Oncology pt2

Question 1

What are the principal benefits of continuous infusion via catheters for cancer pain? (2)

Answer 1

• ↓ systemic side effects
• Technique and equipment ubiquitous.

Question 2

Chemotherapy target cells in different phases of their ________.

Answer 2

• Cell cycle

Question 3

How do alkylating agents work?
Whats an example of an alkylating agent?

Answer 3

• Damage cell DNA in all phases of the cell cycle causing them to be unable to reproduce.
• Example: Cisplatin (Nitrosurea) [-platins]

Question 4

What is a severe side effect of alkylating agents?

Answer 4

Dose-dependent cause of leukemia 5-10 years after treatment.

Question 5

What types of cancers do antimetabolites commonly treat?

Answer 5

• Breast
• Ovary
• Intestines
• Leukemias

Question 6

How do antimetabolites work?

Answer 6

Interfere with DNA and RNA

act as substitute for normal building blocks

Question 7

What are two examples of antimetabolites?

Answer 7

• Methotrexate
• 5-Fluorouracil (5-FU)

Question 8

How do Anti-tumor antibiotics treat cancer?

Answer 8

• Interfere with enzymes copying DNA

Question 9

What are examples of anti-tumor antibiotics?

Answer 9

-cins

Doxorubicin, bleomycin, mitomycin-C

Question 10

What type of cancer drugs have life-time dosing limits?
Why?

Answer 10

Anti-tumor antibiotics because they permanently damage cardiac tissue in large doses.

Question 11

Which chemotherapy class increases the risk of a second cancer developing? How do these drugs work?

Answer 11

Topoisomerase Inhibitors

• plant alkaloids that prevent strands of DNA from being separated to copy

treat leukemias, lung, ovarian, GI, colorectal, and pancreatic cancers

Question 12

Which chemotherapeutic agent is a plant alkaloid that damages cells in all phases through the prevention of protein synthesis?

Answer 12

Mitotic Inhibitors

Question 13

Which chemotherapeutic class may cause peripheral neuropathy?

Answer 13

Mitotic inhibitors

(-Taxels and vincristine, vinblastine, etc.)

Question 14

What normal cells are most likely to be damaged due to chemotherapy? (4)

Answer 14

• Bone marrow blood forming
• Hair follicles
• GI tract (including mouth)
• Reproductive systems

Question 15

What drug can inhibit hormonal contraceptives?

And thus result in unexpected baby’s.

Answer 15

Aprepitant (neurokinin 1 antagonist)

may inhibit hormonal contraceptives x28 days

Question 16

How does marijuana treat nausea/vomiting? What should be considered by the CRNA with marijuana use?

Answer 16

Depresses CNS vomiting center

more effective than phenothiazines

• Consider that marijuana decreases anesthetic requirements 15-30%

Question 17

What is radiation’s effects on the peripheral vascular system?

Answer 17

Coagulopathy

6x increase in embolic events

Question 18

What is radiation’s effects on tissues treated for head and neck cancers? (3)

Answer 18

• hypothyroidism
• Carotid artery disease
• Possible airway complications

Question 19

What is radiation’s effects on the chest wall and/or breasts?

Answer 19

• Pericarditis
• Cardiomyopathy
• Valvulopathies
• Dysrhythmias

cardiac abnormalities

Question 20

What is the possible effect of radiation on the lungs??

Answer 20

Radiation pneumonitis

pulmonary abnormalities

Question 21

What chemotherapeutic agent is known to cause cardiomyopathy?

Answer 21

Adriamycin

Question 22

What chemotherapeutic agent is known to cause pulmonary toxicity?

Answer 22

Bleomycin

especially with use of high FiO2

Question 23

What chemotherapeutic agents are known to cause peripheral neuropathy?

Answer 23

• Cisplatin
• Vincristine (mitotic inhibitor)

Question 24

What preoperative lab abnormalities might be seen in a cancer patient? (4)

Answer 24

• ↓ RBCs
• ↓ WBCs
• ↓ PLTs
• ↑ Ca⁺⁺

Question 25

Why is hypercalcemia common in cancer?

Answer 25

Many drugs are toxic to bone marrow thus causing breakdown and releasing Ca⁺⁺ into the bloodstream.

Question 26

What test is useful for testing for adrenal insufficiency?

Answer 26

ACTH stimulation test

Question 27

Why is adrenal insufficiency often seen in cancer patients?

Answer 27

Steroid treatments

Question 28

Why is tumor resection a risk factor for tumor recurrence? (3)

Answer 28

- Tumor cells can spread into blood stream - Residue can remain behind - Localized spread via lymphatics

Question 29

Why is inflammation and surgical stress bad for cancer patients?

Answer 29

Surgical stress → elevated COX₂ expression → PG's and thromboxanes → promoted cell survival and cancer cell growth

Question 30

How long can inflammation and stress last post surgery?

Answer 30

last for weeks

Question 31

β adrenergic receptors at the sites of tumor growth will upregulate cancer cell activity via nerve fiber delivery of _______.

Answer 31

norepinephrine

Question 32

What drug class directly stimulates cancer cell proliferation and invasion, inhibits leukocyte migration, and inhibits NK cell activity?

Answer 32

Opioids

Question 33

How do volatiles adversely affect cancer patients? (2)

Answer 33

- Induce chemo resistance - Inhibit NK cells

Question 34

What effects does propofol have on cancer cells? (2)

Answer 34

- Decreases migration - Promotes apoptosis

Question 35

Long term administration of NSAIDS _______ proliferation of cancer cells.

Answer 35

decreases proliferation

Question 36

Cancer types diagram *Flip Card*

Answer 36

Question 37

Chemotherapy is a cancer treatment used to do what? (4)

Answer 37

* kill cancer cells * shrink tumors * prep for bone marrow transplant * control overactive immune dz (s/a lupus or RA)

Question 38

What consideration/complication is associated with bleomycin?

Answer 38

can cause pulmonary complications s/a oxygen toxicity *avoid using high levels of FiO₂ if taking bleomycin*