Chemotherapy for Cancer Flashcards
4 major classes of drugs for cancer
- Cytotoxic drugs = directly kill cells (no prototype)
- Hormones and Hormone Antagonists
- Targeted drugs = drugs that bind to specific molecules that promote cancer growth
- Biologic Response Modifiers = immunomodulating agents
drugs for cancer that directly kill cell?
cytotoxic drugs
drugs for cancer that bind to specific molecules that promote cancer growth
targeted drugs
drugs for cancer that are immunomodulating agents
Biologic Response Modifiers
During what phase of the cell cycle do we not give chemo? Which ones do we give chemo?
No chemo = G0
Yes Chemo= S, G2, M
class of chemo drugs that target S phase of cell cycle
◦ Antimetabolites
Class of chemo drugs that target G2 phase of cell cycle?
taxanes/taxoids
Class of chemo drugs that target M phase of cell cycle?
◦ Vinca alkaloids
Chemo drugs that have killing action REGARDLESS of cell cycle phase?
◦ Alkylating agents
◦ Antitumor antibodies
goal of chemo?
kill or stop the growth of cancer
4 types of cytotoxic agents
a) Alkylating Agents
b) Antimetabolites
c) Antitumor antibiotics
d) Mitotic Inhibitors
what is growth fraction related to chemo, why do i care?
• 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
cancer w/ high or low growth fraction will respond better to chemo?
high
cells that proliferate more in body and are thus effected by chemo
GI tract, hair follicles, bone marrow, sperm forming cells
killing off too many of normal/healthy cells so stop chemo
^ what is a fancy way to say this?
• Chemotherapy dose limiting side effects
examples of cancer w/ low growth fraction?
solid tumors like breast or lung cancer
examples of cancer w/ high growth fraction?
lymphoma , acute lymphocytic leukemia
*will respond better to chemo
what is recruitment related to cancer treatment?
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
what is neoadjuvant chemo?
chemo before surgery –> shrinks tumor, clearer margins, less drastic surgery
How is chemo dosed? (equation)
Total body surface area (TBSA)
◦ Ht (cm) X Wt (kg) divided by 10,000=______cm2
Is chemo continuous or do you go thru cycles?
◦ Every 3-4 weeks with 6-12 treatments at a time
Many chemo drugs are vesicants so need to be administered via _____ _____.
central line
If you have extravasation from chemo what do you do?
leave line in place, call pharmacy, may need skin grafts
examples of combination therapy
- CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)
- CML (cyclophosphamide, methotrexate, 5FU)
Why do we give chemo in combination cycles/ dosing schedule?
- 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
PPE for chemo precautions (3)
Special gloves, gown, mask
3 things you need when giving chemo (safety measures)
PPE
yellow bag
chemo spill prcautions
chemo excrement precautions
–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
General side effects of chemo
- alopecia
- GI: mucositis, stomatitis, diarrhea, emesis
- Bone marrw suppression
- Tissue damage: vesicants
- infertility
- secondary cancers
- hyperuricemia
- fluid/electrolyte imbalance
IS chemo safe for preggos?
‣ after 18 weeks of preg = low risk to fetus = avoid in first trimester
secondary cancers from chemo occurs more with what type of chemo agents?
alkalining b/c of DNA damage
hyperuriciemia w/ which cancers in particular? give patients what to decrease uric acid?
leukemia, lymphoma
allopurinol
considerations for n/v from chemo?
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
most effective drug combo for anti-emetic
◦ Aprepitant + Ondansetron + Dexamethason
what part of brain controls vomitting? why do I care about this?
medulla in brain
–>most antiemetics act on the brain and have a CNS side effect profile
time of lowest count after chemo dose, occurs 10-14 days, stays low for about a week and then comes back up =
nadir
Interventions for nadir?
◦ 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
ANC =
(WBC) (%Neut + %Bands)
Why do I care about ANC related to chemo?
‣ ANC <500= neutropenic
‣ tells us if we should hold next dose of chemo
‣ may need to do drug therapy
ANC< _____ = neutropenic precautions
500
prototype for drug that stimulates neutrophil prdocution by bone marrow?
–filgrastim (Neupogen)
filgrastim (Neupogen) admin consideration
don’t give w/in 24 hours of chemo
side effects of filgrastim (Neupogen)
bone pain
–> makes since b/w it is working inside your bones
treatments for stomatitis
•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
prototype for hormone/hormone antagonist chemotherapy
tamoxifen (Nolvadex) –> SERM
hormone therapy for cancer eill only work on _____ dependent tumors
hormone
general side effects from hormone therapy chemo?
–Hot flashes, decreased libido, gynecomastia, hirsutism, nausea, fatigue
tamoxifen (Nolvadex) fxn
Block estrogen receptors on breast cancer cells, but have estrogen effects on non-breast cells
indication for tamoxifen (Nolvadex)
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)
give tamoxifen (Nolvadex) with or without food?
with! to decrease GI distress (milk okay)
side effects of tamoxifen (Nolvadex)
N/V, hot flashes, fluid retention, menstrual irregularities
◦ estrogen effect: increased risk of endometrial cancer, PE and DVTs
how do targeted therapies fxn
targets proteins that control how cancer cells grow, divide, and spread”
2 classes of targeted therapies
nibs and mabs
nibs vs mabs- where do they work
•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)
different ways mabs work
–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.
targets of targeted therapy examples
- HER2
- Kinase inhibitors
- mTOR inhibitors
- Hedgehog pathway inhibitors
- Angiogenesis targets
- Proteasome targets
side effects of mabs
–Infusion reactions (most given IV or SQ)
–Allergic reaction : Rash, fever, chills
•Humanized has less risk of allergic reaction (U)
nibs side effects?
Dependent on the specific receptors targeted.
2 types of biological response modifiers?
- immunostimmulants: interlukin and interferons
2. immunosuppressant
2 types of immunostimulants
interleukins
interferons
what do immunostimmulants do?
stimulate immune sxs to do what it does
example of immunosuppressant, why use them?
- Prednisone and dextromethasone(Decadron)
- Useful to treat lymphoid cancers
- Manage complications of cancer therapy (decrease swelling/inflammation, stimulate appetite)
