Test 4 set 3 – Flashcards
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Antineoplastic Enzymes
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Ovarian and colorectal & Small-cell lung cancers, Other tumors
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Antineoplastic Nursing Implications
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Bone marrow suppression (predictable, reversible, noncumulative, manageable), GI effects (nausea, vomiting, diarrhea), Irinotecan causes cholinergic diarrhea (delayed, occurring 2 to 10 days after dosage)
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Antineoplastic Nursing Implications
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Synthesized using cultures of bacteria and recombinant DNA technology, As a result, an enzyme is produced, This enzyme is isolated and purified for clinical use (asparaginase (Elspar): used to treat acute lymphocytic leukemia & pegaspargase (Oncaspar)
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Antineoplastic Nursing Implications: Monitor for complications
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Assess baseline blood counts before giving antineoplastic drugs, Follow specific administration guidelines for each antineoplastic drug
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Antineoplastic Nursing Implications- Monitor for complications(cont'd)
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Remember that all rapidly dividing cells (both normal and cancer cells) are affected: Mucous membranes, Hair follicles, Bone marrow component, Monitor for effects on these tissues or complications
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Antineoplastic Nursing Implications: Implement measures to monitor for and prevent ...
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GI mucous membranes: stomatitis, altered bowel function with high risk for poor appetite, nausea, vomiting, diarrhea, and inflammation and possible ulcerations of GI mucosa
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Antineoplastic Nursing Implications: GI
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alopecia, Bone marrow components: dangerously low (life-threatening) blood cell counts, Possible stimulation of CTZ. Monitor for adverse effects specific to the type of antineoplastic drug given
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Antineoplastic Nursing Implications: family oriented
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infection in patients with Neutropenia & leukopenia, and bleeding in pts with thrombocytopenia and anemia. Keep in mind that anemia may result in severe fatigue
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Cancer Drugs:Antineoplastic Medications: Cell cycle-nonspecific (CCNS) drugs
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Monitor for stomatitis (oral inflammation and ulcerations), and implement measures to reduce the effects if it occurs. Anticipate nausea and vomiting, and implement measures to reduce these effects. Antiemetics often work better if given 30 to 60 minutes before chemotherapy is started
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Alkylating Drugs examples
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Women of childbearing age will need to use a nondrug form of contraception during therapy. In addition to physical measures, keep in mind the need for emotional support during this time for both the patient and family. Monitor for therapeutic responses to antineoplastic therapies and the many possible adverse effects
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Alkylating Drugs: Action
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Alkylating drugs, & Cytotoxic antibiotics
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Alkylating Drugs: Indications: Used in combination with other drugs to treat various types of cancer, such as:
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Classic alkylators (nitrogen mustards), Nitrosoureas & Miscellaneous alkylators
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Alkylating Drugs: Adverse Effects
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CCNS antineoplastics, Effective at any stage in the growth cycle of cancer cells, Prevent cancer cells from reproducing with the process of alkylation
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Alkylating Drugs: Examples
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Recurrent ovarian cancer, Brain tumors, Lymphomas, Leukemias, Various forms of cancer (breast, ovarian, bladder), Others
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Cytotoxic Antibiotics
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Dose-limiting adverse effects, Nausea and vomiting, myelosuppression, Alopecia, Nephrotoxicity, peripheral neuropathy, ototoxicity, Hydration can prevent nephrotoxicity, Extravasation causes tissue damage and necrosis
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Cytotoxic Antibiotics Adverse FX
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cisplatin (Platinol), cyclophosphamide (Cytoxan), mechlorethamine (Mustine, nitrogen mustard), carmustine (BiCNU), Others
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Cytotoxic Antibiotics: Anthracycline antibiotics
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Natural substances produced by the mold Streptomyces, Synthetic substances also used, Used to treat cancer; too toxic to treat infections
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Cytotoxic Antibiotics: Anthracenedione antibiotic
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All can produce BMS, except bleomycin, Pulmonary toxicity: bleomycin, Heart failure: daunorubicin, Acute left ventricular failure (rare): doxorubicin
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Cytotoxic Antibiotics: Other cytotoxic antibiotics
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daunorubicin, doxorubicin, idarubicin, others
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Cytotoxic Antibiotics: Action
