GI/Cancer/CNS Flashcards
1
Q
Cancer (Carcinoma)
A
- disease characterized by abnormal, uncontrolled cell division
2
Q
Metastasis
A
- abnormal cells travel to distant sites where they populate new tumors
3
Q
Tumor
A
- swelling, abnormal enlargement
- aka mass,neoplasm
4
Q
3 goals of chemotherapy
A
- cure
- control
- palliation
5
Q
Radiation
A
- prescribed post op to kill cancer cells that remain or for inoperable cancers to shrink size of tumors that may be pressing on organs or obstructing breathing
6
Q
Adjuvant Chemotherapy
A
- adminstration of antineoplastic drugs after surgery or radiation
7
Q
Growth Fraction
A
- ratio of replicating cells to resting cells
- antineoplastic drugs are more effective on cells with high growth fractions
- hair follicles, bone marrow, GI tissue have high GF–might explain adverse effects
8
Q
Vesicants
A
- agents that can cause serious tissue injury if they escape from an artery or vein during injection or infusion
- use central line if possible (subclavian vein)
9
Q
Antineoplastic Drugs
A
- extracted from plants and bacteria, also made in lab
- kill or stop growth of cancer cells
- alkylating agents, antimetabolites, antitumor antibiotics, hormones, hormone antagonists, natural products, biologic response modifiers and monoclonal antibodies
10
Q
Antitumor Antibiotics
A
- inhibit cell growth through cytotoxicity, similar to alkylating agents
- wear gloves when preparing
- monitor IV site
- adverse effects: **cardiotoxicity **
11
Q
Hormones and Hormone Anatagonists
A
- used to slow growth of hormone dependent tumors
- glucocorticoids, progestins, estrogens, androgens
- doses are magnitudes larger than what the body produces
- less cytotoxic
- blocks substances essential for tumor growth
12
Q
Glucocorticoids
A
- dexamethasone, prednisone
- inhibit inflammation
- sometimes given as adjunct to reduce nausea, weight loss, tissue inflammation caused by other antineoplastics
- prolonged use can result in symptoms of Cushing’s disease
13
Q
Hormones and Hormone Antangonists
Antiestrogens
A
- treat tumors dependent on estrogen
- breast cancer
- Tamoxifen
14
Q
methotrexate (Folex, Mexate)
A
- antimetabolite
- blocks synthesis of folic acid (vit B12) to inhibit replication
- used to treat choriocarcinoma, osteogenic carcinoma, leukemias, head and neck cancers, breast carcinoma, lung carcinoma
- improved status of pts w/ rheumatoid arthritis
- BLACK BOX
- fatal bone marrow toxicity in high doses
- hemorrhage/bruising due to low platelet counts
- n/v, anorexia, GI ulceration
- dermatologic reactions such as Stevens Johnson syndrome
15
Q
doxorubicin
A
- antitumor antibiotic
- attaches to DNA, prevents normal DNA & RNA synthesis
- severe vesicant
- tx for solid tumors of lung, breast, ovary, bladder, leukemias, lymphomas
16
Q
tamoxifen (Nolvadex)
A
- hormone/hormone antagonist
- blocks estrogen receptors on breast cancer cells
- adverse effects; nausea, vomiting, hot flashes, fluid retention, increased risk of endometrial cancer and thrombolytic disease
- used as a prophylactic–Nurses study
- hirsutism, gyneocomastia
17
Q
Immunosuppressants
A
- used to treat severe auto immune disease
- inhibit patients immune system
- prevent tissue rejection in transplants
- toxic to bone marrow
- increase risk of infections and lymphoma
- glucocorticoids, antimetabolites, antibodies, cacineurin inhibitors
- monitor for indications of infections, bone marrow suppression
18
Q
Cyclosporine
A
- calcineurin inhibitor
- bind to calcineurin and inhibit helper T cells
- used to treat psoriasis
19
Q
ulcer
A
erosion of the mucosa layer of the GI tract usually associated with acute inflammation
20
Q
PUD
A
cause: infection by H pylori
risk factors:
- family hx
- Blood type O
- smoking
- caffeine
- NSAIDs, corticosteroids
- stress
- H. pylori
21
Q
H2-receptor blockers
A
- slow acid secretion by stomach by blocking H2-receptors
22
Q
antacids
A
- neutralize stomach acid
- inexpensive, OTC
23
Q
