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Pharmacology: Test 1 > Week 3- Antineoplastics, & Vitamins And Minerals > Flashcards

Week 3- Antineoplastics, & Vitamins And Minerals Flashcards

0
Q

Goals of treatment with antineoplastic drugs

A

Kill the abnormal cells Control growth of cells Minimize damage to pt Maintain high quality of life

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1
Q

Neoplasms

A

Cancer- second leading cause of death -uncontrolled rapid, abnormal cell growth -able to migrate via circulatory or lymphatic -cell growth cycle is key to treatment -therapy aimed to stop replication of cells

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2
Q

Types of antineoplastic agents:
Cell cycle specific (CCS)
And
Cell cycle non specific (CCNS)

A

CCS- attack cell at DNA synthesis/how it replicates

CCNS- kill, decrease growth

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3
Q

Barriers to successful treatment of cancer

A
  • Toxicity to the normal tissues b/c chemo is toxic to cancerous cells and normal growing tissue
  • Resistance to drugs begins to develope
  • % of cells affected, each dose will only kill a certain % of cells (cure requires 100% cell kill)
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4
Q

Dose limiting side effects

A
  • Meds cause damage or death to all growing cells: cancer cells or healthy cells (hair loss, GI problems, bone marrow suppression, reproductive problems)
  • Side effects can be a result of meds effects on normal cells
  • CANNOT give meds in doses high enough to kill all the cancer cells
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5
Q

Gastrointestinal effects of treatment

A

-Stomatitis/mucositis (Pain, difficulty swalling, eating and speaking)
Prodive oral hygiene, bland diet, topical meds

  • ANorexia
  • Diarrhea
  • N/V
  • To help GI upset, maybe give meals before chemo
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6
Q

Hair and reproductivew effects with treatment

A
  • Alopecia (Will grow back)
  • Infertility
    1. fetus and testes highly susceptible
    2. consider sperm banking
    3. may induce menopausal symptoms
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7
Q

Vascular issues with treatment

A
  1. Bone Marrow Suppression -Anemia low RBC, treat with FE, RBC transfus., erythropoetin -Thrombocytopenia low platelets, risk for bleeding,no ASA, aticoagulants -Neutropenia low WBC, susceptible to infection, fever is only sign 2.Extravasation severe local reation with IV inflitration
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8
Q

WBC less than 1000 =

A

NO chemo

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9
Q

Chemo Drugs: Alkylating Agents

A
  1. Cyclophosphamide (Cytoxan)
  2. Cisplatin (Platinol)
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10
Q

Alkylating Agent:
Cyclophosphamide (Cytoxan):
Class/how it works/what it treats

A
  • CCNS
  • given IV or PO
  • Class: alkylating agents
  • It works by attaching to DNA/disrupting replication in dividing cells
  • used to treat: leukemias, lymphomas, multiple myelomas, solid tumors, hodgkins disease
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11
Q

Alkylating Agent:
Cyclophosphamide (Cytoxan):
Side effects/ onset, peak, duration

A

Side effects: -VERY immunosuppresant -N/V/D -thrombocytopenia -hair loss -bone marrow suppression

Onset-unknown
peak- 1 hr
duration- unknown

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12
Q

Alkylating Agent:
Cisplatin (Platinol):
class/how it works/what it treats

A
  • CCNS -given IV -Alkylator like agent
  • Class:Alkylating agents
  • It works by inhibiting dna synthesis by producing cross-links with parent dna strands. Death of rapid replicating cells
  • used to treat: *testicular cancer, *metastatic breast CA, advanced bladder CA, ovarian CA, cervical CA, head neck and lung CA
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13
Q

Alkylating Agent:
Cisplatin (Platinol):
Side effects/ onset, peak, duration

A

Side effects: -hemorrhagic cystitis -siezures -ototoxicity -N/V/D -hypokalemia -hypocalcemia -hypomag -kidney damage -neurotoxicity onset-uknown peak- 18-23 days duration- 39 days

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14
Q

Antimtabolites

A

THESE ARE CCS
1) Fluorouracil (5-FU, Adrucil)

2)Methotrexate (Folex)

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15
Q

Antimetabolites:
Fluorouracil (5-FU, Adrucil):

Class/ how it works/ what it treats

A

1) Class= Antimetabolites
2) It works by inhibiting DNA and RNA synthesis by preventing thymidine production

