Exam 1 Flashcards by MARIAN NELSON

What symptoms should be concerning to the nurse when introducing an immunosuppressant?

new cough, dysuria, painful urination, rash, fever, sore throat–anything indicating an infection

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What is a similar drug to cyclosporine?

tacrolimus

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Why are pts at increased risk for cancer with cyclosporine?

Will be immunosuppressed for life which reduces natural cancer defense too.

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Does constipation increase risk for infection? Is diarrhea a sign of infection?

Yes, in the GI tract

Yes

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Why do chemotherapy drugs cause so many side effects?

They attack rapidly dividing cells

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What does tamoxifen do to estrogen? What does it do to the uterus? What is a sign of uterine cancer? What is another concerning SE? Does tamoxifen cause immunosupression?

It doesn’t do anything to the estrogen, it changes the estrogen receptors so that it is blocked.

It increases estrogen receptor sensitivity in the uterus which put her at higher risk for uterine cancer

vaginal bleeding

DVT, clotting issues

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How does cyclophosphamide cause hemmoraghic cystitis? What is it paired with to circumvent this AE?

when it is metabolized it is very irritating to the bladder

Mensa

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What puts a person at higher risk for lung cancer?

COPD diagnosis
history of smoking
non-healing sores in the mouth
family history of lung cancer

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What is the #1 type of cancer in US?

lung cancer

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What is the “red devil”? What is most unique about it? What is the common similar drug?

doxorubicin

there is a lifetime limit, hard on heart

donorubicin

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What is the adjunct drug for methotrexate for cancer patients only?

leucovorin

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What organ is methotrexate really hard on? What are contraindications? What is it similar to?

liver

hepatitis, liver failure, etc.

azathioprine

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What is ondansetron? How is it used with chemotherapy?

Zophran

prophylactically

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What are vesicants?

Drugs toxic to the tissue outside of the vein

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What can petechial rash be related to?

thrombocyte level

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What are signs of dose related toxicity for vincristine?

Neurotoxicity, paraesthesia (pins and needles)–presents like numbness in fingers and toes

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What are the normal counts for WBC, HGB and PLT?

WBC: 5,000-10,000 mm

HGB: Femailes 12-16/g/dL, males 14-18 g/dL

Platelets: 150,000-400,000 mm

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What can s/s indicate infection and should be reported immediately when immunosuppressed?

Immediately report s/s of infection wounds, increased cough, increased fatigue, white patches in the mouth, white & itchy vaginal discharge, itchy blister-like vesicles on the skin

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What are 4 examples of immunostimulants?

interferons
interleukins
colony-stimulating factors (filgrastim)
vaccines (hepatitis B)

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What are 4 examples of immunosuppressants?

calcineurin inhibitors (cyclosporin)
cytotoxic drugs (azathioprine)
antibodies
corticosteroids

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What is the action of vaccines? Therapeutic use?

stimulate immune system to produce antibodies

eradicate infectious disease in population, prevent disease in individual

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What are 3 additional vaccines for immunocompromised?

pneumococcal polysaccride
meningococcal polysaccride
Zoster

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What are immunoglobulins? When are they administered? What are 6 examples?

An infusion or injection of antibodies providing immediate protection for an individual that has been exposed to a threat or disease

Often administered with the immunization to provide immediate and long-term protection.

CMV
Hep B
Rabies & Rabies Vaccine
RhoGAM
Tetanus
Varicella Zoster

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What are some neutropenic precautions?

wash hands, bathe, brush teeth
sanitize toothbrush
prevent constipation
do not use tampons
do not share personal items
avoid fresh plants
don’t clean up after pets

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What are some neutropenic food precautions?

wash keep cooked and raw separate cook food thoroughly refrigerate food

With fevers and cancer when should you seek medical attention?

38 C (100.4) for more than 1 hour 38.3 (101.0) once

What is neoplasia?

new, uncontrolled growth of cells

What is a biologic response modifier?

substance that enhances the body's defenses in removing cancer cells

What are 2 general classes of biological modifiers (cytokines and MAB)?

interferons interleukins

What are targeted therapies? What are 4 examples?

drugs that block the cancer with a molecular process specific to the cancer cell tyrosine enzymes epidermal growth factor receptor vascular endothelial growth factor (angiogenesis inhibitors) CD20

What is an adjunct cancer treatment for mucositis?

GI cocktail of viscous lidocaine, diphenhydramine and sulcralfate

What is used prophylactically and post cancer treatment to manage nausea?

ondansetron (Zofran)

Bone marrow suppression causes what three insufficiencies? How might they present?

thrombocytopenia, neutropenia, anemia anemia: fatigue, pallor, shortness of breath neutropenia: susceptible to infection thrombocytopenia: bleeding, bruising, petechial rash

What is a concerning temperature that should be reported to HCP when immune suppressed? What else should be reported? A simple infection can turn into what?

