Neoplasm 2 Flashcards
How are fixed chemotherapeutic doses determined?
finalized based on body surface area (BSA), weight, creatinine clearance, or other adjustments made for each patient
What happens to a tumor’s growth fraction over time?
It decreases
Why are CCS and CCNS drugs given together?
CCS drugs reduce the tumor growth factor and CCNS drugs help to reduce the tumor burden
Tx combination for Hodgkins lymphoma
ABVD
Tx combination for non-Hodgkins lymphoma
CHOP +/- R
Tx combination for colorectal CA
FOLFOX
Tx combination for small cell CA
ICE-V
Tx combination for breast CA
TAC
ABVD drugs
(doxorubicin) + Bleomycin + Vinblastine + Dacarbazine
CHOP +/- R drugs
Cyclophosphomide + Doxorubicin + Oncovin (vincristine) + Prednisone ± Rituximab
FOLFOX drugs
5-Flourouracil + Leucovorin + Oxaliplatin
ICE-V drugs
Ifosfamide + Carboplatin + Etoposide + Vincristine
TAC drugs
Taxotere (docetaxel) + Adriamycin (doxorubicin) + Cyclophosphamide
What determines the type of vascular access devices (VADs) chosen for chemo?
based on determining the length of time it will be needed
Midline cath length of use
Used when peripheral IV cannot be used, intermediate length of therapy
PICC line use length
Several wks or longer
Tunneled central catheter
Surgically placed in a large central vein, with a catheter tunneled under the skin
Implantable port
a catheter surgically placed under the skin of the chest or arm in a large or central vein
When is intravesical chemo given?
Early stage bladder CA - placement of a urinary catheter to give the drug into the bladder
When is Intrapleural and intraperitoneal chemo used?
useful for some with mesothelioma, ovarian cancer that has spread to the peritoneum, and lung or breast cancers that have spread to the pleura
Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Involves cutting all visible cancer out of the abdomen and then flooding the cavity with heated chemotherapy drugs
What is HIPEC used in?
Used to treat peritoneal metastases resulting from several primary cancers, including colon cancer
How to treat CNS CA?
Intrathecal - Most chemotherapy drugs that are given IV are unable to cross the blood-brain barrier
What are irritant drugs?
Irritants: drugs that can cause a short-lived and localized/limited cellular damage to a vein
What are vesicant drugs?
Vesicants: drugs that cause severe redness, blistering, and severe tissue damage (chemical cellulites) at an injection site
Examples of vesicants
5-FU
doxorubicin
paclitaxel
vinblastine
vincristine
vinorelbine
What can be used to tx extravasation caused by Cisplatin?
Local injection of sodium thiosulfate
What can be used to tx extravasation caused by anthracyclines?
Systemic administration of dexrazoxane or topical dimethyl sulfoxide
What can be used to tx extravasation caused by Vinca alkaloids, paclitaxel, ifosfamide?
Local injection of hyaluronidase
Why do cytotoxic drugs damage bone marrow stem cells?
Because the cells of the bone marrow are almost always in some phase of cell division
What is myelosuppression?
Depressed bone marrow function is called myelosuppression
Effects of myelosuppression?
Anemia
Leukopenia
Thrombocytopenia
When are transfusions of packed RBCs needed?
Low hematocrit and Hgb - May be required until the bone marrow has recovered its normal ability to produce more blood cells
When are transfusions of packed RBCs needed?
Low hematocrit and Hgb - May be required until the bone marrow has recovered its normal ability to produce more blood cells
When is erythropoietin used to tx anemia?
Usually reserved for those with long-standing anemia
If neutropenia is severe, what can be done?
Abx are given as a preventative measure
When is neutropenia most severe with chemo?
