Chemotherapy Flashcards
What is the goal of Chemotherapy?
to eliminate or reduce the number of malignant cells
What are the factors involved in determining response to treatment?
- Rapid mitotic rate
- Size of tumor
- Age of tumor
- Location of tumor
- Presence of resistant tumor cells
What is the effect of chemotherapy against cells?
It stops the replication of cancer cells by arresting them in the G0 phase
What protective measures must be taken when handling chemotherapy drugs and why?
- Wear gloves and mask when handling drugs
- Drugs may be absorbed through skin or inhaled
What are the four stages of chemotherapy?
- Induction
- Intensification
- Consolidation
- Maintenance
Describe the induction stage of chemotherapy.
- Large amounts of therapy given in an attempt to induce remission.
- Seek to destroy leukemic cells in tissues, peripheral blood, and bone marrow.
- Patient may become critically ill.
During the induction phase, nursing interventions focus on…
- Neutropenia, thrombocytopenia, and anemia
- Psychological support for the patient and family
After one course of induction therapy, approximately __% of newly diagnosed patients achieve complete remission.
• 70%
Describe the intensification stage of chemotherapy.
- High-dose therapy to kill any remaining cancer cells post induction therapy
- Same drugs at higher doses and/or other drugs
Describe the consolidation stage of chemotherapy.
- Given after remission is achieved to eliminate remaining leukemic cells that may not be pathologically evident
- Same drugs at higher doses and/or other drugs
Describe the maintenance stage of chemotherapy.
- Lower doses of the same drug given every 3 to 4 weeks
- Goal is to keep the body free of leukemic cells.
- In AML, maintenance therapy is rarely effective and therefore is rarely administered.
What is the point of combination chemotherapy?
- ↓ Drug resistance
- ↓ Drug toxicity using multiple drugs
- Interrupt cell growth at multiple points
Drugs may be irritants or vesicants. Describe the difference.
- Irritants: Damage intima of vein, but not tissue
- Vesicants: Severe local tissue breakdown and necrosis
What are some s/s of extravasation?
Redness or swelling w/ cool pale skin surrounding the IV site
If extravasation is suspected, what action should be taken?
- STOP infusion: aspirate rest of drug
- Leave needle in place: so can infuse antidote
- No pressure-sterile occlusive dressing, elevate, heat or cold (according to guidelines)
- Document: photo if guidelines specify; monitor
- Patient teaching-site care
- Plastic Surgery prn
What should the patient report when receiving vesicant drugs?
Sensations of burning or pan at infusion site
What are the methods of administration for chemotherapy?
- Central line
- Directly into tumor
- Intra-arterial
- Intra-vesical bladder
- Intrathecal/intraventricular
What are the advantages of central line chemotherapy?
- Placement in large blood vessels (safety)
- Frequent, continuous, or intermittent administration
- Can be used to administer other fluids (blood, electrolytes, etc.)
What is the advantage of delivering chemotherapy directly into tumor site?
Higher concentrations of drug can be delivered with less systemic toxicity.
Describe intra-arterial administration of chemotherapy.
Delivers drug through arterial vessel supplying tumor
Describe intra-peritoneal administration of chemotherapy.
Delivers drug to peritoneal cavity for treatment of peritoneal metastases
How is intra-peritoneal chemotherapy delivered?
- Chemotherapy is generally infused into the peritoneum in 1 to 2 L of fluid
- Allowed to “dwell” in the peritoneum for a period of 1 to 4 hours.
- Following the “dwell time,” the fluid is drained from the peritoneum.
Describe Intrathecal or intraventricular chemotherapy administration and what cancers it is commonly used for.
- Involves lumbar puncture and injection of chemotherapy into subarachnoid space
- Commonly used for breast, lung, and GI tumors, leukemia, and lymphoma.
Describe intra-vesical bladder administration of chemotherapy.
Agent added to bladder by urinary catheter and retained for 1 to 3 hours
What are the complications of intra-vesical bladder chemotherapy?
- Dysuria
- Urinary frequency
- Hematuria
- Cystitis
- Urinary tract infection
- Bladder spasms.
What are the two types of venous access devices used for systemic delivery of chemotherapy?
- Non-tunneled PICC line
- Tunneled central venous line
True or False
The use of PICC and Central lines is a clean procedure and are flushed with procedure with LR solution.
False. It is a STERILE procedure and they are flushed w/ NS
True or False
Chemotherapeutic agents cannot distinguish between normal and cancer cells
True
What are 3 common body responses to products of cellular destruction
- Fatigue
- Anorexia
- Taste alterations
What are the 3 classes of general and drug-specific adverse effects of chemotherapy?
- Acute
- Delayed
- Chronic
Describe acute toxicity to chemotherapy.
Occurs during and immediately after drug administration and includes:
- Anaphylactic and hypersensitivity reactions
- Extravasation or a flare reaction
- Anticipatory nausea and vomiting, and cardiac dysrhythmias.
Delayed effects to chemotherapy are numerous and include:
- Delayed N/V
- Mucositis
- Alopecia
- Skin rashes
- Bone marrow suppression, and
- Altered bowel function (diarrhea or constipation)
Chronic toxicities of chemotherapy involve damage to
organs such as the heart, liver, kidneys, and lungs.
True or False
Chemotherapy drugs are given one after another
False, they are given in combination
Chemotherapy dosages are carefully calculated according to
Chemotherapy dosages are carefully calculated according to
BSA
Selecting chemotherapy drugs with different modes of action minimizes
occurrence and severity of adverse effects
