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Pharmacology Exam 3 > Chemotherapy Lecture > Flashcards

Chemotherapy Lecture Flashcards

1
Q

What causes cancer?

A

Accumulated DNA mutations alter cellular function.
Mutations occur in proto-oncogenes (→ oncogenes) or tumor suppressor genes.
Leads to unchecked cell growth, tumor formation, and invasion

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2
Q

what are proto-oncogenes and oncogenes?

A

Sections of DNA that encode for genes used to make specific proteins vital to promoting cell growth

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3
Q

what are tumor suppressor genes?

A

Some genes encoded in DNA help regulate cell growth (ie, serve as a mechanism to prevent over-stimulating cell growth

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4
Q

How are the types of cancer named/classified?

A

typically named for site of origin/tissue type (breast, lung, colon)

solid tumors = affect organs and other solid tissues and is specified by origin of cell type
hematologic malignancies = affect blood cells

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5
Q

how is cancer treated?

A

Localized: Surgery, radiation.
Systemic: Chemotherapy (monoclonal antibodies), targeted therapy, CAR-T cell therapy, stem cell transplantation.

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6
Q

how is radiation used for cancer?

A

exposes the patient to ionizing radiation using high energy photon beams – destroys cancer cells or stops them from growing
*may cause damage to neighboring tissues

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7
Q

how is chemo used for cancer?

A

many chemo drugs targets normal mechanisms of cell function to block cancer cell growth and division

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8
Q

What is the purpose of combination chemotherapy?

A

Efficacy: Target cancer in multiple ways.
Toxicity: Minimize overlapping toxicities.
Mechanisms: Use drugs with differing MOAs to reduce resistance

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9
Q

What are neoadjuvant vs. adjuvant chemotherapy?

A

Neoadjuvant: Before surgery/radiation to shrink tumors.
Adjuvant: After surgery/radiation to eliminate residual cancer cells.

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10
Q

what is the dosing “risk” with chemo?

A

chemo kills in a dose dependent fashion. higher doses = kill more cells. HOWEVER, higher doses = more side effects.

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11
Q

what is apoptosis?

A

cell-mediated mechanism of cell death that can be induced by drugs blocking activities the cell needs to function

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12
Q

goals of cancer treatment?

A

Cure: a sustained cancer-free period

Control: reduce cancer burden, prevent extension of cancer and extend survival. *cure is unlikely

Polliation: reduce symptoms of disease, improve QoL, prolong survival. *cure is unlikely

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13
Q

what are the responses to cancer treatment?

A

Remission/Complete Response: unable to detect presence of cancer

Cure: prolonged period of remission (~5 years)

Partial Response: reduction in tumor burden but cancer still present

Stable Disease: tumor present but not grown or shrunk

Treatment Failure/Progressive Disease: cancer continues to grow despite treatment

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14
Q

how does a medical team determine the response to cancer treatment?

A

physical exam, radiographic tests (MRI, CT, PET), tumor markers (proteins in blood), biopsies/blood tests

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15
Q

what are other reasons there might be a lack of effect from chemo?

A

drug interactions between chemo and non-chemo drugs
food interactions
poor adherence to therapy

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16
Q

What is cancer-related fatigue, and how is it managed?

A

Fatigue that doesn’t resolve with rest; worsens with treatment.
Management: Regular exercise, hydration, balanced diet, managing comorbid conditions.

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17
Q

What is CAR-T therapy?

A

T-cells harvested, re-engineered to express chimeric antigen receptors (CARs), and reinfused.
Targets specific cancer antigens (e.g., CD19 in leukemia/lymphoma)

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18
Q

how are cancer cells able to evade detection by the immune system?

A

due to their development from normal cells and activation of methods to shut down immune-mediated destruction

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19
Q

how does immunotherapy help treat cancer?

A

enhances, manipulates, and/or mimics the body’s ability to identify and destroy cancer cells

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20
Q

why are monoclonal antibodies a good choice for immunotherapy for cancer?

