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Patho/Pharm > Chemotherapy > Flashcards

Chemotherapy Flashcards

1
Q

Chemotherapy (uses)

A
  • can be used for cure, control, palliation
  • antineoplastic drugs
  • divided into 2 groups (cell cycle nonspecific CCNS, or cell cycle - specific
  • narrow therapuetic index
  • combination of drugs is more effective than single-use drug therapy
  • dose calculated based on body surface area
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2
Q

Chemotherapy (toxicities)

A
  • affect rapidly dividing cells (harmful and healthy: hair follicles, GI tract cells, bone marrow cells, neutrophils, ova or testes)
  • symptoms: hair loss, nausea and vomiting, bone marrow toxicity (depletion of RBC, WBC, and platelets)
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3
Q

Myelosupression

A

bone marrow supression (BMS) or bone marrow depression

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4
Q

Nadir

A

the lowest level of WBC in the blood following chemotherapy or radiation. Normally occurs 10-28 days after dosing. Anticipation allows phrophylactic treatment admin of antibiotics or blood stimulants

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5
Q

Targeted drug therapy

A

recognition of a specific molecule involved in the growth of cancer cells while sparing healthy cells

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6
Q

Dose-limiting adverse effect

A

patient can no longer tolerate an increase in dosage (GI tract and bone marrow)

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7
Q

Emetic potential

A

likelihood that a drug will produce vomiting

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8
Q

Chemotherapy (contraindications)

A
  • very low WBC count (ANC <500 = severe neutropenia)
  • ongoing infectious process
  • severe compromise in nutrition and hydration status
  • reduced kidney or liver function
  • decline in organ function
  • pregnancy (category D or X)
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9
Q

Chemotherapy (routes)

A
  • oral (more available today, storage and side effects)
  • IM
  • IV (most common, through CVAD)
  • regional administration: directly into the tumor site = less toxcicity
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10
Q

Chemotherapy administration

A
  • only people specially trained in chemotherapy handling technique should prepare and administer
  • people handling chemo are at high risk of absorbing the durg
  • there can be risk 48 hrs after chemo when handling body fluids and excretions
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11
Q

Chemotherapy side effects

A
  • destruction of normal cells
  • neurologic, cardiovascular, respiratory, hepatobiliary, gastrointestinal, genitourinary, dermatologic, ocular, otic, metabolic, musculoskeletal
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12
Q

Killing of normal cells in GI tract

A
  • altered nutritonal status
  • stomatitis: inflammation and/or ulceration of oral mucosa throughout GI tract
  • altered bowel function
  • poor appetite
  • nausea
  • vomiting
  • diarrhea
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13
Q

Killing of normal cells of hair follicles

A

alopecia = loss of hair

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14
Q

killing of normal cells in bone marrow

A
  • low, possibly life threatening blood cell count
  • constantly assess WBCs, RBCs, hemoglobin, hematocrit, and platelet
  • must monitor ANC (absolute neutrophil count), allows to identify nadir (< 500 cells/mm3 high risk of infection
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15
Q

killing of germinal epithelial cells

A
  • sterility in males
  • damage to ovaries with amenorrhea in females
  • teratogenic effects with possible fetal death in pregnant women
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16
Q

killing of normal cells in chemo

A

can lead to release of waste products such as uric acid into the blood resulting in hyperuricemia

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17
Q

Cell cycle Specific drugs (function)

A
  • cytotoxic during a specific cell cycle
  • used to treat a variety of solid or circulating tumors
  • drugs that work at different places in the cell cycle can more effectively kill cancer cells
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18
Q

Antimetabolites (function)

A
  • CCS analouges that work by antagonizing the actions of key cellular metabolites
  • “trick” cancer cells into using the drug instead of usinf the molecules it needs (folate, purines, pyrimidines) to make genetic material
  • work primarily in the S phase when DNA synthesis is most active
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19
Q

Folate (folic acid) anatagonist

A
  • antimetabolites
  • inhibits the conversion of folic acid to folate which is needed for DNA synthesis
  • methotrexate (MTX), pemetrexed, pralatrexate
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20
Q

Purine antagonists

A
  • antimetabolites
  • purine bases (adenine and guanine) inhibited
  • inhibits synthesis of DNA and RNA
  • fludarabine (F-AMP), mercaptoputine (6-MP), thioguanine (6-TG), cladribine, pentostatin
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21
Q

Pyrimidine antagonists

A
  • antimetabolites
  • pyrimidine bases (cytosine, thymine, uracil)
  • inhibits synthesis of DNA and RNA
  • flurouracil (5-FU), cytarabine (ara-C), capecitabine, floxuridine (FUDR), gemcitabine
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22
Q

