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Pharmacology > week 6: Ch. 57 [Neoplasia] > Flashcards

week 6: Ch. 57 [Neoplasia] Flashcards

1
Q

_________________ agents kill or stop the growth of cancer cells & may be classified as:

–Alkylating agents
–Antimetabolites
–Antitumor antibiotics
–Hormones and hormone antagonists
–Natural products
–Biologic response modifiers and targeted therapies
–Miscellaneous antineoplastic drugs

A

Antineoplastic

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2
Q

Antineoplastic agents kill or stop the growth of :

A

cancer cells

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3
Q

Alkylating Agents

  • Alter the shape of the : 1
  • Prevent DNA from : 2
  • Kill cancer cells when : 3
  • Suppress : 4
    (myelosuppression)
  • Damage epithelial cells
A

1- DNA double helix

2- duplicating

3- they divide

4- bone marrow

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4
Q

Alkylating Agents can lead to :

A
  • Alopecia
  • Strong vesicants [blistering]
  • Secondary malignancies
  • Can develop resistance
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5
Q

Prototype drug for Alkylating Agents :

A

Cyclophosphamide (Cytoxan)

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6
Q

Prototype drug: Cyclophosphamide (Cytoxan)

Adverse effects:

A

anorexia, nausea, vomiting, weight loss, diarrhea, and mouth sores

–Alopecia occurs in 50% of patients

– jaundice, acne, blistered skin, darkened or thickened skin

▪Serious adverse effects
–Bone marrow suppression
–Severe infection and sepsis
– Cardiotoxicity
–Pulmonary fibrosis
– Hematuria may signal hemorrhagic cystitis
– Interfere w/ ability to reproduce
– Risk of secondary malignancies

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7
Q

Prototype drug: Cyclophosphamide (Cytoxan)

– Therapeutic classification ?
– Pharmacologic classification ?

A

Therapeutic classification
▪Antineoplastic

Pharmacologic classification
▪Alkylating agent, nitrogen mustard, disease-modifying antirheumatic drug, immunosuppressant

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8
Q

Therapeutic effects and uses of Cyclophosphamide (Cytoxan)

▪Cancers of ____________________
– Chemo of Hodgkin’s & non- Hodgkin’s lymphoma
– Acute & chronic lymphocytic & myelogenous leukemia
▪Ovarian & _________ cancer
▪Multiple myeloma
▪Mycosis fungoides
▪Neuroblastoma
▪Sarcomas
▪Retinoblastoma
▪Off-label uses = other cancers

A

▪Cancers of the lymph nodes
– Chemo of Hodgkin’s & non- Hodgkin’s lymphoma
– Acute & chronic lymphocytic & myelogenous leukemia
▪Ovarian & breast cancer
▪Multiple myeloma
▪Mycosis fungoides
▪Neuroblastoma
▪Sarcomas
▪Retinoblastoma
▪Off-label uses = other cancers

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9
Q

Cyclophosphamide (Cytoxan)
– Mechanism of action

▪Converted to its active form (phosphoramide mustard) in ______________

▪Binds to DNA and forms cross-links
–Prevent the synthesis of______________________________

▪It is a cell cycle nonspecific drug.

A

▪Converted to its active form (phosphoramide mustard) in the liver

▪Binds to DNA and forms cross-links
–Prevent the synthesis of DNA, RNA, & protein

▪It is a cell cycle nonspecific drug.

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10
Q

Cyclophosphamide (Cytoxan)
– Contraindications/precautions

A

▪Pregnancy & lactation
▪Severe myelosuppression
▪Leukopenia
▪Thrombocytopenia
▪Previous radiation therapy
▪Bone marrow infiltration of tumor cells
▪Chronic kidney disease (CKD)
▪Impaired hepatic function
▪Recent history of steroid use
▪Previous therapy that caused cytotoxicity

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11
Q

Cyclophosphamide (Cytoxan)
– Drug interactions

A

▪Many drug interactions possible due to its extensive hepatic metabolism.
▪Additive immunosuppressive effects if taken with other agents that cause bone marrow toxicity
▪May be an increased anticoagulant effect if given with anticoagulants
▪Increased cardiotoxicity may result if given with doxorubicin
▪Insulin may increase hypoglycemia.
▪Lower serum digoxin levels in patients who takes digoxin
▪Phenobarbital use may lead to increased rate of metabolism
▪Phenytoin use may lead to an increased risk of toxicity.

