ATI Pharm – Immune System – Drill & Test Questions – Flashcards

Cisplatin, a platinum compound, can cause renal toxicity. Prior to therapy, you should hydrate the patient with 1 to 2 L of IV fluid and continue for 24 hr following therapy to help prevent renal impairment. Monitor serum creatinine, BUN, fluid I&O, and weight. Cisplatin can cause severe nausea and vomiting. Administer an antiemetic 30 min before starting the infusion. This drug can cause ototoxicity, so make sure to evaluate the patient's hearing prior to therapy and periodically thereafter, and to tell the patient to report tinnitus, vertigo, or hearing loss. Cisplatin is unlikely to affect peripheral circulation, but it can cause peripheral neuropathy.

Mercaptopurine, a purine analog, can cause bone marrow suppression, so you should instruct the patient to report easy or unexplained bruising or bleeding, sore throat, or fever. Monitor CBC throughout treatment and advise the patient to avoid activities that can cause injury. Mercaptopurine is unlikely to cause paresthesias, blurred vision, or tinnitus, although it can cause liver toxicity and gastrointestinal symptoms, including stomatitis (mouth sores), esophagitis, and anorexia.

Filgrastim, a colony stimulating factor, stimulates neutrophil proliferation for patients with neutropenia due to bone marrow suppression. The combination of filgrastim and topotecan, a topoisomerase 1 inhibitor, can worsen bone marrow suppression. To avoid interaction, administer filgrastim 24 hr after the topotecan infusion, not before or during the infusion.

Tamoxifen, an estrogen receptor blocker, palliates estrogen-receptor-positive breast cancer for postmenopausal women and is an adjunct to surgery for breast cancer with positive lymph nodes. Enfuvirtide, an entry/infusion inhibitor, treats HIV infection that is advanced or resists treatment with other drugs. Delavirdine, a non-nucleoside reverse transcriptase inhibitor, treats the symptoms of HIV-1 infec tion. Flutamide, an androgen receptor blocker, treats early and metastatic prostate cancer.

Imatinib, a targeted antineoplastic drug, can cause fluid retention and pulmonary edema. You should monitor the patient's weight and report weight gain. Assess for peripheral edema by listening to breath sounds and monitoring for shortness of breath. Report crackles in the lung bases as they might indicate pulmonary edema. Imatinib is unlikely to cause bradycardia, dry mouth or constricted pupils, although it can cause muscle pain and cramping.

Trastuzumab, a monoclonal antibody, can cause an allergic reaction. You should have epinephrine available to treat anaphylaxis. Monitor the patient for hives, wheezing, or hypotension.

Zidovudine prevents the transmission of HIV to the fetus. The patient should take the drug orally five times daily from 14 weeks of gestation until delivery. During delivery, the patient should receive the drug via IV infusion until the birth attendant clams the newborn's cord.

Ritonavir, a protease inhibitor, can cause hypoglycemia and diabetes mellitus. Tell the patient to expect periodic blood glucose checks. Patients who already have diabetes should check their blood glucose levels frequently and report elevations as well as increased hunger, thirst, or urination. Tell the patient to take the drug with food to maximize its absorption and minimize gastrointestinal upset. Ritonavir can cause liver toxicity, so tell the patient to watch for and report indications of liver toxicity, such as yellowed sclera and skin. Ritonavir can reduce bone density, so instruct the patient to increase weight-bearing activity and calcium and vitamin D intake. Tell the patient to expect periodic cholesterol checks.

Paclitaxel, an antimitotic, treats Kaposi's sarcoma, ovarian and breast cancer, and non-small cell lung cancer. Cytarabine, an antimetabolite (pyrimidine analog), treats acute myelocytic and acute lymphocytic leukemia and non-Hodgkin's lymphoma. Cyclophosphamide, an alkylating agent (nitrogen mustard), treats leukemia; multiple myeloma; lymphomas; and head, ovary, breast, and lung cancer. Carmustine, an alkylating agent (nitrosourea), treats brain tumors, lymphomas, multiple myeloma, melanoma, hepatoma, and gastrointestinal adenocarcinoma.

