Chapter 45: Antineoplastic Drugs Part 1: Cancer overview and cell cylce- specific drugs Flashcards

1
Q

Extravasation

A

The leakage of any intravenously or intraarterially
administered medication into the tissue space surrounding
the vein or artery. Such an event can cause serious tissue
injury, especially with antineoplastic drugs. (p. 729)

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2
Q

Nadir

A

Lowest point in any fluctuating value over time; for
example, the lowest white blood cell count measured after
the count has been depressed by chemotherapy. (p. 729)

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3
Q

Sarcomas

A

Malignant neoplasms of the connective tissues arising
in bone, fibrous, fatty, muscular, synovial, vascular, or
neural tissue, often first presenting as painless swellings.
(p. 724)

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4
Q

Tumor lysis syndrome

A

A common metabolic complication of
chemotherapy for rapidly growing tumors. It is characterized
by the presence of excessive cellular waste products and
electrolytes, including uric acid, phosphate, and potassium,
and by reduced serum calcium levels. (p. 731)

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5
Q

Carcinomas

A

arise from epithelial tissue, which is located
throughout the body. This tissue covers or lines all body surfaces,
both inside and outside the body. Examples are the skin,
the mucosal lining of the entire gastrointestinal (GI) tract, and
the lining of the bronchial tree (lungs). The purpose of these
epithelial tissues is to protect the body’s vital organs

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6
Q

sarcomas

A

are malignant tumors that arise primarily from
connective tissues, but some sarcomas are tumors of epithelial
cell origin. Connective tissue is the most abundant and widely
distributed of all tissues and includes bone, cartilage, muscle,
and lymphatic and vascular structures. Its purpose is to support
and protect other tissues.

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7
Q

Lymphomas

A

are cancers within the lymphatic tissues.
Lymphomas
can be quite bulky and are usually classified as solid tumors.

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8
Q

Leukemias

A

arise from the bone marrow and are cancers of blood
and bone marrow. Leukemias differ from carcinomas and sarcomas
in that the cancerous cells do not form solid tumors but
are interspersed throughout the lymphatic or circulatory system
and interfere with the normal functioning of these systems this reason, they are sometimes referred to as circulating tumors,
although hematologic malignancy is a more precise term.

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9
Q

Cachexia

A

(general ill health and malnutrition)

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10
Q

Radiation is a well-known and potent carcinogenic agent. There
are two basic types of radiation:

A

(1) ionizing, or high-energy,

radiation, and (2) nonionizing, or low-energy, radiation

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11
Q

ionizing because

A
it causes the formation of ions within living cells. This type of
radiation (e.g., that used in radiographic studies) is also used
to treat (irradiate) cancerous tumors (e.g., radium implants).
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12
Q

Nonionizing radiation is much less potent and cannot penetrate
deeply into the body.

A

Ultraviolet light is an example of this

type of radiation and is the cause of skin cancer

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13
Q

Adverse effects of

radiation therapy

A

(e.g., radiation burns; nausea with GI tract
irradiation) tend to be more localized to the site of treatment
as well.

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14
Q

Neoplastic cells are believed to develop in everyone;

A

however, a healthy person’s immune system recognizes them
as abnormal and eliminates them by means of cell-mediated
immunity (cytotoxic T lymphocytes;

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15
Q

• Causative factors that have been identified include

A

include age-related and sex-related characteristics; genetic and ethnic factors; oncogenic viruses; environmental and occupational factors; radiation; and immunologic factors.

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16
Q

o Epstein-Barr virus is a

A

a type of herpesvirus commonly recognized as the cause of infectious mononucleosis. It is also associated with the development of Burkitt’s lymphoma and nasopharyngeal cancer

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17
Q

• The percentage of cells undergoing mitosis at any given time

A

is called the growth fraction of the tumor. The number of cells in the M phase of the cell cycle is called the mitotic index. Chemotherapy is most effective when used in a rapidly dividing or highly proliferative tumor.

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18
Q

• Factors that affect the chances of cure and the length of patient survival include

A

the cancer stage at time of diagnosis, the type of cancer and its doubling time, the efficacy of the cancer treatment, the development of drug resistance, and the general health of the patient.