– Herbal/Food
▪St. John’s wort may increase toxic effects.

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12
Q

Cyclophosphamide (Cytoxan) – Treatment of overdose

A

▪General supportive measures for severe myelosuppression with the possibility of infection

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13
Q

Antimetabolites are similar structured to nutrients required by:

A

rapidly growing cancer cells

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14
Q

Antimetabolites disrupt _________ ____________ of cancer cells

A

metabolic pathways

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15
Q

Antimetabolites inhibit __________ and are cell cycle specific

A

enzymes

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16
Q

Antimetabolites
Prototype drug:

A

Methotrexate (MTX, Rheumatrex, Trexall)

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17
Q

Methotrexate (MTX, Rheumatrex, Trexall)

– Therapeutic classification ?
– Pharmacologic classification ?

A

Therapeutic classification
▪Antineoplastic

Pharmacologic classification
▪Antimetabolite, folic acid analog,
immunosuppressant, disease-modifying antirheumatic drug (DMARD)

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18
Q

Methotrexate (MTX, Rheumatrex, Trexall)
– Therapeutic effects and uses

A

▪Neoplastic conditions, including osteosarcoma
▪Acute lymphocytic and
lymphoblastic leukemias
▪Lymphosarcoma in children
▪Certain inoperable head, neck, and pelvic cancers
▪Breast & Lung cancer
▪Advanced-stage non-Hodgkin’s lymphoma
▪Combo therapy to maintain remissions after surgical resection of a primary tumor
▪Powerful immunosuppressant

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19
Q

Methotrexate (MTX, Rheumatrex, Trexall)
– Mechanism of action

▪Specific for ___ _______ of the cell cycle

▪It blocks an enzyme that is responsible for
_________________________________________, which
interferes with DNA synthesis, repair, and cellular
replication mainly in actively proliferating tissues.

▪This action enables it to be effective in treating
_________________________________ in addition to cancer.

A

▪Specific for S phase of the cell cycle

▪It blocks an enzyme that is responsible for
converting folic acid to reduced folate, which
interferes with DNA synthesis, repair, and cellular
replication mainly in actively proliferating tissues.

▪This action enables it to be effective in treating
psoriasis and arthritis in addition to cancer.

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20
Q

Methotrexate (MTX, Rheumatrex, Trexall)
– Adverse effects/ black box warning

A

– Adverse effects
▪Nausea and vomiting are severe at high doses.

▪Serious adverse effects
– Uric acid nephropathy
– GI hemorrhage
– Hemorrhagic enteritis
–Pancreatitis
–Pericardial effusion
–Pulmonary embolism

– Black box warnings
▪Methotrexate combined with NSAIDs may cause
severe/fatal myelosuppression
▪Hepatotoxic
▪Ulcerative stomatitis & diarrhea may lead to
hemorrhagic enteritis & death from intestinal
perforation.
▪Pneumocystis pneumonia
▪Pulmonary toxicity may result in acute or chronic
interstitial pneumonitis at any dose level.
▪Severe, sometimes fatal, dermatologic reactions