Neutropenia is most severe with the use of cell cycle–specific drugs, particularly those that are active in the S and M phases
Neutropenia + fever tx
Cancer patients with neutropenia (ANC <500 or expected to be so within 24 hours) and a fever (>38.5°C or 101.5°F ) are usually treated with broad-spectrum antibiotics and colony-stimulating factors
Examples of granulocyte colony stimulating factors (G-CSF)
Filgrastim (Neupogen)
Pegfilgrastim (Neulasta)
Which drugs can worsen platelet count when combined with chemo?
acetylsalicylic acid (aspirin) or NSAIDS can worsen the potential for thrombocytopenia while increasing the risk of GI bleeding
What can be done in pts with platelet counts are very low (<10,000) or if a person with moderately low counts has greater than normal bleeding?
Transfusion OR platelet growth factor
Examples of platelet growth factors
Romiplostim (Nplate) - SQ
Eltrombopag (Promacta, Revolade) - PO
Avatrombopag (Doptelet) - PO
What determines hair loss with chemo?
The extent of hair loss depends on which drugs are given, drug doses, and the length of treatment
Chemo hair loss time line?
Hair loss usually begins within 2 weeks after chemotherapy begins
After chemotherapy is completed, hair regrowth may take 3-5 months
What is a radiation recall rxn?
Radiation recall reactions (radiation recall dermatitis) is an inflammatory reaction that occurs in a previously irradiated area precipitated by certain drugs
Radiation recall rxn sxs
Symptoms: skin reddening, blistering, hyperpigmentation, edema, exfoliation, and ulceration
Which meds are associated with radiation recall rxn?
bleomycin, cytarabine, doxorubicin, daunorubicin, idarubicin, hydroxyurea, methotrexate, paclitaxel, and vinblastine
Which drugs cause acral eruthema?
cytarabine, methotrexate, 5-fluorouracil
What is “hand foot syndrome”?
Acral Erythema - burning, swelling, tingling, and a rash (erythema) on the palms and fingers of the hands and the soles of the feet
Drugs used to tx anorexia in chemo pts?
Dexamethasone
Prednisolone
Methylprednisolone
Megestrol (Megace)
Canabinoids - not routinely recommended d/t limited data
Stomatitis from chemo can lead to what?
The tongue may be coated and swollen, leading to difficulty swallowing, eating, and talking
Which drugs cause stomatitis?
Common drugs associated with stomatitis: antimetabolites (5-fluorouracil and methotrexate) and antitumor antibiotics (doxorubicin)
What is used to tx stomatitis?
Magic mouthwash
Why does chemo cause N/V?
Occur because drugs irritate the lining of the stomach and duodenum and stimulate nerves that lead to the vomiting center in the brain
Drugs notorious for causing N/V
cisplatin, carboplatin
Which pts are at higher risk of N/V with chemo?
Younger patients, females, and those prone to motion sickness
N/V related to chemo tx
Behavioral approaches include guided imagery, relaxation, hypnosis, and distraction
Zofran
Which chemo drugs cause constipation?
vinca alkaloid drugs, vincristine and vinblastine, opioids given for pain relief, and antiemetics (serotonin receptor antagonists)
Which chemo drugs cause diarrhea?
5-fluorouracil, methotrexate, and docetaxel
Which chemo drug is notorious for causing cardiotoxicity?
Doxorubicin associated with causing cardiotoxicity
What is the max lifetime dose of docxorubicin?
the maximum lifetime dose of doxorubicin is 550 mg/m2
What drug may be combined with doxorubicin to avoid cardiotoxicity?
dexrazoxane
Use of which chemo drugs increases the risk of neurotoxicity?
vinca alkaloids
Which drugs cause pulm damage?
bleomycin, busulfan
Which drugs are nephrotoxic?
ifosfamide, cyclophosphamide, cisplatin, and methotrexate
How will direct kidney damage from dysfunction present?
Increased Cr
What is Amifostine used for?
Amifostine is a cytoprotective agent used to reduce potential renal toxicity associated with cumulative doses of platinum-containing medications such as cisplatin.
