chemotherapy - pharm E4 Flashcards
cell cycle
G0: rest phase
G1: cell growth
S: DNA synthesis
G2: prepare to divide
M: mitosis (division)
growth fraction
the ration of proliferating cells to resting cells (G0)
higher amount in prolif = high GF, more in G0 = low G0
what growth fraction rate is harder to kill
the low growth rate
malignant tumors initially grow very
rapidly (high growth fraction)
as the size of the tumor increases, the growth fraction rate and what does it create
lowers -> a necrotic core, decreased nutrient supply at core, more cells in G0
barriers to success
-100% kill required for cure
-toxicity
-late detection
-tumor response
-drug resistance
-cell heterogeneity
same dose treatment
to kill the cancer cells, patient needs to have the same dose of chemo every time but the problem is that in the beginning the pt might be able to tolerate the dose for a few rounds but as they grow weaker they might not be able to tolerate it
what is the earliest we can detect cancer
when it is 1cm in diameter (& the cancer already has a billion cells)
intermittent chemo
Goal: 100% cancer cell death w/ limited normal cell injury
-needs a balance to let normal cells recover and aggressive treatment
combination therapy
-multiple drugs are better than one
-Adv: reduces drug resistance & normal cell injury
-increases cancer cell killed
don’t pair drugs that have the same toxicity
optimal dosing : dosing schedule
-maximize results
-cell cycle specific agents
-keep active drug present in body as long as possible so it can hit all parts of the cell cycle
optimal dosing: regional drug therapy
-access to tumors
-high drug concentrations
-decrease systemic toxicity
ex: intra arterial, intrathecal, intraperitoneal, intravesical
acting on the tumor, not the cell
usual toxicities from chemo
-N/v for several days after chemo
-1 to 2 wks after first round: decreased WBCs, RBCs, pallor, platelets, diarrhea, alopecia, fatigue
-neutropenia, erythrocytopenia, thrombocytopenia (bone marrow)
-stomatitis & GI tract injury & malnutrition
-hyperuricemia (kidney risk)
magic mouth wash
-prescription “cocktail” for stomatitis
-swish, gargle & spit 5-10ml q6 prn
-not curative
reproductive toxicities of chemo
do not take while pregnant / get pregnant while on
-can cause sterility in men
chemo is the treatment but aslo a
carcinogen so can cause organ damage
anti cancer agents
-cytotoxic agents
-hormonal agents
-biologicals
-targeted drugs
cytotoxic agent
cell death
hormonal agents
block effects of hormones on tumor
ex) tamoxifen
biologics
alter the body’s response to cancer
ex) interferon therapy
targeted drugs
new class, targets only cancer cells
ex) bevacizumab
cytotoxic agents: MOA
disrupt DNA synthesis & mitosis
what drugs are considered cytotoxic agents
alkylating agents
antimetabolites
antitumor antibiotics
mitotic inhibitors
immune check point inhibitors
allow for immune cells to respond more strongly to cancer
T cell transfer therapy
boost natural ability of the T cells to fight cancer
taken out of body, grown in lab, put back in for this effect
Monoclonal abx
used to mark the cancer cells so that they are better seen by body’s immune system
Treatment vaccines
boosts immune systems response to cancer
Immune system modulators
enhance the body’s immune response against cancer to prevent or slow tumor growth
what are the biological agents
Immune checkpoint inhibitors
T cell transfer therapy
Monoclonal abx
Treatment vaccines
Immune system modulators
biological agents MOA
Uses body’s immune system to kill cancer cells
biological agents indications
-Leukemias/
lymphomas
-breast
-bladder
-brain
-colon
-lung
-pancreatic
biological agents SE
Pain
Swelling
Soreness
Flu like
Wt gian
Diarrhea
Inc risk of infection
biological agents nursing considerations
Not as effective as surgery
cytotoxic agents MOA
Disrupt DNA synthesis & mitosis causing cell death
cytotoxic agents SE
N/v
Hair loss
Malnutrition
cytotoxic agents nursing considerations
Give through central line or port
what class is Cyclophosphamide
alkylating agents
alkylating agents MOA
Cell cycle phase nonspecific
Cyclophosphamide indication
Cancer
Cyclophosphamide SE
Vesicant
Hemorrhagic cystitis
Sterility
Discoloration of skin & nails
Cyclophosphamide nursing considerations
Includes G0
High likely hood of resistance
Bladder injury
what class is Methotrexate
Antimetabolites
Antimetabolites MOA
Cell cycle specific
Methotrexate indications
Leukemia
Lymphomas
Methotrexate SE
Nephrotoxicity
Hepatotoxicity
Fetal death or abnormalities
Methotrexate nursing considerations
Interferes w/ S phase (DNA synthesis) of cell growth
Resistance likely
what class is Doxorubicin
Antitumor
Antitumor MOA
Cell cycle phase nonspecific
Doxorubicin indications
Cancer
Doxorubicin SE
Turns urine & sweat red
Cardiotoxicity
Acute & delayed rxn
Doxorubicin nursing considerations
Can be used in all phases
what class is Vincristine
Mitotic inhibitor
Mitotic inhibitor MOA
Cell cycle specific
Vincristine indications
cancer
Vincristine SE
Peripheral neuropathy
Vesicant
Vincristine nursing considerations
Blocks mitosis
Bone marrow sparing
Good combo drug
what class is Ondansetron
Antiemetic: serotonin antagonist
Ondansetron MOA
Blocks serotonin receptors on vagal nerve & in the chemoreceptor trigger zone
Ondansetron indications
N/v
Ondansetron SE
Headache
Diarrhea
Dizziness
Ondansetron nursing considerations
Better w/ steroids
what class is Promethazine
Antiemetic: dopamine antagonist
Promethazine MOA
Blocks dopamine receptors in the CTZ
Promethazine indications
Chemo
Post op
General N/v
Promethazine SE
Respiratory depression
Drowsiness, sedation
Promethazine nursing considerations
BBW: resp depression <2, gangrenous extravasation
