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Med Conditions II > Chemotherapy Basics For the Physical Therapist > Flashcards

Chemotherapy Basics For the Physical Therapist Flashcards

1
Q

Second messenger pathways

A

Important for proliferation and differentiation

Intracellular and Extracellular

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2
Q

Activation of oncogenes/inactivation of tumor supporessor genes

A

alters normal cell signaliing

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3
Q

Surgery

A

remove known tumor masses

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4
Q

radiation

A

kill rapidly dividing tumor cells including tumor cells in adjacent tissues

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5
Q

chemotherapy

A

kill rapidly dividing tumor cells

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6
Q

hormonal therapy

A

inhibit the growth and survival of hormone-dependent tumor cells

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7
Q

targeted therapy

A

specifically inhibit processes required for tumor cell growth

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8
Q

chemotherapy toxicity

A

“chemo brain”; mucositis; fatigue; nausea/vomiting; diarrhea; cystitis; sterility; 2nd cancers; neuropathy; alopecia; ototoxicity; pulmonary toxicity; cardiotoxicity; extravasations; organ failure; myelosuppression; skin reactions

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9
Q

quantifying toxicity

A

numerical scale 1-5 (1=mild, 5=death)

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10
Q

toxicity perspective

A

everyone gets some, no one gets all; grades 1-2 most common but 3-4 are likely; grade 5 uncommon

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11
Q

grade 1-2 toxicity

A

accepted by oncology providers, dose reduction not warranted

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12
Q

grade 3-4 toxicity

A

hold dose to permit recovery; reduce subsequent doses; prevention if possible

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13
Q

myelosuppression

A

most common dose-limiting toxicity; onset depends on lifespan of blood cells

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14
Q

neutropenia

A

low WBC count dur to radiation and chemo; precautions include washing hands and minimizing exposure to sick people and crowds

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15
Q

thrombocytopenia

A

low platelet level; need to decrease fall risks (higher bleed risk); watch for increased bruising/petechiae, prolonged bleeding, concomitant meds

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16
Q

anemia

A

signs: fatigue/cardiac symptoms; may be managed w/RBC transfusion, erythropoietic stimulating agents (chemo-induced anemia only)

17
Q

erythropoietic stimulating agents risks

A

Shortened survival and increase is tumor progression or recurrence
Increased risk of serious cardiovascular and thromboembolic events

18
Q

alopecia

A

scalp hair&raquo_space; other body hair; onset 1-2 weeks, maximal ~3 weeks; reversible (regrows in 2-3 months)

19
Q

alopecia risk

A

lowest: hormones, targeted agents; low/moderate: antimetabolites, heavy metals; high: classic alkylating agents; very high: anthracyclines and taxanes

20
Q

diarrhea info

A

mucosa has high cell turnover rate; direct and indirect toxic effects on mucosa; acute: within 24 hours of treatment, cholinergic symptoms; chronic: more than 24 hours after treatment, risk of dehydration

21
Q

nausea/vomiting types

A

acute, delayed, breakthrough, refractory, anticipatory

22
Q

blood clots

A

not as common but still important; watch for DVT/PE; cancer patients at higher risk

23
Q

chemotherapy agents associated with neurotoxicity

A 
Drug Classes
Alkylating agents
Antimetabolites
Mitotic spindle agents
Proteasome inhibitors
24
Q

alkylating agents neurotoxicity (ifosfamide)

A

lethargy, dizziness, confusion, ataxia, coma

25
Q

platinum compounds

A 
Cisplatin and Carboplatin
Peripheral Neuropathy
“Stocking and glove” 
Dysesthesias, parethesias, loss of proprioception
Ototoxicity
Vestibular toxicity
Oxaliplatin
Neuropathies
Acute 
Cold-induced distal dysesthesia and/or paresthesia, hypoesthesia 
Occurs in hands, feet, perioral area, or throat.
Persistent
Cisplatin-like
26
Q

