Drugs Affecting Immune System Flashcards
(102 cards)
1
Q
Goal of Chemotherapy
A
Maximize therapeutic effects, while reducing toxic effects
2
Q
Purpose of Chemotherapy
A
Achieve a cure
Control growth
Provide palliation
Attempts to increase survival rates and times
3
Q
What does cytotoxic mean?
A
Kills all cells (healthy and cancerous)
4
Q
What labs are best to monitor during chemotherapy?
A
RBC, WBC, platelets
5
Q
When does chemotherapy act?
A
During reproductive cycle, most active on rapidly dividing cells
6
Q
What is remission?
A
Cancer is not actively growing
7
Q
What is Induction Therapy?
A
High dose therapy to get the client into remission
8
Q
What is Consolidation Therapy?
A
Administered after induction therapy to increase cure rate or prolong survival
9
Q
Why would a patient receive Intensification Therapy?
A
High dose therapy during remission to increase cure rate or prolong remission
10
Q
What are drawbacks of Induction Therapy?
A
Depletes immune system Lowers RBC,WBC, platelet
11
Q
What is Adjuvant Therapy used for?
A
To destroy or reduce the spread of cancer after surgery or radiation therapy
12
Q
How is Pallatative Therapy used?
A
To control symptoms, provide comfort, and improve quality of life when cure is not possible
13
Q
Benefits of Combination Therapy
A
- Different chemotherapy drugs act on different phases of the cell cycle
- Decreases drug resistance
- Increases drug effectiveness for remission/cure
- Reduces toxic effects to normal cells
- Can give lower doses with multiple drugs
14
Q
Chemo vs Combo Therapy on cell cycle
A
Chemo drugs work best on rapidly multiplying cells
Combo drugs work on all phases
15
Q
What is the purpose of chlorambucil?
A
non-cell cycle specific; react chemically with portions of RNA, DNA, or other cellular proteins to produce cytotoxic effects
16
Q
What drug class is chlorambucil?
A
Alkylating Agents
17
Q
Therapeutic uses for Chlorambucil
A
Treat slow-growing cancers such as lymphomas, leukemias, and myelomas.
18
Q
Adverse Effects of Chlorambucil
A
- Highly neurotoxic (tremors/muscle twitching)
- Nephrotoxic, Hepatotoxic
- Alopecia (7-10 after starting drugs)
- Sterility
- N/V/A
19
Q
How soon will patient experience alopecia after taking Chlorambucil?
A
7-10 days
20
Q
Nursing Interventions for Chlorambucil
A
- Monitor CBC frequently
- Monitor liver and kidney function
- Monitor uric acid levels (Allopurinol)
- Administer Antiemetics 30 minutes before chemo dose
21
Q
What should a nurse educate the patient about when administering Chlorambucil?
A
- Increase fluid intake
- Infection precautions, patients are immunosupressed
- Use contraceptives during treatment
22
Q
Why is allopurinol given in conjunction with chemo therapy?
A
Chemo increases risk for gout.
Allopurinol decreases uric acid production
23
Q
Purpose of Antimetabolites
A
- inhibit DNA production in cells that depend on certain natural metabolites to produce DNA, preventing normal cellular function.
- Most effective in rapidly dividing cells
24
Q
Methotrexate is an
A
Antimetabolites
25
What are the therapeutic uses for methotrexate?
treatment of leukemias and some GI and basal cell cancers. Also used as treatment for rheumatoid arthritis.
26
How is methotrexate typically given and why?
Used in combination therapy because of increased resistance to treatment.
27
Adverse effects of Methotrexate
1. Fatigue / malaise
2. Rashes
3. Alopecia
4. Ulcerative stomatitis
5. Hepatic toxicity
6. Severe bone marrow suppression
7. Interstitial pneumonitis
8. Chills/ fever/ anaphylaxis
28
Nursing Interventions for Methotrexate
1. Assess lung sounds! Don’t administer if hearing wheezing or abnormal sound at base
2. Always pre-medicate with nausea meds
3. Frequent vitals to watch for reactions
4. Pre-hydrate with sodium bicarb to alkalize urine
5. Send urine samples to the lab if frequent urination
29
Why should the nurse rehydrate a patient with sodium bicarb when administering methotrexate?
Sodium bicarb alkalizes urine.
| Acidic urine can cause crystals to form and shutdown kidneys
30
What is the rescue drug for methotrexate? How long is it given?
Leucovorin
| 4 days
31
Why is Leucovorin administered?
Methotrexate depletes folic acid. Leucovorin replaces folic acid
32
Uses of Leucovorin
1. cell protectant
2. replace folic acid
3. decrease bone marrow suppression, GI toxicity, and neuro toxicity
33
Purpose of Antineoplastic Antibiotics
Break up or prevent DNA synthesis, leading to cell death. Cell cycle specific: S phase
34
What drug class is Doxorubin in?
