Drug Therapy for Cancer Flashcards
Term for medications used to treat cancer:
Antineoplastic
Characteristics of Cancer:
Persist, Invade, Metastasize, Immortal
When does chemotherapy work?
Only works when cells are dividing. Does not work on slow growing cancer.
Why would a cancer patient undergoing chemotherapy have to be on more than one chemo treatments?
Different types of chemo work at different phases of the cell cycle.
Factors influencing response to chemo:
Tumor characteristics, characteristics of client, and administration schedule.
Karnofsky Performance Scale
Scale that determines how well a patient can tolerate therapy treatment
Based on Karnofsky Performance Scale when is a patient considered not a good candidate for chemo?
40 or below
Role of chemotherapy:
Cure/complete response
Control
Palliation
Approaches to chemotherapy:
Single agent chemo, combination chemo, regional chemo, high dose chemo.
What is regional chemotherapy?
chemo directly applied to site
Example of regional chemo?
Ommaya reservoir
Dose determination for chemo?
Body surface area and body weight (doses are individualized)
Alkylating Agents mechanism of action:
binds to DNA causing impaired functioning and replication (kills cancer cell from the inside).
Alkylating Agents impact on cell cycle:
non-specific
Example of Alkylating Agent:
Cyclophosphamide
Adverse effects of Alkylating agents:
bone marrow suppression, severe N/V, hair loss
Platinum compounds all end in:
-tin
Example of Platinum compound:
Cisplatin
Platinum compounds mechanism of action:
Binds to DNA causing impaired functioning and replication.
Platinum compounds impact on cell cycle:
non-specific
Adverse effects of Platinum compounds:
neuropathy, mild-moderate bone marrow suppression, severe N/V, ototoxicity.
Folic Acid Analogs mechanism of action:
interrupts folic acid synthesis
What phase of the cell cycle do Folic acid analogs impact?
S-phase specific
Example of Folic Acid Analog:
Methotrexate
Adverse effects of Folic acid analogs:
bone marrow suppression, GI distress, renal impairment.
If someone develops any of these adverse effects then chemotherapy cannot continue and will need to stop:
myelosuppression pulmonary fibrosis neurotoxicity hypersensitivity renal toxicity tumor lysis syndrome
myelosuppression:
bone marrow activity decreases resulting in fewer RBC, WBC, and platelets.
Hematopoietic side effects of chemo:
Anemia, Thrombocytopenia, Leukopenia/neutropenia
Anemia:
- Decrease RBC
- S&S:
Treatment for Anemia:
Epoetin, Darbepoetin, blood transfusion
Thrombocytopenia:
- Decrease platelets
- S&S:
Treatment for thrombocytopenia:
Oprelvekin (Neumega), platelet transfusion
Leukopenia/Neutropenia:
- Decrease WBC/neutrophils
- S&S:
Treatment for Leukopenia/Neutropenia:
Filgrastim (Neupogen)
Genitourinary side effects of chemo:
Cystitis
Acute renal failure
Hemorrhagic cystitis
Chronic renal insufficiency
Integumentary side effects of chemo:
Alopecia Dermatitis Nail changes Hand-foot syndrome Hyperpigmentation Radiation recall Rash Extravasation (can cause damage to SQ tissue)
Cardiovascular side effects of chemo:
Cardiac toxicity
Phlebitis
Extravasation
Venous fibrosis
Pulmonary side effects of chemo:
Fibrosis
Pneumonitis
Edema
Neurological side effects of chemo:
Central neurotoxicity
Metabolic encephalopathy
Ototoxicity
Peripheral neuropathy
Mood alteration side effects from chemo:
Anxiety
Euphoria
Depression
Reproductive side effects from chemo:
Infertility
Erectile dysfunction
Changes in libido
Amenorrhea
What is amenorrhea?
absence of menstruation
Metabolic side effects from chemo:
Hypo/hypercalcemia Hypo/hyperglycemia Hyperphosphatemia Hyperuricemia Hypo/hyperkalemia Hypomagnesemia Tumor lysis syndrome
Antiestrogen Example:
Tamoxifen (Nolvadex)
Antiestrogens Mechanism of action:
Blocks estrogen receptors on breast cancer cells.
Uses for antiestrogens:
used for people after breast cancer
Adverse effects of antiestrogens:
fluid retention, hot flashes, N/V, menopause like symptoms, blood clots.
Administration of Tamoxifen:
20 mg PO daily for 2-5 years
Aromatase inhibitors example:
Letrozole (Femara)
Aromatase inhibitors mechanism of action:
inhibits aromatase which reduces estrogen levels (blocks the enzyme that produces estrogen).
Uses for aromatase inhibitors:
for breast cancer and sometimes ovarian cancer.
Adverse effects of Letrozole:
Musculoskeletal pain and fatigue
EBP recommendation for aromatase inhibitors:
Should be taken after 2-3 years of tamoxifen