  • Give IV for Solid tumors, breast CA, stomach CA, liver CA, pancrease CA, and skin CA
  • Given topically for basal cell skin CA
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16
Q

Antimetabolites:
Fluorocuracil (5-FU, Adrucil):

Side effects/onset, peak, and duration

A

Side effects:

  • stomatitis
  • mild GI reactions are early signs of toxicity with this med!!!!
  • N/V/D
  • hair loss
  • decrease in WBC
  • anemia
  • bone marrow suppression

onset- 1-9 days
peak- 9-21 days
duration- 30 days

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17
Q

Antimetabolites:

Methotrexate (Folex):

class/how it works/what it treats

A
  • Can be given PO or IM
  • Class: Folic Acid analog/antimetabolites
  • works by blocking unthesis of folic acid (vitamin B), Inhibits replication in rapid cell division

-Treatment of:
solid tumors, rheumatoid arthritis, chrons disease

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18
Q

Antimetabolites:

Methotrexate (Folex):

Side effects/ onset, peak, duration

A

Side effects:
hepatic damage, renal damage, pulmonary fibrosis, sun sensitivity, hemorrage and bruising, N/V/A, hair loss, gl ulcerations, bone marrow toxicity, low platelet count, steven johnson syndrome

onset- variable

peak- 1-4 hrs PO/ 0.5-2 hrs IM

duration- unknown

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19
Q

Cytotoxic Antibiotics:

Doxorubicin (Adriamycin):

class/how it works/ what it treats

A

**CCNS**

**Given IV ONLY b/c Poor PO absorption (HIGH incidence of tissue irritation with IV)

Class: Antitumor agent

-It works by attaching to DNA and preventing DNA and RNA synthesis

-Treatment of:
breast, bladder, ovarian, lung, leukemias, lymphomas, soft tissue, bone sarcoma

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20
Q

Cytotoxic Antibiotics:

Doxorubicin (Adriamycin):

Side effects/ onset, peak, duration

A

Side effects:
red urine, cardio toxicity, n/v, hair loss

onset-rapid

peak- unknown

duration- unknown

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21
Q

Natural Products (aka: Miotic inhibitors):

Vincristine (Oncovin):

Class/how it works/what it does

A

**CCS**

  • given IV/ often a COMBO treatment
  • Class: Vinca alkaloid, mitotio inhibitor, natural product
  • From a Periwinkle Plant
  • It works by killing cancer calls by preventing the ability to complete mitosis

-Used for:
Wilms tumor, leukemia, hodgkins, non hodgkins lymphoma, neuroblastoma, thyroid & brain tumors and others

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22
Q

Natural Products:

Vincristine (Oncovine):

side effects/ onset, peak, duration

A

Side effects:
N/V and bone marrow suppression are LESS!!!, may develope paripheral neuropathy, numbness/tingling in legs, muscle weakness, loss of neural reflexes.

Onset-unknown, Peak- unknow, duration- 7 days

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23
Q

Mitotic Inhibitors:

Paclitaxel (Taxol):

class/how it works/what it treat/ onset, peak, duration/side effects

A
  • Pharm Class: taxoids
  • From western Yew tree
  • Oil based IV
  • combo therapy with Cisplatin
  • Treatment of metastatic ovarian and breat cancer
  • It works by interfering with the normal cell function that needed for interphase and mitosis. Death of rapid replicating cells.

-Side effects:
bone marrow suppression, peripheral neauropathy, cardiac effects (hypotension, EKG changes), muscle and joint pain

Onset-unknown, peak- 11 days, duration 3 weeks

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24
Q

Hormonal Antagonists:

Tamoxifen (Nolvadex)

Class/how it works/what it treats

A
  • Pharm Class: hormonal agent, estrogen receptor blocker
  • It works by blocking estrogen receptors on breast CA cells
  • Antiestrogen decreases estrogen effects
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25
Q

Hormonal Antagonists:

Tamoxifen (Nolvadex)

Side effects/ onset, peak, duration

A

Side effects:
NOT the usual chemo effects, except do have N/V, induces menopausal sumptoms, ophthalmic changes, uterine malignancies, high risk for endometrial cancer, thromembolic disease.

