APHON:12 Principles of Cancer Chemotherapy ppt 12
Help!
|
|
||||
|---|---|---|---|---|---|
| Two drugs origionally designed as antibiotic's that are antimetabolites (anti cancer drugs)? | Actinomycin (second antibiotic ever developed) & Daunorubicin
🗑
|
||||
| Class of dDrugs developed specifically for cancer treatment? | ANTIMETABOLITES: interfere with metabolic pathways or disrupt DNA synthesis
🗑
|
||||
| NCI formed in what decade? | 1930's
🗑
|
||||
| Clinical trials on 1st chemo (nitrogen mustard) completed in what decade? | 1940's
🗑
|
||||
| Def: Pharmacokinetics | Pharmacokinetics:drug absorption, metabolism, and excretion. How the body processes drugs.
🗑
|
||||
| Def: Pharmocodynamics | CONCENTRATION of Rx in vivo BIOPHYSICAL MECHANISM. Principles of pharmacokinetics and pharmocodynamics are used to develop drug dose and schedules, which will maximize tumor cell kill and minimize toxicity.
🗑
|
||||
| Def: Multimodal Therapy | Use of several forms of therapy in the course of treatment. Chemotherapy, surgery, hematopoietic cell transplant (HCT),radiation (XRT).
🗑
|
||||
| Def Adjuvant chemotherapy | use of chemotherapy following another form of therapy, such as surgery, to treat residual disease or undetectable metastasis.
🗑
|
||||
| Def: Neoadjuvant chemotheapy | Neoadjuvant chemotherapy is used preoperatively to decrease tumor bulk in order to make it easier to remove the tumor surgically.
🗑
|
||||
| Def Sanctuary site | places within the body that tumor cells can hide. Sites not easily reached by systemic chemotherapy. Ex: CNS in leukemia.
🗑
|
||||
| How does chemo work | "indiscriminately kills rapidly dividing cells". Malignant & normal cells (BM, oral mucosa, GI tract, hair folicles)
🗑
|
||||
| Goals of chemo | cure dx, control dx or palliation
🗑
|
||||
| Cell cycle: what is G 0 (gap 0)? | RESTING PHASE: cells not dividing. length extremely variable. (not "in cell cycle")
🗑
|
||||
| Cell cycle: what is G 1 (gap 1)? | Second phase. POST-MITOTIC PHASE; cells enter cell cycle. Production of enzymes needed for DNA synthesis, proteins and RNA synthesis occurs. The length 18 hours.
🗑
|
||||
| Cell cycle: what is S (synthesis) phaze? | DNA DUPLICATION PHASE in preparation for cellular division. Length 20 hours.
🗑
|
||||
| Cell cycle: what is G2 (gap 2)? | PREMITOTIC PHASE. Both protein and RNA synthesis occur and the precursors to the mitotic spindle apparatus are produced. This phase is very short.
🗑
|
||||
| Cell cycle: what is M (Mitosis) phaze? | CELL DEVISION. Four phases: Prophase: nuclear membrane breaks down chromosomes clump. Metaphase chromosomes align in middle of the cell. Anaphase chromosomes separate move to centriole. Telophase cell division two identical “daughter” cells. one hour.
🗑
|
||||
| Cell cycle: what is Prophase? | phase 1 of Mitosis: . During prophase the nuclear membrane breaks down and chromosomes clump
🗑
|
||||
| Cell cycle: what is metaphase? | Phase 2 of Mitosis: In metaphase the chromosomes align in the middle of the cell.
🗑
|
||||
| Cell cycle: what is Anaphase? | Phase 3 of Mitosis: During anaphase the chromosomes separate and move to the centriole
🗑
|
||||
| Cell cycle: what is Telophase? | Phase 4 of mitosis:Telophase results in actual cell division and the production of two identical “daughter” cells. This process takes approximately one hour.
🗑
|
||||
| Cell cycle: what is cell cycle time? Significance? | 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.
🗑
|
||||
| What is the Cell Kill Hypothesis | Sates that a percent of CA cells are killed with each cycle of chemo. ultimately only a few cells remain and the immune system destroys them. Rational for multiple cycles of chemo. Peds Ca high growth fraction so are suseptible to tx.
🗑
|
||||
| Def: Growth Fraction | % 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
🗑
|
||||
| Def: Tumor burden | # of cells in tumor - ca with small tumor burden more responsive to antienoplastic tx. - Higher cell burden -> Rx resistance
🗑
|
||||
| Def: Gompertzian function | Tumor burden growth is initially exponential but levels off as blood, O2 & nutrient supply is limits. Center of tumor becomes necrotic.
