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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
Q

doxorubicin

A
  • “red devil”
  • class: anthracycline
  • route: IV
  • action: alters DNA, cell cycle non-specific
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26
Q

doxorubicin SE

A
  • myelosuppression
  • N&V
  • stomatitis
  • tissue damage (vesicant)
  • alopecia
  • acute cardiac toxicity, dysrhythmias
  • cardiomyopathy, HF
  • red urine
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27
Q

dactinomycin

A
  • class: non-anthracycline
  • route: IV
  • action: binds to DNA, alters structure; cycle non-specific
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28
Q

dactinomycin SE

A
  • myelosuppression
  • N&V
  • stomatitis
  • tissue damage (vesicant)
  • alopecia
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29
Q

interventions for antitumor antibiotics

A
  • monitor for
    • bleeding/bruising
    • fever/infection
  • diagnostics/labs
    • CBC
    • LFTs
    • renal
    • EKG
  • antiemetics for N&V
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30
Q

vincristine

A
  • class: vinca alkaloid, antimimotic
  • route: IV
  • action: cell phase specific; usually given in combo
  • only mild, brief myelosuppression
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31
Q

vincristine SE

A
  • peripheral neuropathy
  • tissue damage (vesicant)
  • alopecia
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32
Q

paclitaxel

A
  • class: taxane, antimimotic
  • route: IV
  • action: stops cell division during mitosis
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33
Q

paclitaxel SE

A
  • myelosuppression
  • bradycardia, heart block
  • alopecia
  • SJS
  • hypersensitivy rxn/anaphylaxis
  • toxic epidermal necrolysis
  • pylmonary embolism, fibrosis
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34
Q

antimimotic interactions

A
  • ↑ myelosuppression: cisplatin, doxorubicin
  • ↑ bradycardia: beta blockers, calcium channel blockers, digoxin, etc.
  • ↑ risk for bleeding: NSAIDs, anticoagulants, etc.
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35
Q

generalities of antimimotics

A
  • 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
Q

cyclophosphamide

A
  • class: nitrogen mustard, alkylating agent
  • route: PO, IV
  • action: interrupts RNA, DNA synthesis
37
Q

cyclophosphamide SE

A
  • myelosuppression
  • N&V
  • acute hemorrhagic cystitis: sudden onset hematuria, pain
  • alopecia
38
Q

carmustine

A
  • class: nitrosoureas, alkylating agents
  • route: IV, intracavitary
  • action: interrupts DNA, RNA synthesis; non cell-cycle specific
39
Q

carmustine SE

A
  • myelosuppression
  • N&V
  • pulmonary fibrosis
  • liver and kidney toxicity
40
Q

cisplatin

A
  • class: platinum compound, alkylating agent
  • route: IV
  • action: interrupts DNA, RNA synthesis
41
Q

cisplatin SE

A
  • myelosuppression
  • N&V
  • renal toxicity
  • hearing loss
42
Q

pt ed for alkylating agents

A
  • 2-3 L fluid/day
  • monitor for
    • blood in urine
    • bleeding
    • bruising
    • infection
    • hearing/tinnitus (get baseline)
  • good oral care
  • use birth control
43
Q

topotecan

A
  • class: topoisomerase inhibitor
  • route: IV, PO
  • action: interferes with DNA synthesis; cell cycle phase specific
44
Q

topotecan SE

A
  • myelosuppression
  • N&V
  • alopecia
45
Q

hydroxyurea

A
  • class: antimetabolite
  • route: PO
  • action: disrupts DNA synthesis; cell-cycle specific
46
Q

hydroxyurea SE

A
  • N&V
  • myelosuppression
47
Q

leuprolide

A
  • class: GRH agonist, hormone, antineoplastic
  • route: SQ, IM
  • action: stops production of testosterone in testes
  • indication: advanced prostate ca (palliative)
48
Q

leuprolide SE

A
  • hot flashes
  • ↓ libido
  • gynecomastia
  • ↓ bone density
  • arrhythmias
  • pulmonary edema
  • initial dz flare: brief; Tx with flutamide
49
Q

flutamide

A
  • class: antiandrogen, antineoplastic
  • route: PO
  • action: blocks testosterone at receptor sites
50
Q

flutamide SE

A
  • hot flashes
  • ↓ libido
  • gynecomastia
  • N&V
  • diarrhea
  • hepatitis
51
Q

tamoxifen

A
  • 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
Q

tamoxifen SE

A
  • endometrial cancer
  • hypercalcemia
  • N&V
  • PE
  • hot flashes
  • vaginal discharge or bleeding
53
Q

anastrozole

A
  • class: aromatase inhibitor, antineoplastic
  • route: PO
  • action: inhibits enzyme that converts precursors to estrogen
  • indication: breast ca in post-menopausal women
54
Q

anastrozole SE

A
  • muscle and joint pain
  • HA
  • nausea
  • vaginal bleeding
  • ↑ risk of osteoporosis
  • hot flashes
55
Q

trastuzumab

A
  • class: monoclonal antibody, antineoplastic
  • route: IV
  • action: inhibits proliferation of cells that overexpress HER2 protein
  • may be used with paclitaxel
56
Q

trastuzumab SE

A
  • cardiac toxicity
  • tachycardia
  • HF
  • hypersensitivity rxn
  • N&V
  • flu-like sx after first infusion
57
Q

