APHON:12 Principles of Cancer Chemotherapy ppt 12
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| show | Actinomycin (second antibiotic ever developed) & Daunorubicin
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| Class of dDrugs developed specifically for cancer treatment? | show 🗑
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| NCI formed in what decade? | show 🗑
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| Clinical trials on 1st chemo (nitrogen mustard) completed in what decade? | show 🗑
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| show | Pharmacokinetics:drug absorption, metabolism, and excretion. How the body processes drugs.
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| Def: Pharmocodynamics | show 🗑
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| Def: Multimodal Therapy | show 🗑
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| show | use of chemotherapy following another form of therapy, such as surgery, to treat residual disease or undetectable metastasis.
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| show | Neoadjuvant chemotherapy is used preoperatively to decrease tumor bulk in order to make it easier to remove the tumor surgically.
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| show | places within the body that tumor cells can hide. Sites not easily reached by systemic chemotherapy. Ex: CNS in leukemia.
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| How does chemo work | show 🗑
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| Goals of chemo | show 🗑
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| show | RESTING PHASE: cells not dividing. length extremely variable. (not "in cell cycle")
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| Cell cycle: what is G 1 (gap 1)? | show 🗑
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| show | DNA DUPLICATION PHASE in preparation for cellular division. Length 20 hours.
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| Cell cycle: what is G2 (gap 2)? | show 🗑
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| Cell cycle: what is M (Mitosis) phaze? | show 🗑
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| show | phase 1 of Mitosis: . During prophase the nuclear membrane breaks down and chromosomes clump
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| show | Phase 2 of Mitosis: In metaphase the chromosomes align in the middle of the cell.
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| Cell cycle: what is Anaphase? | show 🗑
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| show | Phase 4 of mitosis:Telophase results in actual cell division and the production of two identical “daughter” cells. This process takes approximately one hour.
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| show | time for cell to move from one mitotic episode to another. Length dependent on cell type & time in GO. Short cycle= higher kill with cycle specific agents. Continuous infusion of these Rx => higher cell kill in tumors with short cell cycle times.
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| What is the Cell Kill Hypothesis | show 🗑
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| show | % of cells actively dividing at a given point in time - higher growth fraction ->higher cell kill with cycle specific agents - tumors with greater fraction of cells in G0 will be more sensitive to cell cycle nonspecific agents
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| Def: Tumor burden | show 🗑
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| show | Tumor burden growth is initially exponential but levels off as blood, O2 & nutrient supply is limits. Center of tumor becomes necrotic.
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| show | 1)Mutated DNA alters function 2) Parasitic to host 3)Uncontrolled reproduction 4) Invade surrounding tissues and metastasize 5)immortal (no apoptosis) 6)cell birth> cell death
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| 6 mechanisms of Rx resistance | show 🗑
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| show | - intrinsic (MDR present in tumor prior to tx) - acuired (resullt from genetic mutation following chemo) -Results from P-glycoprotein (rapidly eliminates Rx from cell eg anthracycline, vinca alkaloids)
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| 3 reasons for multidrug resistance gene (MDR) | show 🗑
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| show | - 2+ Rx have greater response (act in diff phases of cycle, vary toxicities) - each Rx has independent action - synergistic effects -decreased Rx resistance
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| 4 characterists of cell cycle specific chemo | show 🗑
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| show | -work in any phase -active in G0 - best as bolus -cytotoxic effects when cell division attempted
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| 5 classificaitons of chemo agents | show 🗑
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| Major toxicities of Alkylating Agents | show 🗑
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| Are alkylating agents specific or non-speific? | show 🗑
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| MOA of alkylating agents? | show 🗑
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| show | -mustartd derivatives -aziridines -hydrozines -alkyl sulfonates -triazenes -heavy metals -topisomerase I inhibitors
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| show | - Cyclophosphamide/ ifosfamide -Melphalan -Mechlorethamine (nitrogen mustard)
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| show | -Thiotepa -mitomycin
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| show | Procarbazine
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| show | Busulfan
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| show | - Dacarbazine (DTIC) - Temozolomide
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| show | - Carboplatin/cisplatin
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| show | -Topotecan -Irinotecan
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| show | S phase
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| show | Structurally similar to normal cellular metabolites. Inhibits production or replacement of a specific enzyme so that a nonfunctioning end product is produced. This causes an interruption in protein, RNA, and DNA synthesis.