A

laboratory created antibodies that target specific sites on cancer cells and has multiple mechanisms of action to kill cancer cells

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21
Q

what are the two types of hematopoietic stem cell transplant for cancer?

A

allogeneic and autologous

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22
Q

What is the difference between allogeneic vs. autologous hematopoietic stem cell transplant?

A

Allogeneic: Uses stem cells from a donor after chemo; includes risks of graft-versus-host disease (GVHD) but may provide graft-versus-tumor effect. *gives brand new immune system

Autologous: Uses patient’s own stem cells post-high-dose chemo; lower GVHD risk, primarily for rescue and recovery.

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23
Q

What are the side effects of chemotherapy?

A

Nausea/vomiting (CINV): Acute, delayed, anticipatory.
Myelosuppression: Neutropenia, anemia, thrombocytopenia.
GI: Diarrhea, mucositis, constipation.
Hair loss (alopecia)

24
Q

are people undergoing chemo toxic?

A

NO lol

BUT urine, stool, blood, and vomit may contain active chemo so that should be considered a biohazard (usually is anyway)

25
Q

What causes anorexia in cancer patients, and how is it managed?

A

Causes: Altered taste, reduced hunger mechanisms, chemo-induced nausea, GI ulcerations.

Management:
Small, frequent, high-calorie meals.
Light daily exercise to maintain muscle.
Medications

26
Q

How is nausea and vomiting (CINV) managed?

A

Before chemo: 5HT3 antagonists (ondansetron) give meds to prevent acute and anticipatory
After chemo: cannabinoids after chemo to treat or prevent delayed CINV

27
Q

What are the benefits of physical activity in cancer patients?

A

Improves strength, balance, and mental health.
Reduces fatigue, risk of DVT, osteoporosis, and secondary cancers.
Enhances overall quality of life

28
Q

What are precautions for physical activity in cancer patients?

A

Avoid public gyms with neutropenia.
Modify activities for neuropathy, anemia, or IV catheters.
Avoid heavy weight exercises with osteoporosis or low platelets

29
Q

What are colony-stimulating factors used for in cancer patients?

A

Stimulate WBC recovery post-chemotherapy

30
Q

What is graft-versus-tumor effect?

A

Engrafted donor cells attack cancer cells, primarily seen in hematologic malignancies

31
Q

What are secondary malignancies?

A

Cancers caused by mutagenic effects of prior chemo.
Commonly leukemia or lymphoma; typically harder to treat

32
Q

What are the 3 phases of cancer patient care?

A

During treatment: Focus on tolerance and response.
Recovery: Rebuild strength, manage late effects.
Advanced cancer: Quality of life improvements.

33
Q

What are the 3 phases of chemotherapy-induced nausea and vomiting (CINV)?

A

Acute: Within 24 hours of chemotherapy.
Delayed: Occurs 24–48 hours after chemotherapy.
Anticipatory: Triggered by prior negative experiences or anxiety about chemotherapy

34
Q

Patient Factors that also affect the likelihood of CINV?

A

Age < 50 years
Anxiety
History of motion sickness
Female gender
Previous episodes of CINV

35
Q

What are other GI tract toxicities of chemotherapy?

A

Diarrhea: Dehydration risk.
Constipation: From medication or reduced activity.
Mucositis: Painful ulcerations in the GI lining, affecting nutrition and quality of life

36
Q

What is bone marrow suppression (myelosuppression)?

A

Most common dose-limiting toxicity of chemotherapy.
Affects production of red blood cells, white blood cells, and platelets.
Leads to anemia, neutropenia, and thrombocytopenia.

37
Q

What are the effects and management of anemia in chemotherapy?

A

Effects: Fatigue, shortness of breath, dizziness, pallor.
Management: RBC transfusions or erythropoietin-stimulating agents

38
Q

What is thrombocytopenia and how is it managed?

A

Definition: Low platelet count → increased bleeding risk (e.g., gums, nose, GI tract).
Management: Platelet transfusions; avoid NSAIDs and aspirin.

39
Q

What is normal platelet count and what levels restrict patients from physical activity?

