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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
Q

Carmustine Monitoring

A

CBC (bone marrow suppression)

Vitals

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26
Q

Carmustine Baseline information

A

LFT
BUN
Cr

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27
Q

Platinum Compound Drug

A

Cisplatin

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28
Q

Cisplatin MOA

A

Produces cross links to DNA
Cell cycle phase non specifc
Kills cells by forming cross links between and within strands of DNA

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29
Q

Cisplatin Use

A

Metastatic testicular and ovarian cancers

Advanced bladder cancer

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30
Q

Cisplatin Route

A

IV

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31
Q

Cisplatin A/E

A 
Highly emetogenic (severe N/V)
Peripheral neuropathy (years later)
Bone marrow suppression (mild to moderate) 
Ototoxic 
Vesicant
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32
Q

Cisplatin Dose limiting toxicity

A

Kidney damage (might need a diuretic)

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33
Q

Cisplatin Monitoring

A

I/O
BUN
Cr

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34
Q

Antimetabolites Folic acid analog

A

Methotrexate

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35
Q

Methotrexate MOA

A

Blocks the conversion of folic acid to its active form

S phase specific

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36
Q

Methotrexate Use

A 
Non-hodgkin's
Leukemia 
Head/Neck
Crosses BBB
RA
Crohn's
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37
Q

Methotrexate A/E

A 
N/V
Fetal malformation/death
Pulmonary infiltrates, fibrosis 
Oral/GI ulcerations 
Kidney injury
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38
Q

Methotrexate Contraindications

A

Pregnancy +6mo after

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39
Q

Methotrexate dose limiting toxicity

A

Bone marrow suppression

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40
Q

Methotrexate Nursing considerations

A

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

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41
Q

Antimetabolites Pyrimidine analog Drug

A

Fluorouracil (5-Fluorouracil/ 5FU)

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42
Q

Fluorouracil MOA

A

Inhibits thymidylate synthase depriving cells of thymidylate needed to make DNA
S phase specific

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43
Q

Fluorouracil Use

A 
Solid tumors (colorectal)
DOC: Skin cancer due to topical use
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44
Q

Fluorouracil Route

A

Continuous IV

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45
Q

Fluorouracil A/E

A

Alopecia
Cognitive impairment
Hyperpigmentation

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46
Q

Fluorouracil Dose limiting toxicity

A

Bone marrow suppression (neutropenia)
Oral/GI ulcerations/ Diarrhea (D/C as soon as they occur)
Hand/ Foot syndrome (give uridine triacetate- antidote)

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47
Q

Antimetabolite Purine analog Drug

A

Mercaptopurine

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48
Q

Mercaptopurine MOA

A

Disrupts purine biosynthesis, nucleotide conversion, and biosynthesis of nucleic acid
S phase specific

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49
Q

Mercaptopurine Use

A

Maintenance acute lymphocytic leukemia

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50
Q

Mercaptopurine Route

A

PO

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51
Q

Mercaptopurine Dose limiting toxicity

A

Bone marrow suppression

Hepatotoxic

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52
Q

Mercaptopurine Drug interactions

A

Allopurinol

53
Q

Mercaptopurine Contraindication

A

Pregnancy cause chemical changes and malformations

54
Q

Antimetabolites Hypomethylating agents

A

Azacitidine

55
Q

Azacitidine MOA

A

becomes incorporated into DNA and then inhibits DNA methyltransferase

56
Q

Azacitidine Use

A 
Myelodysplastic syndrome (reduces RBCs)
Preventing leukemia or lymphoma
57
Q

Azacitidine Route

A

Sub Q

58
Q

Azacitidine Dose limiting toxicity

A

Myelosuppression
N/V
CNS depression

59
Q

Antitumor Abx Anthracycline

A

Doxorubicin (Adriamycin)

60
Q

Doxorubicin (Adriamycin) MOA

A

Kills cell by intercalation with DNA and inhibition of topoisomerase II
Isolated from cultures of streptomyces
Injure cell through direct interaction with DNA