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19
Q

• Most chemotherapy is withheld when the patient’s

A

absolute neutrophil count (ANC) is less than 500 cells/mm3 (severe neutropenia).

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20
Q

• Antimetabolite antineoplastic drugs are used for the treatment

A

of a variety of solid tumors and some hematologic cancers; they may also be used in combination chemotherapy

are cell cycle–specific analogues that work by antagonizing the actions of key cellular metabolites

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21
Q

• Allopurinol and rasburicase are both indicated

A

for the hyperuricemia associated with tumor lysis syndrome and are usually given in anticipation of this condition during various chemotherapy regimens associated with this syndrome.

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22
Q

• Mitotic inhibitors include

A

natural products from plants and semisynthetic drugs from plants. Depending on the particular drug, these plant-derived compounds can work in various phases of the cell cycle (late S phase, throughout G2 phase, and M phase), but they all work shortly before or during mitosis and thus retard cell division.

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23
Q

• Vincristine and other vinca alkaloids are not given intrathecally

A

Administering these drugs through the spinal route is almost always fatal, and the death is slow and excruciating.

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24
Q

antineoplastic enzymes is a fairly unique adverse effect

A

impaired pancreatic function. This can lead to hyperglycemia and severe or fatal pancreatitis.

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25
Q

• Complete an assessment of

A

cultural, emotional, spiritual, sexual, and financial influences, concerns, and issues.

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26
Q

• One specific assessment consideration associated with the use of the antimetabolite cytarabine is monitoring for the

A

occurrence of cytarabine syndrome. This usually occurs within 6 to 12 hours after drug administration and is characterized by fever, muscle and bone pain, maculopapular rash, conjunctivitis, and malaise.

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27
Q

• In patients receiving mitotic inhibitors (e.g., vinblastine, vincristine) and alkaloid topoisomerase II inhibitors (e.g., etoposide)

A

• In patients receiving mitotic inhibitors (e.g., vinblastine, vincristine) and alkaloid topoisomerase II inhibitors (e.g., etoposide)

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28
Q

• Assess individuals for the following characteristics before chemotherapy

A

(1) genetic markers for oral cancers, (2) genetic determinants of testosterone or estrogen metabolism, and (3) genetically linked enzyme system abnormalities such as those involving specific cytochrome P-450 enzymes that metabolically convert nicotine to a carcinogenic substance

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29
Q

• GI adverse effects usually occur

A

on about the fourth day, which may require preplanning for special pharmacologic interventions (e.g., antiemetics, antispasmodics, analgesics) and nonpharmacologic measures (dietary changes, oral care).

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30
Q

(teratogenesis)

A

antineoplastics may also have a negative impact on the reproductive tract, causing destruction of the germinal epithelium of the testes and damage to the ovaries and to a fetus

31
Q

G0: Resting phase

A

Most normal human cells exist predominantly
in this phase. Cancer cells in this phase are
not susceptible to the toxic effects of cell
cycle–specific drugs.

32
Q

G1: First gap phase or

postmitotic phase

A

Enzymes necessary for DNA synthesis are

produced

33
Q

S: DNA synthesis phase

A

DNA synthesis takes place, from DNA strand
separation to replication of each strand to
create duplicate DNA molecules

34
Q

G2: Second gap phase or

premitotic phase

A

RNA and specialized proteins are made

35
Q

M: Mitosis phase

A

Divided into four subphases: prophase, metaphase,
anaphase, and telophase; cell divides
(reproduces) into two daughter cells

36
Q

Chemotherapy is most effective

A

when used in a rapidly

dividing or highly proliferative tumor.

37
Q

No antineoplastic drug is effective against all types of cancer.
Most cancer drugs have a low therapeutic index, which means

A

that a fine line exists between therapeutic and toxic levels. Clinical
experience has shown that a combination of drugs is usually
more effective than single-drug therapy

38
Q

To
be most effective, however, the drugs used in such a combination
regimen would ideally possess the following characteristics:

A

• Some efficacy even as single drugs in the treatment of the
particular type of cancer
• Different mechanisms of action so that the cytotoxic effect is
maximized; this includes differences in cell cycle specificity
• No or minimal overlapping toxicities

39
Q

chemotherapy drugs affect
rapidly dividing cells—both harmful cancer cells and healthy,
normal cells.

