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wvc cancer lecture
wvc cancer lecture l visser summer 2011
| Question | Answer |
|---|---|
| Screening (secondary prevention) | Annual mammography, women > 40 ; Annual clinical breast exam, women > 40; Colonoscopy age 50 & then every 10 yrs; Annual fecal occult blood, adults, all ages; Annual prostate specific antigen (PSA) & digital rectal exam, men > 50 yrs |
| Growth: Mitosis occurs to develop normal tissue, or to replace lost or damaged normal tissue. A balance is maintained between cell birth and cell death; Oncogenes & tumor suppressor genes regulate this process; | Oncogenes were the genes that directed early embryonic development. At 8 days after conception, these genes should be turned off forever by “suppressor genes.” When normal cells are exposed to any carcinogen, the normal cell’s |
| 5 phases of cell growth ( 12-24 hrs) | ggsg, (good, girls, skip, grand, marna) G0- resting > G1 phase- RNA synthesis> S phase- DNA synthesis > G2 RNA & protein synthesized > M phase Mitosis cell divides (takes 1hr) (radiation effects G2 and M phase) |
| Suppressor genes turn off oncogenes after ____ days | 8 days |
| Oncogenes & proto-oncogens - | Mutations damage suppressor genes, preventing them from controlling expression of proto-oncogenes… result, is that proto-oncogens are turned on. They are then called oncogenes & can cause cell to change from normal cells to cancer cells. |
| Oncogenes Become a Problem | oncogenes are not abnormal genes but are part of every cell’s normal makeup & were important in development. Oncogenes become a problem if they are activated after development is complete, d/t exposure to carcinogenic agents or events. |
| Malignant vs Benign Tumors -Shape: Irregular vs regular; structure: Atypical vs Typical;Growth rate: Malignant may be rapid vs usually slow; Mode of Growth: Malignant infiltrates surrounding tissue vs expansion; Progression: Progressive vs stationary | Microscopic: Cells are atypical varying degrees of origin; Tissue Destruction: Commonly causes necrosis. Vascularity: Moderate to marked vs slight. Recurrence after surgical removal: Common vs rare; Spread: Frequently spreads from distant tumors. |
| Diagnosis of Malignancy | histology using: Biopsy; Brush (pap); Shave (skin); Punch (skin); Needle aspiration (skin/csf/ pleural space) ; Incisional (taking out a piece); Excisional (taking the whole) ; Sentinel lymph node; Bone marrow biopsy; Bone Marrow Aspiration Biopsy |
| Secondary prevention | screening |
| Sites of mets for BREAST CANCER | Bone*; Lung*; Liver; Brain |
| Sites of mets for LUNG CANCER | Brain*; Bone; Liver; Lymph nodes; Pancreas |
| Sites of mets for COLORECTAL CANCER | Liver*; Lymph nodes; Adjacent structures; |
| Sites of mets for PROSTATE CANCER | Bone (especially spine and legs)*; Pelvic nodes |
| Sites of mets for MELANOMA | GI tract; Lymph nodes; Lung; Brain |
| Sites of mets for PRIMARY BRAIN CANCER | Central nervous system |
| Metastasis | Defined as the spreading of cancer cells from the primary site to other parts of the body. Most frequent sites of mets are: 1) Bone, 2) Lung, 3) Brain, 4) Liver. |
| Mets can occur via: | 1) Extension into surrounding tissues; 2) Blood vessel penetration by enzymes. 3) Release of tumor cells. 4) Invasion of tissues @ remote sites. |
| Three routes for spread for metastasis: | Local seeding (shedding cells from ovary into peri cavity).2 Bloodborne mets in capillaries. Most common (capillary wall damaged, allowing cancer cells to enter surrounding tissue).3. Lymphatic spread (ex breast cancer)(systemic dis. b/c involves lymph. |
| Neoplastic cells originate from _____cells. | normal |
| Transformation of a normal cell into a cancer cell involves mutation of the _____of the normal cell. | DNA |
| Only ___ cell has to undergo malignant transformation for cancer to begin. | one |