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| show | - bone marrow suppression - GI tract (n/v, mucositis, injury to the liver)
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| show | - Folic Acid Antagonists - Pyrimidine Antagonists - Purine Antagonists
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| Antimetabolites: list 2 Folic Acid Antagoinists | show 🗑
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| Antimetabolites: list 4 Pyrimidine Antagonists | show 🗑
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| show | - 6 Mercaptopurine (6-MP) - 6 Thioguanine (6-TG) - Fazarabine - Fludarabine
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| show | Usually cell cycle non specific. bind to DNA and impede its replication, transcription, and repair by interfering with RNA and nucleic acid synthesis and function
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| Major toxicities of antitumor antibiotics | show 🗑
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| show | Anthracyclines, Chromomycin, Miscellaneous
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| Antitumor antibiotics: list 4 Anthracyclines | show 🗑
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| show | Dactinomycin
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| show | Bleomycin, Mitomycin
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| Largest category of antitumor antibiotics used in pediatric cancers | show 🗑
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| show | inhibition of topoisomerase II (enzyme associated with uncoiling of DNA)
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| show | Free radical formation, involving O2 & it's conversion to hydrogen peroxide.
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| What phase of the cell cycle does Bleomycin (antitumor abx) work in | show 🗑
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| What phase of the cell cycle do plant alkaloids work in | show 🗑
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| show | They interfere with the development of the mitotic spindle, preventing cell replication. Cause arrest during mitosis, DNA strand breakage/ death
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| show | Link with secondary maligant neoplasms. Neurological (peripheral neuropathies -> constipation & ambulation problems) GI (n/v/diarrhea), reproductive (amenorrhea, infertility. BM suppression minimal in standard doses.
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| 3 catagories of Plant Alkaloids | show 🗑
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| show | Vinblastine, Vincristine
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| Plant Alkaloids: list 4 Epipodophyllotoxins | show 🗑
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| show | Paclitaxel, Docetaxel
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| show | Trick question!! primarily cell cycle non-specific. Interfere with DNA replication and repair.
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| Nature of relationships b/t nitrosureas & BBB | show 🗑
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| show | Delayed nadir (usually 30-45 days)
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| Major toxicities of nitrosureas | show 🗑
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| show | Carmustine (BCNU), Lomustine (CCNU)
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| show | Hydroxyurea, Procarbazine
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| Miscellaneous Agents: List Enzyme agents | show 🗑
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| Miscellaneous Agents: List 2 Retinoids | show 🗑
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| show | S phase: inhibits DNA synthesis
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| show | Trick question! cell cycle non-specific
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| show | Cross the BBB
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| show | 1) interfere with metabolic functions=> hyperglycemia 2)higher incidences of allergic reactions than other chemo's
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| show | the retinoids: 13-cis-retinoic acid (accutane), All-tras retinoic acid (ATRA)
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| show | prevent growth of new microvessels from capillary endothelial cells to tumor
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| List 2 antiangiogenic agents | show 🗑
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| Major toxicities of antiagiogenic agents | show 🗑
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| Major toxicities of Biological Response Modifiers | show 🗑
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| How to biologic response modifiers treat cancer (5 ways) | show 🗑
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| List 6 Biological Response Modifiers | show 🗑
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| show | Modulate immune responses
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| show | Supports growth/maturation of T-cells
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| show | Stimulates proliferation/ differentiation of neutrophils
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| Biological Response Modifiers: Clinical use of GM-CSF? | show 🗑
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| Biological Response Modifiers: Clinical use of Erythropoietin (EPO)? | show 🗑
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| Biological Response Modifiers: Clinical use of Monocolnal Antibodies? | show 🗑
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| Hormonal Agents: list the 1 category of hormonal agents commonly used in children | show 🗑
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| show | directly lyse lymphoblasts (lymphoid maligancies) may indirectly effect other malignancies. Supportive care: antiemetic, potentiate anti serotonins, decrease cerebral edema.
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| show | Strengthen BBB blocking chemo (??) Effect metabolic function: increase appetite, redistribute body fat, hyperglycemia, acne, striae, behavior changes, mood swings, irritablity, avascular necrosis of humoral and femoral heads (LT use)
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| show | Square root of (ht(cm)x wt (kg)/3600)
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| show | Use KG not BSA. BSA (M2) give approx 1/3 greater amoung of drug than calculated by KG. Infants have different pharmokenitics
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| show | For pt's very thin or very obese (ideal body wt may be used) For pt's with decrease renal or hepatic function, ascities or other significant toxicities modified dosing maybe used.