🗑
|
||||
| 6 characteristics of malignant cells | 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
🗑
|
||||
| 6 mechanisms of Rx resistance | -decreased drug uptake by cell -increased excretion out of cell -detoxification of drug by cell -increased DNA repair -alterations in structure of Rx receptor sites -decreased apoptosis
🗑
|
||||
| 3 reasons for multidrug resistance gene (MDR) | - 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)
🗑
|
||||
| 3 reasons for multidrug resistance gene (MDR) | - 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)
🗑
|
||||
| 4 principles of combination chemotherapy | - 2+ Rx have greater response (act in diff phases of cycle, vary toxicities) - each Rx has independent action - synergistic effects -decreased Rx resistance
🗑
|
||||
| 4 characterists of cell cycle specific chemo | -greatest effect on actively deviding cells -not active in G0 -best as in divided doses or as continuous infusion -cytotoxic effects occur when cell repair or devision attempted
🗑
|
||||
| 4 characteristics of cell cycle non-specific chemo | -work in any phase -active in G0 - best as bolus -cytotoxic effects when cell division attempted
🗑
|
||||
| 5 classificaitons of chemo agents | - Rx interfere with DNA (alkylating agents/ antitumor abx, antimetabloites/nitrosureas) - Rx that cause cell cycle arrest (plant alkaloids) -Rx that interfere with protein synthesis (hormonal agents) -Antiangiogenesis -Biological response modifiers
🗑
|
||||
| Major toxicities of Alkylating Agents | Hematopoiectic, GI tract (n/v), Reproductive
🗑
|
||||
| Are alkylating agents specific or non-speific? | cell cycle non-specific, most active in G0 Phase
🗑
|
||||
| MOA of alkylating agents? | -may cause DNA strand breakage or uncoiling -interfere with DNA replication, transcription & synthesis - variation in onset & duration of action
🗑
|
||||
| 7 catagories of alkylating agents | -mustartd derivatives -aziridines -hydrozines -alkyl sulfonates -triazenes -heavy metals -topisomerase I inhibitors
🗑
|
||||
| Alkylating Agents: list 3 mustard derivatives | - Cyclophosphamide/ ifosfamide -Melphalan -Mechlorethamine (nitrogen mustard)
🗑
|
||||
| Alkylating Agents: list 2 azurudubes | -Thiotepa -mitomycin
🗑
|
||||
| Alkylating Agents: list a hydrozine | Procarbazine
🗑
|
||||
| Alkylating Agents: list a Alkyl Sulfonates | Busulfan
🗑
|
||||
| Alkylating Agents: list 2 Triazenes | - Dacarbazine (DTIC) - Temozolomide
🗑
|
||||
| Alkylating Agents: list a Heavy mental | - Carboplatin/cisplatin
🗑
|
||||
| Alkylating Agents: list 2 Topisomerase I inhibitors | -Topotecan -Irinotecan
🗑
|
||||
| What cell cycle specific are antimetabolities most active in? | S phase
🗑
|
||||
| MOA of antimetabolites | 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.
🗑
|
||||
| Major toxicities of antimetabolites | - bone marrow suppression - GI tract (n/v, mucositis, injury to the liver)
🗑
|
||||
| 3 catagories of antimetabolites | - Folic Acid Antagonists - Pyrimidine Antagonists - Purine Antagonists
🗑
|
||||
| Antimetabolites: list 2 Folic Acid Antagoinists | - Methotrexate - Trimetrexate
🗑
|
||||
| Antimetabolites: list 4 Pyrimidine Antagonists | - 5 Azacytidine - 5 Flurouracil - cytosine arabinoside (Cytarabine) - Gemcitabine
🗑
|
||||
| Antimetabolites: list 4 Purine Antagonists | - 6 Mercaptopurine (6-MP) - 6 Thioguanine (6-TG) - Fazarabine - Fludarabine
🗑
|
||||
| MOA of antitumor antibiotics | 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
🗑
|
||||
| Major toxicities of antitumor antibiotics | Cardiac, BM suppression, mucositis, n/v, reproductive effects
🗑
|
||||
| 3 catagories of antitumor antibiotics | Anthracyclines, Chromomycin, Miscellaneous
🗑
|
||||
| Antitumor antibiotics: list 4 Anthracyclines | Daunorubicin, Doxorubicin, Idarubicin, Mitoxantrone
🗑
|
||||
| Antitumor antibiotics: list 1 Chromoycin | Dactinomycin
🗑
|
||||
| Antitumor antibiotics: list 2 miscellaeous | Bleomycin, Mitomycin
🗑
|
||||
| Largest category of antitumor antibiotics used in pediatric cancers | Anthracyclines (daunorubicin, doxorubicin, idarubicin, methoxantrone)
🗑
|
||||
| MOA of anthracyclines (antitumor abx) | inhibition of topoisomerase II (enzyme associated with uncoiling of DNA)
🗑
|
||||
| What causes the cardiac tissue damage associated with anthracyclines (antitumor antibiotics) | Free radical formation, involving O2 & it's conversion to hydrogen peroxide.
🗑
|
||||
| What phase of the cell cycle does Bleomycin (antitumor abx) work in | G2 & M phases.
🗑
|
||||
| What phase of the cell cycle do plant alkaloids work in | Predominatly M, some G1 & S
🗑
|
||||
| MOA of plant Alkaloids | They interfere with the development of the mitotic spindle, preventing cell replication. Cause arrest during mitosis, DNA strand breakage/ death
🗑
|
||||
| Major toxicities of plant alkaloids | Link with secondary maligant neoplasms. Neurological (peripheral neuropathies -> constipation & ambulation problems) GI (n/v/diarrhea), reproductive (amenorrhea, infertility. BM suppression minimal in standard doses.
