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2021 Pharm 2 > Immune System > Flashcards

Immune System Flashcards

1
Q

myelosuppression

A
  • suppression of bone marrow
  • fever = high priority
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2
Q

neutropenic precautions

A
  • avoid
    • large crowds
    • sick people
    • recently vaccinated people (live vaccine)
    • fresh flowers
    • fresh fruits/veggies
  • may require hospitalization if severe
    • staff, visitors wear PPE to protect pt
    • fever = high priority
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3
Q

N&V with chemo

A
  • CINV
  • pharm: antiemetics, glucocorticoid
  • non-pharm: avoid strong or sudden odors
  • monitor for metabolic alkalosis (Tx: NaHCO3)
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4
Q

BARFS

A
  • bone marrow suppression
  • alopecia
  • retching
  • fear and anxiety
  • stomatitis
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5
Q

CANCER interventions

A
  • comfort
  • altered body image
  • nutrition
  • chemotherapy
  • evaluate response
  • respite for caregiver
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6
Q

mucositis interventions

A
  • monitor for GI bleed, mouth sores
  • frequent oral hygiene
  • use soft toothbrush
  • avoid alcohol mouthwash
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7
Q

cytotoxic meds

A
  • lack tissue specificity
  • kill fast-growing cancer and healthy cells
  • many are cell-cycle non-specific
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8
Q

vesicant

A
  • → tissue damage if extravasation occurs
  • requires immediate attention
  • neutralizing solution specific to drug may be required
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9
Q

antimetabolites

A

interrupt specific phase of cell division

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10
Q

antitumer antibiotics

A

stop synthesis of RNA, DNA, or proteins

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11
Q

antimiotics

A

inhibit mitosis

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12
Q

alkylating agents MOA

A

alter DNA structure and prevent cell division

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13
Q

topoisomerase inhibitors MOA

A

interrupt DNA synthesis

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14
Q

methotrexate

A
  • class: folic acid analog
  • route: oral, IV, IM, intrathecal
  • action: stops cell reproduction by inhibiting folic acid conversion
  • pregnancy risk category X
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15
Q

methotrexate SE

A
  • myelosuppression
  • N&V
  • mucositis
    • gastric ulcers
    • GI perforation
  • reproductive toxicity: congenital abnormalities
  • renal damage
    • hyperuricemia
    • ↑ uric acid
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16
Q

methotrexate interactions

A
  • methotrexate toxicity
    • salicylates
    • NSAIDs
    • sulfonamides
    • PCN
    • tetracyclines
  • ↓ response to methotrexate: folic acid
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17
Q

cytarabine

A
  • class: pyrimidine analog
  • route: SQ, IT, IV
  • action: inhibits RNA, DNA synthesis
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18
Q

fluorouracil

A
  • class: pyrimidine analog
  • route: IV, topical
  • action: inhibits RNA, DNA synthesis
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19
Q

cytarabine, fluorouracil SE

A
  • myelosuppression
  • N&V
  • liver dz
  • pulmonary edema
  • arachnoiditis
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20
Q

arachnoiditis

A

inflammation of the arachnoid membrane, middle layer of the three meninges

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21
Q

cytarabine interactions

A
  • ↓ digoxin level
  • ↓ gentamicin response for Klebsiella pneumoniae
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22
Q

mercaptopurine

A
  • class: purine analog
  • route: PO
  • action: dirupts RNA, DNA synthesis
  • pregnancy risk category X
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23
Q

mercaptopurine SE

A
  • myelosuppression
  • N&V
  • liver toxicity
  • mucositis
    • gastric ulcers
    • GI perforation
  • reproductive toxicity
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24
Q