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| Methods of IV administration of Chemo? | show 🗑
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| Dose category of Chemo administration (4)? | show 🗑
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| show | PO, IV, IV push, intraarterial (IVA), intrathecal (IT), IM, SQ
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| Def irritant Rx? | show 🗑
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| show | Carmustine, Cisplatin, Dacarbazine, Docetaxel, Etoposide
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| Def Vesicant Rx? | show 🗑
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| IV vesicant Rx: list 7? | show 🗑
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| Def: flare reaction | show 🗑
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| show | leadage of drug/fluid out of vein into surrounding tissue. Can occur with + blood return, but IV fluids should always be discontinued. If the infiltration is along the tunnel of a VAD a radiographic or dye study might be indicated.
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| show | leakage of Rx/fluids into surrounding tissue causing a chemical burn. + Pain, +inflammation, + ulceration. Stop Rx, Necrosis may take 4wk to appear & progress for 6 mth.
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| Rx that causes neuro SE of mood alterations (1) | show 🗑
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| show | Vincristine, cisplatin
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| 2 Rx's that causes neuro SE of Ototoxicity: | show 🗑
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| 3 Rx's that cause Cardiomyopathy: | show 🗑
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| 3 Rx's that cause pulmonary fibrosis: | show 🗑
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| 2 Rx's that have infertility as SE: | show 🗑
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| show | Retinoids, thalidomide, antimetabolites, alkylating agents, vinca alkaloids, topoisomerase II inhibitors
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| Classes of Rx's that do not cause Alopecia | show 🗑
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| 2 Rx with SE of Acne | show 🗑
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| one drug know to cause rash | show 🗑
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| Specific SE associated with specific Rx: (INTEGUMENTARY)Striae (1) | show 🗑
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| Specific SE associated with specific Rx: (INTEGUMENTARY)photosensitivity (2) | show 🗑
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| show | Actinomycin, daunorubicin, doxorubicin
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| Specific SE associated with specific Rx: (INTEGUMENTARY)hyperpigmentation (2) | show 🗑
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| Specific SE associated with specific Rx: (INTEGUMENTARY)Extravasation by vesicants (8) | show 🗑
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| show | Many Rx esp cisplatins, cytosine arabinoside, cyclophosphamides, anthracyclines
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| show | Irinotecan, cisplatin
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| Specific SE associated with specific Rx: (GI)Constipation (2) | show 🗑
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| Specific SE associated with specific Rx: (GI)Mucositis (3) | show 🗑
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| Specific SE associated with specific Rx: (GI)Hepatoxicity (4) | show 🗑
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| Specific SE associated with specific Rx: (GI)pancreatitis (2) | show 🗑
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| Specific SE associated with specific Rx: (GU)Hemorrhagic cystitis (2) | show 🗑
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| show | Cisplatin, carboplatin
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| Specific SE associated with specific Rx: (Hypersensitivity)Anaphylaxis (1) | show 🗑
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| Specific SE associated with specific Rx: (Hypersensitivity) Allergic Rxn (3) | show 🗑
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| show | Etoposide
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| show | 1) protect from specific SE (eg leucovorin, mesna) 2) halt/minimize immediate SE (eg antiemetics) 3) assist in recovery (eg growth factors)
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| show | Class: Alkylating agent. Subclass: alkyl sulfonates. PO/ IT in clinical trials
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| Busulfan/ myleran: SE (9) | show 🗑
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| Busulfan/ myleran: Nursing implications | show 🗑
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| show | prep for HCT
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| show | Class: Alkylating agent. Sub class: heavy metal. IV
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| Carboplatin/ paraplatin: SE (7) | show 🗑
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| show | Bone marrow suppression Monitor hearing, renal, & liver function Other than bone marrow suppression, side effects milder than cisplatin
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| Cisplatin/ platinol: class of Rx & route | show 🗑
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| Cisplatin/ platinol: SE (7) | show 🗑
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| Cisplatin/ platinol: Nursing implications | show 🗑
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| show | Class: Alkylating agent. Subclass: mustard derivative. IV/PO
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| show | N&V/anorexia Bone marrow suppression Alopecia Hemorrhagic cystitis Cardiomyopathy (high dose) Infertility
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| show | Give with MESNA (high dose) Hyperhydration/I&0
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| Dacarbazine (DTIC): Class of Rx & route | show 🗑
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| Dacarbazine (DTIC): SE (7) | show 🗑
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| show | Severe pain along vein if in peripheral IV Protect solution from light
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| show | Class: Alkylating agent. Subclass: mustard derivatives. IV
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| Ifosfamide: SE (7) | show 🗑
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| show | Give with MESNA Hyperhydration/I&0
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| show | Class: Alkylating agent. Subclass: Topisomerase II inhibitors. IV
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| Irinotecan/ comptosar: SE (3) | show 🗑
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| show | Monitor for diarrhea Antidiarrhea medications may be given prophylactally or they need to be given immediately if symptoms occur Atropine may be given to control diarrhea
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| show | Class: Alkylating agent. Subclass: Triazene. PO
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| Temazolamide: SE | show 🗑
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| Temazolamide: Nursing Implications | show 🗑
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| show | Class: Alkylating agent, Subclass: Aziridines IV, IT in trials
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| Thiotepa: SE | show 🗑
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| Thiotepa: Nursing implications | show 🗑
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| show | Class: Alkylating agent. Subclass: Topisomerase II inhibitor, IV
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| show | Diarrhea Bone marrow suppression Alopecia Renal toxic
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| show | Monitor for diarrhea Dilute with either 0.9% normal saline or D5W
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| show | Class: Antimetabolite. Subclass: ? IV/SQ/IM/IT
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| show | N/V/anorexia, Diarrhea, BM suppression, mucositits, Rash (esp hands), Flu-like syndrome/fever, conjunctivitis (high dose)
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| show | Dexametasone eye drops for high dose. N/V directly related to high dose.
