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Pharm Exam 3 > Cancer/Chemo > Flashcards

Cancer/Chemo Flashcards

1
Q

Chemo man N

A

Nitrosoureas (Carmustine)

Neurotoxic (crosses the BBB)

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2
Q

Chemo man C

A

Cisplatin, Carboplatin

Nephro/ototoxic

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3
Q

Chemo man V

A 
Vinca Alkaloid (Vincristine, Vinblastine)
Peripheral neuropathy
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4
Q

Chemo man B

A

Bleomycin, Busulfan

Pulmonary fibrosis

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5
Q

Chemo man D

A

Doxorubicin

Cardiotoxic

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6
Q

Chemo man P

A

CycloPhosphamide

Hemorrhagic cystitis

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7
Q

Chemo man MF

A

Methotrexate and 5-Fluorouracil

Myelosuppression

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8
Q

Max benefits of chemo

A

Intermittent chemo
Combo chemo
Dosing schedule
Drug delivery

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9
Q

Tumor lysis syndrome

A

From destruction of cells causing hyperuricemia which causes AKI
Increased K, Phosphorus
Decreased Ca

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10
Q

Alkylating Drugs

A

Cyclophosphamide

Carmustine

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11
Q

Nitrogen mustard Drug

A

Cyclophosphamide

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12
Q

Cyclophosphamide MOA

A

Cell kill results primarily from alkylation of DNA
Toxic tissue that have growth fraction
Cross links with DNA and prevents replication
Disrupts DNA/RNA synthesis

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13
Q

Cyclophosphamide Use

A 
Broad spectrum 
Hodgkins, Non hodgkins
MM
Solid tumors 
RA
MS
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14
Q

Cyclophosphamide Route

A

IV

PO - Give with food

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15
Q

Cyclophosphamide A/E

A 
Severe nausea
Vomiting 
Alopecia
Acute hemorrhagic cystitis
Vesicant
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16
Q

Cyclophosphamide Dose limiting toxicity

A

Bone marrow suppression

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17
Q

Cyclophosphamide Pt edu

A

Mesna is often used to protect the bladder

Need to increase fluids and urination

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18
Q

Cyclophosphamide Nursing considerations

A

Conversion to active form in the liver
Resistance is common
Give antiemetic daily

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19
Q

Nitrosoureas Drug

A

Carmustine

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20
Q

Carmustine MOA

A

Cell kill results primarily from alkylation of DNA
Toxic tissue that have growth fraction
Cross links with DNA and prevents replication
Crosses the BBB

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21
Q

Carmustine Use

A 
Primary metastatic brain cancer 
Hodgkins, Non hodgkins 
MM
Malignant melanoma 
Hepatoma 
Adenocarcinoma
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22
Q

Carmustine Route

A

Topical (wafer that is often placed where the tumor is on the brain and slowly dissolves and destroys the tumor)
IV

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23
Q

Carmustine A/E

A

Severe N/V
Injury to liver and kidneys
Pulmonary fibrosis (cumulative high doses)

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24
Q

Carmustine Dose limiting toxicity

A

Delayed bone marrow suppression (4-6wk)