pt education about antimetabolites

A
  • 2-3 L fluid/day
  • good oral hygiene
  • no alcohol mouthwash
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25
doxorubicin
* "red devil" * class: anthracycline * route: IV * action: alters DNA, cell cycle non-specific
26
doxorubicin SE
* myelosuppression * N&V * stomatitis * tissue damage (vesicant) * alopecia * acute cardiac toxicity, dysrhythmias * cardiomyopathy, HF * red urine
27
dactinomycin
* class: non-anthracycline * route: IV * action: binds to DNA, alters structure; cycle non-specific
28
dactinomycin SE
* myelosuppression * N&V * stomatitis * tissue damage (vesicant) * alopecia
29
interventions for antitumor antibiotics
* monitor for * bleeding/bruising * fever/infection * diagnostics/labs * CBC * LFTs * renal * EKG * antiemetics for N&V
30
vincristine
* class: vinca alkaloid, antimimotic * route: IV * action: cell phase specific; usually given in combo * **only mild, brief myelosuppression**
31
vincristine SE
* peripheral neuropathy * tissue damage (vesicant) * alopecia
32
paclitaxel
* class: taxane, antimimotic * route: IV * action: stops cell division during mitosis
33
paclitaxel SE
* myelosuppression * bradycardia, heart block * alopecia * *SJS* * *hypersensitivy rxn/anaphylaxis* * *toxic epidermal necrolysis* * *pylmonary embolism, fibrosis*
34
antimimotic interactions
* ↑ myelosuppression: cisplatin, doxorubicin * ↑ bradycardia: beta blockers, calcium channel blockers, digoxin, etc. * ↑ risk for bleeding: NSAIDs, anticoagulants, etc.
35
generalities of antimimotics
* assess * s/sx neuropathy * breath sounds (bronchospasm) * monitor for * bleeding/bruising * IV site for extravasation * mucositis * use birth control if indicated * perform good mouth care
36
cyclophosphamide
* class: nitrogen mustard, alkylating agent * route: PO, IV * action: interrupts RNA, DNA synthesis
37
cyclophosphamide SE
* myelosuppression * N&V * acute hemorrhagic cystitis: sudden onset hematuria, pain * alopecia
38
carmustine
* class: nitrosoureas, alkylating agents * route: IV, intracavitary * action: interrupts DNA, RNA synthesis; non cell-cycle specific
39
carmustine SE
* myelosuppression * N&V * pulmonary fibrosis * liver and kidney toxicity
40
cisplatin
* class: platinum compound, alkylating agent * route: IV * action: interrupts DNA, RNA synthesis
41
cisplatin SE
* myelosuppression * N&V * renal toxicity * hearing loss
42
pt ed for alkylating agents
* 2-3 L fluid/day * monitor for * blood in urine * bleeding * bruising * infection * hearing/tinnitus (get baseline) * good oral care * use birth control
43
topotecan
* class: topoisomerase inhibitor * route: IV, PO * action: interferes with DNA synthesis; cell cycle phase specific
44
topotecan SE
* myelosuppression * N&V * alopecia
45
hydroxyurea
* class: antimetabolite * route: PO * action: disrupts DNA synthesis; cell-cycle specific
46
hydroxyurea SE
* N&V * myelosuppression
47
leuprolide
* class: GRH agonist, hormone, antineoplastic * route: SQ, IM * action: stops production of testosterone in testes * indication: advanced prostate ca (palliative)
48
leuprolide SE
* hot flashes * ↓ libido * gynecomastia * ↓ bone density * arrhythmias * pulmonary edema * initial dz flare: brief; Tx with flutamide
49
flutamide
* class: antiandrogen, antineoplastic * route: PO * action: blocks testosterone at receptor sites
50
flutamide SE
* hot flashes * ↓ libido * gynecomastia * N&V * diarrhea * hepatitis
51
tamoxifen
* class: estrogen receptor blocker, antineoplastic * route: PO * action: stops growth of estrogen-dependent breast cancer cells * normal: pt will feel pain in bones, affected breast
52
tamoxifen SE
* **endometrial cancer** * hypercalcemia * N&V * PE * hot flashes * vaginal discharge or bleeding
53
anastrozole
* class: aromatase inhibitor, antineoplastic * route: PO * action: inhibits enzyme that converts precursors to estrogen * indication: breast ca in post-menopausal women
54
anastrozole SE
* muscle and joint pain * HA * nausea * vaginal bleeding * ↑ risk of osteoporosis * hot flashes
55
trastuzumab
* class: monoclonal antibody, antineoplastic * route: IV * action: inhibits proliferation of cells that overexpress HER2 protein * **may be used with paclitaxel**
56
trastuzumab SE
* cardiac toxicity * tachycardia * HF * hypersensitivity rxn * N&V * flu-like sx after first infusion
57
breast ca meds pt ed
* ↑ Ca and vitamin D intake and weight-bearing exercises * encourage regular mammograms, BSEs, gyn appts * use birth control during Tx if pregnancy possible
