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CSO Exam 2018 > Chapter 9: Nutrition Effects of cancer treatment +Medications (2021) > Flashcards

Chapter 9: Nutrition Effects of cancer treatment +Medications (2021) Flashcards

1
Q

What is medical oncology?

A

Cancer treatment using chemotherapy, targeted therapy, immunotherapy, and hormone therapy

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2
Q

Factors that effect recommended treatment

A

The type of cancer, tumor size, location and any metastasis, age and general health of the patient, medical and social history, comorbid conditions, previous cancer treatments, genetic testing, cancer pharmacogenomics.

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3
Q

What is chemotherapy?

A

It is the use of chemical agents or drugs to systemically kill cancer cells.

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4
Q

T/F: Chemotherapy has a cytotoxic effect on all cells (both healthy and malignant).

A

True

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5
Q

Which cells have rapid turnover and more more susceptible to the effects of chemotherapy?

A

bone marrow (blood cells), hair follicles, gonads (ovaries and testes) and gastrointestinal mucosa (mouth, esophagus, stomach and intestines)

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6
Q

T/F: Chemotherapy interferes with cell division and therefore leads to cell death?

A

True

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7
Q

T/F: Slow growing cells are less responsive to the effects of chemo?

A

True

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8
Q

What are the phases of the cell cycle?

A

G0-resting phase (cells are not dividing)
G1-postmitotic phase (cells synthesize DNA and protein)
S-synthesis phase (DNA is synthesized)
G2-premitotic phase (cells prepare to divide)
m-mitotic phase (cells divide into 2 daughter cells)

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9
Q

What are cell cycle nonspecific agents?

A

Agents that damage cells in all phases of the cell cycle.

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10
Q

Examples of cell cycle nonspecific agents.

A

Alkylating agents
Antitumor metabolites
Hormone therapy
Nitrosoureas

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11
Q

What are cell cycle specific agents?

A

Agents that exert their effect within a specific phase of the cell cycle.

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12
Q

Examples of cell cycle specific agents.

A

Antimetabolites (s phase)
Camptothecins (s phase)
Plant alkaloids and Taxans (m phase)

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13
Q

What impacts the amount of side effects a person experiences?

A 
personal health history
the amount of the agent given
the way it is delivered
the length of time it is given
other agents / drugs that may have been previously given
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14
Q

T/F: Patients generally recover from chemotherapy quickly once treatment has stopped.

A

False. It can take weeks, months and even years of the side effects to resolve.

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15
Q

Which organs are most likely to receive permanent damage from chemotherapy?

A

Lungs, heart, liver, kidney, reproductive organs, nerves, bone marrow

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16
Q

What is personalized medicine?

A

Also called “recision medicine”. It uses a patient’s genetic info to prevent, diagnose or treat cancer.

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17
Q

T/F: Knowing if a person has a genetic mutation helps guide the oncologist in customizing certain treatments that may be more effective.

A

True

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18
Q

What is an example of personalized medicine?

A

Genetic testing for the genetic variation that causes a reduction in the enzyme DPD which is needed to metabolize 5-FU. If someone has this variation, 5-FU would not be given because it could cause life-threatening side effects.

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19
Q

What is targeted therapy?

A

The use of drugs that are specific to a type of tumor or they concentrate on the genetic change. They target specific genes or proteins found on the cancer cell. Or it acts on the tissue environment related to cancer cell growth/survival (blood supply).

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20
Q

What are examples of targeted therapy?

A

monoclonal antibodies
immune checkpoint inhibitors
small molecule drugs

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21
Q

What do monoclonal antibodies do?

A

Target specific receptors on the cell surface then activate pathways within the tumor cell to disrupt call function and cause apoptosis.

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22
Q

What are side effects of monoclonal antibodies?

A

Fever, chills, hives, flushing, fatigue, headache, N/V, mouth sores, diarrhea, reduced appetite, dyspnea (labored breathing), rash, hand-foot syndrome

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23
Q

What do immune checkpoint inhibitors do?

A

They block pathways and stop / slow cancer growth.

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24
Q

What do small molecule drugs do?

A

Protein-targeted agents that use small molecules use small molecules that penetrate malignant cell membranes to interact with specific areas of the targeted protein. They disrupt cell function and cause apoptosis.

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25
Q

Example of a small molecule drug.

A

Angiogenesis inhibitor - hinders the formation of new blood vessels in primary and metastatic tumors.

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26
Q

What are the side effects of small molecule drugs?

