Cancer Chemotherapy and General Anesthetics Flashcards by Tahlia Wasserman

what is the pathophysiology of cancer?

malignant forms of neoplastic disease

uncontrolled proliferation of cells

exact cause is unknown

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what is the dif bw benign and malignant cancers?

benign tumors have normal cells

malignant tumors have abnormal cells

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what are the options for cancer treatment?

surgery

radiation

chemotherapy

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what are the 2 types of chemotherapy for cancer?

antineoplastic agents

gene therapy

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what are the general principles of cancer chemotherapy?

cytotoxic strategy

cell kill hypothesis

cell cycle specific vs cell cycle non-specific

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what is the basic strategy of anticancer drugs to stop cells from growing?

the cytotoxic strategy

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how does the cytotoxic strategy limit cell proliferation?

by killing or attenuating the growth of the cancerous cells

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what is the cell kill hypothesis?

theoretical ability of chemo to kill a % of cancer cells, never 0 cancer cells left in the body , it only takes care of a proportion of cancer cells

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what are cell cycle non-specific drugs?

cancer drugs that attack cells in any stage

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what are cell cycle specific drugs?

cancer drugs that only target actively dividing cells

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t/f: many anticancer drugs are non-specific

true

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what cells are affected by chemo?

hair follicles

bone marrow

immune cells

epithelial cells in skin and GI tract

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what are the side effects of chemo?

hair loss

anemic symptoms

easier to get sick

fragile skin

nausea/vomiting

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what are the 3 classes of anticancer drugs?

drugs that act on DNA

drugs that act on mitotic spindles

hormonal agents

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what are the MOAs of cancer drugs that act on DNA?

damage DNA

inhibit DNA synthesis or fxns

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what cancer treatments damage DNA?

alkylating agents

free radical formation

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what cancer treatments inhibit DNA synthesis or fxns?

antimetabolites

toposomerase inhibitors

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what cancer drugs act on mitotic spindles?

microtubule inhibitors

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t/f: there are agonist and antagonist hormonal agents to treat cancer

true

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what are alkylating agents?

cell cycle non-specific drugs that work by damaging the DNA chain to prevent replication and translation

one of the largest categories of anticancer drugs

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what are some alkylating agents?

cyclophosphamide (Cytoxan, Neosar)

chlorambucil (Leukeran)

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what are the drug interactions with alkylating agents?

anticoagulants effects may be increased, increasing the risk of bruising and bleeding

digoxin with alkylatng agents can cause a Dec in plasma levels of digoxin

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what are free radical formation/anticancer antibiotics?

cell cycle non-specific drugs that are reserved for cancer due to its toxicity

using free radicals to kill cancer cells

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what are the anticancer antibiotics?

Doxorubicin (Adriamycin)

Dounorubicin (Cerubidine)

Mitomycin (Mutamycin)

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what do the anticancer antibiotics end in?

- mycin - rubicin

what are the drug interactions with anticancer antibiotics?

alkylating agents as the combo may inc risk of cardiotoxicity

what are antimetabolites?

cell cycle specific drugs that attack cells in the S phase related to DNA synthesis and replication

what are the antimetabolite drugs?

Methotrexate Fluorouracil (Adrucil)

what are plant alkaloids?

cell cycle specific drugs that inhibit mitosis

what two categories of drugs are plant alkaloids?

microtubule inhibitors toposomerase inhibitors

what do microtubule inhibitors do?

they disrupt the fxn of the mitotic apparatus

what is one of the most toxic microtubule inhibitors?

Vinca alkaloids

what are the vinca alkaloids (plant alkaloids-microtubule)?

Vincristine vinblastine vinorelbine vindesine

what are the microtubule drugs?

vinca alkaloids (vincristine, vinblastine, vinorelbine, vindesine) Paclitaxel (Taxol)

what do topoisomerase inhibitors do?

they inhibit the enzymes needed for DNA replication

what are the topoisomerase inhibitors?

Etoposide (VP-16) Irinotecan (Camptosar)

what cancers can use hormonal agents?

hormone sensitive cancers like breast, prostate, endometrial, Hodgkin's lymphoma, and some leukemias

what hormonal agents can treat Hodgkin's lymphoma and some leukemias?

glucocorticoids

what hormonal agents can treat breast cancer?

