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NURS 2514 > Week 1 - Chemotherapy > Flashcards

Week 1 - Chemotherapy Flashcards

1
Q

what is chemotherapy

A
  • pharmacologic treatment of cancer
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2
Q

what are chemotherapy drugs also called?

A
  • antineoplastic drugs
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3
Q

how is chemotherapy categorized?

A
  • split into 2 groups based on where in the cell cycle they work
    1. cell cycle nonspecific
    2. cell cycle specific
  • note: some drugs have characteristics of both
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4
Q

what are the 3 main goals of chemotherapy?

A
  1. cure
  2. control
  3. palliation
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5
Q

what is meant by palliation?

A
  • relieve pain
  • relieve obstruction
  • improve sense of well being
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6
Q

describe the therapeutic index of chemotherapy

A
  • these drugs have a very narrow therapeutic index
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7
Q

what is combination therapy?

A
  • where a combo of drugs is given for treatment
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8
Q

what is the purpose of combination therapy?

A
  • more effective than single-drug therapy
  • allows us to work around the narrow therapeutic index of drugs by using a lower dose of more drugs to avoid side effects
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9
Q

what is an example of combination therapy?

A

RCVP for lymphoma

  • rituximab
  • cyclophosphamide
  • vincristine
  • prednisone
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10
Q

describe drug resistance related to chemo; what does this mean

A
  • drug resistance occurs in almost all drugs over a period of time
  • therefore, once we use a drug once, we cannot use it again
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11
Q

what is meant by dose limiting adverse effects?

A
  • many chemo drugs cause dose-limiting adverse effects which are often intolerable
  • this is why we give “rounds” of chemo
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12
Q

describe the effect chemo has on cells in general

A
  • harmful to all rapidly dividing cells

- this means it is harmful to both cancer cells & healthy, normal human cells bc they are both dividing

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13
Q

which cells/tissues are most effected by chemo (3)? why?

A
  1. hair follicles
  2. GI tract cells
  3. bone marrow cells
    - chemo targets all rapidly dividing cells & these are some of the fastest growing cells in the body
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14
Q

what does chemo’s effect on hair follicles cause?

A
  • alopecia
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15
Q

what is alopecia?

A
  • hair loss
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16
Q

what does chemo’s effect on GI tract cells cause?

A
  • emetic potential
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17
Q

what is emetic potential?

A
  • nausea & vomiting

- gastric upset

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18
Q

what does chemo’s effect on bone marrow cells cause?

A
  • myelosuppression (bone marrow suppression)
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19
Q

what is nadir?

A
  • lowest WBC count we are willing to accept before we have to stop giving chemo
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20
Q

what is extravasation

A
  • leakage of an intravenously infused fluid onto the tissue around the site of infusion
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21
Q

describe the relation between extravasation & chemotheraoy

A
  • most chemo is intravenously infused

- extravasation of chemotherapy causes significant skin & tissue breakdown

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22
Q

how does the relation between extravasation & chemo effect the care we provide?

A
  • it is important to monitor IV lines
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23
Q

what are cell cycle specific drugs

A
  • drugs that are cytotoxic during a specific cell-cycle phase
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24
Q

what are cell cycle-specific drugs used to treat?

A
  • a variety of solid and/or circulating tumours
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25
Q

what are 2 categories of cell cycle-specific drugs

A
  1. antimetabolites

2. mitotic inhibitors –> vinca alkaloids

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26
Q

what is the MOA of antimetabolites?

A
  • disrupt critical metabolic processes, such as disrupting DNA replication & formation
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27
Q

what phase of the cell cycle do antimetabolites typically work in?

A
  • S phase
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28
Q

what are the 3 classes of antimetabolites?

A
  1. folate (folic acid) antagonists
  2. purine antagonists
  3. pyrimidine antagonists
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29
Q

what is a type of folate (FA) antagonist?