🗑
|
||||
| 3 catagories of Plant Alkaloids | Vinca Alkaloids, Epipodophyllotoxins, Taxanes
🗑
|
||||
| Plant Alkaloids: list 2 vinca alkaloids | Vinblastine, Vincristine
🗑
|
||||
| Plant Alkaloids: list 4 Epipodophyllotoxins | Etoposide (VP-16), Teniposide (VM-26), Vindesine, Vinorelbine
🗑
|
||||
| Plant Alkaloids: list 2 Taxanes | Paclitaxel, Docetaxel
🗑
|
||||
| What part of the cell cycle do Nitrosureas work in & MOA? | Trick question!! primarily cell cycle non-specific. Interfere with DNA replication and repair.
🗑
|
||||
| Nature of relationships b/t nitrosureas & BBB | Cross BBB
🗑
|
||||
| Nature of nadir with nitrosureas | Delayed nadir (usually 30-45 days)
🗑
|
||||
| Major toxicities of nitrosureas | Liver & GI (short term n/v which can be decreased if medications are taken with antiemetic at bedtime)
🗑
|
||||
| List 2 Nitrosureas | Carmustine (BCNU), Lomustine (CCNU)
🗑
|
||||
| Miscellaneous Agents: List 2 Lipid Soluble agents | Hydroxyurea, Procarbazine
🗑
|
||||
| Miscellaneous Agents: List Enzyme agents | Asparaginase (Erwinia, Escherichia coli, Pegaspraginase)
🗑
|
||||
| Miscellaneous Agents: List 2 Retinoids | 13-cis-retinoic acid (accutane), All-tras retinoic acid (ATRA)
🗑
|
||||
| What phase of the cell cycle does hydroxyurea work in? | S phase: inhibits DNA synthesis
🗑
|
||||
| What phase of the cell cycle do Asparaginase drugs work in? | Trick question! cell cycle non-specific
🗑
|
||||
| What is the significance of hydroxurea and procarbazine being lipid soluable? | Cross the BBB
🗑
|
||||
| Special conciderations of Asparaginases? | 1) interfere with metabolic functions=> hyperglycemia 2)higher incidences of allergic reactions than other chemo's
🗑
|
||||
| Which class of miscellaneous agents are vitman A derivatives? | the retinoids: 13-cis-retinoic acid (accutane), All-tras retinoic acid (ATRA)
🗑
|
||||
| MOA of antiangiogenic agents? | prevent growth of new microvessels from capillary endothelial cells to tumor
🗑
|
||||
| List 2 antiangiogenic agents | Thalidomide, Anti-bascular endothelial growth facotr (VEGF)
🗑
|
||||
| Major toxicities of antiagiogenic agents | GI (constipation), Neurologic (peripheral neuropathy)
🗑
|
||||
| Major toxicities of Biological Response Modifiers | 1) Capillary leak syndrome 2) Flu-like syndrome: fever/chills/ bone pain 3) Dependent on agent adn dose
🗑
|
||||
| How to biologic response modifiers treat cancer (5 ways) | Direct antitumor activity: cytotoxic, antiproliferation mechanism, affect differentiation/maturarion of tumor cell, prevent metastiasis. Supportive: initate, modify, resore immune system
🗑
|
||||
| List 6 Biological Response Modifiers | Alpha interferon (a-IFN), Interleukin-2 (IL-2), Granulocyte-colony stimulating factor (G-CSF), Granulocyte-macrophage colony stimulating factor (GM-CSF), Erythropoietin (EPO), Monoclonal Antibodies.
🗑
|
||||
| Biological Response Modifiers: Clinical use of Alpha interferon (a-IFN)? | Modulate immune responses
🗑
|
||||
| Biological Response Modifiers: Clinical use of Interleukin-2 (IL-2)? | Supports growth/maturation of T-cells
🗑
|
||||
| Biological Response Modifiers: Clinical use of GCSF? | Stimulates proliferation/ differentiation of neutrophils
🗑
|
||||
| Biological Response Modifiers: Clinical use of GM-CSF? | Enhances function of granulocyte and macrophage lineages (remembering that neutrophils are granulocytes)
🗑
|
||||
| Biological Response Modifiers: Clinical use of Erythropoietin (EPO)? | Stimulates production/ differentiation of RBC's
🗑
|
||||
| Biological Response Modifiers: Clinical use of Monocolnal Antibodies? | Causes cell death through interaction with immune responses/ recognize tumor-asociated antigens
🗑
|
||||
| Hormonal Agents: list the 1 category of hormonal agents commonly used in children | corticosteroids (prednisone & Dexamethasone)
🗑
|
||||
| MOA of steroids? | directly lyse lymphoblasts (lymphoid maligancies) may indirectly effect other malignancies. Supportive care: antiemetic, potentiate anti serotonins, decrease cerebral edema.
🗑
|
||||
| Specific concerns with steriods | 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)
🗑
|
||||
| BSA formula | Square root of (ht(cm)x wt (kg)/3600)
🗑
|
||||
| Dose calculations for child <1yr or <10kg | Use KG not BSA. BSA (M2) give approx 1/3 greater amoung of drug than calculated by KG. Infants have different pharmokenitics
🗑
|
||||
| When would dose modifications be used? | 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.
