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138 Cards in this Set
- Front
- Back
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Carcinogensis?
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newly reproduced cells change shape, lose ability to function, make no contribution
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Cellular features of cancer cells?
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local increase in number
loss of normal cellular arrangement variation in cell shape and size increase nuclear size and density of staining increased mitotic activity abnormal mitosis and mutation of chromosomes |
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Benign tumors?
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neoplasm/nonmalignant
grows slowly usually encapsulated usually treated |
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Malignant tumors?
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cancer
grows rapidly carried by blood or lymph not encapsulated various therapies |
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Characteristics of a malignant tumor?
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loss of topoinhibition
malignant transformation tumor establishment |
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Important Basic Concepts
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carcinogenesis is...
cancer is a disease of the... cells in a tumor are asynchronous... rapidly cycling cells... |
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carcinogenesis is mutagenesis?
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carcinogenic insult must affect...
progeny of a malignant cell is also malignant |
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Cancer is a disease of the cell?
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cell membranes alterations:
decreased number cell junctions increased sialomucoproteins increased fibrinolysin changes in antigenicity changes in receptors (growth factors) |
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Increase in sialomucoproteins?
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malignant cells display
increased number of sialomucoprotein on their cell membrane sialomucoproteins are acidic proteins increased acidity enhances cell motility increased motility potentiates metastasis |
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Increase in fibrinolysin?
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malignant cells display
increased number of fibrinolysin molecules on their cell membrane fibrinolysin (=plasmin) is substance with strong proteolytic action capable of destroying intercellular proteins increased fibrinolysin enhances local invasiveness |
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Changes in antigenicity?
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natural (self) antigens are
not "seen" by the host's immune system as cells become malignant new antigens are produced malignat cells are now seen as foreign immune system then destroys them |
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Changes in receptors?
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commands for cell growth
(multiplication) require cell membrane receptors malignant cells have increased numbers of such receptors malignant cells have greater growth potential |
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Changes in the cell that becomes cancerous?
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microtubular disorganization
rounded mitochondria changes in size and shape abnormal karyotype and mitotic figures |
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Tumor establishment?
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transformed cell
cell division - malignant clone stroma tumor growth |
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Tumor Establishment?
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factors influencing tumor
growth... continued, unrestricted growth size of growth fraction (% dividing cells) cell growth increased cell loss (death or metastasis) |
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Types of Malignant Tumors?
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solid tumors and liquid
cancers epithelial tissue: carcinomas non-hematopoietic mesenchy- mal (connective) tissue: sarcomas hematopoietic and lymphoid tissue: leukemias and lymphomas neural tissue: gliomas, choroid plexus tumors, peripheral nerve tumors, retinal tumors etcet miscellaneous: melanoma, neuroblastoma, etc |
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Metastasis?
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pre-requisite: primary in
invasive phase influencing factors: mechanical forces decreased cell-to-cell adhesiveness increased cell motility |
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Metastasis...dissemination routes?
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cerebrospinal pathway
hematogenous spread lymphatic spread transcelomic spread |
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Metastasis...mechanisms of formation?
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cells detach from primary...
cells gain access to distributive system cells able to survive in the distributive system cells adhere to vascular endothelium and form a fibrin coat (nidation) cells break through endothe- lium, secure vascular supply and stroma unopposed tumor growth |
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Metastasis...general characteristics?
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agreement with primary tumor...
cells usually less differentiated than primary... mets may appear several years after primary... site is usually a well- vascularized area or organ |
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How is a tumor classified?
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by type of tissue from which it grows
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Where does carcinoma grow?
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develops in tissues covering
or lining organs of body orginate in epithelial cells such as skin, uterus, lung breast |
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Where does adenocarcinoma grow?
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involves lining of organs
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Where does basal cell carcinoma grow?
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most common form of skin cancer...
squamous cell carcinoma |
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Where does melanoma grow?
