Chemotherapy Week 3 Flashcards
2 Forms of Chemotherapy
Antineoplastic and Cytotoxic antibiotics
Antineoplastic Drug Category and Examples
Antimetabolite: methotrexate
Mitotic Inhibitor: vincristine
Alkylating agent: cyclophosphamide
Cytotoxic Antibiotic generic drug example
doxorubicin
MOA of Chemotherapy
cytotoxic during specific cell-cycle phase
Mitotic MOA
kills cells at the start of mitosis
alkylating MOA
react chemically with parts of RNA, DNA, or cellular proteins
Hormones MOA
used in cancers sensitive to estrogen stimulation
Indication of methotrexate
acute and chronic lymphocytic leukemia, psoriasis, RA
Indication of Vincristine and doxorubicin
acute lymphocytic leukemia
indication of ALL chemo
breast/ovarian/testicular cancer and Hodgkin’s lymphoma
indication of cyclophosphamide
alkylating
-acute lymphomas, leukemia, breast/ovarian/bladder cancers
SE AE of ALL chemo drugs
Alopecia, N/V, anorexia, diarrhea, stomatitis, low WBC, and decreased bone marrow suppression
Cyclophosphamide SE/AE
peripheral neuropathy, ototoxicity, nephrotoxicity
Doxorubicin SE/AE
acute cardiac toxicity
-left ventricular failure cardiomyopathy, HF
Interactions with Methotrexate
ASA, NSAIDS leads to toxicity
Interactions with Vincristine
any drug toxic to the liver because hepatotoxicity is already an AE
Nsg implications of Chemo and assess
Infection Prevention
monitor extravasation
Avoid direct skin and eye contact w/ drug
premedicate N/V with antiemetic
assess
CBC (WBCs RBCs and platelets) UA for blood and infection, AST/ALD for liver function, kidney function BUN and creatine
Other drugs: Hydroxyurea, MOA and Indication, SE/AE, Nsg
Kills cancer cells by interrupting DNA synthesis
Tx squamous cell cancer
SE/AE- HA, hyperuricemia, nephrotoxicity
Nsg: monitor bleeding & infection
-WBC < 2,500
-Platelets < 100,000
Cancer Cell specific agent: Imatinib
MOA, indication SE/AE, Nsg
MOA: stops Ca growth by inhibiting enzymes
indication: tx of adults with chronic myelocytic leukemia
SE AE: N/V, HF, Edema
Hormone Modulators:
Selective Estrogen Receptor modulator AND
Progestin
Tamoxifen
and
medroxyprogesterone
MOA of hormone modulators
as antineoplastics, they block receptors and prevent cancer growth that are sensitive to a specific hormone (estrogen)
TX metastatic breast Ca
hormone modulators selective estrogen receptor: tamoxifen
and progestin SE AE and Nsg
Menopause like - hot flashes, vag dryness, moody, depression
endometrial Cancer, GI toxic, CVA, hypercalcemia, DVT and PE
Nsg
take with Ca and Vit D because lowered calcium = osteoporosis
Extravasation
leaks of antineoplastic drugs into surrounding tissues during IV
permanent tissue damage resulting in skin grafts, surgery, amputation
Nsg extravasation
stop infusion ASAP, and aspirate any remaining drug, do not remove the catheter, contact the pharmacist and provider
apply sterile dressings, elevation and rest of limp
document and follow protocol
Nsg implications of chemo
infection prevention
no crowds or fresh/frozen produce, or plants
avoid bleeding
women need to be on a nondrug contraceptive (category X and D)
monitor for stomatitis
tx N/V with antiemetics 30-60 mins before chemo tx, small and frequent meals
do not clean chemo spills with bare hands, they require spill kits, and gloves
chemo pt edu
-soft bristle toothbrush, electric razor
hydration to prevent nephrotoxicity
report tinnitus
peripheral neuropathy
infection prevention
avoid injury
donate egg or sperm for future
chemo in general
monitor anaphylactic rxns, keep epi-pen, antihistamines, and anti-inflammatories near
monitor for infections closely (fever, sore throat, chills, elevated WBC)
monitor for bone marrow suppression - anemia, low platelets, neutropenia
ONC EMERGENCY
-infections, thrombocytopenia, pulmonary toxicity, allergic rxns, severe stomatitis bleeding,
Hematopoietic drugs
-erythropoietin drugs
colony stimulating factors
platelet promoting drugs
erythropoietic drugs
Epoetin alpha
colony-stimulating factors
-filgrastim- given before infection begins
Platelet-promoting drugs
-Oprelvekin: enhances platelet formation
Hematopoietic drugs MOA and Indication
MOA: decreases the length of chemo-induced anemia, neutropenia, thrombocytopenia
Indication: better RBC and platelet counts and avoid any transfusions
Hematopoietic drugs SE AE and Nsg
SE AE edema, diarrhea, N/V headache
Nsg this allows for higher chemo doses and results in more cancer cells being targeted/killed
Immune modulators
interferons alfa-2a
Interferons MOA and indication
MOA interferon receptor sites on noninvaded cells are stimulated to make antiviral proteins and it stops tumor growth/replication into healthy cells.
Ind: Viral-genital warts, hepatitis, cancer-hairy cell leukemia, malignant melanoma, AIDs Kaposi sarcoma, autoimmune-MS
SE AE of interferons immune modulators, interactions, Nsg
flu-like effects, HA, myalgia, anorexia,
all excessive feeling be reported
interact: live virus vaccines
Nsg
-ensure pt hydration to prevent AE
-acetaminophen for myalgia
-assess egg allergy
-report signs of infections
-fever, sore throat, diarrhea, vomiting, fever of 100.5
Monitor Therapeutic effect
-less lesions, better CBC, no anemia, or infections
Disease Modifying antirheumatic drugs DMARS examples
Adalimumab, etanercept
methotrexate, hydrocycholorquine-used for auto-immune disorders
Disease Modifying antirheumatic drugs DMARS MOA, indication, SE/AE, Nsg
MoA: tumor necrosis factor inhibitor
indication RA, crohn’s, psoriasis
SE/AE irritation at injection site, headache, heartburn NV,
contraindicated by active infections
NSG: minimal effect on healthy cells, decreases levels of c reactive protein CRP and erythrocyte sedimentation rate ESR and serum cytokines
VAX
-artificial active immunity to expose the body to weak/less toxic proteins of the specific disease-causing organism
-live: MMR, Varicella, Zoster, Influenza
inactivated: polio, DTaP, HPV, IPV, Hep A, B,
Nasal spray
is stored in freezer as a powder and reconstituted into a mist to be stored in a fridge
used between ages 2-49
Vax severe effects
fever over 103
encephalitis
convulsions
anaphylactic rxn
dyspnea
vax at 2 mo
IPV
DTaP
Hib
PCV
RV
vax at 4mo
RV
DTaP
hib
PCV
IPV
6mo vax
RV
DTaP
Hib
PCV
4-6 vax
DTap
IPV
MMR
Varicella
