Antineoplastic Flashcards
The branch of medicine concerned with the study of malignancy-development, dx, tx, and prevention is defined as:
Oncology
Pertaining to a substance, procedure, or measure that prevents proliferation of cells is defined as:
antineoplastic
The pharmaceutical agents used to destroy CA cells are defined as:
antineoplastics or cytoxic drugs
What phase of the cell cycle is not as sensitive to antineoplastic Tx as the other phases of the cell:
Go
What type of cells arise from a single abnormal cell that multiplies and grows:
CA cells
What happens as abnormal cells continue to divide:
They lose some of their original characteristics
What are the characteristics of CA cells:
anaplasia; autonomy; metastasis; angiogenesis
The loss of cellular differentiation and organization is defined as what type of CA characteristic:
anaplasia
To grow in an uninhibited way/manner is defined as what type of CA characteristic:
autonomy
The ability to travel to other sites of the body is defined as what type of CA characteristic:
metastasis
The ability to grow new bld vessels to feed a tumor is defined as what type of CA characteristic:
angiogenesis
What are the specific protocols used before giving chemotherapy to pts:
type/extent of malignancy; type of chemo given; side effects; amount of time normal cells need to recover=giving the chemo in cycles
What are the major factors that affect the CA cells response to chemotherapy:
Growth fraction and doubling time
The percent of actively dividing cells is defined as:
growth fraction
The time it take the cell to double in size is defined as:
Doubling time/growth rate
Anticancer drugs are most effective on CA cells d/t what major factor:
Cells with high growth fraction
Antineoplastic/Anticancer drugs treat malignancies by directly killing tumor cells how:
Damaging the DNA; inhibiting DNA synthesis from replication; stoping mitosis
Antineoplastic drugs destroy CA cells by inhibiting cell division but also affect normal cells. What type of normal cells do they affect the most:
Rapidly multiplying cells or cells that replaces themselves quickly; thus, causing side effects
This type of chemotherapy is used to relieve S/S associated with advanced CA (pain, breathing…) and improve quality of life is defined as:
palliative chemotherapy
This category of antineoplastic drugs exert their influence during a specific phase of the cell cycle; are the most effective against rapidly growing CA cells is defined as and what are the examples:
CCS (cell-cycle specific or cell-cycle dependent); antimetabolites and mitotic inhibitors
This category of antineoplastic drugs exert their influence during any phase of the cell cycle, especially the Go phase is defined as and what are the examples:
CCNS (Cell-cycle nonspecific or cell- cycle independent); alkylating; anti-tumor antibiotics; hormones
The combined use of CCS and CCNS drugs maximize cell death is defined as:
synergistic effect
The synergistic effect of the combination of CCS and CCNS is:
Kills cells in all phases of the cell cycle, especially the cells that have a high fraction rate; decreases drug resistance and increases destruction of CA cells
What are the causes of MDRL:
Cell mutation; natural resistance; gene amplification; repair DNA damage
What are the specific classes of chemotherapy drugs:
alkylating agents; antimetabolites; anti-tumor antibiotics; plant alkaloids; Miscellaneous agents
Alkylating agents are of the CCNS category, but what phase are they most effective on:
Go phase d/t slow-growing CA which may have cells in the resting phase
What is the mechanism of action brought upon by alkylating agents:
Inhibits DNA synthesis by binding and damaging the DNA which prevents the cell from dividing
What is the main type of alkylating agent given for Tx:
Cytoxan (cyclophosphamide)
What are the pharmacokinetics of Cytoxan:
50 PERCENT IS EXCRETED UNCHANGED IN THE URINE; onset =2-3 hrs; therapeutic effect takes several days
What are the adverse effects of Cytoxan:
HEMORRHAGIC CYSTITIS (give >500 mL of fluid prior); BONE MARROW SUPPRESSION; 2dary malignancies (secondary neoplasm), sterility
What are the Cytoxan major dose-limiting toxicities:
Hematopoietic system and urinary system
Cytoxan is contraindicated to pts with:
pregnant; bone marrow suppression; impaired renal/hepatic function
What may occur if I take Allopurinol or HTCZ w/Cytoxan?