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type of skin cancer, very
aggressive |
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Where does sarcoma grow?
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form of cancer that arises
in supportive/connective tissues such as: bone (osteosarcoma) cartilage fat (lipoma) muscle |
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What is leukemia a cancer of?
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cancer of blood forming tissues
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What is non-Hodgkin's lymphoma a cancer of?
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cancers originating in immune/infection-fighting organs...
form of lymphatic cancer, very aggressive |
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What is Hodgkin's lymphoma?
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form of lymphatic cancer
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Staging?
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extent of primary which based on:
type depth penetration invasion presence, extent and location of presence or absence of distant and degree of dissemination in place, localized and confined to one area, earliest stage of cancer i.e. DCIS (ductal carcinoma in situ - early stage of breast cancer in milk ducts) |
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Grading?
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GX-grade cannot be assessed
G1-well differentiated G2-moderately well differentiated G3 & G4 |
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Target points
cell-cycle specific? |
S phase-specific drugs interfere with synthesis of
DNA, RNA, proteins M phase-specific drugs interfere with assembly of mitotic spindle |
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What happens in mitosis?
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mitotic spindle assembled in
metaphase chromosomes align along the spindle chromatids separate in anaphase chromatids (new chromosomes) move to chromatids (new chromosomes) move to opposite poles and new daughter cells receive equal numbers |
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How to kill cells in mitosis?
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mitotic inhibitors stop assembly of the mitotic spindle:
vincristine, vinblastine, VP-16 equal distribution of chromosomes is disrupted cell proliferation is arrested |
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How to kill cells in S phase?
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Stop DNA replication
Stop transcription (DNA--RNA) Stop translation (RNA--protein) fragment already formed proteins |
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Events in DNA replication?
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original DNA molecule unwinds...
original DNA molecule splits... nucleotides are available inside nucleus... nucleotides pair to BOTH half-molecules: A---T C---G DNA polymerase unites new nucleotides result: 2 "new" DNA molecules re-unite |
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Important concept #1?
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cells in the cell cycle are?
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Important concept #2-A?
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rapidly cycling cells are easy to kill (and cells in G-0 are resistant)
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Important concept #3?
Cytotoxic agents kill both rapidly proliferating malignant and normal cells Evidence: side-effects in normal tissues? |
alopecia
GI disturbances myelosuppression sterility (males) |
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Health care team consists of?
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clergy
dietician occupational therapist pharmacist physical therapist physician psychiatrist psychologist radiologist respiratory therapist social worker speech therapist vocatonal counselor |
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Oncotip: "preparing for the first oncology consultation"?
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forward all recent medical records, including operative reports, path reports and radiology reports to your oncologist
make sure you have any necessary referrals prior to seeing your oncologist consider bringing a tape recorder and asking permission to tape the conversation with your physician so you can review the details of your consultation consider having your consultation at a multi-disciplinary clinic if this is available to your area make sure your oncologist's secretary has received all of the necessary information beforehand bring a list of all your medications and allergies to medicines bring a list of the physicians and addresses that you want reports of the consult sent make sure you bring your health insurance id card if you have one make sure you have the phone number of your oncologists secretary do not become frustrated if additional blood tests, x-rays or other procedures are necessary prior to getting a final recommendation |
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Treatment modalities...the most common cancer treatments include?
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growth factors
novel treatments - monoclonal antibodies vaccines shrink the tumors alleviate pain and other complications associated either with the cancer or the treatment |
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Principles of cancer
treatment? |
disease gone forever
extend life of patient; disease will never go away completely provide comfort, relief of symptoms, and improve quality of life no disease but person at high risk for disease development |
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What is curative surgery?
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excision of all of the tumor, involved surrounding tissue and regional lymph nodes
most effective in early dx |
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What is palliative surgery?
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since 70% of clients with cancer show metastasis at diagnosis cure is not always possible
palliative surgery is done to relieve complications such as obstructions or to surgically interrupt nerve pathways for intractable pain |
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What is reconstructive surgery?
