Exam 1 Flashcards
What symptoms should be concerning to the nurse when introducing an immunosuppressant?
new cough, dysuria, painful urination, rash, fever, sore throat–anything indicating an infection
What is a similar drug to cyclosporine?
tacrolimus
Why are pts at increased risk for cancer with cyclosporine?
Will be immunosuppressed for life which reduces natural cancer defense too.
Does constipation increase risk for infection? Is diarrhea a sign of infection?
Yes, in the GI tract
Yes
Why do chemotherapy drugs cause so many side effects?
They attack rapidly dividing cells
What does tamoxifen do to estrogen? What does it do to the uterus? What is a sign of uterine cancer? What is another concerning SE? Does tamoxifen cause immunosupression?
It doesn’t do anything to the estrogen, it changes the estrogen receptors so that it is blocked.
It increases estrogen receptor sensitivity in the uterus which put her at higher risk for uterine cancer
vaginal bleeding
DVT, clotting issues
no
How does cyclophosphamide cause hemmoraghic cystitis? What is it paired with to circumvent this AE?
when it is metabolized it is very irritating to the bladder
Mensa
What puts a person at higher risk for lung cancer?
COPD diagnosis
history of smoking
non-healing sores in the mouth
family history of lung cancer
What is the #1 type of cancer in US?
lung cancer
What is the “red devil”? What is most unique about it? What is the common similar drug?
doxorubicin
there is a lifetime limit, hard on heart
donorubicin
What is the adjunct drug for methotrexate for cancer patients only?
leucovorin
What organ is methotrexate really hard on? What are contraindications? What is it similar to?
liver
hepatitis, liver failure, etc.
azathioprine
What is ondansetron? How is it used with chemotherapy?
Zophran
prophylactically
What are vesicants?
Drugs toxic to the tissue outside of the vein
What can petechial rash be related to?
thrombocyte level
What are signs of dose related toxicity for vincristine?
Neurotoxicity, paraesthesia (pins and needles)–presents like numbness in fingers and toes
What are the normal counts for WBC, HGB and PLT?
WBC: 5,000-10,000 mm
HGB: Femailes 12-16/g/dL, males 14-18 g/dL
Platelets: 150,000-400,000 mm
What can s/s indicate infection and should be reported immediately when immunosuppressed?
Immediately report s/s of infection wounds, increased cough, increased fatigue, white patches in the mouth, white & itchy vaginal discharge, itchy blister-like vesicles on the skin
What are 4 examples of immunostimulants?
interferons
interleukins
colony-stimulating factors (filgrastim)
vaccines (hepatitis B)
What are 4 examples of immunosuppressants?
calcineurin inhibitors (cyclosporin)
cytotoxic drugs (azathioprine)
antibodies
corticosteroids
What is the action of vaccines? Therapeutic use?
stimulate immune system to produce antibodies
eradicate infectious disease in population, prevent disease in individual
What are 3 additional vaccines for immunocompromised?
pneumococcal polysaccride
meningococcal polysaccride
Zoster
What are immunoglobulins? When are they administered? What are 6 examples?
An infusion or injection of antibodies providing immediate protection for an individual that has been exposed to a threat or disease
Often administered with the immunization to provide immediate and long-term protection.
CMV
Hep B
Rabies & Rabies Vaccine
RhoGAM
Tetanus
Varicella Zoster
What are some neutropenic precautions?
wash hands, bathe, brush teeth
sanitize toothbrush
prevent constipation
do not use tampons
do not share personal items
avoid fresh plants
don’t clean up after pets
What are some neutropenic food precautions?
wash
keep cooked and raw separate
cook food thoroughly
refrigerate food
With fevers and cancer when should you seek medical attention?
38 C (100.4) for more than 1 hour
38.3 (101.0) once
What is neoplasia?
new, uncontrolled growth of cells
What is a biologic response modifier?
substance that enhances the body’s defenses in removing cancer cells
What are 2 general classes of biological modifiers (cytokines and MAB)?
interferons
interleukins
What are targeted therapies? What are 4 examples?
drugs that block the cancer with a molecular process specific to the cancer cell
tyrosine enzymes
epidermal growth factor receptor
vascular endothelial growth factor (angiogenesis inhibitors)
CD20
What is an adjunct cancer treatment for mucositis?
GI cocktail of viscous lidocaine, diphenhydramine and sulcralfate
What is used prophylactically and post cancer treatment to manage nausea?
ondansetron (Zofran)
Bone marrow suppression causes what three insufficiencies? How might they present?
thrombocytopenia, neutropenia, anemia
anemia: fatigue, pallor, shortness of breath
neutropenia: susceptible to infection
thrombocytopenia: bleeding, bruising, petechial rash
What is a concerning temperature that should be reported to HCP when immune suppressed? What else should be reported? A simple infection can turn into what?