Increased bone marrow suppression
What may occur if I take Phenobarbital with Cytoxan:
Cytoxan toxicity increases
What may occur if I take Cytoxan with Warfarin or ASA (NSAIDs):
bleeding
What may occur if I take Digoxin with Cytoxan:
Cytoxan will decrease digoxin effects
An accumulation of toxic metabolites that causes inflammation of the bladder (may be painless) and bleeding in the urine is a result is defined as:
hemorrhagic cystitis (MUST HYDRATE BEFORE GIVING CYTOXAN)
Cytoxan should be taking early in the morning why and what should be avoided in the diet during Cytoxan Tx:
avoid accumulation in the bladder at night; avoid high purines (beans/peas/organ meats) to alkalinize the urine. avoid citric acid
Bone marrow suppression include:
Low RBC (anemia); low WBC (neutropenia); low platelet count (thrombocytopenia)
Antimetabolites are S phase specific with the exception of what type of antimetabolite drug:
5-FU adrucil (fluoroacil) is considered both CCNS and CCS
What is the therapeutic action of antimetabolite drugs:
Disrupts the metabolic process and inhibits enzyme synthesis which prevents normal cellular function
Antimetabolites are often given with other agents to…
help overcome MDR tumors
5-FU Adrucil is contraindicated in pts with:
GI ULCERATIONS/DISEASES; pregnant; bone marrow suppression; renal/hepatic disfunction
What are the adverse effects of antimetabolite drugs:
STOMATITIS; BONE MARROW SUPPRESSION (LIFE-THREATENING INFECTIONS/BLEEDING); hepatic/renal dysfunction
What is the action of 5-FU adrucil:
prevention of thymidine synthase production, thus inhibiting DNA/RNA synthesis
What are the adverse effects of 5-FU adrucil:
STOMATITIS: may be early sign of 5-FU toxicity
What may occur if I take Leucovorin calcium with 5-FU adrucil:
increases 5-FU toxicity
What may occur if I take Metronidazole with 5-FU adrucil:
increases 5-FU toxicity
What may occur if I take HTCZ with 5-FU adrucil:
increases myelosuppression (decrease in blood cell production)
Soreness, ulcerations, and white patches of the mouth is defined as:
stomatitis (Can use NS to rinse mouth out every 2 hrs/avoid mouthwashes)
Anti-tumor antibiotics are CCNS drugs with the exception of:
bleomycin (Blenoxane) EFFECTS G2 PHASE
What is the action of anti-tumor antibiotics:
inhibits protein/RNA synthesis and binds to DNA causing FRAGMENTATION
What are the main two types of anti-tumor antibiotics:
bleomycin (G2 specific) and Doxorubicin (CCNS)
What is the adverse effect of Doxorubicin:
CARDIOTOXIC EFFECTS
What are the common side effects of anti-tumor antibiotics:
mucositis, N/V; CARDIOTOXIC EFFECTS
How should anti-tumor antibiotics be given:
very slowly if pt has a congestive heart (pts’ cardiovascular system-EKG- should be assessed prior to administering drug)
What other drug is given along with Doxorubicin to reduce cardiac symptoms:
Dextrazoxane (Zinecard)
Plant alkaloids are mitotic inhibitors CCS. What is their action:
Blocks cell division at the M phase of the cell cycle
What are the adverse reactions of plant alkaloids mitotic inhibitors:
NEUROTOXICITY=PERIPHERAL NEUROPATHY; leukopenia; loss of DTR
What are some examples of plant alkaloids mitotic inhibitors:
Vincristine (Oncovin)
What are the adverse reactions of Vincristine (oncovin):
SENSORY LOSS; NEUROPATHY=PERIPHERAL NEUROPATHY; extravasation; hypoNA; ILEUS
Wha are some life-threatening effects of Vincristine (Oncovin):
intestinal necrosis; SZ; coma; bronchospasm; bone marrow suppression
What may occur if I take digoxin and Vincristine (Oncovin) together:
Vincristine decreases the effects of digoxin
What may occur if I take Vincristine (Oncovin) with phenytonin (Dilantin):
Vincristine decrease effect of Phenytonin (Dilantin): MONITOR FOR SZ
What are miscellaneous cytotoxic agents:
A category that includes antineoplastic agents in which the mechanism of action is unclear, but is used in the combination of other drugs:
When are miscellaneous cytotoxic agents given:
Given for ACUTE LYMPHOCYTIC/LYMPHOBLASTIC LEUKEMIAS
What are the examples of miscellaneous agents:
Elspar and Oncaspar
Elspar is used for what:
Lymphocytic leukemia
Oncaspar is used for what:
Lymphoblastic leukemia
Major toxicity of miscellaneous cytotoxic agents is:
hypersensitivity reactions
What are the adverse effects of taking Elspar and Oncaspar:
IMPAIRED PANCREATIC FUNCTION; hepatotoxicity; coagulopathy
Hormonal agents are CCNS; they are cytostatic, which means…
prevents the growth of the tumor instead of causing cell death
What is the hormonal agent’s mechanism of action :
