chemotherapy as prophylaxis:
Zofran ondansetron
125
What drug is given to pts with Low-Risk emetogenic chemotherapy as prophylaxis:
Reglan or Compazine
126
What's included in the nsg role in pre-treatment/managing CINV:
pt expectations; risk factors CINV; taking med as scheduled; self-care strategies; provide clear post-instructions and contact numbers
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What's included in the nsg role in supportive care for CINV:
minimize nose/odors/stimulants; flat sodas and crackers; hard candies; ice chips
128
What is some care for pts w/stomatitis:
NO ETOH/ETOH mouthwashes; USED SOFT TOOTH BRUSHES OR SPONGE TOOTHETTES
129
What type of tx would you provide for a pt with stomatitis:
mouth rinses (MAALOX/LIDOCAINE/BENADRYL MIX); antifungal meds; pain meds
130
What do you assess from a pt with stomatitis:
taste changes, redness, swollen tissue, dry mouth, tiny ulcers, white patches
131
What do you give a pt to relieve symptoms of stomatitis:
ice chips or ice-pops
132
What are some tx for pts with anorexia:
Small frequent meals high in calories and proteins; hard candy or ice chips to relieve bitter taste
133
What may cause diarrhea:
meds, comorbid conditions, enteral feedings
134
What type of antidiarrheal meds may be given:
Kaolin or pectin; small frequent meals; avoid very hot/cold foods
135
What may be given as a prophylactic measure for hyperuricemia:
allopurinol (zyloprim); encourage high fluid intake
136
How can cytotoxic drugs be accidentally absorbed:
inhalation, contact w/skin/mucous membranes, ingestion
137
How do you reduce your exposure when administering chemo drugs:
Wash hands; prepare med in separate work station; avoid hand-to-hand or hand-to-eye contact; use gown/mask/glove/face shield; use powder free gloves
138
Why is the monitoring of chemo effects performed at baseline, during, and after treatment:
D/t the quick effect of the drug which enables us to determine optimal Tx options/evaluate pts response; monitor toxicity
139
What labs would you assess for hematologic system during chemo Tx:
CBC with diff; WBC; ANC: RBC; platelet; Pt; PTT
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What labs would you assess for hepatic system during chemo Tx:
LFTs (liver function tests=ALT/AST)
141
What labs would you assess for the renal system during chemo Tx:
creatine, BUN, electrolytes
142
What labs would you assess for the cardiovascular system during Chemo Tx:
ECG, echocardiography, cardiac enzymes trotopin (d/t doxorubicin)
143
What labs would you assess for the pulmonary system during chemo Tx:
PFTs (pulmonary function tests d/t bleomycin associate with pulmonary toxicity (can cause pnemothorax)
144
How long does chemo therapy remain in the body:
48-72 hrs and excreted in bodily fluids
145
A pt is about to receive an alkylating agent, an antimetabolic, and an anti-tumor antibiotic. He asks the nurse why he needs so much chemotherapy. What is the best response: A) combination chemo works in the S-phase to kill cells; B) Combination Tx increases the extent of tumor cell kill; C) Combination Tx has drugs that work the same way; D) Combination Tx has no dose-limiting toxicities
B) Combination chemo increases the extent of tumor cells killed
146
A pt is scheduled to receive chemo that will cause myelosuppression. What action by the nurse would be most important: A) monitor for a change in temp; B) Evaluate GI infection; C) assess for cardiac compromise; D) question the pt about change in taste
A) monitor for change in temp
147
A pt has a low platelet count secondary to administrating chemo. What nsg action is most appropriate: A) Assess for diarrhea and provide sm frequent meals; B) assess I&Os and help pt conserve energy; C) Assess for localized infection and monitor BS: D) Assess for occult bleeding and apply pressure to injection sites
D) Assess for occult bleeding and apply pressure
148
A pt is about to receive 5-FU as part of his Tx protocol for CA. Which symptom would be most appropriate for the nurse to report: A) Nausea, B) decreased appetite, C) Stomatitis, D) Constipation
C) Stomatitis
149
A pt in the oncology unit is c/o fatigue after chemo. What nsg intervention would be most appropriate: A) assess for factors contributing to her fatigue (trouble sleeping); B) Encourage a high protein diet, C) Refer the pt to a PT to develop a strenuous exercise program: D) encourage the pt to sleep as much as possible during the day to ease fatigue
A) assess for factors contributing to fatigue
150
A nsg is teaching about alopecia. Which statement, made by the pt, indicates that she needs additional teaching about alopecia: A) The hair on all areas of my body will be affected; B) My hair won't grow back after chemo Tx is completed; C) the extent of my hair loss is dependent on the type of chemo drugs I take; D) the texture of my hair may be different when it grows back
B) My hair won't grow back after chemo Tx has completed
151
A pt in the oncology unit has developed mucositis after receiving 5-FU. Which statement made by the pt indicates additional teaching about mucositis: A) I will frequently rinse out my mouth with NS; B) I will use ice pops or ice chips to relieve my pain; C) I will use a mouthwash with ETOH to rinse out my mouth; D) I will use a soft toothbrush
C) I will use a mouth wash with ETOH
152
A pt is scheduled to receive a high dose of cytoxan. Which would be the most important for the nsg to include in her teaching of cytoxan to the pt: A) an indwelling urinary catheter will be placed; B) drink 2-3 L of fluid per day; C) empty the bladder every 4-6 hrs; D) limit fluid intake during chemotherapy
B) drink 2-3 L of fluids per day
153
A pt is about to receive MPV (mitomycin, vincristine, cisplatin). She asks the nsg what side effects should she expect. what is the most appropriate nsg dx for the pt: A) anxiety r/t dx of CA; B) knowledge deficit r/t to side effects of chemo; C) potential bleeding r/t chemo; D) risk for alteration in nutrition r/t side effects of chemo
B) knowledge deficit r/t side effects of chemo
154
A nsg is administering doxorubicin to a pt in an outpt setting. Which info would be most appropriate to include in pt teaching: A) bld counts will likely remain normal; B) complete alopecia rarely occurs w/this drug; C) report any SOB, palpations, or edema; D) tissue necrosis usually occur 2-3 days after administration
C) report any SOB; palpations; edema
155
A pt is scheduled to receive vincristine as part of his chemo protocol. Which nsg action would have the highest priority when providing care to this pt: A) assess for degree of alopecia; B) assess for increased digoxin levels; C) assess for increased phenytonin levels; D) assess for peripheral neuropathy
D) assess for peripheral neuropathy
156
Which have been identified causes of MDR to chemo Tx. Select all that apply: A) CA cells that are not killed may mutate and become resistant to Chemo Tx: B) some CA cells may be naturally resistant to Chemo; C) cell-cycle nonspecific chemo Tx drugs; D) gene amplification can cause overproduction of proteins that make chemo less effective; E) CA cells develop the ability to repair damage caused by chemo Tx
A, B, D, E
157
A pt is experiencing mucositis (stomatitis) secondary to receiving chemo. What symptomatic Tx would be appropriate. Select all that apply: A) frequent mouth rinses; B) provide antiemetics; C) topical anesthetics; D) encourage stress reductions; E) ABX
A,C,E