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21
Q

Methotrexate (MTX, Rheumatrex, Trexall)
– Contraindications/precautions

A

▪Thrombocytopenia
▪Anemia, Leukopenia
▪Concurrent administration of hepatotoxic drugs
and hematopoietic suppressants
▪Alcoholism
▪Lactation
▪CKD
▪Impaired hepatic function
▪Active infections
▪Ulcerative colitis, Peptic ulcers
▪Patients with cancer who have preexisting bone
marrow impairment
▪Patients who are very young, older, or debilitated
▪poor nutritional status
▪Confirmed teratogen; avoid pregnancy during
therapy
▪caution in handling; can cause severe skin
reactions
▪Interacts with many drugs
▪Increased serum methotrexate levels can occur with the penicillins, vancomycin, cyclosporine, and para-amino benzoic acid.
▪Chloramphenicol may decrease intestinal absorption.
▪Increased effect can occur with probenecid, ibuprofen, aspirin, and tetracyclines
▪Folic acid may alter the body’s response to
methotrexate
▪Can cause decreased phenytoin effects
▪Immunization during therapy is not effective.
▪Any live vaccine use may lead to a severe
reaction secondary to the immunosuppressant
activity of methotrexate

– Herbal/Food
▪Food delays oral absorption.
▪Echinacea may increase risk of hepatotoxicity.
▪More than 180 mg/day of caffeine may decrease
effectiveness of methotrexate when taken for
arthritis

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22
Q

Methotrexate (MTX, Rheumatrex, Trexall)
– Treatment of overdose

▪_______________ or levoleucovorin as soon as possible
▪In some cases, leucovorin is given 24 to 36 hours after methotrexate chemotherapy to “rescue” normal cells.

A

▪Leucovorin or levoleucovorin as soon as possible
▪In some cases, leucovorin is given 24 to 36 hours after methotrexate chemotherapy to “rescue” normal cells.

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23
Q

methotrexate (MTX, Rheumatrex, Trexall)
– Nursing responsibilities

▪Monitor: 1
▪Be alert for and report symptoms of: 2

A

1- I&O ratio and pattern

2- thrombocytopenia

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24
Q

Antitumor Antibiotics bind to:

A

DNA

  • Mechanism of action similar to alkylating agents
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25
Q

Antitumor Antibiotics contain substances obtained from bacteria that can:

A

kill cancer cells

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26
Q

Antitumor Antibiotics: their use is restricted to treating

A

a few specific types of cancer

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27
Q

Antitumor Antibiotics

how are they given?

A

IV or direct instillation via catheter

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28
Q

Antitumor Antibiotics

a great risk is:

A

bone marrow supression

[myelosuppresion]

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29
Q

Antitumor Antibiotics can cause major damage to the skin, subcutaneous tissue, and nerves should __________ occur

A

extravasion

30
Q

Antitumor Antibiotics
Prototype drug: Doxorubicin (Adriamycin)

– Therapeutic classification ?
– Pharmacologic classification ?

A

Therapeutic classification
▪Antineoplastic

Pharmacologic classification
▪Antitumor antibiotic, anthracycline

31
Q

Doxorubicin (Adriamycin)
– Therapeutic effects and uses:

▪Treat neuroblastoma and____________________ of the bone, bladder, breast, ovary, GI tract, lung, & thyroid

▪Part of many ______________ regimens for other tumors

▪Effective as a pre-radiation therapy to sensitize superficial tumors

A

▪Treat neuroblastoma and solid tumors of the bone, bladder, breast, ovary, GI tract, lung, & thyroid

▪Part of many chemotherapy regimens for other tumors

▪Effective as a pre-radiation therapy to sensitize superficial tumors

32
Q

Doxorubicin (Adriamycin)
– Mechanism of action’

▪Binds to DNA, causing:
▪It is cell cycle:

A

▪Binds to DNA, causing strand splitting and inhibition of DNA synthesis

▪It is cell cycle nonspecific

33
Q

Doxorubicin (Adriamycin)
– Adverse effects
& Black box warnings

A

▪Severe nausea, vomiting, mucositis, rash, excessive lacrimation, hepatotoxicity, anaphylaxis, complete alopecia, & radiation recall phenomenon
▪Turns urine and tears a red color
▪Temporary decreased fertility likely (M & F)

