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Kol- Pharm 323 Spring > Chemotherapy for Cancer > Flashcards

Chemotherapy for Cancer Flashcards

1
Q

4 major classes of drugs for cancer

A
  1. Cytotoxic drugs = directly kill cells (no prototype)
  2. Hormones and Hormone Antagonists
  3. Targeted drugs = drugs that bind to specific molecules that promote cancer growth
  4. Biologic Response Modifiers = immunomodulating agents
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2
Q

drugs for cancer that directly kill cell?

A

cytotoxic drugs

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3
Q

drugs for cancer that bind to specific molecules that promote cancer growth

A

targeted drugs

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4
Q

drugs for cancer that are immunomodulating agents

A

Biologic Response Modifiers

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5
Q

During what phase of the cell cycle do we not give chemo? Which ones do we give chemo?

A

No chemo = G0

Yes Chemo= S, G2, M

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6
Q

class of chemo drugs that target S phase of cell cycle

A

◦ Antimetabolites

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7
Q

Class of chemo drugs that target G2 phase of cell cycle?

A

taxanes/taxoids

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8
Q

Class of chemo drugs that target M phase of cell cycle?

A

◦ Vinca alkaloids

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9
Q

Chemo drugs that have killing action REGARDLESS of cell cycle phase?

A

◦ Alkylating agents

◦ Antitumor antibodies

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10
Q

goal of chemo?

A

kill or stop the growth of cancer

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11
Q

4 types of cytotoxic agents

A

a) Alkylating Agents
b) Antimetabolites
c) Antitumor antibiotics
d) Mitotic Inhibitors

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12
Q

what is growth fraction related to chemo, why do i care?

A

• Ratio of replicating cells vs. number of resting cells
◦ most chemo is more active against proliferating cells than resting cells
◦ types of cancer w/ high growth fraction will respond better to chemo
◦ chemo toxicity and side effects will be seen in cells that proliferate more: GI tract, hair follicles, bone marrow, sperm forming cells

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13
Q

cancer w/ high or low growth fraction will respond better to chemo?

A

high

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14
Q

cells that proliferate more in body and are thus effected by chemo

A

GI tract, hair follicles, bone marrow, sperm forming cells

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15
Q

killing off too many of normal/healthy cells so stop chemo

^ what is a fancy way to say this?

A

• Chemotherapy dose limiting side effects

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16
Q

examples of cancer w/ low growth fraction?

A

solid tumors like breast or lung cancer

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17
Q

examples of cancer w/ high growth fraction?

A

lymphoma , acute lymphocytic leukemia

*will respond better to chemo

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18
Q

what is recruitment related to cancer treatment?

A

surgery to debulk can stimulate remaining cancer cells to leave G0 phase and enter cell cycle which means it will respond better to chemo
‣ do surgery first THEN chemo

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19
Q

what is neoadjuvant chemo?

A

chemo before surgery –> shrinks tumor, clearer margins, less drastic surgery

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20
Q

How is chemo dosed? (equation)

A

Total body surface area (TBSA)

◦ Ht (cm) X Wt (kg) divided by 10,000=______cm2

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21
Q

Is chemo continuous or do you go thru cycles?

A

◦ Every 3-4 weeks with 6-12 treatments at a time

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22
Q

Many chemo drugs are vesicants so need to be administered via _____ _____.

A

central line

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23
Q

If you have extravasation from chemo what do you do?

A

leave line in place, call pharmacy, may need skin grafts

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24
Q

examples of combination therapy

A
  • CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)
  • CML (cyclophosphamide, methotrexate, 5FU)
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25
Q

Why do we give chemo in combination cycles/ dosing schedule?

A
  • Allow cell recovery time between cycles
  • Time allows different cell cycles to be attacked
  • Suppresses drug resistance when using different agents

• Normal cells come back first and then cancer cells don’t have enough time for recovery before next round of chemo

26
Q

PPE for chemo precautions (3)

A

Special gloves, gown, mask

27
Q

3 things you need when giving chemo (safety measures)

A

PPE
yellow bag
chemo spill prcautions

28
Q

chemo excrement precautions

A

–Wear gloves for all body fluids
–Double flush toilet, cover toilet w/ chux when flushing to prevent backsplash
–No body fluids in trash, dispose in chemo disposal bags
–Chux over toilet when flushing
–“chemo precautions” on door

29
Q

General side effects of chemo

A
  • alopecia
  • GI: mucositis, stomatitis, diarrhea, emesis
  • Bone marrw suppression
  • Tissue damage: vesicants
  • infertility
  • secondary cancers
  • hyperuricemia
  • fluid/electrolyte imbalance
30
Q

IS chemo safe for preggos?

A

‣ after 18 weeks of preg = low risk to fetus = avoid in first trimester

31
Q

secondary cancers from chemo occurs more with what type of chemo agents?

A

alkalining b/c of DNA damage

32
Q

hyperuriciemia w/ which cancers in particular? give patients what to decrease uric acid?

