N304 Exam 2

Front 1

What are the latest radiation treatments?

Back 1

1. Shaped-beam surgery
2. Stereotactic radiosurgery
3. Cyberknife

Front 2

What is chemotherapy?

Back 2

The use of chemical agents to destroy cancer cells

Front 3

What is the advantage of chemotherapy?

Back 3

Its applicability to the treatment of metastatic disease, because surgery and radiation therapy are limited to the treatment of localized disease

Front 4

What is the log cell kill theory?

Back 4

1. In an ideal system, chemotherapy kills a constant proportion of the remaining cancer cells with each dose

2. However, between doses, cell regrowth occurs at a logarithmic rate (10^x)

3. When therapy is successful, cell killing is greater than cell growth

Front 5

What are the phases of the cell cycle?

Back 5

1. G1
2. S
3. G2
4. M
5. G0

Front 6

What is the G1 phase?

Back 6

1. Post mitotic period

2. Enzymes necessary for DNA production, other proteins and RNA are produced

Front 7

What is the S phase?

Back 7

DNA synthesis occurs

Front 8

What is the G2 phase?

Back 8

When DNA synthesis is complete, cell enters a pre-mitotic period during which further protein and RNA synthesis occurs

Front 9

What is the M phase?

Back 9

Mitosis - actual cell division takes place

Front 10

What is the G0 phase?

Back 10

1. Resting state

2. Cells are relatively inactive because they are not dividing

3. Cells in G0 phase are considered protected from exposure to many chemotherapeutic agents

Front 11

What are Cell Cycle Specific drugs (CCS)?

Back 11

1. Drugs that exert their action only when cells are in a specific phase of the cell cycle

2. These drugs have the greatest tumor-cell kill when given in divided but frequent doses, or as a continuous infusion with short cycle time

3. Short cycle time allows the maximum number of cancer cells to be exposed to the drug at a specific time in their life cycle where they are vulnerable to the drug

Front 12

What are Cell Cycle Nonspecific drugs (CCNS)?

Back 12

1. Drugs that affect dividing and resting (G0 phase) cells in all phases of the cell cycle

2. Effective in treating tumors with more slowly dividing cells

3. Destruction of tumor cells is directly proportional to the amount of drug administered

4. Given intermittently, allowing the individual to recover from dose-limiting toxicities before the drug is repeated

Front 13

What are alkylating agents?

Back 13

CCNS drugs that act directly by attacking DNA, causing breaks in and cross linking the DNA strands preventing mitosis

Front 14

What are examples of alkylating agents?

Back 14

1. Cytoxan
2. Cisplatin
3. Ifosfamide

Front 15

What are antimetabolites?

Back 15

CCS drugs that are active during S phase and block cell development by interfering with metabolic process, usually DNA synthesis

Front 16

What are examples of antimetabolites?

Back 16

1. Methotrexate
2. 5FU
3. Cytarabine (Ara-C)

Front 17

What are nitrosoureas?

Back 17

CCNS drugs act similarly to alkylating agents and also inhibit enzymatic changes necessary for DNA repair

Front 18

What are examples of nitrosoureas?

Back 18

1. BCNU
2. CCNU

Front 19

What are antitumor antibiotics?

Back 19

Most common CCNS drug that act by binding with DNA and preventing RNA synthesis

Front 20

What are examples of antitumor antibiotics?

Back 20

1. Doxorubicin
2. Mitomycin-C
3. Bleomycin

Front 21

What are plant (Vinca) alkaloids?

Back 21

CCS drugs active during the M phase and are naturally occurring substances that block cell division by inhibiting spindle formation during mitosis.

Front 22

What are examples plant (Vinca) alkaloids?

Back 22

1. Vincristine
2. Vinblastine
3. Paclitaxel

Front 23

What is combination therapy?

Back 23

1. Drugs to be utilized have demonstrated single-agent anti-tumor activity against the disease to be treated

2. Drugs to be utilized have been demonstrated to have synergistic effect

3. Drugs to be utilized manifest different mechanisms of action in order to minimize drug resistance

4. Drugs to be utilized have differences in toxicity to allow therapeutic dosages while preventing life-threatening toxicity to the patient

5. Intermittent administration of combination agents minimize immunosuppression and permit recovery of bone marrow and normal tissue between cycles

Front 24

What is the combination chemotherapy for breast cancer?

Back 24

AC, CMF, FAC

Front 25

What is the combination chemotherapy for non-Hodgkin's lymphoma?

