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Pharm 2 > Exam 2- Chemo and Immune > Flashcards

Exam 2- Chemo and Immune Flashcards

1
Q

Goal of chemotherapy

A

cure, control, or palliation

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2
Q

Adjuvant chemotherapy

A
  • Antineoplastic drugs after surgery or radiation

- Purpose is to remove any cancer cells that were not removed during surgery or have not been detected

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3
Q

Nonadjuvant chemotherapy

A
  • Antineoplastic drugs before surgery or radiation
  • Goal= shrink tumor to a manageable size
  • Reduce invasiveness of cancer (if it is invading tissues that will make surgery difficult)
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4
Q

Chemoprophylaxis

A
  • Preventing cancer in high risk patients
  • Tamoxifen for breast cancer
  • Uncommon because most of these drugs have serious side effects
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5
Q

Cell cycle non specific

A

kills resting cells and dividing cells

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6
Q

cell cycle specific

A

kills actively dividing cells

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7
Q

How to improve the success of chemotherapy?

A

Multiple drugs and intermittent dosing

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8
Q

Intrathecal

A
  • Requires specially trained individual

- Is able to readily pass blood brain barrier and penetrate CSF

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9
Q

Intra-arterial

A

Requires surgery and x-ray techniques

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10
Q

Intravesicular

A
  • Via Foley catheter

- For tumors of bladder mucosa

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11
Q

Intraperitoneal

A
  • For intra-abdominal metastases
  • HIPEC (hyperthermic intraperitoneal chemotherapy) includes “hot chemo” and is a newer innovative way to deliver
  • intraperitoneal chemo
  • Reduces side effects
  • Allows for higher doses
  • Improves absorption
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12
Q

IV (benefits and downfalls)

A
  • Including PICC line
  • Most common delivery method
  • Benefit: Consistent serum levels of medicine
  • Downfall: sclerosing, or abnormal tissue hardening of the veins.
  • Danger of extravasation
  • Administered in a health care providers office – hardship to patient
  • By leaving home more exposure to illness
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13
Q

Oral (benefits and downfalls)

A
  • Benefits:
  • Easiest because patients can self-administer
  • Less expensive
  • Can be done in the comfort of your own home
  • Downfalls:
  • Variation in absorption
  • CINV creates problems
  • Patient must be taught safe handling
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14
Q

Side effects of chemotherapeutic, what tissues?

A

Chemotherapeutic drugs are more toxic to tissue with a high growth fraction (those that are growing and turning over rapidly)

Side effects will be common in these tissues:
Bone marrow
Skin
Hair follicles
Sperm
Gastrointestinal tract
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15
Q

Hemotologic system side effects of chemo (2 main)

A
  • Myelosuppression (bone marrow suppression)
  • Reduces neutrophils (increases infection)
  • Reduces platelets (increases risk of bleeding)
  • Reduces erythrocytes (causes Anemia)
  • Nadir
  • Blood cell and platelet cell counts at a low
  • Usually occurs about 10 days post treatment, improves in around 3 weeks.
  • Time period during which patients most susceptible to symptoms
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16
Q

Gastrointestinal system side effects of chemo (4)

A
  • Nausea and Vomiting (CINV- Chemotherapy induced N/V)
  • Diarrhea
  • Mucositis (Mouth sores)
  • Cachexia (General wasting of muscle and other tissue)
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17
Q

Reproductive system side effects of chemo (3)

A
  • Infertility- temporary or permanent sterility
  • Sterility risk higher in men
  • Toxic effect on babies in utero
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18
Q

Nervous system side effects of chemo (3)

A
  • Muscle weakness
  • Peripheral neuropathy (impaired sensation)
  • Hearing loss and deafness in some patients
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19
Q

Integumentary system side effects of chemo (3)

A
  • Skin shedding
  • Blistering
  • Toxicity of meds to skin and soft tissue
    (Can cause serious tissue injury if they escape from artery or vein during infusion or injection)
    (Careful administration of chemotherapeutics!)
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20
Q

Other side effects of chemo (7)

A
  • Fatigue
  • Alopecia (Hair loss)
  • Hyperuricemia
  • Secondary malignancy
  • Unique toxicities (med specific)
    Heart injury
    Kidney injury
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21
Q

