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86 Cards in this Set

  • Front
  • Back
Phase I Clinical Trials
- identify maximum toerated dose
- in peds this dose is usually 80% of adult dosage
Phase II Clinical Trials
- identify effectiveness of new chemo agents
Phase III Clinical Trials
- trying different dosing schedule, dosing regimens or combinations of both
Phase IV Clinical Trials
- FDA approval of a particular chemo regimen
Factors leading to chemo resistance
- decreased uptake of drug by cell
- increased egress of drug out of cell
- increased DNA repair of cancerous cell
- decreased apoptosis of cancerous cells
Tumor burden
- the larger the tumor, the less likely chemotherapy will work on the tumor
5 phases of the cell cycle
G0 - resting phase (chemo resistant phase)
G1 - RNA production
S - DNA replication
G2 - RNA synthesis complete
mitosis - cell division
the ability of cancerous tumors or cells to generate their own blood supply
a cell's own "self destruct" mechanism that the cell activates when it is damaged
indefinite proliferation
ability to reproduce indefinitely
kill or damage cancer cells
common infective agents
- rota
- shigella
- c. difficile
- e. coli
- salmonella
- giardia
Signs and symptoms of hepatic dysfunction
jaundice, fatigue, malaise, irritability, N&V, hepatosplenomegaly, pruritis, encephalopathy, ascites, anorexia, RUQ pain, dark orange urine, clay colored urine, bruising & bleeding, elevated LFTs
- hair loss
Factors leading to diabetes insipidus
tumor effects, surgery, trauma to pituitary, radiation
Treatment for nephrotoxicity
- 12-24 hour creatinine clearance
- hydration
- allopurinol
- keep pH between 6.5-8
- sodium bicarbonate
S/S of Fanconi's syndrome
- metabolic acidosis
- protein & glucose in urine
Body Surface Area (BSA)
Height(in Cm) X Weight(in kg)
divided by 3600

then the square root of that number
dosage for a child less than 12 months or less than 10kg
dosage based on kg of body weight
intrathecal dosing
based on age
exposure routes for chemotherapy
skin, mucous membranes, injection, inhalation, ingestion
- hormone to increase RBC production
- decreased WBC count less than 4500-5000 cells/mm3
tumor lysis syndrome
increased PO4, increased KCl, increased urinc acic acid, decreased calcium
- less than 150,000/mm3 platelets
- petecchiae, ecchymosis
- hemoglobin less than 6-7g/dl
- hematocrit less than 21%
RBC transfusion rate
- 2-5mL/kg/hr or over 4 hours
When is GCSF/filgrastim/neupogen started?
Start 24 hours after chemo therapy is complete
How do you calculate ANC?
total WBC count X neutrophils
What is neutropenia?
ANC less than 1000/mm3
What are neutrophils needed for?
key to fighting infection
What are thrombocytes important for?
Definition of nadir?
When blood cell count is at its lowest
Definition of myelosuppression?
Suppression of bone marrow activity.
Treatment for fever & neutropenia?
- CBC and cultures
- physical exam
- frequent VS
- treat signs of shock
- start ABX asap
Delayed nausea and vomiting
- 24 or more hours after chemo has ended
- can happen with cisplatin and cyclophosphamide
Anticipatory nausea and vomiting
- getting N&V just from thinking about an upcoming dose of chemo
- anxiolytics can be helpful
Variables affecting pharmacodynamics or clinical response of drugs
- rate of drug administration
- age of recipient
- gender
- organ fxn
- exposure to other chemical agents or repeated exposure to the same agents
- tree extract
- inhibits enzyme that maintains DNA structure
- side FX: elevate liver enzymes, myelosuppression and alopecia
- extracts from mandrake plant
- single and double strand DNA breaks
- late 2 and early G2 phases of the cell cycle
- side FX: hypersensitivity rxns and hypotension
- an agent or influence that causes physical defects
cytotoxic chemotherapy
- killing or damaging cancer cells
components of pretreatment
- Assessment and history
- Past medical history
- Tumor type, grade and stage
-Recent treatment, radiation, surgery and cytotoxic therapy
- Allergies
- Meds, vitamins, dietary supplements
- Current and previous lab values
- Psychosocial status and cultural considerations
- Review of systems
- Height, weight and VS
Vinca alkaloids
- leaf extract of periwinkle plant
- disrupts cellular function - failure of mitosis
- M phase (some G1 & S)
- Side fx: neurotoxicity, constipation
Dosage of intrathecal meds
Based on age rather than BSA or weight
Prior to age 3, spinal fluid volume is proportionally much greater than in adults and older children
Treatment phase
#1 Goal is safe administration of chemotherapy
Review of specific drug administration guidelines
1 Does it need to be protected from light or require special tubing?
- Does it have vesicant or high emetogenic potential?
- Have relevant baseline labs or tests been performed and reviewed?
- Is special monitoring required?
- Are there special caveats to administration?
- Are meds more effectively give at a certain time of day?
- Know what chemo-protective agents are used.
- Review side effects.
Post treatment
- Stop infusion and dispose of waste
- Give post treatment hydration
- Side effect recognition and management
IV administration of cytotoxic agents
- check for IV patency
- Use central line
- no scalp veins for vesicant delivery
- flush line with NS
- place plastic backed drape
- use an IV pump
- vesicant push, use push-pull technique
- administer agent
- monitor IV site & patient
- extravasation: stop infusion and call MD
- leakage of any fluid into the extravascular space that has the capacity to cause tissue damage or necrosis
acral erythema
- "hand and foot syndrome"
- rash, edema and pain
Synthesis of glucose from non-carbohydrate sources
HLA alloimmunization
Immune response against donor HLA antigens
Biologic response modifier, sometimes used as antineoplastic agents
- Affects of drugs on white matter of brain
- mild to severe brain dysfunction
Dosage of GCSF
5-10 mcg/kg/day IV or SQ
GCSF administration
- give 24 hours after last chemo dose
- continue until ANC > 10,000/m3
- Dilute with D5W, not NS
- Keep refrigerated but not frozen
- Give at room temp but do not leave out of refrigerator for more than 6 hours
- minimum concentration is 5mcg/ml
Extravasation care
- stop infusion
- open extravasation kit
- leave catheter in place - aspirate residual med
- notify MD
- give antidote
- elevate site and rest X 48 hours
- monitor site at 24 hours, 1 week, 2 weeks
- plastics consult
- inhibit nucleic acid synthesis defects in DNA & RNA
- cell cycle specific to the S phase
- given in long continuous infusions or in repeated daily dosing
- side FX: myelosuppression, mucositis
alkylating agents
- cell cycle nonspecific
- most effetive in G0 phase
- side effects: myelosuppression, permanent renal damage
antitumor antibiotics
1 - DNA breakage
2 - Drug binds to the DNA
3 - Drug produces O2 free radicals that can cause DNA breakage