| Benign tumors grow by _____________. | expansion |
| Malignant tumors grow by __________. | invasion |
| Cancer cells have a life span that is ____. | infinite |
| An example of primary prevention of cancer is ________. | HPV vaccine/ sunblock/ avoidance |
| An example of secondary prevention of cancer is ________. | screening for early detection |
| The original tumor is called the ________. | primary tumor |
| In metastasis, cancer cells move from the primary location by breaking off from the original group & establishing remote colonies. These additional tumors are called ____________ or ___________ ______. | metastatic or secondary tumors (Even though the tumor is now in another organ, it is still a ca from the original altered tissue. ) |
| 78-80% of ca in North America may be the result of | environmental, or external factors. Chemical, physical, or viral agents = environmental carcinogens. |
| Co-carcinogens | when two substances together form a greater cancer risk…example tobacco& alcohol |
| Physical Carcinogenesis | Even small doses; Two types: Ionizing & ultraviolet (UV); Examples of “ radiation”: radon, uranium, radium, X-Rays. UV comes from sun; tanning beds, germicidal light; Most common ca type caused by UV exposure = skin ca. |
| Tobacco initiates and promotes? | caner |
| Cancer Types Associated with Tobacco Use | Lung; Oral cavity; Pharyngeal; Laryngeal; Esophagus; Pancreatic; Cervical; Kidney; Bladder; Liver; Stomach; Myeloid leukemia |
| Viral Carcinogenesis | Break DNA chain, inserting own genetic material into human DNA chain. Called oncoviruses. |
| Dietary Factors r/t Cancer Development (Rarely independent of other possible carcinogenic agents) | Suspected connections: Low fiber intake High red meat intake; Preservatives; High animal fat intake; Contaminants & Additives. |
| Grading | (Grading always compares the cancer cell w/ the normal parent tissue) (Some cancer cells are aggressive & spread rapidly (“high-grade” cancers); cellular aspects of the cancer, growth pattern of the cell |
| Differentiated | a cell that is well differentiated it looks like the parent cell. |
| Gx- | Grade cannot be determined |
| G1- | Cells well differentiated; closely resemble parent cells; Considered low grade of malignant change; Malignant but relatively slow growing |
| G2- | Cells moderately differentiated; retain some characteristics of parent cells; More malignant characteristics than G1 cells |
| G3- | Cells poorly differentiated; parent tissue can be determined; Cells have few normal cell characteristics |
| G4- | Cells poorly differentiated; retain no normal cell characteristics; Difficult to figure out tissue of origin, sometimes impossible |
| Staging | Determines exact location of cancer & degree of metastasis at diagnosis. |
| Clinical staging – | assesses client’s clinical manifestations & evaluates clinical signs for tumor sz & possible spread. Obtaining ca cells for biopsy (no major surg) |
| Surgical staging – | assesses tumor size, number, sites & spread by inspection at surgery. |
| Pathologic staging – | pathologic examination of tissues obtained at surgery determine tumor size, number, sites & spread |
| TNM Staging System | Tumor (Extent of Primary Tumor (T)) , Node (Presence or absence & extent of regional lymph node involvement (N) , Metastasis (Presence or absence of distant metastasis (M)) |
| (Extent of Primary Tumor (T)) | Tx – unknown; To- no tumor present; Tis tumor in situ (not mets at site) T1, T2, T3, T4 (size of tumor) |
| Presence or absence & extent of regional lymph node involvement (N) | Nx unknown; N 0- no tumor present; N1, N2, N3 (number of nodes involved) |
| Presence or absence of distant metastasis (M) | Mx unknown; Mo- no evidence of distance mets; M1-evidence of distance mets |