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mitoxantrone
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Cytotoxic Antibiotics: Indications
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bleomycin, dactinomycin, mitomycin
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Cytotoxic Antibiotics: Adverse Effects
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CCNS drugs are active in all phases of the cell cycle. Act by intercalation, resulting in blockade of DNA synthesis
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Cytotoxic Antibiotics: Adverse Effects (cont'd)
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Used in combination chemotherapy regimens. Used to treat a variety of solid tumors and some hematologic malignancies. Leukemia, ovarian, breast, bone, others. Squamous cell carcinomas. AIDS-related Kaposi's sarcoma (when intolerant to other treatments)
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Miscellaneous Antineoplastics
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Hair loss, nausea and vomiting, myelosuppression, Pulmonary fibrosis and pneumonitis (bleomycin), Liver, kidney, and cardiovascular toxicities, Many others
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Miscellaneous Antineoplastics: bevacizumab (Avastin)
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Cardiomyopathy is associated with large amounts of doxorubicin. Dexrazoxane can be used as a cytoprotective drug. Monitor cardiac ejection fractions
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Miscellaneous Antineoplastics: hydroxyurea (Hydrea)
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bevacizumab (Avastin), hydroxyurea (Hydrea), imatinib (Gleevec), mitotane (Lysodren), Radiopharmaceuticals
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Miscellaneous Antineoplastics: imatinib (Gleevec)
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Angiogenesis inhibitor, Blocks blood supply to the growing tumor, Many adverse effects, including nephrotoxicity
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Miscellaneous Antineoplastics: mitotane (Lysodren)
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Action similar to antimetabolites, Used to treat squamous cell carcinoma and some leukemias, Oral form only, Many adverse effects
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Hormonal Drugs
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Used to treat chronic myeloid leukemia (CML), Targeted therapy, but it is NOT a monoclonal antibody, Works by inhibiting an enzyme that is active in the CML process, Use with other hepatic-metabolized drugs may cause severe interactions, Many adverse effects and drug interactions
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Hormonal therapy used to
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Adrenal cytotoxic drug, Used specifically for adrenal corticoid carcinoma, Oral form only
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Hormonal therapy Used most commonly as ...
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Used to treat a variety of neoplasms in men and women
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Hormonal Drugs for Female-Specific Neoplasms
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Oppose effects of hormones, Block the body's sex hormone receptors
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Hormonal Drugs for Male-Specific Neoplasms
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adjuvant and palliative therapy, But may be a drug of first choice for some cancers
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Radiopharmaceuticals
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Aromatase inhibitors, anastrozole, aminoglutethimide, Selective estrogen receptor modulators, tamoxifen, toremifene, Progestins, megestrol (Megace), medroxyprogesterone, Androgens, fluoxymesterone, testolactone, Estrogen receptor antagonist, fulvestrant
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Radiopharmaceuticals (examples)
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Antiandrogens: bicalutamide, flutamide, nilutamide. Antineoplastic hormone: estramustine
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Extravasation
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Used to treat a variety of cancers, or symptoms caused by cancers, Administered by nuclear medicine specialists
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Extravasation precautions
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porfimer sodium, chromic phosphate P 32, samarium SM 153 lexidronam, sodium iodide I 131, sodium phosphate P 32, strontium Sr 89
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Extravasation (cont'd)
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Leaking of an antineoplastic drug into surrounding tissues during IV administration. Can result in permanent damage to nerves, tendons, muscles; loss of limbs. Skin grafting or amputation may be necessary. Leaking of an antineoplastic drug into surrounding tissues during IV administration. Can result in permanent damage to nerves, tendons, muscles; loss of limbs. Skin grafting or amputation may be necessary
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Handling Antineoplastic Drugs
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Prevention is essential. Continuous monitoring of the IV site is essential. If suspected, stop the IV infusion immediately but do not remove the IV tube. If possible, aspirate remaining drug or blood from the tube. Follow instructions for giving the appropriate antidote through the existing IV tube, then remove the catheter. Some antidotes are not given through the IV catheter
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Handling Antineoplastic Drugs (cont'd)
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Cover area with sterile, occlusive dressing if ordered. Apply warm or cold compresses, depending on the extravasated drug. Rest and elevate the affected limb. PREVENTION is the best approach!
