Pharmacology, Unit 4, Ch. 45 – Cancer Drugs (Cell-Cycle Specific) – Flashcards
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What is a primary lesion of cancer?
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Original site of growth
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What is a neoplasm?
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Basically a tumor. A mass of new cells. "New tissue."
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What is the difference between a tumor being benign or being malignant?
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Malignant is cancerous.
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Difference between carcinomas and sarcomas?
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They both just describe the tissue of origin of the cancer, but - Carcinomas: Epithelial tissue like skin, GI, or lungs. Sarcomas: Connective like bone, cartilage, muscle, lymph, vascular.
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What are lymphomas and leukemias known as?
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Circulating tumors or hematologic malignancies.
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What are paraneoplastic syndromes?
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Variuos groups of symptoms that cannot be directly attributed to spread of a cancerous tumor. May be the first sign of malignancy.
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Examples of paraneoplastic syndrome symptoms?
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Cachexia (wasting syndrome... so loss of weight/muscle, etc.), fatigue, fever, chills night sweats, SOB, cough, GI disturbances, pain.
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What are 2 examples of genetic cancers, ethnic cancers, and oncogenic viruses?
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Genetic: breast and colon cancer. Ethnic: Burkitts, and nasopharyngeal cancer. Oncogenic viruses: HPV, and Epstein Barr virus.
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Explain the cancer cell growth cycle?
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G0: resting phase G1: first gap phase S: Synthesis phase G2: second gap phase M: Mitosis phase (cell reproduction)
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Cancer treatment?
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Surgery, radiation, chemotherapy.
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What is chemotherapy?
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Antineoplastic pharmacologic treatment of cancer..... Divded into 2 groups based on where in the cellular life cycle they work (either cell cycle - nonspecific [CCNS], or cell cycle - specific [CCS]).
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When not all of the tumor is killed with the chemotherapy, what do you do?
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Sometimes our immune systems may clear the remaining tumor, but when this total cure is not possible, the primary goal of therapy is to control growth of the cancer while maintaining the best quality of life for patient with least possible level of discomfort/leave adverse effects.
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Cell cycle-specific (CCS) drugs do what?
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Cytotoxic during a specific cell-cycle phase. Treats a variety of solid and/or circulating tumors (antimetabolites, mitotic inhibitors, alkaloid topoisomerase II inhibitors, topoisomerase I inhibitors, and antineoplastic enzymes).
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Cell cycle-nonspecific (CCNS) drugs do what?
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Cytotoxic during any cell-cycle phase. Have hormonal and radioactive antineoplastic agents.
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True or false, single drug therapy is more effective than combination of drugs to attack cancer?
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False, combination therapy is much more effective against cancer.
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Do chemotherapy drugs have a narrow therapeutic index?
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Yes
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What can chemotherapy cause?
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Dose-limiting adverse effects to GI and bone marrow and hair.... Alopecia, emetic potential, myelosuppression, bone marrow suppression/depression, nadir (lowest level of WBCs in blood after chemotherapy or radiation),
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Why is knowing nadir important?
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Anticipate this to guide the timing of prophylactic administration of antibiotics and blood stimulants...
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Typical contraindications for anti-neoplastic drugs?
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With the fatal outcome of most cancers, there are typically no complete contraindications, like even if they are allergic to it, we will still give them this treatment bc it's either this or they die. But generally: Very low WBC, ongoing infectious process, severely poor nutrition/hydration, reduced kidney/liver function, or decline in organ function.
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If you are going to give a chemotherapy or something like that during pregnancy, when should you?
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Pregnancy category D. The 1st trimester is the worst to give it. 2nd or 3rd would be better.... whether you give the chemotherapy drugs or not depends on risk-reward scenario.
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Antimetabolites are what (either CCS or CCNS), and do what?
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They are CCS analogues (work primarily in S phase of cell cycle, when DNA synthesis is most active).
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What are some examples of antimetabolites?