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follows durative or radical surgery
goal is to produce a better function or a better cosmetic effect, to minimize deformity |
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What is radiation therapy?
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uses high energy ionizing radiation to kill cancer cells
the intense energy of the ionizing radiation causes |
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Radiotherapy goal?
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eradicate malignant cells without harm to healthy tissues
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Which cells are more sensitive to radiation?
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vascular
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Radiotherapy is usually combined with other?
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treatment modalities
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Radiotherapy may be done before surgery to ______ the size of the tumor
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shrink
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Postoperatively, radiotherapy is hoped to decrease risk of local __________
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recurrence
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Unit of dose for measuring radiation may be referred "rad" which stands for?
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radiation absorbed dose
or gry |
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The actual dose of radiotherapy is determined by the radiologist and is dependent on?
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sensitivity of the tumor, tissue tolerance, amount of tissue to irradiated
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External radiation is given with?
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specialized equipment
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External radiation treatments are usually given on an _______ basis and divided over days or weeks
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outpatient
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With external radiation, special care is taken to minimize risk to healthy?
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tissue
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With external radiation, customized shielding ________
may be created |
blocks
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What is placed on the skin and is used to identify and maintain the exact reference points
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dye "tattoos"...the nurse should instruct the client not to wash or rub off these markers, not to wear restrictive clothing, or put any type of ointment over the skin
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What are the complications or side effects of external radiation?
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GI discomforts
cramping diarrhea anorexia |
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How does internal radiation deliver radioactive isotopes?
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directly within the body
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What are 7 isotopes used to deliver internal radiation?
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cesium
cobalt gold iodine iridium radium |
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How are internal radiation isotopes introduced?
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either in a sealed or unsealed source
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What are sealed sources in which internal radiation isotopes are delivered?
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encapsulated radioactive elements in special containers -
tubes wires needles seeds capsules |
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Internal radiation isotoopes are implanted close to cancer cells to deliver ____ ____ ______?
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high concentrated doses
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Depending on the type of internal radiation, implants may be ______ or _______?
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permanent or temporary
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What is required to prevent dislodgement of an internal radiation implant?
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bedrest
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With internal radiation, body fluids are not _____ because the source is sealed.
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radioactive
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Unsealed sources of internal radiation may be given orally, parenterally, or instilled into ______-_____
or peritoneal spaces |
intra-pleural
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Unsealed sources may be eliminated in _____ ______
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body fluids
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With internal radiation, care must be taken not to expose ______ ______ workers, hospital personnel, visitors.
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health care
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What would the nurse do if patient is receiving brachytherapy and an UNSEALED source falls out?
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?
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What is the universal symbol indicating radiation is used to indicate caution?
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?
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What are the toxic effects of therapy?
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?
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What are precautions to be taken with radiation?
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?
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What is the purpose of chemotherapy?
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cure
prevent relieve |
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What are the drugs used in chemotherapy called?
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antineoplastics
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Unfortunately, anticancer drugs are cytotoxic and kill both cancer cells and ______ cells.
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healthy
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What are the phases of human studies related to drug development?
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Phase 1 trials - determine
toxicity Phase 2 trials - determine efficacy to diseases Phase 3 trials - compare to standard treatment... drug is approved for use by FDA Phase 4 trials - determine other uses for drug |
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What is Phase 1 of drug development?
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pharmacokinetics
MTD DLT 15-20 subjects, without other options not disease - specific |
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What is Phase II of drug development?
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firm starting dose and
schedule spectrum of activity breast, lung, colon, melanoma, lymphoma, leukemia effectiveness in specific tumors 18-30 subjects, progressed on standard therapy |
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What is Phase III of drug development?
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drug compared to conventional, standard therapy...
for specific cancers.. extent and duration of response, and toxicities evaluated... quality of life assessment mandatory |
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About how many years does it take for a drug to go through Phases I-III?
