Chemo Flashcards
what is the difference between adjuvant and neoadjuvant therapies?
Neoadjuvant therapy: when CA mass is too large to eliminate initially w/ surgery, so therapy is used to shrink tumor so that they can do radiation therapy or surgery once the mass is smaller (done with breast and colon cancers)
· Adjuvant therapy: for pts who are diagnosed w/ CA and have surgery to remove it
What are the main side effects of almost all chemotherapy agents, acute and long term?
- Malnourishment
- Nausea/diarrhea
- Alopecia (hair loss)
- Damage of GI epithelium
- Fatigue, pain
- Sterility
- Cardiotoxicity
- Depression in growth in children
- Organ toxicity
Why might a PT treat someone on a Plant alkaloid (Taxanes)?
● Plant alkaloids often produce paresthesias and foot or wrist drop
What is the difference between tyrosine Kinase inhibitors and Mammaliam target of rapamycin?
Tyrosine kinase inhibitors: work inside the cell to inhibit tyrosine kinase receptors (inhibit signaling system that would lead to cell division)
● Mammalian target of rapamycin (MTOR) inhibitor: prevent MTOR from activating signaling pathways involved in angiogenesis and cell growth (inhibits angiogenesis so CA can’t feed itself)
What serious side effect of anthracycline should the PT be aware of?
Cardiac toxicity (can lead to heart problems over time) (pts get no more than 4 doses)
what is the role of Mabs, cytokines, cancer vaccines and colony stimulating factors in the treatment of cancer?
● MABs (monoclonal antibodies): flag CA cells for destruction, block growth signals and receptors (prevents angiogenesis-cuts off cell’s food supply
● Cytokines: stimulate T cell growth and help them get “revved” up (provides immune system boost)
● CA vaccines: delay/stop CA cell growth, cause tumor shrinkage, prevent CA from recurring, eliminate CA cells that have not been killed by other treatments
○ Autologous CA vaccines: derived from pt-specific materials/cells (customized to pt-most costly)
○ Allogeneic CA vaccines: not-pt specific (off the shelf) (target tumor-specific antigen common to CA)
● Colony stimulating factors: helps regenerate neutrophil recovery following myelosuppressive therapy to minimize extent of pt’s nadir and reduce infection
What is neutropenia? When should chemotherapy be held? What are risk factors for neutropenia?
● Neutropenia – low white blood cell count, most common chemo dose-limiting side effect
● When should chemo be held: when neutrophil count drops below 500mm^3 and/or platelet count below 100,000/mm^3
● Do NOT treat if you (therapist) have an active active infection/cough/fever
● Risk Factors: age, female, malnutrition, open wounds, comorbidities (hepatic and renal dysfunction), hx of neutropenia, type of chemo (combined modality), dose intensity, extensive previous chemo, radiation
What signs of infection should you be looking for when treating patients on chemotherapy?
● GI (mucositis, diarrhea), Respiratory tract (cough, dyspnea, abnormal breath sounds), Urinary tract (dysuria, frequency, urgency, color/odor changes), indwelling devices (site redness, edema, tenderness, warmth), skin/mucous membranes (redness, edema, tenderness, warmth), generalized (flu-like, fever, chills, myalgia, malaise, fatigue)
● Fever >38dgrC is most reliable sign of infection in pts with neutropenia
● Septic shock from neutropenia has high mortality rate so do NOT let a fever go untreated
What are risk factors for thrombocytopenia? What are some clinical signs of this condition?
● Thrombocytopenia: low platelet count
● Risk factors: myelosuppressive chemotherapy, radiation therapy, bone marrow involvement, DIC, fever, concomitant disease, nutrition deficiencies
● Clinical Signs: petechiae/bruising, overt bleeding, enlarged liver/spleen, occult/overt blood in stool/urine, headaches, hypotension, tachycardia, prolonged menstruation
What is a vesicant injury?
Strong vesicants can cause severe muscle and tissue damage if there is leakage occurring outside the vein