| Tumor Markers (rapidly increasing can indicate the course of the cancer) | specialized blood tests detect markers; markers are proteins & hormones produced by certain tumors. As tumor ^ in size, marker levels ^.Ex: prostates-specific antigen, PSA which ^ proportionately to total mass of prostate gland. Normal is < 4 ng/mL. |
| Treatments for Cancer: Surgery | debulking; radiation shrinks most of tumor & then removes most of tumor….excision- removes tumor… 2nd look tumor is removed then they go back in to see If the tumor is still growing or not. |
| Labs with cancer | cbc can tell if pt. has anemia this gives a base line |
| Radiation treatment Side effects/: | local hair loss, n&v, fatigue, low blood count; desquamation, mucositis; radiation burns; long term effects- fatigue, scaring of the blood vessels, area must be treated gently for life, additional cancers later in life (2ndary cancer); sterility |
| Acute side effects | up to 6 months |
| Chronic side effects | can last more than 6 months up to years |
| Radiation Specific Nursing Care | risk vs benefit; manage the symptoms; |
| Radiation LONG TERM ISSUES | Disruption of all cells (it is unpredictable which cells get radiated non cancerous cells vs cancerous cells); other structures become damaged in radiation therapy. For example bone marrow can get zapped or bone can be weakened or colon becomes scarred. |
| Exposure | the amount that is delivered to tissue |
| Radiation dose | The amount that is absorbed |
| Teletherapy (radiation source is external to patient) Patient education: | Area will be marked; Important to follow regimen; Expect irritation & hair loss at site; skin care(gentle washing); FATIGUE (enormous energy to repair damaged tissue); Change in taste sensation (release of metabolites from dead & dying cells); Avoid SUN |
| Brachytherapy | Radiation therapy is within the patient; Unsealed: IV or oral, peritoneal, spinal. Not confined to one body area, but have an affinity for one type of tissue. Sealed: Implanted within or near the tumor. Pt. emits radition |
| Chemotherapy | Anti-neoplastics; Anti-angiogenics; Biological Response Modifiers (Immunotherapy); Hormone Therapy; Monoclonal antibiotics |
| Monoclonal antibiotics | attack the cancer cells and make it ineffective |
| Hormone Therapy | compete for the receptor sites;It is most often used to help reduce the risk of the cancer coming back after surgery, but it may also be used for breast cancer that has spread or come back after treatment. ex. blocking estrogen in breast cancer |
| General Notes about Chemotherapy | Smaller the tumor burden-easier to treat the patient. More effective after debulking; More effective at high doses; Plural therapy is the norm |
| Nadir | the lowest point, such as the blood count after it has been depressed by chemotherapy. (Leukopenia can lead to infection & death) What is the patient at risk for???? Immunosuppression….How will you know the patient’s risk? |
| Absolute Neutrophil Count (ANC) | WBCs x (% neutrophils + bands) Example: If WBCs are 1000; neutrophils are 25% & Bands are 2 %=27>>>>1000 x .27 = 270 (very low ANC) …low ANC can also limit the chemotherapy given. (Segs=neutrophil) WBC=10000 Segs= 25% Bands=2% ANC= 2700 (normal ANC) |
| Top 4 cancers diagnosis in men | prostate; lung & bronchus; colon & rectal; urinary bladder |
| Top 4 cancers diagnosis in women | breast; lung & bronchus; colon & rectal; uterine |
| ANC < 2000 = | Neutropenia; Slight risk of infection |
| ANC 1000-1500 = | Mild Neutopenia; Minimal risk of infection |
| ANC 500-1000 = | Moderate Neutropenia; Moderate risk of infection |
| ANC <500 = | Severe Neutropenia; Severe risk of infection risk of infection |
| Thrombocytopenia low platelet count (150,000-450,000 normal) | (less than 20,000 spontaneous bleeding) (less than 50,000 can cause uncontrolled bleeding) avoid IM injection, venapuncture hold for 10 min; avoid asprin; check all emesis and stool for blood. Nuemega stimulates bone marrow to produce platelets |
