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Oncology > Treatment > Flashcards

Treatment Flashcards

1
Q

Define Growth Factor

A

Proportion of cells in a tumor actively involved in cell division

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2
Q

Define Generation Time

A

Length of a cell cycle

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3
Q

Define Resting Phase

A

Cells do not engage in synthetic activity

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4
Q

Cell Cycle Specific Chemotherapy Mode of Action

A

Kills in specific phase of cell cycle

Useful in tumors with high growth index

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5
Q

Cell Cycle Non-specific Chemotherapy Mod of Action

A

Kills in all phases

Useful in tumors with low growth index

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6
Q

Which part of the cell cycle does Nitrosoureas act on?

A

G0 State

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7
Q

Which part of the cycle does Asparaginase & Actinomycin D act on?

A

G1

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8
Q

Which medications act on the S phase of the cell cycle?

A

Antimetabolites
Antifolates
Antipyrimidines
Antipurines

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9
Q

Which part of the cell cycle does Bleomycin act on?

A

G2

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10
Q

Which part of the cell cycle does Vinca alkaloids act on?

A

Mitosis

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11
Q

Which medications are phase non-specific?

A

Alkylating agents
Antitumor antibiotics
Other (cisplatin)

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12
Q

What are the 3 modalities for treatment of cancer?

A

Surgery: definitive, staging, palliative
Chemotherapy: IV vs. oral, neoadjuvent vs. adjuvent
Radiation: definitive, salvage, palliative

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13
Q

Define Definitive

A

Treatment plan that has been chosen as the best one for the patient after all other choices have been considered

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14
Q

Define Palliative

A

Relieving or soothing the symptoms of a disease without producing a cure

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15
Q

Means of Administering Systemic Chemotherapy

A 
Intravenously
Injection
Intraperitoneal
Orally
Topically
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16
Q

What are the classes of chemotherapy drugs?

A 
Alkylating agents
Antimetabolites
Mitotic inhibitors
Anthracyclines
Topoisomerase inhibitors
Miscellaneous
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17
Q

MOA of Alkylating Agents

A

Directly damage DNA to keep the cell from reproducing

Work in ALL phases of cell cycle

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18
Q

What types of cancers are treated with alkylating agents?

A 
Leukemia
Lymphoma
Hodgkin's disease
Multiple myeloma
Sarcoma
Lung
Breast
Ovarian
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19
Q

Alkylating Agent Primary Toxicities

A

N/V
Myelosuppression
Alopecia

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20
Q

Classes of Alkylating Agents

A

Nitrogen mustards
Platinum analogs
Tiazenes
Miscellaneous

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21
Q

Nitrogen Mustards Medications (Alkylating Agents)

A

Mechlorethamine (nitrogen mustard)
Cyclophosphamide (Cytoxan)
Ifosfamide (Ifex)

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22
Q

Cyclphosphamide (Cytoxan) SE

A

Hemorrhagic Cystitis

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23
Q

Hemorrhagic Cystitis

A

May shed large segments of bladder mucosa
May lead to urinary obstruction
Concentrated urine may cause severe bladder damage
Increase fluid intake before & after infusion & empty bladder frequently

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24
Q

Platinum Analogues Medications (Alkylating Agents)

A

Carboplatin (Paraplatin)
Cistplatin (Platinol)
Oxaliplatin (Eloxatin)

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25
Q

Cisplatin (Platinol) SE

A

Nephrotoxicity
Neurotoxicity
Ototoxicity

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26
Q

What labs do you need to follow with cisplatin?

A

CBC

CMP

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27
Q

Ways to Prevent Nephrotoxicity with Cisplatin

A

Vigorously hydrated prior, during, & after administration
Amifostine

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28
Q

Ways to Preven Neurotoxicity with Cisplatin

A

Amifostine

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29
Q

What cancer is there a possibility of developing with the use of alkylating agents?