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25
Carmustine Monitoring
CBC (bone marrow suppression) | Vitals
26
Carmustine Baseline information
LFT BUN Cr
27
Platinum Compound Drug
Cisplatin
28
Cisplatin MOA
Produces cross links to DNA Cell cycle phase non specifc Kills cells by forming cross links between and within strands of DNA
29
Cisplatin Use
Metastatic testicular and ovarian cancers | Advanced bladder cancer
30
Cisplatin Route
IV
31
Cisplatin A/E
``` Highly emetogenic (severe N/V) Peripheral neuropathy (years later) Bone marrow suppression (mild to moderate) Ototoxic Vesicant ```
32
Cisplatin Dose limiting toxicity
Kidney damage (might need a diuretic)
33
Cisplatin Monitoring
I/O BUN Cr
34
Antimetabolites Folic acid analog
Methotrexate
35
Methotrexate MOA
Blocks the conversion of folic acid to its active form | S phase specific
36
Methotrexate Use
``` Non-hodgkin's Leukemia Head/Neck Crosses BBB RA Crohn's ```
37
Methotrexate A/E
``` N/V Fetal malformation/death Pulmonary infiltrates, fibrosis Oral/GI ulcerations Kidney injury ```
38
Methotrexate Contraindications
Pregnancy +6mo after
39
Methotrexate dose limiting toxicity
Bone marrow suppression
40
Methotrexate Nursing considerations
Leucovorin rescue ↳helps prevent kidney damage, alkalize urine, promote excretion ↳given 24hr after meth is given Must have negative pregnancy test done before Hydrate very well Give Sodium bicarbonate to alkalize the urine
41
Antimetabolites Pyrimidine analog Drug
Fluorouracil (5-Fluorouracil/ 5FU)
42
Fluorouracil MOA
Inhibits thymidylate synthase depriving cells of thymidylate needed to make DNA S phase specific
43
Fluorouracil Use
``` Solid tumors (colorectal) DOC: Skin cancer due to topical use ```
44
Fluorouracil Route
Continuous IV
45
Fluorouracil A/E
Alopecia Cognitive impairment Hyperpigmentation
46
Fluorouracil Dose limiting toxicity
Bone marrow suppression (neutropenia) Oral/GI ulcerations/ Diarrhea (D/C as soon as they occur) Hand/ Foot syndrome (give uridine triacetate- antidote)
47
Antimetabolite Purine analog Drug
Mercaptopurine
48
Mercaptopurine MOA
Disrupts purine biosynthesis, nucleotide conversion, and biosynthesis of nucleic acid S phase specific
49
Mercaptopurine Use
Maintenance acute lymphocytic leukemia
50
Mercaptopurine Route
PO
51
Mercaptopurine Dose limiting toxicity
Bone marrow suppression | Hepatotoxic
52
Mercaptopurine Drug interactions
Allopurinol
53
Mercaptopurine Contraindication
Pregnancy cause chemical changes and malformations
54
Antimetabolites Hypomethylating agents
Azacitidine
55
Azacitidine MOA
becomes incorporated into DNA and then inhibits DNA methyltransferase
56
Azacitidine Use
``` Myelodysplastic syndrome (reduces RBCs) Preventing leukemia or lymphoma ```
57
Azacitidine Route
Sub Q
58
Azacitidine Dose limiting toxicity
Myelosuppression N/V CNS depression
59
Antitumor Abx Anthracycline
Doxorubicin (Adriamycin)
60
Doxorubicin (Adriamycin) MOA
Kills cell by intercalation with DNA and inhibition of topoisomerase II Isolated from cultures of streptomyces Injure cell through direct interaction with DNA
61
Doxorubicin (Adriamycin) Use
Broad spectrum | Hodgkins/Non hodgkins
62
Doxorubicin (Adriamycin) Route
IV (poor absorption in GI)
63
Doxorubicin (Adriamycin) Total life dose
550mg
64
Doxorubicin (Adriamycin) A/E
N/V Red colored urine and sweat (notify to be safe) Extravasation injury to tissue Cardiotoxic (immediate to years)
65
Doxorubicin (Adriamycin) Dose limiting toxicity
Bone marrow suppression
66
Doxorubicin (Adriamycin) Nursing considerations
Must have baseline Echo with an EJ of 55% Monitor for cardiac effects with Echo Cardiac effects can happen from minutes-2wk (dysrhythmias) to months-years later (HF) Dexrazoxane (Zincard): given to protect against cardiac damage
67
Mitotic inhibitor Vinca Alkaloid Drug
Vincristine
68
Vincristine MOA
Acts during M phase to prevent cell division | Blocks mitosis during metaphase
69
Vincristine Use
``` Hodgkins/ Non hodgkins acute lymphocytic leukemia Wilms tumor Rhabdomyosarcoma (kidney damage) Kaposi's sarcoma Breast/ bladder cancer ```
70
Vincristine Route
Central line
71
Vincristine A/E
Given in combo with other chemo due to it not causing bone marrow suppression Vesicant Teratogenic Constipation (give something prior)
72
Vincristine Dose limiting toxicity
``` Peripheral neuropathy (fall precautions) Hepatotoxic ```
73
Mitotic inhibitor Taxanes Drug
Paclitaxel
74
Paclitaxel MOA
Acts during late G2 and M phase
75
Paclitaxel Use
1st line therapy for advanced ovarian cancer and non small cell lung cancer
76
Paclitaxel A/E
Peripheral neuropathy (multiple infusions, dose limiting) Bradycardia 2nd and 3rd degree heart block MI Mild GI: N/V, mucositis Severe hypersensitivity (tremors, fever, rash)
77
Paxlitaxel Dose limiting toxicity
Bone marrow suppression
78
Paxlitaxel Monitoring
EKG before VS Hypersensitivity reaction (premed with steroid, antihistamine, tylenol)
79
Asparaginase MOA
Converts aspargin intot aspartic acid G1 mitotic phase Focuses on deaminating protein synthesis
80
Asparaginase Use
Limited almost exclusively to leukemic lymphoblasts
