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Pharm Cancer
| Question | Answer |
|---|---|
| What is cancer? What does it cause cells to do? | Rapid, uncontrolled cell division (damage to genes controlling cell growth); cancer cells lose normal functions; cancer cells invade surrounding cells; cancer cells can metastasize |
| What is a carcinogen? | Causes cancer; associated with a higher risk of acquiring cancer |
| What carcinogen is responsible for 1/3 of all cancers? | Chemicals in tobacco smoke |
| What chemical carcinogens are associated with the workplace? | Asbestos (lung cancer) and benzene (leukemia) |
| What physical factors are also associated with cancer? | Exposure to large amounts of x-rays (leukemia); UV light from the sun (skin cancer) |
| Viruses are associated with what percentage of cancers? What are some examples? | 15% of all human cancers; ex.: Herpes I and II, Epstein-Barr virus, papillomavirus, cytomegalovirus, HPV |
| What are oncogenes? | Predispose client to certain cancers; inhibit development of cancers |
| What healthy lifestyle habits should be encouraged? | Eliminate tobacco/exposure to 2nd hand smoke; limit/eliminate alcohol use; reduce animal fats in diet; increase fiber in diet (plant sources); exercise regularly; keep weight within normal guidelines |
| Why would someone be encouraged to reduce animal fats in diet? | Carcinogens can get stored in fat cells |
| What tests should be performed starting at age 50 for men? | Digital rectal prostate exam, prostate specific antigen (PSA), fecal occult blood test (FOBT), sigmoidoscopy/colonoscopy |
| What tests should be performed starting at age 50 for women? | Periodic mammograms as directed by PCP, fecal occult blood test (FOBT), sigmoidoscopy/colonoscopy |
| When should a woman receive her first Pap test? | Within 3 years of a woman becoming sexually active, or before the age of 21 |
| What does the suffix –oma mean? | Tumor; swelling, enlargement, or mass |
| What are the characteristics of benign tumors? | Grow slowly, do not metastasize, rarely require drug treatment |
| How are benign tumors removed? Do they normally grow back? | Surgically removed; do not normally grow back |
| What are 2 examples of benign tumors? | Adenoma (benign tumor of glandular tissue) and lipoma (benign tumor of adipose tissue) |
| What are the characteristics of malignant tumors (cancer)? | Rapid growth, can easily metastasize; resistant to treatment; normally results in death |
| What are the two major divisions of malignant tumors? | Carcinoma and sarcoma |
| What are 3 types of “other tumors”? | Leukemia (blood-forming cells), lymphoma (lymphatic tissue), glioma (central nervous system tumors) |
| How is cancer treated? | Surgery, radiation therapy, and chemo; greater chances for cure if the cancer is treated early |
| What should be done if extravasation/infiltration of chemo occurs? | Shut it off (leave IV in place), notify the oncologist, aspirate as much chemo from the cath as possible, admin antidote, apply heat/cold/steroid cream as ordered, thorough documentation |
| Why are different antineoplastic classes given to a patient? | Different classes affect different stages of the cancer’s life cycle; allows lower dosages of each agent (reduces toxicity, shows development of resistant, fewer side effects) |
| Why is a patient specific dosing schedule/cycle mapped out at the beginning of treatment? | Single or multiple doses are given over several days, gives normal cells time to recover, cancer cells may be more sensitive at the time of next treatment |
| What is serious toxicity? | Pt is pushed to maximum possible dosage (greatest # of tumor cells killed); always results in adverse effects (means drugs are working); rapidly growing cells are most susceptible to adverse effects |
| What are the adverse effects that may occur in the blood? | Anemia, thrombocytopenia, leucopenia |
| What are the adverse effects that may occur in the GI tract? | Nausea/vomiting (give antiemetics prior to treatment; vomiting center in the brain is affected); diarrhea; anorexia |
| What are the “other” adverse effects that may occur during chemo (not in the blood or GI tract)? | Fatigue (r/t anemia); opportunistic infections; alopecia; stomatitis (unique to chemo) |
| What is stomatitis and how is it treated? | Inflammatory process in the mouth (unique to chemo); treated with special mouth rinse (usually contains Benadryl - antihistamine, Maalox - antacid, xylocaine – local analgesic, nystatin – antifungal (prevents opportunistic infx) |
| What are the different types of antineoplatic drugs? | Alkylating agents, antimetabolites, antitumor antibiotics, plant alkaloids/natural products, hormones and hormone blockers, miscellaneous |
| How are alkylating agents used to treat cancer? | They are the most widely used; form bonds or linkages with DNA (changes the shape) and prevents normal DNA function; kill or slow down replication of tumor cells |
| When do alkylating agents peak? | 1-2 days after administration |
| What are the drug interactions for alkylating agents? | Herbal – Echinacea immune stimulator, interferes with action |
| What are the adverse effects of alkylating agent therapy? | Bone marrow suppression; damage epithelial cells lining GI tract |
| What are two examples of alkylating agents? | cyclophosphamide (cytoxan) and chlorambucil (Leukeran) |
| How do antimetabolites work? | Chemically similar to essential building blocks of the cell; interfere with nutritional metabolism within the cell; cancer cells use this drug to construct proteins or DNA; block DNA synthesis; kill cancer cells or slow growth |
| What are two examples of anitmetabolites? | methotrexate (Folex, Rheumatrex) and fluorouracil (5-FU: infused or skin cream) |
| What are the actions and uses for methotrexate (Mexate)? | Many cancers; psoriasis; rheumatoid arthritis |
| What are the adverse effects and interactions of methotrexate (Mexate)? | Pulmonary toxicity and the usual adverse effects |
