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Pathopharmacology > Drugs Affecting Immune System > Flashcards

Drugs Affecting Immune System Flashcards

1
Q

Goal of Chemotherapy

A

Maximize therapeutic effects, while reducing toxic effects

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2
Q

Purpose of Chemotherapy

A

Achieve a cure
Control growth
Provide palliation
Attempts to increase survival rates and times

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3
Q

What does cytotoxic mean?

A

Kills all cells (healthy and cancerous)

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4
Q

What labs are best to monitor during chemotherapy?

A

RBC, WBC, platelets

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5
Q

When does chemotherapy act?

A

During reproductive cycle, most active on rapidly dividing cells

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6
Q

What is remission?

A

Cancer is not actively growing

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7
Q

What is Induction Therapy?

A

High dose therapy to get the client into remission

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8
Q

What is Consolidation Therapy?

A

Administered after induction therapy to increase cure rate or prolong survival

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9
Q

Why would a patient receive Intensification Therapy?

A

High dose therapy during remission to increase cure rate or prolong remission

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10
Q

What are drawbacks of Induction Therapy?

A

Depletes immune system Lowers RBC,WBC, platelet

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11
Q

What is Adjuvant Therapy used for?

A

To destroy or reduce the spread of cancer after surgery or radiation therapy

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12
Q

How is Pallatative Therapy used?

A

To control symptoms, provide comfort, and improve quality of life when cure is not possible

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13
Q

Benefits of Combination Therapy

A
  1. Different chemotherapy drugs act on different phases of the cell cycle
  2. Decreases drug resistance
  3. Increases drug effectiveness for remission/cure
  4. Reduces toxic effects to normal cells
  5. Can give lower doses with multiple drugs
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14
Q

Chemo vs Combo Therapy on cell cycle

A

Chemo drugs work best on rapidly multiplying cells

Combo drugs work on all phases

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15
Q

What is the purpose of chlorambucil?

A

non-cell cycle specific; react chemically with portions of RNA, DNA, or other cellular proteins to produce cytotoxic effects

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16
Q

What drug class is chlorambucil?

A

Alkylating Agents

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17
Q

Therapeutic uses for Chlorambucil

A

Treat slow-growing cancers such as lymphomas, leukemias, and myelomas.

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18
Q

Adverse Effects of Chlorambucil

A
  1. Highly neurotoxic (tremors/muscle twitching)
  2. Nephrotoxic, Hepatotoxic
  3. Alopecia (7-10 after starting drugs)
  4. Sterility
  5. N/V/A
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19
Q

How soon will patient experience alopecia after taking Chlorambucil?

A

7-10 days

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20
Q

Nursing Interventions for Chlorambucil

A
  1. Monitor CBC frequently
  2. Monitor liver and kidney function
  3. Monitor uric acid levels (Allopurinol)
  4. Administer Antiemetics 30 minutes before chemo dose
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21
Q

What should a nurse educate the patient about when administering Chlorambucil?

A
  1. Increase fluid intake
  2. Infection precautions, patients are immunosupressed
  3. Use contraceptives during treatment
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22
Q

Why is allopurinol given in conjunction with chemo therapy?

A

Chemo increases risk for gout.

Allopurinol decreases uric acid production

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23
Q

Purpose of Antimetabolites

A
  1. inhibit DNA production in cells that depend on certain natural metabolites to produce DNA, preventing normal cellular function.
  2. Most effective in rapidly dividing cells
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24
Q

Methotrexate is an

A

Antimetabolites

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25
Q

What are the therapeutic uses for methotrexate?

A

treatment of leukemias and some GI and basal cell cancers. Also used as treatment for rheumatoid arthritis.

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26
Q

How is methotrexate typically given and why?

A

Used in combination therapy because of increased resistance to treatment.