58
interferon alpha-2B
* class: biologic response modifier * route: IM, SQ, intralesional * action: ↑ immune response, ↓ production of ca cells
59
interferon alpha-2B SE
* flu-like sx: fever, fatigue, HA, chills, myalgia * with prolonged therapy * myelosuppression * alopecia * cardiotoxicity * neurotoxicity * depression * anxiety * insomnia * AMS
60
cetuximab
* class: EGFR-tyrosine kinase inhibitor, monoclonal antibody * route: IV * action: prevents cell growth and differentiation, ↑ cell death * **premedicate with diphenhydramine and corticosteroid** * for EGFR+ cancers
61
cetuximab SE
* infusion rxn: rash, hypotension, wheezing * PE * skin toxicity/rash * *SJS* * *toxic epidermic necrolysis*
62
imatinib
* class: BCR-ABL tyrosine kinase inhibitor, enzyme inhibitor * route: PO * action: inhibits intracellular enzymes
63
imatinib SE
* N&V * flu-like sx * edema * hypokalemia * neutropenia, anemia * *tumor lysis syndrome* * *thrombocytopenia* * *DRESS* * *hepatotoxicity*
64
rituximab
* class: CD20-directed antibody * route: IV * action: stops cancer cell growth, ↑ cell death * **premedicate to prevent infusion rxn**
65
rituximab SE
* infusion rxn: rash, hypotension, wheezing * flu-like sx * tymor lysis syndrome → renal failure, hypocalcemia, hyperuricemia * *hypersensitivity rxn* * *anemia, neutropenia, thrombocytopenia* * *mucocutaneous skin rxns*
66
bevacizumab
* class: angiogenesis inhibitor, monoclonal antibody * route: IV * action: stops cancer cell growth, ↑ cell death
67
bevacizumab SE
* thromboembolism: CVA, MI, TIAs * alopecia * hemorrhage: GI, vaginal, nasal, intracranial, pulmonary * HTN * gastric perforation * *HF* * *bleeding* * *hemoptysis* * *wound dehiscence* * *posterior reversible encephalopathy syndrome*
68
generalities about targeted antineoplastic meds
* monitor for infusion rxn * protect skin from sun * notify provider for SOB * good oral hygiene * monitor CBC, electrolytes * monitor fluid status * assess for edema * report * abd pain * skin lesions * HA * bleeding
69
interventions for myelosuppression
* monitor * CBC * s/sx infection * s/sx bleeding * neutropenic precautions if needed * **fever = high priority**
70
criterion for neutropenic precautions
WBC \< 1,000
71
prophylactic drugs for CINV
* ondansetron + dexamethasone * granisetron * metoclopramide
72
s/sx of metabolic alkalosis
* abnormal sensations * neuromuscular irritability * tetany * abnormal heart rhythm r/t electrolyte imbalances * coma * sz * confusion
73
Tx for metabolic alkalosis
NaHCO3
74
CINV
chemo-induced nausea and vomiting
75
mucositis
* inflammation of a mucous membrane * chemo-induced: GI tract
76
arachnoiditis s/sx
* HA * N&V * fever
77
arachnoiditis Tx
dexamethasone
78
antimetabolite labs
* CBC * LFTs * renal fxn * electrolytes (N&V)
79
When giving antimetabolites, monitor for ...
* bruising * bleeding * infection * N&V (electrolytes) * jaundice * UOP, dysuria
80
antimetabolites interventions
* NaHCO3 to alkalize urine * ↑ fluids (2-3 L) * electrolyte replacement (severe N&V) * **fever = high priority**
81
doxorubicin interventions
* acute cardiac toxicity, dysrhythmias * monitor EKG, echo * Tx: dexrazoxane (↑ myelosuppression) * cardiomyopathy, HF * monitor EKG, echo * Tx: ACE inhibitors * N&V: antiemetics, electrolytes (severe)
82
nursing actions alkylating agents
* monitor for * blood in urine * bleeding * bruising * infection * hearing loss/tinnitus (get baseline) * labs * CBC * LFT * renal fxn * N&V: antiemetics
83
with breast ca meds, monitor for
* heart rhythm * breath sounds * CBC * Ca levels
84
tamoxifen contraindications
* contraindication: h/o blood clots * warfarin use
85
pt ed for antitumor antibiotics
* good oral hygiene * no alcohol mouthwash * quick hair loss: 1 wk up to 2 mo after Tx * will need cardiac monintoring for years * s/sx of cardiac failure
86
s/sx of cardiac failure
* SOB (exertional, nocturnal, at rest) * inspiratory crackles, experatory wheezes * cool, clammy skin * right-sided * NVD * pallor or cyanosis * mental confusion * anxiety * hepatojugular reflux (engorged liver) * left-sided * pulmonary edema * tachypnea * tachycardia * gallop (S3, S4) * murmurs
87
**vesicants**, *exfoliants*, and irritants
**doxorubicin** **dactinomycin** **vincristine** paclitaxel * cisplatin* * topotecan* (dexrasoxane) * fluorouracil* * methotrexate*

2021 Pharm 2 (18 decks)

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