| What is the mechanism of action for methotrexate (Mexate)? | Interferes with folic acid use in cells |
| How do antitumor antibiotics work? | Interact with DNA in a manner similar to alkylating agents (side effects are similar) |
| How often are antitumor antibiotics prescribed? | Not widely prescribed; only given IV or instilled into cavity |
| What are two examples of antitumor antibiotics? | bleomycin (Blenozane) and doxorubicin (Dozil) |
| What are the actions and uses of doxorubicin (Adriamycin)? | Prevents cell division; delivered per liposomes which delivers higher concentrations to cancer cells |
| What are the side effects of doxorubicin (Adriamycin)? | Will change urine and tears to red color |
| What are the adverse effects and interactions of doxorubicin (Adriamycin)? | Usual adverse effects and cardiac toxicity (lifetime max dose – if taken beyond the max dose starts to kill the heart); many drug interactions (herbal: green tea enhances action) |
| What are plant alkaloids/natural products? | Structurally very different from each other; common ability to arrest cell division (sometimes called mitotic inhibitors) |
| What is an example of a plant alkaloid/natural product? | vincristine (Oncovin) |
| How is vincristine (Oncovin) given and how much immunosuppression does it cause? | Must be given IV and causes minimal immunosuppression |
| What are the actions and uses for vincristine (Oncovin)? | Inhibits mitosis |
| What are the adverse effects and interactions for vincristine (Oncovin)? | Nervous system toxicity and usual side effects (numbness, tingling, weakness, many drug interactions) |
| How do hormones and hormone blockers work? | Used to slow the growth of hormone-dependant tumors; administered as natural or synthetic products |
| What are hormone-dependant tumors and why do hormones and hormone blockers work on them? | Hormone dependent tumors are stimulated by natural hormones; specific hormones or hormone blockers can block receptor sites |
| What hormones may be used to slow breast cancer? | Testosterone or antiestrogen; tamoxifen citrate (Nolvadex) |
| What may be some effects of taking estrogen to slow the growth of prostate cancer? | May cause feminizing effects; may interfere with normal function (may be due to hormone or from cancer itself) |
| Why would corticosteroids be given to cancer patients? | Palliation |
| What are the adverse effects of hormones used in chemotherapy? | Higher doses of hormone than normally present in the body; produce few of the typical cytotoxic side effects; can produce significant side effects when given at high doses for prolonged periods |
| What are the actions and uses for tamoxifen (Nolvadex)? | Treats breast cancer that have estrogen receptors; also prevents breast cancer |
| What are the adverse effects and interactions of tamoxifen (Nolvadex)? | Nausea, vomiting, increased risk of uterine cancer, hot flashes, fluid retention, venous blood clots, abnormal vaginal bleeding |
| How does asparaginase affect cancer cells? | Deprives cancer cells of an essential amino acid |
| How does mitotane (Lysodren) work? | Poisons cancer cells |
| How do biologic response modifiers (immunotherapy) work? | Stimulate the body’s immune system: do not kill cancer cells, minimize immunosuppressive effects of other anticancer drugs, some used to minimize the toxic effects of other antineoplastics |
| What kind of drug is interferon alfa 2 (Roferon – A, Intron A)? | Biologic response modifier: combination drug |
| What are the actions and uses for interferon alfa 2? | Stimulates immune system to remove antigens; suppresses the growth of cancer cells |
| What are the adverse effects and interactions of interferon alfa 2? | Flu-like symptoms (fever, chills, dizzy, fatigue); nausea, vomiting, diarrhea, anorexia |
| What kinds of toxicity may occur when a patient is on interferon alfa 2 and why? | Hepatotoxicity and nephrotoxicity; immunosuppression |
| What are the actions and uses of Epoetin alpha? | Stimulate RBC production (can cause hypertension); administered 3times per week sub-q |
| What are the administration alerts for Epoetin alpha? | Infants must be given the preservative free type; do not shake vial; inspect for particulates; adequate nutrition (iron is essential) |
| What are the adverse effects and interactions for Epoetin alpha? | 30% incidence of hypertension (monitor BP; may need anti-HTN meds); increased risk of thromboembolic events; iron deficiency must be corrected first |
| What are the actions and uses of filgrastim (Neupogen)? | Increase neutrophil production and enhance function of existing neutrophils; used after chemo is finished, AIDS, organ recipients |
| What are the adverse effects and interactions of filgrastim (Neupogen)? | Wait 24hrs after chemo session; bone pain – report if not relieved by OTC meds |
| What is the function of oprelvekin (Neumega) and what is it given for? | Stimulates platelets; given for thrombocytopenia caused by chemo |
| When is the onset of action for oprelvekin (Neumega)? | 5-9 days |
| What is the duration for oprelvekin (Neumega)? | 7 days |
| How is oprelvekin (Neumega) administered? | Sub-q |
| What is the scope of practice for pharmacists regarding chemo? | Only pharmacists mix/prepare IV chemo |
| What is the scope of practice for RNs regarding chemo? | Only RNs hang chemo and access devices |
| What is the scope of practice for LPNs regarding chemo? | LPNs monitor chemo infusion |
| What should the nurse administering chemo do to reduce body fluid exposure? | Pt is contaminated for approx. 48hrs after admin.; wear gown and gloves; linens and equip should be leak and puncture proof |
| It is important to avoid splashing during urination for a chemo patient. How can splashing be avoided? | Use toilet if possible, ask males to sit, flush with the lid down |
| How should chemo infusion equipment be disposed of? | Hazardous waste |
Created by:
kthoma
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