Tamoxifen, an estrogen receptor blocker, can cause uterine cancer. Instruct the patient to watch for and report abnormal uterine bleeding, pelvic pain, or pressure and make sure she has regular gynecologic examinations.

Cyclophosphamide, a nitrogen mustard, can cause renal toxicity, often manifesting as hemorrhagic cystitis. The health care professional will administer mesna, a chemoprotectant, with each dose of cyclophosphamide to reduce the risk for hemorrhagic cystitis, while also increasing IV fluids and monitoring the patient's urine for hematuria.

Cyclophosphamide, a nitrogen mustard, can cause bone marrow suppression. The health care professional will monitor the patient for indications of leukopenia, such as a fever, and instruct the patient to report a sore throat, fever, or easy or unexplained bruising. The patient and her family should wash their hands frequently and thoroughly and avoid crowds and people who have infections.

Doxorubicin, an antitumor antibiotic, can cause cardiotoxicity. Cardiac symptoms can develop years after treatment, so it is essential to monitor cardiac function before, during, and after doxorubicin therapy. The health care professional should instruct the patient to watch for and report palpitations, shortness of breath, or chest pain.

Doxorubicin, an antitumor antibiotic, can cause a suprainfection often manifested as fungal overgrowth in the mouth, vagina, or intestines. The health care professional should instruct the patient to watch for and report a black hairy tongue, pain in the mouth, diarrhea, and vaginal itching or discharge. Doxorubicin can cause a reddish discoloration of tears and urine, typically 1 to 2 days after therapy. Doxorubicin is a pregnancy risk category D drug, so female patients who are sexually active should use reliable contraceptive methods and report any suspicion of pregnancy. The health care professional should tell the patient to expect complete but reversible alopecia. Bone loss is not likely with doxorubicin therapy. Increasing calcium and vitamin D intake is essential with anastrozole (Arimidex), an aromatase inhibitor that causes bone loss.

Doxorubicin, an antitumor antibiotic, can cause tissue damage from extravasation. The health care professional should stop the IV infusion immediately and contact the primary care provider. Continuing the infusion, even at a slower rate, can cause further tissue damage, as can applying ice or pressure to the site. After stopping the infusion, the health care professional should monitor the patient's skin for ulceration, which can occur 1 to 4 weeks after extravasation.

Raltegravir, an integrase inhibitor, along with other antiretroviral drugs, treats HIV disease that is resistant to other drugs. Health care professionals should always give the drug along with other antiretroviral drugs.

Trastuzumab, a monoclonal antibody and a pregnancy risk category D drug, treats metastatic breast cancer with tumors that over express. This type accounts for up to 30% of metastatic breast tumors.

Paresthesias is correct. Cisplatin, a platinum compound, can cause peripheral neuropathy. The health care professional should tell the patient to report numbness, tingling, or decreased sensation in the hands or feet. Sore throat is correct. Cisplatin can cause bone marrow depression. The health care professional should tell the patient to report fever, sore throat, bruising, or fatigue. Flank pain is correct. Cisplatin can cause kidney toxicity. Prior to therapy, the health care professional should hydrate the patient with 1 to 2 L of IV fluid and continue for 24 hr following therapy to flush the kidneys and help prevent indications of kidney toxicity, such as flank pain. Tinnitus is correct. Cisplatin can cause ototoxicity. The health care professional should monitor the patient's hearing, and tell him to report hearing loss, vertigo, or tinnitus. Conjunctivitis is incorrect. Cisplatin is unlikely to cause conjunctivitis, although it can cause blurred vision, papilledema, and optic neuritis.

Wheezing is correct. Trastuzumab, a monoclonal antibody, can cause a severe allergic reaction, manifesting as hives, bronchospasm, dyspnea, and wheezing. The health care professional should have epinephrine ready to treat anaphylaxis. Dysrhythmias is correct. Trastuzumab can cause cardiotoxicity, manifesting as ventricular dysfunction, heart failure, and dysrhythmias. The health care professional should monitor the patient's ECG. Hypotension is correct. Trastuzumab can cause a severe allergic reaction, manifesting as hives, dyspnea, hypotension, and hypoxia. The health care professional should have epinephrine ready to treat anaphylaxis. Fever is correct. Trastuzumab can cause flu-like reactions, manifesting as fever, chills, nausea, and headache. The health care professional should monitor the patient's temperature. Ascites is incorrect. Trastuzumab is unlikely to cause ascites, although it can cause abdominal pain, nausea, and vomiting. The health care professional should monitor the patient's fluid and electrolyte balance.