– Black box warnings
▪Severe myelosuppression may occur.
▪Significant cardiotoxicity
▪Cardiac adverse effects may be life threatening.
▪Heart failure
▪Severe local necrosis
▪Secondary malignancies

34
Q

Doxorubicin (Adriamycin)
– Contraindications/precautions

A

▪Pregnancy
▪Lactation
▪Myelosuppression
▪Thrombocytopenia
▪Preexisting cardiac disease
▪Obstructive jaundice
▪Previous treatment with complete cumulative
doses of doxorubicin or daunorubicin
▪CKD
▪Impaired hepatic function
▪History of atopic dermatitis
▪Patients who have received cyclophosphamide or
pelvic radiation therapy to areas surrounding the
heart

35
Q

Doxorubicin (Adriamycin)
– Drug interactions

A

▪Increased toxicity may occur with other antineoplastics, radiation therapy, or mercaptopurine.
▪Cyclophosphamide may increase the risk of hemorrhagic cystitis or cardiac toxicity.
▪Paclitaxel may decrease the clearance of doxorubicin.
▪Phenobarbital and other barbiturates increase elimination.
▪Decreased phenytoin levels may occur.
▪Concurrent use with verapamil can raise serum levels.
▪Use with paclitaxel > increased incidence of stomatitis, neutropenia, heart failure.
▪Concurrent use with NSAIDs, anticoagulants, or platelet inhibitors may cause excessive bleeding.

36
Q

Doxorubicin (Adriamycin)
– Treatment of overdose

A

▪Antibiotics, platelets, and granulocytes

▪Symptoms of mucositis and heart failure treated symptomatically

37
Q

Hormones & Hormone Antagonists

they block substances necessary for :

A

continued tumor growth

38
Q

Hormones & Hormone Antagonists

Therapy is limited to hormone-sensitive tumors of the :

A

breast or prostate.

39
Q

Hormones & Hormone Antagonists are NOT:

A

cytotoxic

[not toxic to living cells]

40
Q

Hormones used in treating cancer include:

A

–Corticosteroids
–Progestins
–Estrogens
–Androgens

41
Q

Hormones & Hormone Antagonists are usually given for palliative care, meaning

A

given to reduce symptoms/pain of cancer, not to cure

42
Q

Hormones & Hormone antagonists
* Prototype drug: Tamoxifen

– Therapeutic classification ?
– Pharmacologic classification ?

A

Therapeutic classification
▪Antineoplastic

Pharmacologic classification
▪Hormonal agent, estrogen receptor blocker

43
Q

Tamoxifen
– Therapeutic effects and uses

▪Palliative treatment of advanced, metastatic, ER-positive ________________ in men and postmenopausal women
▪Off-label indications include astrocytoma, malignant glioma, malignant melanoma, and ovarian cancer.
▪Prophylaxis of __________________ in women who have a high risk of developing the disease
▪Adjunctive therapy in women following a mastectomy to decrease the potential for cancer in the contralateral breast

▪Off-label: Treatment of infertility and to reduce pain associated with gynecomastia in women and men

A

▪Palliative treatment of advanced, metastatic, ER-positive breast cancer in men and postmenopausalwomen
▪Off-label indications include astrocytoma, malignant glioma, malignant melanoma, and ovarian cancer.
▪Prophylaxis of breast cancer in women who have a high risk of developing the disease
▪Adjunctive therapy in women following a mastectomy to decrease the potential for cancer in the contralateral breast

▪Off-label: Treatment of infertility and to reduce pain associated with gynecomastia in women and men

44
Q

Tamoxifen
– Mechanism of action

▪Binds to _________________, producing agonist effects in some tissues (bone) and antagonist effects in other tissues (breast)

▪The binding in breast tissue inhibits ______ _______________ and affects other growth factors in cancer cells.

A

▪Binds to Estrogen Receptors (ER), producing agonist effects in some tissues (bone) and antagonist effects in other tissues (breast)

▪The binding in breast tissue inhibits DNA replication and affects other growth factors in cancer cells.