  • Does NOT cause osteoporosis
  • give with fluids or food to decrease gi symtpoms

onset- unknow

peak- 3-6 hrs

duration- unknown

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26
Q

Hormonal Antagonists:

Leuprolide (Lupron)

Class/ how it works/ what it treats

A

Class: hormones, gonadotropin releasing hormone

  • Decreases effects of testosterone
  • It works by a synthetic form of LHRH causes increase in testosterone and with contiuous administration of testosterone, levels will decrease which leads to decrease in spread of prostate cancer.
  • treats advance prostate cancer
  • Given SW or IM
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27
Q

Hormonal Antagonists:

Leuprolide (Lupron)

Side effects/ onset, peak, duration

A

Side effects:
Not the usual chemo side effects….menopausal sumptoms, impotence, decreased libido, gi bleeding

onset- within 1st week

peak- 2-4 weeks

duration- 4-12 weeks

28
Q

Combination Theraphy

A
  • Several agents combined to decrease toxicity of each individually and to increase effectiveness of treatment
  • May use more than one drug to attach cancer in more than one way

-If you slow the growth….you slow the DNA process

  • Example: MOPP
    1) Mustargen (alkylating agent)
    2) Oncovin (mitotic inhibitor)
    3) Procarbazine (antimetabolite)
    4) Prednisone (steriod)
29
Q

Nursing Implications for cancer treatment

A

1)baseline assessment
2)GI/Oral: non pharm measures, anti-nauseas?
3)Teaching and planning about side effects
4)renal & hepatic monitoring
5)hematologic/infection monitoring
6)reproductive planning/teaching
7)local tissue damage-rescue
(stop med, pull out remaining fluid, remove IV, apply sterile dressing, elevate affected limb, apply cold compresses, administer medication as ordered

30
Q

Nursing considerations: Chemo treatment

A

1) Chemo drugs are toxic to staff as well
2) Meds should be prepared under vented hood
3) wear gown, mask and gloves when preparing and administering most IV chemo medications
4) Have to be specially certified to give chemo

31
Q

BIologic response modifiers

A

1) Enhancing bodys own immune system so can better destroy cancerous cells
2) Has 3 mechanisms (modigies the host’s defenses against the tumor, kills tumors, modifies tumors biology to make it more susceptible)
3) Inhibition of metastases, cell division, cell maturation

32
Q

Interferons

A
  • Tell macrophages to work harder
  • enhance activity of macrophages and restore immune symstem
 -Treats:
 Viral infections (retrovirus, papillomavirus, hepatitis), CA (leukemias, melanoma, kaposi sarcoma), autoimmune (Multiple sclerosis, HIV)
33
Q

Interferons

Alpha-2

A
  • given IM, SQ, IV, or intreperitoneal
  • caution with cardiac disease, renal and hepatic disese, CNS disease, bone marrow suppression

-Side effects:
flu like symptoms, V/D, rash, ittching, hair loss, psych changes, sleep disturbance, cough, dyspnea

-Nursing Implications:
monitor labs, teaching about contraceptives, staying hydrated, CNS effects-saftey, photosensitivity

34
Q

Colony Stimulating Factors

A

**Boost for your immunity

  • Decrease bone marros suppression
  • Stimulate immune system
  • No effect on Cancer cells themselves

-Side effects:
fever, flushing, bone pain, muscle aches, N/V

-May take acetaminiphen or other OTC analgesics for side effects, blood work is important

35
Q

Colongy Stimulating Factors:

Epoetin Alfa (Procrit)

Class/used to treat/how it works/side effects

A
  • Class: Hormones
  • given IV or SQ
  • use for: ESRD, HIV, Cancer
  • It works by stimulating production of RBCs, maintaings or increases RBCs, decrease need for transfusion
  • STOP therapy when hgh is 12 or great
  • Side effects: seizures, hypertension, heart attack

onset- 7 -10 days
Peak- w/ in 2 months
duration- 2 weeks

36
Q

Colony Stimulating Factors:

Filgrastim (Neupogen):

Class/how it works/side effects/ what it treats

A
  • Class: Colony stim factors
  • The formation of basophils, eosinophils, neutrophils

-Used to prevent neutropenia from infections…filgrastim binds to/stimulates immature neutrophils..and activated mature
neutrophils

  • Given IV or SQ
  • DO NOT give within 24 hours of chemo
  • Side effects: leukocytosis, bone pain

onset-unknown
peak-unknow
duration- 4 days

37
Q

Targeted cancer therapy

A
  • New and experimental therapy
  • targeted to specific CA cells
  • Less incidence of side effects
  • 0often PO, can be given at home
  • very expensive
38
Q

Vitamins
Function

A

metabolic function and help with tissue/bone growth and mass

39
Q

What increases need for vitamins?