Tamoxifen (Soltamox) androgens anti-estrogens

what hormonalagents can treat prostate cancer?

estrogens anti-androgens

what hormonal agent can treat breast cancer, endometrial cancer, and prostate cancer?

progesterones

what are some of the bolded side effects of anti-cancer drugs?

neuropathy cardiotoxicity

what is chemotherapy induced peripheral neuropathy (CIPN)?

numbness and tingling pain (burning, shooting, stabbing) hypersensitivity to hot or cold or touch or pressure hypo- or areflexia muscle weakness trouble swallowing balance problems constipation BP changes

do we usually see motor or sensory problems first with cancer treatment?

sensory

t/f: once CIPN has started there is nothing to stop or slow it

true

are the symptoms of CIPN short or long term?

can be either

what % of pts on chemo experience "chemo brain"?

82%

what are the s/s of chemo related cognitive and memory problems?

mental fog ST memory problems difficulty concentrating confusion fatigue

what may be the cause of "chemo brain"?

lower perfusion of the pre-frontal cortex w/chemo

what are the drugs that decrease non-neural side effects of chemo?

corticosteroids Ondansetron (Zofran) IV fluids with potassium, magnesium, calcium

what do corticosteroids do for chemo side effects?

they prevent allergic rxns to chemo meds

what does Ondansetron (Zofran) do for chemo side effects?

it reduces nausea and vomiting

what are the PT implications of chemo?

acknowledge the severe toxic effects address deconditioning with a combo of aerobic and anaerobic exercises starting at low doses and working up pain management pt support

what are severe toxic effects of chemo that PTs should be aware of?

neurotoxicity loss of appetite, nausea, vomiting fluid and electrolyte imbalances myelosuppression (reduced WBCs, RBCs, or platelets) fatigue, weakness

how do general anesthetics work?

CNS depression absence of all perceived sensations

general anesthesia is characterized by...

analgesia unconsciousness amnesia skeletal muscle relaxation inhibition of sensory and autonomic reflexes

why does general anesthesia lead to depression in HR and BP?

it inhibits autonomic reflexes leading to unresponsive baroreceptors

what is stage 1 CNS depression?

analgesia conscious and aware of surroundings begin to lose somatic sensations good for local surgeries that don't require full body anesthesia

what is stage 2 CNS depression?

excitement/delirium agitated and disturbed state loss of consciousness, amnesia rapid/irregular breathing, vomiting

what is stage 3 CNS depression?

surgical amnesia unconsciousness rhythmic and deep respirations desirable for surgical procedures

what is stage 4 CNS depression?

DANGER meduallry paralysis resp control centers and vasomotor center inhibition ventilatory and circulatory support needed

what are the inhaled anesthetics?

gas-nitrous oxide volatile liquids-halothane and isoflurane

which inhaled anesthetic is used for short surgeries or dental work?

nitrous oxide

which inhaled anesthetics is used for longer surgeries?

volatile liquids

what are the IV anesthetics?

barbiturates (thiopental) dissociative s (ketamine) opioids (fentanyl) benzos (midazolam) miscellaneous (etomidate, propofol)

what general anesthetics are given to calm pts pre-op?

opioids and benzos

what are the general anesthetics that increase inhibition?

benzos barbiturates propofol

what are the general anesthetics that decrease excitation?

halogenated liquids ketamine nitrous oxide opioids

what receptors do benzos act on?

GABA

what receptors do barbiturates act on?

GABA Glycine

what receptors do propofol act on?

GABA Glycine

what receptors do halogenated liquids act on?

GABA K+ channels ACh

what receptors does ketamine act on?

NMDA

what receptors does nitrous oxide act on?