A
  • methotrexate
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30
Q

list the 3 actions of methotrexate

A
  • chemo effects
  • immunosuppressive
  • anti-inflammatory
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31
Q

what is the MOA of methotrexate in chemo therapy

A
  • blocks the conversion of folic acid into its active form, which is required for many biochemical reactions
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32
Q

what conditions is methotrexate used for besides cancer

A
  • rheumatoid arthritis

- psoriasis

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33
Q

what is the rescue med for methotrexate

A
  • leucovorin
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34
Q

what is leucovorin

A
  • folinic acid

- very similar to folic acid but not the same

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35
Q

why would we need to give leucovorin?

A
  • used to avoid folate deficiency which can lead to anemia, etc.
  • used to protect healthy cells so they can continue to produce folic acid
  • helps reduce BMS
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36
Q

what are mitotic inhibitors? what phase do they work in?

A
  • drugs that work in the M phase to prevent cell division
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37
Q

how are mitotic inhibitors obtained ?

A
  • vinca alkaloids are derived from the periwinkle plant
  • semisynthetic drugs are obtained from the mandrake (mayapple) plant
  • some drugs are obtained from the yew tree
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38
Q

what are the 2 major groups of mitotic inhibitors?

A
  1. vinca alkaloids

2. taxanes

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39
Q

what is the prototype of vinca alkaloids

A
  • vincristine (oncovin)
40
Q

what is the benefit to vincristine (2)?

A
  • its bone marrow sparing

- ideal for combo therapy

41
Q

what is a con to vincristine?

A
  • peripheral neuropathy is a major dose-limiting side effect
42
Q

what are cell-cycle nonspecific drugs

A
  • drugs that can act during any phase of the cell cycle, including G0
43
Q

what are the 3 major classes of cell cycle nonspecific drugs?

A
  • alkylating drugs
  • cytotoxic antibiotics
  • hormonal drugs
44
Q

what is the MOA of alkylating drugs?

A
  • kills & prevents cancer cells from reproducing thru alkylating DNA
45
Q

what are the 3 major classes of aklyating drugs?

A
  • nitrogen mustards
  • nitrosoureas
  • miscellaneous alkylators
46
Q

what is the prototype of nitrogen mustards?

A
  • cyclophosphamide (cytoxan)
47
Q

what are cytotoxic antibiotics?

A
  • natural substances produced by the mold streptomyces

- can also be synthetic

48
Q

what is the difference between cytotoxic antibiotics & regular antibiotics?

A
  • cytotoxic = only to treat cancer, too toxic to treat infections
49
Q

what is the MOA of cytotoxic antibiotics

A
  • act by intercalation = direct blockade of DNA synthesis
50
Q

what are 2 types of cytotoxic antibiotics?

A
  1. bleomycin

2. doxorubicin

51
Q

what is a common side effect of cytotoxic antibiotics? which type does not cause this?

A
  • all cause BMS

- except bleomycin

52
Q

what is the major adverse effect of bleomycin

A
  • pulmonary toxicity

- can cause pneumonitis and pulmonary fibrosis

53
Q

what is the major adverse effect of doxorubicin

A
  • cardiotoxicity

- can cause heart failure

54
Q

what is the MOA of hormonal drugs

A
  • oppose the effects of hormones

- block the body’s sex hormone receptors

55
Q

what are hormonal drugs used to treat?

A
  • variety of neoplasms in men & women

- specifcally for breast & prostate cancer

56
Q

how are hormonal drugs used most commonly?

A
  • most commonly as an adjuvant & palliaitive therapy

- occassionally may be first choice for some cancers

57
Q

what is are 2 classes are hormonal drugs?

A
  1. selective estrogen receptor modulators

2. estrogen receptor antagonist

58
Q

what is the prototype for selective estrogen receptor modulators? what is the MOA?

A
  • tamoxifen

- can cause receptor activation & blockade

59
Q

what is tamoxifen considered the gold standard for?

A
  • for endocrine treatment of breast cancer
60
Q

what is the prototype for estrogen receptor antagonists? what is the MOA?

A
  • fulvestrant

- pure estrogen receptor antgaonist

61
Q

what is extravasation

A
  • leaking of an antineoplastic drug into surrounding tissues during IV admin
62
Q

what can extravasation result in?

A
  • can result in permanent damage to nerves, tendons, muscles, and loss of limbs
  • skin grafting & amputation may be necessary
63
Q

describe prevention of extravasation

A
  • thru Iv monitoring
64
Q

what type of anti-inflammatory drug may be used for cancer treatment?