100.4 for more than an hour
101+ report immediately
malaise, new cough, fever, chills, dysuria
sepsis, septicemia
What 2 drugs are calcineurin inhibitor immunosuppressants?
cyclosporine and tacrolimus
What are cyclosporine and tacrolimus almost always used for? What is the pt at increased risk for? What is the challenge with these drugs? What is the most difficult AE associated with it? Making who a most risk?
transplant rejection
cancers and infection due to immunosuppression
pt is on it for life, and must be compliant forever
HTN
someone with uncontrolled HTN
What are the future drugs for cancer? Why?
monoclonal antibodies (MABs)
very specific, targets cells rather than killing all cells like other cancer drugs do
When is basiliximab given? why? What does it do? What do we assesss the pt for first? Why?
before transplant and just after
the greatest risk for rejection is 48-72 hours after transplant, given to prevent that
decimates the immune system, to not have any rejection response
Any signs of infection
if they have an infection, turning off the immune system will almost certainly send them into sepsis
What is interferon most used for? What does it do? What is the AE of note?
viral infections and hepatits C
targets specific cells and kills them off by activating the immune response
flu-like illness for a week or so
What drug increases white blood cell activity? What is the SE of note? How does is present? What would we do for a pt with this SE
aldesleukin
capillary leak syndrome
anemia, low blood pressure, edema
elevate, wrap legs, ted hose
What are the age groups for the 2 tetanus injections?
Dtap: under 6
Tdap: over the age of 6
When is the 1st time you get a hep B injection?
at birth, with the first 12 hours
What is the exception of a live vaccine that is completed under the age of 1? how is it administered? Why?
rotavirus
oral
prevent diarrhea, vomiting and dehydration which is a killer of children worldwide
HPV is administered when?
11-12, before they turn sexually active
menigitis vaccine (meningococcal) is given when?
7 yr, booster around 16-17
When are the MMR and the varicella vaccine given? Should they be given under 1 year of age? Why?
12-15 yrs and 4 yrs
No
Live vaccines should not
What vaccine protects babies from pneumonia? When is it administered
pneumococcaal conjugate
2, 4, 6 and 12 mos
What vaccine are contraindicated in pregnant and immunosupressed? What can they get?
MMR, varicella, rotavirus
pneumococcal polysaccharide, Tdap, inactivated flu, Hep A and B
What is the general difference between an immunoglobulin and a vaccine?
immunoglobulins work immediately, just not long-lasting
What does the Hep A infection affect?
liver
What is the biggest contraindication of the rotavirus vaccine? What is it? Why is rotavirus not given then?
intussusception
telescoping of the bowel
prevent it from happening again
What vaccine is used for bacterial infection and epiglottitis?
HIB
What does tetanus protect us against? What 2 ways can it be given for a high risk animal bite?
tetanus, diptheria and pertussis
before a baby is born
serious wounds, metal wounds
animal bites
rabies immunoglobulin and tetanus vaccine
What does HPV prevent?
genital warts, cervical cancer
Why is rhogam given? How? What does it prevent? Is rhogam an immunoglobulin?
Moms with Rh-
prevents hemolysis of the next baby’s red blood cells from antibodies the mother created
Binds to the baby’s Rh+ fetal red blood cells which protects them in the mom’s bloodstream
fetal anemia, miscarriage
yes
What is another term for antineoplastics? Why do they have so many side effects?
cytotoxic, chemotherapy agents
They go after all fast-growing cells and kill them off
What is mylelosupression synonymous with?
bone marrow supression
What is mucositis or stomatitis? What is the concern? What should you avoid? Why?
ulcers in the mouth and GI tract
increases the risk of infection
caffeine, peroxide, alcohol, citrus, spicy foods, acidic, soda
dries out and irritates which increases risk
What is doxirubicin? what is it nicknamed? Specific SE? What is unique about it? What are signs of heart failure?
anti-tumor drug
red devil
congestive heart failure
there is a lifetime limit, to protect the heart
pedal edema, crackles in the lungs, swelling, JVD, wet lungs, wet cough
What is the unique SE of cyclophosphamide? What are signs? What is taken to protect? What is it?
Hemorragic cystitis
blood in urine, pain, bladder pain, pubic pain
mesna
uroprotectant
What is methotrexate and azathioprine used for? What does it do?
RA, MS, myocinea gravis (sp?), Crohn’s disease, inflammatory disease, and cancer
inacitvates ablility to use folic acid
What is paired with methotrexate only when it is used between rounds of chemo–only used for ?
leukovorin
What should be avoided with methotrexate or azathioprine?
NSAIDs, naproxen, aspirin, liver issues
What is used for breast cancer? Why? Where does it not block them? Does it cause immunosuppression? What SE should you worry about?
tamoxifen
blocks estrogen receptors
uterus
no
DVT–calf pain, redness, pain, erythema
vaginal bleeding–sign of uterine cancer
What chemo drug is an alkylating agent?
cisplatin
What is an immunostimulant? What does it do? How is it monitored for effectiveness? What is the worst SE? Who is it contraindicated for?
filgrastim
increases WBCs
CBC, increased WBCs
bone pain
sickle cell
What is the AE for vincristine?
neuropathy, paraesthesia (pins and needles)
with cancer, what is the main reason to use cannabis?
appetite stimulation
