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N365: Pharmacology in Nursing > Week 14: Oncology Meds > Flashcards

Week 14: Oncology Meds Flashcards

1
Q

Chemotherapy is best for those cancers with a high growth factor. What does this mean?

A

there ar emore proliferating cells than dying cells

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2
Q

Since chemo is effective on cells with high growth fractions (like cancer), what else can be effected?

A

High growth fraction normal cells:

Bone Marrow
Hair Follicles
Sperm Forming Cells
GI Epithelium

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3
Q

Solid tumors respond ___ to anti-cancer drugs

A

poorly (need debulking)

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4
Q

If solid tumors respond poorly to chemo, what does chemo help against?

A

metastasis or spreading cancer

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5
Q

What kinds of cancers respond best to drug therapy

A

disseminated cancers (high growth fraction) like leukemia and lymphoma

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6
Q

Why are CNS tumors hard to treat

A

the BBB prevents drugs from getting where the cancer is

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7
Q

What is the most effective way of tackling cancer via chemo

A

using multiple agents and attacking at different cell cycle stages

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8
Q

What are some commonly seen effects from anticancer drugs

A

Bone Marrow Depression (Neutropenia, Thrombocytopenia, Anemia)

Gi Issues

Hair Loss (Alopecia)

Sperm Forming Cell Issues (Sterility)

NV

Hyperuricemia

Vessel Injury from extravasation

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9
Q

Most traditional chemotherapeutic drugs interfere …

A

either with the synthesis of DNA, RNA, or proteins OR with the appropriate functioning molecules

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10
Q

How do cells die when someone has a chemo agent given

A

a proportion dies - thats why multiple doses are needed

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11
Q

Cell Cycle Specific Drugs

A

toxic to the cell at a particular phase and cause no significant harm during other phases

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12
Q

Cell Cycle Non Specific Drugs

A

kills cells regardless of their phase in the cell cycle - and are considered more toxic but stronger

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13
Q

Targeted Cancer Therapy

A

Newest chemo drugs that block the growth and spread of cancer by “Harnessing” bodys own immune system

Blocks signals that tell cancer cells to grow and divide uncontrollably

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14
Q

Advantage of Targeted Cancer Therapies

A

may be more effective and less harmful to normal cells

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15
Q

Prototype Cancer Chemotherapy/Oncology Drugs

A

9:

Cyclophosphamide (Cytoxan)
Methotrexate (Rheumatrex, MTX)
Mercaptopurine (Purinethol)
Fluorouracil (Adrucil)
Doxorubicin (Adriamycin)
Vincristine (Oncovin)
Cisplatin (Cisplatinum)
Paclitaxel (Taxol)
Tamoxifen (Nolvadex)

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16
Q

Cyclophosphamide (Cytoxin) Classification

A

ALKYLATING Chemotherapeutic Agent

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17
Q

Action of cyclophosphamide

A

Inactivation of DNA (via alkylation)

Binds to DNA to form cross links and prevent DNA, RNA, and protein synthesis

DNA Breakage will occur from alkylation

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18
Q

Is cyclophosphamide cell cycle phase specific or non specific

A

cell cycle phase non specific

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19
Q

What sort of cancers is cyclophosphamide used in

A

hematologic cancers and solid tumors

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20
Q

What happens when cyclophosphamide is metabolized by the liver

A

it turns into the cytotoxic agent against cancer cells (alkylation)

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21
Q

ADRs of Cyclophosphamide

A
  1. LEUKOPENIA (major one)
  2. Thrombocytopenia
  3. Hemorrhagic Cystitis (High Dose Therapy)

Other - Bone marrow depression, alopecia, amenorrhea, azoospermia, teratogenesis,hyperuricemia, NV

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22
Q

What is the lowest point of bone marrow depression with cyclophosphamide

A

nadir of WBC is between 9-14 days - most sensitive to infection but neupogen can help counteract this

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23
Q

What is hemorrhagic cystitis and how do we prevent it form occurring when taking cyclophosphamide?

A

It is bleeding inflamed bladder form high doses

we prevent by giving IV fluids and liberal amounts of fluid intake

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24
Q

What is length of cyclophosphamide therapy guided by?