61
Q

Doxorubicin (Adriamycin) Use

A

Broad spectrum

Hodgkins/Non hodgkins

62
Q

Doxorubicin (Adriamycin) Route

A

IV (poor absorption in GI)

63
Q

Doxorubicin (Adriamycin) Total life dose

A

550mg

64
Q

Doxorubicin (Adriamycin) A/E

A

N/V
Red colored urine and sweat (notify to be safe)
Extravasation injury to tissue
Cardiotoxic (immediate to years)

65
Q

Doxorubicin (Adriamycin) Dose limiting toxicity

A

Bone marrow suppression

66
Q

Doxorubicin (Adriamycin) Nursing considerations

A

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
Q

Mitotic inhibitor Vinca Alkaloid Drug

A

Vincristine

68
Q

Vincristine MOA

A

Acts during M phase to prevent cell division

Blocks mitosis during metaphase

69
Q

Vincristine Use

A 
Hodgkins/ Non hodgkins 
acute lymphocytic leukemia
Wilms tumor
Rhabdomyosarcoma (kidney damage)
Kaposi's sarcoma 
Breast/ bladder cancer
70
Q

Vincristine Route

A

Central line

71
Q

Vincristine A/E

A

Given in combo with other chemo due to it not causing bone marrow suppression
Vesicant
Teratogenic
Constipation (give something prior)

72
Q

Vincristine Dose limiting toxicity

A 
Peripheral neuropathy (fall precautions) 
Hepatotoxic
73
Q

Mitotic inhibitor Taxanes Drug

A

Paclitaxel

74
Q

Paclitaxel MOA

A

Acts during late G2 and M phase

75
Q

Paclitaxel Use

A

1st line therapy for advanced ovarian cancer and non small cell lung cancer

76
Q

Paclitaxel A/E

A

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
Q

Paxlitaxel Dose limiting toxicity

A

Bone marrow suppression

78
Q

Paxlitaxel Monitoring

A

EKG before
VS
Hypersensitivity reaction (premed with steroid, antihistamine, tylenol)

79
Q

Asparaginase MOA

A

Converts aspargin intot aspartic acid
G1 mitotic phase
Focuses on deaminating protein synthesis

80
Q

Asparaginase Use

A

Limited almost exclusively to leukemic lymphoblasts

81
Q

Asparaginase Contraindications

A

Pregnancy/BF

82
Q

Asparaginase A/E

A

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
Q

Filgrastim (Neupogen) MOA

A

Leukopoietic growth factor produced by recombinant DNA technology
Promote growth of neutrophils
Stimulate myeloid cells to increase production of neutrophils

84
Q

Pegfilgrastim (Neulasta)

A

Lasts longer

1 injection

85
Q

Filgrastim Use

A

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
Q

Filgrastim A/E

A

Bone pain (most common and worst A/E) - give claritin to help prevent
Splenic rupture
Leukocytosis

87
Q

Anti Estrogen Drug

A

Tamoxifen

88
Q

Tamoxifen MOA

A

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
Q

Tamoxifen Use

A

Treatment/Prevention of breast cancer ‘gold standard’

Can be used in premenopausal women

90
Q

Tamoxifen A/E

A 
Risk for endometrial cancer *
Hot flashes 
Fluid retention
N/V
Vaginal discharge (yellow to clear)
Menstrual irregularities 
Risk for thromboembolic event*
91
Q

Tamoxifen Drug interactions

A

Warfarin CYP3A4 inhibitors

92
Q

Tamoxifen Contraindications

A

Pregnancy cat D

Hypersensitivity

93
Q

Tamoxifen Pt edu

A

Take with food if GI symptoms occur

94
Q

Tamoxifen Nursing considerations

A

Consult provider if SxS of DVT occur

95
Q

Aromatase inhibitor Drug

A

Anastrozole

96
Q

Anastrozole MOA

A

Deprive breast cancer cells of estrogen by blocking the production of estrogen from androgenic precursors

