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Pharm Final > Anticancer Drugs > Flashcards

Anticancer Drugs Flashcards

1
Q

Types of Cancer

A

Genetic and environmental/diet

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2
Q

Genetic Cancers

A

Breast, ovarian, prostate, endometrial/ovarian, colon, pancreatic, lung, malignant melanoma

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3
Q

Environmental/diet Cancers

A

Lung (tobacco/asbestos, arsenic), liver (Hep B+C, aflatoxin), AML (Benzene), sarcoma (vinyl chloride), colon/rectal (animal fat), stomach (smoked meats), mouth/throat/esophagus (ETOH)

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4
Q

Types of Anticancer Drugs

A

Cell cycle-nonspecific (CCNS) and cell cycle-specific (CCS)

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5
Q

Cell Cycle-nonspecific (CCNS)

A

Act during any phase of the cell cycle
Alkylating drugs
Anti-tumor antibiotics
Hormones

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6
Q

Cell Cycle-specific (CCS)

A

Act during a specific phase/phases
Effective for rapidly growing cancer cells
Anti-metabolites
Miotic inhibitors

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7
Q

General Sxs of Anticancer Drugs

A

Immunocompromised, N/V/D, loss of appetite, fatigue, low platelet count, low blood count, elevated BUN, elevated creatinine, alopecia, HA, dizziness, dermatitis

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8
Q

All Anticancer Drugs Are What Pregnancy Category?

A

Pregnancy category D

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9
Q

Most Anticancer Onset Times?

A

Between 7-10 days

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10
Q

General Adverse Reactions of Anticancer Drugs

A

Secondary neoplasm, bone marrow depression, anemia, reactivation of dormant viruses, cardiac dysrhythmias, HF

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11
Q

General Life-threatening Reactions of Anticancer Drugs

A

Leukopenia, thrombocytopenia, severe myelosuppression, anaphylaxis

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12
Q

General Contraindications of Anticancer Drugs

A

Hypersensitivity, severe bone marrow depression. pregnancy, liver or kidney disease, severe HF?, may increase INR, smoking?, dehydration

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13
Q

General Drug Interactions of Anticancer Drugs

A

Increase action of barbituates, chloramphenicol, AC
Bone marrow depressants increase toxicity
Avoid live virus vaccines
Thiasized diuretics may increase myelosuppression
Reduces effectiveness of vaccines

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14
Q

General Nursing Considerations of Anticancer Drugs

A

Assess CBC, plts (may hold med if levels are too low)
Handle drug with care (avoid direct contact with skin, eyes, mucous)
Monitor IV site frequently for irritation and phlebitis
Administer anti-emetic 30-60 minutes before giving drug
Hydrate pt with IV and oral fluids prior to administration
Monitor BUN and creatinine
Strict asepsis techniques during dressing changes or invasive procedures
Maintain good hygiene
Consult with oncologist before getting vaccines
Testicular atrophy and reversible oligospermia/azoospermia may occur in men
Avoid pregnancy for 3-4 months after completing treatment
Avoid others with respiratory infections
Report signs of infection immediately
Monitor I and O
Monitor electrolytes (serum K+)
Avoid ETOH or other hepatotoxic substances
Avoid live virus vaccines (2 months after therapy)

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15
Q

Mustard Gas Derivative Prototype

A

Cyclophosphamide (Cytoxan)

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16
Q

Cyclophosphamide (Cytoxan) Routes and Onset?

