Antineoplastics and Biologic Response Modifiers 2

Question 1

What is the origin of all cancers?

Answer 1

All cancers start with a single cell that is genetically different from the other cells in the surrounding tissue.

Question 2

Define anaplasia.

Answer 2

Loss of cellular differentiation and organization.

Question 3

What is autonomy in cancerous cells?

Answer 3

Cancerous cells grow without the usual homeostatic restrictions that regulate cell growth.

Question 4

What is the goal of cancer chemotherapy?

Answer 4

To decrease the size of the neoplasm so that the human immune system can eliminate the abnormal cells.

Question 5

What is the cell kill theory?

Answer 5

A set percentage of cells is killed after each dose of chemotherapy, dependent on the drug therapy.

Question 6

What happens to malignant cells that remain dormant after treatment?

Answer 6

They can emerge long after treatment has finished to begin their division and growth cycle again.

Question 7

Why are antineoplastic agents often administered in sequence?

Answer 7

To affect the cancer cells as they emerge from dormancy or move into a new phase of the cell cycle.

Question 8

What are common toxic effects of antineoplastic drugs?

Answer 8

• Toxic effects on ova and sperm causing infertility
• Danger to developing fetus during pregnancy
• Decreased immune system function due to bone marrow suppression
• Nausea and vomiting
• Hair and/or skin effects

Question 9

What are the prototype drugs of alkylating agents?

Answer 9

Cisplatin and cyclophosphamide.

Question 10

What are the indications for alkylating agents?

Answer 10

Most useful in the treatment of slow-growing cancers.

Question 11

What are some examples of slow-growing cancers?

Answer 11

Lymphomas, leukemias, myelomas, some forms of ovarian, testicular, and breast cancer, along with some pancreatic cancers.

Question 12

What is the MOA for alkylating agents?

Answer 12

They’re cytotoxic, chemically altering portions of RNA, DNA, or other cellular proteins.
They are also non-cell cycle specific

Question 13

What are some contraindications/cautions for alkylating agents?

Answer 13

1. Contraindicated in pregnancy/lactation
2. Caution in patients with any known allergy, bone marrow suppression, suppressed renal/hepatic function
3. Recent immunization with a live virus, concurrent radiation therapy
4. Cisplatin is contraindicated in those with hearing loss

Question 14

What are the drug interactions for alkylating agents?

Answer 14

1. Use cautiously with other drugs that may be renal or hepatic toxic
2. Cisplatin with aminoglycoside may increase renal toxicity risk
3. Cisplatin with furosemide may cause hearing loss
4. Cyclophosphamide with succinylcholine may increase neuromuscular blockage.

Question 15

What are some nursing considerations/ interventions for those receiving alkylating agents?

Answer 15

1. Monitor CBC and platelets weekly
2. Monitor uric acid, liver and renal functions before and throughout therapy
3. Ensure proper hydration
4. Premedicate with antiemetics or keep them around for pt comfort ( ondansetron or gransitron are preferred.)
5. Keep the drugs in an airtight container @ room temp

Question 16

What is important to remember about all drugs that cause cell death?

Answer 16

They may cause a potentially toxic increase in uric acid levels. Allopurinol and resburicase have been used to help with this.

Question 17

What two drugs have been used to help manage uric acid levels while patients receive antineoplastic therapy?

Answer 17

Allopurinol and rasburicase

Question 18

What special considerations should be considered when a patient is taking cyclophosphamide?

Answer 18

Hemorrhagic cystitis is a potentially fatal side effect; may cause sterility

Question 19

What special considerations should be considered when a patient is taking Cisplatin?

Answer 19

The drug can be neurotoxic and nephrotoxic and may cause severe hypersensitive reactions; it is also highly emetogenic

Question 20

What drug helps preserve the healthy cells from the toxic effects of cisplatin? What are some essential considerations about this drug?

Answer 20

Amifostine
- Associated with severe nausea and vomiting
- It can cause hypotension

Question 21

What drug is used to help reduce incidents of hemorrhagic cystitis caused by cyclophosphamide? What are some essential considerations about this drug?

Answer 21

Mesna
- There is a risk of dermatologic toxicity
- Associated with nausea and vomiting

Question 22

What do antimetabolites inhibit?

Answer 22

Cell DNA production depends on specific natural metabolites that rely on the DNA.
-They’re S-phase specific in t the cell cycle
-Mose effective in rapidly diving cells, preventing cell replication, and leading to cell death

Question 23

What is an essential consideration for antimetabolites?

Answer 23

The use of these drugs is limited due to neoplastic cells’ ability to develop resistance to them. These drugs are usually administered in combination therapy.

Question 24

What are some contraindications/cautions for antimetabolites?

Answer 24

1. Contraindicated in pregnancy/lactation
2. Caution for any known allergy, bone marrow suppression, renal or hepatic dysfunction

Question 25

What are some undesirable effects of antimetabolic therapy?