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Nursing Implications: Antineoplastics
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Those preparing and administering these drugs may be exposed to negative consequences. Most facilities have these drugs mixed under special environments in the pharmacy
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Nursing Implications: Alkylating drugs
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During care of a patient receiving these drugs, special precautions may be implemented, depending on facility policies. Double flushing of bodily fluids in the commode, Special hampers for disposal of all objects that contact the patient's bodily fluids. Personal protective equipment. Special concerns if chemotherapy liquid spills
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Nursing Implications: Alkylating drugs (cont'd) 2
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Assess baseline blood counts before giving antineoplastic drugs. Follow specific administration guidelines for each antineoplastic drug
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Nursing Implications Antineoplastics (cont'd) 3
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Monitor for expected effects of bone marrow suppression. Expect nausea, vomiting, diarrhea, stomatitis. Hydration is important to prevent nephrotoxicity. Report ringing/roaring in the ears―possible ototoxicity. Report tingling, numbness, or pain in extremities― peripheral neuropathies may occur
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Nursing Implications Antineoplastics (cont'd) 4
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2 Cytotoxic antibiotics. Expect bone marrow suppression, nausea, vomiting, diarrhea, stomatitis. Monitor pulmonary status. Monitor for nephrotoxicity, liver toxicity. Monitor cardiovascular status. Daunorubicin may turn the urine a reddish color
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Nursing Implications Antineoplastics: Monitor for oncologic emergencies
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3 In general: Monitor closely for anaphylactic reactions. Keep epinephrine, antihistamines, and antiinflammatory drugs on hand. Monitor closely for complications associated with bone marrow suppression. Anemia, thrombocytopenia, neutropenia
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Explain the function of parietal cells in the stomach.
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4 Cytoprotective drugs may be used to reduce toxicities. IV amifostine to reduce renal toxicity associated with cisplatin. IV or PO allopurinol to reduce hyperuricemia
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PUD is Peptic Ulcer Disease. What treatments are recommended when PUD is caused from helicobacter pylori? (there are several listed in text)
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Infections, Pulmonary toxicity, Allergic reactions, Stomatitis with severe ulcerations, Bleeding, Metabolic aberrations, Bowel irritability with diarrhea, Renal, liver, cardiac toxicity
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The following antacids can be used alone or in combinations.: aluminum salts, magnesium salts, calcium salts, and sodium bicarbonate. List the most common side effect of each.
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They produce gastric acid (Hcl) in response to acetylcoline, histamine & gastrin. They also produce intrinsic factor, which facilitates B12 metabolism.
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Your grandmother is fond of taking baking soda out of the kitchen cabinet and using one tablespoon in water after eating a large meal. What does your grandmother need to know about taking too much of the baking soda too often?
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10-14 day course of a proton pump inhibitor. antibiotics clarithromycin & amoxycillin or metronidazole., Combo of ppi, bismuth subsalicylate & the aforementioned antibiotics
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What is the most significant difference between MOM (milk of magnesia), and Mylicon or Phazyme?
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Al: constipation, Mg:diarrhea, Ca: constipation, , Na(CO3)2: systemic alkalosis
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6. List 4 contraindications to using antacids.
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It may raise her pH too high and she'll get systemic alkalosis
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7. What is the difference in mechanism of action between the H2 Antagonist drugs and Proton Pump Inhibiting drugs?
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MoM is an antacid, is often used as a laxative, and is not recommended during pregancy. the other 2 are anti-gas and are safer during pregnancy
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8. List 4 of the most common H2 Antagonist Drugs and 4 of the Proton Pump Inhibiting drugs (generic/trade names)
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Allergy, renal failure, electrolyte disturbances, GI obstruction.
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9. What is the primary use of misoprostol/Cytotec?