| Myelosuppression | Decreased bone marrow activity that leads to lower blood cell counts (including red blood cells, white blood cells, and platelets). In turn, myelosuppression can result in anemia, increased risk of infection, or bleeding tendencies. |
| Extravasation | Movement of the IV needle so the drug leaks into the surrounding tissues. Major complication b/c many chemotherapy agents are vesicants. Many chemotherapy agents are irritants. |
| Vesicant | a drug capable of causing tissue necrosis when extravasated. |
| Caution- | c-Changes in bowel or bladder; a-a sore that does not heal; u-unusual healing; t-thickening or lump in breast; i-indigestion; o-obvious change in wart or mole; n-nagging cough |
| Documentation of Extravasation | (page 424) note date and time, stop infusion, what was infused and how much, estimate amount of fluid extravasated, needle type & size, what did pt. tell you, what did you see & do, administer the antidote, chart the response |
| Patient Education Prior to Chemo-Therapy… Importance of contraceptive use; Importance of adequate nutritional intake—monitor weight; Importance of adequate fluid intake; Importance of oral care; Energy conservation measures; Community support groups; | Avoid alcohol (increases risk of toxicity); Avoid aspirin (increases risk of bleeding; Importance of infection prevention |
| Measures to Reduce Risk of Infection in chemotherapy patients…Hand washing; Up to date on immunizations before beginning therapy; Avoid large crowds or those you know are ill; Reducing Infection Risk; Wear gloves when gardening/working outside; | Wash all fruits & veggies; cook thoroughly; dental work complete; no raw meats or unpasteurized foods; KEEP ALL LAB APPOINTMENTS!!!!! Know your Nadir is for their drug |
| Anti-Neoplastics | Can be administered through many different routes. CELL CYCLE SPECIFIC (when the cells are dividing) & CELL CYCLE NON-SPECIFIC (effects cells in the cells (G zero) phase) |
| Anti-neoplastics class overview | Alkylating agents; Anti-metabolites Mitotic Inhibitors; Cytoxic Antibiotics; Topoisomerase Inhibitors (each have a different method for kill cancer cells) |
| Hormones as cancer treatment | Compete for receptor sites; These are NOT A CURE but they do slow growth of tumors; Androgens and anti-estrogen receptors; Estrogens and anti-androgen receptors |
| Anti-Neoplastics pre-Administration Protocol… Weigh pt; Calculate BSA & double check dose ordered (Nurse to Nurse); Check pt’s recent lab work (anemia?, anc)?; Hx of patient’s response to last round of chemo (concerns: N&V&D, fatigue,anorexia, pain ); | Patient assessment; Clarify with physician any concerns-dose/labs prior to mixing; Premedicate for nausea, anxiety, diuresis if indicated for treatment; Check IV site; assess cardiac, renal, respitory, gi, gu |
| Preparing Anti-Neoplastic Medications Have all pre administration work completed; Personal protective equipment; Laminar hood; Do not do this when rushed!!!; | When you are done, and med is drawn up—double check with another nurse AGAIN; Know any particular extravasation procedure for the drug you are giving and have it & order on hand! |
| Administering Anti-Neoplastics | Make sure that patient is comfortable and premedicated ; Once more, check IV placement; Begin infusion slowly at first and watch patient closely for any side effects; Check patient at regular intervals..assess before during and after |
| Cytokines- (Biological Response Modifiers) | Stimulate the immune response & bone marrow recovery |
| Interleukins (Biological Response Modifiers) | Help to recognize and destroy abnormal body cells (melanoma!)side effects are an inflammatory response MUCH LIKE FLU SYMPTOMS |