A

Leukemia: due to damaged DNA, can cause long-term damage to the bone marrow

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30
Q

MOA of Antimetabolites

A

Interfere with DNA & RNA growth by substituting for the normal building blocks of RNA & DNA
Damage during the S phase

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31
Q

What are antimetabolites used to treat?

A

Leukemias
Breast CA
Ovarian CA
Intestinal tract CA

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32
Q

Primary Antimetabolite Toxicities

A

Myelosuppression
N/V
Mucositis
Dermatologic (rash, injection site reaction, dermatitis, pruritis)

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33
Q

Classes of Antimetabolites

A

Folate antagonists
Purine analogs
Pyrimidine analogs

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34
Q

Folate Antagonist Medication

A

Methotrexate (MTX, Trexall)

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35
Q

Purine Analog Medication

A

Mercaptopurine (6-MP, Purinethol)

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36
Q

Pyrimidine Analog Medications

A

Fluorouracil (5-FU)

Gemcitabine (Gemzar)

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37
Q

Methotrexate (MTX; Trexall) Toxicity

A

Myelosuppression
Mucositis
Damage to liver & kidney

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38
Q

What medication can help reverse the toxic effects of MTX?

A

Leucovorin

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39
Q

Methotrexate (MTX; Trexall) & Effusions

A

Methotrexate will go into the effusions and leak out continuously exposing normal tissue to the drug

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40
Q

What can help prevent crystallization of the urine in methotrexate use?

A

Vigorous hydration & bicarbonate

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41
Q

Drugs that may impair methotrexate (MTX) excretion

A 
ASA
NSAIDs
Amiodorone
Omeprazole
PCN
Phenytoin
Sulfa compounds
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42
Q

MOA of Mitotic Inhibitors

A

Altering the DNA inside cancer cells to keep them from growing & multiplying
Stops mitosis from happening

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43
Q

What are mitotic inhibitors also known as?

A

Anti-tumor antibiotics

Antimicrotubules

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44
Q

Classes of Mitotic Inhibitors

A

Vinca Alkaloids
Taxanes
Epothilone
Antracyclines

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45
Q

Mitotic Inhibitor Toxicities

A

Myelosuppression
Anaphylactic reactions
Peripheral neuropathy

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46
Q

Types of Cancer Mitotic Inhibitors Treat

A 
Breast
Lung
Myelomas
Lymphomas
Leukemias
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47
Q

Taxane Medications

A

Paclitaxel (Taxol)

Docetaxel (Taxotere)

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48
Q

Epothilone Medications

A

Ixabepilone (Ixempra)

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49
Q

Vinca Alkaloid Medications

A

Vinblastine (Velban)
Vincristine (Oncovin)
Vinorelbine (Navelbine)

50
Q

Where do the Vinca Alkaloids act?

A

Interfere with M phase

51
Q

Vincristine (Oncovin) SE

A

Neuropathy: paresthesias in fingers and toes; distal to proximal; constipation

52
Q

Anthracyclines Medication

A

Daunorubicin (Cerubidine)
Doxorubicin (Adriamycin)
Idarubicin
Epirubicin

53
Q

Anthracyclines SE

A

Cardiotoxicity: systolic CHF; acute, subacute, late

54
Q

Risk Factors for Cardiotoxicity

A

High cumulative dose
Age >70
Previous/current chest radiation
Cardiac disease

55
Q

Scan to determine ejection fraction with anthracyclines

A

MUGA

56
Q

MOA of Topoisomerase Inhibitors

A

Interfere with topoisomerases

Help separate strands of DNA to be copied in the S phase

57
Q

Topoisomerase I Inhibitor Medications

A

Topotecan

58
Q

Topoisomerase II Inhibitor Medications

A

Etoposide

59
Q

Topoisomerase Inhibitors Treat Which Cancers

A

Leukemias
Lung
Ovarian
Gastrointestinal

60
Q

Topoisomerase Inhibitors SE

A

Myelosuppression
Alopecia
GI toxicity

61
Q

What medications can increase the risk of a second cancer (AML)?

