Cancer Chemotherapy and General Anesthetics Flashcards
what is the pathophysiology of cancer?
malignant forms of neoplastic disease
uncontrolled proliferation of cells
exact cause is unknown
what is the dif bw benign and malignant cancers?
benign tumors have normal cells
malignant tumors have abnormal cells
what are the options for cancer treatment?
surgery
radiation
chemotherapy
what are the 2 types of chemotherapy for cancer?
antineoplastic agents
gene therapy
what are the general principles of cancer chemotherapy?
cytotoxic strategy
cell kill hypothesis
cell cycle specific vs cell cycle non-specific
what is the basic strategy of anticancer drugs to stop cells from growing?
the cytotoxic strategy
how does the cytotoxic strategy limit cell proliferation?
by killing or attenuating the growth of the cancerous cells
what is the cell kill hypothesis?
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
what are cell cycle non-specific drugs?
cancer drugs that attack cells in any stage
what are cell cycle specific drugs?
cancer drugs that only target actively dividing cells
t/f: many anticancer drugs are non-specific
true
what cells are affected by chemo?
hair follicles
bone marrow
immune cells
epithelial cells in skin and GI tract
what are the side effects of chemo?
hair loss
anemic symptoms
easier to get sick
fragile skin
nausea/vomiting
what are the 3 classes of anticancer drugs?
drugs that act on DNA
drugs that act on mitotic spindles
hormonal agents
what are the MOAs of cancer drugs that act on DNA?
damage DNA
inhibit DNA synthesis or fxns
what cancer treatments damage DNA?
alkylating agents
free radical formation
what cancer treatments inhibit DNA synthesis or fxns?
antimetabolites
toposomerase inhibitors
what cancer drugs act on mitotic spindles?
microtubule inhibitors
t/f: there are agonist and antagonist hormonal agents to treat cancer
true
what are alkylating agents?
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
what are some alkylating agents?
cyclophosphamide (Cytoxan, Neosar)
chlorambucil (Leukeran)
what are the drug interactions with alkylating agents?
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
what are free radical formation/anticancer antibiotics?
cell cycle non-specific drugs that are reserved for cancer due to its toxicity
using free radicals to kill cancer cells
what are the anticancer antibiotics?
Doxorubicin (Adriamycin)
Dounorubicin (Cerubidine)
Mitomycin (Mutamycin)
what do the anticancer antibiotics end in?
- mycin
- rubicin
what are the drug interactions with anticancer antibiotics?
alkylating agents as the combo may inc risk of cardiotoxicity
what are antimetabolites?
cell cycle specific drugs that attack cells in the S phase related to DNA synthesis and replication
what are the antimetabolite drugs?
Methotrexate
Fluorouracil (Adrucil)
what are plant alkaloids?
cell cycle specific drugs that inhibit mitosis
what two categories of drugs are plant alkaloids?
microtubule inhibitors
toposomerase inhibitors
what do microtubule inhibitors do?
they disrupt the fxn of the mitotic apparatus
what is one of the most toxic microtubule inhibitors?
Vinca alkaloids
what are the vinca alkaloids (plant alkaloids-microtubule)?
Vincristine
vinblastine
vinorelbine
vindesine
what are the microtubule drugs?
vinca alkaloids (vincristine, vinblastine, vinorelbine, vindesine)
Paclitaxel (Taxol)
what do topoisomerase inhibitors do?
they inhibit the enzymes needed for DNA replication
what are the topoisomerase inhibitors?
Etoposide (VP-16)
Irinotecan (Camptosar)
what cancers can use hormonal agents?
hormone sensitive cancers like breast, prostate, endometrial, Hodgkin’s lymphoma, and some leukemias
what hormonal agents can treat Hodgkin’s lymphoma and some leukemias?
glucocorticoids
what hormonal agents can treat breast cancer?