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27
Q

Adverse effects of Methotrexate

A
  1. Fatigue / malaise
  2. Rashes
  3. Alopecia
  4. Ulcerative stomatitis
  5. Hepatic toxicity
  6. Severe bone marrow suppression
  7. Interstitial pneumonitis
  8. Chills/ fever/ anaphylaxis
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28
Q

Nursing Interventions for Methotrexate

A
  1. Assess lung sounds! Don’t administer if hearing wheezing or abnormal sound at base
  2. Always pre-medicate with nausea meds
  3. Frequent vitals to watch for reactions
  4. Pre-hydrate with sodium bicarb to alkalize urine
  5. Send urine samples to the lab if frequent urination
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29
Q

Why should the nurse rehydrate a patient with sodium bicarb when administering methotrexate?

A

Sodium bicarb alkalizes urine.

Acidic urine can cause crystals to form and shutdown kidneys

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30
Q

What is the rescue drug for methotrexate? How long is it given?

A

Leucovorin

4 days

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31
Q

Why is Leucovorin administered?

A

Methotrexate depletes folic acid. Leucovorin replaces folic acid

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32
Q

Uses of Leucovorin

A
  1. cell protectant
  2. replace folic acid
  3. decrease bone marrow suppression, GI toxicity, and neuro toxicity
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33
Q

Purpose of Antineoplastic Antibiotics

A

Break up or prevent DNA synthesis, leading to cell death. Cell cycle specific: S phase

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34
Q

What drug class is Doxorubin in?

A

Antineoplastic Antibiotics

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35
Q

Therapeutic Uses for Doxorubin

A

treat lymphomas, leukemias, breast and ovarian cancers,thyroid cancer, AIDs related Kaposi sarcoma

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36
Q

Adverse Effects of Doxorubin

A
  1. Red Urine
  2. Mucositis (extremely painful, pt won’t eat)
  3. Cardiac Toxicity
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37
Q

Patient Education for Doxorubin

A
  1. Red urine is normal
  2. Antibiotics are only for chemo
  3. Wait 6 months after finishing treatment before trying to have kids
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38
Q

Purpose of mitotic inhibitors

A

kills cells as the process of mitosis begins and therefore, inhibit DNA synthesis

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39
Q

Therapeutic uses of Vincristine

A

treatment of a variety of tumors and leukemias (acute leukemias, Hodgkins and non-Hodgkins lymphomas, Wilms’ tumor

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40
Q

Adverse Effects of Vincristine

A
  1. Ataxia
  2. Cranial nerve malfunctions
  3. Neuropathic pain
  4. Muscle wasting
  5. Leukopenia (loss of WBC=inc risk for infection)
  6. Weight loss
  7. Constipation
  8. SIADH
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41
Q

Nursing Interventions for Vincristine

A
  1. Assess injection sites for extravasation

2. Restrict fluid, Diuretics, Na diet for SIADH

42
Q

Purpose of Tamoxifen

A

Competes with hormone binding sites (estrogen) in target tissues. Used for cancers that are sensitive to estrogen stimulation.

43
Q

Therapeutic Uses for Tamoxifen

A

treatment of metastatic breast cancer or prevention of breast cancer in high risk clients

44
Q

Adverse Effects of Tamoxifen

A

Menopause effects** (hot flashes, periodic bleeding, moody)
CNS depression
Bone marrow depression
GI toxicity
Visual changes and retinopathy
Hypercalcemia (need weight bearing activities)

45
Q

Patient eduction for Tamoxifen

A

Eye exams needed every 6 months to a year

46
Q

What type of agent is imatinib?

A

Protein Tyrosine Kinase Inhibitors

47
Q

Purpose of Protein Tyrosine Kinase Inhibitors (imatinib)

A

act on specific enzymes that are needed for protein building by specific tumor cells. Blocking these enzymes inhibits cell growth. Goal is to not affect healthy cells.

48
Q

Therapeutic Uses of Imatinib

A

treats CML (leukemia), GI stromal tumors

49
Q

How long is one typically on Imatinib?