NMDA

what receptors do opioids act on?

opioid receptors

what kind of drugs are Midazolam, fentanyl, proprofol, isoflurane

sedation/general anesthesia

what kind of drugs are lidocaine and bupivacaine?

local anesthesia

what kind of drug is Rocuronium?

neuromuscular blocker

what kind of drug is Neostigmine?

neuromuscular blocker reverser

what kind of drug is Ondansetron (Zofran)?

antiemetic

what kind of drugs are fentanyl, hydromorphone, morphine?

analgesia/pain control

what kind of drug is glycopyrrolate?

anticholinergic

what is the goal of step 1: pre-op meds?

sedation and anti-anxiety

what are the classifications of Midazolam (Versed)?

Benzo, anxiolytic, amnesia

t/f: Midazolam (Versed) is usually given 1-2 hours b4 surgery

true

when the pt is brought to the OR in step 2, what med is given?

Fentanyl

what is the classification of fentanyl?

opioid analgesic, anesthetic

t/f: side effects of fentanyl are more severe in older adults

true

what drugs are given in step 3?

lidocaine (xylocaine) propofol (diprivan)

how does lidocaine work?

interrupting nerve conduction relieve pain w/o systematic effects and loss of consciousness minimize the stinging of propofol

what are the classifications for lidocaine?

local anesthetic antiarryhthmic

what are the side effects of lidocaine?

hypotension, arryhthmia

which drug mimics the effects of deep sleep?

propofol

what is the classification of propofol?

sedative-hypnotic

what are the side effects of propofol?

nausea/vomiting, involuntary muscle movements, hypotension

what drug is involved in paralysis of step 4?

rocuronium (Zemuron)

what does Rocuronium (Zemuron) do?

binds to nicotinic cholinergic receptors to induce neuromusclar blockade and relaxation of vocal cords for intubation

what are the classifications of Rocuronium (Zemuron)?

neuromuscular blocker paralytic

what drug is used in step 5 to induce and maintain general anesthesia?

Isoflurance (Forane)

what are the classifications of Isoflurane (Forane)?

inhalation anesthetic volatile liquid

what does Isoflurane (Forane) do?

achieves unconsciousness, muscles relaxation. and reduced pain sensitivity diffuses into adipose tissue due to lipid solubility

how is Isoflurane (Forane) eliminated?

expiration

what are the side effects of Isoflurane (Forane)?

shivering, nausea, vomiting, resp depression, hypotension, arryhthmia, slowing psychomotor skills, delirium potential CV and pulm toxicity

what 3 drugs are involved in step 6 before the end of surgery?

Ondansetron (Zofran) Neostigmine (Bloxiverz) Glycopyrrolate (Robinul)

what are the classifications of Ondansetron (Zofran)?

antiemetic serotonin receptor antagonist

what drug reduces post op, chemo , or radiation induced nausea/vomiting?

Ondonsetron (Zofran)

what are the side effects of Ondansetron (Zofran)?

confusion, dizziness, tachycardia, fever, headache, trouble breathing

what is the classification of Neostigmine (Bloxiverz)?

neuromuscular blocker reversal

what does Neostigmine (Bloxiverz) do?

counteracts Rocuronium (Zemuron)

what are the side effects of Neostigmine (Bloxiverz)?

GI distress, abdominal cramps, headache, fever

what is the classification of glycopyrrolate (Robinul)?

anticholinergic

what does Glycopyrrolate (Robinul) do?

minimizes the side effects of Neostigmine

what are the side effects of Glycopyrrolate (Robinul)?

blurred vision, constipation, urinary retention, dry mouth

what drugs are given in the recovery room?

Bupivacaine (Marcaine) Hydromorphone (Exalgo ER)

what is the classification of Bupivacaine (Marcaine)?

local anesthetic (spinal or epidural)

is Bupivacaine (Marcaine) long or short acting?

long acting (about 6 hours)

what are the side effects of Bupivacaine (Marcaine)?

pruritis, CNS depression, cardiotoxicity, bradycardia, arryhthmia, hypotension, resp arrest, urinary retention

what is the classification of hydromorphone (exalgo ER)?

opioid analgesic

what are the PT implications of general anesthetics?

nausea/vomiting resp compromise sedation, lethargy muscle weakness OH ST confusion

what are the populations of concern with general anesthetics?

obesity elderly comorbidities children

Cancer Chemotherapy and General Anesthetics Flashcards

(120 cards)