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105 Cards in this Set
- Front
- Back
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What is cancer?
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A group of disorders, not a single disease.
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What are the characteristics of neoplastic cells?
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Persistent proliferation
Invasive growth Formation of metastases Immortality |
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What are two properties of persistent proliferation?
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Unrestrained growth and division (most distinguishing property)
Malignant cells are unresponsive to feedback mechanisms that regulate cellular proliferation in healthy tissue |
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What does invasive growth of neoplastic cells mean?
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Take over and penetrate adjacent tissues
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Define immortality in relation to cancer?
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Normal cells die, but cancer cells undergo endless divisions because of the enzyme (Telomerase)
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What are the methods of cancer treatment?
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Surgery
Radiation Drug Therapy/Chemotherapy |
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What are the chemotherapy drug classes?
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Cytotoxic agents (most common)
Hormones & hormone antagonists Biologic response modifiers |
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Describe the etiology of cancer.
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Alterations in DNA caused by:
virus chemical carcinogens radiation |
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Define growth fraction.
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In any tissue, some cells are going through the cell cycle, whereas others are resting in the GO stage. Ratio of proliferating cells in Go stage.
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When do you want to target cancer cells in treatment?
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While they are in their go phase.
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Which cancers have a high/low growth fraction?
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High-disseminated cancers
Low-Solid tumors |
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Which tissues are chemotherapy drugs more toxic to?
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Tissues with high growth fraction.
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Chemotherapy affects what other tissues?
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Bone marrow
Skin Hair follicles Sperm Gastrointestinal tract (N/V) |
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Are cancer chemotherapies selectively toxic?
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No. They target all proliferating cells.
Terrorist vs. Sniper (select) |
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Define cure rate.
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100% cell kill
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Define remission.
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Less than 1 million cells detected.
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What tests detect cancers?
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Pap test
Mammogram |
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What cancer does a pap test confirm?
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Cervical-only neoplastic disease capable of true early detection
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What are the consequences of late detection?
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Metastases
Tumor is less responsive to chemo Pt may already be debilitated |
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How does the immune system react to cancer?
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It fails to identify cancer cells as abnormal b/ they are similar to normal cells. No help.
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When should chemotherapy stop?
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Unknown. Cancer is undetectable at less than 1 million cells, but not all cells are killed.
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When is the greatest risk of infection from chemo?
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10-14 days after chemo
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What is neutropenia?
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Normal is 2500-7000 cell/mm3
Nuetrophil counts under 500/mm3, withhold chemo and place on inf. precautions |
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What is neutropenic isolation?
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No flowers, fruit, etc.
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Which cancers respond best to chemo?
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Rapidly growing malignant neoplastic tumors
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Which cancers respond poorly to chemo?
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Solid tumors d/t low growth fraction
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What size tumors respond better to chemo?
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Large are less responsive than small. The larger and older the tumor, the growth fraction declines.
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How do drugs affect therapy?
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Cancer cells develop resistance, leading to failure
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Define heterogeneity of tumor cells.
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Mutation becoming subpopulations of dissimilar cells altering the responsiveness.
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What other factors of tumors affect the effectiveness of drug therapy?
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Size-large tumors are poorly vascularized.
Location-Tumors in CNS are protected by the blood brain barrier. |
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Which is the most common chemotherapy type?
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Intermittent chemotherapy.
primary technique for cell kill. Allows normal cells to repopulate b/n rounds of chemo. |
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What chemo type is most effective? Why?
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Combination chemo.
Less drug resistance w/combos. Reduced injury to normal cells. |
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How to reduce injury to normal cells during chemo?
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Use drugs w/o overlapping toxicities.
Use drugs effective alone, but better in combo. Each drug has different MOA. |
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What are the three types of chemo modalities?
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Intra-arterial
Intrathecal Intracavity |
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Describe Intra-arterial chemo.
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Use on solid tumors.
Use in high concentration to site w/ specific artery. |
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Describe Intrathecal chemo.
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Get drugs to CNS that do no cross blood brain barrier so they are injected into subarachnoid space.
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Describe intracavity chemo.
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Chemo directly into cavity (pleural or peritoneal) or bladder.
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What are the major toxicities of cancer chemo?
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Bone marrow suppression, neutropenia, thrombocytopenia, anemia, stomatitis, diarrhea, N/V, alopecia, reprodutive toxicity, hyperuricemia r/t high blood uric acid
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What leads to bone marrow suppression?