Receptor-site specific or hormone specific that blocks the stimulation of growing CA cells that are sensitive to that specific hormone being given
What are the examples of hormonal agents:
Corticosteroids; estrogen therapy; antiestrogens; SERMs; progestins; Gonadotropin-releasing Hormones
This hormonal agent decreases cerebral edema caused by malignant brain tumors; and suppresses the inflammatory process:
corticosteroids
What are the examples of corticosteroids given for CA:
prednisone and dexamethasone
What are the adverse effects of prednisone or dexamethasone:
fluid retention; hypokalemia; hyperglycemia; risk of infection; muscle weakness; euphoria
These hormonal agents slow the growth of hormone dependent tumors:
sex hormones
What is estrogen therapy used for and what are some types of examples:
palliative treatment used to decrease the progression of prostate CA in men and breast CA in women; ESTINYL & PREMARIN
What types of estrogen therapy is given to pts with prostate/breast CA:
Estinyl or Premarin
This hormonal agent competes with estrogen for binding sites to target tissues of the breast:
Antiestrogen
What are the examples of antiestrogen:
tamoxifen (Nolvadex)
When or why is tamoxifen (Nolvadex) given:
Advance breast CA and prevents tumor recurrence
What are the adverse effects of tamoxifen (Novaldex):
endometrial CA; thrombosis; hot flashes
What could I give a pt with advance breast CA in place of tamoxifen (Nolvadex) to decrease side effects:
SERMs (selective estrogen receptor modulator)
What is an example of selective estrogen receptor modulator:
Raloxifene (EVISTA)
What hormonal agent is given to treat RENAL CA, endometrial and breast CA:
progestins
What are some examples of progestins that I could give a renal CA pt:
Megace and Depo-provera
These hormonal agents are primarily used for the treatment of prostate CA:
Gonadotropin-releasing hormone
What are the types of Gonadotropin-releasing Hormone used for prostate CA:
LH-RH (leutinizing) = leuprolide (LUPRON)
What is the mechanism of action of Lupron (leuprolide):
suppression of follicle hormone and luteinzing hormone from pituitary resulting is the suppression of testosterone that stimulates the growth of prostate CA cells
Long-term survivors of chemotherapy have an increased risk of developing what type of secondary malignancies:
acute leukemias and solid tumors
What are the antineoplastic drugs that commonly are associated with secondary malignancies:
alkylating agents: cytoxan and alkeran
Why do secondary malignancies occur:
D/t toxic damage effects on DNA, mutations, and chromosomal damage
Drugs that may be used to reduce toxicities are called:
cytoprotective drugs
What are some examples of cytoprotective drugs:
allopurina (zyloprim) reduces hyperuricemia; Mesna (mesnex) is given w/high doses of cytoxan to inactivate urotoxic metabolites in the bladder
What are some nsg measures for low RBC amount (anemia):
Assist for SOB/VS/LOC/O2 sat; rest periods; control pain/elevate HOB; Rx FeSO4 (Iron) and erythropoietin (stimulates RBCs from kidneys) or blood transfusion of PRBC
What are some nsg measures of Low WBC count (leukopenia:
assess for localized infections; hand/pt hygiene precautions; TEMPERATURE; Fever/chills/sore throat should be reported to HCP
A low absolute neutrophil count (ANC) is defined as and what is the normal range:
neutropenia; 1500-8000
What value of neutropenia is considered to be severe and what is usually administered:
less than 500; Colony-stimulating factors filgrastin (Neupogen)
What shouldn’t be brought into the room to a pt that has leukopenia or neutropenia:
fresh flowers/plants, or raw foods
For neutropenia or leukopenia pts, temps must be monitores why:
If they have a temp of 99 degreas, that is a fever. If they temp drops, may be d/t sepsis
What is given to pts with Anemia (low RBCs):
FeSO4 (iron) and erythropoietin
Where are pts kept if their neutrophils are below 200 (normal is 1500-8000):
reverse isolation/protective isolation
What parts of the body should be checked every 8 hrs in pts with neutropenia:
Tiny ulcers in the mouth and anal fissures
If a neutropenic pt has chills, how should it be handled:
As an emergency
A low platelet count is defined as:
thrombocytopenia
What should be avoided in pts with thrombocytopenia:
Meds that promote bleeding (NSAIDs); IM unless withdrawing blood in which case pressure should be applied for 10 minutes; rectal temps; use smaller gauge needles if starting an IV
What should be reported to HCP from a pt with thrombocytopenia:
