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Antineoplastic RX
| Question | Answer |
|---|---|
| What are the mose common Sites for malingnant Neoplasm Growth? | bladder/kidney, colon, prostate, blood producing tissue, lymphatic tissue, uterus, rectum, breast, lung, & skin; |
| Classifications of tumors? (4) | 1. carcinomas (arise from epithelial tissue); 2. Sarcomas (arise from supportive and protective connective tissue); 3. Lymphomas (arise from lymphatic tissue); 4. Leukemias (arise from Leukocytes); |
| What are Paraneoplastic Syndromes (PNS) of cancer of the lungs? (3) | 1. hypercalcemia; 2. sensory neuropathies; 3. SIADH; |
| What are Paraneoplastic Syndromes (PNS)of leukemia? (1) | DIC: Disseminated Intravascular Coagulation; |
| What are Paraneoplastic Syndromes (PNS) of cancer of the adrenal & Lymphomas? | Addison's syndrome; |
| What are Paraneoplastic Syndromes (PNS) cancer of the lung, thyroid, testes, & adrenal? | Cushing's Syndrome; |
| What are the stages of cancer growth? (5) | 1. G0 (resting phase); 2. G1 (Postmitotic phase); 3. S (DNA Synthesis phase); 4. G2 (Premitotic Phase); 5. M (Mitotic phase); |
| When is chemotherapy the most effective? | Chemotherapy is the most effective when the greatest number of cells are dividing; |
| What are the types of antineoplastic drugs? (2) | 1. Cell Cycle Specific (CCS); 2. Cell Cycle Non Specific (CCNS); |
| Which classification of antineoplastic drug is effective against rapidly growing tumors? | Cell Cycle Specific (CCS) |
| which classification of antineroplastic drug is effective against large, slow growing tumors? | Cell Cycle Non Specific (CCNS) |
| What factors can effect the cure of cancer? (6) | 1. cancer stage at the time of dx; 2. type of neoplasm; 3. neoplasm's doubling time; 4. efficacy of cancer Tx; 5. the developement of drug resistance; 6. general health of the pt; |
| Basics to remember about antineoplastic therapy? (5) | 1. no one agent is effective against all cancers; 2. all antineplastic agents have a narrow therapeutic index; 3. a combination of agents is usually more effective than single agents alone; |
| Basics to remember about antineoplastic therapy? (5)cont. | cont. 4. major drawback = high incidence of side effects involving other papidly growing cells (hair follicles, GI cells, Bone Marrow Cells; 5. Do not administer with other drugs having similar toxicities; |
| When does a side effect become dose limiting? | a side effect becomes "dose Limiting" when it prevents giving these agents in high enough doses to kill the cancer; |
| What is the nadir? | the time frame within which an antineplastic drug has killing effects ont he bone marrow; |
| What are the categories of Antineoplastics? (6) | 1. alkalating agents (CCNS); 2. Antimetabolites (CCS); 3. Cytotoxic Antibiotics; 4. Mitotic Inhibitors; 5. Miscellaneous Agents; 6. biologic response modifiers; |
| Classification and MAO of Cisplantin (DDP) (Cytoxan)? | Alkalating agent that is effective against rapidly diving cells malignant and nonmalignant; |
| Therapeutic use of Cisplantin (DDP) (Cytoxan)? | solid tumors, hematologic malignancies, frequently used in combination with other agents; |
| Advers rxn of Cisplantin (DDP) (Cytoxan)? | BMS is dose limiting, nephrotoxicity, pulmonary ficrosis, cardiomyopathy; |
| Toxicity/OD of Cisplantin (DDP) (Cytoxan)? | most devistationg consequence of chemotherapy is loss of a linb due to extravasated IV fluids; |
| Classification and MOA of Methotrexate (Folex PFS) & Mercaptopurine (6-MP)? | antimetabolie, folic acid antagonist and purine antagonist that inhibits synthesis of folate needed for DNA formation or interfere with purine needed for DNA/RNA; |
| Therapeutic use of Methotrexate (Folex PFS) & Mercaptopurine (6-MP)? | solid tumors of the colon, rectum, stomach, lung, liver, bladder, pancreas; |
| Adverse rxn of Methotrexate (Folex PFS) & Mercaptopurine (6-MP)? | hair loss, myelosuppression, N&V; |
| Toxicity/OD of Methotrexate (Folex PFS) & Mercaptopurine (6-MP)? | severe toxicity if methotrexate is used with NSAIDS; |
| Drug interactions of Methotrexate (Folex PFS) & Mercaptopurine (6-MP)? | additive toxicity is co-administered with agents having similar toxicity; |
| Classification and MOA of Doxoyrubicin (Adriamycin RDF) & Bleomycin (Bleoxane)? | cytotoxic antibiotics act as CCNS agents, bacteriocidal, may kill some viruses; |
| Therapeutic use of Doxoyrubicin (Adriamycin RDF) & Bleomycin (Bleoxane)? | used in combination with other agents for solid and hematologic tumors; |
| Advers rxn of Doxoyrubicin (Adriamycin RDF) & Bleomycin (Bleoxane)? | moderate to severe BMS, hair loss, N&V; |
| Toxicity/OD of Doxoyrubicin (Adriamycin RDF) & Bleomycin (Bleoxane)? | CHF, Left ventricular failuer; all agents produce BMS except for Bleoxane which produces pulmonary toxicity leading to pulmonary fibrosis & pnemonia; danger of extravasation b/c can only be administered IV; |
| Classification and MOA of Paclitaxel (Taxol) & Vincristine (Oncovin)? | Mitotic inhibitors; CCS from periwinkle and bark of pacific yew; inhibit cell mitosis; |
| Adverse rxn of Paclitaxel (Taxol) & Vincristine (Oncovin)? | Hair loss, N&V, BMS; |