🗑
|
||||
| Methods of IV administration of Chemo? | Bolus (IV push) or Infusion
🗑
|
||||
| Dose category of Chemo administration (4)? | STANDARD DOSE: SE mild. HIGH DOSE: increase dosing & SE. > supportive care(G-CSF, blood products) DOSE INTENSIFICATION (DI):higher than standard dose, shorter interval. Often to consolidate. ABLATIVE THERAPY:large dose ablate tumor & BM must have SCT
🗑
|
||||
| 7 routes of Chemo administration? | PO, IV, IV push, intraarterial (IVA), intrathecal (IT), IM, SQ
🗑
|
||||
| Def irritant Rx? | causes local inflammatory rxn along venous tract and surrounding skin.
🗑
|
||||
| IV irritant Rx: list 5 | Carmustine, Cisplatin, Dacarbazine, Docetaxel, Etoposide
🗑
|
||||
| Def Vesicant Rx? | has potential to cause tissue necrosis if drug leaks out of the vein into surrounding tissue.
🗑
|
||||
| IV vesicant Rx: list 7? | Actinomycin, Daunorubicin, Doxorubicin, Idarubicin, Mechlorethamine, Vinblastine, Vincristine
🗑
|
||||
| Def: flare reaction | SE of IV admin of chemo (Central OR PIV)inflammation, no pain, along the venous tract 2ndry to histamine. Wheals may occur, usually a blood return; and it almost always resolves in 30 minutes, or less, without treatment. Occur with any RX esp irratant.
🗑
|
||||
| Def: infiltration | 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.
🗑
|
||||
| Def: extravasation | 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.
🗑
|
||||
| Rx that causes neuro SE of mood alterations (1) | steroids
🗑
|
||||
| 2 Rx's that causes neurotoxicity SE: | Vincristine, cisplatin
🗑
|
||||
| 2 Rx's that causes neuro SE of Ototoxicity: | Cisplatin, carboplatin
🗑
|
||||
| 3 Rx's that cause Cardiomyopathy: | Dauorubicin/doxorubicin, Cyclophosphamide (high dose)
🗑
|
||||
| 3 Rx's that cause pulmonary fibrosis: | Bleomycin, mitomycin, carmustine
🗑
|
||||
| 2 Rx's that have infertility as SE: | Mustard, Cyclophosphmide
🗑
|
||||
| 7 Teratogenic Rx/ Rx classes: | Retinoids, thalidomide, antimetabolites, alkylating agents, vinca alkaloids, topoisomerase II inhibitors
🗑
|
||||
| Classes of Rx's that do not cause Alopecia | steroids, retinoids, antiangiogenics (nearly every other chemo does)
🗑
|
||||
| 2 Rx with SE of Acne | Steroids, actinomycin
🗑
|
||||
| one drug know to cause rash | Cytosine arabinoside
🗑
|
||||
| Specific SE associated with specific Rx: (INTEGUMENTARY)Striae (1) | Steroids
🗑
|
||||
| Specific SE associated with specific Rx: (INTEGUMENTARY)photosensitivity (2) | methotrexate, retinoids
🗑
|
||||
| Specific SE associated with specific Rx: (INTEGUMENTARY)Radiomimetic (3) | Actinomycin, daunorubicin, doxorubicin
🗑
|
||||
| Specific SE associated with specific Rx: (INTEGUMENTARY)hyperpigmentation (2) | Bleomycin, busulfan
🗑
|
||||
| Specific SE associated with specific Rx: (INTEGUMENTARY)Extravasation by vesicants (8) | Actinomycin, daunorubicin, doxorubicin, mechlorethamine, mitomycin, vinblastine, vincristine, vinorelbine
🗑
|
||||
| Specific SE associated with specific Rx: (GI)N/V, Dose related anorexia | Many Rx esp cisplatins, cytosine arabinoside, cyclophosphamides, anthracyclines
🗑
|
||||
| Specific SE associated with specific Rx: (GI) Diarrhea (2) | Irinotecan, cisplatin
🗑
|
||||
| Specific SE associated with specific Rx: (GI)Constipation (2) | Vincristine, thalidomide
🗑
|
||||
| Specific SE associated with specific Rx: (GI)Mucositis (3) | Methotrexate, daunorubicin, doxorubicin
🗑
|
||||
| Specific SE associated with specific Rx: (GI)Hepatoxicity (4) | 6-MP, 6-TG, VP-16, cytosine arabinoside
🗑
|
||||
| Specific SE associated with specific Rx: (GI)pancreatitis (2) | Asparaginase, steroids
🗑
|
||||
| Specific SE associated with specific Rx: (GU)Hemorrhagic cystitis (2) | Cyclophosphamide, Ifosfamide
🗑
|
||||
| Specific SE associated with specific Rx: (GU)Renal (2) | Cisplatin, carboplatin
🗑
|
||||
| Specific SE associated with specific Rx: (Hypersensitivity)Anaphylaxis (1) | Asparaginase
🗑
|
||||
| Specific SE associated with specific Rx: (Hypersensitivity) Allergic Rxn (3) | Carboplatin, Etoposide, Belomycin
🗑
|
||||
| Specific SE associated with specific Rx: (Hypersensitivity)Hypotension (1) | Etoposide
🗑
|
||||
| 3 catagories of suppotive care meds | 1) protect from specific SE (eg leucovorin, mesna) 2) halt/minimize immediate SE (eg antiemetics) 3) assist in recovery (eg growth factors)