A

1) Rapid growth periods
2) pregnancy & lactation
3) Illness
4) Inadequate dietary intake

40
Q

What are the fat-soluble vitamins?

A
  • Vit. A
  • Vit. D
  • Vit. E
  • Vit. K
41
Q

Fat Soluble vitamins are….

A

Stored in large quantaties in the body

-are not digested well in the gut so stored for later.

42
Q

Vitamin A

A
  • Fat Soluble Vit.
  • Responsible for bone growth, maintain skin/eyes/hair
  • Foods with vit. A: whole milk, butter, eggs, leafy greens, yellow veggies/fruits, some fish
  • Route: PO, IM for severe cases, caution with liver & kidneys!
  • Toxicity: leukopenia, aplastic anemia, increased ICP
43
Q

Vitamin D

A
  • Fat Soluble vit.
  • Responsbile for: CA absorption, bones, and teeth
  • Found in: fortified milks, egg yolks, tuna, salmon, dairy
  • Only take if levels are low…to much can be really dangerous!
  • Calcitriol is an active form–works with PTH to regulate calcium and phosphorous absorption
  • Toxicity: elevated CA levels, anorexia, n/v
44
Q

Vitamin E

A
  • fat soluble vitamin
  • Responsible for: functoning of RBC’s, muscle, other tissues, stops oxidation of cells, shown to reduce MI’s and protection from CAD
  • Foods with it: whole grain cereal, wheat germ, veg oils, sunflower seeds, milk, eggs, meat
  • May prolong prothrombin time, Iron intereferes with absorption
  • Toxicity: fatigue, weakness, n/v, headache, breat tenderness
45
Q

Vitamin K

A
  • Blood clotting
  • Foods with it: leafy green veg, liver, cheese, egg yolk, veg oil, tomatoes
  • get 1/2 from intestional flora, and 1/2 from diet
  • Supplement only for: deficiency, antidote for anticoagulant overdose, newborns(phytonadione)
  • Antidote to warfran
  • A pt anti-coagulated, normally given some vitamin K PO
46
Q

Water Soluble Vitamins

A
  • not stores by the body!
  • excreted in urine by kidneys
  • only toxic in extremely excessive amounts
  • minimal protein binding
  • Vit. B complex
  • Vit. C
  • Folic acid
  • B12
47
Q

Vitamin B Complex

A

-most found in bread/cereal, yeast, liver, pork, fish, milk. B2 and B3 found in leafy greens

B1: neuro s/s related to alcoholism

B2: skin conditions

B3: hyperlipidemia

B6: INH neuropathy, RBC formation

48
Q

Vitamin C

A
  • tissuye growth and repair, assist in iron absorption, some use to treat colds?
  • Foods: citrus fruits, tomatoes, leafy greens, potatoes, strawberries
  • large doses decrease oral anticoagulant effects
  • urine crystallization with large doses combined with asprin or sulfonamides
49
Q

Floic acids

A

for pregnancy to prevent neuro affects with baby developing

50
Q

Minerals

A

1) Iron

2)Copper: RBC formation/connective tissue
(shellfish, liver, nuts, seeds, legumes, cocoa)

3)Zinc: tissue growth/repair & wound healing
(can interfere with tetracycline–take 2 hrs apart——-beef, lamb, eggs,leafy greens, root veggies)

4)Chromium: increase insulin effect on cells, normalizes blood sugar
(*Be carefule with hypoglycemic meds—-meats, whole grain cereal,yeasts)

5)Selenium: antioxidant properties
(meats, seafood, eggs, dairy products)

51
Q

Hematopoesis

A

process of blood cell formation in bone marrow

  • kidneys secret erythropoetin to stimulate RBC production
  • Maturation process: 24-36 hours from reticulocyte to mature
  • RBC lifespan: 120 days
52
Q

1/3 of RBC is….

A

Hemoglobin!!!
-This is an O2 carrying cell

-Carries oxygen to tissues….a decrease in hgb means decreased ocygen carrying.

