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CFT I > Exam 1 - Principles of Chemotherapy > Flashcards

Exam 1 - Principles of Chemotherapy Flashcards

1
Q

when was breast cancer first described?

A

460 BC by ancient egyptians

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2
Q

what did hippocrates describe cancer as?

A

disease of black bile

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3
Q

what did hippocrates name cancer? what does it mean? was surgery recommended?

A

karkinos - greek for crab

no surgery

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4
Q

when was the earliest cancer treatment documented? examples?

A

200 AD

opium, castor oil, licorice

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5
Q

when was hodgkins-lymphoma described in data?

A

1946 - after explosion in 1942 that exposed soldiers to mustard gas

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6
Q

T/F: vet med is about 20 years behind human medicine when it comes to cancer treatment

A

true

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7
Q

what are the big 3 components of cancer therapy in vet med?

A

surgery, chemotherapy, & radiation

spay/neuter as prevention!!

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8
Q

what is the difference between localized & systemic therapy for cancer?

A

localized involves surgery & radiation, so targeted approach

systemic includes chemotherapy & immunotherapy

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9
Q

after determining your histological diagnosis for a tumor, what 3 questions should you consider next?

A
  1. benign or malignant?
  2. is surgery necessary?
  3. is adjuvant therapy necessary?
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10
Q

what are the 2 general groups of tumors that require systemic therapy?

A

hematopoietic tumors & tumors with high metastatic rates

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11
Q

what are some examples of hematopoietic tumors?

A

leukemias, lymphomas, & myelomas

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12
Q

what are some examples of tumors with high metastatic rates that require systemic therapy?

A

hemangiosarcoma, osteosarcoma, melanoma, AGASACA, & high grade tumors

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13
Q

how do sarcomas spread first?

A

hematogenously - organs with large capillary beds/endocrine organs

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14
Q

how do carcinomas spread first?

A

lymphatically - regional lymph nodes 1st

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15
Q

how do round cell tumors spread first?

A

both hematogenously & lymphatically

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16
Q

why is staging important?

A

you need to determine if the cancer has spread?

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17
Q

what are common concerns clients have about cancer treatment?

A

cost, side effects, prognosis, time commitment, & disfigurement

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18
Q

what is adjuvant therapy?

A

chemotherapy administered after the primary tumor has been removed

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19
Q

what is neoadjuvant therapy?

A

chemotherapy used to reduce the bulk of the tumor before local therapy

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20
Q

with what type of tumor would you want use neoadjuvant therapy?

A

mast cell

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21
Q

what is nadir?

A

lowest point of the white blood cell count or platelet count after chemotherapy

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22
Q

when making a drug plan for a tumor, why is it important to know the tumor’s responsiveness?

A

when picking specific drugs - want to pick one that has shown prior success

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23
Q

why do you consider drug mechanisms when making a drug plan for chemotherapy?

A

you want to pick drugs that have different mechanisms from each other & the drug’s cytotoxic activity/mechanism of resistance to the drug

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24
Q

why is drug toxicity important when making a chemotherapy plan?

A

drugs may cause more side effects/problems than the cancer

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25
Q

what is the main goal of chemotherapy when addressing solid tumors?

A

often palliative in a gross setting - trying to slow things down to aim for partial remission/stable disease

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26
Q

what is the exception to palliative care of tumors in chemotherapy? why?

A

lymphoma!

curative intent - goal to reach clinical remission

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27
Q

in a microscopic disease setting, what are the 3 goals of chemotherapy?

A
  1. kill micro-metastatic cells throughout the body
  2. kill tumor cells remaining at the primary tumor site
  3. prevent delay or recurrence
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28
Q

what is the fractional cell kill hypothesis?

A

given drug concentration applied for a defined period of time will kill a constant fraction of the cells with regrowth of the tumor between drug cycles

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29
Q

what is the goal of the fractional cell kill hypothesis?

A

give the highest tolerated dose at the shortest frequency tolerated

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30
Q

the fractional cell kill hypothesis works best in what 2 cancer types? what cancer is it not great for?

A

great for leukemias & lymphomas

not great with solid tumors

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31
Q

why is the fractional cell kill hypothesis not great for solid tumors?

A

biochemical heterogeneity of tumors - subclinical dose to areas further from vessels can become resistance

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32
Q

T/F: cytotoxic chemotherapy is preferred most of the time but is more likely to induce toxicity in the patient

A

true

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33
Q

what is the goal of cytotoxic chemotherapy?

A

kill the cancer cell directly

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34
Q

how does cytotoxic chemotherapy generally work?

A

often aims to kill the cancer directly through DNA damage or altered cellular metabolism

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35
Q

when is cytostatic chemotherapy used?

A

palliative care or metronomic chemotherapy

36
Q

how does cytostatic chemotherapy work?

A

often targets growth factors or other signaling pathways that may not be required for survival, but may be required for growth

37
Q

when may you use the tyrosine kinase receptor inhibitor, target c-kit receptor?

A

mast cell tumors

38
Q

when may you use the tyrosine kinase receptor inhibitor, target PDFGR?

A

vaccine associated sarcomas

39
Q

when may you use the tyrosine kinase receptor inhibitor, target VEGFR?

A

AGASACA

40
Q

how is the chemotherapy dose calculated?

A

based off of body surface area in meters squared

41
Q

what is the calculation for body surface area?