🗑
|
||||
| Busulfan/ myleran: class of RX & Route | Class: Alkylating agent. Subclass: alkyl sulfonates. PO/ IT in clinical trials
🗑
|
||||
| Busulfan/ myleran: SE (9) | N/V, anorexia (@ high dose), BM suppression, Alopecia, hyperpigmentation, hyperuricemia, seizures, gynecomastia, sperm/ovarian faliure
🗑
|
||||
| Busulfan/ myleran: Nursing implications | Seizure precautions
🗑
|
||||
| Busulfan/ myleran: main use | prep for HCT
🗑
|
||||
| Carboplatin/ paraplatin: class of RX & Route | Class: Alkylating agent. Sub class: heavy metal. IV
🗑
|
||||
| Carboplatin/ paraplatin: SE (7) | N&V (mild) Bone marrow suppression (severe) Renal/hepatotoxic (rare) Hypersensitivity Ototoxic Hypomagnesaemia
🗑
|
||||
| Carboplatin/ paraplatin: nursing implications | Bone marrow suppression Monitor hearing, renal, & liver function Other than bone marrow suppression, side effects milder than cisplatin
🗑
|
||||
| Cisplatin/ platinol: class of Rx & route | Class: Alkylating agent. Subclass: heavy metal. IV
🗑
|
||||
| Cisplatin/ platinol: SE (7) | N&V/anorexia (severe) Bone marrow suppression (mild) Renal/hepatotoxic (severe) Hypersensitivity (rare) Ototoxic (severe) Hypomagnesaemia Neurotoxic/peripheral neuropathies
🗑
|
||||
| Cisplatin/ platinol: Nursing implications | Rigorous hydration/I&0 Long term need for antiemetics Monitor hearing/renal function
🗑
|
||||
| Cyclophosphamide/ cytoxan: Class of Rx & route | Class: Alkylating agent. Subclass: mustard derivative. IV/PO
🗑
|
||||
| Cyclophosphamide/ cytoxan: SE (6) | N&V/anorexia Bone marrow suppression Alopecia Hemorrhagic cystitis Cardiomyopathy (high dose) Infertility
🗑
|
||||
| Cyclophosphamide/ cytoxan: Nursing implications | Give with MESNA (high dose) Hyperhydration/I&0
🗑
|
||||
| Dacarbazine (DTIC): Class of Rx & route | Class: Alkylating agent. Subclass: Triazene. IV (irritant)
🗑
|
||||
| Dacarbazine (DTIC): SE (7) | N&V/severe up to 12 hours Anorexia Fever/flu-like syndrome (up to 7 days) Bone marrow suppression (nadir 2-3 wks) Alopecia/rash/photosensitivity Hypotension/hypersensitivity Hepatic dysfunction
🗑
|
||||
| Dacarbazine (DTIC): Nursing implications | Severe pain along vein if in peripheral IV Protect solution from light
🗑
|
||||
| Ifosfamide: Class of Rx & route | Class: Alkylating agent. Subclass: mustard derivatives. IV
🗑
|
||||
| Ifosfamide: SE (7) | N&V/anorexia Diarrhea Bone marrow suppression Alopecia Hemorrhagic cystitis Encephalopathy/peripheral neuropathy Fanconi’s syndrome
🗑
|
||||
| Ifosfamide: Nursing Implications | Give with MESNA Hyperhydration/I&0
🗑
|
||||
| Irinotecan/ camptosar: Class & route | Class: Alkylating agent. Subclass: Topisomerase II inhibitors. IV
🗑
|
||||
| Irinotecan/ comptosar: SE (3) | Diarrhea (usually cholinergic) Bone marrow suppression Alopecia
🗑
|
||||
| Irinotecan/ comptosar: Nursing Implications | 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
🗑
|
||||
| Temazolamide: class & route | Class: Alkylating agent. Subclass: Triazene. PO
🗑
|
||||
| Temazolamide: SE | N&V Bone marrow suppression Hepatotoxicity Allergy/anaphylaxis (uncommon) Second malignant neoplasms
🗑
|
||||
| Temazolamide: Nursing Implications | teach to take at bedtime to decrease N/V
🗑
|
||||
| Thiotepa: Class & route | Class: Alkylating agent, Subclass: Aziridines IV, IT in trials
🗑
|
||||
| Thiotepa: SE | N&V Bone marrow suppression Rash/skin burn Fever Pain at infusion site if peripheral Testicular/ovarian failure
🗑
|
||||
| Thiotepa: Nursing implications | Often used with hematopoietic stem cell support Closely monitor renal function
🗑
|
||||
| Topotecan: Class & Route | Class: Alkylating agent. Subclass: Topisomerase II inhibitor, IV
🗑
|
||||
| Topotecan: SE (5) | Diarrhea Bone marrow suppression Alopecia Renal toxic
🗑
|
||||
| Topotecan: Nursing Implications | Monitor for diarrhea Dilute with either 0.9% normal saline or D5W
🗑
|
||||
| Cytosine arabinoside (ARA-C, cytarabine): Class & Route | Class: Antimetabolite. Subclass: ? IV/SQ/IM/IT
🗑
|
||||
| Cytosine arabinoside (ARA-C, cytarabine): SE (6) | N/V/anorexia, Diarrhea, BM suppression, mucositits, Rash (esp hands), Flu-like syndrome/fever, conjunctivitis (high dose)
🗑
|
||||
| Cytosine arabinoside (ARA-C, cytarabine): Nursing implications | Dexametasone eye drops for high dose. N/V directly related to high dose.
