Cancer Treatment Modalities: Chemotherapy Flashcards
Neoadjuvant chemotherapy =
Preop chemo, sometimes used to shrink a cancer tumor before surgery so that it is easier to remove
Adjuvant chemotherapy =
Postop chemo, where surgery is the main treatment but chemo is given after with intent to cure or control disease
Multi-modal therapy =
chemo can be given in combo with other therapies such as radiation
The 5 phases of the cell cycle
GO phase (resting phase) G1 phase S phase G2 phase M phase
G0 phase (resting stage) =
The cell has not yet started to divide
G0 can last from a few hours to a few years. When the cell gets a signal to reproduce , it moves to G1 phase
G1 phase =
Cell starts making more proteins and growing larger, so the new cells will be of normal size
~18-30 hours
S phase =
Chromosomes containing the genetic code (DNA) or copied, so both of the new cells formed will have matching strands of DNA
~18-20 hours
G2 phase =
The cell checks the DNA and gets ready to start splitting into two cells
~2-10 hours
M phase =
Mitosis phase, cell splits into two new cells
~30-60 minutes
Chemotherapy classifications (6)
Alkylating Agents Antimetabolites Antitumor Antibiotics Plant Alkaloids Glucocorticoids Hormonal Agents
Alkylating agents treat which types of cancer?
Leukemia Lymphoma Hodgkin disease Multiple myeloma sarcoma Cancers of lung, breast, ovary
How do Alkylating agents work?
What part of the cell cycle do they work in?
Interferes with DNA replication, RNA transcription, and nucleic acid function
Cell cycle nonspecific, works in all phases of the cycle
What is a potential downfall of receiving alkylating agents? (2)
Can eventually lead to acute leukemia bc it damages DNA causing long term damage to bone marrow (dose dependent)
Also a significant threat to future fertility in adolescents and young adults of child bearing age (discuss egg retrieval, sperm banking, etc)
Alkylating agents
2 types
Non-platins
Platinum analogs
Alkylating agents
Non-platins (5)
1) Nitrogen mustards (mechlorethamine, chlorambucil, cyclophosphamide, ifosfamide, melphalan)
2) Nitrosoureas (Streptozocin, carmustin BCNU, lomustine)
3) Alkyl sulfonates (Busulfan)
4) Triazines (Dacarbazine DTIC and temozolomide)
5) Ethylenimines (Thiotepa and altretamine (hexmethylmelamine) )
Alkylating agents
Platinum analogs (3)
Carboplatin
Cisplatin
Oxaliplatin
How do Antimetabolites work?
What part of the cell cycle do they work in?
Inhibits protein synthesis, substitute erroneous substances needed for DNA/RNA replication, and inhibit DNA synthesis
S phase
Examples of Antimetabolites
5FU
6-MP
Capecitabine, Cladribine, Clofarabine, Cytarabine
Floxuridine, Fludarabine, Gemcitabine
Hydroxurea
Methotrexate, Pemetrexed, Pentoastatin, Thioguanine
How do antitumor antibiotics work =
Interfered with enzymes required for ->
Are cell cycle _______
Used to treat hematologist and various types of solid tumors
DNA replication
Nonspecific (all phases)
Antitumor Antibiotics (2)
Anthracyclines
Liposomal formulations
Major consideration for Anthracyclines
Can permanently damage heart if given in high doses
-> Lifetime dose limits
Baseline cardiac function (ECG, MUGA scans)
Examples of Anthracyclines (5)
Daunorubicin Doxorubicin Epirubicin Idaraubicin Valrubicin
Liposomal Formulations (2)
Doxorubicin hydrochloride liposome
Daunorubicin citrate liposomal
What are Plant Alkaloids?
Cell Cycle _____
Derived from certain types of plants and have varying mechanisms of action
Specific
Types of Plant Alkaloids (3)
Vinca Alkaloids
Epipodophyllotoxins
Taxanes
Vinca Alkaloids come from?
From Madagascar Periwinkle plant, naturally extracted from pink periwinkle plant
Vinca Alkaloids
Have hy____ and cy____ effects, therefore have been used to treat (2)
Hypoglycemic
Cytotoxic
Diabetes, HTN, as a disinectant
What part of the cell cycle do Vinca Alkaloids work on?
M Phase
Vinca Alkaloids significant SE (3)
Myelosuppression
Peripheral Neuropathy
N/V
Examples of Vinca Alkaloids (3)
Vinblastine
Vincristine
Vinorelbine
Types of Epipodophyllotoxins Categories (2)
Camptothecans
Podophyllotoxins
Campothecans come from the?
Asian “happy tree” plant
Podophyllotoxins come from the?
May apple plant
How do Epipodophyllotoxins work on the cell cycle? What enzyme?
Forms a complex with topoisomerase and DNA resulting in inhibition and function of topoisomerase enzyme (required for DNA synthesis)
What part of the cell cycle do Epipodos work on?
Late S, G2 phases
Types of Cancer Epipodos are used to treat (2)
Leukemia’s
GI Cancers
Common SE of Epipodos (2)
Diarrhea
Neutropenia
Types of Epipodophyllotoxins (4)
Etoposide
Teniposide
Camptothecan
Topotecan hydrochloride
What are Taxanes? Where are they derived from?
Mitotic inhibitors (stops mitosis)
Pacific Yew Tree
What part of the cell cycle do taxanes work on?
M phase
Also active in G1 and S transition phase a last checkpoint where cell division can be stopped
What types of cancers do taxanes treat?
Breast, Lung
Myelomas, Lymphomas, Leukemia’s
What side effect are taxanes known for causing?