| Interferons-(Biological Response Modifiers) | Protect the non infected cells from viral infection and replication |
| Colony stimulating factors (Biological Response Modifiers) | Support cancer therapy & hasten bone marrow recovery…Leukopenia-Leukine; Neutropenia-Neupogen (filgrastim); Fatigue-Epogen, Procrit (epoetin alfa) daily or Aranesp (weekly) |
| Chemotherapy induced leukopenia? | —Leukine (sargramostim) Leukopenia = decreased WBCs |
| Chemotherapy induced neutropenia? | —Neupogen (filgrastim)-a subset of leukkopenia-addresses decreased neutrophils… Not to be used within 24hr of chemo or radiation |
| Chemotherapy induced fatigue? | —Epogen, Procrit (epoetin alfa) Too rapid an increase in red cells can cause hypertension, in addition, it can cause seizures. Avoid in patients with hypertension; Watch for seizure activity; Not to be given to those with cancers of the bone marrow |
| Chemotherapy induced thrombocytopenia? | —Neumega (oprelvekin) Low platelet count Cardiac stimulation can lead to signs of CHF; Causes cardiac stimulation-watch for tachycardia, dysrhythmias and edema |
| Stem Cell Transplant | To rescue and restore function of the blood cell producing system, normally harvested, stored, & after high-dose chemotherapy &/or radiation therapy, transplanted back into the body. a treatment option for leukemia, lymphoma, and multiple myeloma. |
| Graft vs Host Disease overview | Acute: happens in days 7-100 after transplant; 30-40% of identical transplant recipients; 60-80% of those with 1 antigen mismatch; Chronic: occurs after 100 days; Patient is no longer at the transplant center—be aware |
| Symptoms Graft vs Host Disease complex inflammatory response | Can affect any organ but typically-alopecia, thickened tight fragile skin/pain oral mucosal dryness/jaundice/bile duct damage/cataracts/photophobia/recurrent resp infections/anorexia/diarrhea/weight loss/ macula & paupulas |
| Treatment of Graft-Host Disease | Life time immunosuppression; Cyclosporine; Steroids |
| Common SE in the Patient Receiving Chemotherapy | Fatigue; Myelosuppression; Anorexia; Nausea; Stomatitis/mucositis ; Diarrhea; Altered nutritional status; Alopecia; Venous fragility; Hypersensitivity |
| Fatigue | “A subjective state of overwhelming sustained exhaustion and decreased capacity for physical and mental work that is unrelieved by rest.”*Most distressing and most common side effect of chemotherapy (radiation therapy also) |
| Fatigue: Causative Factors | Pain; Emotional distress; Sleep disturbance; Anemia; Nutrition; Activity level; group your interventions not tire them out; |
| Fatigue: Interventions | “It has been shown that exercise, including walking and aerobic and resistance training have beneficial effects on some symptoms related to cancer, including fatigue, distress, anxiety, and depressive symptoms.”* schedule rest; nutrition; |
| Nausea and Vomiting | 70%-80% of patients receiving chemo experience this; Anticipatory, acute, breakthrough and delayed Don’t underestimate the power of anticipatory or delayed nausea—MANAGE THESE EARLY—if the pt feels they are going to get nauseated—TREAT |
| Give what medication before meals to encourage intake? | Antiemetic |
| Acute antiemetic | Compazine, phenergan (never given iv push), Anzemet, Zofran, Dexamethasone...anzemet & zofran do not have extraprymidal effects. |
| Breakthrough antiemetic | Ativan, Reglan |
| Delayed antiemetic therapy | Aloxi (palonosetron) |
| Diarrhea | Most often due to antimetabolites; Watch closely for electrolyte disturbance; Careful treatment of diarrhea in the immunocompromised; Stress the need for fluids; Yogurt; Add bulk to diet as tolerated |
| Alopecia | copious and in clumps; Prepare patient; Purchase hats, scarves & wigs before it happens & while the patient has the energy; hair loss is total body, not just the head; Reassure the patient that hair will grow back; may not be same color or texture |