ranitidine (Zantac)
A
- H2-receptor blocker
- decreases acid production to treat PUD
- AE: possible reduction in red and while blood cells and platelets, loss of libido in men
24
Q
omeprazole (Prilosec)
A
- proton pump inhibitor
- reduces acid secretion in stomach by binding to H1 K1-ATPase
- short term use
- AE: headache, nausea, diarrhea, rash, abdominal pain
25
aluminum hydroxide (Amophejel)
* antacid
* neutralizes stomach acid by raising pH of stomach contents
* for relief of heartburn due to PUD or GERD
* AE: minor; constipation
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27
Sympathetic Nervous System
| (Adrenergic System)
* "fight or flight"
* neurotransmitter: norepinephrine
* receptors: alpha 1, alpha 2, beta 1, beta 2
28
Parasympathetic Nervous System
| (Cholinergic System)
* "rest and digest"
* neurotransmitter: acetycholine
* receptors: nicotinic (neuromuscular), muscarinic (smooth muscle/heart)
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Alpha 1
* increases force of cardiac contraction
* **vasocontriction**
* increases BP
* dilates pupils
* decreases salivary gland secretion
* increases contraction in prostate capsule
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Alpha 2
* dilates blood vessels--hypotension
* decreases GI motility and tone
* inhibits release or norepinephrine
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Beta 1
* (mainly cardiac) increase HR & force of contraction
* increase release of renin
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Beta 2
* (mainly pulmonary) bronchioles dilate
* blood flow increases to skeletal muscles, GI, uterus
* bladder relaxation
* increases glucose production
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Epinephrine
* acts on more than one receptor (nonselective)
* Alpha1: increases BP
* Beta1: increases HR (tachycardia)
* Beta2: promotes bronchodilation
* used to treat allergic reaction, bronchospasm, cardiac arrest
* adverse effects: tachycardia, V-fib, nervousness, headache, pulmonary edema, palpitations
34
metroclopramide (Reglan)
* direct-acting cholinergic
* used to increase GI motility/GERD
* also used for post op nausea and vomiting
35
atropine
* anticholinergic
* acetylcholine inhibitor, increases HR, decreases secretions
* blurred vision, urinary hesitancy, dry mouth, flush, constipation
36
Immunostimulants
* biologic response modifiers
* boost patient's immune system
* tx of viral infections, immunodeficiencies, cancers
* interferons, interleukins
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Immunosuppressants
* inhibit patient's immune system
* tx of severe autoimmune disease and to prevent transplant rejection
38
Drugs with Immunosuppresant activity
* glucocorticoids
* antimetabolites
* antibodies
* calcineurin inhibitors
39
metformin
| (Fortamet, Glucophage, Glumetza)
* Biguanide
* decreases hepatic production of glucose (gluconeogenesis)
* do not promote insulin resistance
* lowers LDL & triglyceride levels
* adverse effects: anorexia, flatulence, n/v/d,
* monitor liver function--contraindicated in patients with renal disease or excessive ETOH
* discontinue before using contract dye
40
Sulfonylureas
| (glipizide, glimeripride, glyburide)
* oral hypoglycemic
* stimulates production of insulin from pancreatic islet cells
* increases sensitivity of insulin receptors on target cells
* adverse effects: hypoglycemia, GI distress, hepatotoxicity
* flushing, palpitations, nausea with ETOH
41
Insulin regular
| (Humulin)
* short acting
* onset: 30-60min
* peak: 1-5h
* duration: 6-10h
* only insulin that can be given IV
* used for emergency cases of DKA
* Promotes cellular uptake of glucose, amino acids, potassium
* Promotes protein synthesis
Glycogen formation and storage
* Fatty acid storage as triglycerides
* Conserves energy stores by promoting utilization of glucose for energy needs
* Inhibits gluconeogenesis
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isophane susp
