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39 Cards in this Set

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Cell cycle specific cytotoxic
Act during a specific phase of the cell's reproductive cycle
Cell cycle specific, G1 phase
Steroids
Cell cycle specific, S phase
Antimetabolites
Cell cycle specific, G2 phase
Epothilones, podophyllotoxins
Cell cycle specific, M phase
Taxanes, taxoids, vinca alkaloids
Cell cycle non-specific
Act during any phase of the cell's reproductive cycle: alkylating agents, antibiotics, nitrosoureas
TLS
Tumor lysis syndrome, seen especially with large tumor burden (leukemia, lymphomas)
S&S of TLS
hyperkalemia, hyperphosphatemia, hyperuricemia, hypomagnesemia, hypocalcemia, acidosis; GI upset, fatigue, altered mental status, hypertension, muscle cramps, paresthesias, tetany, seizures, ECG changes, cardiac arrest, reduced urine output, acute renal failure
Treatment of TLS
Aggressive IV hydration with normal saline, IV alkalinization with sodium bicarbonate, administration of allopurinol; maintain urine pH at or above 7 to prevent renal failure from precipitation of uric crystals in the kidneys; hyperkalemia treated by IV dextrose and insulin to drive potassium back into cells or Kayexalate to eliminate potassium in feces; hemodialysis of other measures not effective
Alkylating agents
cell cycle non-specific: nitrogen mustard derivatives, nitrosoureas, platinum compounds
common SE of cytotoxic drugs
bone marrow depression (nadir 7 to 14 days, return to normal 21 days after drug administration); GI: anorexia, nausea, vomiting (usually a few hours after administration, subside 12 to 24 hours after administration), diarrhea, constipation, oral and intestinal mucositis, oral candidiasis; dermatologic: alopecia, dermatitis, hand-foot syndrome, phlebitis at injection sites;
SE of platinum compounds
cisplatin (Platinol) - nephrotoxicity, carboplatin (Cisplatin) - nephrotoxicity, ototoxicity(
SE of nitrogen mustard derivatives
chlorambucil (Leukeran): hepatotoxicity; cyclophosphamide (Cytoxan): hemorrhagic cystitis; ifosfamide (Ifex): hemorrhagic cystitis
Antimetabolites
Cell-cycle specific - S phase: are allowed to enter cancer cells because they are similar to metabolites or nutrients needed by the cells for reproduction; include: folic acid antagonists (MTX), purine antagonists (mercaptopurine) and pyrimidine antagonists (flurouracil).
oxaliplatin (Eloxatin) SE
Alkylating drug - platinum compound: cold-induced acute neurotoxicities
Antitumor antibiotics
Cell cycle non-specific
bleomycin (Blenoxane) SE
antitumor antibiotic; pulmonary toxicity
doxorubicin (Adriamycin), daunorubicin, idarubicin (Idamycin) SE
cardiomyopathy, extravasation may lead to necrosis; doxorubicin liposomal and daunorubicin liposomal decrease of adverse cardiac effects
epirubicin (Ellence) SE
cardiotoxicity
Plant toxoids
podophyllotoxin (G2 phase), vinca alkaloids (M phase), taxanes or taxoids (M phase).
Examples of miscellaneous cytotoxic agents
Hydroxyurea (S phase); epothilones - a new class of anti-neoplastic drugs, obtained from bacteria (Ixempra);
Biologic antineoplastic drugs
1. monoclonal antibodies
2. gsrowth factor and tyrosine kinase inhibitors
3. proteasome inhibitor
Monoclonal antibodies - three main mechanisms of action
1. blocking a receptor and preventing the over-expressed growth factor receptors from signaling for cell devision
2. attaching to a cell receptor so that the body's own immune system can kill the cell
3. carrying chemotherapy or radioisotope to the cancer cells and causing cell death
Monoclonal antibodies: SE
1. Hypersensitivity-type infusion reaction: premedication with diphenhydramine (Benadryl) and acetaminophen
2. leukopenia (esp. with alemtuzumab - prophylactic antimicrobial drugs during and 2 to 3 month after drug administration
3. cardiotoxicity (esp. with bevacizumab and trastuzumab; increased if patient over 60, or if also received doxorubicin or cyclophosphamide
Growth factor and tyrosine kinase inhibitors
Prevent epidermal growth factor (EGF) from combining with its receptors and thereby prevent or decrease cell growth
Three parts of the EGF receptor
1. Extracellular area
2. Transmembrane area
3. intracellular (tyrosine kinase) area
Tyrosine kinase
Tyrosine kinase enzymes play an important role in the proliferation and differentiation of cells
Hormone inhibitors SE
Hot flashes and nausea are the most common adverse effects of drugs that decrease \estrogen
Antineoplastic hormone inhibitor drugs
corticosteroids (G1 phase), mainly prednisone and dexamethasone; sex-hormone blocking drugs: LHRH (luteinizing hormone releasing hormone, also known as gonadrotropin releasing hormone) analogs, aromatase inhibitors, antiestrogens, antiandrogens
Antiestrogens
prevent estrogens from binding to receptors in breast cancer cells
Antiandrogens
prevent DHT, the active form of testosterone, from binding to receptors in prostate cancer cells
Aromatase
an enzyme that catalyzes the production of estrogen in the ovaries of premenopausal women and in fat, liver, and muscle cells of postmenopausal or castrated women
Luteinizing hormone-releasing hormone (LHRH) analogs
Therapeutic doses of LHRH analogs initially increase the release of luteinizing hormone (LH) and follicle stimulating hormone (FSH) from the anterior pituitary, then decrease their relase by down-regulating receptors; inhibiting the relase of LH and FSH reduces the production of ovarian estrogen in women to postmenopausal levels and testicular testosterone in men to castration levels.
Managing chemotherapy complications: N&V
(serotonin receptor antagonist - ondansetron, corticosteroid- dexamethasone, benzodiazepine - lorazepam): most effective when started before drug administration and continued on a regular schedule for 24 to 48 hours afterward
Managing chemotherapy complications: mucositis (stomatitis)
1. brush teeth after meals and at bedtime with a soft toothbrush and floss once daily. If platelet count < 20,000/mm3, stop brushing and flossing - clean with soft, spnge-tipped or cotton-tipped applicator
2. do not use commercial mouth-washes (drying effect of alcohol); alternately 1 teaspoon of baking soda and 1 teaspoon of table salt in 1 quart of water
3. maintain hydration
4. remove dentures or limit to 8 hours a day
5. viscous lidocaine or systemic analgesics to decrease pain: caution: aspiration and burns
Managing chemotherapy complications: extravasation
1. stop drug immediately
2. aspirate the drug (about 5 mL of blood)
3. elevate involved extremity
4. apply warm compresses (dacarbazine, etoposide, vinblastine, and vincristine).
5 .apply cold compresses (doxorubicin, daunorubicin).
Managing chemotherapy complications: hyperuricemia
High fluid intake, high urine output, alkalinizing the urine with sodium bicarbonate, giving allopurinol to inhibit uric acid formation
Hand-foot syndrome (plantar/palmar erythema)
attributed to leakage of drug from capillaries into the palms and soles - heat and friction increase the leakage; associated with some traditional cytotoxic drugs (doxorubicin, fluorouracil) and and some growth factor-tyrosine kinase inhibitors (sorafenib, sunitinib, lapatinib).
Managing chemotherapy complications: hand-foot syndrome
decreasing heat and friction (minimizing exposure of hands and feet to hot water), avoiding increase pressure (from long walks, squeezing small implements in cooking, gardening), applying ice packs for 15 or 20 mintues at a time; acetaminophen for discomfort