Antimetabolites

A 
Mechanism of Action
Act as structural analogues for DNA base pairs
Inhibit critical enzymes in DNA synthesis
Cytarabine
Cerebellar syndrome
Occurs with high doses
Dysarthria, nystagmus, ataxia
Gemcitabine
No significant neurotoxicity 
Others
Pulmonary toxicity
Rare
27
Q

Antimetabolites - Methotrexate

A

Neurotoxicity
Headache, N/V
Motor paralysis, cranial nerve palsy
Chronic demyelinating encephalopathy

28
Q

mitotic spindle agents

A

Mechanism:
Promote and stabilize microtubule assembly and interfere with disassembly

Peripheral neuropathy
“Stocking and glove”
Others
Alopecia - total body

29
Q

Vinca Alkaloids
Inhibit microtubule assembly

Vincristine
Vinblastine
Vinorelbine

A 
Neuropathy
Sensory
Paresthesias
Motor 
Loss deep tendon reflexes
Cranial
Palsy
Autonomic
Constipation
30
Q

proteasome inhibitor

A

Bortezomib and Carfilzomib
Indication: Multiple Myeloma & Non-Hodgkin’s lymphoma

Peripheral neuropathy

31
Q

antitumor antibiotics

A 
Mechanism of Action
Intercalation into DNA
Interact with topoisomerase
Free radical productionAnthracyclines
The “rubicins”
Doxorubicin

Cardiotoxicity
Acute – arrhythmias, pericarditis
Chronic – Congestive cardiomyopathy

32
Q

molecularly targeted agents

A

Targeted therapy refers to treatment strategies directed against molecular pathways considered to be involved in neoplastic transformation

Drug Classes
Monoclonal antibodies
Signal transduction inhibitors

33
Q

monoclonal antibodies

A

Trastuzumab, Pertuzumab, ado-trastuzumab
Receptor: HER2
Indication: Breast cancer

Reversible cardiac dysfunction – cardiomyopathy

Bevacizumab
Receptor: VEGF
Indication: Colon and Lung cancer

Rare heart failure, hypertension,
Other - GI perforation

34
Q

signal transduction inhibitors

A 
Tyrosine kinase inhibitors (TKIs)
Sorafenib
Receptors: RAF, KIT, VEGF and PDGF 
Indication: Renal Cell Cancer
Other
Hypertension,  heart failure
Sunitinib
Receptors: FLT3, KIT, VEGF and PDGF 
Indication: Renal Cell Cancer & GIST
Other
Hypertension,  heart failure
35
Q

rash

A

Monoclonal antibody
Cetuximab
Receptor: EGFR
Indication: Colon cancer

Toxicity
Acneform rash
Other
Pulmonary toxicity – rare but serious
TKI
Erlotinib 
Receptor: EGFR 
Indication: Lung and Pancreatic cancer
36
Q

hand-foot syndrome

A

Signs and symptoms
Erythema and swelling
Dysesthesia, blistering, desquamation

Agents
Antimetabolites
Fluorouracil (5-FU)
Capecitabine 
TKIs
Sunitinib, sorafenib
Antitumor antibiotics
Doxorubicin
37
Q

hormonal agents

A

Antiestrogens
Tamoxifen, Toremifene, Fulvestrant
thromboembolic events, hot flashes

Aromatase inhibitors
Anastrozole, Letrozole
Hot flashes, joint pain

Androgen Ablation
Lutenizing hormone releasing hormone (LHRH) agonists
Lueprolide, Gosrelin
Hot Flashes, feminization, TUMOR FLARE

38
Q

“Chemo-Brain”

A 
Found in 20-25% of patients 
Subtle shifts in cognitive function
May be seen early or late in treatment
May improve over 6 months – 2 years following chemotherapy
Effects
Difficulty concentrating
Difficulty handling/performing multiple tasks
Difficulty with memory
Mechanism
Unknown
? Which chemotherapy agents
? Genetic or hormonal factors
Not a result of anemia, fatigue or depression
Methods to help function more effectively
? work load
Avoid multiple tasks
Make lists
Encourage more sleep

Med Conditions II (8 decks)

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