A

It is guided by keeping leukocyte count between 3000-4000 mm^3

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25
What other disease does cyclophosphamide help treat
rheumatoid arthritis (lower immune system to help)
26
Route of cyclophosphamide
IV or oral
27
Mesnex (Mesna)
a drug to help protect the bladder from high doses of cyclophosphamide
28
What is the issue with long term cyclophosphamide therapy
secondary cancers can occur like with other chemo drugs
29
Methotrexate (Rheumatrex, MTX) Classification
Antimetabolite Chemotherapeutic Agent ; Folate Antagonist
30
Action of Methotrexate
inhibits folic acid reduction, thereby interfering with synthesis of the coenzyme needed for DNA synthesis S phase specific
31
Is methotrexate cell cycle phase specific or non specific
specific (S Phase)
32
Route of Methotrexate
Oral - for routine doses IM - large doses
33
ADRs of Methotrexate
1. STOMATITIS 2. PULMONARY INFILTRATES AND FIBROSIS (In Lungs) (can permanently effect resp fxn) Other: Leukopenia, Thrombocytopenia, Hepatotoxicity, NV, Alopecia, Tubular Necrosis (In Kidneys), HA, Gingivitis, Alopecia
34
What other disease can methotrexate be used on and why
Rheumatoid Arthritis - strong immunosuppressive effects inhibiting T Lymphocytes Can also be used in Chrohns Disease soemtimes
35
Methotraxate is an anti-metbolite. What does this mean
it looks like folic acid to the body but is not it will antagonize the receptors to stop cell DNA synthesis
36
Leucovorin
"Rescue" Folinic Acid It is an antidote for methotrexate that can save normal body cells
37
Mercaptopurine (6-MP, Purinethol) Classification
Antimetabolite, Chemotherapeutic Agent, Purine Analog
38
Action of 6-MP / Mercaptopurine
Inhibits DNA synthesis by preventing purine incorporation into the DNA (antagonist) S Phase Specific
39
Is 6-MP/Mercaptopurine cell cycle phase specific or non specific
Specific (S Phase_
40
Route of 6-MP/Mercaptopurine
Oral - Readily IV - an option
41
ADRs of 6-MP/Mercaptopurine
1. BONE MARROW DEPRESSION (Neutropenia, Thrombocytopenia, Anemia) 2. JAUNDICE Other: NV, anorexia, leukopenia, hyperuricemia
42
Why do patients on 6-MP/Mercaptopurine develop Jaundice
It reflects liver damage 30% of patients on this drug develop hepatic dysfunction
43
Fluorouracil (5-FU, Adrucil) Classification
Antimetabolite, Chemotherapeutic Agent, Pyrimidine Analog
44
Action of Fluorouracil/5-FU
Affects specific steps in pyrimidine (Not purine) metabolism leading to inhibition of DNA and RNA synthesis S Phase Specific
45
Is 5-FU/Fluorouracil cell cycle phase specific or non specific
Specific (S Phase)
46
What sort of cancer is 5-FU/Fluorouracil used for
solid tumors, esp. malignant GI tymors - can be used for other stuff as well though
47
Route of 5-FU/Fluorouracil
IV (Oral is too unpredictable)
48
ADRs of 5-FU/Fluorouracil
1. MYELOSUPPRESSION (Anemia, Leukopenia, Thrombocytopenia) (Nadir 9-14 days) 2. GI ULCERS 3. ALTERATION IN TASTE Other: Stomatitis, Diarrhea, Anorexia, NV, Alopecia, hand and foot syndrome
49
What is the alteration in taste like with 5-FU
aversion to protein foods
50
What are special situations for 5-FU/Fluorouracil use
PALLIATIVE TX: Breast, Colon, Rectal Cancer (Solid Tumors) GI, Ovarian, bladder, Prostate, Pancreatic Carcinomas Direct Hepatic Artery infusion for Liver Carcinoma or Metastasis
51
What does antibiotic mean
one organism against another its not just for infection - some products of streptomyces can help tx cancer
52
Doxorubicin HCI (Adriamycin) Classification
Antibiotic Antitumor Agent ; Anthracycline
53
Action of Doxorubicin HCl
Distorts DNA structure so synthesis of DNA and RNA is inhibited
54
Is Doxorubicin HCl Cell cycle phase specific or nonspecific
non specific
55
Route of Doxorubicin HCl
mostly given as IV infusion
56
ADRs of Doxorubicin HCl
1. ACUTE AND DELAYED CARDIOTOXICITY (dysrhythmias, EKG changes, cardiomyopathy, CHF and death) 2. SIGNIFICANT BONE MARROW DEPRESSION 3. RED/ORANGE URINE/TEARS Other: Alopecia, NV, Stomatitis, Local Extravasation Risk
57
What is important about the dosage of Doxorubicin HCl
once a person reaches maximum dosage they cannot have anymore and there needs to be careful calculation and administration due to the RISK FOR HEART DAMAGE that is great
58
How is the bone marrow depression worse in Doxorubicin HCl
the neutropenia occurs at day 7 (earlier than most)
59
What kind of cancers is Doxorubicin HCl used in
solid tumors or disseminated cancer
60
Why does red colored food cause NV and anorexia with patients on Doxorubicin HCl
The drug is a dark cherry kool aid red color This even turns your urine and tears red orange or red pink
61
Doxorubicin HCl is a severe vesicant, what implication does this have on a patient