(Hypoxia and ischemia to tissues)

53
Q

heme=

A

red pigment that contains iron

54
Q

globin=

A

a protein chain

55
Q

Anemia

A
  • A symptom of an underlying disese.
  • Anemia is NOT a dx..it is a symptom of something else

Effects on RBC depends on Cause:

  • decrease in erythrocyte #
  • alteration in size or shape of erythrocytes
  • Alteration in function

s/s: fatigue, pallor, weakness, exercise intolerance, shortness of breath

56
Q

Iron deficiency anemia
Causes/risk for

A

-most common cause of anemia

  • increased demand from blood loss (surgery, gi blee, frequent donations, trauma)
  • increased demand during pregnancy, lactation, early childhood
  • primary nutritional deficit: elderly often at risk
  • medication/substance induced (alcohol, indocin, steriods)
57
Q

Treament for Iron deficincy anemia

A

-Correct underlying cause and supplement with iron during process and prohylaxis for at risk groups

58
Q

Ferrous Sulfate

Adverse effects
and
Interactions

A

-Rx or OTC therapy

-Adverse Effects:
GI: constipation, N/D, bloating, dark stools, GERD, liquid stains teeth, fatally toxic in large doses

-Interactions:
Antacids, eggs, corn, beans, and cereal products decrease absorption, Herbals: camomille, peppermint can also decrease absorption….Ascorbic acid (Vit. C) increases absorption

59
Q

Ferrous Sulfate:
Nursing implications

A
  • Caution with PO dosing in pts with GI distress
  • Take with meals to reduce GI upset…but food does decrease absoption
  • stool softners for the constipation
  • Prevent tooth staining by diluting with water or juice, use straw/dropper and rinse mouth after taking
  • Child proof containers to avoid overdosing
60
Q

Iron Dectran
how to give/adverse reactions

A
  • Give IV or deep IM (if unable to take oral iron supplement)
  • Risk for tissue discoloration….so IM given Z track method

-Adverse effects:
potential fatal anaphylaxis, HA, fever, itching, phlebitis, local IM injections

61
Q

Vitamin b12
(Cyanocobalamin)

Required for/a deficiency

A
  • Required for: fat & carbohydrate metabolism, protein synthesis, hematopoiesis, DNA synthesis
  • Foods with it: animal origin such as organ meats, fish, dairy
  • with a deficiency…caused by malabsoprtion from poor diet, alcoholism, chronic bleeding, gastrectomy sx, pernicious anemia.

results in anemia, nervous system damage, GI distress, impaired production of WBC and platelets

62
Q

Pernicious Anemia

Define/caused by/ signs and symptoms/treatment

A
  • Lack of intrinsic factor needed for B12 absorption from gut
  • Caused by: atrophy of gastric mucosa, surgery(stomach or small instestine), chronic intestinal disease, genetics, age
  • s/s: megaloblastic anemia, weakness, sore tongue, anorexia, SOB, parasthesias, decreased reflexes
  • treatment: with folic acid to correct hematologic defects…will NOT help the neurologic destruction
  • Treat B12 with B12
63
Q

Drug Therapy

Vitamin B12 (Cyanocobalamin)

A
  • Oral therapy: when lack of dietary intake is the cause
  • Parenteral: IM or deep subq (NO IV): when malabsorption is the cause, given monthly/rotate sites
  • few adverse reactions: hypokalemia possible
  • severe deficeincy: IM B12 plus folic acid (may need transfusion)
  • Neuro effects slow to recover
  • Increased risk of infection due to alteration in bone marrow functioning
64
Q

Folic Acid

define/ foods with it/ deficiency

A
  • works together with B12…for DNA, RNA, and RBC synthesis
  • Foods with it: dried beans, peas, oranges, green veggies, fortified cereal
  • Deficiency from: malabsorption syndrome, dietary dificiency, alcoholism, lixer dz, renal dz or dialysis
  • folic acide supplementation can mask s/s of pernicious anemia (neuro damage continues)
65
Q

Folic Acid anemia s/s

A

poor appetite, hair loss, stomatitis

66
Q

Folic Acid: drug Therapy

A
  • PO most commonly used
  • IV and IM available for severe cases or malabsorption

Prophylactic treatment:

  • for pregnant women
  • some evidence shows decrease in CAD & colon cancer
  • Teach about diet changes
  • Interaction with phenytoin
67
Q

Epoetin alfa (Procrit)

A
  • synthetic form of erythropoietin(which is secreted by the kidneys)
  • it corrects deficiencies of endogenous erythropoietin in order to produce enough RBC’s
  • treatment for anemia secondary to chronic renal failure, HIV, and cancer
  • Adverse effects: must monito for hypertension, seizures from maturing RBC’s to quickly

Pharmacology: Test 1 (4 decks)

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