Answer 25

Bone marrow suppression, alopecia, renal/hepatic impairment, and toxic GI effects. They're also teratogenic

Question 26

What are the drug-drug interactions for antimetabolites?

Answer 26

1. Use cautiously with other drugs that may cause renal or hepatic toxicity 2. Increased risk of toxic effects when MTX is used with salicylates, other NSAIDs, and some antibiotics 3. Folic acid supplements decrease the action of MTX

Question 27

What is the prototype drug for antimetabolites?

Answer 27

Methotrexate

Question 28

What are some nursing considerations/interventions for those receiving antimetabolites?

Answer 28

1. Assess for any contraindications/allergies 2. Assess orientation and reflexes, RR and adventitious sounds, pulse, heart rhythm, cardiac auscultation, bowel sounds, and mucous membranes 3. Monitor labs: CBC, renal, and liver function

Question 29

What two drugs can be used to protect from antimetabolites?

Answer 29

Leucovorin and levoleucovorin

Question 30

What is leucovorin?

Answer 30

It is a drug that helps protect normal cells from the adverse effects of methotrexate therapy in osteosarcoma. In some conditions, it is also used to treat folic acid deficiency.

Question 31

What is important to remember about levoleucovorin?

Answer 31

It has high calcium levels and should be given slowly

Question 32

What is the action of hormones and hormone modulators in cancer treatment?

Answer 32

Block stimulation of growing cancer cells sensitive to the presence of hormones.

Question 33

What are some indications for using Hormones and Hormone modulators for antineoplastic therapy?

Answer 33

Treatment of some breast ( in postmenopausal pts or those without ovarian function) and prostatic cancers

Question 34

What are menopause-associated effects?

Answer 34

Hot flashes, vaginal spotting, vaginal dryness, moodiness, and depression

Question 35

What is the prototype hormone/hormone modulator drug?

Answer 35

Tamoxifen

Question 36

What are immune modulators?

Answer 36

Modify the actions of the immune system.

Question 37

What are immune stimulants used for?

Answer 37

To energize the immune system when it is exhausted from fighting prolonged invasion and when it needs help fighting a specific pathogen.

Question 38

What are some nursing considerations/interventions for colony-stimulating factors?

Answer 38

1. Assess for contraindications/cautions, allergies 2. Obtain a baseline ECH 3. Assess renal and liver function 4. Monitor CBC

Question 39

What is the prototype drug for colony-stimulating factors?

Answer 39

Filgrastim

Question 40

What are some drug-drug interactions for colony-stimulating factors?

Answer 40

1. Increase in the myeloproliferative effects of sargramostim when combined with lithium or corticosteroids.

Question 41

What are the adverse effects of colony-stimulating factors?

Answer 41

* GI effects * Headache * Fatigue * Generalized weakness * Alopecia and dermatitis * Generalized pain and bone pain

Question 42

What should be monitored when using filgrastim?

Answer 42

White blood cell counts due to the risk of leukocytosis.

Question 43

What is erythropoiesis?

Answer 43

RBCs are produced in the bone marrow.

Question 44

What components are required for erythropoiesis?

Answer 44

* Iron * Amino acids * Carbohydrates * Folic acid * Vitamin B12

Question 45

What is a boxed warning associated with erythropoiesis-stimulating agents?

Answer 45

Increased risk of death, myocardial infarction, stroke, and tumor progression or recurrence.

Question 46

What is the action of T- and B-cell suppressors? What are they indicated for?

Answer 46

Block antibody production by B cells and inhibit T cells. They're indicated for the prevention and treatment of specific transplant rejections and the treatment of some forms of arthritis

Question 47

What is the prototype drug for T- and B-cell suppressors?

Answer 47

Cyclosporine

Question 48

True or False: Immune suppressants are used to enhance the immune response.

Answer 48

False.

Question 49

Fill in the blank: The primary indication for erythropoiesis-stimulating agents is to benefit patients who are no longer able to produce enough _______.

Answer 49

erythropoietin.

Question 50

What are the MOA and indication for erythropoiesis-stimulating agents?

Answer 50

These agents act like the natural glycoprotein erythropoietin to stimulate the production of RBCs in the bone marrow. -Indicated for the treatment of anemia associated with chronic renal failure or kidney disease and the other indications depend on the actual drug

Question 51

What are the two prototype drugs used for erythropoiesis-stimulating agents?

Answer 51

Darbepoetin alfa and eopetin alfa

Question 52

What are some nursing considerations/interventions for erythropoiesis-stimulating agents?

Answer 52

1. Assess for any contraindications/cautions, allergies 2. Assess neurological status 3. Monitor vitals 4. Assess respirations and auscultate lungs 5. Monitor labs: CBC, renal function, HCT, iron concentration, transferrin, and electrolytes)