Therefore ->
Peripheral nerve damage
Dose limiting
Types of Taxanes (4)
Paclitaxel
Docetaxel
Cabazitaxel
Paclitaxel protein bound
What are Glucocorticoids?
Steroids, naturally occurring hormones, hormone like drugs
How do glucocorticoids work on the cell cycle?
They modify transcription and protein synthesis within the cell -> reversal of increased capillary permeability, inhibits glucose transport and phosphorylation to induce cell death
Glucocorticoids treat what types of cancers?
L/L
MM
Glucorticoids can also be used for what?
Before, after, during tx
- antiemetics
- allergic reactions
- SVC, SCC
Types of Glucocorticoids (4)
Prednisone
Hydrocortisone
Methylprednisone
Dexamethasone
Hormonal Agents =
Effects sex hormones, change the action of production of female or male hormones
Hormonal agents treat what types of cancers?
Breast
Prostate
Endometrial
How do hormonal agents work on cancer?
They prevent the cancer cell from using the hormone it needs to grow to prevent body from making hormones
Categories of Homronal Agents (2)
Estrogen receptor (ER) modulators
Aromatase inhibitors
Types of Estrogen Receptor (ER) modulators (3)
Tamoxifen
Toremifene
Raloxifine
Types of Aromatase inhibitors
Anastrozole, Letrozole Exemestane Fulvestrant Leuoprolide Glutamine Bicatulamide Nilutamide Fluoxymesterone Estradiol Octreotide Megestrol Medroxyprogesterone acetate
Chemotherapy effects normal rapidly dividing cells as well such as?
Blood cells formin in bone marrow
Digestive tract
Reproductive system
Hair follicles
Chemo side effects present as ->
Myleosuppression
Mucositis
N/V
Alopecia
Most common SE of chemo
1) Myleosuppression (anemia, neutropenia, thrombo)
2) GI (anorexia, n/v, constipation, diarrhea, mucositis
3) Fatigue
4) Cognitive/ Neuro changes
5) Sexual and reproductive dysfunction (hot flashes, decreased libido, infertility)
6) Organ dysfunction (renal, hepatic, cardiac, pulmonary)
Hazardous drugs are those that exhibit one or more of what types of toxicities?
Carcinogenicity Teratogenicity/other developmental toxicity Reproductive toxicity Organ toxicity in low doses Genotoxicity
Adverse health effects of occupational exposure to hazardous drugs include
1) Integumentary/mucosal (3)
2) Neuro (2)
3) Respiratory (1)
4) GI (2)
5) Hypersensitivity (2)
6) Reproductive 6)
1) Skin irritation or contact dermatitis, mouth and nasal sores, partial alopecia, hair thinning
2) HA, dizziness
3) Dyspnea
4) N/V, abdominal pain
5) Allergic asthma, eye irritation
6) Infertility, prolonged time to conception, premature delivery/low birth weight, ectopic pregnancy, spontaneous abortions/miscarriages, stillbirths, learning disabilities in offspring
Risk levels for Hazardous drugs
1) Chronic low-level exposure to HD’s can lead to a______
2) Chronic low level absorption may cause significant long term ___ ___
3) Acute exposure may cause ___ symptoms
4) Use of _ _ _ reduces risk of absorption
1) absorption
2) side effects
3) acute
4) PPE
Ways you can be exposed to Hazardous drugs (4)
1) Absorption (through skin, eyes, mucous membranes)
2) Injection (accidental needle sticks)
3) Ingestion
4) Inhalation (sprays, aerosolization, drug dust, spills)
What do you wear for PPE when administering hazardous drugs?
1) Gloves (two pairs)
2) Gown
3) Face shield
4) Respirator mask (only if required by specific drug)
Postadmin considerations for body fluids and linen handling
Body fluids
1) HDs are found in?
2) Consider all bodily fluids contaminated for at least __ hours after completion of drug admin
3) ____ toilets without a lid before flushing to avoid spray contamination. Encourage use of toilets instead of urinal/bed pan to decrease exposure
4) Protect the skin of ____ patients
5) Remember: D____ can be contaminated too
6) Wear _ _ _ when emptying foley catheters and urinals or bed pans
1) Urine, feces, sweat, vomit, breast milk, seminal fluid
2) 48
3) Cover
4) incontinent
5) Diapers
6) PPE
Postadmin considerations for linen handling
1) Prevent exposure: use ___ backed disposable pads under incontinent patients
2) Use v___/p____ pillow covers
3) If linen becomes contaminated with any body fluid within 48 post admin, what do you do?
1) plastic
2) vinyl/plastic
3) don PPE, bas as contaminated, double wash, if home double wash separately from other linen
CAM stands for
Complementary, Alternative, and Integrative medicine
A broad category of approaches to health care with origins outside of mainstream western medicine
A non-mainstream therapy combined with conventional medicine =
Complementary
A non-mainstream therapy used instead of conventional medicine =
Alternative
Therapies that have had widespread use in western medicine =
Conventional
Unproven therapy
Any therapy that has not been scientifically tested and approved, therapies under investigation
Disproven therapy
One for which evidence exists but not in support a therapy
The following are all examples of?
Vitamin or mineral supplements
Intercessory or self prayer
Chiropractic or osteopathic care
Herbal therapies
CAM therapies
Acupuncture, Animal assisted activity, Aromatherapy, art therapy, ayurveda, chiropractic medicine, naturopathy, osteopathy, reflexology, reiki, yoga are all examples of CAM therapy that require?
Licensure, certification, training
