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DPT 530 > Cancer Chemotherapy and General Anesthetics > Flashcards

Cancer Chemotherapy and General Anesthetics Flashcards

1
Q

what is the pathophysiology of cancer?

A

malignant forms of neoplastic disease

uncontrolled proliferation of cells

exact cause is unknown

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2
Q

what is the dif bw benign and malignant cancers?

A

benign tumors have normal cells

malignant tumors have abnormal cells

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3
Q

what are the options for cancer treatment?

A

surgery

radiation

chemotherapy

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4
Q

what are the 2 types of chemotherapy for cancer?

A

antineoplastic agents

gene therapy

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5
Q

what are the general principles of cancer chemotherapy?

A

cytotoxic strategy

cell kill hypothesis

cell cycle specific vs cell cycle non-specific

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6
Q

what is the basic strategy of anticancer drugs to stop cells from growing?

A

the cytotoxic strategy

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7
Q

how does the cytotoxic strategy limit cell proliferation?

A

by killing or attenuating the growth of the cancerous cells

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8
Q

what is the cell kill hypothesis?

A

theoretical ability of chemo to kill a % of cancer cells, never 0 cancer cells left in the body , it only takes care of a proportion of cancer cells

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9
Q

what are cell cycle non-specific drugs?

A

cancer drugs that attack cells in any stage

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10
Q

what are cell cycle specific drugs?

A

cancer drugs that only target actively dividing cells

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11
Q

t/f: many anticancer drugs are non-specific

A

true

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12
Q

what cells are affected by chemo?

A

hair follicles

bone marrow

immune cells

epithelial cells in skin and GI tract

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13
Q

what are the side effects of chemo?

A

hair loss

anemic symptoms

easier to get sick

fragile skin

nausea/vomiting

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14
Q

what are the 3 classes of anticancer drugs?

A

drugs that act on DNA

drugs that act on mitotic spindles

hormonal agents

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15
Q

what are the MOAs of cancer drugs that act on DNA?

A

damage DNA

inhibit DNA synthesis or fxns

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16
Q

what cancer treatments damage DNA?

A

alkylating agents

free radical formation

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17
Q

what cancer treatments inhibit DNA synthesis or fxns?

A

antimetabolites

toposomerase inhibitors

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18
Q

what cancer drugs act on mitotic spindles?

A

microtubule inhibitors

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19
Q

t/f: there are agonist and antagonist hormonal agents to treat cancer

A

true

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20
Q

what are alkylating agents?

A

cell cycle non-specific drugs that work by damaging the DNA chain to prevent replication and translation

one of the largest categories of anticancer drugs

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21
Q

what are some alkylating agents?

A

cyclophosphamide (Cytoxan, Neosar)

chlorambucil (Leukeran)

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22
Q

what are the drug interactions with alkylating agents?

A

anticoagulants effects may be increased, increasing the risk of bruising and bleeding

digoxin with alkylatng agents can cause a Dec in plasma levels of digoxin

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23
Q

what are free radical formation/anticancer antibiotics?

A

cell cycle non-specific drugs that are reserved for cancer due to its toxicity

using free radicals to kill cancer cells

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24
Q

what are the anticancer antibiotics?

A

Doxorubicin (Adriamycin)

Dounorubicin (Cerubidine)

Mitomycin (Mutamycin)

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25
Q

what do the anticancer antibiotics end in?

A
  • mycin
  • rubicin
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26
Q

what are the drug interactions with anticancer antibiotics?

A

alkylating agents as the combo may inc risk of cardiotoxicity

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27
Q

what are antimetabolites?

A

cell cycle specific drugs that attack cells in the S phase related to DNA synthesis and replication

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28
Q

what are the antimetabolite drugs?

A

Methotrexate

Fluorouracil (Adrucil)

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29
Q

what are plant alkaloids?

A

cell cycle specific drugs that inhibit mitosis

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30
Q

what two categories of drugs are plant alkaloids?

A

microtubule inhibitors

toposomerase inhibitors

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31
Q

what do microtubule inhibitors do?

A

they disrupt the fxn of the mitotic apparatus

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32
Q

what is one of the most toxic microtubule inhibitors?

A

Vinca alkaloids

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33
Q

what are the vinca alkaloids (plant alkaloids-microtubule)?

A

Vincristine

vinblastine

vinorelbine

vindesine

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34
Q

what are the microtubule drugs?

A

vinca alkaloids (vincristine, vinblastine, vinorelbine, vindesine)

Paclitaxel (Taxol)

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35
Q

what do topoisomerase inhibitors do?

A

they inhibit the enzymes needed for DNA replication

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36
Q

what are the topoisomerase inhibitors?

A

Etoposide (VP-16)

Irinotecan (Camptosar)

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37
Q

what cancers can use hormonal agents?

A

hormone sensitive cancers like breast, prostate, endometrial, Hodgkin’s lymphoma, and some leukemias

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38
Q

what hormonal agents can treat Hodgkin’s lymphoma and some leukemias?