A

Three types of rapidly dividing human cells are

the cells of hair follicles, GI tract cells, and bone marrow cells

40
Q

Myelosuppression

A

bone marrow suppression
or bone marrow depression, is another unwanted adverse effect
of certain antineoplastics. It commonly results from drug- or
radiation-induced destruction of certain rapidly dividing cells
in the bone marrow, primarily the cellular precursors of WBCs,
red blood cells (RBCs), and platelets

41
Q

nadir… occurs roughly 10 to 28 days

after dosing

A
The lowest level of WBCs in the blood
following chemotherapy (or radiation) treatment is called
42
Q

Anticipation

of this nadir based on known cancer drug data

A

can be used to
guide the timing of prophylactic (preventative) administration
of antibiotics and blood stimulants known as hematopoietic
growth factors

43
Q

Targeted drug therapy utilizes drugs
that recognize a specific molecule involved in the growth of
cancer cells, while mostly sparing healthy cells

A

One example of
such targeted therapy is the newer class of cancer drugs known
as monoclonal antibodies

44
Q

Common relative contraindications for cancer drugs include

A

weakened status of the patient as manifested by indicators such
as very low WBC count, ongoing infectious process, severe compromise
in nutritional and hydration status, reduced kidney
or liver function, or a decline in organ function in any system
that may be further affected by the toxic effect of the drug being
administered

45
Q

Cell cycle–specific drug classes include

collectively used to treat a variety of solid and/or circulating
tumors, although some drugs have much more specific indications
than others.

A

antimetabolites, mitotic
inhibitors, alkaloid topoisomerase II inhibitors, topoisomerase
I inhibitors, and antineoplastic enzymes

46
Q

antagonist analogue

A

also known as an antimetabolite

47
Q

antimetabolites inhibit cellular growth
by interfering with the synthesis or actions of compounds critical
to cellular reproduction:

A

the vitamin folic acid, purines, and
pyrimidines. Purines and pyrimidines make up the bases contained
in nucleic acid molecules (DNA and RNA).

48
Q

Antimetabolites
work via two mechanisms:

primarily during S phase

A

(1) by falsely substituting for
purines, pyrimidines, or folic acid; and (2) by inhibiting critical
enzymes involved in the synthesis or function of these compounds.
Thus, they ultimately inhibit the synthesis of DNA,
RNA, and proteins, all of which are necessary for cell survival

49
Q

Folate antagonists

A
  • methotrexate (MTX)
  • pemetrexed
  • pralatrexate
50
Q

Purine antagonists

A
  • cladribine
  • fludarabine (F-AMP)
  • mercaptopurine (6-MP)
  • pentostatin
  • thioguanine (6-TG)
51
Q

Pyrimidine antagonists

A
  • capecitabine
  • cytarabine (ara-C)
  • floxuridine (FUDR)
  • fluorouracil (5-FU)
  • gemcitabine
52
Q

allopurinol is chemically similar to purines, it

does not disrupt DNA synthesis. Instead

A

it inhibits xanthine
oxidase, which reduces serum and/or urinary levels of uric
acid.

53
Q

pyrimidine bases

A

cytosine and thymine, occur in the structure
of DNA molecules, and cytosine and uracil are part of the
structure of RNA molecules

54
Q

Floxuridine and fluorouracil

A

are synthetic
analogues of uracil, and cytarabine is a synthetic analogue of
cytosine. Capecitabine is actually a prodrug of fluorouracil and
is converted to that drug in the liver and other body tissues

55
Q

Hyperuricemia can lead to

A

nephropathy, and hemodialysis

may be required in severe cases of tumor lysis syndrome

56
Q

A severe, but usually reversible, form of dermatologic toxicity
is known as palmar-plantar dysesthesia or paresthesia (also
called hand-foot syndrome).

A

range from mild symptoms
such as painless swelling and erythema to painful blistering
of the patient’s palms and soles.