A

Topoisomerase II inhibitors

62
Q

Examples of Miscellaneous Agents

A

Actinomycin-D

Bleomycin

63
Q

Bleomycin (Blenoxane) SE

A 
Edema of interphalangeal joints
Hardening of the skin on the palms & soles
Anaphylactic or serum sickness 
Pulmonary fibrosis
Hypotensive reaction
64
Q

What to watch for with pulmonary fibrosis?

A

Cough
Dyspnea
Infiltrates

65
Q

What are targeted therapies?

A

Newer drugs that attack cancer cells more specifically than traditional chemotherapy drugs

66
Q

Targeted therapies are most effective in what cancers?

A

Non-Hodgkin’s lymphoma
Leukemia
Lung CA
Breast CA

67
Q

Example of Targeted Therapy

A

Imatinib (Gleevec)

68
Q

MOA of Differentiating Agents

A

Act on the cancer cells to make them mature into normal cells

69
Q

Examples of Differentiating Agents

A

Retinoids, tretinoin (ATRA or Atralin)
Bexarotene (Targretin)
Arsenic trioxide (Arsenox)

70
Q

MOA of Hormone Therapy

A

Change the action or production of female or male hormones

Making the cancer cells unable to use the hormone needed to grow

71
Q

Classes of Hormone Therapy

A 
Anti-estrogens
Aromatase inhibitors
Progestins
Estrogens
Anti-androgens
Gonadotropin-releasing hormone
72
Q

Example of Anti-Estrogen Agent

A

Tamoxifen

73
Q

Example of Aromatase Inhibitors

A

Anastrozole (Arimidex)

74
Q

Example of Anti-Androgen

A

Bicalutamide (Casodex)

75
Q

Example of Gonadotropin-Releasing Hormone

A

leuprolide (Lupron)

76
Q

Types of Immunotherapy

A

Active immunotherapy

Passive immunotherapy

77
Q

Define Active Immunotherapy

A

Stimulate the body’s own immune system to fight the disease

78
Q

Define Passive Immunotherapy

A

Doesn’t rely on the body to attack the disease

Man made monoclonal antibodies

79
Q

Define Checkpoint Inhibitor

A

New monoclonal antibody that works by blocking the signal that cancer cells send out telling the immune system not to attack
Allows immune system to recognize the tumor

80
Q

Cancers that Respond to Immunotherapy

A

Melanoma
Kidney CA
Lung CA

81
Q

Examples of Active Immunotherapy

A

Rituximab (Rituxan)

BCG

82
Q

Define Chemotherapy Cycle

A

Involves a dose of one or more drugs followed by several days or weeks without treatment

83
Q

Why are chemotherapy cycles separated by a certain amount of days?

A

Allow normal cells time to recover from drug SE

84
Q

Define Adjuvent Chemotherapy

A

Set course given to patients with no evidence of disease after surgery or radiation

85
Q

Define Neoadjuvent Chemotherapy

A

Aims at eradicating micrometastatic disease or reduce inoperable disease

86
Q

Define Induction Chemotherapy

A

Combination chemotherapy given in high dose to cause a remission

87
Q

Define Maintenance Chemotherapy

A

Long term, low dose regimen given in remission

Helps to maintain remission

88
Q

Define Ionizing Radiation

A

Production of free hydrogen ions & hydroxyl radicals

89
Q

Acute Toxicities of Skin Radiation

A

Erythema
Dry desquamation
Moist desquamation

90
Q

Subacute Toxicity of Skin Radiation

A

Hyperpigmentation

91
Q

Late Toxicities of Skin Radiation

A

Hypopigmentation in the treatment field
Telangiectasis (spider veins)
Fibrosis

92
Q

Acute Toxicities of Brain Radiation

A

Fatigue
Hair loss
Erythema of the skin
Desquamation

93
Q

Late Toxicities of Brain Radiation

A

Cognitive dysfunction
Edema
Necrosis

94
Q

Acute Toxicities of Head/Neck Radiation

A

Mucositis
Taste dysfunction
Pain
Xerostomia

95
Q

Signs/Symptoms of Mucositis

A

Odynophagia
Dehydration
Weight loss

96
Q

Late Toxicities of Head/Neck Radiation

A 
Permanent xerostomia
Soft tissue fibrosis
Osteoradionecrosis of the mandible
Dysphagia
Pharyngeal stricture
97
Q