A

PO/IV onset 7 days

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17
Q

Sxs Specific to Cyclophosphamide (Cytoxan)

A

Hematuria, impotence, sterility

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18
Q

Adverse Reaction Specific to Cyclophosphamide (Cytoxan)

A

Hemorrhagic cystitis

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19
Q

Life-threatening Reaction Specific to Cyclophosphamide (Cytoxan)

A

Cardio toxicity (high doses), hepatotoxicity (long-term)

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20
Q

Drug Interactions Specific to Cyclophosphamide (Cytoxan)

A

Decrease digoxin level
Prolonged leukopenia with thiazide diuretics
Potentiates cardiomyopathy with Adriamycin
Potentiates action and toxicity of allopurinol, probenicid, colchicine, AC
Toxicity increases if given with corticosteroids, phenytoin or sulfonamides

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21
Q

Nursing Considerations Specific to Cyclophosphamide (Cytoxan)

A

Assess for sxs of hematuria, polyuria, dysuria
Teach client to empty bladder every 2-3 hours
Increase fluid intake to 2-3 L/day to reduce risk of hemorrhagic cystitis
Monitor I and O
Take drug early in the day to prevent accumulation of drug in bladder at night
Drug is excreted in breast milk

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22
Q

Antitumor Antibiotic Prototype

A

Anthracyclines ex: doxorubicin (Adriamycin)

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23
Q

Doxorubicin (Adriamycin) Route and Onset

A

IV 7-10 days

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24
Q

Sxs Specific to Doxorubicin (Adriamycin)

A

IV reaction, potent vesicant may cause flare reaction, discolors urine pink-red for up to 48 hours, may cause radiation recall to previously radiated skin

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25
Q

Adverse Reactions Specific to Doxorubicin (Adriamycin)

A

Esophagitis, hyperpigmentation of nails, tongue and oral mucosa may darken (more often in African Americans)

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26
Q

Life-threatening Reactions Specific to Doxorubicin (Adriamycin)

A

Cardio toxicity, CHF

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27
Q

Contraindications Specific to Doxorubicin (Adriamycin)

A

Severe cardiac disease (check EF prior to starting), do not exceed lifetime does of 550 mg/m2 or 450 mg/m2 if prior radiation, hepatic impairment

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28
Q

What is Used with Doxorubicin (Adriamycin) to Help Prevent/Decrease Cardiac Damage?

A

Dextazoxane (Zinecard)

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29
Q

Drug Interactions Specific to Doxorubicin (Adriamycin)

A

Increased risk of cardiotoxicity with CA+ blockers, Taxol, mitomycin
Decreases phenytoin levels
Increased risk of hemorrhage and cardiotoxicity with Cytoxan
Retrovir may decrease effectiveness
Increased hepatoxicity with mercaptopurine
Green tea may enhance antitumor effect, use with caution w/ grape seed, garlic, and st. johns wort

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30
Q

Nursing Considerations Specific to Doxorubicin (Adriamycin)

A

Monitor IV site, severe tissue necrosis may occur 3-4 weeks after infiltration
Monitor cardiac status

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31
Q

Plant Alkaloid Prototype

A

Vincristine (Oncovin)

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32
Q

Vincristine (Oncovin) Route and Onset

A

IV 7 days

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33
Q

Sxs Specific to Vincristine (Oncovin)

A

Peripheral neuropathy, loss of DTR (deep tendon reflex)

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34
Q

Adverse Reactions Specific to Vincristine (Oncovin)

A

Hypotension, visual disturbances, ileus, SIADH, hyponatremia, severe local reaction with extravasation, fever

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35
Q

Life-threatening Reaction Specific to Vincristine (Oncovin)

A

Intestinal necrosis

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36
Q

Contraindications Specific to Vincristine (Oncovin)

A

FATAL if given intrathecally, do not give to pts: receiving radiation through parts of liver, with Charcot-Marie-Tooth syndrome

37
Q

Drug Interactions Specific to Vincristine (Oncovin)

A

Give 12-24 hours prior to L-asparaginase to minimize toxicity, bronchospasm may occur (especially if given with mitomycin), L-asparaginase (elspar) may reduce drug clearance, decreases the effect of phenytoin (monitor for seizures), mix only with NS or D5W

38
Q

Nursing Considerations Specific to Vincristine (Oncovin)