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| Fludarabine: Class & Route | show 🗑
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| Fludarabine: SE | show 🗑
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| Fludarabline: nursing implicatons | show 🗑
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| Gemcitabine: Class & Route | show 🗑
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| show | N/V, BM suppression (especially anemia), Rash, Fever/flu-like symptoms
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| show | Infuse with NS, generally given over 30min, BM suppression is dose limiting
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| Mercaptopurine (6-MP): Class & Route | show 🗑
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| show | BM suppression, mucositis (rare), Rash, Hepatotoxic, Mild nausea
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| show | Monitor liver function, Teach: take at bedtime on empty stomach to increase absorption. May need decreased dose if on allopurinol
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| Methotrexate (MTX): Class & Route | show 🗑
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| show | BM suppression, Mucositis/ GI ulceration, Rash/photosensitivity, Hepatic/renal toxic, Nausea (dose related)
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| Methotrexate (MTX): nursing implications | show 🗑
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| show | Class: Antimetabolite. Subclass: Purine antagonist. PO
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| Thiguanine (6-TG): SE | show 🗑
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| Thiguanine (6-TG): Nursing Implications | show 🗑
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| show | Class: Antitumor abx. Subclass: anthracyclines (vesicant)
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| show | Alopecian, N/V, BM suppression, mucositis, cardiomyopathy, Radiomimetic
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| Daunorbubicin, Doxorubicin: Nursing implications | show 🗑
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| show | Class:antitumor abx. Subclass: anthracycline. (vesicant) IV
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| show | Alopecia, N/V, BM suppression, Mucositis, Cardiomyopathy (less common)
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| Idarubicin: nursing implications | show 🗑
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| Bleomycin: Class & route | show 🗑
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| Bleomycin: SE | show 🗑
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| show | test dose prior to first dose. Monitor PFT. Cumulative max dose (400 Units)
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| show | Class:antitumor abx. Subclass: chromomycin (vesicant) IV
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| show | Bone marrow suppression N/V Photosensitivity/radiomimetic Acne Mucositis
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| Dactinomycin (Actinomycin-D, AMD): nursing implications | show 🗑
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| Alpha interferon (a-IFN): Class & Route | show 🗑
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| show | Flu-like syndrome Fatigue Neurologic Anorexia/weight loss Pruritis Neutropenia/thrombocytopenia
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| show | Chills usually occur 3-6 hours following administration Fevers to 400 C may occur and last 24 hours
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| show | Biologic agent, IV, SQ
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| show | HTN, Diarrhea
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| show | Teach re: injection techniques Monitor BP Safety and efficacy have not been established in pediatrics
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| show | Biologic agent, SQ, IVq
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| show | Capillary leak syndrome Flu-like syndrome/fevers CNS changes N&V, anorexia Skin changes
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| Interleukin-2 (IL-2): Nursing Implication | show 🗑
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| Granulocyte colony stimulating factor (G-CSF): Class & route | show 🗑
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| Granulocyte colony stimulating factor (G-CSF):SE | show 🗑
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| Granulocyte colony stimulating factor (G-CSF):nursing implications | show 🗑
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| show | biologic agent
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| Granulocyte-macrophage colony stimulating factor (GM-CSF): SE | show 🗑
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| show | Teach re: injection techniques and potential for bone pain as counts recover (more common in adolescents) Treat bone pain with acetaminophen Monitor WBC/ANC
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| Monoclonal Antibodies: Class & route | show 🗑
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| Monoclonal Antibodies: SE | show 🗑
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| Monoclonal Antibodies: Nursing Implications | show 🗑
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| show | Hormone, IV/PO
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| Glucorticoids (prednisone, hydrocortisone, dexamethasone): SE | show 🗑
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| show | Teach re: increased risk of infection/GI protection, diet Taper dose if on greater than 3-4 weeks Perineal burning with rapid IV infusion