45
Q

Tamoxifen
– Adverse effects & Black box warning

A

▪Nausea & vomiting
▪Other common adverse effects:
– Hot flashes, vaginal discharge, irregular menses, vaginal bleeding, fluid retention, headaches, light-headedness, rash

– Black box warnings
▪Increased risk of endometrial cancer
▪Slightly increased risk of thromboembolic disease,
including stroke, pulmonary embolism, and deep
vein thrombosis (DVT)

46
Q

Tamoxifen
– Contraindications/precautions

A

▪Contraindications:
–Anticoagulant therapy, preexisting endometrial
hyperplasia, history of thromboembolic disease, pregnancy and lactation

▪Precautions:
– Leukopenia, thrombocytopenia, visual disturbances, cataracts, bone marrow suppression, hypercalcemia, hypercholesterolemia

47
Q

Tamoxifen
– Drug interactions

A

▪May interact with inducers or inhibitors of CYP
enzymes
▪Use with warfarin increases risks of bleeding
▪Cytotoxic antineoplastics may increase risk of
thromboembolism.
▪Bromocriptine may increase tamoxifen levels.
▪Aminoglutethimide, medroxyprogesterone, or rifamycin may decrease tamoxifen levels.
▪SSRIs may decrease effectiveness.
▪Should not be used with oral contraceptives

– Herbal/Food
▪Black cohosh should not be taken unless approved by the healthcare provider.

48
Q

Tamoxifen – Treatment of overdose

A

Symptomatic for seizures, neurotoxicity, and QT interval changes

[Treating these symptoms of the after-effects / adjusting dose]

49
Q

Natural products that are derived from ______ are another class of Antineoplastic medication

A

plants

50
Q

Natural Products
* Three subdivisions

–Vinca alkaloids = derived from-
–Taxanes = derived from-
–Topoisomerase inhibitors

A

–Vinca alkaloids = derived from periwinkle plant

–Taxanes = derived from bark of the pacific yew tree

–Topoisomerase inhibitors

51
Q

Natural products (antineoplastic meds) are able to:

A

stop cell divison

52
Q

Natural Products
Vincristine (Marqibo, Oncovin)

– Therapeutic classification ?
– Pharmacologic classification ?

A

– Therapeutic classification
▪Antineoplastic

– Pharmacologic classification
▪Vinca alkaloid, mitotic inhibitor, natural product

53
Q

Vincristine (Oncovin)
– Therapeutic effects and uses

▪Acute lymphocytic ____________
▪Hodgkin’s and non-Hodgkin’s ________________
▪Lymphosarcoma
▪Malignant glioma
▪Neuroblastoma
▪Rhabdomyosarcoma
▪Soft tissue sarcoma
▪Wilms’ tumor
▪Off-label for breast, colorectal, and lung cancers

A

▪Acute lymphocytic leukemia
▪Hodgkin’s and non-Hodgkin’s lymphomas
▪Lymphosarcoma
▪Malignant glioma
▪Neuroblastoma
▪Rhabdomyosarcoma
▪Soft tissue sarcoma
▪Wilms’ tumor
▪Off-label for breast, colorectal, and lung cancers

54
Q

Vincristine (Oncovin)
– Mechanism of action

▪Binds to ___________, a protein that makes up the _____________ of the cell that are necessary for cell division

▪This disrupts the process whereby chromosomes are distributed to the daughter cells during _________, resulting in:

A

▪Binds to tubulin, a protein that makes up the microtubules of the cell that are necessary for cell division

▪This disrupts the process whereby chromosomes are distributed to the daughter cells during mitosis, resulting in cell death.

55
Q

Vincristine (Oncovin)
– Adverse effects & black box warning

A

▪Neurotoxicity
– Motor difficulties, peripheral neuropathy,
paresthesias (especially of the hands and feet),
weakness, cranial nerve palsies (diplopia,
hoarseness, deafness, trigeminal neuralgia,
vocal cord paralysis), and decreased reflexes

▪CNS effects may include seizures, depression,
hallucinations, and coma.