🗑
|
||||
| Fludarabine: Class & Route | Class: Antimetabolite. Subclass: purine antagonist. IV
🗑
|
||||
| Fludarabine: SE | N/V/D, BM suppression, Mucositis, fatigue/ muscle aches, rash, neurotoxicity/ pulmonary toxicity
🗑
|
||||
| Fludarabline: nursing implicatons | Monitor pulmonary function
🗑
|
||||
| Gemcitabine: Class & Route | Class: Antimetabolite Subclass: pyrimidine antagonist IV
🗑
|
||||
| Gemcitabine: SE | N/V, BM suppression (especially anemia), Rash, Fever/flu-like symptoms
🗑
|
||||
| Gemcitabine: nursing implications | Infuse with NS, generally given over 30min, BM suppression is dose limiting
🗑
|
||||
| Mercaptopurine (6-MP): Class & Route | Class: Antimetabolite. Subclass: purine antagonist. PO/IV
🗑
|
||||
| Mercaptopurine (6-MP): SE | BM suppression, mucositis (rare), Rash, Hepatotoxic, Mild nausea
🗑
|
||||
| Mercaptopurine (6-MP): Nursing Implications | Monitor liver function, Teach: take at bedtime on empty stomach to increase absorption. May need decreased dose if on allopurinol
🗑
|
||||
| Methotrexate (MTX): Class & Route | Class: Antimetabolite. Subclass:Folic acid antagonist. PO/IV/IT/IM
🗑
|
||||
| Methotrexate (MTX): SE | BM suppression, Mucositis/ GI ulceration, Rash/photosensitivity, Hepatic/renal toxic, Nausea (dose related)
🗑
|
||||
| Methotrexate (MTX): nursing implications | Monitor liver function, Teach: PO at bedtime on empty stomach, avoid folic acid supplements. High dose needs aggressive hydration, urine alkalinization & leucovorin/ monitor levels
🗑
|
||||
| Thiguanine (6-TG): Class & Route | Class: Antimetabolite. Subclass: Purine antagonist. PO
🗑
|
||||
| Thiguanine (6-TG): SE | BM suppression, Mild nausea, mucositis (rare) Hepatotoxic
🗑
|
||||
| Thiguanine (6-TG): Nursing Implications | Monitor liver function, Teach: take at bedtime on empty stomach
🗑
|
||||
| Daunorbubicin, Doxorubicin: class & route | Class: Antitumor abx. Subclass: anthracyclines (vesicant)
🗑
|
||||
| Daunorbubicin, Doxorubicin: SE | Alopecian, N/V, BM suppression, mucositis, cardiomyopathy, Radiomimetic
🗑
|
||||
| Daunorbubicin, Doxorubicin: Nursing implications | Teach: red/orange urine Monitor: ECHO, photosensitivity. Cumulative max dose (450-550mg/M2)
🗑
|
||||
| Idarubicin: class & route | Class:antitumor abx. Subclass: anthracycline. (vesicant) IV
🗑
|
||||
| Idarubicin: SE | Alopecia, N/V, BM suppression, Mucositis, Cardiomyopathy (less common)
🗑
|
||||
| Idarubicin: nursing implications | Teach: red/orange urine Monitor: ECHO, photosensitivity.