Back 25

CHOP, COP, CVAD-R (Cytoxan, Vincristine, Adriamycin, Dexamethasone, Rituxan)

Front 26

What is the combination chemotherapy for non-small cell lung cancer?

Back 26

CAP (Cytoxan, Adria, Cisplatin)

Front 27

What is the combination chemotherapy for colorectal cancer?

Back 27

FU-LVR (Leukovorin), FU-IFN (Interferon)

Front 28

What is the combination chemotherapy for multiple myeloma?

Back 28

VAD (Vincristine, Adria, Dexamethasone)

Front 29

What are the routes of administering chemotherapy?

Back 29

1. Orally
2. IV
3. Intrathecal

Front 30

When is the oral route used for chemotherapy?

Back 30

Used for drugs that are well absorbed and nonirritating to the GI tract

Front 31

What are examples of oral chemotherapy?

Back 31

1. Cytoxan
2. VP-16
3. Methotrexate

Front 32

When is the IV route used for chemotherapy?

Back 32

Most commonly used since it achieves a therapeutic blood level quickly, and most chemo drugs are not absorbed in the GI tract

Front 33

When is the intrathecal route used for chemotherapy?

Back 33

When it is desirable for drug to reach the CNS; allows the drug to be given directly into the CSF

Front 34

What are examples of intrathecal chemotherapy?

Back 34

MTX and Ara-C in treating CNS leukemia or carcinomatosis meningitis

Front 35

Where is intrathecal chemotherapy administered?

Back 35

CSF

Front 36

What is intracavitary chemotherapy?

Back 36

Installation of drugs directly into body cavities, such as the bladder (BCG), peritoneum (Cisplatin), pleura (TCN, Bleomycin), or pericardium

Front 37

What is intraperitoneal chemotherapy?

Back 37

Installation of drugs in the peritoneum. Cisplatin, Ara-C, Doxorubicin, 5FU

Front 38

What drugs are administered intraperitoneally?

Back 38

1. Cisplatin
2. Ara-C
3. Doxorubicin
4. 5FU

Front 39

What is intraperitoneal chemotherapy used for?

Back 39

Frequently used for metastasis ovarian cancer

Front 40

What is intra-arterial chemotherapy?

Back 40

Large concentrations of drug are given through the artery supplying the area as in primary or metastatic liver ca, primary brain tumors

Front 41

What is the advantage of intra-arterial chemotherapy?

Back 41

Needs a reservoir to deliver drug

Front 42

What is chemoembolization?

Back 42

1. Chemotherapy drugs are injected into the hepatic artery blocking blood supply to the liver

2. Since drug is given directly into the liver, dose is usually higher than standard dose given IV

Front 43

What are the advantages of chemoembolization?

Back 43

1. Because artery is blocked, no blood washes through the tumor

2. Drug stays in the tumor for a longer period (usually a month)

3. Decrease side effects since drug is confined to the liver

Front 44

How does chemotherapy affect the bone marrow?

Back 44

Causes bone marrow suppression/depression

Front 45

What is seen with bone marrow suppression?

Back 45

1. Neutropenia: ANC <2000

2. Agranulocytosis: ANC < 500

3. Anemia

4. Thrombocytopenia

5. Nadir: blood count reaches its lowest point after chemo. Varies according to drug used but generally 7-14 days after first dose with expected recovery in 14-28 days.

Front 46

What is the nursing care of neutropenia?

Back 46

1. Private room

2. Prevent nosocomial infections—good handwashing, do not use supplies from common areas

3. Limit the number of visitors/personnel in room

4. Inspect mouth, skin, mucous membranes, esp. anal area, for fissures and abscesses

5. Change IV tubings/dressings per hospital policy

6. Monitor CBC daily. Transfuse PRN

7. Avoid use of indwelling catheters

8. Keep fresh flowers/potted plants out of room

9. Low bacteria diet — avoid fresh fruits and vegetables

Front 47

What is the nursing care of thrombocytopenia?

Back 47

1. Gentle handling - use lift sheet when moving/positioning

2. No IM injections and venipunctures. If unavoidable, use smallest gauge needle.

3. Apply firm pressure to the needlestick site until no longer oozing (10 mins)

4. Avoid trauma to rectal tissues — no rectal temperatures, no enemas, well-lubricated suppositories

5. Use electric razors for shaving

6. Avoid mouth trauma - use soft bristled toothbrush, no flossing, soft foods

7. Wear shoes with firm soles when ambulating

Front 48

What are the gastrointestinal side effects of chemotherapy?