A

Monitor bilirubin levels (decrease dose if > 1.5 mL), monitor for neurotoxicity, assess for neuropathy and loss of DTR’s, monitor for paralytic ileus, monitor for bronchospasm

39
Q

Liposomal Chemotherapy

A

Anticancer drugs packed into synthetic fat (liposomes)
Stays in system longer with decreased sxs
Increased therapeutic effects

40
Q

Hormonal Agents

A

Corticosteroids
Sex hormones (estrogen, progestins, androgens, antiadrogens, aromatase inhibitors)

41
Q

Corticosteroids

A

Help slow the growth of tumor through anti-inflammatory effects
Decreases cerebral edema in brain CA
Gives pts sense of euphoria

42
Q

Biotherapy Agents

A

Cytokinins
Monoclonal antibodies
Vaccines (prevents CA)

43
Q

Antimetabolite Prototype

A

Fluorouracil, 5-Fluorouacil, 5-FU (Adrucil)

44
Q

Fluorouracil (Adrucil) Pregnancy Category When Topical?

A

Pregnancy category X

45
Q

Fluorouracil (Adrucil) Routes and Onset

A

IV 10-14 days, topical 2-3 days

46
Q

Contraindications Specific to Fluorouracil (Adrucil)

A

Marginal nutritional status
Decrease dose with patients with impaired renal or hepatic function, or impaired nutrition

47
Q

Drug Interactions Specific to Fluorouracil (Adrucil)

A

Increased toxicity with leucoviron, flagyl
Increased effects with cimetidine

48
Q

Targeted Therapy Drugs

A

Interfere with cancer cell growth and division
Monotherapy, combination therapy with chemo or radiation
Can be orally administered at home or IV
Ex: Tyrosine Kinase inhibitors

49
Q

Tyrosine Kinase Inhibitor Prototype

A

Imatinib mesylate (Gleevec)

50
Q

Sxs Specific to Imatinib Mesylate (Gleevec)

A

Gi sxs, diarrhea (most notable in this drug compared to the others), N/V, decreased appetite, upset stomach, muscle cramping, difficulty sleeping

51
Q

Imatinib Mesylate (Gleevec) Route and Onset

A

PO rapid onset not affect by meals

52
Q

Contraindications Specific to Imatinib Mesylate (Gleevec)

A

Drugs that inhibit the cytochrome P450 increase adverse reactions and reduce Gleevac effectiveness (ex: Amiodarone)
Any drug metabolized by cytochrome P450 may have increase in drug levels

53
Q

Nursing Considerations Specific to Imatinib Mesylate (Gleevec)

A

Monitor LFT’s + renal function once a month
Monitor electrolytes during and after for 8 weeks (especially ca+ and phosphorus for low levels)
Monitor EF
Monitor hands and feet for redness, swelling, pain, blisters
Avoid grapefruit juice

54
Q

Epidermal Growth Factor/Receptor Inhibitor Prototype

A

Erlotinib (Tarceva)

55
Q

Erlotinib (Tarceva) Route and Onset

A

PO absorption enhanced w/ food

56
Q

Adverse Reactions Specific to Erlotinib (Tarceva)

A

Ocular changes, GI perforation

57
Q

Contraindications Specific to Erlotinib (Tarceva)

A

Pt with peptic ulcer disease or diverticulitis
Grape juice increase blood levels and adverse effects
Cigarette smoking decreases blood levels

58
Q

Monoclonal Antibody Prototype

A

Rituximab (Rituxan)

59
Q

Pregnancy Category Specific to Rituximab (Rituxan)

A

Pregnancy category C

60
Q

Rituximab (Rituxan) Route

61
Q

Sxs Specific to Rituximab (Rituxan)

A

Night sweats, hypotension, joint and muscle aches

62
Q

Contraindications Specific to Rituximab (Rituxan)

A

Preexisting pulmonary fibrosis

63
Q

Drug Interaction Specific to Rituximab (Rituxan)