A

No longer than 5 years

50
Q

Nursing Interventions for Imatnib

A
  1. administer with a meal and full glass of water / PO
  2. administer analgesics for headache and muscle pain
  3. monitor CBC
  4. assess for edema
51
Q

Nursing Management for Cancer

A
  1. Know client’s diagnosis and goals
  2. Provide holistic care
  3. Obtain baseline physical and emotional assessment
  4. Check allergies and drug history
  5. Assess lab data:
    CBC
    Liver enzymes
    Renal function (BNP, creatinine)
    CXR, EKG, pulmonary function tests
52
Q

Most common adverse effects of chemotherapy are

A
  1. N/V

2. Fatigue

53
Q

What drugs should be administered to present N/V with chemotherapy?

A 
Prochlorperazine (Compazine)
Lorazepam (Ativan)
Metoclopramide (Reglan)
Ondansetron (Zofran)
Dexamethasone (Decadron)
54
Q

Purpose of Dexamethasone with chemotherapy drugs

A

increase the effects of the anti-nausea drugs

55
Q

Nursing Interventions for Chemotherapy

A
  1. Monitor for signs of bleeding/ blood loss
  2. Assess client’s mouth for sores
  3. Provide frequent oral care
    (Soft toothbrushes, avoid mouthwash with alcohol)
  4. Encourage increased fluid intake to 2-3 L/day
  5. Advise females from becoming pregnant during treatment and 6 months after
  6. Instruct clients to avoid large crowds or ill persons
  7. Hair loss typically occurs in 7-10 days after start of treatment
56
Q

Safety Precautions for Administering Chemotherapy

A
  1. Use chemotherapy gloves for administration
  2. Flush toilet twice
  3. Dispose as hazardous waste using special precautions
    4, Know procedure for chemotherapy spills (Spill kit)
  4. Do not administer if pregnant – fertility impairment
57
Q

Why is chemotherapy given through central line?

A

Most agents are vesicants causing extravasation

58
Q

Overall goal of Chemotherapy

A

Decrease tumor size

Prevention of metastasis

Relief of symptoms

No major adverse effects

59
Q

What is the function of RBC?

A

Carry oxygen to organs and tissues

60
Q

What are the normal RBC ranges for men and women?

A

Men – 13-16 g/dL

Women – 12-15 g/dL

61
Q

Why are women normal RBC ranges lower than men?

A

Menstruation

62
Q

What is anemia and how is it managed?

A

Anemia is when RBC is low and causes fatigue

Monitor Hgb & Hct

63
Q

Function of WBC

A

Fight infection

64
Q

Normal WBC count

A

4,000-10,000

65
Q

A client with a WBC lower than 4,000 is at risk for?

A

Neutropenia (low WBC count)

66
Q

What is thrombocytopenia?

A

Low platelet count

<100000

67
Q

What should the nurse understand about a patient with a platelet count <20,000

A

Patient is at high risk for bleeding

68
Q

What is Nadir?

A

7-14 day period after chemo when blood cell counts are at the lowest

69
Q

What is hematopoiesis?

A

production of blood cells and platelets in the body

70
Q

Ways to increase RBCs

A 
Erythropoietin
Epoietin alpha (Procrit) 
1 unit PRBCs – increases Hct by 3 points
71
Q

Why is Epoietin alpha contraindicated in cancer patients?

A

causes spread of cancer

72
Q

What determines the need for RBC?

A

Hgb & Hct values

73
Q

Ways to increase WBCs

A

Leukopoietic growth factors

Filgrastim (Neupogen)

74
Q

Drugs to increase platelets

A

Thrombopoietic growth factors

1 unit of platelets – increases platelets by 20-30,000

75
Q

Why should NSAIDs be avoided with platelet administration?

A

Alters platelet function

76
Q

Purpose of Epoietin Alpha

A

Stimulates bone marrow to produce more RBCs

77
Q

What is Epoietin Alpha used for>

A

Treatment of anemia (low RBCs, Hg, and Hct) in RENAL patients

78
Q

Adverse Effects of Epoietin Alpha?