| Classification and MOA of Hydroxyurea (Hydrea)? | miscellaneous agent that works as both CCS and CCNS; |
| therapeutic use of Hydroxyurea (Hydrea)? | solid and hematologic tumors |
| Adverse rxn of Hydroxyurea (Hydrea)? | hair loss, N&V, sever BMS; |
| Important things to remember about Cisplatin (DDP)? | used to treat solid tumores, such as bladder testicular & ovarian; May Cause ototoxicity & Nephrotoxicity; |
| Importnat things to remember about Cytoxan? | used to treat cancers of bone and lymph as well as solid tumore; may cause cystitis and nephrotoxicity; |
| What drug is used to treat solid tumors of breast, head, neck, lung, lymphocytic, leukemia, non hodgkins lymphoma? | Methotexate (Folex FFS) |
| Important things to remember about Methotreaxate (Folex FFS)? | useful as anti-inflammatory in the tx of rheumatoid arthritis & oher immune related inflammatory conditions; available both parenterally and orally, can cause photosensitivity; |
| Important things to remember about Mercaptopurine (6MP)? | used in the tx of leukemias; observe for hearing loss in these pt's; |
| important things to remember about Doxorubicin (Adriamycin)? | very potent, contraindicated in lactating women & in 1st trimester of pregnancy; contraindicated in persons having systemic infections; can cause cardiotoxicity; |
| important things to remember about Bleomycin (Bleoxane)? | very toxic to lungs, given in units rather than mg; given SQ, IM, or IV; |
| important things to remember about Paclitaxel (Taxol)? | for tx of metastatic ovarian cancer not responsive to other regimens; pt's are premedicated with steroid, antihistamine, & H2 antagonist (Cimetidine); only available IV; |
| important things to remember about Vincristine (Oncovin)? | used in tx of lymphomas, hodgkins, neuroblastoma, leukemia, osteogenic &other sarcomas, tumors of breast & lung; contraindicated in infants; can develope urinary problems and neurotoxicity with joint and back pain; |
| important things to remember about Hyroxyurea? | CCS agent; causes sever BMS, it's nadir (maximum destruction og granulocyte cells) occurs within one week of start of therapy; |
| important things to remember about Interferon? | reduced frequency of neurological exacerbation in multiple sclerosis; |
| important things to remember about Interlukin 2? | causes production of LAK cells that kill cancer cells; given SQ, IV peri-lesionally, intra-peritoneal, intra-hepatic, intra-thecal routes; |
| What are the components of the cellular immune system and their functions? (3) | 1. Cytotoxic Cells (lyse target cells); 2. T-helper cells (Direct the action of other immune cells); 3. T-suppressor cells (regulate or inhibit the immune response; overactive cells may be responsible for tumor growth; |
| Types of Biological Response Modifiers? (3) | 1. Interferons; 2. Interleukins; 3. Colony Stimulating Factors; |
| what are the effects of the Biologic REsponse Modifiers? (3) | 1. Regulate or augment the immune response; 2. cytotoxic behavior toward cancer cells; 3. Inhibition of metastasis; |
| Therapeutic uses of Interferons (INF's)? | antiviral, immune modulating, antitumor; |
| Common side effects of Interderons (INF's)? | flu-like symptoms, fatigue is major dose limiting effect; anorexia, N&V; |
| Classification and MOA of interleukins? | biologic response modifier that encourage the development of LAK killer cells; LAK cells destroy cancer cells while ignoring normal cells; |
| Therapeutic use of interleukins? | melanomas and renal carcinoma |
| Adverse rxn of interleukins? | Tx can cause severe toxicity: capillary leak syndrom may cause massive fluid retention (20-30 lbs), respiratory distress, CHF, MI; Heptatoxicity, fatigue, eosinophilia; |
| Classification and MOA of Epoetin (Procrit)? | COlony stimulating Factors (CSF's) regulate the growth, differentiation and function of bone marrow stem cells; |
| How does Epoetin (Procrit) enable higher doses of chemotherapy to be given? (3) | 1. decreasing chemotherapy induced neutropenia; 2. decreasing bone marrow recovery time; 3. stimulating other immune cells to destroy cancers, fungi, & viruses; |
| Adverse rxn of Epoetin (Procrit)? | fever, muscle aches, bone pain, flushing; |
| What should the nurse do if she detects Antineoplastic Extravasation? (7 steps) | 1. Stop IV flow; 2. Leave IV in place and aspirate as much residual blood and fluid as possible; 3. prepare and instill requisite antidote through exisitng tube (unable to aspirate=don't use existing line 4 antidote); 4. remove needle; |
| What should the nurse do if she detects Antineoplastic Extravasation? (7 steps)cont. | cont. 5. place an occlusive dressing over the entire area; 6. apply warm of cold agents as dictated by the agent; 7. elevate the limb and allow it to rest; |
| What are the nursing implications for antineoplastic agents? (2) | 1. If hair loss is a source of distress, wigs can be rented, purchased or obtained free from the American Cancer society; 2. pregnant women should not handle antineoplastic agents; |
| What are the pt teachings for antineoplastic agents? (2) | 1. report fever, chills, tarry stools, sore throat, SOB to MD; 2. avoid using ETOH, asppirin, razors & commercial mouthwash during tx; |
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