ONS Tx Managment Flashcards
1
Q
What side effect does amifostine (Ethyol) help to prevent for patients undergoing radiation therapy?
A
Salivary gland damage. It is a type of radio protector.
2
Q
What are the most common acute side effects of radiation therapy?
A
Fatigue, skin irritation, bone marrow suppression, urinary or bowel dysfunction. And sit specific problems.
3
Q
What population is at highest risk for secondary cancers?
A
Children and adolescent diagnosed with cancer 
4
Q
In radiation Saftey. What does ALRA stand for?
A
As low as reasonably achievable.
5
Q
What are the 3 main factors included in ALARA?
A
1.) time of exposure.
- minimize
2.) distance between you and the radiation source.
-double the distance between you and the RT source. doing this reduces RT exposure by x4
3.) Using radiation shields
- Use absorber materials, such as plexiglass for beta particles. And lead for x-rays and gamma rays
6
Q
Melphalan (EVOMELA) chemotherapy has what sE that requires what special nursing intervention?
A
Mucositis, and placing ice in the patients mouth before, enduring infusion 
7
Q
During the process of stem cell therapy transplant, this is the point at which new blood cells start to grow after chemotherapy. This is called.
A
Engraftment
8
Q
During the process of stem cell therapy transplant, this is the point at which chemotherapy is given to prep your body for the transplant. This step is called
A
Conditioning
9
Q
How are donors matched for stem cell transplants? What factor is looked at primarily?
A
HLA (human leukocyte Antigens)
10
Q
What is the primary treatment for graft versus host disease?
A
Steroids and or immuno suppressant drugs
11
Q
How long does it take to infuse stem cells?
A
Approximately 1 to 5 hours
12
Q
How long does it take for your immune system to fully recover from a stem cell transplant? Is this the same for both autologous and allogenic?
A
Several months for autologous. One to two years for allogenic.
13
Q
What chromosome is genetic information for HLA stored on?
A
Chromosome 6
14
Q
What are the advantages and disadvantages to bone marrow as a vehicle for stem cell collection?
A
advantage: less graph versus host disease
Disadvantage: surgery required, and longer process for engraftment
15
Q
What are the advantages and disadvantages to peripheral blood as a vehicle for stem cell collection?
A
Advantage: shorter time for cell engraftment
Disadvantage: higher risk versus host disease
16
Q
What are the advantages and disadvantages to umbilical cord as a vehicle for stem cell collection?
A
Advantage: high in stem cells and low risk for graft versus host disease
Disadvantage: duration of my suppression and time required for engraftment
17
Q
Myeloablative regimen
A
Is the administration of lethal doses of therapy to severely immuno, suppress and eradicate cancer cells only used for very healthy patients
18
Q
Non-myeloablative Regimen
A
A reduced dose of chemotherapy and comparison to a myeloablative regimen. Used for older patients or those with comorbid conditions the goal is to suppress the immune system and enhance engraftment of stem cells
19
Q
What are some side effects specific to stem cell infusions?
A
1.) pink or red tinged urine from the breakdown of cells, generally resolving within one to two days.
2.) garlic, smell or taste in the mouth as a result of breakdown of DMSO.
3.) Nausea, vomiting diarrhea.
4.) standard infusion reaction s/s
20
Q
What blood cell counts does the clinical team look for to define engraftment?
A
ANC greater than 500 and platelet count greater than 20,000
21
Q
Define chimerism
A
A term meaning successful in graft for patients who have received allogenetic transplants. Only donor cells remain.
22
Q
 how is graft versus host disease diagnosed
A
Biopsy of the affected organ
23
Q
What are risk factors for the development of graft versus host disease?
A
Older patients, peripheral stem cell collection, and having unrelated donors
24
Q
What defines acute versus chronic graft versus host disease?
A
Acute occurs during the first 100 days post transplant, chronic is anything there after
25
What are the three organs most affected by graft versus host disease?
