Exam 1 - Principles of Chemotherapy

Question 1

when was breast cancer first described?

Answer 1

460 BC by ancient egyptians

Question 2

what did hippocrates describe cancer as?

Answer 2

disease of black bile

Question 3

what did hippocrates name cancer? what does it mean? was surgery recommended?

Answer 3

karkinos - greek for crab

no surgery

Question 4

when was the earliest cancer treatment documented? examples?

Answer 4

200 AD

opium, castor oil, licorice

Question 5

when was hodgkins-lymphoma described in data?

Answer 5

1946 - after explosion in 1942 that exposed soldiers to mustard gas

Question 6

T/F: vet med is about 20 years behind human medicine when it comes to cancer treatment

Answer 6

true

Question 7

what are the big 3 components of cancer therapy in vet med?

Answer 7

surgery, chemotherapy, & radiation

spay/neuter as prevention!!

Question 8

what is the difference between localized & systemic therapy for cancer?

Answer 8

localized involves surgery & radiation, so targeted approach

systemic includes chemotherapy & immunotherapy

Question 9

after determining your histological diagnosis for a tumor, what 3 questions should you consider next?

Answer 9

1. benign or malignant?
2. is surgery necessary?
3. is adjuvant therapy necessary?

Question 10

what are the 2 general groups of tumors that require systemic therapy?

Answer 10

hematopoietic tumors & tumors with high metastatic rates

Question 11

what are some examples of hematopoietic tumors?

Answer 11

leukemias, lymphomas, & myelomas

Question 12

what are some examples of tumors with high metastatic rates that require systemic therapy?

Answer 12

hemangiosarcoma, osteosarcoma, melanoma, AGASACA, & high grade tumors

Question 13

how do sarcomas spread first?

Answer 13

hematogenously - organs with large capillary beds/endocrine organs

Question 14

how do carcinomas spread first?

Answer 14

lymphatically - regional lymph nodes 1st

Question 15

how do round cell tumors spread first?

Answer 15

both hematogenously & lymphatically

Question 16

why is staging important?

Answer 16

you need to determine if the cancer has spread?

Question 17

what are common concerns clients have about cancer treatment?

Answer 17

cost, side effects, prognosis, time commitment, & disfigurement

Question 18

what is adjuvant therapy?

Answer 18

chemotherapy administered after the primary tumor has been removed

Question 19

what is neoadjuvant therapy?

Answer 19

chemotherapy used to reduce the bulk of the tumor before local therapy

Question 20

with what type of tumor would you want use neoadjuvant therapy?

Answer 20

mast cell

Question 21

what is nadir?

Answer 21

lowest point of the white blood cell count or platelet count after chemotherapy

Question 22

when making a drug plan for a tumor, why is it important to know the tumor’s responsiveness?

Answer 22

when picking specific drugs - want to pick one that has shown prior success

Question 23

why do you consider drug mechanisms when making a drug plan for chemotherapy?

Answer 23

you want to pick drugs that have different mechanisms from each other & the drug’s cytotoxic activity/mechanism of resistance to the drug

Question 24

why is drug toxicity important when making a chemotherapy plan?

Answer 24

drugs may cause more side effects/problems than the cancer

Question 25

what is the main goal of chemotherapy when addressing solid tumors?

Answer 25

often palliative in a gross setting - trying to slow things down to aim for partial remission/stable disease

Question 26

what is the exception to palliative care of tumors in chemotherapy? why?

Answer 26

lymphoma! curative intent - goal to reach clinical remission

Question 27

in a microscopic disease setting, what are the 3 goals of chemotherapy?

Answer 27

1. kill micro-metastatic cells throughout the body 2. kill tumor cells remaining at the primary tumor site 3. prevent delay or recurrence

Question 28

what is the fractional cell kill hypothesis?

Answer 28

given drug concentration applied for a defined period of time will kill a constant fraction of the cells with regrowth of the tumor between drug cycles

Question 29

what is the goal of the fractional cell kill hypothesis?

Answer 29

give the highest tolerated dose at the shortest frequency tolerated

Question 30

the fractional cell kill hypothesis works best in what 2 cancer types? what cancer is it not great for?

Answer 30

great for leukemias & lymphomas not great with solid tumors

Question 31

why is the fractional cell kill hypothesis not great for solid tumors?

Answer 31

biochemical heterogeneity of tumors - subclinical dose to areas further from vessels can become resistance

Question 32

T/F: cytotoxic chemotherapy is preferred most of the time but is more likely to induce toxicity in the patient

Answer 32

true

Question 33

what is the goal of cytotoxic chemotherapy?

Answer 33

kill the cancer cell directly

Question 34

how does cytotoxic chemotherapy generally work?

Answer 34

often aims to kill the cancer directly through DNA damage or altered cellular metabolism

Question 35

when is cytostatic chemotherapy used?

Answer 35

palliative care or metronomic chemotherapy

Question 36

how does cytostatic chemotherapy work?

Answer 36

often targets growth factors or other signaling pathways that may not be required for survival, but may be required for growth

Question 37

when may you use the tyrosine kinase receptor inhibitor, target c-kit receptor?

Answer 37

mast cell tumors

Question 38

when may you use the tyrosine kinase receptor inhibitor, target PDFGR?

Answer 38

vaccine associated sarcomas

Question 39

when may you use the tyrosine kinase receptor inhibitor, target VEGFR?

Answer 39

AGASACA

Question 40

how is the chemotherapy dose calculated?

Answer 40

based off of body surface area in meters squared

Question 41

what is the calculation for body surface area?