57
Q

Killing of normal cells of the GI mucous membranes may result in adverse
effects such as

A

altered nutritional status, stomatitis with inflammation
and/or ulceration of the oral mucosa throughout the GI tract, altered bowel
function, poor appetite, nausea, vomiting (often intractable and requiring
aggressive antiemetic treatment), and diarrhea

58
Q

Killing of normal cells in the bone marrow results in

A

dangerously low (lifethreatening)
blood cell counts. Because of the negative impact on these
normal cells, the nurse must carefully assess the patient’s WBCs levels
(
leukocytes, neutrophils, and band neutrophils), RBC counts, hemoglobin
level, hematocrit, and platelet counts (see the Safety: Laboratory Values
Related to Drug Therapy box). In addition, monitoring of the patient’s absolute
neutrophil count (ANC) is needed (ANC = % of neutrophils + % bands × WBC).
Monitoring ANC values allows the nurse and other health care providers to
identify the nadir—the time of the lowest count when the patient is most vulnerable.
An ANC of 500 cells/mm3 or lower indicates high risk for infection

59
Q

Killing of the normal cells of hair follicles leads to

A

alopecia (loss of hair).

60
Q

Killing of germinal epithelial cells (also rapidly dividing) leads to

A

sterility
(irreversible) in males, damage to the ovaries with subsequent amenorrhea
in females, and teratogenic effects with possible fetal death in pregnant
women.

61
Q

• For altered nutritional status and impaired oral mucosa:

A

Assess signs and symptoms of altered nutrition with a focus
on weight loss, abnormal serum protein-albumin and blood
urea nitrogen (BUN) levels (a negative nitrogen status due to
low protein levels would be indicated by a decreasing BUN
level), weakness, fatigue, lethargy, poor skin turgor, and pale
conjunctiva. Assess oral mucosa for any signs and symptoms
of stomatitis, such as pain or burning in the mouth, difficulty
swallowing, taste changes, viscous saliva, dryness, cracking,
and/or fissures with or without bleeding of the mucosa.

62
Q

For effects on the GI mucosa:

A

Assess bowel sounds (hyperactive
or hypoactive versus normoactive). Assess for signs and
symptoms of diarrhea, such as frequent, loose stools (more
than three stools per day), urgency, and abdominal cramping.
Obtain information about the presence of blood in the stool as
well as consistency, color, odor, and amount. Assess for nausea
and vomiting and determine whether symptoms are acute,
delayed, or anticipatory; if vomiting occurs, determine the
color, amount, consistency, frequency, and odor, and whether
blood is present. The severity of nausea and vomiting may be
rated using a scale of 1 to 10 (where 10 is the worst symptoms)
or using the terms mild, moderate, and severe

63
Q

For alopecia

A

Assess the patient’s views, concerns, and emotions
about potential hair loss. Assess the patient’s need to prepare for hair loss, either by leaving the hair as it is and allowing it to fall out on its own; having the hair cut short;
or wearing a scarf, hat, bandana, or hair wrap and/or purchasing
a wig before the hair is actually lost. Purchasing a
wig prior to chemotherapy will allow for a closer match to a
patient’s pre-chemotherapy hairstyle.

64
Q

For bone marrow suppression:

A

Assess for signs and symptoms
of anemia or the decrease in RBCs, hemoglobin level, and
hematocrit (e.g., pallor of the skin, oral mucous membranes,
and conjunctiva; fatigue; lethargy; loss of interest in activities;
shortness of breath; and inability to concentrate). Assess for
signs and symptoms of leukopenia (decrease in WBCs [see
Chapter 46] and/or absolute neutrophil count [ANC; normal
range is 1500 cells/mm3, with severe neutropenia being
less than 500 cells/mm3]), including fever; chills; tachycardia;
abnormal breath sounds; productive cough with purulent,
green, or rust-colored sputum; change in the color of
the urine; lethargy, fatigue; and/or acute confusion. Assess
for signs and symptoms of thrombocytopenia (decrease in
thrombocytes [usually less than 100,000] and platelet clotting
factors), including indications of unusual bleeding such
as petechiae; purpura; ecchymosis; gingival (gum) bleeding;
excessive or prolonged bleeding from puncture sites (e.g.,
intramuscular or IV administration sites or blood draw sites);
unusual joint pain; blood in the stool, urine, or vomitus; and
a decrease in blood pressure with elevated pulse rate (see the
Safety: Laboratory Values Related to Drug Therapy box in
this chapter as well as Chapters 26 and 27; see also Box 45-2).
Always assess for the normal ranges of laboratory values.