Skin, G.I. tract, and liver
26
Glossectomy
Removal of the tongue or part of the tongue
27
Maxillectomy
Removal of all or part of the maxilla, a.k.a. the hard palette/roof of the mouth. This whole can be filled with a special fit denture or prosthesis or a skin graft from a muscle of the forearm or thigh.
28
Explain the process of curettage ( intrapersonal excision)
Used for bone tumors less likely to spread. The tumor may be scraped out of the inside of the bone. This is done with a sharp instrument called a curette and it leaves a hole in the bone. The goal is to remove as much tumor as possible, and then the surgeon might treat nearby bones with other techniques, such as cryosurgery and then filled in using bone cement
29
Define oncoplasty
And oncologic surgery combined with plastic surgery to give ideal outcomes
30
A type of treatment that uses a substance made from living organisms to treat disease. The substances may occur naturally in the body or be made in the laboratory. They may stimulate or suppress the immune system. Examples include immunotherapy and targeted therapies.
Biotherapy
31
A type of treatment that uses drugs or other substances to target specific molecules. They can work in many different ways to treat cancer.
Targeted therapy
32
A type of substance used to stimulate or suppress the immune system to help your body fight cancer infection, or other diseases.
Immunotherapy
33
Reticulocyte count
Low indicates high proliferative disease high indicates homolysis 
34
Name four causes of neutropenia
Infection, drug, side effect, leukemia (abnormal neutrophil function), and abnormal neutrophil production
35
ANC EQUATION
% neutrophils ( bands+ segments) x WBC
36
What bacteria most commonly causes febrile neutropenia
Nosocomial gram negative bacteria; most commonly from the pts own normal flora
37
White blood cell CFs medications. What are the side effects?
Filgrastim (NEUPOGEN)
Pegfilgrastim (NEULASTA)
Sargramostim (LEUKINE)
SE: bone pain, injection site pain, allergic reactions
38
Red blood cell CFs medications. What are the side effects?
Erythropoietin
Epoetin-alfa (EPOGEN)
Darbepoetin (ARANESP)
SE: hypertension, DVT, diarrhea, fluid retention
39
Platelet CFs medications. What are the side effects?
Oprelvekin (NEUMEGA)
SE: ventricular arrhythmia, ocular defect, fluid retention, anaphylaxis, pulmonary embolism
40
Causes of thrombocytopenia
Metastatic, bone marrow infiltration, DIC, spleen immediately, chemotherapy, certain medications, including NSAIDs
41
What are the five phases of mucositis development and resolution?
Initiation, primary damage response, signal amplification, ulceration, healing
42
What are the most common drugs that caused mucositis?
Capecitabine
Doxil
Busulfan
Cyclophosphamide
5-fluorouracil
Mechlorethamine
43
What patients are at the highest risk for oral mucositis
Younger patients,
Women
Head, neck and esophageal cancer
Frequent alcohol and tobacco use
Comorbid conditions
Poor oral hygiene
44
Prevention and treating mucositis
Establish an oral care protocol
Educate regarding oral hygiene
Cryotherapy (ice / cold water 5 minutes before infusion, during, and for 30 minutes after)
Palifermin
45
Cachexia- define
Known as wasting syndrome, it is a combination of weight loss with muscle loss. Symptoms include anorexia, nausea, and weakness.Often seen an end stage disease.
46
Treatments for anorexia and cachexia
1.) treat the underlying etiology.
Corticosteroids, progestins, nutritional counseling, Reglan, cannabis, entry, or parental supplements,
47
What types of anti-nausea medication’s can cause constipation
1.) 5–HT3 (ondansetron (Zofran), granisetron (Sancuso), palonosetron (Aloxi) Antagonists
2.) benzodiazepines (lorazepam (Ativan), alprazolam (Xanax),
48
Define anorgasmia
Inability to achieve orgasm
49
Define dyspareunia
Pain with intercourse
50
What three drugs can cause hemorrhagic cystitis? A life-threatening side effect.