A

glucocorticoids

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39
Q

what hormonal agents can treat breast cancer?

A

Tamoxifen (Soltamox)

androgens

anti-estrogens

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40
Q

what hormonalagents can treat prostate cancer?

A

estrogens

anti-androgens

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41
Q

what hormonal agent can treat breast cancer, endometrial cancer, and prostate cancer?

A

progesterones

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42
Q

what are some of the bolded side effects of anti-cancer drugs?

A

neuropathy

cardiotoxicity

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43
Q

what is chemotherapy induced peripheral neuropathy (CIPN)?

A

numbness and tingling

pain (burning, shooting, stabbing)

hypersensitivity to hot or cold or touch or pressure

hypo- or areflexia

muscle weakness

trouble swallowing

balance problems

constipation

BP changes

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44
Q

do we usually see motor or sensory problems first with cancer treatment?

A

sensory

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45
Q

t/f: once CIPN has started there is nothing to stop or slow it

A

true

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46
Q

are the symptoms of CIPN short or long term?

A

can be either

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47
Q

what % of pts on chemo experience “chemo brain”?

A

82%

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48
Q

what are the s/s of chemo related cognitive and memory problems?

A

mental fog

ST memory problems

difficulty concentrating

confusion

fatigue

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49
Q

what may be the cause of “chemo brain”?

A

lower perfusion of the pre-frontal cortex w/chemo

50
Q

what are the drugs that decrease non-neural side effects of chemo?

A

corticosteroids

Ondansetron (Zofran)

IV fluids with potassium, magnesium, calcium

51
Q

what do corticosteroids do for chemo side effects?

A

they prevent allergic rxns to chemo meds

52
Q

what does Ondansetron (Zofran) do for chemo side effects?

A

it reduces nausea and vomiting

53
Q

what are the PT implications of chemo?

A

acknowledge the severe toxic effects

address deconditioning with a combo of aerobic and anaerobic exercises starting at low doses and working up

pain management

pt support

54
Q

what are severe toxic effects of chemo that PTs should be aware of?

A

neurotoxicity

loss of appetite, nausea, vomiting

fluid and electrolyte imbalances

myelosuppression (reduced WBCs, RBCs, or platelets)

fatigue, weakness

55
Q

how do general anesthetics work?

A

CNS depression

absence of all perceived sensations

56
Q

general anesthesia is characterized by…

A

analgesia

unconsciousness

amnesia

skeletal muscle relaxation

inhibition of sensory and autonomic reflexes

57
Q

why does general anesthesia lead to depression in HR and BP?

A

it inhibits autonomic reflexes leading to unresponsive baroreceptors

58
Q

what is stage 1 CNS depression?

A

analgesia

conscious and aware of surroundings

begin to lose somatic sensations

good for local surgeries that don’t require full body anesthesia

59
Q

what is stage 2 CNS depression?

A

excitement/delirium

agitated and disturbed state

loss of consciousness, amnesia

rapid/irregular breathing, vomiting

60
Q

what is stage 3 CNS depression?

A

surgical amnesia

unconsciousness

rhythmic and deep respirations

desirable for surgical procedures

61
Q

what is stage 4 CNS depression?

A

DANGER

meduallry paralysis

resp control centers and vasomotor center inhibition

ventilatory and circulatory support needed

62
Q

what are the inhaled anesthetics?

A

gas-nitrous oxide

volatile liquids-halothane and isoflurane

63
Q

which inhaled anesthetic is used for short surgeries or dental work?

A

nitrous oxide

64
Q

which inhaled anesthetics is used for longer surgeries?

A

volatile liquids

65
Q

what are the IV anesthetics?

A

barbiturates (thiopental)

dissociative s (ketamine)

opioids (fentanyl)

benzos (midazolam)

miscellaneous (etomidate, propofol)

66
Q

what general anesthetics are given to calm pts pre-op?

A

opioids and benzos

67
Q

what are the general anesthetics that increase inhibition?

A

benzos

barbiturates

propofol

68
Q

what are the general anesthetics that decrease excitation?

A

halogenated liquids

ketamine

nitrous oxide

opioids

69
Q

what receptors do benzos act on?

A

GABA

70
Q

what receptors do barbiturates act on?

A

GABA

Glycine

71
Q

what receptors do propofol act on?

A

GABA

Glycine

72
Q

what receptors do halogenated liquids act on?

A

GABA

K+ channels

ACh

73
Q

what receptors does ketamine act on?

A

NMDA

74
Q

what receptors does nitrous oxide act on?

A

NMDA

75
Q

what receptors do opioids act on?

A

opioid receptors

76
Q

what kind of drugs are Midazolam, fentanyl, proprofol, isoflurane

A

sedation/general anesthesia

77
Q

what kind of drugs are lidocaine and bupivacaine?

A

local anesthesia

78
Q

what kind of drug is Rocuronium?