Vincristine, a vinca alkaloid, can cause peripheral neuropathy. The health care professional should monitor deep-tendon reflexes and the strength and movement of the hands and feet. The health care professional should tell the patient to report paresthesias or reduced sensation in the hands or feet.

Clean fruits and vegetables thoroughly is correct. Imatinib, a targeted antineoplastic drug, can cause bone marrow suppression. The health care professional should tell the patient to clean fruits and vegetables carefully and completely to prevent transmission of bacteria. Increase calcium intake is incorrect. Imatinib is more likely to cause hypokalemia than hypocalcemia or bone loss. Weigh yourself daily is correct. Imatinib can cause fluid retention and weight gain. The health care professional should tell the patient to record daily weights and watch for edema. Perform hand hygiene frequently is correct. Imatinib can cause bone marrow suppression. The health care professional should tell the patient to wash hands or use an alcohol-based hand rub frequently and prevent exposure to illness. Avoid herbal supplements is correct. St John's wort can decrease imatinib levels. The health care professional should tell the patient to avoid herbal supplements and check with the primary care provider before taking any.

Administer the drug subcutaneously is correct. The health care professional should administer enfuvirtide, a fusion inhibitor, subcutaneously, twice a day. This is the only appropriate route of administration for the drug. Discard unused portion is incorrect. The health care professional should refrigerate the unused portion. The health care professional should also warm the solution to room temperature prior to giving the next dose out of the vial. Roll the vial gently to reconstitute the solution is correct. The health care professional should roll the vial of enfuvirtide gently between the palms of the hands after adding sterile water for injection. This reconstitutes the drug. Inject the solution at room temperature is correct. The health care professional may store unused solutions of enfuvirtide in a refrigerator up to 24 hr but must restore it to room temperature before injection. Expect a cloudy solution is incorrect. Enfuvirtide should be clear and without particulates after reconstitution. The health care professional should not administer a cloudy solution.

Enfuvirtide, a fusion inhibitor, treats HIV disease that is advanced or resistant to other types of treatment. Health care professionals should always give the drug along with other antiretroviral drugs.

Paresthesias is correct. Maraviroc, a chemokine receptor 5 antagonist, can cause paresthesias, dizziness, and musculoskeletal pain. Cough is correct. Maraviroc can cause a cough and upper respiratory infection. Tinnitus is incorrect. Maraviroc is unlikely to cause tinnitus. Cisplatin, a platinum compound, is an immune system drug that can cause ototoxicity and hearing loss. Jaundice is correct. Maraviroc can cause liver damage. The health care professional should tell the patient to report an allergic reaction, such as a rash, because it can precede liver damage, manifested as jaundice or abdominal pain. Fever is correct. Maraviroc can cause a fever and sinus infection.

Maraviroc, a CCR5 antagonist, acts by binding to CCR5 and preventing HIV-1 from entering the cell. It is only effective for patients who have CCR5-tropic HIV-1. It is contraindicated for those who do not have CCR5-tropic HIV-1.

Vincristine, a vinca alkaloid, can cause severe constipation and upper colon fecal impaction. The health care professional should monitor the patient's bowel function and palpate the abdomen for distention. The patient should increase fluid and fiber intake, and take stool softeners.

Delavirdine, a non-nucleoside reverse transcriptase inhibitor, can cause a rash. The health care professional should tell the patient to report a rash, which can occur 1 to 3 weeks after therapy, because it can develop into Stevens-Johnson syndrome, a potentially life-threatening complication.

Carmustine, a nitrosourea drug, can cause delayed bone marrow suppression. Thrombocytes and leukocytes reach nadirs at 4 to 6 weeks following IV infusion. The patient should use hand hygiene often and wash fruits and vegetables thoroughly. It is crucial to avoid contact with crowds and people who have communicable infections.

