antineoplastic agents

Question 1

Cancer Pathophysiology

Answer 1

Dysregulation of cell cycle
Continuous growth and division
Imbalance between oncogene expression and tumor suppressor gene expression
Tumor development

Question 2

antineoplastic agents MOA

Answer 2

Stop or slow growth of cancer cells, which grow and divide quickly
Also affect healthy cells that grow quickly
Bone marrow cells
Cells of the gastrointestinal (GI) tract including cells that line the mouth and intestines
Hair

Question 3

antineoplastic agents adverse effects

Answer 3

Bone marrow suppression (BMS)/myelosuppression
Neutropenia, anemia, thrombocytopenia
Nausea, vomiting, diarrhea, mucositis
Alopecia

Question 4

antineoplastic agents counseling

Answer 4

Watch for fever, malaise, sore mouth or throat

May cause hair loss

Question 5

antineoplastic agents interactions

Answer 5

Vaccines:
Inactivated
Live

Question 6

antineoplastic agents key points

Answer 6

Monitor for signs of BMS and infection
Often give antiemetics for N/V
Dosing:
Body surface area (BSA)
Adjustments

Question 7

Cyclophosphamide Alkylating Agents MOA

Answer 7

Forms strong covalent bonds with DNA inhibiting replication and causing bond breaks and cell death.

Question 8

Cyclophosphamide Alkylating Agents uses

Answer 8

Cancers, autoimmune disorders

Question 9

Cyclophosphamide Alkylating Agents dosing

Answer 9

Dosage forms: injection, tablets
Usual doses: 400-1800 mg/m2 IV x 1 dose that may be repeated at 2-4 week intervals, 50-100 mg/m2 PO daily for up to 14 continuous days

Question 10

Cyclophosphamide Alkylating Agents adverse effects

Answer 10

BMS, N/V/D/mucositis, alopecia, hemorrhagic cystitis

Amenorrhea, sterility, secondary malignancies

Question 11

Cyclophosphamide Alkylating Agents Hemorrhagic cystitis

Answer 11

Acrolein metabolite binds to bladder wall
Cystitis with tissue edema, ulceration, local hemorrhage
Painful urination, hematuria
Prevention:
Hydration
Mesna

Question 12

Cyclophosphamide Alkylating Agents counseling

Answer 12

Drink plenty of fluids
Take oral doses early in the day
Report painful urination, discolored or bloody urine

Question 13

Cyclophosphamide Alkylating Agents key points

Answer 13

Hydration ± Mesna to prevent hemorrhagic cystitis

Give antiemetics to prevent N/V

Question 14

Doxorubicin Anthracyclines MOA

Answer 14

Inhibition of DNA and RNA synthesis by intercalation of DNA base pairs and inhibition of DNA repair by topoisomerase

Question 15

Doxorubicin Anthracyclines uses

Answer 15

Cancers

Question 16

Doxorubicin Anthracyclines dosing

Answer 16

Dosage forms: injection
Usual doses: 60-75 mg/m2 per dose every 3-4 weeks; 20-30 mg/m2 per day for 3 days every 4 weeks; 60 mg/m2 per dose every 2 weeks (dose dense

Question 17

Doxorubicin Anthracyclines adverse effects

Answer 17

BMS, N/V/D/mucositis, alopecia, cardiotoxicity
Extravasation
Amenorrhea, sterility, secondary malignancies

Question 18

Doxorubicin Anthracyclines cardiotoxicity

Answer 18

Measure ejection fraction (EF) prior to starting therapy
Echocardiogram
Limit cumulative lifetime dose
550 mg/m2 
Dexrazoxane
Chemoprotectant 
Liposomal doxorubicin (Doxil)

Question 19

Doxorubicin Anthracyclines extravasation

Answer 19

Leakage of vesicants into surrounding tissue leading to tissue necrosis
Central access preferred
Dimethylsulfoxide and cold compresses
Dexrazoxane

Question 20

Doxorubicin Anthracyclines interactions

Answer 20

Trastuzumab

Question 21

Doxorubicin Anthracyclines counseling

Answer 21

Watch for pain or swelling at injection site

Question 22

Doxorubicin Anthracyclines key points

Answer 22

Cardiotoxicity
Extravasation
Give antiemetics to prevent N/V

Question 23

Cytarabine, 5-Fluorouracil, Capecitabine, Methotrexate, Antimetabolites MOA

Answer 23

Similar in structure to naturally occurring compounds

Incorporate themselves into DNA leading to cell death

Question 24

Cytarabine, 5-Fluorouracil, Capecitabine, Methotrexate, Antimetabolites uses

Answer 24

Cancers

Methotrexate – psoriasis, rheumatoid arthritis, ectopic pregnancy, Chron’s disease