A

skin rash, facial reddening, hand-foot syndrome, cardiotoxicities, hair can turn white, N/V/D, decreased appetite, taste change

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27
Q

What is immunotherapy?

A

Also called “Biological Therapy” uses the body’s immune system to fight cancer.

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28
Q

What are examples of immunotherapy?

A

Nonspecific immunotherapy
Oncolytic viral therapies
T-cell therapies
Cancer vaccines

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29
Q

Which are the only two cancer vaccines that are approved?

A
  • HPV - Gardasil or cervardix

- Hep B vaccine

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30
Q

Which kinds of cancers does hormone therapy treat?

A

Hormone sensitive cancers: breast, ovarian and prostate.

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31
Q

What are examples of Hormonal Agents?

A 
Antiestrogen
Aromatase inhibitor
Progesterones
Antiandrogens
LHRH agonists
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32
Q

How do antiestrogen agents work?

A

They compete with estrogen for binding to estrogen receptors.

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33
Q

What are examples of antiestrogen agents and which cancer does it treat?

A

tamoxifen
toremifene
raloxifene
(breast ca)

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34
Q

How do aromatase inhibitors work?

A

They block the production of estrogen.

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35
Q

What are examples of aromatase inhibitors and which cancer does it treat?

A

anastrozole
letrozole
exemetane
(post-menopausal breast ca)

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36
Q

What are side effects of antiestrogen agents?

A

menstrual symptoms (hot flashes, sweating, nausea, menstrual irregularities, vaginal dryness, reduced libido, fatigue), weight gain, achy joints

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37
Q

What are the side effects of aromatase inhibitors?

A

hot flashes, N/V, increased cholesterol

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38
Q

How do progesterones work?

A

They inhibit the availability and stability of estrogen receptors.

39
Q

What is an example of a progesterone and which cancer does it treat?

A 
Megasetrol acetate (megase)
(breast, endometrial, renal cell ca)
40
Q

What are the side effects of progesterones?

A

weight gain, N/V, hyperglycemia, hot flashes, mood changes

41
Q

How do antiandrogens work? Which cancer does it work on?

A

They bind to androgen receptors and block the effects of testosterone in androgen-sensitive prostate cancer cells.

42
Q

How do LHRH agonists work?

A

They signal the pituitary gland to stop producing LHRH which results in suppression of testosterone.

43
Q

Which caners are LHRH agonists used for?

A

Prostate and ovarian

44
Q

What are the side effects of LHRH agonists?

A

hot flashes, fatigue, reduced libido, gynecomastia, headaches

45
Q

Notable side effects of Carboplatin (Paraplatin).

A

hypomagnesemia

taste change

46
Q

Notable side effects of cisplatin (Platinol)

A 
N/V - acute and delayed vomiting
Metallic taste
Hypomagnesema
low calcium and potassium
Ototoxicity
47
Q

Which medication needs IV fluids to be given before and after its administration?

A

Cisplatin, d/t risk of renal toxicity

48
Q

What special side effect does Oxaliplatin (eloxatin) have?

A

cold sensitivity / neuropathy - avoid cold for 5 days after drug administration

49
Q

What is one of the major side effects of Irinotecan (camptosar)?

A

Diarrhea - both early diarrhea (within 24 hours) and late diarrhea (>24 hours after receiving drug)
Fluid replacement is important
Can reduce appetite
No St. John’s Wort

50
Q

Side effect of Azacitidine (vidaza)?

A

hypokalemia

51
Q

Notable side effect of Capecitabine (xeloda)?

A

Hand-foot syndrome

52
Q

Notable side effects of Fluorouracil (5-FU)?

A

Hand-foot syndrome
Taste changes
Photosensitivity

53
Q

Notable side effects of Hydroxyurea (hydrea)?

A

Darkening / thickening of the nails

54
Q

Notable side effect of Methotrexate (MTX)?

A

oral and GI ulcerations

photosensitivity

55
Q

What is the antidote for methotrexate (MTX)?

A

leucovorin (folinic acid)

56
Q

Pemetrexed (alimta) requires which two vitamins to reduce its side effects?

A

Folic acid and B12

57
Q

What two things should you avoid with Procarbazine?

A

Tyramine-rich foods

alcohol

58
Q

What should you avoid when taking vincristine (oncovin)?

A

alcohol

59
Q

Notable side effects of Bleomycin (blenoxane)?

A 
Pulmonary toxicity (SOB)
skin / nail changes - hyperpigmentation
60
Q

Notable side effects of Doxorubicin (adriamycin)?

A

Hand-foot syndrome
Red-orange urine
“The Red Devil” - can cause tissue damage if it leaves the vein.