Antineoplastic Antibiotics
35
Therapeutic Uses for Doxorubin
treat lymphomas, leukemias, breast and ovarian cancers,thyroid cancer, AIDs related Kaposi sarcoma
36
Adverse Effects of Doxorubin
1. Red Urine
2. Mucositis (extremely painful, pt won't eat)
3. Cardiac Toxicity
37
Patient Education for Doxorubin
1. Red urine is normal
2. Antibiotics are only for chemo
3. Wait 6 months after finishing treatment before trying to have kids
38
Purpose of mitotic inhibitors
kills cells as the process of mitosis begins and therefore, inhibit DNA synthesis
39
Therapeutic uses of Vincristine
treatment of a variety of tumors and leukemias (acute leukemias, Hodgkins and non-Hodgkins lymphomas, Wilms’ tumor
40
Adverse Effects of Vincristine
1. Ataxia
2. Cranial nerve malfunctions
3. Neuropathic pain
4. Muscle wasting
5. Leukopenia (loss of WBC=inc risk for infection)
6. Weight loss
7. Constipation
8. SIADH
41
Nursing Interventions for Vincristine
1. Assess injection sites for extravasation
| 2. Restrict fluid, Diuretics, Na diet for SIADH
42
Purpose of Tamoxifen
Competes with hormone binding sites (estrogen) in target tissues. Used for cancers that are sensitive to estrogen stimulation.
43
Therapeutic Uses for Tamoxifen
treatment of metastatic breast cancer or prevention of breast cancer in high risk clients
44
Adverse Effects of Tamoxifen
Menopause effects** (hot flashes, periodic bleeding, moody)
CNS depression
Bone marrow depression
GI toxicity
Visual changes and retinopathy
Hypercalcemia (need weight bearing activities)
45
Patient eduction for Tamoxifen
Eye exams needed every 6 months to a year
46
What type of agent is imatinib?
Protein Tyrosine Kinase Inhibitors
47
Purpose of Protein Tyrosine Kinase Inhibitors (imatinib)
act on specific enzymes that are needed for protein building by specific tumor cells. Blocking these enzymes inhibits cell growth. Goal is to not affect healthy cells.
48
Therapeutic Uses of Imatinib
treats CML (leukemia), GI stromal tumors
49
How long is one typically on Imatinib?
No longer than 5 years
50
Nursing Interventions for Imatnib
1. administer with a meal and full glass of water / PO
2. administer analgesics for headache and muscle pain
3. monitor CBC
4. assess for edema
51
Nursing Management for Cancer
1. Know client’s diagnosis and goals
2. Provide holistic care
3. Obtain baseline physical and emotional assessment
4. Check allergies and drug history
5. Assess lab data:
CBC
Liver enzymes
Renal function (BNP, creatinine)
CXR, EKG, pulmonary function tests
52
Most common adverse effects of chemotherapy are
1. N/V
| 2. Fatigue
53
What drugs should be administered to present N/V with chemotherapy?
```
Prochlorperazine (Compazine)
Lorazepam (Ativan)
Metoclopramide (Reglan)
Ondansetron (Zofran)
Dexamethasone (Decadron)
```
54
Purpose of Dexamethasone with chemotherapy drugs
increase the effects of the anti-nausea drugs
55
Nursing Interventions for Chemotherapy
1. Monitor for signs of bleeding/ blood loss
2. Assess client’s mouth for sores
3. Provide frequent oral care
(Soft toothbrushes, avoid mouthwash with alcohol)
4. Encourage increased fluid intake to 2-3 L/day
5. Advise females from becoming pregnant during treatment and 6 months after
6. Instruct clients to avoid large crowds or ill persons
7. Hair loss typically occurs in 7-10 days after start of treatment
56
Safety Precautions for Administering Chemotherapy
1. Use chemotherapy gloves for administration
2. Flush toilet twice
3. Dispose as hazardous waste using special precautions
4, Know procedure for chemotherapy spills (Spill kit)
5. Do not administer if pregnant – fertility impairment
57
Why is chemotherapy given through central line?
Most agents are vesicants causing extravasation
58
Overall goal of Chemotherapy
Decrease tumor size
Prevention of metastasis
Relief of symptoms
No major adverse effects
59
What is the function of RBC?
Carry oxygen to organs and tissues
60
What are the normal RBC ranges for men and women?
Men – 13-16 g/dL
| Women – 12-15 g/dL
61
Why are women normal RBC ranges lower than men?
Menstruation
62
What is anemia and how is it managed?
Anemia is when RBC is low and causes fatigue
Monitor Hgb & Hct
63
Function of WBC
Fight infection
64
Normal WBC count
4,000-10,000
65
A client with a WBC lower than 4,000 is at risk for?