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H2Agonists prevent the parietal cells from producing Acetylcoeline & gastrin.. PPId's bind to H-K-ATPase pump mechanism and totally block acid production
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10. Cimetidine/Tagamet is which classification of drugs and list 4 specific drugs that should not be taken with Tagamet.
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H2Ad's: Tagamet, Pepcid, Zantac, Pepci AC. PPId's: prevacid, prilosec, protonix, AcipHex
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1. What are three of the most common reasons someone has diarrhea?
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Reduce gastric ulcers for those taking NSAID's
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Anti-diarrheal: Adsorbents:
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Proton Pump Inhibitors, warfarin, ketoconazole, ampicillin, iron salts, digoxin
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Anti-diarrheal: Anticholinergic drugs:
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Drugs, bacteria, viruses
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Anti-diarrheal: alkaloids/phenobarbital combinations /
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bismuth subsalicylate/Pepto Bismal
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Anti-diarrheal: Opiates:
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belladona
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Anti-diarrheal: Intestinal flora modifiers:
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Donnatal
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3. Under what medical conditions should you NOT try to stop diarrhea?
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diphenoxylate c/atropine/Lomotil
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4. List 6 causes of constipation.
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Lactobacillus acidophilus/Bacid
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Bulk forming laxative:
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When diarrhea is caused by a bacterial or viral infection. You want to get the pathogen out of the system as quickly as possible.
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Emollient laxative:
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Adverse drug effects: analgesics, etc..., Lifestyle: low-roughage diet, physical inactivity, Metabolic & endocrine disorders: hypothyroidism, Neurogenic disorders: multiple sclerosis
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Hyperosmotic laxative:
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acute/chronic constipation, IBS, diverticulosis
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Saline laxative:
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acute/chronic constipation, fecal impaction, anorectal conditions requiring facilitation of bowel movements
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Stimulant laxative:
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chronic constipation, bowel preparation for diagnostic and surgical procedures
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mechanism of action of Bulk forming laxative:
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constipation, bowel preparation for diagnostic & surgical procedures
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mechanism of action of emollient: stool softeners/lubricant laxatives:
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acute constipation, bowel preparation for diagnostic & surgical procedures
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mechanism of action of Emollient: Lubricant laxative:
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act like fiber in diet, absorb H2O into intestine, increases bulk, distends bowel & promotes peristalsis
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mechanism of action of hyperosmotic laxative:
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lower surface tension of GI fluids, absorbing more H2O & fat into stool.
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mechanism of action of saline laxative:
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prevents absorbtion from intestines, the fluid then expands the stool, distending the bowel, promoting peristalsis
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mechanism of action of stimulant laxative:
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increases fecal H2O content, → bowel distension → peristalsis
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7. Give an example of a Bulk forming: laxative:
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inhibits H2O absorption & increases H2O & salt secretions from bowel wall into lumen → watery stool→ bowel distension → peristalsis
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Give an example of an emollient: laxative:
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stimulate nerves → peristalsis, also increase fluid in colon, increases bulk, softens stool
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Give an example of a hyperosmotic: laxative:
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methylcellulose/Citrucel
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Give an example of a saline: laxative:
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docusate/colase
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Give an example of a stimulant: laxative:
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glycerin/colase
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8. Give three contraindications to a patient desiring to use laxatives.
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magnesium sulfate (no brand name, Epsom salts)
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9. What types of health problems are generally related to chronic use of laxatives?
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bisacodyl/dulcolax
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10. What is one Trade name for Bismuth Subsalicylate and what do you need to include when you are educating your patient about taking it?
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Allergy, appendicitis symptoms, fecal impaction (mineral oil enemas excepted)
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part 2 chapter 48.....cytotoxic antibiotics make you retain water and will gain wt.....make sure client knows to report any ringing/roaring in ears...monitor for anaphylaxis; keep EPI. close; monitor for oncologic emergencies: infections, allergic reactions, renal/liver/cardia toxicity, and metallic taste in mouth........that's all i have written down for part 2
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Electrolyte imbalances, irritation, rashes, bloating
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need to perform a thorough skin assessment w/ regards to mucous membranes
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Pepto-bismal: use c/ caution c/ pediatric & adolescent pts due to Reye's syndrome risks.
