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73 Cards in this Set
- Front
- Back
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The ratio of the number of replicating cells to the number of resting cells. |
Growth Fraction |
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What type of drug is most toxic to tumors with high growth fraction ( Best choice)
a. Antineoplastic Drugs b. Mitotic Inhibitors c. Antimetabolites d. Alkylating agents
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D- Alklyating agents -- have a broad spectrum and are used against many types of malignancies. They are most widely prescribed antineoplastics.
p 548 |
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What is a vesicant? |
Are agents that can cause severe tissue injury if they escape from an artery or vein during and infusion or injection.
pg 546. |
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True or False?
Vesicants should be administered through Central Line (subclavian veins) whenever possible? |
True
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The use of 'multiple drug therapy" to treat cancer cells is known as
hint: ____ ____ resistance |
Reduction in resistance |
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What is term "debulking" refer to in cancer. |
Surgical removal/ reduction of a tumor |
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What is EGF stand for and what information can be gathered from it? |
Epidermal Growth Factor- is the percentage of cancer cells undergoing mitosis at an times.
It tells how fast cancer cells divide and helps determine success of chemotherapy .
pg 564. (37.4)
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Where in the body are cells rapidly dividing & list common SE of chemotherapy? |
1.Hair follicle: SE (hair loss or Alopecia) 2.GI Tract: SE (Mucuositis -is inflammation of digestive tract resulting in Ulcers , difficulty eating or swallowing, nausea, vomitting, severe diarrhea, ) 3. Bone Marrow- SE ( bone marrown suppression/ destruction- Anemia, Leukopenia, Thrombocypenia)
pg 546 |
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What is cytomegalovirus (CMV)? |
Cancer causing virus spread through saliva and urine.
Linked to Saliviry Gland Cancer |
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What is a nadir? |
The lowest point to which erythrocyte, neutrophil and platelet count is depressed by a antineoplastic drug. |
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What is neutropenia? |
Neutrophil count 1,500cells/mL or less |
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Nursing implication of ANC less than 500 cells/ml |
An absolute neutrophil count of 500cells/ml or less indicates a severely suprressed immune sysyem and no chemotherapy medications should be schedule |
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Why are antineoplastics sometimes classified by their emetic potenial. |
Antineoplastics stimulate the vomitting center of the medulla, resulting in significant nausea and vomitting.
pg 546 |
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Cyclophosphamide is the generic name for what drug & what Pharmacological class does it fall under |
Cytoxan Pharmacological Class= is a Nitrogen Mustard Alkylating Agent |
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What are some AE of Cytoxan? |
Bone Marrow suppression( 9-14 days after therapy high risk sepsis during this period) immunosuppressent,Steven Johnson Syndrome, severe nausea and vomiting, diarrhea, nephrotoxicity, hemorrhagic cysts, anaphylaxis, permanent sterility, ,reversible alopecia, |
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What are some drug interactions with Cytoxan |
Digoxin-decrease serum level of digoxin St. Johns wort increase toxicity of Cytoxan
Allopurinol-increase bone marrow toxicity Anticoagulants- increase risk bleeding
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What are some IMPORTANT things to consider before administering Cytoxan. |
Check CBC (platelet count) before administering
Take with meals or divide doses to avoid upsetting GI |
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How do alkylating agents work |
*Alkylating agents changes the shape of DNA and prevents nucleic acids from completing cellular division.
*Slows the replication of tumor cells |
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Are alkylating agents broad or narrow spectrum cancer drugs? |
Broad spectrum as they are used against many types of malignancies.
pg 548 |
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What percent of pt develop acute nonlymphocytic leukemia 4 yrs of more after being treated with alkylating agents. |
5 % pts develop leukemia 4 yrs or more after treatment
pg 548 |
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These antineoplastic drugs resemble the essential building blocks of cells, and interfere with aspects of nutrient and nucleic acid metabolism. |
Antimetabolites- are structurally similar to the nutrients needed by cancel cells for growth |
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What are the classes of antimetabolites? |
1. Folic Acid Analog (commonly give if this class is methotrexate) 2. Purine Analog- 3. Pyrimidine Analogs
pg 550 |
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What are the classes of alylating agents? |
Nitrogen Mustards & Nitrosoureas
pg 548 |
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Contraindications of Cytoxan |
Pts with hypersensitivity to the drug and for those who have active infection or severely supressed bone marrow |
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The Brand name drug Rheumatrex and Trexall are what pharmacological class of drug |
Methotrexate |
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This drug is give to 'rescue' normal cells and protect against severe myelosuppression of Methotrexate |
Leucovorin ( a reduced form of folic acid) |
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By blocking the synthesis of folic acid (b9) ________ inhibits division of rapidly dividing cancer cells.