Back 48

1. Nausea & vomiting
2. Stomatitis/Mucositis
3. Anorexia

Front 49

How does chemotherapy cause nausea and vomiting?

Back 49

1. Study findings suggest chemotherapy-induced vomiting ends within 48 hours after treatment, while nausea persists for 72 hours or more

2. Uncontrolled nausea and vomiting and retching may cause fluid and electrolyte imbalances, esophageal tears and severe psychologic distress

3. Anticipatory nausea and vomiting usually begin the day before actual drug administration and may be elicited by a variety of stimuli, including sights, sounds, smells and activities associated with drug administration

Front 50

How can chemotherapy-induced nausea and vomiting prevented?

Back 50

Administer 30-60 mins before chemotherapy to block neurotransmitter sites and minimize stimulation of the chemoreceptor trigger zone and the true vomiting center

Front 51

What is the pharmacological management for chemotherapy-induced nausea and vomiting?

Back 51

1. Serotonin antagonists:
Ondansetron (Zofran)
Granisetron (Kytril)
Dolasetron (Anzemet)

2. Benzodiazepines:
Lorazepam (Ativan)

3. Phenothiazines
Prochlorperazine (Compazine)
Chlorpromazine (Thorazine, Ormazine)

4. Antihistamines
Diphenhydramine (Benadryl)

5. Corticosteroids
Dexamethasone (Decadron)

6. Metoclopramide (Reglan)

7. CNS Depressants
Trimethobenzamide (Tigan)

Front 52

How does chemotherapy cause stomastitis/mucositis?

Back 52

1. Chemical tissue injury damages the basal layers of the oral mucosa and inhibits replacement of the superficial layers, resulting in ulcerations that occur 5-7 days after chemo

2. Infection can occur as a result of immunosuppression and oral tissue breakdown and is caused by a wide variety of organisms such as Staphyloccoccus, Candida, and Herpes Simplex virus

3. Pain and irritation have a negative effect on nutritional and emotional status

Front 53

What is the nursing care for stomastitis/mucositis?

Back 53

1. Examine mouth including the roof, under the tongue, and between teeth, every 4 hours

2. Brush teeth and tongue with soft bristled brush of sponges Q8H

3. Rinse mouth with NS Q 1-2H

4. Apply petrolatum jelly to lips after mouth care

5. Avoid use of alcohol or glycerin-based mouthwash

6. Use artificial saliva PRN

7. Avoid spicy or hard foods

8. Mouth care after every meal

Front 54

What is the nursing care for chemotherapy-induced anorexia?

Back 54

1. Offer small, frequent high caloric foods

2. Adjust meal size to appetite

3. Enhance or minimize food odors

4. Create a relaxed, pleasant eating environment

5. Anti-emetics 30 mins prior to meals

Front 55

Which chemotherapy drugs commonly cause alopecia?

Back 55

1. Doxorubicin
2. Cyclophosphamide
3. Vincristine
4. Methotrexate
5. Cisplatin

Front 56

What is the nursing care for chemotherapy-induced alopecia?

Back 56

1. Provide info about hair loss, when to expect it, obtaining a wig, and protecting scalp from sun

2. Cut hair short soon after chemotherapy

3. Hair loss is temporary and regrowth is evident 4-6 weeks after chemo

Front 57

What are the germinal tissue effects of chemotherapy?

Back 57

1. Decreased libido

2. Impotence secondary to neurological toxicity associated with the vinca alkaloids and Cisplatin

3. Decreased sperm count to infertility in men

4. Irregular menses, vaginal dryness and amenorrhea in women

5. It is strongly recommended that individuals avoid having babies during or immediately after course treatment

6. Sperm banking

Front 58

What causes chemotherapy-induced local tissue irritation?

Back 58

Occurs infrequently and usually results from extravasation

Front 59

What chemotherapy drugs can cause local tissue irritation?

Back 59

1. Vesicants
2. Irritants

Front 60

What are vesicants?

Back 60

Drugs that cause severe necrosis when extravasated

Front 61

What chemotherapy drugs are vesicants?

Back 61

1. Doxorubicin
2. Mitomycin C
3. Vincristine
4. Vinblastine

Front 62

What are irritants?

Back 62

Drugs that cause less severe reactions of burning or inflammation

Front 63

Which chemotherapy drugs are irritants?

Back 63

1. Bleomycin
2. Cisplatin
3. 5FU
4. Etoposide
5. Paclitaxel

Front 64

What are the guidelines of treatment for extravasation?