Acute (Common & Temporary) Toxicities of Breast Radiation

A 
Skin Redness
Dry desquamation
Moist desquamation
Pain: OTC analgesics, narcotics
Fatigue
98
Q

Late (Uncommon & Permanent) Toxicities of Breast Radiation

A 
Fibrosis
Hyperpigmentation
Cosmetic failure
Rib fracture (rare)
Pneumonia (rare)
Cardiac (rare)
Secondary malignancies (rare)
99
Q

Acute Toxicities of Lung Radiation

A

Esophagitis
Cough
Skin Reaction
Fatigue

100
Q

Ways to Treat Esophagitis

A

Mucosal anesthetics
Agents that coat the surface
Liquid analgesics

101
Q

Ways to Treat Cough as a Toxicity of Lung Radiation

A

Antitussives with or without codeine
Bed rest
Bronchodilators
Corticosteroids

102
Q

Late Toxicities of Lung Radiation

A

Radiation pneumonitis
Pulmonary fibrosis
Esophageal stricture
Brachial plexopathy

103
Q

Acute Toxicities of Esophageal Radiation

A 
Esophagitis
Modest skin tanning
Fatigue
Weight loss
Diarrhea
N/V
104
Q

Late Toxicities of Esophageal Radiation

A

Esophageal stricture & stenosis
Perforation
Pneumonitis

105
Q

What percentage of patients develop esophageal stricture & stenosis in esophageal radiation treatment?

A

> 60%

106
Q

Signs/Symptoms of Esophageal Perforation

A

Substernal chest pain
Elevated pulse
Fever
Hemorrhage

107
Q

Acute Toxicities of Abdominal, Stomach, Pancreas, or Hepatobiliary Radiation

A

Dyspepsia: PPI
Anorexia
Nausea: prophylactic zofran
Fatigue

108
Q

Late Toxicities of Abdominal, Stomach, Pancreas, or Hepatobiliary Radiation

A

Bowel obstruction
Worsening DM secondary to worsening pancreatic function
Liver/Kidney issues

109
Q

Acute Toxicities of Pelvic Radiation

A

Diarrhea
Rectal irritation
Urinary symptoms
Fatigue

110
Q

Medications to Treat Diarrhea

A

Imodium

Lomotil

111
Q

Signs/Symptoms of Rectal Irritation in Pelvic Radiation

A

Pain

Bleeding

112
Q

Urinary Symptoms with Pelvic Radiation

A

Frequency/urgency
Dysuria
Nocturia
Retention

113
Q

Late Toxicities of Pelvic Radiation

A

Persistent urinary symptoms
Bowel changes
Erectile dysfunction

114
Q

Persistent Urinary Symptoms in Pelvic Radiation

A

Frequency
Nocturia
Incontinence with stress

115
Q

Bowel Changes in Pelvic Radiation

A

Loose stools

116
Q

Acute Toxicities of Anal Radiation

A 
Skin reactions: dry or moist desquamation
Leukopenia
Thrombocytopenia
Proctitis
Diarrhea
Cystitis
117
Q

Subacute & Late Toxicities of Anal Radiation

A 
Chronic diarrhea
Rectal urgency
Sterility
Impotence
Vaginal dryness
Vaginal fibrosis
Possible decreased testosterone
118
Q

Toxicities of GYN Radiation

A 
Cystitis
Proctitis
Fistula: rectovaginal, vesicovaginal
Vaginal ulceration or necrosis
Vaginal stenosis
Skin reactions
119
Q

What is the only systemic toxicity with radiation?

A

Fatigue

120
Q

What is degree of damage dependent on?

A

Types of radiation used
Total dose administered
Field size/fractionation

Oncology (11 decks)

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