hint: it is a Folic acid analog |
Methotrexate |
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Methotrexate has a Black Box Warning and is Pregnant Category X
True or False |
When combined with NSAID's Methotrexate may cause severe /fatal Myelosuppresson (bone marrow suppression)
*liver cirrhosis w/prolonged use *Hemorrhagic enteritis and death from intestinal perforation *Stevem Johnson Syndrome |
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Drug interaction with methotrexate |
*NSAIDs'- increases toxicity of drug *Live Vaccines-decreased immune response can cause adverse effects of vaccination * Chemotherapy or radiation may cause increas effects of methotrexate (pt will require smaller dose of methotrexate) |
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Herbal/ Food interactions with methotexate. |
Food delays absorption of methotrexate *Coffee- more than 3-4 cups decrease effectiveness of methotrexate *Echinacea- increases risk of hepatotoxicity |
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Why should Cytoxan be given early in the morning? |
Prevent hemorrhagic cystitis (bleeding) of bladder-
Pt to consume minimum of 2-3 L fluid to increase frequency and volume of urination throughout the day |
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These drugs are obtained from bacteria and are not widely used as they treat only few specific types of cancer |
Antitumor Antibiotics
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Major Adverse Effect of Antitumor drug- doxorubicin (Adriamycin)
BLACK BOX WARNING |
* Severe Bone marrow suppression (also called myelosupression) * Cardiotoxicity (tachycardia,braycardia , heart failure may occur months later) *Anaphylaxis * Severe local Necrosis (extravasation) * Secondary Malignancies (myelogenous leukemia 1-3 yrs after treatment) |
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Antitumor drugs- distorts structure of DNA/RNA preventing normal synthesis, Thus preventing cancer cell replication
True or False |
True |
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Which anti-tumor antibiotic drug is most effective single agent against SOLID TUMORS. |
Adriamycin (doxorubicin) |
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Drug & Food interactions of Adriamycin (doxorubicin) |
* Digoxin- decrease effectiveness of digoxin *Dilantin-decrease effectiveness of Dilantin (pt more susceptible to seizure) *Green Tea- increases doxorubicin activity (toxicity) * St. Johns Warts decreases doxorubicin effectiveness |
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doxorubicin (Adriamycin) can be administered
1.orally 2.IV 3.IM 4. ALL |
Can ONLY be administered IV as it can cause Extravasation. |
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What kind of cancers is doxorubicin (Adriamycin ) treat? |
Solid tumors- lung , breast,,ovary, bladder & various leukemia/ lymphoma's
pg. 552
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What class of drugs do Vinca Alkoids belong |
Class of Natural Antineoplastic Drugs pg 552 |
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The drug vincrinstine (Oncovin) is derived from what plant |
periwinkle (vinca rosea) pg 553 |
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Natural Antineoplastic Drugs are also called_____ |
Mitotic Inhibitors |
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What are the subdivision of Mitotic Inhibitors (Antineoplastic Drugs derived from Plants/ Natural plants) |
1. Vinca Alkaloids (vincristine Oncovin) 2. Texanes 3. Topoisomerase inhibitors (blocks (topoisomerase) enzyme that repair DNA)
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How do Mitotic Inhibitors treat cancer |
Inhibits mitosis, by interfering with phases of cell cycle.
g0, g1,g2,S,M, |
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vincristine (Oncovin) is specific for what phase of cell cycle |
M-phase. |
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vincristine(Oncovin) is prototype drug for which pharmacological class of drugs |
Vinca Alkaloid, Mitotic Inhibitors, |
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Adverse Effects of vincacristine (Oncovin) |
Myelosuppression, Extravasation can cause intense pain and tissue necrosis, Paralytic ileus (severe constipation)
Numbness, muscular weakness, loss of neutral reflexes . |
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Why are hormones or hormone antagonist used in cancer treatment. |
They are used to slow the growth of hormone dependent tumors |
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What are the commonly prescribed groups of hormone/hormone agonist ? |
1.Corticosteroids 2. Estrogen antagonist 3. Gonadal hormones 4. Androgen Antagonist
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What is palliation? |
Treatment approach that focuses on relieving pain, symptoms and stress caused by serious illnesses, improving pt quality of life. |
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Why shouldn't you palpate a pt who has Wilms Tumor? |
The cancer 'seeds' and can quickly metastasizes as it is a rapidly growing tumor.