Tamoxifen (Soltamox)
androgens
anti-estrogens
what hormonalagents can treat prostate cancer?
estrogens
anti-androgens
what hormonal agent can treat breast cancer, endometrial cancer, and prostate cancer?
progesterones
what are some of the bolded side effects of anti-cancer drugs?
neuropathy
cardiotoxicity
what is chemotherapy induced peripheral neuropathy (CIPN)?
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
do we usually see motor or sensory problems first with cancer treatment?
sensory
t/f: once CIPN has started there is nothing to stop or slow it
true
are the symptoms of CIPN short or long term?
can be either
what % of pts on chemo experience “chemo brain”?
82%
what are the s/s of chemo related cognitive and memory problems?
mental fog
ST memory problems
difficulty concentrating
confusion
fatigue
what may be the cause of “chemo brain”?
lower perfusion of the pre-frontal cortex w/chemo
what are the drugs that decrease non-neural side effects of chemo?
corticosteroids
Ondansetron (Zofran)
IV fluids with potassium, magnesium, calcium
what do corticosteroids do for chemo side effects?
they prevent allergic rxns to chemo meds
what does Ondansetron (Zofran) do for chemo side effects?
it reduces nausea and vomiting
what are the PT implications of chemo?
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
what are severe toxic effects of chemo that PTs should be aware of?
neurotoxicity
loss of appetite, nausea, vomiting
fluid and electrolyte imbalances
myelosuppression (reduced WBCs, RBCs, or platelets)
fatigue, weakness
how do general anesthetics work?
CNS depression
absence of all perceived sensations
general anesthesia is characterized by…
analgesia
unconsciousness
amnesia
skeletal muscle relaxation
inhibition of sensory and autonomic reflexes
why does general anesthesia lead to depression in HR and BP?
it inhibits autonomic reflexes leading to unresponsive baroreceptors
what is stage 1 CNS depression?
analgesia
conscious and aware of surroundings
begin to lose somatic sensations
good for local surgeries that don’t require full body anesthesia
what is stage 2 CNS depression?
excitement/delirium
agitated and disturbed state
loss of consciousness, amnesia
rapid/irregular breathing, vomiting
what is stage 3 CNS depression?
surgical amnesia
unconsciousness
rhythmic and deep respirations
desirable for surgical procedures
what is stage 4 CNS depression?
DANGER
meduallry paralysis
resp control centers and vasomotor center inhibition
ventilatory and circulatory support needed
what are the inhaled anesthetics?
gas-nitrous oxide
volatile liquids-halothane and isoflurane
which inhaled anesthetic is used for short surgeries or dental work?
nitrous oxide
which inhaled anesthetics is used for longer surgeries?
volatile liquids
what are the IV anesthetics?
barbiturates (thiopental)
dissociative s (ketamine)
opioids (fentanyl)
benzos (midazolam)
miscellaneous (etomidate, propofol)
what general anesthetics are given to calm pts pre-op?
opioids and benzos
what are the general anesthetics that increase inhibition?
benzos
barbiturates
propofol
what are the general anesthetics that decrease excitation?
halogenated liquids
ketamine
nitrous oxide
opioids
what receptors do benzos act on?
GABA
what receptors do barbiturates act on?
GABA
Glycine
what receptors do propofol act on?
GABA
Glycine
what receptors do halogenated liquids act on?
GABA
K+ channels
ACh
what receptors does ketamine act on?
NMDA
what receptors does nitrous oxide act on?
NMDA
what receptors do opioids act on?
opioid receptors
what kind of drugs are Midazolam, fentanyl, proprofol, isoflurane
sedation/general anesthesia
what kind of drugs are lidocaine and bupivacaine?
local anesthesia
what kind of drug is Rocuronium?
neuromuscular blocker
what kind of drug is Neostigmine?
neuromuscular blocker reverser
what kind of drug is Ondansetron (Zofran)?
antiemetic
what kind of drugs are fentanyl, hydromorphone, morphine?
analgesia/pain control
what kind of drug is glycopyrrolate?
anticholinergic
what is the goal of step 1: pre-op meds?
sedation and anti-anxiety
what are the classifications of Midazolam (Versed)?