▪GI: Nausea, vomiting, anorexia, stomatitis, severe
constipation, and abdominal pain.
▪Other adverse reactions include hepatotoxicity,
rash, paralytic ileus (especially in children), and
alopecia.

– Black box warnings
▪Myelosuppression
▪Extravasation

56
Q

: Vincristine (Oncovin)
– Contraindications/precautions

A

▪Obstructive jaundice
▪Men and women of childbearing age
▪Active infection
▪Adynamic ileus
▪Radiation of the liver
▪Infants
▪Pregnancy
▪Lactation

– Precautions
▪Patients with leukopenia, preexisting
neuromuscular or neurologic disease,
hypertension, CKD or hepatic impairment
▪Those taking drugs with neurotoxic properties
▪Older adults
▪Reduce doses in patients with hepatic or biliary
disease
▪Avoid exposure of skin to this drug

57
Q

Vincristine (Oncovin)
– Drug interactions

A

▪Agents that induce CYP3A4 may increase metabolism of vincristine and decrease effects of the medication.
▪Increases action of methotrexate, bleomycin, and
anticoagulants
▪Decreased digoxin and phenytoin levels will occur.
▪Administration of L-asparaginase just prior to
vincristine will cause additive neurotoxicity.
▪Concurrent administration with mitomycin may cause acute dyspnea and severe bronchospasm.
▪Neurotoxicity may occur with peripheral nervous
system drugs.

58
Q

Vincristine (Oncovin) – Treatment of overdose

A

▪No antidote [no specific treatment]
▪Patients treated symptomatically

59
Q

A biologic response modifier is a substance that enhances the ability of body defenses to:

A

remove cancer cells

60
Q

Biologic Response Modifiers and Targeted Therapies

  • Two general classes:
A

cytokines and monoclonal antibodies

61
Q

Cytokines that act as biologic response modifiers [3]

A

–Interferons
–Interleukin-2
–Hematopoietic growth factors

62
Q

Interleukin-2 activates the ____________________________ and promotes other actions of immune response so it can decrease tumor/kill cancer that is growing

A

cytotoxic T-lymphocyte

63
Q

Hematopoietic growth factors promote the formation of ___________________________ and these enhance the ability of the immune system to respond and reduce some of the myelosuppression caused by antineoplastic meds

A

specific blood cells

64
Q

Targeted therapies
–Drugs that block the :

A

growth, progression, and spread of cancer

65
Q

Monoclonal antibodies (MABs) are ____________________________________________

A

biologic response modifiers

66
Q

Monoclonal antibodies (MABs)

–Once MAB binds to specific antigen, cancer cell is
either killed by drug or _________________________ by other cells of immune response.

A

marked for destruction

67
Q

Monoclonal antibodies (MABs) require that tumor cells possess specific :

A

protein receptors

68
Q

Miscellaneous Antineoplastics

*Structurally dissimilar to:
*Each is unique, so:

A

*Structurally dissimilar to other neoplastics
*Each is unique, so adverse reactions vary.

69
Q

Antiemetics decrease or prevent:

A

nausea and vomiting

70
Q

Drugs for bowel disorders
–Decrease either:

A

constipation or diarrhea

71
Q

3 types of drugs used to prevent serious complications of _________________:

–Epoetin alfa (Epogen, Procrit)
–Colony-stimulating factors such as filgrastim (Granix, Neupogen, Zarxio)
–Oprelvekin (Neumega

A

myelosuppression

72
Q

A large number of antineoplastic medications are
absorbed through the skin and mucous membranes, so the individual preparing and administering them is at risk for:

A

absorbing them.

~Nurses/healthcare professionals must wear protective clothing, including gloves, whenever handling them.

~Both the Oncology Nursing Society and OSHA have established and publicized guidelines for safe handling of antineoplastic medications

Pharmacology (12 decks)

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