A

Hypotension with antihypertensives

64
Q

Nursing Considerations Specific to Rituximab (Rituxan)

A

Infusion reactions are common (have resuscitation equipment nearby for 1st 15 mins of infusion
Client is a radiation hazard 4-7 days post infusion, stay 6 ft away from children and pregnant women
Sleep in a separate bed, use separate toilet, sit while urinating
Separate eating utensils, wash hands frequently
Wash laundry separately

65
Q

Biological Response Modifiers

A

Enhance host immunologic function
Destroy or interfere with tumor activities
Promote differentiation of stem cells
Ex: Procrit, Neupogen, Leukine

66
Q

Erythropoietin-Stimulating Agents

A

Epoetin Alpha (Erythropoietin, trade names Epogen, Procrit, Eprex)

67
Q

Epoetin Alpha (Erythropoietin, trade names Epogen, Procrit, Eprex) Pregnancy Category

A

Pregnancy Category C

68
Q

Procrit Routes and Onset

A

SQ/IV 7-10 days

69
Q

Procrit Sxs

A

Fatigue, SOB

70
Q

Procrit Adverse Reactions

A

Seizures, hyperkalemia

71
Q

Procrit Life-threatening Reactions

72
Q

Procrit Contraindications

A

Uncontrolled HTN, hypersensitivity to mammalian products or human albumin
Caution: pregnancy, lactation, increased mortality/and tumor progression, not used for children
Serious cardiovascular and thromboembolic events if target Hemoglobin of 12g/dl exceeded

73
Q

Procrit Nursing Considerations

A

Do not shake bottle, shaking may denature (roll the bottle between hands)
Only one use per vial (no preservatives)
Use smallest amount per injection
Do not use same needle to draw and inject medication (change needle in between)

74
Q

Granulocyte Colony-stimulating Factor

A

Filgrastim (Neupogen)

75
Q

Filgrastim (Neupogen) Pregnancy Category

A

Pregnancy Category C

76
Q

Filgrastim (Neupogen) Routes

77
Q

Filgrastim (Neupogen) Sxs

A

Skeletal pain, general anticancer drug sxs

78
Q

Filgrastim (Neupogen) Adverse Reactions

A

Neutropenia, SOB

79
Q

Filgrastim (Neupogen) Life-threatening Reactions

A

Thrombocytopenia, ARDS with sepsis, splenic rupture

80
Q

Filgrastim (Neupogen) Contraindications

A

Hypersensitivity to E. coli derived proteins, 24 hours before or after cytotoxic chemo, pregnancy, lactation
Do not administer 14 days before and 24 hours after chemo
Keep pre-filled syringes away from light and discard any unused medication
May administer acetaminophen for bone pain
Takes 2 weeks for Neupogen to become effective

81
Q

Granulocyte Macrophage Colony Stimulating Factor

A

Sargramostim (Leukine)

82
Q

Sargramostim (Leukine) Pregnancy Category

A

Pregnancy Category C

83
Q

Sargramostim (Leukine) Routes

A

IV/SQ (SQ not as often)

84
Q

Sargramostim (Leukine) Sxs

A

Chills, peripheral edema

85
Q

Sargramostim (Leukine) Adverse Reactions

A

Pleural/pericardial effusion, SOB

86
Q

Sargramostim (Leukine) Contraindications

A

Do not use within 24 hours of chemo or 12 hours of radiation therapy, pts sensitive to yeast products, hypersensitivity
Caution: pregnancy, lactation, HF

87
Q

Sargramostim (Leukine) Drug Interactions

A

Lithium/steroids may increase effects

88
Q

Nursing Considerations for Biologic Response Modifiers

A

Monitor temperature, may give meperidine to decrease chills
Pre-medicate with acetaminophen, diphenhydramine to reduce chills, fever, nausea
Maintain hydration
Only one dose per vial

Pharm Final (5 decks)

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