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13 years
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What is Phase IV of drug development?
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post-marketing, after FDA approval..
other uses, doses or schedules... use in combination with other therapies |
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Cancers highly sensitive to chemotherapy?
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Hodgkin's disease
ALL non-Hodgkin's lymphoma (children) Burkitt's lymphoma testicular cancer gestational trophoblastic tumors Wilms tumor osteogenic sarcoma rhabdomyosarcoma |
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Tumor cell kill fraction depends on?
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tumor sensitivity
tumor growth rate tumor size vascular supply host immunity nutrient supply |
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Factors affecting response (3)?
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patient factors
tumor factors drug factors |
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Patient factors affecting response?
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oorgan dysfunction
previous treatment ototoxicity |
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Tumor factors affecting response?
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histology
growth rate size (Tumor Burden) hormone receptor status |
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Drug factors affecting response?
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antineoplastic activity
pharmacokinetics dose and schedule combination vs single agent therapy administration schedule dose category drug resistance |
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Which term is no longer used that refers to cancer that is temporarily inactive?
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"remission"
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A cancer patient is having a tumor response (not in remission) if the following are met?
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absence of all tumor for at least one month...
greater than 50% reduction in measurable tumor for at least one month... less than 50% reduction or less than 25% increase in cancer size... greater than 25% growth of tumor... subjective response |
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Antineoplastic are given IV because?
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these drugs are irritating and may cause tissue necrosis
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Most IV antineoplastics are given through two types of special devices called?
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explantable
implantable |
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What is an example of an explantable venous access device (EVAD)?
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triple lumen, inserted into the subclavian vein
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What does an implantable venous access device (IVAD) include?
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self-sealing implanted ports
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What are types of antineoplastic administration (4)?
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bolus therapy - IV push or
piggyback infusional therapy (runs over a number of hours) --multiple agents in different bags --multiple agents in same bag sequential infusions combined modality therapy- chemo given with radiation to increase response rate |
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Cancer treatments are most effective against cells that reproduce?
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rapidly
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Cancer treatments are most effective in ____ stages and diagnosis?
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early
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A single drug treatment is less toxic to normal tissue, but also less toxic to the _____ cells.
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cancer
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A single dose treatment has an overall lower ______ rate.
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response
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With single drug treatments, there are exceptions:
Fludarabine Rituxan Targretin Temodar |
Fludarbine for CLL
Rituxan for NHL Targretin for Cutaneous T-cell lymphoma Temodar for Glioblastoma |
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How is combination therapy beneficial?
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most often used..
each drug effective against cancer minimally overlapping toxicities drugs have different mechanisms of action drugs may maximize the other drug's effect (synergy) decrease possibility of drug resistance increase percent of cells killed at one time |
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What are 2 types of drug resistance?
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intrinsic
acquired |
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What is intrinsic drug resistance?
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resistance occurs prior to exposure to antineoplastics
P-glycoprotein Topoisomerase |
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What is acquired drug resistance?
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malignant cells become resistant after being exposed to antineoplastic agent
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If a patient is on a high dose treatment, patient will need supportive?
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therapies
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Dose intensification is how many times higher than standard dose?
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10 to 200
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Treatment doses can be given in single dose, divided doses, or continuous ___ over several days
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IV
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_________ differ depending on length of time of administration
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toxicities
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How does chemotherapy effect cellular reproduction (2)?
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some drugs are cell-cycle specific and some drugs are cell-cycle non-specific
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How do cell-cycle specific drugs work?
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work in a certain phase of cell growth...
work best given continuously or frequently... antimetbolites, plant alkaloids, miscellaneous |
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How do cell-cycle non-specific drugs work?
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work in all phases of cell
cycle... used to treat slow-growing tumors... cell kill proportional to amount of drug given... aklkylating agents, antitumor antibiotics, nitrosources, hormones |
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How do alkylating agents (CCNS) work?