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Decreased neutrophils, thrombocytes, and erythrocytes. Loss of these leads to infection, bleeding, anemia.
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What is the normal range of neutrophils?
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2500-7000 cells/mm3
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What is the nursing intervention for nuetropenia?
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At below 500, withhold chemo and place on infection precautions?
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What is the normal range of thrombocytes in the body?
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150,000-450,000 mm3
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What is thrombocytopenia?
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Reduction of circulating platelets in the bloodstream.
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What is contradictory with thrombocytopenia?
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No ASA, NSAID taken. Use soft toothbrush.
All to prevent gum bleeding. Can use Tylenol for joint pain. |
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Define anemia. How do you treat?
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Reduction of erythrocytes.
Treat w/ epoetin or transfusion. |
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What is the cause of nausea and vomiting in chemo treatment?
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Stimulation of CTZ-chemoreceptor trigger zone.
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How do you treat N/V in chemo treatment?
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Zofran
Phenergan Marijuana |
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What is alopecia?
When does it stop? |
Hair loss r/t chemotherapy.
Hair growth will return 1-2 mo after Tx end. |
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What is the cause of hyperuricemia?
How to treat? |
Excessive uric acid in blood formed by breakdown of DNA and damage kidneys.
Increase fluid and give allopurinol. |
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In Assessment of chemo patient, look for...
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Increase in temperature (early sign of low neutrophil count)
Place on reverse isolation r/t risk of infection. Bloodwork for neutrophil count- s/s are no mucus, pus, etc. |
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What toxicity is caused by Daunorubicin?
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Cardiac damage
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What toxicity is caused by Cisplatin?
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Kidneys
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What toxicity is caused by Vincristine?
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Peripheral nerves
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How does the chemo caused local damage?
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Extravasation of Vesicants
(injury to local tissue at IV site) |
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Define carcinogenosis.
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Cancer causing.
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What are the benefits of chemo?
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cure
palliation prolongation of useful life |
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What factors predict the outcome?
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Patient's general health (Karnofsky Performance Scale)
Responsiveness of type of cancer |
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How to intervene with anemia?
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Epoetin and transfusion
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How to intervene on stomatitis?
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Bland diet, good hygiene, control Candida, inflammation w/ steroids
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How to intervene on diarrhea?
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Add fiber and constipating foods (cheese)
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How to intervene on N/V?
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Premedication w/ antiemetic (Zofran or marijuana-like drugs)
Prevent dehydration and malnutrition |
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How to intervene on hyperuricemia?
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Give allopurinol.
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How do cytotoxic agents work?
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They act directly on cancer cells to cause cell death.
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What are the seven major groups of cytotoxic agents?
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Alkylating agents, Platinum cmpds, Antimetabolites, Antitumor antibiotics, Mitotic inhibitors, Topoisomerase inhibitors, Misc.
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What is cell cycle specificity?
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specific from one mitotic division to next. Toxic to only cells passing through particular phase of cycle..higher cell kill
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Define cell cycle non-specific?
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Drugs that act on any phase.
Usually alkating agents and anti-tumor antibiotics. |
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How do you handle chemo drugs?
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Special training.
No direct contact b/ mutagenic, teratogenic, and carcinogenic |
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How to administer IV chemo?
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Use only good IV flow veins w/o previous irradiation
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How do you administer alkylating agents?
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Highly toxic.
Can be administered in a single bolus. Non specific. Drug resistance is common. |
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What are the adverse effects of alkylating agents?
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Injury in high growth fraction tissues.
N/V "Blistering agents" |
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What are the three nitrogen mustard drugs in the alkylating agents category?
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Cyclophosphamide (Cytotoxan)
Mechlorethamine (Mustargen) Chlorambucil (Leukeran) |
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Describe treatment with Cyclophosphamide (Cytotoxan).
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Treats Hodgkins & Non-H tumors
Undergoes liver conversion Give PO with food, Not IV |
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What are the adverse effects of Cyclophosphamide (Cytotoxan)?
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Bone marrow depression w/ severe N/V and alopecia
Acute hemorrhagic cystitis pos Keep pt well hydrated |
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Describe treatment with Mechlorethamine (Mustargen).
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Treats Hodgkins & non-H, brocogenic & metastic carcinomas
IV, powerful |
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What are the adverse effects of Cyclophoshamide (Cytotoxan)?
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Active conversion in blood
Severe bone marrow depression N/V, alopecia, diarrhea, stomatitis, amennorhea, sterility |
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Describe treatment using Chlorambucil (Leukeran).