A
  1. Hypertension (High RBC=Inc Blood Vol=HTN)
  2. Increased risk for clot formation
  3. Headache
  4. body aches
  5. Pregnancy Category C
79
Q

Nursing Interventions/Client Education for Epoietin alpha

A
  1. Monitor Hgb levels and blood pressure
  2. Administer prophylactic anticoagulant to prevent clots
  3. Can not be given for certain cancers due to possible increase in tumor growth
80
Q

How does the nurse know that Epoietin Alpha has been effective?

A
  1. Hgb level increased to 10 or 11 g/dL

2. Hct level increased to 33%

81
Q

Purpose of fligrastim?

A

To stimulate the bone marrow to increase production of neutrophils

82
Q

Therapeutic Uses for Filgrastim

A
  1. To decrease risk of infection in clients with neutropenia

2. To increase stem cells for transplant

83
Q

Adverse Effects of Filgrastim

A

Bone pain, leukocytosis, and splenomegaly

84
Q

Nursing Interventions/Client Education for Filgrastim

A
  1. Give acetaminophen for bone pain
  2. Monitor CBC weekly
  3. Can be administered IV or SQ
  4. Must be refrigerated
85
Q

Purpose of Oprelvekin

A

Increases the production of platelets

86
Q

Therapeutic Uses for Oprelvekin

A

Decreases thrombocytopenia and need for platelet transfusions

87
Q

Adverse Effects of Oprelvekin

A

Fluid retention, cardiac dysrhythmias, allergic reactions

88
Q

Nursing Interventions/ Client Education for Oprelvekin

A

Monitor intake and output
Use cautiously in clients with heart problems
Administered by SQ injection only

89
Q

How do you know if Oprelvekin has been effective?

A

Platelet count is >50,000

90
Q

What causes anemia?

A

Decreased RBC Production
Increased RBC Loss
Increased RBC Destruction

91
Q

Acute Anemia vs Chronic Anemia

A

Acute: within week

Chronic weeks-months

92
Q

Example of Hemolytic Anemia

A

Sickle Cell Anemia (loss of ability to carry oxygen)

93
Q

Importance of Iron

A

Needed for RBC production

94
Q

Purpose of Ferrous Sulfate

A

elevates serum iron levels, and then converted to Hgb or trapped in reticuloendothelial cells for storage

95
Q

Therapeutic Uses for Ferrous Sulfate

A

iron deficiency anemia or adjunct treatment with erythropoiesis-stimulating drugs

96
Q

Nursing Interventions/ Patient education for Ferrous Sulfate

A
  1. Give with meals but avoid eggs, milk, coffee, and tea- can decrease med absorption
  2. If liquid, drink with straw because Iron stains teeth
  3. Orange juice inc iron absorption
  4. Should not be concerned with black/green poop
  5. Causes constipation, so teach preventative measures
  6. Painful administration, use Ztrack method. Inject all meds before removing needle, may stain skin
97
Q

S/S of Iron Toxicity

A
  1. Dizziness
  2. Confusion
  3. Fever
  4. Bradychardia
  5. Seizures
98
Q

Foods high in Iron

A 
Broccoli
Sardine
Chicken
Spinach
Eggs
99
Q

Importance of Vitamin B12

A

Needed for cell growth and RBC strength, maintenance of myelin sheath in nerves

100
Q

Therapeutic Use for Hydroxocobalamin

A

poor diet, increased demand, lack of intrinsic factor (pernicious anemia)

101
Q

How is Hydroxocobalamin administered?

A

IM or Intranasal

102
Q

Nursing Interventions / Client Education for Hydroxocobalamin

A
  1. Pt will receive Vit B12 daily for first 5-10 days, then once a month for life
  2. Acetominophen for nasal discomfort
  3. Pt may experience HF/pulmonary edema with excess B12

Pathopharmacology (6 decks)

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