🗑
|
||||
| Bleomycin: Class & route | Class: Antitumor abx. Subclass: miscellaneous IV
🗑
|
||||
| Bleomycin: SE | Fever/chills, Hyperpigmentation/ peeling of skin (palms), Hypersensitivity (rare), Renal/hepatic toxicity, pulmonary fibrosis
🗑
|
||||
| Bleomycin: Nursing implications | test dose prior to first dose. Monitor PFT. Cumulative max dose (400 Units)
🗑
|
||||
| Dactinomycin (Actinomycin-D, AMD): Class & route | Class:antitumor abx. Subclass: chromomycin (vesicant) IV
🗑
|
||||
| Dactinomycin (Actinomycin-D, AMD): SE | Bone marrow suppression N/V Photosensitivity/radiomimetic Acne Mucositis
🗑
|
||||
| Dactinomycin (Actinomycin-D, AMD): nursing implications | Teach: skin care, Dose often ordered in mcg not mg
🗑
|
||||
| Alpha interferon (a-IFN): Class & Route | Biologic agent, SQ/IM/IV/ Intracavitary
🗑
|
||||
| Alpha interferon (a-IFN): SE | Flu-like syndrome Fatigue Neurologic Anorexia/weight loss Pruritis Neutropenia/thrombocytopenia
🗑
|
||||
| Alpha interferon (a-IFN): Nursing implications | Chills usually occur 3-6 hours following administration Fevers to 400 C may occur and last 24 hours
🗑
|
||||
| Erythropoientin (EPO): Class & route | Biologic agent, IV, SQ
🗑
|
||||
| Erythropoientin (EPO): SE | HTN, Diarrhea
🗑
|
||||
| Erythropoientin (EPO): Nursing implications | Teach re: injection techniques Monitor BP Safety and efficacy have not been established in pediatrics
🗑
|
||||
| Interleukin-2 (IL-2): Class & Route | Biologic agent, SQ, IVq
🗑
|
||||
| Interleukin-2 (IL-2): SE | Capillary leak syndrome Flu-like syndrome/fevers CNS changes N&V, anorexia Skin changes
🗑
|
||||
| Interleukin-2 (IL-2): Nursing Implication | Premedicate with acetaminophen Monitor BP Skin care
🗑
|
||||
| Granulocyte colony stimulating factor (G-CSF): Class & route | biologic agent, SQ, IV
🗑
|
||||
| Granulocyte colony stimulating factor (G-CSF):SE | Bone pain, fever
🗑
|
||||
| Granulocyte colony stimulating factor (G-CSF):nursing implications | Teach re: injection techniques, and the development of bone pain as counts recover (more common in adolescents) May require analgesia Monitor WBC/ANC
🗑
|
||||
| Granulocyte-macrophage colony stimulating factor (GM-CSF): Class & route | biologic agent
🗑
|
||||
| Granulocyte-macrophage colony stimulating factor (GM-CSF): SE | Bone pain Local skin reaction Flu-like syndrome Third spacing at high dose
🗑
|
||||
| Granulocyte-macrophage colony stimulating factor (GM-CSF): Nursing implications | Teach re: injection techniques and potential for bone pain as counts recover (more common in adolescents) Treat bone pain with acetaminophen Monitor WBC/ANC
🗑
|
||||
| Monoclonal Antibodies: Class & route | Biologic agent, IV
🗑
|
||||
| Monoclonal Antibodies: SE | Potential allergic reactions Flu-like syndrome Fever Achiness
🗑
|
||||
| Monoclonal Antibodies: Nursing Implications | Keep emergency drugs/dosages available Monitor VS frequently during first hour of infusion
🗑
|
||||
| Glucorticoids (prednisone, hydrocortisone, dexamethasone): Class & Route | Hormone, IV/PO
🗑
|
||||
| Glucorticoids (prednisone, hydrocortisone, dexamethasone): SE | Sodium/fluid retention Excessive appetite/food cravings/weight gain Hyperglycemia/GI irritation Cushingoid appearance/acne/striae Cataracts/glaucoma Osteoporsis/avascular necrosis (AVN) Mood alteration/nightmares Restless sleep/night sweats
🗑
|
||||
| Glucorticoids (prednisone, hydrocortisone, dexamethasone): nursing implications | Teach re: increased risk of infection/GI protection, diet Taper dose if on greater than 3-4 weeks Perineal burning with rapid IV infusion
🗑
|
||||
| Carmustine (BCNU): class & route | Class: Nitrosoureas, IV, irritant
🗑
|
||||
| Carmustine (BCNU): SE | N&V Bone marrow suppression Renal/hepatic toxicity Pulmonary fibrosis Ovarian/sperm suppression
🗑
|
||||
| Carmustine (BCNU): nursing implications | Crosses the blood-brain barrier Delayed nadir (4-6 weeks) Cough & dyspnea initial symptoms of respiratory failure
🗑
|
||||
| Lomustine (CCNU): class & route | Class: nitrosoureas, PO
🗑
|
||||
| Lomustine (CCNU):SE | N&V Bone marrow suppression (severe) Renal/hepatic toxicity Mucositis Alopecia
🗑
|
||||
| Lomustine (CCNU): nursing implications | crosses BBB, delayed nadir (4-6 weeks)
🗑
|
||||
| Etoposide (VP-16): class and route | Class: Plant alkaloid. Subclass: Epipodophyllotoxins. (Irritant) IV, PO
🗑
|
||||
| Etoposide (VP-16):SE | Mild N&V Bone marrow suppression Alopecia Hypotension/hypersensitivity Liver toxicity
🗑
|
||||
| Etoposide (VP-16):Nursing implications | Precipitates easily Monitor for hypotension/hypersensitivity
🗑
|
||||