Petechiae (rash like red dots that can be purple), bruising, bleeding gums, nosebleeds
What is the normal range for platelets and what should you do if a pt’s platelet count is at 50 or less:
150-350; check to see if pt is bleeding in the urine;
What may be given to thrombocytopenic pts:
Numega to stimulate platelet production
What drugs may cause cardiotoxicity:
Adriamycin (EKG or CHF), cytoxan (If high doses), Herceptin (cardiomyopathy)
What may cause Nephrotoxicity:
5-FU, mutamycin
What may cause Hepatoxicity:
Cytoxan (chronic use), Adriamycin (if pts are hepatic/renal impaired)
A complication of chemotherapy that occurs when there’s an escape of a vesicant drug into surrounding tissue causing severe tissue damage or permanent damage to nerves/tendons/loss of limbs is defined as:
Extravasation
Extravasation typically occurs with what type of access:
peripheral access; seldom in central catheters
What is to be done if you see a pt with extravasation:
Stop IV; DONT REMOVE IV LINE; ASPIRATE REMAINING DRUG AND BLOOD IF POSSIBLE; give appropriate antidote according to policy in EXISTING IV SITE OR SUBQ AROUND INFILTRATED SITE; elevate affected extremity=PREVENTION IS THE BEST APPROACH
What is the most common and distressing symptoms of receiving CA treatment:
chemotherapy-induced nausea and vomiting (CINV)
How is CINV stimulated:
antineoplastic drugs stimulate chemoreceptor trigger zone (CTZ) leading to N/V
This type of CINV occurs within a few minutes to several hours of chemo, ends in 24 hrs:
acute CINV
This type of CINV occurs more than 24 hr after chemo, lasts several days:
Delayed CINV
This type of CINV is triggered by anything the pt associates w/N/V r/t previous chemo treatment, such as smell or taste:
anticipatory CINV
This type of CINV occurs even though preventative measures have been taken:
breakthrough CINV
What drug is given to pts with highly emetogenic chemotherapy as prophylaxis:
Zofran ondansetron
What drug is given to pts with Low-Risk emetogenic chemotherapy as prophylaxis:
Reglan or Compazine
What’s included in the nsg role in pre-treatment/managing CINV:
pt expectations; risk factors CINV; taking med as scheduled; self-care strategies; provide clear post-instructions and contact numbers
What’s included in the nsg role in supportive care for CINV:
minimize nose/odors/stimulants; flat sodas and crackers; hard candies; ice chips
What is some care for pts w/stomatitis:
NO ETOH/ETOH mouthwashes; USED SOFT TOOTH BRUSHES OR SPONGE TOOTHETTES
What type of tx would you provide for a pt with stomatitis:
mouth rinses (MAALOX/LIDOCAINE/BENADRYL MIX); antifungal meds; pain meds
What do you assess from a pt with stomatitis:
taste changes, redness, swollen tissue, dry mouth, tiny ulcers, white patches
What do you give a pt to relieve symptoms of stomatitis:
ice chips or ice-pops
What are some tx for pts with anorexia:
Small frequent meals high in calories and proteins; hard candy or ice chips to relieve bitter taste
What may cause diarrhea:
meds, comorbid conditions, enteral feedings
What type of antidiarrheal meds may be given:
Kaolin or pectin; small frequent meals; avoid very hot/cold foods
What may be given as a prophylactic measure for hyperuricemia:
allopurinol (zyloprim); encourage high fluid intake
How can cytotoxic drugs be accidentally absorbed:
inhalation, contact w/skin/mucous membranes, ingestion
How do you reduce your exposure when administering chemo drugs:
Wash hands; prepare med in separate work station; avoid hand-to-hand or hand-to-eye contact; use gown/mask/glove/face shield; use powder free gloves
Why is the monitoring of chemo effects performed at baseline, during, and after treatment:
D/t the quick effect of the drug which enables us to determine optimal Tx options/evaluate pts response; monitor toxicity
What labs would you assess for hematologic system during chemo Tx:
CBC with diff; WBC; ANC: RBC; platelet; Pt; PTT
What labs would you assess for hepatic system during chemo Tx:
LFTs (liver function tests=ALT/AST)
What labs would you assess for the renal system during chemo Tx:
creatine, BUN, electrolytes
What labs would you assess for the cardiovascular system during Chemo Tx:
ECG, echocardiography, cardiac enzymes trotopin (d/t doxorubicin)
What labs would you assess for the pulmonary system during chemo Tx:
PFTs (pulmonary function tests d/t bleomycin associate with pulmonary toxicity (can cause pnemothorax)
How long does chemo therapy remain in the body:
48-72 hrs and excreted in bodily fluids