Nursing implications/Patient education for chemo (8)

A
  • Pre-treat with antiemetic medications
  • Monitor labs and prepare to administer replacement blood products as needed
  • Mouthwash containing anesthetic for mouth sores, hydration
  • Other symptom management (pain, sleep, etc)
  • Monitor IV site carefully
  • Careful handling and administration of Chemo drugs
  • Educate Patients about Nadir and when symptoms will be worst
  • Instruct patients to avoid illness, signs of infection, use a soft toothbrush
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22
Q

Cyclophosphamide (Cytoxan) class

A

Alkylating agent

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23
Q

Cyclophosphamide (Cytoxan) MOA

A
  • Prodrug- Converted to its active form (phosphoramide mustard) in the liver
  • Binds to DNA and forms cross-links
  • Prevent the synthesis of DNA, RNA, and protein
  • cell-cycle non specific drug
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24
Q

Cyclophosphamide (Cytoxan) common side effects (2)

A
  • Myelosuppression

- Alopecia

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25
Q

Cyclophosphamide (Cytoxan) CI (3)

A
  • Pregnancy
  • Lactation
  • Severe Myelosuppression
26
Q

Cyclophosphamide (Cytoxan) drug interactions (2)

A
  • Heavy hepatic involvement (pro drug) so interacts with many other drugs especially those involved in liver
  • Increased cardiotoxicity if it is given with doxorubicin
27
Q

Methotrexate (Rheumatrex) class

A
  • Antimetabolite (Folic Acid analog)

- DMARD (disease modifying antirheumatic drug)

28
Q

Methotrexate (Rheumatrex) MOA

A
  • Specific for S phase of the cell cycle (cell cycle specific)
  • It blocks an enzyme that is responsible for converting folic acid to reduced folate, which interferes with DNA synthesis, repair, and cellular replication mainly in actively proliferating tissues
29
Q

Methotrexate (Rheumatrex) CI (3)

A

Pregnancy Category X
Lactation
Pre-existing bone marrow impairment

30
Q

Methotrexate (Rheumatrex) drug interactions

A
  • Any live vaccine use may lead to a severe reaction secondary to the immunosuppressant activity of methotrexate.
  • Many drug interactions
  • Caffeine may lower effectiveness, patient must reduce
31
Q

Doxorubicin (Adriamycin) class

A
  • Antitumor Antibiotic

- Anthracycline

32
Q

Doxorubicin (Adriamycin) MOA

A
  • Binds to DNA, causing strand splitting and inhibition of DNA synthesis
  • It is cell cycle nonspecific
33
Q

Doxorubicin (Adriamycin) Black box warning

A
  • Severe myelosuppression

- This is the dose limiting factor with this medicine

34
Q

Doxorubicin (Adriamycin) common side effects (3)

A
  • Urine and tears turn a red color
  • Excessive lacrimation
  • Heart failure months or years after use
35
Q

Doxorubicin (Adriamycin) drug interactions (2)

A
  • Cyclophosphamide may increase risk of hemorrhagic cystitis or cardiac toxicity.
  • Excessive bleeding with NSAIDS and other anticoagulants
36
Q

Tamoxifen class

A

Estrogen Receptor Blocker

37
Q

Tamoxifen MOA

A
  • Binds to ERs, producing agonist effects in some tissues (bone) and antagonist effects in other tissues (breast)
  • The binding in breast tissue inhibits DNA replication and affects other growth factors in cancer cells.
38
Q

Tamoxifen indications

A
  • Prophylaxis of breast cancer (very high risk patients)

- Adjunctive therapy after mastectomy to protect other breast

39
Q

Tamoxifen side effects (7)

A
  • N/V
  • Vaginal bleeding/discharge/ irregular cycles
  • Menopausal symptoms (blocking estrogen)
  • Hot flashes
  • Fluid retention
  • Increased risk of endometrial cancer
  • Increased risk of thromboembolic disease
40
Q

Tamoxifen CI (3)

A
  • Pregnancy/lactation
  • History of thromboembolic disease
  • Endometrial hyperplasia
41
Q