ifosfamide (IFEX)
cyclophosphamide (CYTOXAN)
busulfan (MYLERAN)
51
Prevention of cystitis
Hydration and diuresis for patients on high-risk medications
Give Mesns IV as a bladder protectant when giving high risk medications
Avoid caffeine, spicy food and alcohol
Continuous bladder irrigation
Hyperbaric oxygen therapy
Avoid alkalizing agents
If symptoms develop antispasmodics and analgesic for pain control
52
Name 4 dermatologic emergencies
Stevens Johnson syndrome, toxic, epidermal necrolysis, drug hypersensitive syndrome, and angioedema
53
Define hypertrichosis
An increase of hair on the face
54
Define Hirsutism
An increase of hair in a male like pattern, such as a beard
55
What drug classes are most commonly associated with hand-foot syndrome?
Taxanes, Anti-angiogenic agents, and topoisomerase inhibitors
56
Xerosis definition and treatment
Dry skin more severe than typical.
Management includes moisturizing cream. To affected areas:
ammonium lactate 12% cream salicylic acid 6% cream
topical high potency steroid. 
57
Define Paronychia
Nail inflammation that develops when bacteria enter broken skin near the cuticle or nail fold
58
Discuss patient education regarding nails when initiating chemotherapy
It is possible nails will become brittle, dry and cracked. These changes are temporary, but it’s important to protect your hands and feed during this time to prevent infection and permanent nail loss.
Gently trim fingernails do not cut them too close to the nail bed
Do not get professional manicures or pedicures
Use unscented lotions and creams to keep your hands moisturized
Wear gloves when cleaning around the house yard
Do not use nail strengthening products as they could irritate your skin or nails
Do not apply artificial as they can breed fungus infections underneath
Contact your care if you develop redness, pain or other changes around your cuticles 
59
Treatment of paronychia
Vinegar soaks
topical iodine
combine topical steroid and antibiotic or anti fungal
Oral antibiotics
Nail avulsion (removal of the finger or toenail)
60
Describe pharmacologic and nonpharmacologic management of alopecia 
During chemotherapy:
Minoxidil 5% twice daily
Biotin 2.5 mg daily
After chemotherapy completion:
Orthosilicic acid 10 mg daily
Teaching:
Council on the use of hats, scarfs and wigs.
Scalp hypothermia
61
Name a few end of life strategies for managing dyspnea
Oxygen therapy
Decrease fluid support
Mild diuretic
Sedation
Scopolamine , hyoscyamine, and atropine to decrease secretions
62
Which cancer types are most high-risk for cognitive impairment?
Brain tumors
Lung tumors
Acute myeloid leukemia
Breast cancer
63
Drugs, most commonly associated with peripheral neuropathy
Platinum chemotherapy:
-cisplatin ( Lhermitte’s sign- a lightning like sensation down the neck to the legs flexion of the neck occurs. Recovery will take up to two years)
-oxaliplatin ( pharyngo-laryngo- dysesthesia: A feeling of a jaw tightening and loss of breath. Recovery will take 6 to 8 months.)
Taxanes: paclitaxel and docetaxel (can develop as soon as 1-3 days after treatment)
Vinca alkaloids: vincristine, vinblastine, vinorelbine
Proteasome inhibitors: bortezmib (Often given for multiple myeloma. Many patients have been heavily pre-treated with neurotoxic agents.)
64
Which hormones aid in regulating bone formation
Parathyroid hormone
Estrogen
Androgens
Vitamin D
Growth factor
65
Name several nonpharmacologic interventions for prevention of osteoporosis
Increase dietary calcium, vitamin D, and protein intake
Smoking cessation
Weight-bearing muscle resistance training
66
You are directing a patient on how to take Risedronate ( an orally available bisphosphonate). What dosing education should you as the nurse review with the patient?
Must be taken on an empty stomach with 8 ounces of water
67
Describe the difference between osteolytic lesions, and osteoblastic lesions
Osteolytic lesions: commonly seen in multiple myeloma, lung, thyroid, breast, and kidney tumors. Most often associated with pathological fractures.