A

normal = 150K - 450K

<50K is super low and restricts physical activity

40
Q

What is normal neutrophil count

A

3K - 7K

41
Q

What is neutropenia, and why is it significant?

A

Definition: Low neutrophil count → ↑ risk of infections.
Management: Prophylactic antibiotics, G-CSF (e.g., filgrastim)
Precautions: Avoid public places; use masks and gloves.

42
Q

What is the WHO Pain Ladder for managing cancer pain?

A

Non-opioids: NSAIDs, acetaminophen.
Weak opioids: Codeine, tramadol.
Strong opioids: Morphine, fentanyl, oxycodone.

43
Q

What is alopecia in cancer treatment?

A

Hair loss caused by chemotherapy targeting rapidly dividing cells.
Usually starts 7–10 days after treatment begins; hair regrows post-treatment.
Management: wigs, hats, other head covering

44
Q

What is extravasation, and why is it dangerous?

A

Definition: Leakage of chemotherapy drugs into surrounding tissues during IV administration.
Effects: Tissue damage, large open wounds
Occurs with only some chemotherapy - Vesicants: Vincristine

45
Q

What are the signs/symptoms of Extravasation?

A

pain, redness, burning, pallor, no blood return, edema, decreased IV flow or flush

46
Q

What is chemotherapy-induced neuropathy?

A

Symptoms: Sensory, motor, or autonomic nerve damage (e.g., pain, numbness, weakness).
Causes: Drugs like vincristine, cisplatin, paclitaxel.
Management: Physical therapy, duloxetine, gabapentin, TCAs

47
Q

What are organ toxicities caused by chemotherapy?

A

Renal: Cisplatin.
Cardiac: Doxorubicin.
Pulmonary: Bleomycin.
Liver: Methotrexate.
Neurologic: Vincristine, paclitaxel.

48
Q

What is the impact of cancer on patients?

A

Physical: Fatigue, nerve damage, deconditioning.
Mental: Cognitive impairment (“chemo brain”), anxiety, depression.
Social: Dependency, reduced quality of life

49
Q

What are the ACS guidelines to reduce cancer risk in healthy individuals?

A

150–300 minutes of moderate or 75–150 minutes of vigorous activity per week.
Healthy diet: Limit alcohol, maintain healthy weight.
Avoid prolonged sitting; stay active daily.

50
Q

What is targeted physical therapy for cancer patients?

A

Pain: Soft tissue mobilization, massage.
Deconditioning: Aerobic training to rebuild endurance.
Lymphedema: Range of motion, bandaging.
Genitourinary issues: Pelvic floor strengthening

51
Q

When should you avoid exercise in cancer patients?

A

when it puts them at risk of injury or health issues
anemia
electrolyte imbalances
immunocompromised
unrelieved pain, N/V
Pts undergoing radiation avoid pools bc chemicals can irritate irradiated skin

52
Q

when should you limit or change exercise in cancer patients?

A

severe fatigue
IV catheters or feeding tubes (avoid pool/lake/ocean to reduce infection risk)
^IV catheters avoid resistance training in area where IV is
AVOID heavy weights with osteoporosis or low platelets

53
Q

What is the role of physical therapists in caring for cancer patients?

A

Assess functional limitations and provide tailored training.
Educate on activity benefits and fatigue management.
Design individualized plans for pain, deconditioning, and recovery

54
Q

Why is surgery not typically used for hematologic malignancies?

A

Hematologic malignancies (e.g., leukemia, lymphoma) affect circulating cells, not solid tumors.
Surgery is limited to diagnostic biopsies or addressing specific complications

55
Q

What are common prognostic factors for cancer?

A

Tumor-related: Size, grade, stage (TNM classification).
Patient-related: Age, comorbidities, functional status.
Biological: Genetic mutations, hormone receptor status, molecular markers

56
Q

What is salvage chemotherapy, and when is it used?

A

High-dose chemo used for relapsed or refractory cancer.
Goal: Prolong survival, achieve remission in patients unresponsive to standard therapy

Pharmacology Exam 3 (8 decks)

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