Methotrexate, a folic acid antagonist, can cause severe bone marrow suppression with decreased thrombocyte counts and also oral and GI ulceration. Patients should use a soft-bristled toothbrush to prevent gum bleeding and mouth trauma.

Give the patient an antihistamine is correct. Prior to administering paclitaxel, an antimitotic drug, the health care professional should give the patient an antihistamine, such as diphenhydramine, a proton-pump inhibitor, such as cimetidine (Tagamet), and a glucocorticoid, such as dexamethasone, to prevent a hypersensitivity reaction. Infuse the drug over 1 hr is incorrect. The health care professional should infuse paclitaxel over 3 hr, not 1 hr. Administer the drug through non-PVC tubing is correct. Paclitaxel is incompatible with PVC tubing. Paclitaxel (Abraxane) is compatible with PVC tubing. Use an in-line filter is correct. Paclitaxel requires administration through an in-line filter. Paclitaxel (Abraxane) does not require an in-line filter. Add heparin to the paclitaxel solution is incorrect. The health care professional should not mix paclitaxel with any other drugs. Heparin and other anticoagulants increase the risk for bleeding.

Give zidovudine, a nucleoside reverse transcriptase inhibitor, along with ritonavir, a protease inhibitor, to reduce the risk for drug resistance and to increase drug effectiveness. Monotherapy with zidovudine quickly results in drug resistance, as is also the case with monotherapy with ritonavir.

Use contraception if pregnancy is a risk is correct. Mercaptopurine, a purine analog, is a pregnancy risk category D drug. Women of childbearing age who take the drug should use contraception, and the health care professional should confirm non-pregnancy before starting therapy. Perform oral hygiene frequently is correct. Mercaptopurine can cause stomatitis. The health care professional should tell the patient to perform frequent oral hygiene to help prevent or minimize this adverse effect. Avoid activities that require mental alertness is incorrect. Mercaptopurine is unlikely to cause sedation or dizziness. Trastuzumab (Herceptin), a monoclonal antibody, is an immune system drug that can cause dizziness, which would warrant avoiding activities that require mental acuity. Perform hand hygiene frequently is correct. Mercaptopurine can cause neutropenia. The health care professional should tell the patient either to wash hands thoroughly or use an alcohol-based hand rub frequently and to avoid crowds and contact with people who have communicable infections. Avoid activities that can cause injury is correct. Mercaptopurine can cause thrombocytopenia. The health care professional should monitor patients' CBC throughout treatment, and tell them to avoid activities that can cause injury and report easy or unexplained bruising or bleeding.

Cyclophosphamide, a nitrogen mustard, is contraindicated for patients who have a fluid-volume deficit because dehydration increases the risk for renal toxicity.

All adults should receive the seasonal influenza immunization once per year. All children 6 months older and older adults should also receive this immunization once per year.

Anastrozole, an aromatase inhibitor, treats early or advanced estrogen receptor-positive breast cancer in postmenopausal women. It is contraindicated for women who are premenopausal as well as for women who are postmenopausal but are taking estrogen. Anastrozole stops tumor growth by inhibiting estrogen synthesis.

Flutamide, an androgen receptor blocker, treats early and metastatic prostate cancer. It can cause gynecomastia, or growth of breast tissue, decreased libido, and impotence.

Interferon alfa-2a, a biologic-response modifier, can cause a flu-like reaction, manifesting as fever, myalgia, and fatigue. For this effect, the health care professional should give the patient acetaminophen (Tylenol).

NSAIDs, anticoagulants, and antiplatelet drugs increase the patient's risk for bleeding while receiving topotecan, a topoisomerase inhibitor. The health care professional should advise the patient against taking aspirin, ibuprofen (Advil), and other NSAIDs during the therapy.

Tamoxifen, an estrogen-receptor blocker, can cause retinopathy, cataracts, and decreased visual acuity. Its use requires caution with patients who already have cataracts.

With the intrathecal form of cytarabine, the patient should also receive dexamethasone, a glucocorticoid, to help decrease the inflammation of the arachnoid that the drug can cause. IV dexamethasone reduces the patient's risk for neurotoxicity.