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| Carmustine (BCNU): class & route | show 🗑
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| show | N&V Bone marrow suppression Renal/hepatic toxicity Pulmonary fibrosis Ovarian/sperm suppression
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| show | Crosses the blood-brain barrier Delayed nadir (4-6 weeks) Cough & dyspnea initial symptoms of respiratory failure
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| show | Class: nitrosoureas, PO
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| show | N&V Bone marrow suppression (severe) Renal/hepatic toxicity Mucositis Alopecia
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| Lomustine (CCNU): nursing implications | show 🗑
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| show | Class: Plant alkaloid. Subclass: Epipodophyllotoxins. (Irritant) IV, PO
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| show | Mild N&V Bone marrow suppression Alopecia Hypotension/hypersensitivity Liver toxicity
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| show | Precipitates easily Monitor for hypotension/hypersensitivity
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| show | Class: Plant alkaloid. Subclass: vinca alkolodis. (vesicant) IVP
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| show | Alopecia Bone marrow suppression (mild) Peripheral neuropathy/foot drop (uncommon) Constipation/ileus Jaw pain Hepatotoxic
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| show | Teach re: need for stool softeners, high fiber diet/fluids May need pain medication Neurotoxicities are cumulative
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| Vinorelbine (Navelbine): class & Route | show 🗑
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| show | N&V Bone marrow suppression Neurotoxic/peripheral neuropathies
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| show | Given over 4-6 minutes as an IVP Observe for neurotoxicities
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| show | Miscellaneous IV
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| show | Electrolyte imbalances Electrolyte imbalances Headache Rash/pruritis Cough/dyspnea N&V/anorexia
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| Arsenic: Nursing implications | show 🗑
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| Asparaginase (e-coli, erwinia, PEG): class & route | show 🗑
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| show | Skin reaction at injection site Systemic allergic reaction (may be delayed with PEG) Hyperglycemia Pancreatitis Coagulapathies
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| Asparaginase (e-coli, erwinia, PEG): (3) | show 🗑
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| show | Class: miscellaneous. Subclass: lipid soluable. PO
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| Hydroxyurea: SE (5) | show 🗑
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| Hydroxyurea: nursing implications (2) | show 🗑
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| Gleevac: Class & route | show 🗑
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| Gleevac: SE (5) | show 🗑
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| Gleevac: Nursing implications (3) | show 🗑
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| show | Route: PO Class: Miscellaneous. Subclass: retinoids. Rx: All-trans retinoic acid (ATRA®),13-cis-retinoic acid (Accutane®)
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| Retinoids: SE (4) | show 🗑
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| show | Teach: Take with food for better absorption. Monitor pregnancy tests on post menarchal females
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| show | Protective agent, IV
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| show | Hypotension, Rash, Hepatic toxicity, Bad taste in mouth, N&V,
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| Amifostine: nursing implications (4) | show 🗑
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| show | Protective agent, IV/ PO
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| Mesna: SE (5) | show 🗑
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| show | May be mixed with cyclophosphamide or ifosphamide. False positive ketones. Administer IV bolus dose over 15 minutes. May mix oral form with small amount of juice or carbonated drink.
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| Leucovorin: class & route | show 🗑
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| Leucovorin: SE | show 🗑
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| show | Timing of doses crucial, IV solution should be diluted to 10 mg/ml, Do not infuse IV at > 160 mg/minute
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| show | Protective agent/unclassified chemotherapeutic agent. IV.
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| Zinecard: SE (5) | show 🗑
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| Zinecard: nursing implications (1) | show 🗑
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| show | protects heart from doxorubicin
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| show | To prevent haemorrhagic cystitis and haematuria when a patient receives ifosfamide or cyclophosphamide for cancer chemotherapy which converts tp urotoxic metabolites such as acrolein. Increases excretion & binds to toxin.
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| What does amifostine do? | show 🗑
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Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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