| Venous Fragility | Naturally occurring with aging; Complication with cytotoxic agents; Thrombocytopenia; Leukopenia; Capillary leak syndrome |
| Oncologic Emergencies | Sepsis; Disseminated Intravascular Coagulation—DIC; Syndrome of Inappropriate Antidiuretic Hormone—SIADH; Hypercalcemia; Spinal Cord Compression; Superior Vena; ava Syndrome; Tumor Lysis Syndrome |
| Sepsis Recognition: | FEVER-MAYBE NOT!; Decreased BP; Altered mental status; Grossly decreased tissue perfusion;Check ANC; |
| Prevention of sepsis: | Anticipate potential sources of infection; Get CULTURES; Treat ASAP |
| DIC | Complex hematological disorder where clotting factors and platelets are used up and bleeding ensues, complete cardio pulmonary collapse |
| SIADH (body is holding on to H20 which causes hyponatremia) | Tumors can secrete their own ADH; Sx: Weakness, cramps, decreased appetite & fatigue are early sx ; Personality changes, confusion & seizures, coma & death are late sx Treatment: Fluid restriction, Na+ supplement; Medication, chemo and radiation; |
| Hypercalcemia | Causes: Bone metastasis &PTH release; SX:Fatigue, anorexia, nausea, vomiting to muscle weakness, loss of deep tendon reflexes, Tx: hydrate or glucocorticoids, but patient may need dialysis…hypercalcemia & chemo/ radiation side effects look the same |
| Spinal Cord Compression | tumor is causing compresion Sx: pain; TX: High dose corticosteroids/radiation to shrink & relive pain/palliation |
| Superior Vena Cava Syndrome | Because of tumor growth this becomes compressed and obstructs the return of blood to the central circulation; Most often a result of lymphoma &lung cancer; sx: swollen head and neck TX: Radiation, surgical placement of shunt |
| Tumor Lysis Syndrome (Labs for tumor lysis syndrome# hyperkalemia(> 6); hyperphosphosatemia (> 4.5) accute renal failure; hypocalcemia (<7) tetanay & seizures ; urica acid (> 8) | dump of K+ into blood stream from breakdown of cells—life threatening cardiac arrhythmias…Indirect elevation of uric acid—leading to uric acid crystals in renal system—renal then liver failure: TX: Prophylactic HYDRATION..Most often lymphomas, & leukemias |
| Hydration levels for chemotherapy patients | 5 L fluid per day before chem and 3 L each day for 3-5 days |
| Hemorrhagic Cystitis | Marked by large quantities of blood in the urine; Cause:Side effect of radiation therapy or Treatment with cyclophosphamide (cytoxin) pre & post hydration to rid of metabolites |
| Palliative Care-a philosophy that provides a compassionate and supportive approach to clients & families who are living with life threatening illnesses. | Holistic approach; Does not hasten death; Does not postpone death; Provides relief of sx experienced by the dying client; Provides emotional support; Provides spiritual support; Improves quality of care at the end of life |
| Death and dying: Goals of care | Assess client needs; Manage symptoms; Promote meaningful interactions between client and significant others; Facilitate a peaceful death; Hospice |
| Hospice care | seeks an interdisciplinary approach ; to facilitate both quality of life and a “good” death for clients who are nearing the end of their lives. |
| Pain is | what the client says it is; self report most reliable. anticipate side effects |
| 3 major types of pain: | acute, chronic cancer, and chronic noncancer. |
| Acute pain | warns the body, causing sympathetic responses, such as ^ HR, ^ BP & P, dilated pupils, & sweating. |
| Chronic pain | does not cause sympathetic reaction; so some clients don't appear to be in pain, even when they are... Chronic non cancer pain i.e. back pain... Chronic cancer pain. Pain associated w/ ca or progressive dz. pain can be profound |
| greatest risk factor for getting caner? | Age |