Osteoblastic lesions: commonly seen in prostate and breast cancers. Tumor cells cause overproduction of Osteo blast causing rigid in flexible bone formation. these rigid formations are not deposited near the area of typical bone resorption, Ulting increased bone strength, and increase of vertebral collapse
68
What type of cancer is most high risk for acute DIC
Acute promyelocytic leukemia(APL)
69
Thrombotic thrombocytopenic purpura is the result of abnormal activity in which enzyme?
ADAMTS13- decreased activity in this enzyme allows loose strands of von Willebrand factor (VWF) to damage platelets and red blood cells; causing them to become lodged in small blood vessels and create tiny thrown by to further damage exacerbating thrombocytopenia.
70
Signs of thrombotic, thrombocytopenic purpura include:
Petechie & purpura, Pale skin, fatigue, fever tachycardia, tachypnea, oliguria, and neurologic changes.
Lab value changes include the following :
decrease in red blood cells and platelets
Increase of Bilirubin
Increase in LDH
Negative coombs test
Proteinuria & hematuria
Schistocytes present on peripheral blood smear
71
What are the five clinical labs that are key to diagnose TTP?
1.) Schistocytes seen on blood smear
2.) thrombocytopenia.
3.) renal dysfunction.
4.) fever.
5.) neurologic changes.
72
What does a Schistocyte indicate on a blood smear?
Thrombotic thrombocytopenic purpura
These are fragments of red blood cells, their presence indicates cell injury and hemolytic anemia 
73
What is a coombs test?
This is completed on a blood sample. A positive result indicates that you have antibodies attacking your red blood cells. Several conditions can cause this such as:
Autoimmune hemolytic anemia
Chronic lymphocytic leukemia
Syphilis
Lupus
Mycoplasm infection
74
Define syndrome of inappropriate antidiuretic hormone syndrome (SIADH)
An endocrine based dysfunction, causing the abnormal production in release of anti-diuretic hormone. In the condition ADH in the presence of normal blood osmolality result in the absorption of too much water.
75
What is the normal cycle of ADH hormone?
1.) ADH is released by the posterior pituitary gland in response to increase osmolality or decrease plasma volume
2.) this causes the kidneys to re-absorb water and concentrate the urine to improve plasma volume.
ADH controls blood vessel constrictions and dilation
76
Sarah RN SIADH stats
⬆️ ADH - either being produced somewhere else OR increase amounts d/t hypothalamus damage
Causes: lung cancer, hypothalamus/posterior pituitary damage, infection, other neurological conditions
Signs/ symptoms:
Fluid overload - Edema, weight gain
Hypertension - d/t fluid overload
Fast heart rate - compensating for extra fluid
Hyponatremia
Confusion
Seizures
Anorexia
⬇️ urine output & ⬆️ urine specific gravity
77
Which chemotherapy drugs lead to an increase risk of SIADH
Cyclophosphamide, vinblastine, cisplatin, carboplatin, vincristine, melanin, bortezomib, ifosfamide
78
What is mesothelioma?
A tumor tissue, that lines, the lung stomach heart, and other organs. Usually affecting the lungs most commonly. Especially associated with exposure to asbestos. Symptoms include a cough, chest pain, SOB.
79
What is a thyoma?
A rare tumor that forms in the thymus. Can present asymptomatically as a mediastinal mass, chest pain, shortness of breath, a trouble swallowing.
80
What is Ewing sarcoma?
A type of cancer that begins as a growth of cells within the bone and soft tissue around the bones. Most commonly occurring in children and young adults. Most commonly affecting the leg bones and pelvis.