Immunosuppressants

A
  • Drugs that decrease or prevent an immune response, thus suppressing the immune system
  • Used to prevent or treat rejection of transplanted organs and stop autoimmune disease (rheumatoid arthritis, systemic lupus erythematosus, Crohn’s disease, multiple sclerosis (MS), myasthenia gravis, psoriasis, and others)
42
Q

Immunostimulants

A
  • Increase the immune system’s ability to fight infection and disease
  • Usually used to treat patients with cancer
  • Vaccines also considered immunostimulants
43
Q

Cyclosporine (Sandimmune) class

A

Calcineurin inhibitor

44
Q

Cyclosporine (Sandimmune) MOA

A
  • Inhibits the function of calcineurin (Enzyme that acts as intracellular messenger)
  • Diminishes the activity of T cells and B cells and suppresses the immune response
45
Q

Cyclosporine (Sandimmune) indications (2)

A
  • Drug of choice to prevent organ transplant rejection

- Psoriasis and other autoimmune disorders

46
Q

Cyclosporine (Sandimmune) side effects (6)

A
  • Nephrotoxicity
  • Hypertension
  • Tremor
  • Elevated hepatic enzymes
  • Infection
  • Increased malignancies
47
Q

Cyclosporine (Sandimmune) CI/cautions (3)

A
  • Renal impairment
  • Hepatic impairment
  • Avoid exposure to the sun
48
Q

Cyclosporine (Sandimmune) drug interactions

A
  • Grapefruit juice can raise drug levels by 50% to 200%.
  • Hyperkalemia with potassium-sparing diuretics
  • Other nephrotoxic drugs
49
Q

Interferon alfa-2b (Intron A) class

A
  • Interferon

- Biologic response modifier

50
Q

Interferon alfa-2b (Intron A) MOA

A
  • Increases the phagocytic activity of macrophages and monocytes
  • Suppresses the growth of cancer cells
51
Q

Interferon alfa-2b (Intron A) indications (3)

A
  • Cancer
  • HIV
  • Viruses (herpes simplex, varicella-zoster, west nile)
52
Q

Interferon alfa-2b (Intron A) side effects (7)

A
  • Flu-like syndrome of fever, chills, dizziness, weight loss, and fatigue (occurs in at least 50% of patients)
  • Headache, nausea, vomiting, diarrhea, and anorexia
  • Hair loss
  • Depression and suicidal ideation
  • Serious adverse effects (with prolonged therapy)
  • Immunosuppression
  • Hepatotoxicity
  • Neurotoxicity
53
Q

Interferon alfa-2b (Intron A) Black box warning

A
  • Can cause or aggravate fatal or life-threatening neuropsychiatric, autoimmune, ischemic, or infectious disorders
54
Q

Interferon alfa-2b (Intron A) CI (2)

A
  • Autoimmune hepatitis or hepatic decompensation

- Neonate or infant

55
Q

Interferon alfa-2b (Intron A) drug interactions (3)

A
  • Increase theophylline levels
  • Zidovudine (ART) may increase hematologic toxicity and cause immunosuppression
  • Alcohol may cause excessive drowsiness and dehydration
56
Q

Interferon alfa-2b (Intron A) Nursing implications

A

Monitor labs- baseline and need to be monitored monthly

57
Q

Vaccinations

A

Introduction of foreign cells or proteins to trigger immune response before patient is exposed to pathogen

58
Q

Attenuated (live) vaccines

A
  • Rendered less able to cause disease through application of heat or chemicals
  • Cause subclinical case of disease while inducing lasting immunity
59
Q

Inactivated (killed) vaccines

A

Safer because organism is unable to replicate, mutate, or cause disease

60
Q

Nasal Spray flu vaccination

A
  • Live Attenuated Influenza Vaccine (LAIV) should not be given within 2 wks. before or 48hrs after Tamiflu
  • Approved for healthy people 2-49 yrs. of age who are not pregnant
  • Has not been available or effective since 2015 ish
61
Q

Flu shot

A
  • Injected influenza vaccines, or trivalent inactivated (killed) influenza virus vaccines (TIV)
  • Approved for people older than 6 months

Pharm 2 (5 decks)

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