Benzo, anxiolytic, amnesia
t/f: Midazolam (Versed) is usually given 1-2 hours b4 surgery
true
when the pt is brought to the OR in step 2, what med is given?
Fentanyl
what is the classification of fentanyl?
opioid analgesic, anesthetic
t/f: side effects of fentanyl are more severe in older adults
true
what drugs are given in step 3?
lidocaine (xylocaine)
propofol (diprivan)
how does lidocaine work?
interrupting nerve conduction relieve pain w/o systematic effects and loss of consciousness
minimize the stinging of propofol
what are the classifications for lidocaine?
local anesthetic
antiarryhthmic
what are the side effects of lidocaine?
hypotension, arryhthmia
which drug mimics the effects of deep sleep?
propofol
what is the classification of propofol?
sedative-hypnotic
what are the side effects of propofol?
nausea/vomiting, involuntary muscle movements, hypotension
what drug is involved in paralysis of step 4?
rocuronium (Zemuron)
what does Rocuronium (Zemuron) do?
binds to nicotinic cholinergic receptors to induce neuromusclar blockade and relaxation of vocal cords for intubation
what are the classifications of Rocuronium (Zemuron)?
neuromuscular blocker
paralytic
what drug is used in step 5 to induce and maintain general anesthesia?
Isoflurance (Forane)
what are the classifications of Isoflurane (Forane)?
inhalation anesthetic
volatile liquid
what does Isoflurane (Forane) do?
achieves unconsciousness, muscles relaxation. and reduced pain sensitivity
diffuses into adipose tissue due to lipid solubility
how is Isoflurane (Forane) eliminated?
expiration
what are the side effects of Isoflurane (Forane)?
shivering, nausea, vomiting, resp depression, hypotension, arryhthmia, slowing psychomotor skills, delirium
potential CV and pulm toxicity
what 3 drugs are involved in step 6 before the end of surgery?
Ondansetron (Zofran)
Neostigmine (Bloxiverz)
Glycopyrrolate (Robinul)
what are the classifications of Ondansetron (Zofran)?
antiemetic
serotonin receptor antagonist
what drug reduces post op, chemo , or radiation induced nausea/vomiting?
Ondonsetron (Zofran)
what are the side effects of Ondansetron (Zofran)?
confusion, dizziness, tachycardia, fever, headache, trouble breathing
what is the classification of Neostigmine (Bloxiverz)?
neuromuscular blocker reversal
what does Neostigmine (Bloxiverz) do?
counteracts Rocuronium (Zemuron)
what are the side effects of Neostigmine (Bloxiverz)?
GI distress, abdominal cramps, headache, fever
what is the classification of glycopyrrolate (Robinul)?
anticholinergic
what does Glycopyrrolate (Robinul) do?
minimizes the side effects of Neostigmine
what are the side effects of Glycopyrrolate (Robinul)?
blurred vision, constipation, urinary retention, dry mouth
what drugs are given in the recovery room?
Bupivacaine (Marcaine)
Hydromorphone (Exalgo ER)
what is the classification of Bupivacaine (Marcaine)?
local anesthetic (spinal or epidural)
is Bupivacaine (Marcaine) long or short acting?
long acting (about 6 hours)
what are the side effects of Bupivacaine (Marcaine)?
pruritis, CNS depression, cardiotoxicity, bradycardia, arryhthmia, hypotension, resp arrest, urinary retention
what is the classification of hydromorphone (exalgo ER)?
opioid analgesic
what are the PT implications of general anesthetics?
nausea/vomiting
resp compromise
sedation, lethargy
muscle weakness
OH
ST confusion
what are the populations of concern with general anesthetics?
obesity
elderly
comorbidities
children