81
What is the treatment for mild or chronic SIADH
Initiate fluid restriction of 500 to 1000 ML’s per day
Continue or initiate treatment for underlying malignancy 
Possible demeclocycline (a tetracycline antibiotic which inhibits ADH, allowing the kidneys to secrete more water)
82
What is the treatment for moderate to severe SIADH
Stabilize neurological symptoms
Fluid restriction
Initiate or continue treating underlying malignancy
83
What is the treatment for severe SIADH
Admit to ICU
Hypertonic saline(3%)
Frequent neurological monitoring
Seizure precautions
Loop diuretics
Vasopressin receptor antagonist
- conivaptan: load dose of 20 mg IV, then 20 to 40 mg per hour as a continuous infusion
84
Describe the chemicals at a cellular, lower level involved in sepsis and septic shock
Endotoxins and exotoxins from bacteria within the bloodstream, caused the activation and release of histamines, interleukins, tumor necrosis factor-alpha, and vasoactive mediators.
This also activates the coagulation cascade
85
What cancers are at highest risk for SIRS
Multiple myeloma & chronic lymphocytic leukemia
86
What are some ways to prevent hypercalcemia of malignancy?
Encourage hydration and adequate salt intake
Prevention or management, nausea and vomiting
Management of
Encourage mobility
Review drugs that may exacerbate the problem
87
What is contraindicated for patients with hypercalcemis of malignancy(HCM)?
Thiazide diuretics
Loop diuretics should only be used after fluid volume is normalized
88
What is the difference between cardiac tamponade and a pericardial effusion?
The accumulation of fluid in the pericardial sac is known as a pericardial effusion.
Cardiac tamponade is the physiologic event that occurs from a pericardial effusion. This is when pressure is being placed on the cardiac chambers, causing obstruction of blood flow to the ventricles and diminished cardiac output
89
Name the top malignancy is that cause cardiac tamponade?
Lung cancer
breast cancer
Lymphoma with chest involvement
90
Name etiologies of cardiac tamponade
Malignancies of the chest
Hematologic malignancies
Radiation therapy
High dose chemotherapy
HIV
Infections
Traumatic injuries
Auto immune diseases
91
What are late signs of cardiac tamponade?
Hypertension, decreased output, cyanosis, hoarness, coughing, mental, status, changes, anxiety,dyspnea at rest, orthopnea
92
Describe the cause of symptoms with cardiac tamponade
Progressive fluid accumulation leads to decrease cardiac output. This causes an increase in heart rate and an increase in vasoconstriction
93
What clinical signs would be assessed on a patient with cardiac tamponade?
Breck’s triad: JVD, increase central venous pressure, hypotension, distant heart sounds
Absent lower extremity pulses
Altered mental status
94
What is the gold standard for diagnosing spinal cord compression?
MRI
95
What signs are associated with a poor prognosis for patients with spinal cord compression?
Paraplegia before treatment, initiation, urinary and bowel dysfunction and rapidly deteriorating neurological symptoms
96
Which gender is associated with a better prognosis when presenting for spinal cord compression
Females
97
Which area of the back is a more favorable prognosis when presenting with spinal cord compression
Lumbar or thoracic. Cervical compression is associated with poor outcomes.
98
Given an example of an intrinsic factor that can cause superior vena cava syndrome
Thrombosis
99
Given an example of an extrinsic factor that can cause superior vena cava syndrome
Tumor or lymph nodes
100
Which groups are most at risk for superior vena cava syndrome?
Small cell lung cancer (65-85%)
Non-Hodgkin’s lymphoma
Men ages 50 to 70
Esophageal carcinoma
Thyroid carcinoma
Leukemia
those with pacemakers or central venous catheters
Previous radiation or tumor involvement with the mediastinum
101
What are symptoms that accompany, superior vena cava syndrome?
Dysphasia
Facial and neck swelling
Nonproductive cough
Arm swelling
Chest pain
Dyspnea
JVD
Cyanosis
Decreased or absent peripheral pulses
Hypotension
Tachycardia and increase respirations
Mental status changes
Blurred vision and diplopia
Hemoptysis
Syncope
Strider
vocal cord paralysis
102
How is superior vena cava syndrome diagnosed?
Primarily via physical evaluation
Chest x-ray, CT, MRI, and sputum specimens can be taken in addition
103
What tests are used to diagnose increased ICP?
Blood counts and chemistry
Oxygen saturation
Brain imaging - contrast enhanced MRI preferred
104
How should the head of the bed be elevated for a patient with increased ICP?