A

leukemia, lymphoma

allopurinol

33
Q

considerations for n/v from chemo?

A 
Chemo is emetogenic
•Onset when drug is given and for 1-2 days after 
•Sometimes delayed onset or ongoing 
•Pre-medicate 
•Drug therapy 
•Combination drug therapy most effective
•Nonpharmacological
–Music, relaxation, imagery
–Smell 
–Watch for dehydration, F&E imbalances 
• Directly stimulates the chemoreceptor trigger zone = why it makes you so nauseous 
	◦ Drugs can be classified by emetic potential
34
Q

most effective drug combo for anti-emetic

A

◦ Aprepitant + Ondansetron + Dexamethason

35
Q

what part of brain controls vomitting? why do I care about this?

A

medulla in brain

–>most antiemetics act on the brain and have a CNS side effect profile

36
Q

time of lowest count after chemo dose, occurs 10-14 days, stays low for about a week and then comes back up =

A

nadir

37
Q

Interventions for nadir?

A

◦ sometimes give drugs to help
◦ can be life threatening, can limit dosing of next chemo
◦ do CBC prior to next dose to make sure numbers are back up: if #s too low = delay dose

38
Q

ANC =

A

(WBC) (%Neut + %Bands)

39
Q

Why do I care about ANC related to chemo?

A

‣ ANC <500= neutropenic
‣ tells us if we should hold next dose of chemo
‣ may need to do drug therapy

40
Q

ANC< _____ = neutropenic precautions

A

500

41
Q

prototype for drug that stimulates neutrophil prdocution by bone marrow?

A

–filgrastim (Neupogen)

42
Q

filgrastim (Neupogen) admin consideration

A

don’t give w/in 24 hours of chemo

43
Q

side effects of filgrastim (Neupogen)

A

bone pain

–> makes since b/w it is working inside your bones

44
Q

treatments for stomatitis

A

•Topical antimicrobial: chlorohexadine gluconate (Peridex)
—-Swish and spit regimen
•Half/half saline peroxide mixture
•Viscous lidocaine
•Magic mouthwash (lidocaine, diphenhydramine, maalox, nystatin, predisone, etc.)
•Baking soda/salt rinses (Mission)
•Antifungal- Candida infections

45
Q

prototype for hormone/hormone antagonist chemotherapy

A

tamoxifen (Nolvadex) –> SERM

46
Q

hormone therapy for cancer eill only work on _____ dependent tumors

A

hormone

47
Q

general side effects from hormone therapy chemo?

A

–Hot flashes, decreased libido, gynecomastia, hirsutism, nausea, fatigue

48
Q

tamoxifen (Nolvadex) fxn

A

Block estrogen receptors on breast cancer cells, but have estrogen effects on non-breast cells

49
Q

indication for tamoxifen (Nolvadex)

A

breast cancer prevention in pre and post menopausal women (reduce risk by 50%), also given to treat breast cancer
–Improve bone density
–Improve lipid profiles (inc. HDL, low LDL)

50
Q

give tamoxifen (Nolvadex) with or without food?

A

with! to decrease GI distress (milk okay)

51
Q

side effects of tamoxifen (Nolvadex)

A

N/V, hot flashes, fluid retention, menstrual irregularities

◦ estrogen effect: increased risk of endometrial cancer, PE and DVTs

52
Q

how do targeted therapies fxn

A

targets proteins that control how cancer cells grow, divide, and spread”

53
Q

2 classes of targeted therapies

A

nibs and mabs

54
Q

nibs vs mabs- where do they work

A

•Small molecule drugs (-nibs)
–Able to enter cells and therefore the target site is inside the cell

•Monoclonal antibodies (-mabs)
–Looking for a specific protein receptor that is found on the outside of the cell. (Only 1 target)

55
Q

different ways mabs work

A

–Some mark cancer cells for destruction
–Some stop cancer from growing or cause them to self destruct
–Some carry toxins (such as chemo or radioactive particles) to the cancer cells.

56
Q

targets of targeted therapy examples

A
  • HER2
  • Kinase inhibitors
  • mTOR inhibitors
  • Hedgehog pathway inhibitors
  • Angiogenesis targets
  • Proteasome targets
57
Q

side effects of mabs

A

–Infusion reactions (most given IV or SQ)
–Allergic reaction : Rash, fever, chills
•Humanized has less risk of allergic reaction (U)

58
Q

nibs side effects?

A

Dependent on the specific receptors targeted.

59
Q

2 types of biological response modifiers?

A
  1. immunostimmulants: interlukin and interferons

2. immunosuppressant

60
Q

2 types of immunostimulants

A

interleukins

interferons

61
Q

what do immunostimmulants do?

A

stimulate immune sxs to do what it does

62
Q

example of immunosuppressant, why use them?

A
  • Prednisone and dextromethasone(Decadron)
  • Useful to treat lymphoid cancers
  • Manage complications of cancer therapy (decrease swelling/inflammation, stimulate appetite)

Kol- Pharm 323 Spring (41 decks)

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