Back 64

1. Stop the infusion immediately and notify M.D.

2. Attempt to aspirate drug thru existing needle with a tuberculin syringe

3. Check policy for administration of antidote

4. Remove needle

5. Apply ice (or heat if vinca alkaloid)

6. Document interventions and response

Front 65

What are the guidelines for chemotherapy administration?

Back 65

1. Chemo agents are administered by RNs who have been trained and designated as qualified according to institutional policies

2. Ensure that informed consent has been given

3. Evaluate appropriate lab results (CBC, Renal and liver functions). Hold if WBC<3.0, ANC <1500, Platelets <100,000, Creat >1.5, Total Bili >1.5

4. Measures to minimize side effects of the drugs are carried out before administration (i.e. hydration, antiemetics, antianxiety)

5. Wear gloves, gown, goggles, mask

6. Wash hands before and after handling chemo. Avoid touching agent.

7. Check chemo syringe, bag against MD order- drug, dose, infusion time, drug exp. Double check with another RN

8. Document drug administration including any adverse reactions

9. Wear gloves and gown when handling body secretions from patients who received chemotherapy within the previous 48 hours. Double flush toilet.

10. In the event of accidental exposure, remove contaminated gown and gloves immediately and discard acdg to policy

11. Wash contaminated skin with soap and water

12. An eye that is accidentally exposed to chemo should be flooded with water or isotonic eyewash for at least 5 mins

13. Obtain medical evaluation ASAP

Front 66

What are the guidelines for chemotherapy disposal?

Back 66

1. Regardless of the setting, all equipment and unused drugs are treated as hazardous and are disposed per policy

2. All contaminated equipment, including needles, are disposed of intact to prevent aerosolization, leaks, and spills

3. All contaminated materials used in drug prep are disposed of in leakproof, punctureproof container with a distinctive warning label

4. Linen contaminated with bodily secretions of patients who have received chemo within previous 48 hours is placed in a specially marked laundry bag, which is then placed in a bag with a warning label

5. In the event of a spill, don double surgical gloves, goggles, gown. Small amounts of spill are cleaned up with gauze pads; larger spills (>5ml) are cleaned up with absorbent pads. (Get spill kit).

6. Document spill and actions taken

Front 67

What is biotherapy?

Back 67

1. AKA Biological Response Modifier Therapy, Immunotherapy, Biological Therapy

2. Treatments that boost or restore the ability of the immune system to fight cancer, infections and other diseases

Front 68

What are the methods of biotherapeutic action?

Back 68

1. Enhance the patient’s own immune response

2. Alter the milieu in which cancer cells grow by modifying the actions of the normal cells in the area of the tumor

3. Alter the pathway by which normal cells transform into malignant cells, which may be preventive than therapeutic

4. Increase the vulnerability of cancer cells to the body’s own immune system

5. Prevent the metastasis of cancer cells

6. Enhance the repair of normal cells damaged by treatment

Front 69

What are the categories of biotherapy?

Back 69

1. Cytokines - Interferon, Interleukins, Hematopoetic growth factors

2. Monoclonal antibodies

Front 70

What are cytokines?

Back 70

Cytokines are proteins that bind to specific cell surface receptors differentially expressed on the cells of the hematopoietic and lymphoid system and are responsible for controlling the growth, development and functional activity of these cells

(examples: 16 types of Interleukins, Interferon, Hematopoetic growth factors)

Front 71

What are the functions of cytokines?

Back 71

Controlling the growth, development and functional activity of the cells of the hematopoietic and lymphoid system

Front 72

What is interleukin-2?

Back 72

1. Produced by lymphocytes.

2. Augments T cell functions and enhances NK cell functions

3. Also activates lymphokine-activated killer (LAK) cells which are a type of killer T cell.
LAK cells destroy tumor cells and improve the recovery of immune function in certain immunodeficiency states

4. FDA approved for renal cell cancer, melanoma, and non-Hodgkin’s lymphoma

Front 73

What are the side effects of interleukin-2?

Back 73

1. Increase capillary permeability which causes hypotension, ascites, generalized body edema, and pulmonary edema

2. Flu-like symptoms: chills, fever, headache, malaise

3. GI symptoms: nausea, vomiting, diarrhea, mucositis

Front 74

What is the mode of action of interferons?