Answer 41

(W^0.425 X H^0.725) X 0.007184

Question 42

T/F: all chemotherapy is bone marrow suppressive

Answer 42

true

Question 43

what values would you see on a CBC/chem that would make you not treat your patient with chemo?

Answer 43

neutrophil counts <2000 cells/dL platelet counts <75000 cells/uL total bilirubin >1.5 mg/dL (dose adjustment may be required)

Question 44

what are the 3 pharmacologic determinants of response to chemotherapy?

Answer 44

absorption metabolism elimination

Question 45

how does absorption affect the response to chemotherapy?

Answer 45

intestinal disease or co-administration with other drugs can impede/decrease/increase absorption

Question 46

how does metabolism affect the response to chemotherapy?

Answer 46

liver & kidney function - if disease is present, can lead to toxicity much quicker genetic differences - mrd1 mutation

Question 47

how does elimination affect the response to chemotherapy?

Answer 47

liver & kidney function - if disease is present, can lead to toxicity much quicker specific enzyme alterations

Question 48

when was combination chemotherapy introduced?

Answer 48

1950s for childhood leukemia

Question 49

why was combination chemotherapy started?

Answer 49

single agent drugs induced resistance rapidly

Question 50

what is combination chemotherapy?

Answer 50

use of combo of drugs with various mechanisms of action & target resistant target subpopulations left behind in single agent protocols

Question 51

what two chemo drugs are better to use on dividing cells?

Answer 51

doxorubicin (hydroxydaunarubicin) & vincristine (oncovin)

Question 52

what is the CHOP protocol?

Answer 52

C - cyclophosphamide H - hydroxydaunarubicin O - oncovin P - prednisone

Question 53

what is important to remember if using cisplatin & methotrexate?

Answer 53

they are both cleared by the kidneys, so increased risk for toxicity

Question 54

T/F: chemotherapy causes delayed healing of surgical wounds

Answer 54

true

Question 55

in the chop protocol, which drugs are not cell-cycle specific?

Answer 55

cyclophosphamide & prednisone

Question 56

what chemo drug is M phase specific?

Answer 56

vincristine

Question 57

what chemo drug works best in the S phase of the cell cycle?

Answer 57

doxorubicin

Question 58

T/F: chemotherapy affects rapidly dividing normal cells

Question 59

what are the big 3 side effect categories of chemo therapy?

Answer 59

1. bone marrow suppression 2. alopecia 3. gastrointestinal

Question 60

what are 2 long term effects of chemotherapy on the bone marrow?

Answer 60

anemia & myelofibrosis

Question 61

what cells are most effected in the blood with chemo?

Answer 61

neutrophils & platelets - highest turnover rate of cells

Question 62

how is bone marrow suppression from chemotherapy treated?

Answer 62

antibiotics, drug holidays, colony growth stimulating factors, transfusions, & active surveillance

Question 63

what does chemotherapy cause peripherally in the gi tract?

Answer 63

blunting of the crypt cells

Question 64

what peripheral gi signs are seen as chemo side effects?

Answer 64

diarrhea, vomiting, nausea, inappetence, & weight loss

Question 65

what is the most common gi sign from chemo?

Answer 65

peripheral - diarrhea, vomiting, & nausea

Question 66

what chemo drugs cause central gi signs?

Answer 66

cisplatin & doxorubicin

Question 67

what central gi signs are seen as chemo side effects?

Answer 67

vomiting

Question 68

when do peripheral gi signs occur from chemo?

Answer 68

3-5 days after chemotherapy

Question 69

what anti-emetics are used for gi side effects from chemo?

Answer 69

ondansetron, maropitant, & metoclopramide also acupuncture

Question 70

what antidiarrheals can be used for treating gi side effects from chemo?

Answer 70

metronidazole, fiber, tylosin, & imodium

Question 71

what drugs can be used as appetite stimulants for treating chemo side effects?

Answer 71

steroids & capromorelin

Question 72

what animals commonly get alopecia from chemo?

Answer 72

dogs with hair not fur

Question 73

how is alopecia treated in chemo patients?

Answer 73

sweaters

Question 74

what chemo drug causes fulminant pulmonary edema in cats?

Answer 74

cisplatin

Question 75

what chemo drug commonly causes immediate vomiting in dogs?

Answer 75

cisplatin

Question 76

if starting an animal on lomustine, what other drug should you start immediately? why?

Answer 76

denamarin - lomustine is hepatotoxic

Question 77

what chemo drug causes sterile hemorrhagic cystitis?

Answer 77

cyclophosphamide

Question 78

what chemo drug is known to cause DCM & arrhythmias in dogs?

Answer 78

doxorubicin

Question 79

what can you give prophylactically in a patient you're treating with cyclophosphamide?

Answer 79

pred or lasix - help prevent sterile hemorrhagic cystitis

Question 80

what chemo drug is associated with a 'walking on eggshells' gait, pigmentation of skin, gi ulcers, hypertension, proteinuria, & muscle pain

Question 81

T/F: the board won't get you for USP 800 violations

Answer 81

true - but OSHA will

Question 82

what is USP 800?

Answer 82

provides standards for safe handling of hazardous drugs to minimize the risk of exposure to healthcare personnel, patients and the environment.

Question 83

who has to follow USP 800?

Answer 83

all facilities that store, handle, or administer hazardous drugs (not just chemotherapy)

Question 84

in a facility under USP 800 regulations, what is required in the environment?

Answer 84

externally vented powder hood negative air pressure around the hood PPE

Question 85

what PPE should be utilized?

Answer 85

gloves with a long sleeve water resistant gowns face mask goggles sharps container chemo-waste receptacle