Question 25

Cytarabine, 5-Fluorouracil, Capecitabine, Methotrexate, Antimetabolites adverse effects

Answer 25

All: BMS, N/V/D, mucositis Cytarabine: tumor lysis syndrome, CNS toxicity, conjunctivitis 5-Fluorouracil and Capecitabine: photosensitivity, palmar-plantar erythrodysesthesias (hand-foot syndrome), eye irritation/lacrimation Methotrexate: neurotoxicity, hepatotoxicity, nephrotoxicity

Question 26

Cytarabine adverse effects

Answer 26

``` !!Tumor lysis syndrome!! Caused by tumor cell lysis Release of intracellular contents Potassium, phosphate, nucleic acids/uric acid Acute renal failure ```

Question 27

5-Fluorouracil adverse effects

Answer 27

Palmar-plantar erythrodysesthesias

Question 28

Methotrexate adverse effects

Answer 28

neurotoxicity, hepatotoxicity, nephrotoxicity

Question 29

Cytarabine, 5-Fluorouracil, Capecitabine, Methotrexate, Antimetabolites counseling points

Answer 29

Cytarabine: stay well hydrated, report changes in mental status, steroid eye drops 5-Fluorouracil and Capecitabine: Avoid sunlight exposure and use sunscreen when exposure cannot be avoided, may cause painful rash on the hands and feet Methotrexate: watch for fever, malaise, bleeding, bruising, flank pain, leucovorin rescue

Question 30

Carboplatin, Cisplatin. Platinum Compounds MOA

Answer 30

form strong covalent bonds with DNA inhibiting replication and causing cell death

Question 31

Carboplatin, Cisplatin. Platinum Compounds uses

Answer 31

cancers

Question 32

Carboplatin, Cisplatin. Platinum Compounds adverse effects

Answer 32

BMS, N/V, peripheral neuropathies, alopecia, ototoxicity Carboplatin – hypersensitivity Cisplatin – nephrotoxicity, ELYTE losses (K, Mag)

Question 33

Carboplatin, Cisplatin. Platinum Compounds interactions

Answer 33

Aminoglycosides

Question 34

Carboplatin, Cisplatin. Platinum Compounds counseling

Answer 34

Drink plenty of fluids, contact your healthcare provider if you are unable to keep fluids down, or if there is any hearing loss

Question 35

Carboplatin, Cisplatin. Platinum Compounds key points

Answer 35

Cisplatin nephrotoxicity

Question 36

Docetaxel, Paclitaxel- Taxanes MOA

Answer 36

Promote assembly and preventing depolymerization, leading to stabilization of microtubule bundles and inhibition of cell replication

Question 37

Docetaxel, Paclitaxel- Taxanes uses

Answer 37

: cancers

Question 38

Docetaxel, Paclitaxel- Taxanes counseling

Answer 38

Peripheral neuropathies can occur with continued use

Question 39

Docetaxel, Paclitaxel- Taxanes adverse effects

Answer 39

BMS, peripheral neuropathy, myalgia, arthralgia, alopecia Docetaxel – fluid retention syndrome, skin and nail changes Paclitaxel – hypersensitivity

Question 40

Docetaxel, Paclitaxel- Taxanes key points

Answer 40

Docetaxel – premedicate with corticosteroid to reduce fluid retention Paclitaxel – premedicate with a corticosteroid, diphenhydramine, and histamine-2 blocker to prevent hypersensitivity

Question 41

Imatinib (Gleevec), Rituximab (Rituxan), Trastuzumab (Herceptin) MOA

Answer 41

``` Target abnormal genetic signaling proteins specific to the cancer Imatinib (Gleevec) Targets Philadelphia fusion gene Rituximab (Rituxan) Targets CD-20 antigen on B-cells Trastuzumab (Herceptin) Targets HER2/neu oncogene Breast Cancer ```

Question 42

NCI Toxicity Rating

Answer 42

0: no toxicity 4: life threatening toxicity

Question 43

Chemotherapeutic Agents are ISMP High-Alert Medications | Methods to prevent medication errors

Answer 43

Double-check orders Specialist prescribers Protocol adherence