A

neuromuscular blocker

79
Q

what kind of drug is Neostigmine?

A

neuromuscular blocker reverser

80
Q

what kind of drug is Ondansetron (Zofran)?

A

antiemetic

81
Q

what kind of drugs are fentanyl, hydromorphone, morphine?

A

analgesia/pain control

82
Q

what kind of drug is glycopyrrolate?

A

anticholinergic

83
Q

what is the goal of step 1: pre-op meds?

A

sedation and anti-anxiety

84
Q

what are the classifications of Midazolam (Versed)?

A

Benzo, anxiolytic, amnesia

85
Q

t/f: Midazolam (Versed) is usually given 1-2 hours b4 surgery

A

true

86
Q

when the pt is brought to the OR in step 2, what med is given?

A

Fentanyl

87
Q

what is the classification of fentanyl?

A

opioid analgesic, anesthetic

88
Q

t/f: side effects of fentanyl are more severe in older adults

A

true

89
Q

what drugs are given in step 3?

A

lidocaine (xylocaine)

propofol (diprivan)

90
Q

how does lidocaine work?

A

interrupting nerve conduction relieve pain w/o systematic effects and loss of consciousness

minimize the stinging of propofol

91
Q

what are the classifications for lidocaine?

A

local anesthetic

antiarryhthmic

92
Q

what are the side effects of lidocaine?

A

hypotension, arryhthmia

93
Q

which drug mimics the effects of deep sleep?

A

propofol

94
Q

what is the classification of propofol?

A

sedative-hypnotic

95
Q

what are the side effects of propofol?

A

nausea/vomiting, involuntary muscle movements, hypotension

96
Q

what drug is involved in paralysis of step 4?

A

rocuronium (Zemuron)

97
Q

what does Rocuronium (Zemuron) do?

A

binds to nicotinic cholinergic receptors to induce neuromusclar blockade and relaxation of vocal cords for intubation

98
Q

what are the classifications of Rocuronium (Zemuron)?

A

neuromuscular blocker

paralytic

99
Q

what drug is used in step 5 to induce and maintain general anesthesia?

A

Isoflurance (Forane)

100
Q

what are the classifications of Isoflurane (Forane)?

A

inhalation anesthetic

volatile liquid

101
Q

what does Isoflurane (Forane) do?

A

achieves unconsciousness, muscles relaxation. and reduced pain sensitivity

diffuses into adipose tissue due to lipid solubility

102
Q

how is Isoflurane (Forane) eliminated?

A

expiration

103
Q

what are the side effects of Isoflurane (Forane)?

A

shivering, nausea, vomiting, resp depression, hypotension, arryhthmia, slowing psychomotor skills, delirium

potential CV and pulm toxicity

104
Q

what 3 drugs are involved in step 6 before the end of surgery?

A

Ondansetron (Zofran)

Neostigmine (Bloxiverz)

Glycopyrrolate (Robinul)

105
Q

what are the classifications of Ondansetron (Zofran)?

A

antiemetic

serotonin receptor antagonist

106
Q

what drug reduces post op, chemo , or radiation induced nausea/vomiting?

A

Ondonsetron (Zofran)

107
Q

what are the side effects of Ondansetron (Zofran)?

A

confusion, dizziness, tachycardia, fever, headache, trouble breathing

108
Q

what is the classification of Neostigmine (Bloxiverz)?

A

neuromuscular blocker reversal

109
Q

what does Neostigmine (Bloxiverz) do?

A

counteracts Rocuronium (Zemuron)

110
Q

what are the side effects of Neostigmine (Bloxiverz)?

A

GI distress, abdominal cramps, headache, fever

111
Q

what is the classification of glycopyrrolate (Robinul)?

A

anticholinergic

112
Q

what does Glycopyrrolate (Robinul) do?

A

minimizes the side effects of Neostigmine

113
Q

what are the side effects of Glycopyrrolate (Robinul)?

A

blurred vision, constipation, urinary retention, dry mouth

114
Q

what drugs are given in the recovery room?

A

Bupivacaine (Marcaine)

Hydromorphone (Exalgo ER)

115
Q

what is the classification of Bupivacaine (Marcaine)?

A

local anesthetic (spinal or epidural)

116
Q

is Bupivacaine (Marcaine) long or short acting?

A

long acting (about 6 hours)

117
Q

what are the side effects of Bupivacaine (Marcaine)?

A

pruritis, CNS depression, cardiotoxicity, bradycardia, arryhthmia, hypotension, resp arrest, urinary retention

118
Q

what is the classification of hydromorphone (exalgo ER)?

A

opioid analgesic

119
Q

what are the PT implications of general anesthetics?

A

nausea/vomiting

resp compromise

sedation, lethargy

muscle weakness

OH

ST confusion

120
Q

what are the populations of concern with general anesthetics?

A

obesity

elderly

comorbidities

children

DPT 530 (14 decks)

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