| Vinblastine: class & route | Class: Plant alkaloid. Subclass: vinca alkolodis. (vesicant) IVP
🗑
|
||||
| Vinblastine: SE | Alopecia Bone marrow suppression (mild) Peripheral neuropathy/foot drop (uncommon) Constipation/ileus Jaw pain Hepatotoxic
🗑
|
||||
| Vinblastine: Nursing implications | Teach re: need for stool softeners, high fiber diet/fluids May need pain medication Neurotoxicities are cumulative
🗑
|
||||
| Vinorelbine (Navelbine): class & Route | Class: Plant alkaloid. Sub class: epipodophyllotoxins.(vesicant) IV
🗑
|
||||
| Vinorelbine (navelbine): SE | N&V Bone marrow suppression Neurotoxic/peripheral neuropathies
🗑
|
||||
| Vinorelbine (navelbine): nursing implications | Given over 4-6 minutes as an IVP Observe for neurotoxicities
🗑
|
||||
| Arsenic: Class & route | Miscellaneous IV
🗑
|
||||
| Arsenic: SE | Electrolyte imbalances Electrolyte imbalances Headache Rash/pruritis Cough/dyspnea N&V/anorexia
🗑
|
||||
| Arsenic: Nursing implications | Concurrent use with antifungal, antihistamine, diuretic, and tricyclic antidepressant drugs can lead to life-threatening cardiac arrhythmias
🗑
|
||||
| Asparaginase (e-coli, erwinia, PEG): class & route | Miscellaneous, IMq
🗑
|
||||
| Asparaginase (e-coli, erwinia, PEG): SE | Skin reaction at injection site Systemic allergic reaction (may be delayed with PEG) Hyperglycemia Pancreatitis Coagulapathies
🗑
|
||||
| Asparaginase (e-coli, erwinia, PEG): (3) | Monitor urine/serum glucose, Observe for 1 hour for allergic reaction, Teach patient that allergic reaction can be delayed especially with PEG.
🗑
|
||||
| Hydroxyurea: class & route | Class: miscellaneous. Subclass: lipid soluable. PO
🗑
|
||||
| Hydroxyurea: SE (5) | Bone marrow suppression (primarily leukopenia, N&V, Skin rashes, Exacerbate mucous membrane inflammation in radiation field, Dysuria.
🗑
|
||||
| Hydroxyurea: nursing implications (2) | Teach: Take at bed time to decreased N&V. Overall well tolerated with mild sedation.
🗑
|
||||
| Gleevac: Class & route | Class: miscellaneous (targeted therapy) PO
🗑
|
||||
| Gleevac: SE (5) | Edema/fluid retention, N&V, Neutropenia, thrombocytopenia, Hepatotoxicity.
🗑
|
||||
| Gleevac: Nursing implications (3) | Teach: Take at bed time to decrease N&V. Observe for signs of fluid retention. Metabolism may be altered in patient is on some antifungal, antibiotics, or steroids.
🗑
|
||||
| Retinoids: Class & route | Route: PO Class: Miscellaneous. Subclass: retinoids. Rx: All-trans retinoic acid (ATRA®),13-cis-retinoic acid (Accutane®)
🗑
|
||||
| Retinoids: SE (4) | Teratogenic, Dry skin/photosensitivity, Conjunctivitis, Headache/pseudotumor cerebri
🗑
|
||||
| Retinoids: Nursing Implications (2) | Teach: Take with food for better absorption. Monitor pregnancy tests on post menarchal females
🗑
|
||||
| Amifostine: class & route | Protective agent, IV
🗑
|
||||
| Amifostine: SE (5) | Hypotension, Rash, Hepatic toxicity, Bad taste in mouth, N&V,
🗑
|
||||
| Amifostine: nursing implications (4) | Administer IV bolus dose over 15 minutes. Pretreat with antiemetics. Begin chemotherapy or radiation 15 minutes AFTER amifostine infusion completed. Patient should be well hydrated prior to infusion.
🗑
|
||||
| Mesna: class & route | Protective agent, IV/ PO
🗑
|
||||
| Mesna: SE (5) | Hypotension, Rash, Hepatic toxicity, renal toxicity, Bad taste in mouth,
🗑
|
||||
| Mesna: Nursing implications (4) | 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.
🗑
|
||||
| Leucovorin: class & route | Protective agent, IV/PO
🗑
|
||||
| Leucovorin: SE | Rash, pruritus, erythema
🗑
|
||||
| Leucovorin: nursing implication (3) | Timing of doses crucial, IV solution should be diluted to 10 mg/ml, Do not infuse IV at > 160 mg/minute
🗑
|
||||
| Zinecard: Class & Route | Protective agent/unclassified chemotherapeutic agent. IV.
🗑
|
||||
| Zinecard: SE (5) | Alopecia, Mild N&V, Low grade fever, Myelosuppression, Hepatotoxic
🗑
|
||||
| Zinecard: nursing implications (1) | Timing of doses crucial, Anthracyclines should be given within 30 minutes of start of Zinecard
🗑
|
||||
| What does zinecard do? | protects heart from doxorubicin
🗑
|
||||
| What does mesna do? | 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.
🗑
|
||||
| What does amifostine do? | reduce neutropenia-related fever and infection induced by DNA-binding chemo. alkylating agents (e.g. cyclophosphamide) and platinum-containing agents (e.g. cisplatin). It is also used to decrease the cumulative nephrotoxicity with platinum-containing rx.
🗑
|
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.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
jjenlouu
Popular Nursing sets