breast ca meds pt ed

A
  • ↑ Ca and vitamin D intake and weight-bearing exercises
  • encourage regular mammograms, BSEs, gyn appts
  • use birth control during Tx if pregnancy possible
58
Q

interferon alpha-2B

A
  • class: biologic response modifier
  • route: IM, SQ, intralesional
  • action: ↑ immune response, ↓ production of ca cells
59
Q

interferon alpha-2B SE

A
  • flu-like sx: fever, fatigue, HA, chills, myalgia
  • with prolonged therapy
    • myelosuppression
    • alopecia
    • cardiotoxicity
    • neurotoxicity
  • depression
  • anxiety
  • insomnia
  • AMS
60
Q

cetuximab

A
  • 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
Q

cetuximab SE

A
  • infusion rxn: rash, hypotension, wheezing
  • PE
  • skin toxicity/rash
  • SJS
  • toxic epidermic necrolysis
62
Q

imatinib

A
  • class: BCR-ABL tyrosine kinase inhibitor, enzyme inhibitor
  • route: PO
  • action: inhibits intracellular enzymes
63
Q

imatinib SE

A
  • N&V
  • flu-like sx
  • edema
  • hypokalemia
  • neutropenia, anemia
  • tumor lysis syndrome
  • thrombocytopenia
  • DRESS
  • hepatotoxicity
64
Q

rituximab

A
  • class: CD20-directed antibody
  • route: IV
  • action: stops cancer cell growth, ↑ cell death
  • premedicate to prevent infusion rxn
65
Q

rituximab SE

A
  • infusion rxn: rash, hypotension, wheezing
  • flu-like sx
  • tymor lysis syndrome → renal failure, hypocalcemia, hyperuricemia
  • hypersensitivity rxn
  • anemia, neutropenia, thrombocytopenia
  • mucocutaneous skin rxns
66
Q

bevacizumab

A
  • class: angiogenesis inhibitor, monoclonal antibody
  • route: IV
  • action: stops cancer cell growth, ↑ cell death
67
Q

bevacizumab SE

A
  • thromboembolism: CVA, MI, TIAs
  • alopecia
  • hemorrhage: GI, vaginal, nasal, intracranial, pulmonary
  • HTN
  • gastric perforation
  • HF
  • bleeding
  • hemoptysis
  • wound dehiscence
  • posterior reversible encephalopathy syndrome
68
Q

generalities about targeted antineoplastic meds

A
  • 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
Q

interventions for myelosuppression

A
  • monitor
    • CBC
    • s/sx infection
    • s/sx bleeding
  • neutropenic precautions if needed
  • fever = high priority
70
Q

criterion for neutropenic precautions

A

WBC < 1,000

71
Q

prophylactic drugs for CINV

A
  • ondansetron + dexamethasone
  • granisetron
  • metoclopramide
72
Q

s/sx of metabolic alkalosis

A
  • abnormal sensations
  • neuromuscular irritability
  • tetany
  • abnormal heart rhythm r/t electrolyte imbalances
  • coma
  • sz
  • confusion
73
Q

Tx for metabolic alkalosis

A

NaHCO3

74
Q

CINV

A

chemo-induced nausea and vomiting

75
Q

mucositis

A
  • inflammation of a mucous membrane
  • chemo-induced: GI tract
76
Q

arachnoiditis s/sx

A
  • HA
  • N&V
  • fever
77
Q

arachnoiditis Tx

A

dexamethasone

78
Q

antimetabolite labs

A
  • CBC
  • LFTs
  • renal fxn
  • electrolytes (N&V)
79
Q

When giving antimetabolites, monitor for …

A
  • bruising
  • bleeding
  • infection
  • N&V (electrolytes)
  • jaundice
  • UOP, dysuria
80
Q

antimetabolites interventions

A
  • NaHCO3 to alkalize urine
  • ↑ fluids (2-3 L)
  • electrolyte replacement (severe N&V)
  • fever = high priority
81
Q

doxorubicin interventions

A
  • acute cardiac toxicity, dysrhythmias
    • monitor EKG, echo
    • Tx: dexrazoxane (↑ myelosuppression)
  • cardiomyopathy, HF
    • monitor EKG, echo
    • Tx: ACE inhibitors
  • N&V: antiemetics, electrolytes (severe)
82
Q

nursing actions alkylating agents

A
  • monitor for
    • blood in urine
    • bleeding
    • bruising
    • infection
    • hearing loss/tinnitus (get baseline)
  • labs
    • CBC
    • LFT
    • renal fxn
  • N&V: antiemetics
83
Q

with breast ca meds, monitor for

A
  • heart rhythm
  • breath sounds
  • CBC
  • Ca levels
84
Q

tamoxifen contraindications

A
  • contraindication: h/o blood clots
  • warfarin use
85
Q

pt ed for antitumor antibiotics

A
  • 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
Q

s/sx of cardiac failure

A
  • 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
Q

vesicants, exfoliants, and irritants

A

doxorubicin

dactinomycin

vincristine

paclitaxel

  • cisplatin*
  • topotecan*

(dexrasoxane)

  • fluorouracil*
  • methotrexate*

2021 Pharm 2 (18 decks)

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