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break up DNA strands, prevent mitosis
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How do antimetabolites (CCS) work?
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block essential enzymes necessary for DNA synthesis
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How do antibiotics (CCMS) work?
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interrupt DNA transcription, because these drugs are highly toxic they are not used for infections
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How do nitrosureas (CCNS) work?
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inhibit DNA, RNA synthesis
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How do vinca alkaloids (CCS) work?
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bind to proteins during specific phase, causing cell to lose ability to divide
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How do hormones (CCNS) work?
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alter "cellular environment"-creating a "hostile" environment and changing cellular permeability
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How do miscellaneous CCCS or CCNS meds work?
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variety of routes - most often PO or IV, but may be given intrathecally or instilled into body cavity
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What is patient teaching to monitor closely for side effects and toxic effects?
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alopecia
anorexia bone marrow suppression fatigue fungal infections nausea and vomiting (Zofran given prior) peeling skin, rash |
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Instruct client to report signs and symptoms of?
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hypersensitivity...
loss of taste... tingling in face, fingers, toes (signs of peripheral neuropathy... dizzines, headache, confusion, slurred speech, convulsions (signs of CNS toxicity)... unusual bleeding, bruising, fever, sore throat, mouth sores (myelosuppression) jaundice, yellowing of eyes, clay colored stools, dark urine (hepatic toxicity) continued cough, shortness of breath (pulmonary fibrosis) peripheral edema, pulmonary congestion, cough (CHF - cardiotoxicity) chemotherapy may need to be discontinued or patient may need to be placed in protective isolation - protected environment |
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What are signs of peripheral neuropathy?
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tingling in face, fingers, toes
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What are signs of CNS toxicity?
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dizziness
headache confusion slurred speech convulsions |
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What are signs of myelosuppression?
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unusual bleeding
bruising fever sore throat mouth sores |
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Signs of hepatic toxicity?
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jaundice
yellowing of eyes clay colored stools dark urine |
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Signs of CHF or cardiotoxicity?
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peripheral edema
pulmonary congestion cough |
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What are radiation sensitizers?
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chemo cytoreduction improves oxygen supply...
affect different cell subpopulations... tumor growth post-XRT is slowed... agents used: 5FU, CDDP, etoposide... tumors treated: head and neck, rectal, pancreas, lung... optimum dosing and scheduling not defined |
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A local reaction for an IV route might be an irritant which may or may not cause symptoms of ______ and there may or may not be _______
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pain
inflammation ex: DTIC BCNU Etoposide |
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A local reaction for an IV route might be a vesicant (extravasant)which is?
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extravascular and causes subcutaneous tissue damage
ex: vincas mitomycin C anthracyclines HN2 |
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Examples of vesicants are?
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vincas
mitomycin C anthracyclines HN2 |
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Signs and symptoms of extravasation?
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lack of blood return
pain (stinging, burning) redness swelling |
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If extravasation occurs, aspirate residual from ______?
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tubing
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If extravasation occurs, instill antidote, if residual aspirated...name 4 agents?
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hyaluronidase (plant alkaloids)...
hydrocortisone (anthrcyclines)... Na thiosulfate (alkylating agents) DMSO |
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Explain steps if extravasation occurs?
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aspirate residual from tubing...
instill antidote... remove needle.. apply a sterile occlusive dressing... elevate extremity... application of warm pack or ice (for anthracyclines) for 24 hours close followup for 3-4 weeks |
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Proper documentation of infusion (7)?
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needle size, type
symptoms site drug sequence amount infused interventions patient instructions and follow up |
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What is photodynamic therapy (PDT)?
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inject photosynthesizing agent, concentrates in cancer cells, then a laser is used to destroy cell
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What are biologic response modifiers (BRMs)?
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agents that stimulate body's natural immune system...
most are in trial studies... ex: interferon monoclonal antibodies interleukin-2 tumor necrosis factor BCG monoclonal antibodies |