- Cell cycle nonspecific
- myelosuppression is common
- cardiotoxic drugs: doxorubicin & daunorubicin
- pulmonary fibrosis - bleomycin
- side FX: - radiation recall and urine discoloration
adjuvant therapy
Chemotherapy given in addition to surgery or radiation
pin-point, non-raised, round, purplish red spot
material at the tail of the chromosome - when the tail is gone the cell continues to divide.
Tumor lysis syndrome
- hyperphosphatemia
- hyperkalemia
- hyperuricemia
- hypocalcemia
- occurs 24-48 hours after induction
- weakness, abd. pain, ascites, hypotension, uric acid crystalizes in kidneys - renal failure
- study of drug asorption, distribution, metabolism and excretion patterns
- relationship between drug concentration & effectiveness or clinical response
Insulin insufficiency
- result from treatment with asparaginase & corticosteroids
- effects are temporary
- may need insulin while on treatment
cardiac toxicity
- anthracyclines - acute & late effects
- high dose cyclophosphamide
- fluorouracil
- acute effects are arrhythmias and conduction abnormalities
hemorrhagic cystitis
- gross hematuria, clot retention & hemorrhage
- cyclophosphamide, ifosfamide
- frequent urine pH checks
- vigorous hydration
- void frequently
- give Mesna for bladder protection
Ondansetron administration
- 0.15mg/kg IV prior to chemo and Q4 hours X 2 doses
- 0.15mg/kg - 0.45mg/kg x 1 dose dailty prior to chemo
- more expensive
- long half-life - give less often
- reactions are generalized urticaria, itching & edema, bronchospasm and laryngeal edema, fluid shifts (hypotension & vascular collapse)
- Cardioprotective agent
- may be started concurrently with anthracycline
- inflammation of the mucosa and peridontium
- mouthpain, change in taste and sensation
- candida albicans & herpes simplex virus
S/S - decreased oral intake, difficulty swallowing, drooling and hoarse voice
Prevention - dental work prior to chemo and good oral care
inflammation of the oral mucosa
dermatologic toxicities
radiation recall, painless erythema, desquamation, necrosis, acral erythema (give pain meds), antipruritics - given for hypersensitivity reactions
Fanconi syndrome
- electrolyte imbalance
- protein and glucose inurine
- metabolic acidosis
Sanctuary therapy
Cancer cells sequestered into one area - ex> CNS tumors
- treat with intrathecal chemo
combination therapy
1 - all agents must demonstrate effectiveness against a particular type of cancer
2. drugs must act synergistically
3. agents act in different phases of the cell cycle and be given at regular intervals to be effective
4. must not have overlapping toxicities
venous occlusive disease
- hyperbilirubinemia, hepatomegaly & fluid retention
neoadjuvant therapy
chemo preoperatively yo shrink the tumor burden
- ex: brain tumor
genetic mutation
multi drug resistance (MDR) gene responsible for tumor resistance to groups of drugs
- p-glycoprotein - acts as an efflux pump to rapidly remove certain cytotoxic agents
- active against anthracycline, vinca alkaloids, epipodophyllotoxins
cell cycle specific drugs
- express cytotoxic effects during a specific phase or phases of the cell cycle
cell cycle non-specific
effective on cells in any stage of the cell cycle
extra cellular matrix (ECM)
- normal cells tied together by ECM
- cancer cells produce protease that breaks down ECM
- this allows cancer cells to migrate in to blood or lymph circulation
mitotic spindle
mitotic spindle pulls all 46 chromosome pairs to the opposite pole of the cell in prep for cell division