A pt is about to receive an alkylating agent, an antimetabolic, and an anti-tumor antibiotic. He asks the nurse why he needs so much chemotherapy. What is the best response: A) combination chemo works in the S-phase to kill cells; B) Combination Tx increases the extent of tumor cell kill; C) Combination Tx has drugs that work the same way; D) Combination Tx has no dose-limiting toxicities
B) Combination chemo increases the extent of tumor cells killed
A pt is scheduled to receive chemo that will cause myelosuppression. What action by the nurse would be most important: A) monitor for a change in temp; B) Evaluate GI infection; C) assess for cardiac compromise; D) question the pt about change in taste
A) monitor for change in temp
A pt has a low platelet count secondary to administrating chemo. What nsg action is most appropriate: A) Assess for diarrhea and provide sm frequent meals; B) assess I&Os and help pt conserve energy; C) Assess for localized infection and monitor BS: D) Assess for occult bleeding and apply pressure to injection sites
D) Assess for occult bleeding and apply pressure
A pt is about to receive 5-FU as part of his Tx protocol for CA. Which symptom would be most appropriate for the nurse to report: A) Nausea, B) decreased appetite, C) Stomatitis, D) Constipation
C) Stomatitis
A pt in the oncology unit is c/o fatigue after chemo. What nsg intervention would be most appropriate: A) assess for factors contributing to her fatigue (trouble sleeping); B) Encourage a high protein diet, C) Refer the pt to a PT to develop a strenuous exercise program: D) encourage the pt to sleep as much as possible during the day to ease fatigue
A) assess for factors contributing to fatigue
A nsg is teaching about alopecia. Which statement, made by the pt, indicates that she needs additional teaching about alopecia: A) The hair on all areas of my body will be affected; B) My hair won’t grow back after chemo Tx is completed; C) the extent of my hair loss is dependent on the type of chemo drugs I take; D) the texture of my hair may be different when it grows back
B) My hair won’t grow back after chemo Tx has completed
A pt in the oncology unit has developed mucositis after receiving 5-FU. Which statement made by the pt indicates additional teaching about mucositis: A) I will frequently rinse out my mouth with NS; B) I will use ice pops or ice chips to relieve my pain; C) I will use a mouthwash with ETOH to rinse out my mouth; D) I will use a soft toothbrush
C) I will use a mouth wash with ETOH
A pt is scheduled to receive a high dose of cytoxan. Which would be the most important for the nsg to include in her teaching of cytoxan to the pt: A) an indwelling urinary catheter will be placed; B) drink 2-3 L of fluid per day; C) empty the bladder every 4-6 hrs; D) limit fluid intake during chemotherapy
B) drink 2-3 L of fluids per day
A pt is about to receive MPV (mitomycin, vincristine, cisplatin). She asks the nsg what side effects should she expect. what is the most appropriate nsg dx for the pt: A) anxiety r/t dx of CA; B) knowledge deficit r/t to side effects of chemo; C) potential bleeding r/t chemo; D) risk for alteration in nutrition r/t side effects of chemo
B) knowledge deficit r/t side effects of chemo
A nsg is administering doxorubicin to a pt in an outpt setting. Which info would be most appropriate to include in pt teaching: A) bld counts will likely remain normal; B) complete alopecia rarely occurs w/this drug; C) report any SOB, palpations, or edema; D) tissue necrosis usually occur 2-3 days after administration
C) report any SOB; palpations; edema
A pt is scheduled to receive vincristine as part of his chemo protocol. Which nsg action would have the highest priority when providing care to this pt: A) assess for degree of alopecia; B) assess for increased digoxin levels; C) assess for increased phenytonin levels; D) assess for peripheral neuropathy
D) assess for peripheral neuropathy
Which have been identified causes of MDR to chemo Tx. Select all that apply: A) CA cells that are not killed may mutate and become resistant to Chemo Tx: B) some CA cells may be naturally resistant to Chemo; C) cell-cycle nonspecific chemo Tx drugs; D) gene amplification can cause overproduction of proteins that make chemo less effective; E) CA cells develop the ability to repair damage caused by chemo Tx
A, B, D, E
A pt is experiencing mucositis (stomatitis) secondary to receiving chemo. What symptomatic Tx would be appropriate. Select all that apply: A) frequent mouth rinses; B) provide antiemetics; C) topical anesthetics; D) encourage stress reductions; E) ABX
A,C,E