61
Q

Notable side effect of Idarubicin (idamycis)?

A

Hand-foot syndrome

Red urine

62
Q

Side effect of Etoposide (vepesid)?

A

Metallic taste during infusion

63
Q

Side effects of Vincristine (oncovin), Vinblastine (velban) and Vinorelbine (navelbine)?

A

Constipation

64
Q

Notable side effect of Erbitux (cetuximab)?

A

hypomagnesemia

65
Q

Notable side effect of Vectibix (panitumumab)?

A

hypomagnesemia

66
Q

Notable side effects of Prolia (denosumab)?

A

hypocalcemia

increased risk for osteoporosis

67
Q

Notable side effects of Nivolumab (opdivo)?

A

hyponatremia (Na)
hypokalemia (K)
hypomagnesemia (Mg)

68
Q

Notable side effects of Pembrolizumab (keytruda)?

A

Hyperglucemia
Hyponatremia
Hypoalbuminemai
constipation

69
Q

What should you avoid with Bortexomin (Velcade)?

A

green tea

70
Q

Many medications use the enzyme Cytochrome P450 (CYP). What common herb stimulates CYP and can cause a reduction in drug availability?

A

St John’s Wort

71
Q

Many medications use the enzyme Cytochrome P450 (CYP). What common food inhibits CYP and can cause an increase in drug availability?

A

grapefruit juice

72
Q

What vitamin reduces the incidents of hand-foot syndrome in 5-FU, Oxaliplatin (eloxatin) and Capecitabine (xeloda)? How much should be given?

A

B6, 50-100 mg/day x 2-3 times per day

73
Q

Important consideration for Cyclophosphamide (cytoxan)?

A

vigorous oral hydration (3L fluid per day). Empty bladder every 2-3 hours

74
Q

What should be monitored with Cetuximab (Erbitux)

A

Mg and Calcium (risk of those going low)

75
Q

What should you avoid when Mercaptomurine (6-MP) is given?

A

dairy

76
Q

What vitamin do you need to limit with Bexarotene (targretin)?

A

Vitamin A - limit to 1500 mg per day

77
Q

Side effects of Cisplatin (Platinol)

A 
Renal toxicity - IV fluids before and after to protect kidneys
Metallic taste
Reductions in Mg, Ca, and potassium
Ototoxicity
Vomiting - acute and delayed
78
Q

What should you monitor when someone is taking Cisplatin (platinol)?

A

Renal function (Cr, electrolytes, Mg, Na, K)

79
Q

With Fluorouracil (5-FU) what should be given for 10-15 minutes before and after medication administration>

A

ice chips

80
Q

Which two vitamins should be given before and during treatment with Pemetrexed (alimta)?

A

Folic acid: 350-1000 nanograms

B12: 1000 nanograms

81
Q

Which macronutrient reduces the absorption of Regorafenib (stivarga)

A

Fat (give with low fat meals for better absorption)

82
Q

Side effects of Tamoxifen?

A

hot flashes / sweating
menstrual irregularities
fluid retention / edema

83
Q

Side effects of Megase?

A

increased appetite and weight

84
Q

Side effects of Dexamothasone (Decadron)

A

increased blood sugars
increased appetite
muscle weakness
impaired wound healing

85
Q

Side effects of Docetaxel (Taxotere)

A 
peripheral neuropathy 
mucositis
myleosuppression
N/V
D
86
Q

Side effect of Aromatase Inhibitors
anastrozole
Letrozole
Exemestane

A

Bone pain

“every bone in my body hurts”

87
Q

Considerations with Temozolomide (Temodar)

A 
Take zofran before
Take on empty stomach
Nausea
Taste changes
reduced appetite
88
Q

Side effects of Paclitaxel (Taxol)

A

peripheral neuropathy
mucositis / mouth sores
may get hypersensitivity reaction after taxol is given

89
Q

What should you avoid with Imatinib (Gleevec)

A

St. John’s Wort

90
Q

What should you take with Deferasiox (Exjade)

A

Lactose enzyme

this medication contains lactose

91
Q

What can alter the absorption of Regorafenib (Stivarga)

A

Fat

Give medication with low fat meals (lower the fat, the better the absorption of this medication)

92
Q

What should you take with Zoledronic Acid (Zameta)?

A

500 mg calcium

400 IU vitamin D

93
Q

When should you recommend Glutamine?

A

to reduce severity of mouth sores (mucositis)

94
Q

What cancer should you avoid Glutamine?

A

Liver Cancer

CSO Exam 2018 (32 decks)

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