A
  • prednisone
65
Q

what is the 4th part of cancer therapy

A
  • biologic response modifiers

- in addition to surgery, chemo, and radiation

66
Q

what else might BRMs be used for

A
  • autoimmune disorders
  • inflammatory disorders
  • infectious
67
Q

what are 3 classes of BRMs?

A
  1. hematopoietic drugs
  2. interferons
  3. monoclonal antibodies
68
Q

what is the MOA of hematopoietic drugs

A
  • promote the synthesis of blood cell types by promoting the growth, differentiation, and function of their precursor cells in the bone marrow
69
Q

how are hematopoietic drugs produced?

A
  • thru rDNA technology
70
Q

what are hematopoietic drugs used for?

A
  • decrease the duration of chemo induced anemia, neutropenia, and thrombocytopenia
  • enable higher doses of chemo
71
Q

what are 3 types of hematopoietic drugs?

A
  1. epoetin alfa (epogen)
  2. filgrastim (neupogen)
  3. oprelvekin (neumega)
72
Q

what is epoetin alfa?

A
  • synthetic derivative of the hormone erythropoetin (hormone that stimulates RBC production)
73
Q

what is the MOA of epoeitin alfa?

A
  • promotes the synthesis of RBC
74
Q

the nurse should monitor what after administering epoeitin alfa?

A
  1. HGB levels

2. bp

75
Q

increased adverse effects are present with epoetin alfa when used by patients with _______

A
  • higher than normal hgb –> blood can become too thick
76
Q

what can occur with patients with higher-than-normal hemogloin when taking epoetin alfa?

A
  • heart attack
  • HF
  • stroke
  • death
77
Q

what is filgrastim (neupogen)? what is its MOA?

A
  • granulocyte colony-stimulating factor

- stimulates precursor cells for the type of WBCs known as granulocytes

78
Q

what are granulocytes?

A
  • neutrophils
  • eosinophils
  • basophils
79
Q

what is oprelvekin (neumega)? what is its MOA

A
  • aka interleukin (IL-11)

- stimulates megakaryocytes to become platelets

80
Q

what are interferons?

A
  • proteins with 3 basic properties:
    1. antiviral
    2. antitumour
    3. immunomodulating
81
Q

what are interferons used to treat?

A
  • viral infections
  • cancer
  • autoimmune disorders
82
Q

what viral infections are interferons used for?

A
  • genital warts

- hepatitis

83
Q

what autoimmune disorders are interferons used for

A
  • multiple sclerosis

- & others

84
Q

what are monoclonal antibodies? (MAB)

A
  • use of synthetically made antibodies to target specific cancer cells
85
Q

describe the effect of MABs on healthy cells

A
  • minimal effect

- fewer, if any, adverse effects than traditional neoplastic meds

86
Q

what are MABs used for?

A
  • to treat cancers & rheumatoid arthritis
87
Q

list 3 types of MABs used to treat cancer

A
  1. trastuzumab
  2. rituximab
  3. bevacizumab
88
Q

list 1 MAB used to treat other disease processes such as rheumatoid arthritis

A
  • infliximab
89
Q

what cancer is trastuzumab good for?

A
  • breast cancer (blocks HER2 receptor)
90
Q

what cancer is rituximab good for? why>

A
  • targeted therapy

- directed against CD20, an antigen found only on the surface of B lymphocytes

91
Q

what is the classification of prednison

A
  • corticosteroid

- cell cycle phase nonspecific

92
Q

what is the MOA of prednisone

A
  • disrupts the cell membrane
  • inhibits synthesis of protein
  • decreases circulating lymphocytes
  • inhibits mitosis
  • depresses the immune system
  • increases feeling of well being
93
Q

what is the MOA of cyclophosphamide

A
  • damages DNA by causing breaks in the double strand helix

- alkylates DNA = cross-links & strand breakage

94
Q

what cellular processes are interupted by cyclophosphamide?

A
  • DNA and RNA synthesis
95
Q

what is the MOA of vincristine

A
  • interrupts cellular replication in mitosis @ metaphase

NURS 2514 (75 decks)

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