| (NPH)
* intermediate
* onset: 1-2h
* peak: 6-14h
* duration: 16-24h
* cloudy--mix last
43
insulin glargine
| (Lantus)
* long acting
* onset: 1.1h
* no peak
* duration: up to 24h
* do not mix
44
insulin lispro
(Humalog)
* rapid acting
* onset: 5-15min
* peak: 1-1.5h
* duration: 3-4h
45
Actos
| (pioglitazone)
* thiazolidinediones (glitazones)
* reduce blood glucose by decreasing insulin resistence and inhibiting hepatic gluconeogenesis
* adverse effects: **fluid retention**, edema, weight gain, liver damage, headache
* monitor LFTs
46
Acarbose
(precose)
* alpha-glucosidase inhibitor
* inhibits enzyme neccessary for breaking down complex carbohydrates--delaying digestion of glucose
* well tolerated, only minor GI side effects
* **take with first bite of meal--**helps with post-prandial hyperglycemia
* hypoglycemia must be treated with glucose not sucrose
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Valproic Acid
(Depakote)
* phenytoin-like drugs, antiseizure
* desensitizes sodium channels
* tx for absence seizures
* adverse effects: GI irritation, sedation, **prolonged bleeding time**
48
Dilantin
| (phenytoin)
* antiseizure, hydantoin derivative
* desensitizes sodium channels
* used for tx of all types of epilepsy except absence seizures
* not compatible with many other drugs--**only use with NS when giving IV**, run 50mg/min . flush or prime line before giving, monitor site (can cause tissue damage)
* first line drug for status epilepticus
* adverse effects: cardiac dysrhythmias, rash, **gingival hyperplasia**, drowsiness, CNS depression, hypotension
49
Levodopa
| (laradopa)
* tx for Parkinsons
* inscreases biosynthesis of dopamine within nerve terminals
* **can cross blood-brain barrier (dopamine cannot)**
* effectiveness "boosted" with cardidopa, combo drug=Sinemet
* Sinemet makes more Levodopa available to CNS
* adverse effects: dizziness, sleep dysfunction, fatigue, n/v, constipation, orthostatic hypotension, dystonia, dyskinesia
50
Remicade
| (Infliximab)
* immunosuppressant, antibody
* suppresses inflammation in autoimmune disorders, blocks TNF
* tx for Crohn's, rheumatoid arthritis, ulcerative colitis
* one infusion can cause remission in 65% of Crohn's pts
* monitor WBC, RBCs, platelets, infection
51
Lomotil
| (diphenoxylate w/ atropine)
* antidiarrheal, opioid
* slows peristalsis
* adverse effects: drowsiness, dizziness, avoid ETOH
* contraindicated in patients with liver disease, glaucoma
52
Vistaril, Atarax
| (hydroxyzine)
* antiemetic, antihistamine
* tx of post op n/v
* PO or IM--never IV
* given pre op with narcotics to decrease nausea
* adverse effects: dry mouth, drowsiness
53
Compazine
| (prochloroperizine)
* antiemetic, dopamine antagonist
* blocks dopamine receptors, inhibits vomiting center
* tx for severe n/v, most frequently prescribed
* adverse effects: dry mouth, sedation, constipation, tachycardia, orthostatic **hypotension**
* adminster 2 hr before or after antacids
* prolonged periods of high doses can cause Parkinsonian like symptoms
54
Psyllium mucilloid
* bulk-type laxative
* increases absorption of water to increase size of fecal mass
* treatment/prevention of chronic constipation
* regular use as fiber supplement
* slow onset
* mix w/ 8oz of juice, milk, water
* **decreases absorption of some drugs--dig, warfarin**
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Insulin
* Protein that is destroyed by the GI tract
* Promotes entry of glucose into cells
* Provides storage of glucose as glycogen
* Inhibits breakdown of fat and glycogen
* Inhibits glycogenesis
* SQ or IV (only regular insulin can be given IV) give at room temp
* Use 100u/ml syringe at 90--rotate sites
* roll first, Clear air bubbles
* Regular and long acting may be mixed together in the same syringe
* Lantus cannot be mixed with any other insulin
* Administration must be carefully planned in conjunction w/ diet and lifestyle habits
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