100.4 for more than an hour 101+ report immediately malaise, new cough, fever, chills, dysuria sepsis, septicemia

What 2 drugs are calcineurin inhibitor immunosuppressants?

cyclosporine and tacrolimus

What are cyclosporine and tacrolimus almost always used for? What is the pt at increased risk for? What is the challenge with these drugs? What is the most difficult AE associated with it? Making who a most risk?

transplant rejection cancers and infection due to immunosuppression pt is on it for life, and must be compliant forever HTN someone with uncontrolled HTN

What are the future drugs for cancer? Why?

monoclonal antibodies (MABs) very specific, targets cells rather than killing all cells like other cancer drugs do

When is basiliximab given? why? What does it do? What do we assesss the pt for first? Why?

before transplant and just after the greatest risk for rejection is 48-72 hours after transplant, given to prevent that decimates the immune system, to not have any rejection response Any signs of infection if they have an infection, turning off the immune system will almost certainly send them into sepsis

What is interferon most used for? What does it do? What is the AE of note?

viral infections and hepatits C targets specific cells and kills them off by activating the immune response flu-like illness for a week or so

What drug increases white blood cell activity? What is the SE of note? How does is present? What would we do for a pt with this SE

aldesleukin capillary leak syndrome anemia, low blood pressure, edema elevate, wrap legs, ted hose

What are the age groups for the 2 tetanus injections?

Dtap: under 6 Tdap: over the age of 6

When is the 1st time you get a hep B injection?

at birth, with the first 12 hours

What is the exception of a live vaccine that is completed under the age of 1? how is it administered? Why?

rotavirus oral prevent diarrhea, vomiting and dehydration which is a killer of children worldwide

HPV is administered when?

11-12, before they turn sexually active

menigitis vaccine (meningococcal) is given when?

7 yr, booster around 16-17

When are the MMR and the varicella vaccine given? Should they be given under 1 year of age? Why?

12-15 yrs and 4 yrs No Live vaccines should not

What vaccine protects babies from pneumonia? When is it administered

pneumococcaal conjugate 2, 4, 6 and 12 mos

What vaccine are contraindicated in pregnant and immunosupressed? What can they get?

MMR, varicella, rotavirus pneumococcal polysaccharide, Tdap, inactivated flu, Hep A and B

What is the general difference between an immunoglobulin and a vaccine?

immunoglobulins work immediately, just not long-lasting

What does the Hep A infection affect?

liver

What is the biggest contraindication of the rotavirus vaccine? What is it? Why is rotavirus not given then?

intussusception telescoping of the bowel prevent it from happening again

What vaccine is used for bacterial infection and epiglottitis?

HIB

What does tetanus protect us against? What 2 ways can it be given for a high risk animal bite?

tetanus, diptheria and pertussis before a baby is born serious wounds, metal wounds animal bites rabies immunoglobulin and tetanus vaccine

What does HPV prevent?

genital warts, cervical cancer

Why is rhogam given? How? What does it prevent? Is rhogam an immunoglobulin?

Moms with Rh- prevents hemolysis of the next baby's red blood cells from antibodies the mother created Binds to the baby's Rh+ fetal red blood cells which protects them in the mom's bloodstream fetal anemia, miscarriage yes

What is another term for antineoplastics? Why do they have so many side effects?

cytotoxic, chemotherapy agents They go after all fast-growing cells and kill them off

What is mylelosupression synonymous with?

bone marrow supression

What is mucositis or stomatitis? What is the concern? What should you avoid? Why?

ulcers in the mouth and GI tract increases the risk of infection caffeine, peroxide, alcohol, citrus, spicy foods, acidic, soda dries out and irritates which increases risk

What is doxirubicin? what is it nicknamed? Specific SE? What is unique about it? What are signs of heart failure?

anti-tumor drug red devil congestive heart failure there is a lifetime limit, to protect the heart pedal edema, crackles in the lungs, swelling, JVD, wet lungs, wet cough

What is the unique SE of cyclophosphamide? What are signs? What is taken to protect? What is it?

Hemorragic cystitis blood in urine, pain, bladder pain, pubic pain mesna uroprotectant

What is methotrexate and azathioprine used for? What does it do?

RA, MS, myocinea gravis (sp?), Crohn's disease, inflammatory disease, and cancer inacitvates ablility to use folic acid

What is paired with methotrexate only when it is used between rounds of chemo--only used for ?

leukovorin

What should be avoided with methotrexate or azathioprine?

NSAIDs, naproxen, aspirin, liver issues

What is used for breast cancer? Why? Where does it not block them? Does it cause immunosuppression? What SE should you worry about?

tamoxifen blocks estrogen receptors uterus no DVT--calf pain, redness, pain, erythema vaginal bleeding--sign of uterine cancer

What chemo drug is an alkylating agent?

cisplatin

What is an immunostimulant? What does it do? How is it monitored for effectiveness? What is the worst SE? Who is it contraindicated for?

filgrastim increases WBCs CBC, increased WBCs bone pain sickle cell

What is the AE for vincristine?

neuropathy, paraesthesia (pins and needles)

with cancer, what is the main reason to use cannabis?

appetite stimulation

Exam 1 Flashcards

(68 cards)