Neutropenia (low WBC count)
66
What is thrombocytopenia?
Low platelet count
| <100000
67
What should the nurse understand about a patient with a platelet count <20,000
Patient is at high risk for bleeding
68
What is Nadir?
7-14 day period after chemo when blood cell counts are at the lowest
69
What is hematopoiesis?
production of blood cells and platelets in the body
70
Ways to increase RBCs
```
Erythropoietin
Epoietin alpha (Procrit)
1 unit PRBCs – increases Hct by 3 points
```
71
Why is Epoietin alpha contraindicated in cancer patients?
causes spread of cancer
72
What determines the need for RBC?
Hgb & Hct values
73
Ways to increase WBCs
Leukopoietic growth factors
| Filgrastim (Neupogen)
74
Drugs to increase platelets
Thrombopoietic growth factors
| 1 unit of platelets – increases platelets by 20-30,000
75
Why should NSAIDs be avoided with platelet administration?
Alters platelet function
76
Purpose of Epoietin Alpha
Stimulates bone marrow to produce more RBCs
77
What is Epoietin Alpha used for>
Treatment of anemia (low RBCs, Hg, and Hct) in RENAL patients
78
Adverse Effects of Epoietin Alpha?
1. Hypertension (High RBC=Inc Blood Vol=HTN)
2. Increased risk for clot formation
3. Headache
4. body aches
5. Pregnancy Category C
79
Nursing Interventions/Client Education for Epoietin alpha
1. Monitor Hgb levels and blood pressure
2. Administer prophylactic anticoagulant to prevent clots
3. Can not be given for certain cancers due to possible increase in tumor growth
80
How does the nurse know that Epoietin Alpha has been effective?
1. Hgb level increased to 10 or 11 g/dL
| 2. Hct level increased to 33%
81
Purpose of fligrastim?
To stimulate the bone marrow to increase production of neutrophils
82
Therapeutic Uses for Filgrastim
1. To decrease risk of infection in clients with neutropenia
| 2. To increase stem cells for transplant
83
Adverse Effects of Filgrastim
Bone pain, leukocytosis, and splenomegaly
84
Nursing Interventions/Client Education for Filgrastim
1. Give acetaminophen for bone pain
2. Monitor CBC weekly
3. Can be administered IV or SQ
4. Must be refrigerated
85
Purpose of Oprelvekin
Increases the production of platelets
86
Therapeutic Uses for Oprelvekin
Decreases thrombocytopenia and need for platelet transfusions
87
Adverse Effects of Oprelvekin
Fluid retention, cardiac dysrhythmias, allergic reactions
88
Nursing Interventions/ Client Education for Oprelvekin
Monitor intake and output
Use cautiously in clients with heart problems
Administered by SQ injection only
89
How do you know if Oprelvekin has been effective?
Platelet count is >50,000
90
What causes anemia?
Decreased RBC Production
Increased RBC Loss
Increased RBC Destruction
91
Acute Anemia vs Chronic Anemia
Acute: within week
| Chronic weeks-months
92
Example of Hemolytic Anemia
Sickle Cell Anemia (loss of ability to carry oxygen)
93
Importance of Iron
Needed for RBC production
94
Purpose of Ferrous Sulfate
elevates serum iron levels, and then converted to Hgb or trapped in reticuloendothelial cells for storage
95
Therapeutic Uses for Ferrous Sulfate
iron deficiency anemia or adjunct treatment with erythropoiesis-stimulating drugs
96
Nursing Interventions/ Patient education for Ferrous Sulfate
1. Give with meals but avoid eggs, milk, coffee, and tea- can decrease med absorption
2. If liquid, drink with straw because Iron stains teeth
3. Orange juice inc iron absorption
4. Should not be concerned with black/green poop
5. Causes constipation, so teach preventative measures
6. Painful administration, use Ztrack method. Inject all meds before removing needle, may stain skin
97
S/S of Iron Toxicity
1. Dizziness
2. Confusion
3. Fever
4. Bradychardia
5. Seizures
98
Foods high in Iron
```
Broccoli
Sardine
Chicken
Spinach
Eggs
```
99
Importance of Vitamin B12
Needed for cell growth and RBC strength, maintenance of myelin sheath in nerves
100
Therapeutic Use for Hydroxocobalamin
poor diet, increased demand, lack of intrinsic factor (pernicious anemia)
101
How is Hydroxocobalamin administered?
IM or Intranasal
102
Nursing Interventions / Client Education for Hydroxocobalamin
1. Pt will receive Vit B12 daily for first 5-10 days, then once a month for life
2. Acetominophen for nasal discomfort
3. Pt may experience HF/pulmonary edema with excess B12