Antimetabolites (indications)

A
  • oral and topical can only bve used for low dose maintenance and palliative cancer therapy
  • often used in combination chemotherapy regimens
  • methotrexate is also used to treat severe cases of psoriasis and rheumatoid arthritis because it decreases lymphocyte and cytokine production
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23
Q

Mitotic Inhibitors

A
  • natural products obtained from the periwinkle plant (vinka alkaloids) or the mandrake plant (taxanes)
  • can work in various phases of the cell cycle (late S phase, throughout G2 phase and M phase)
  • all work shortly before or during mitosis and thus retard cell division
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24
Q

Mitotic Inhibitors (adverse effects)

A

vincristine: peripheral neuropathy
Taxanes: severe hypersensitivy

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25
Q

Examples of vinva alkaloids

A
  • vincristine
  • vinblastine
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26
Q

Mitotic Inhibitors (indications)

A
  • Kaposi sarcomma
  • small cell lung cancer
  • others
27
Q

Alkaloid Topoisomerase II inhibitors

A
  • used to treat small cell lung cancer and testicular cancer
  • not used much now because of significant toxicictes without therapuetic benefit
  • EX: etoposide
28
Q

Antineoplastic enzymes

A
  • synthesized using cultures of bacteria and recombinant DNA technology
  • isolated and purified for clinical use
  • Asparaginase (elspar: used to treat acute lymphocytic leukemia)
  • Pegaspargase (oncaspar)
29
Q

Topoisomerase I inhibitors

A
  • used primarily to treat ovarian and colorectal cancer
  • derived from camptothecin (substance taken from chinese shrub)
  • Topotecan (hycamtin)
  • Irinotecan (CPT-11, camptosar)
30
Q

Antineoplastic enzymes (adverse effects)

A

imparied pancreatic function, which can lead to hyperglycemia and severe or fatal pancreatitis, dermatologic, hepatic, genitourinary, neurologic, musculoskeletal, GI, and cardiovascular effects

31
Q

Cell cycle specific drugs (CCS)

A
  • antimetabolites
  • mitotic inhibitors
  • alkaloid topoisomeras II inhibitors
  • toposiomerase I inhibitors
  • antineoplastic enzymes
32
Q

Cell cycle - nonspecific (CCNS) drugs

A
  • alkylating drugs
  • cytotoxic antibiotics
33
Q

Alkylating drugs (function)

A
  • works by preventing cancer cells from reporducing
  • alter the chemical strucutre of the cells DNA
34
Q

Alkylating drugs (indications)

A
  • recurrent ovarian cancer
  • brain tumors
  • lymphomas
  • leukemias
  • breast cancer
  • bladder cancer
  • others
35
Q

Alkylating drugs (adverse effects)

A
  • possible ototoxcicity: rinings or roaring in ear
  • peripheral neuropathies may occur, report tingling, numbness, or pain in extremities
  • dose limitng adverse effects: nausea and vomitting, myelosupression
  • alopecia
  • nephrotoxicity, peripheral neurophathy, ototoxicity (hydration can prevent nephrotoxicity)
  • extravasation causes tissue damage and necrosis
36
Q

Alkulating drugs (common names)

A
  • Cisplatin (platinol): treat solid tumors
  • Cyclophosphamide (Cytoxan): treat bone, lymph, blood and solid tumors
  • Mechlorethamine (Mustargen, nitrogen mustard): hodkins lymphoma
37
Q

Cytotoxic antibiotics (function)

A
  • natural substances produced by the mold streptomyces
  • block DNA synthesis
  • semisynthetic subtances alo used
  • common toxicity: bone marrow supression
38
Q

Cytotoxic antibiotics (adverse effects)

A
  • Bleomycin: pulmonary toxicity
  • Danotubicin: heart failure, dysrhythmias
  • Doxorubicin: left ventricular failure, dysrhythmias
39
Q

Cytotoxic Antibodies (Indications)

A
  • used in combination chemotherapy regimens
  • used to treat a variety of solid tumors and some heamtologic malignacies
  • leukemia, ovarian, breast, bone
  • squamous cell carcinomas
  • AIDS - related Kapoti’s Sarcoma (when intolerant to other treatments)
40
Q

Bevacizumab (Avastin)

A
  • Angiogenesis inhibitor
  • Blocks blood supply to the growing tumor
  • Used to treat metastatic colon, ovarian and rectal cancer in combination with 5-fluorouracil, non–small cell lung cancer, and malignant glioblastoma
  • Many adverse effects, including nephrotoxicity
41
Q

Hydroxyurea (Hydrea, Droxia)