A vesicant can damage tissue permanently and since it is given IV, extravasation can lead to severe pain and tissue damage permanently (can lessen with an implanted port)
62
Vincristine (Oncovin) Classification
Chemotherapeutic Agent; Vinca Alkaloid
63
Action of Vincristine
binds specifically with the protein TUBALIN, part of cell microtubules Blocks mitosis during metaphase so it is M phase specific and STOPS CELL DIVISION / MITOSIS
64
Is Vincristine Cell Cycle Phase specific or non specific
Specific (M Phase)
65
Route of Vincristine
IV (Oral unpredictable)
66
ADRs of Vincristine
1. NEUROTOXIC (peripheral neuropathy, muscle weakness, loss of deep tendon reflexes, HA, vocal cord paralysis, ptosis, diplopia, paralytic Ileus) Other: GI disturbances, alopecia, only mild bone marrow depression
67
What is unique about vincristine and bone marrow
it only causes mild bone marrow depression - to the point it is considered bone marrow sparring compared to other chemo drugs and thus can be used alongside them
68
Vincristine is a ____ and can damage surrounding tissues
Vesicant
69
What is vincristine very effective at doing in children
inducing remissions in acute leukemias
70
Cis-Platinum (Cisplatin) Classification
Heavy Metal Chemotherapeutic Agent
71
Action of cis-platinum
inhibits DNA precursors, maybe via alkylating effect
72
Is cis-platinumcell cycle phase specific or non specific
Non Specific
73
route of cis-platinum
ORAL, IV is ineffective
74
ADRs of cis-platinum
1. SEVERE NV 2. NEPHROTOXICITY 3. OTOTOXICITY Other: Mild and transient bone marrow depression, peripheral neuropathy (tingling, numbness in fingers, toes and face)
75
How ototoxic is cis-platinum
enough to cause loss of high frequency hearing
76
What must be given alongside cis-platinum
other drugs such as anti-emetics to prevent potential significant side effects
77
Since cis-platinum is a heavy metal, what must be done
a "mannitol flush" must be given before and after to prevent acute tubulular necrosis of the kidneys - get it moving through to prevent pain
78
Paclitaxel (Taxol) Classification
(newer) Chemotherapeutic Agent (Taxane Family)
79
Action of Paclitaxel
Inhibits normal dynamic reorganization of the microtubule network needed for vital mitotic cell fxns (G2 and M phase specific) So it works in prepartion for Mitosis causing problems there but begins working before that phase
80
Is paclitaxel cell cycle phase specific or non specific
specific (works in G2 and M phase)
81
Route of paclitaxel
IV
82
ADRs of Paclitaxel
1. SEVERE HYPERSENSITIVITY RXNs 2. PERIPHERAL NEUROPATHY / NEUROTOXICITY 3. MYELOSUPPRESSION Other: bone marrow suppression (nadir of 11 days), CV bradycardia/heartblock/MI, arthralgia, GI NV/diarrhea/mucositis, alopecia, change in liver fxn
83
What is unique about the alopecia with paclitaxel
it is very sudden and comes out in clumps
84
Hypersensitivity reactions occur in __% of paclitaxel patients and needs what prior?
10%; pre medication with corticosteroids, diphenhydramine, and H2 antagonists
85
Paclitaxel should not be given when
with neutrophil counts of <1500
86
What sort of cancers may have paclitaxel given
ovarian lung breast other
87
Taxmoxifen (Nolvadex) Classification
Antiestrogen (competitive antagonist) , SERM (Selective Estrogen Receptor Modulator)
88
Action of taxmoxifen
Competitive antagonist of estrogen Binds to estrogen receptors to prevent stimulation of the receptors by estradiol (naturally occurring estrogen) Because of this the estrogen cannot feed the cancer
89
Route of taxmoxifen
oral
90
ADRs of taxmoxifen
MOST NOT TROUBLESOME - TOLERATED WELL: 1. MENSTRUAL IRREGULARITIES 2. BONE PAIN (positive sign not bone cancer) 3. ENDOMETRIAL CANCER POTENTIAL Common: NV, Hot flashes Other: Pruritis vulvae, increased tumor pain
91
What is the most widely prescribed anti-cancer agent in the world
taxmoxifen
92
What is taxmoxifen used for
to treat AND prevent breast cancer in high risk women (Adjunct to radiation, chemo and surgery)
93
What is needed for taxmoxifen to be effective
the target tumor cells must be estrogen receptor (ER) positive
94
Since taxomoxifen is a SERM, what effects may it have other than prevent tumor growth?
Agonist effects on tissues like the uterus, bone, and some other areas Antagonist effects in areas like the breast
95
What does the agonist effect of SERMs like taxomoxifen lead to in bone and the uterus
Uterus - Endometrium Cancer potentially Bone - Bone pain (good though sign)
96
What is the max amount of time taxmoxifen is used and why
5 years - want to prevent causing endometrial cancer

N365: Pharmacology in Nursing (15 decks)

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