Back 74

1. Small proteins that inhibit viral replication and promote the T-cell immune response

2. Alpha Interferon was the first BRM approved by the FDA

3. Currently indicated for use in treatment of hairy cell leukemia and AIDS-associated Kaposi’s sarcoma

4. Also effective against hematologic diseases such as non-Hodgkin’s lymphoma, T-cell lymphoma, multiple myeloma, CML

5. Also used in the treatment of viral hepatitis

Front 75

What are the side effects of interferons?

Back 75

1. Flu-like syndrome: fever, chills, tachycardia, muscle aches, malaise, fatigue and headache

2. Extremely common during first therapy but usually decreases in intensity with continued daily therapy

3. Neutropenia

4. Pre-medicate with Acetaminophen and Mepiridine to reduce flu-like effects

Front 76

What is the mode of action of Monoclonal Antibodies (MoAbs)?

Back 76

1. The use of MoAbs involves the development of specific antibodies directed against antigens located on the surface of tumor cells

2. Samples of the pt’s tumor cells are taken and processed to reveal specific antibodies to the tumor associated antigens

3. In order for this approach to work, a sufficient quantity of antigens unique to the tumor cells, must be present

4. In addition, the tumor antigens must be sufficiently different from antigens elaborated by normal cells to provoke immune response

5. The antibodies can be used alone to kill cancer cells or as carriers of other substances used for either therapeutic or diagnostic purposes

6. Chemotherapeutic agents can be attached to MoAbs to deliver high concentrations of these toxic substances directly to the tumor cells

7. MoAbs can also carry radioactive substances to cancer cells, thus pinpointing the location of metastasis previously undetected by other methods

8. Rituximab (Rituxan) approved for tx of non-Hodgkin’s lymphoma

Front 77

What is the action of Rituxan?

Back 77

1. Rituxan works by binding to a particular protein (the CD20 antigen) on the surface of normal and malignant B-cells

2. From there, it recruits the body's natural defenses to attack and kill the marked B-cells

3. Stem cells (B-cell progenitors) in bone marrow lack the CD20 antigen, allowing healthy B-cells to regenerate after treatment and return to normal levels

4. Antibodies bound to a cancer cell are recognized by killer T-cells via specific antibody receptors on the surface of the T-cells

5. These cells then produce toxic compounds that kill the cancer cell

Front 78

What are the Hematopoietic Growth Factors in Cancer Therapy?

Back 78

1. Erythropoetin (EPO, Procrit)

2. Granulocyte Colony Stimulating Factor (GCSF- Neupogen/Filgrastim)

Front 79

What is the function of Erythropoetin?

Back 79

1. Promotes erythropoetin proliferation/production

2. FDA approved for anemia in ESRD and cancer

Front 80

What is the function of Granulocyte Colony Stimulating Factor (GCSF)?

Back 80

1. Promotes neutrophil proliferation

2. Decreases length of myelosuppression

3. Widely used after cytotoxic chemotherapy to accelerate recovery of neutrophils and lessen the risk of bacterial infection

Front 81

What is hormone therapy?

Back 81

1. Some hormones make hormone-sensitive tumors grow more rapidly

2. Some tumors actually require specific hormones to divide

3. Altering the availability of these hormones to hormone-sensitive tumors can directly affect the rate of tumor growth

Front 82

Which hormones are used specifically for hormone therapy?

Back 82

Androgen and estrogen hormones are used specifically because they create an unfavorable environment for metastatic lesions

Front 83

What are hormone antagonists?

Back 83

When administered, hormone antagonists bind to the specific hormone receptor of the tumor cell and prevent the needed hormone from binding to the receptor, slowing down tumor growth

Front 84

What are examples of hormone antagonists?

Back 84

1. Antiestrogen – Tamoxifen

2. Antiandrogen- Flutamide

3. Antiprogestin- Mifepristone

Front 85

What is the action of hormone therapy?

Back 85

1. Hormone antagonists bind to the receptor site, inhibiting the hormone from binding to cancerous cell

2. This blocks signals to prevent cell growth, causing the tumor to shrink in size

Front 86

What are the measurements of tumor response to chemotherapy?

Back 86

1. Complete Remission
2. Partial Remission
3. No response
4. Progression

Front 87

What is complete remission?

Back 87

Tumor and all s/sx of disease disappear for at least 4 weeks, and normal functional status returns

Front 88

What is partial remission?

Back 88

Tumor is reduced by 50% or more, and functional status improves.
Improvement: tumor is reduced 25-50% and some functional improvement is evident.

Front 89

What is no response?

Back 89

Tumor shows no evidence of response and no significant improvement in functional status is evident

Front 90

What is progression?

Back 90

New tumor growth, new metastasis, or reappearance of old lesions