A
  • Action similar to antimetabolites
  • Used to treat squamous cell carcinoma and some leukemias
  • Many adverse effects such as edema, drowsiness, headache, rash, hyperuricemia, nausea, vomiting, dysuria, myelosuppression, nephrotoxicity, and pulmonary fibrosis
42
Q

Octreotide (sandostatin)

A
  • Management of a cancer-related condition called carcinoid crisis (life-threatening complication with neuroendocrine tumors)
  • Treatment of the diarrhea caused by vasoactive intestinal peptide–secreting tumors (VIPomas)
  • Suppresses insulin release
43
Q

Aromatase Inhibitor

A
  • fem. specific neoplasm hormonal drug
  • anastrozole, aminogluthimide
44
Q

Selective estrogen receptor modulators

A
  • fem. specific neoplasm hormonal drug
  • tamoxifen
  • toremifene
45
Q

Progestins

A
  • fem. specific neoplasm hormonal drug
  • megestrol
  • medroxyprogesterone
46
Q

Androgens

A
  • fem. specific neoplasm hormonal drug
  • fluoxymesterone
  • testolactone
47
Q

Estrogen receptor antagonist

A
  • fem. specific neoplasm hormonal drug
  • fluvestrant
48
Q

Antiandrogens

A
  • male specific neoplasm hormonal drugs
  • bicalutamide
  • flutamide
  • nilutamide
49
Q

Antineoplastic hormone

A
  • male specific neoplasm hormonal drugs
  • estramustine
50
Q

Normal ANC

A

1500 - 8000

51
Q

Severe neutropenia

A

ANC <500

52
Q

Signs of Myelosupression

A

RBC, Hgb, Hct (anemia): pale skin and mucosa, fatigue, lethargy, SOB< inability to concentrate, tachycardia
WBC (leukopenia): fever, chills, tachycardia, productive cough with purulent sptutum, change in urine
Platelets (thrombocytopenia): petechiae, ecchymosis, gingival bleeding, blood in urine/stool/vomit, prolonged bleeding from IV
GI: stomatisits, altered bowel function, poor appetitie, nausea, vomiting, diarrhea, and inflammation, and possible ulcerations of GI mucosa

53
Q

vesicants

A

cause severe local tissue breakdowm

54
Q

Extravasation

A
  • leaking of an antineoplastic drug into surrounding tissues during intravenous administration is extravasation
  • can result in premanent damage to nerves, tendons, muscles, loss of limbs
  • skin gafting or amputation may be necessary
  • prevention is essential
  • continous monitoring of the IV site is essential
  • If suspected, stop the infusion immediately and contact the prescriber but leave the IV catheter in place.
  • ## Aspirate any residual drug or blood from the catheter.
55
Q

Oncologic emergencies

A
  • infections
  • pulmonary toxicity
  • allergic reactions
  • stomatitis with severe ulcerations
  • bleedings
  • metabolic aberrations
  • bowel irritability with diarrhea
  • renal, liver, cardiac toxicity
56
Q

Erythropoietic Drugs (common names)

A
  • epoetin alfa, darbepoetin alfa
57
Q

Erythropoietic Drugs (Indications)

A

anemia of chronic cancer (epoetin)
anemia related to chemotherapy (darbepoetin)

58
Q

Erythropoietic Drugs (Action)

A

stimulates the bone marrow to make more RBCs

59
Q

Erythropoietic Drugs (adverse effects)

A
  • hypertension
  • thrombosis
  • Headache
60
Q

Erythropoeitc Drugs (nursing considerations)

A
  • Not given when the hemoglobin is above 10 for cancer patients. Can cause heart attack, stroke or death when continued with hemoglobin above 11.
  • Must have adequate iron for drug to be effective- may need iron supplement
61
Q

Granulocyte colony stimulating factor (G-CSF)

A
  • use: chemotherapy induced neutropenia
  • adverse effects: bone pain, nausea, vomiting
  • filgrastim (neupogen)
  • filgrastim-sndz (zarxio)
  • pegfilgrastim (neulasta
  • tbo-fligrastim (granix)
62
Q

Granulocyte-macrophage colony-simulating factor (GM-CSF)

A
  • use: myeloid cell recovery after bone marrow transplantation
  • adverse effects: nausea, vomiting, diarrhea, fever, chills, myalgia, headache, fatigue
  • sargramostim: leukine
63
Q

Interleukin-II (platelet growth factor

A
  • use: thrombocytopenia related to chemotherapy
  • adverse effects: fluid retention, peripheral edema, dyspnea, increase HR, nausea, mouth sores
  • oprelvekin (neumega)

Patho/Pharm (12 decks)

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