| Xerostomia | dry mouth that is often associated with radiation treatment. Radiation treatment to the head, face, or neck can also cause dry mouth. It can take six months or longer for the salivary glands to start producing saliva again after the end of treatment |
| tertiary prevention | the person already has the disease, but trying to minimize the effects of the cancer that the person la ready has. |
| Tamoxifen | is an antagonist of the estrogen receptor in breast tissue standard endocrine (anti-estrogen) therapy proposed. side effects masuclation in women fluid retention and bone pain |
| drug for Leukopenia- | Leukine; |
| drug for Neutropenia- | Neupogen (filgrastim); |
| drug for Fatigue- | Epogen, Procrit (epoetin alfa) daily or Aranesp (weekly) |
| drug for low platelet count | numega |
| Fatigue: Assessment: | labs, behavior, hard to wake? energized by visitors? Ask: Are there things that seem to drain you? |
| drug for neutropenia | colony stimulating agents factors: neupogen 24hrs after chemo, past nadir and ANC is WNL; neulasta....expect bone pain (adding new cells to the bones so it can hurt) |
| Capillary leak syndrome | size of ores increase, causes leakage into interstitial, results in low bp and edema and can cause multi-organ failure, which will lead to cardio-pulmonary collapse. malnourished patients are more at risk for this. theophyllin is given to vaso constrict |
| WHO Pain Ladder | If pain occurs, there should be prompt oral administration of drugs in the following order: nonopioids (aspirin and paracetamol); then, as necessary, mild opioids (codeine); then strong opioids such as morphine, until the patient is free of pain. |
| Cisplatin Nursing Interventions: | (Alkylating Agents) Assess pt for: dizziness, tinnitus, hearing loss, uncoordination, numbness of extremities. Adequate fluid intake to protect kidneys! Strict I&O; Ensure IV placement; adjust rate/ increase dilution to prevent painful administration |
| Leucovorin rescue drug for? | methotrexate |
| fluorouracil (5 FU); methotrexate (Trexall); cytarabine (Cytosar) Nursing Interventions: | (Antimetabolites)Sunscreen; Increased fluid intake 3-4 liters per day; Necessary follow up visits and lab work |
| -vincristine (Oncovin); etoposide (VP 16 or VePesid) & paclitaxel(Taxol) | (Mitotic inhibitors) (vesicant) Cell cycle M specific; Common SE:, alopecia, ataxia, bone marrow suppression, peripheral neuropathy, Serious SE: extravication, liver & kidney toxicity, Nadir=7 days |
| irinotecan (Camptosar) | (Topoisomerase Inhibitors) Cell cycle S specific; Common SE: :severe diarrhea during infusion; Serious SE: Increased liver enzymes, Nadir 18-25 days after |
| Bleomycin (Blenoxane), doxorubicin (Adriamycin) | (Cytotoxic Antibiotics); S Cell cycle specific; (life time cumulative dose) Common SE: pneumonitis, low platelets; Serious SE: pulmonary fibrosis, Nadir 12-17 days |
| trastuzumab (Herceptin) & rituximab (Rituxin) | (Monoclonal Antibodies); Interfere with cellular processes necessary for cancer cell survival; SE: Fever, chills, hypotension; Anaphylaxis; N,V,D; Anemia; Cardiac & liver toxicity; Tumor lysis syndrome |
| bevacizumab (Avastin) | (Anti-angiogenics) Serious SE: Thromboembolitic events; CHF; Bleeding; GI perforation |
| Cisplatin | (Alkylating Agents) Cell cycle non specific; irritant common SE: hair loss, bone marrow depresion, N,V & D, ototoxic Serious SE: extavascation, pulmonary fibrosis, myopathy, peripheral neurothopathy; hemorragic cytisis, nephrotoxicity; (Nadir 10-20) |
| fluorouracil (5 FU); methotrexate (Trexall); cytarabine (Cytosar) | (Antimetabolite) /Cell cycle S specific; Common SE: bone marrow suppression, N&V, mucosityis, photosensitivity, hyperurocemia; Serious SE effects: hepatic, renal & pulmonary toxicity. Nadir= 9-14 days after administration |
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