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Safest nitrogen mustard
Use for chronic lymphocytic leukemia, Hodgkins, non-H, ovarian CA |
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What are the adverse effects of Chlorambucil (Leukeran)?
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Bone marrow toxicity
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What type of alkylating agent class is a broad spectrum type?
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Nitrosoureas
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What are the two examples of nitrosoureas in the alkylating agents category?
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Carmustine (BiCNU)
Busulfan (Myleran) |
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How does Carmustine (BiCNU) work?
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Cross the blood brain barrier, treats metastatic tumor of brain, H, non-H, multiple myeloma, malig. melanoma
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Adverse effects of Carmustine (BiCNU)?
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Delayed bone marrow suppression, N/V, liver injury
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How do you administer Carmustine (BiCNU)?
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Topically by implantation wafer
IV |
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Use of Busulfan (Myleran) and method of administration?
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Bone marrow treatment
Use for chronic myelogenous leukemia (90% remission) PO, IV |
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What are the properties of platinum compounds?
Three examples. |
cell cycle phase nonspecific.
Cisplatin analog (Platinol AQ) Carboplatin Oxaliplatin |
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How do cisplatin analogs like Platinol AQ work?
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Kill cells by cross link bn/ and w/in strands of DNA.
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What is Platinol AQ used for?
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Metastatic testicular and ovarian cancer, bladder cancer
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What is Carboplatin used for?
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Advanced ovarian cancer
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What is Oxaliplatin approved for?
Adverse? |
colorectal cancer that has progressed after first line treatment.
Adverse is nueropathy, worse by cold. |
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Characteristics of Antimetabolites?
3 Types? |
S phase cycle specific
Types-folic acid analogs and pyrimidie analogs, purine analogs |
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Define S-Phase cycle specific.
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Interferes w/ normal metabolic pathways of dividing cells
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Two examples of folic acid analogs under antimetabolites category?
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Methotrexate (Rheumatrex)
Pemetrexed (ALIMTA) |
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How does Methotrexate (Rheumatrex) work?
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Prevents coversion of folic acid to active form.
Inhibits dihydrofolate reductase. |
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What is an adjunct of Methotrexate (Rheumatrex)?
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Leucovorin resue to enhance Methotrexate uptake by CA cells and protect normal cells (RISKY)
Fatal if right dose, right time is not given. |
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How does Pemetrexed (ALIMTA)work?
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Similar to methotrexate but inhibits 2 other enzymes: thymidylate synthase & glycinamide ribonucleotide
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Adjunct of Pemetrexed (ALIMTA)?
Route? Contra? |
Combo with Cisplatin
IV Pregnancy or trying to get pregnant |
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Three examples of pyrimidine analogs under antimetabolites category?
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Cytarabine (Cytosar-U)
Fluorouracil (Adrucil) Capecitabine (Xeloda) |
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Use of Cytarabine (Cytosar-U)?
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Acute myelogenous leukemia
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Use, method and adverse effects of Fluorouracil (Adrucil)?
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Tx of solid tumor
Convert to active form only in cell going through cycle (no phase specificity) A/E-bone marrow suppression, toxicity |
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Use, contra and of Capecitabine (Xeloda)?
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prodrug form of fluorourcil
Use-metastatic breast cancer, colorectal cancer Contra-pregnancy, renal insuff |
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Drug interactions of Capecitabine (Xeloda)?
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Drug intx-Warfarin-monitor carefully and reduce warfarin dosage as needed.
Do INR, PT frequently. |
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Three examples of purine analogs under antimetabolites category?
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Mercaptopurine (Purinethol)
Fludarabine (Fludara) Cladribine (Leustatin) |
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Function and method of Mercaptopurine (Purinethol)?
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Prodrug is converted in cells (S phase specific)
Give PO Liver metabolized |
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Function and tests of Fludarabine (Fludara)?
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Analog of adenosine
Cell kill by DNA replication inhibition Monitor CBC levels. |
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Function and method of Cladribine (Leustatin)?
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Adenosine analog
Inhibit DNA synthesis and DNA repair Hairy cell leukemia |
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List seven examples of antitumor antibiotics.
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Dactinomycin (Cosmegen)
Doxorubicin (Adriamycin) Daunorubicin (DaunoXome) Epirubicin (Ellence) Idarubicin (Idamycin) Mitoxantrone (Novantrone) Bleomycin (Blenoxane) |