81
Asparaginase Contraindications
Pregnancy/BF
82
Asparaginase A/E
Fatal anaphylaxis/ Hypersensitivity reaction N/V Coagulation deficiencies CNS depression (confusion to coma) Injury to liver, pancreas and kidneys Does not cause GI ulcers or mucositis, alopecia, and does not cross BBB
83
Filgrastim (Neupogen) MOA
Leukopoietic growth factor produced by recombinant DNA technology Promote growth of neutrophils Stimulate myeloid cells to increase production of neutrophils
84
Pegfilgrastim (Neulasta)
Lasts longer | 1 injection
85
Filgrastim Use
Elevation of neutrophil counts in cancer patients Mobilization of hematopoietic progenitor cells into peripheral blood for apheresis collection Treatment of severe chronic neutropenia Given exactly 24 hr after treatment
86
Filgrastim A/E
Bone pain (most common and worst A/E) - give claritin to help prevent Splenic rupture Leukocytosis
87
Anti Estrogen Drug
Tamoxifen
88
Tamoxifen MOA
Blocks the activity of normal estrogen, but only in estrogen sensitive (ER+) cells A prodrug that undergoes hepatic conversion to active metabolites then blocks ER on the breast cancer cells and thereby preventing receptor activation by estradiol
89
Tamoxifen Use
Treatment/Prevention of breast cancer 'gold standard' | Can be used in premenopausal women
90
Tamoxifen A/E
``` Risk for endometrial cancer * Hot flashes Fluid retention N/V Vaginal discharge (yellow to clear) Menstrual irregularities Risk for thromboembolic event* ```
91
Tamoxifen Drug interactions
Warfarin CYP3A4 inhibitors
92
Tamoxifen Contraindications
Pregnancy cat D | Hypersensitivity
93
Tamoxifen Pt edu
Take with food if GI symptoms occur
94
Tamoxifen Nursing considerations
Consult provider if SxS of DVT occur
95
Aromatase inhibitor Drug
Anastrozole
96
Anastrozole MOA
Deprive breast cancer cells of estrogen by blocking the production of estrogen from androgenic precursors
97
Anastrozole Use
Treat ER+ breast cancer in postmenopausal women More effective than tamoxifen, does not cause endometrial cancer and less risk for blood clots Only for postmenopausal women
98
Anastrozole Route
PO daily for 2-5 yr
99
Anastrozole A/E
Increases risk for fractures/ Osteoporosis Moderate to severe myalgias Musculoskeletal pain (sometimes the drug will need to be stopped due to extreme pain)
100
Anastrozole Pt edu
Increase Ca and Vit D, wt bearing exercises | NO smoking, alcohol, glucocorticoids
101
GnRH Agonist Drug
Leuprolide
102
Leuprolide MOA
Suppresses production of androgens by testes | Does not decrease the productions of androgens made my the adrenal gland or the prostate cancer itself
103
Leuprolide Use
Advanced prostate cancer (palliative is primary benefit) Referred to as chemical castration (alternative to surgery, but surgery is preferred)
104
Leuprolide Contraindications
History of stroke or MI
105
Leuprolide A/E
``` Hot flashes Will cause tumor flare symptoms Stroke MI Osteoporosis Erectile dysfunction Gynecomastia Impotence Decreased muscle mass New onset of DM ```
106
Leuprolide Nursing considerations
Increase Ca, Vit D | May cause urinary obstruction (decrease in flow, pain, incontinence), numbness of hands and feet, aggravate bone pain
107
GnRH Antagonist Drug
Degarelix
108
Degarelix MOA
Suppresses production of androgens by the testes | Does not decrease the productions of androgens made my the adrenal gland or the prostate cancer itself
109
Degarelix Use
Palliative treatment of advanced prostate cancer
110
Degarelix A/E
``` Does not produce initial tumor flare Decrease muscle mass Erectile dysfunction Decreased labido (Prolonged QT, Liver injury) ```
111
Androgen Receptor Blocker Drug
Flutamide
112
Flutamide MOA/Purpose
Antiandrogen Prevent tumor flare with GnRH therapy Blocks effects of adrenal and prostate cancer androgens
113
Flutamide Use
Only for advanced androgen sensitive prostate cancer | and only in combo with surgical castration or chemical castration using a GnRh agonist
114
Flutamide Route
PO TID
115
Flutamide A/E
``` Rectal bleeding* Hot flashes Erectile dysfunction Decrease labido Decreased muscle mass Gynecomastia Osteoporosis N/V ```
116
Flutamide Contraindications
Preg cat D
117
Flutamide Toxicity
Hepatotoxic
118
Flutamide Baseline information
LFTs
119
Flutamide Monitoring
Monthly for 1st 4 months then periodically -LFTs Constantly for blood in the stool
120
Cyclophosphamide Monitoring
``` CBC w/Diff Hematuria Bun Cr I&O ```
121
Cisplatin Nursing considerations
Premedicate with antiemetic
122
Fluorouracil Antidote
Uridine Triacetate
123
Methotrexate Monitoring
BUN Cr I&O
124
Bone marrow suppression with chemo
Decreased WBC, RBC/Hgb, Platelets | Increased risk for bleeding and infection and anemia
125
Tumor lysis syndrome Pt edu
Hydration!!! Protect kidneys
126
Paclitaxel Contraindication
History of cardiac problems
127
Tamoxifen Benefits
Decreases LDL | Increases HDL
128
Prostate tumor flare symptoms
Bone pain Decreased urination Weakness in arms and legs from compression of tumor on spinal cord
129
Filgrastim Dosing
Multiple doses over 5 days

Pharm Exam 3 (4 decks)

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