At least 30°
105
What treatments are used for pneumonitis ?
Steroids
Broncodilators
Oxygen
Expectorants
Humid air
Hydration
bedrest
106
Mechanisms of action for cytokines (immunotherapy)
1.) enhance cytotoxic agents
2.) promote cell death via signals
3.) affects growth and differentiation of blood
107
Define cytokine
Hormone-like proteins secreted by various cells which regulate the intensity and duration of immune response
108
Interferons are a type of cytokine. Describe side effects and mechanism of action
Side effects: flu like, fatigue, anorexia, electrolyte disturbances
Mechanism of action: act directly on the cancer cell by slowing growth
109
Interleukins are a type of cytokine. Describe side effects and mechanism of action
Potential side effects, capillary leak syndrome, hypotension, infusion reaction, rigors, muscle, pain, fever, cardiac arrhythmia, SOB, skin rash, diarrhea
110
What two vaccines are considered preventative for cancer
Hepatitis B and HPV 
111
What is the mechanism of action for monoclonal antibodies, and what is the suffix?
Drugs that are designed to work similarly as human antibodies, that specifically target certain antigens known to be found on the cancer cell
These drugs end in -mab
112
What are the four different ways that monoclonal antibodies can be made??
Murine- made from mouse proteins ( ending in -omab)
Chimeric- combination of of human and mouse proteins (-ximab)
Humanized - small parts of mouse protein attached to human proteins (-zumab)
Human- fully human proteins ( -umab)
113
What does - omab indicate?
Murine- made from mouse proteins ( ending in -omab)
114
What does -ximab indicate?
Chimeric- combination of of human and mouse proteins (-ximab)
115
What does -zumab indicate?
Humanized - small parts of mouse protein attached to human proteins (-zumab)
116
What does ( -umab) indicate?
Human- fully human proteins ( -umab)
117
What does it mean when a monoclonal antibody is conjugated?
This means it is connected to a chemotherapy, drug or radioactive material examples of this include kadccyla and Enhertu 
118
What is a bi specific monoclonal antibody and how does it work differently?
These drugs are made up of two different MABS, one works to attach to the cancer cells and the other sticks to a T cells bringing them to the cancer cell
119
Unique side effects of Bevacizumab (Avastin)
High blood pressure bleeding poor wound healing blood clots, and kidney damage
120
Unique side effects of Ceruximab (Erbitux)
Targets EGFR, can cause serious skin side effects
121
What are some common targets for checkpoint inhibitors?
PD-1
-Pembrolizumab (Keytruda)
- Nivolumab (Opdivo)
-Cemiplimab (Libtayo)
PD-L1
-atezolizumab (tecentriq)
-avelumab (Bavencio)
-durvulumab (Imfiza)
CTLA-4
- ipilimab (Yervoy)
-tremelimumab (Imjuno)
LAG-3
-relatlimab (when given with nobleman called: Opfualag)
122
CD20
A protein found on bee cells that is typically higher in cancers of the blood, including B cell lymphoma and leukemia 
123
What does Rituxan target?
CD20
124
CD52
Found on the surface of B and T lymphocytes, monocytes and macrophages
125
Drug that targets CD52
Alemtuzmab. Used 2-3 line for chronic lymphocytic leukemia
126
CD33
Found on Leukemia blast and other myeloid colony forming cells
127
Drug used to target CD33
Gemtuzumab ozogamicin- but taken off market. None currently
128
How do angiogenesis inhibitors work? Examples
1. Interfere with the action of endothelial growth factor
OR
2. Target other molecules that stimulate new blood vessel growth
Examples: Bevacizumab, sorafenib and sunitinib
129
What drug class ends in -tinib
Tyrosine kinase inhibitors; working on the EGFR and VEGF pathways
130
What drug class ends in -nib
Kinase inhibitors; work on the RAF/RAS/MET pathway
131
What is the drug target for those ending in -lisib
PI3K (cell proliferation)
