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WVC cancer meds
wvc cancer meds and lab values
| Question | Answer |
|---|---|
| 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 |
| (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 |
| Absolute Neutrophil Count (ANC) | WBCs x (% neutrophils + bands) Example: WBCs are 1000; neutrophils are 25% & Bands are 2 %=27>>>>1000 x .27 = 270 ANC …low ANC can also limit the chemotherapy given. (Segs=neutrophil) |
| 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 |
| 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 |
| 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 |
| Anti-Neoplastics pre-Administration Protocol… Weigh pt; Calculate BSA and double check the dose ordered (Nurse to Nurse); Check the patient’s recent lab work; Hx of patient’s response to last round of chemo (concerns?); | Patient assessment; Clarify with physician any concerns-dose/labs prior to mixing; Premedicate for nausea, anxiety, diuresis if indicated for treatment; Check IV site |
| 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 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 |
| Cytokines- (Biological Response Modifiers) | Stimulate the immune response & bone marrow recovery |
| Interleukins (Biological Response Modifiers) | Help to recognize and destroy abnormal body cells (melanoma!) |
| 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 |
| Acute antiemetic | Compazine, phenergan, Anzemet, Zofran, Dexamethasone |
| Breakthrough antiemetic | Ativan, Reglan |
| Delayed antiemetic therapy | Aloxi (palonosetron) |
| Labs for tumor lysis syndrome | hyperkalemia(> 6); hyperphosphosatemia (> 4.5) accute renal failure; hypocalcemia (<7) tetanay & seizures ; urica acid (> 8) |
| 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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