97
Q

Anastrozole Use

A

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
Q

Anastrozole Route

A

PO daily for 2-5 yr

99
Q

Anastrozole A/E

A

Increases risk for fractures/ Osteoporosis
Moderate to severe myalgias
Musculoskeletal pain (sometimes the drug will need to be stopped due to extreme pain)

100
Q

Anastrozole Pt edu

A

Increase Ca and Vit D, wt bearing exercises

NO smoking, alcohol, glucocorticoids

101
Q

GnRH Agonist Drug

A

Leuprolide

102
Q

Leuprolide MOA

A

Suppresses production of androgens by testes

Does not decrease the productions of androgens made my the adrenal gland or the prostate cancer itself

103
Q

Leuprolide Use

A

Advanced prostate cancer
(palliative is primary benefit)
Referred to as chemical castration (alternative to surgery, but surgery is preferred)

104
Q

Leuprolide Contraindications

A

History of stroke or MI

105
Q

Leuprolide A/E

A 
Hot flashes 
Will cause tumor flare symptoms 
Stroke 
MI
Osteoporosis 
Erectile dysfunction 
Gynecomastia
Impotence 
Decreased muscle mass
New onset of DM
106
Q

Leuprolide Nursing considerations

A

Increase Ca, Vit D

May cause urinary obstruction (decrease in flow, pain, incontinence), numbness of hands and feet, aggravate bone pain

107
Q

GnRH Antagonist Drug

A

Degarelix

108
Q

Degarelix MOA

A

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
Q

Degarelix Use

A

Palliative treatment of advanced prostate cancer

110
Q

Degarelix A/E

A 
Does not produce initial tumor flare 
Decrease muscle mass
Erectile dysfunction
Decreased labido 
(Prolonged QT, Liver injury)
111
Q

Androgen Receptor Blocker Drug

A

Flutamide

112
Q

Flutamide MOA/Purpose

A

Antiandrogen
Prevent tumor flare with GnRH therapy
Blocks effects of adrenal and prostate cancer androgens

113
Q

Flutamide Use

A

Only for advanced androgen sensitive prostate cancer

and only in combo with surgical castration or chemical castration using a GnRh agonist

114
Q

Flutamide Route

A

PO TID

115
Q

Flutamide A/E

A 
Rectal bleeding* 
Hot flashes
Erectile dysfunction
Decrease labido
Decreased muscle mass
Gynecomastia 
Osteoporosis 
N/V
116
Q

Flutamide Contraindications

A

Preg cat D

117
Q

Flutamide Toxicity

A

Hepatotoxic

118
Q

Flutamide Baseline information

A

LFTs

119
Q

Flutamide Monitoring

A

Monthly for 1st 4 months then periodically
-LFTs
Constantly for blood in the stool

120
Q

Cyclophosphamide Monitoring

A 
CBC w/Diff
Hematuria
Bun
Cr
I&O
121
Q

Cisplatin Nursing considerations

A

Premedicate with antiemetic

122
Q

Fluorouracil Antidote

A

Uridine Triacetate

123
Q

Methotrexate Monitoring

A

BUN
Cr
I&O

124
Q

Bone marrow suppression with chemo

A

Decreased WBC, RBC/Hgb, Platelets

Increased risk for bleeding and infection and anemia

125
Q

Tumor lysis syndrome Pt edu

A

Hydration!!! Protect kidneys

126
Q

Paclitaxel Contraindication

A

History of cardiac problems

127
Q

Tamoxifen Benefits

A

Decreases LDL

Increases HDL

128
Q

Prostate tumor flare symptoms

A

Bone pain
Decreased urination
Weakness in arms and legs from compression of tumor on spinal cord

129
Q

Filgrastim Dosing

A

Multiple doses over 5 days

Pharm Exam 3 (4 decks)

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