65
Q

For possible sterility, teratogenesis, damage to ovaries

with amenorrhea:

A

In adult male patients, assess baseline reproductive history with attention to sexual functioning,
fathering of children, and/or past or current reproductive or
sexual problems or concerns. In female adult patients, in addition
to the relevant aspects already mentioned, inquire about
fertility, menstrual and childbearing history, and age of onset
of menses and menopause, if applicable

66
Q

One specific assessment
consideration associated with the use of the antimetabolite
cytarabine is monitoring for the occurrence of

A

cytarabine syndrome.
This syndrome usually occurs within 6 to 12 hours after
drug administration and is characterized by fever, muscle and
bone pain, maculopapular rash, conjunctivitis, and malaise.
Assessment and quick identification of this syndrome can lead
to its prevention and appropriate treatmen

67
Q

In patients receiving mitotic inhibitors (e.g., vinblastine, vincristine)
and alkaloid topoisomerase II inhibitors (e.g., etoposide),

A

perform baseline hepatic and renal function tests, as ordered.
Serum uric acid levels are usually ordered because these levels rise with increased cell death from cancer and/or its treatment

68
Q

With the use of natural enzyme drugs (e.g., asparaginase,

pegaspargase),

A

assess pancreatic function because of the potential

for severe or even fatal pancreatitis

69
Q

Assess individuals for the presence of

the following characteristics before chemotherapy is initiated:

A

(1) genetic markers for oral cancers, (2) genetic determinants
of testosterone or estrogen metabolism, and (3) genetically
linked enzyme system abnormalities such as those involving
specific cytochrome P-450 enzymes that metabolically convert
nicotine to a carcinogenic substance

70
Q

NURSING DIAGNOSES pg741

A
  1. Diarrhea related to the adverse effects of antineoplastic drugs
  2. Acute pain related to the disease process and drug-induced
    joint pain, stomatitis, GI distress, and other discomforts
    associated with antineoplastic cell cycle–specific therapy
  3. Risk for infection related to drug-induced bone marrow suppression
    with possible leukopenia and neutropenia
71
Q

OUTCOME CRITERIA

1. Patient states measures to minimize diarrhea.

A

• Patient states foods and beverages to avoid such as hot,
spicy foods and beverages; alcohol; foods high in fiber;
gaseous foods such as cruciferous vegetables; and raw
seafood.
• Patient takes antidiarrheal medication, as instructed and
if indicated, to avoid dehydration and electrolyte loss.

72
Q

To address nutritional concerns, the following measures may

prove beneficial in improving oral intake and nutritional status:

A

(1) Perform a 24-hour recall of food intake, and report the typical
week’s diet for the patient. (2) Use antiemetic therapy, pain management,
mouth care, and hydration, as ordered, to reduce the
adverse effects of therapy and improve appetite. (3) To ease taste
alterations, advise the patient to consume mild-tasting foods
and to use chicken, turkey cheese, or greek yogurt for protein
sources as tolerated. (4) Provide plastic rather than metal utensils
if the patient complains of a metallic taste. (5) Encourage eating foods that are easy to swallow, such as custards; gelatins; puddings;
milkshakes; eggnog; commercially prepared high-protein,
high-calorie supplemental shakes; mashed white or sweet potatoes;
blended drinks with crushed ice, fruit, and yogurt; nutritional
supplement drinks and snacks; frozen popsicles; and
lactose-free ice cream. (6) Instruct the patient to avoid sticky or
dry foods. (7) Encourage the consumption of small, frequent
meals in an environment that is conducive to eating (e.g., free of
odors and excess noise). (8) Appetite stimulants such as megestrol
acetate or dronabinol may be helpful. (9) Encourage the
patient to practice energy conservation, with frequent rest periods
before and after meals.

73
Q

administration of colony-stimulating
factors may be beneficial. Filgrastim, pegfilgrastim,
and sargramostim are examples of drugs

A

given to accelerate

WBC recovery during antineoplastic drug therapy

74
Q

Nutritional status may be enhanced

by the intake of foods

A

high in folic acid, including bran, dried

beans, nuts, fruits, asparagus, and other fresh vegetables, if tolerated.