Wilms Tumor- is cancer of the kidneys (nephroblastoma) |
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What is the prototype Hormone Antagonist drug? |
Tamoxifen |
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Is Tamoxifen an estrogen agonist or antagonist |
- It is an antiestrogen drug (Estrogen Antagonist/ Estrogen Receptor Blocker) |
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Tamoxifen is usually given to pt who have what kind of cancer |
Breast cancer or have high risk of developing breast cancer |
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What are the Block Box Warning of Tamoxifen |
*Increased risk of endometrial cancer *Inreased risk thromboembolic disease (stroke, DVT, pulmonary embolism) |
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What are some AE of Tamoxifen |
"Tumor Flare" Hot flashes, vaginal discharge HTN, edema occurs in 10% of pts. taking the drug |
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What is "tumor flare" |
Indiosyncratic increase in tumor size after chemotherapy
I.e ( AE in pt who use Tomaxifen) |
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Due to their cytotoxicity , few Antitumor Antibiotics are used to treat cancer by inhibiting cell growth?
True or false |
True- they have a narrow spectrum of clinical activity
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What are the 3 reason chemotherapy may be used to treat cancer. |
1. Cure 2. Palliation 3. Porphylaxis ( prevention) |
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Which class of drugs have limited use, are broad spectrum & cause Severe myelosuppression?
1. Alkylating Agents 2. Hormone/Hormone Agonist 3. Plant Extract/ Nature 4.Antimetabolites (Mitotic Inhibitors) |
1. Alkylating Agents- broad spectrum by changing DNA structure in cancer cells; use is limited because they cause severe bone marrow suppression |
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A cancer pt undergoing chemotherapy asks why she has to take three different chemotherapy....What is most appropriate explanation. |
Each cancer drug attacks cancer cells in a different way (hormonal, halting cellular division, blocking vital nutrients).
Thus increasing overall effectiveness of the therapy. |
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What is most effective method to prevent common SE ( nausea and vomitting) of chemo durgs.
1. Adm. oral antiemtic when pt complains of nausea and vomitting 2. Adm antiemetic IM when they complain 3. Adm. anitemetic prior to antineoplastic medication 4. Encourage fluids prior to adm. antineoplastic drugs |
3. Adm. antiemetic prior to chemo drugs for maximum effect
(IM injections are usually avoided during chemo because of increased risk of infection) |
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The nurse notes that the client has reached his nadir. What does this mean? |
The client is experience bone marrow suppression and his blood counts are at their lowest (specifically neurtrophils) |
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Is it okay for chemo pt. & their family member to receive vaccines? |
No, they should avoid as the chemo pt. immune system is suppressed and may have adverse or exacerbated response to vaccine. |
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What does BRM stand for |
Biological Response Modifier |
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How do BRM's work |
They enhance the ability of the body's defense to remove tumor cells. |
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What is an antineoplastic drug that has been specifically engineered to attack one specific type of tumor cell (cancer antigens) |
Targeted Therapy |
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What are the two general classes of BRM's: |
Targeted Therapies and Cytokines |
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Interferons and Interleukins are ______ that act as BRM's. |
Cytokines |
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__(blank)___ binds to receptors on cancer cell membrances and suppress cell divison, enhance phagocytosis,and promote T-lymphocyte cytotoxic activity |
Interferons
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_____( Blank)______ is approved to treat melenoma, hairy cell leukemia, chronic myelogenous leukemia, AIDs related Kaposi's sarcoma and chronic Hep B/C.
Hint: it is a Cytokine drug |
Interferon alfa 2b (Intron-A) |
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Monoclonal antibodies (MAB'S) are BRM's
TRUE or FALSE |
TRUE-MAB's are BRM's that are a type of targeted therapy .
Key Thing to note with MAB's: Tumor cells must possess specific protein receptor or MAB will be ineffective |
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AE: of Avastin (bevacizumab) |
Bone marrow suppression, severe nausea, vomiting, diarrhea, pulmonary toxicity , heart failure , anaphylaxis |
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BRM's are effective against tumors by stimulating or assisting the pts immune system & include _____, _______, and _______ |
1. Interferon, 2. Interleukins 3. Targeted Therapies |