A

(W^0.425 X H^0.725) X 0.007184

42
Q

T/F: all chemotherapy is bone marrow suppressive

A

true

43
Q

what values would you see on a CBC/chem that would make you not treat your patient with chemo?

A

neutrophil counts <2000 cells/dL
platelet counts <75000 cells/uL
total bilirubin >1.5 mg/dL (dose adjustment may be required)

44
Q

what are the 3 pharmacologic determinants of response to chemotherapy?

A

absorption

metabolism

elimination

45
Q

how does absorption affect the response to chemotherapy?

A

intestinal disease or co-administration with other drugs can impede/decrease/increase absorption

46
Q

how does metabolism affect the response to chemotherapy?

A

liver & kidney function - if disease is present, can lead to toxicity much quicker

genetic differences - mrd1 mutation

47
Q

how does elimination affect the response to chemotherapy?

A

liver & kidney function - if disease is present, can lead to toxicity much quicker

specific enzyme alterations

48
Q

when was combination chemotherapy introduced?

A

1950s for childhood leukemia

49
Q

why was combination chemotherapy started?

A

single agent drugs induced resistance rapidly

50
Q

what is combination chemotherapy?

A

use of combo of drugs with various mechanisms of action & target resistant target subpopulations left behind in single agent protocols

51
Q

what two chemo drugs are better to use on dividing cells?

A

doxorubicin (hydroxydaunarubicin) & vincristine (oncovin)

52
Q

what is the CHOP protocol?

A

C - cyclophosphamide

H - hydroxydaunarubicin

O - oncovin

P - prednisone

53
Q

what is important to remember if using cisplatin & methotrexate?

A

they are both cleared by the kidneys, so increased risk for toxicity

54
Q

T/F: chemotherapy causes delayed healing of surgical wounds

A

true

55
Q

in the chop protocol, which drugs are not cell-cycle specific?

A

cyclophosphamide & prednisone

56
Q

what chemo drug is M phase specific?

A

vincristine

57
Q

what chemo drug works best in the S phase of the cell cycle?

A

doxorubicin

58
Q

T/F: chemotherapy affects rapidly dividing normal cells

A
59
Q

what are the big 3 side effect categories of chemo therapy?

A
  1. bone marrow suppression
  2. alopecia
  3. gastrointestinal
60
Q

what are 2 long term effects of chemotherapy on the bone marrow?

A

anemia & myelofibrosis

61
Q

what cells are most effected in the blood with chemo?

A

neutrophils & platelets - highest turnover rate of cells

62
Q

how is bone marrow suppression from chemotherapy treated?

A

antibiotics, drug holidays, colony growth stimulating factors, transfusions, & active surveillance

63
Q

what does chemotherapy cause peripherally in the gi tract?

A

blunting of the crypt cells

64
Q

what peripheral gi signs are seen as chemo side effects?

A

diarrhea, vomiting, nausea, inappetence, & weight loss

65
Q

what is the most common gi sign from chemo?

A

peripheral - diarrhea, vomiting, & nausea

66
Q

what chemo drugs cause central gi signs?

A

cisplatin & doxorubicin

67
Q

what central gi signs are seen as chemo side effects?

A

vomiting

68
Q

when do peripheral gi signs occur from chemo?

A

3-5 days after chemotherapy

69
Q

what anti-emetics are used for gi side effects from chemo?

A

ondansetron, maropitant, & metoclopramide

also acupuncture

70
Q

what antidiarrheals can be used for treating gi side effects from chemo?

A

metronidazole, fiber, tylosin, & imodium

71
Q

what drugs can be used as appetite stimulants for treating chemo side effects?

A

steroids & capromorelin

72
Q

what animals commonly get alopecia from chemo?

A

dogs with hair not fur

73
Q

how is alopecia treated in chemo patients?

A

sweaters

74
Q

what chemo drug causes fulminant pulmonary edema in cats?

A

cisplatin

75
Q

what chemo drug commonly causes immediate vomiting in dogs?

A

cisplatin

76
Q

if starting an animal on lomustine, what other drug should you start immediately? why?

A

denamarin - lomustine is hepatotoxic

77
Q

what chemo drug causes sterile hemorrhagic cystitis?

A

cyclophosphamide

78
Q

what chemo drug is known to cause DCM & arrhythmias in dogs?

A

doxorubicin

79
Q

what can you give prophylactically in a patient you’re treating with cyclophosphamide?

A

pred or lasix - help prevent sterile hemorrhagic cystitis

80
Q

what chemo drug is associated with a ‘walking on eggshells’ gait, pigmentation of skin, gi ulcers, hypertension, proteinuria, & muscle pain

A
81
Q

T/F: the board won’t get you for USP 800 violations

A

true - but OSHA will

82
Q

what is USP 800?

A

provides standards for safe handling of hazardous drugs to minimize the risk of exposure to healthcare personnel, patients and the environment.

83
Q

who has to follow USP 800?

A

all facilities that store, handle, or administer hazardous drugs (not just chemotherapy)

84
Q

in a facility under USP 800 regulations, what is required in the environment?

A

externally vented powder hood

negative air pressure around the hood

PPE

85
Q

what PPE should be utilized?

A

gloves with a long sleeve

water resistant gowns

face mask

goggles

sharps container

chemo-waste receptacle

CFT I (30 decks)

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