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Folate (folic acid) antagonists: Methotrexate, pemetrexed, Palatrexate. Purine antagonists: F-AMP, 6-MP, 6-TG, Cladribine, and Pentostatin. Pyrimidine antagonists: 5-FU, ara-C, FUDR, Capexitabine, and Gemcitabine.
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What do folic acid antagonists (Methotrexate) do?
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Interfere with use of folic acid. So DNA doesn't get produced and the cell dies.
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What is methotrexate in particular used for?
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Solid tumors of breast, head, neck, and lung cancers, acute lymphocytic leukemia, and non-hodgkin's lymphoma; and ALSOOOO RA and psoriasis.
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What happens when high doses of methotrexate? What is Methotrexate always given in conjunction with?
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Severe bone marrow suppression and is always given in conjunction with "rescue" drug leucovorin.
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Methotrexate interactions?
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Salicylates, sulfonamides, sulfonylureas, phenytoin, PCN, NSAIDS (these lead to toxicity).
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(still an antimetabolite) Purine antagonists (F-AMP, 6-MP, 6-TG, Cladribine, and Pentostatin) do what?
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Interrupts metabolic pathways of purine nucleotides which interrupts DNA and RNA synthesis. Can cause Tumor lysis syndrome.
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Antimetabolites indications?
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Various types of cancer, such as solid tumors and some hematologic cancers. Acute/chronic lymphocytic leukemias: Colon, rectal, breast, stomach, lung, pancreatic. (Remeber that methotrexate [a folate antagonist] is ALSO used to treat severe cases of psoriasis and rheumatoid arthritis).
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Oral and topical antimetabolite forms indications?
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Low-dose maintenance and palliative cancer therapy.
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Antimetabolites adverse effects?
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Alopecia, N/V, myelosuppression, toxicity in like every body system, tumor lysis, palmar-plantar dyesthesia (hand-food syndrome), Stevens-Johnson syndrome, and toxic epidermal necrolysis.
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Where were most mitotic inhibitors obtained from and what are some examples?
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Periwinkle plant Ex.: Vinca alkaloids (vinblastine, vincristine, and vinorelbine), and Taxanes (Paclitaxel, docetaxel, cabazitaxel, and Eribulin. Docetaxel (European yew tree: needles) Paclitaxel (Western yew tree: bark)
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Mitotic inhibitors mechanism of action?
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Can work in late S phase, throughout G2 phase, and M phase. All work shortly before or during mitosis and thus retards cell division.
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Mitotic inhibitors indications?
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Often used in combination therapies. Treats testicular, ovarian, small cell lung, and non-small cell lung cancers...... Kaposi's sarcoma, and acute leukemia.
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Mitotic inhibitors adverse effects?
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Alopecia N/V, myelosuppression, liver/kidney/lung toxicities, convulsions, extravasation.
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Alkaloid Topoisomerase II inhibitors do what?
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Treat small cell lung cancer and testicular cancer.
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Are alkaloid Topoisomerase II inhibitors used much now? Why?
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No, significant toxicities w/o therapeutic benefit.
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Topoisomerase 1 inhibitors (Camptothecins) treat/do what?
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Ovarian and colorectal cancer. They inhibit proper DNA function in S phase, which prevents DNA relegation. (????)
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2 examples of Topoisomerase 1 inhibitors (Camptothecins)?
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Topotecan, and Irinotecan.
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Topoisomerase 1 inhibitors (Camptothecins) adverse effects?
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Severe diarrhea (cholinergic diarrhea) is the main one apparently.... Irinotecan causes the most severe diarrhea.. May be delayed, so like 2-10 days after infusing Irinotecan. Can be even life-threatening diarrhea. The worst craps you've had in your life!
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What should the aggressive diarrhea with Topoisomerase 1 inhibitors (more specifically Irinotecan) be treated with?
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Loperamide (Imodium).
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Topoisomerase 1 inhibitors (Topotecan, and Irinotecan) indications?
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Ovarian and colorectal cancer, small cell lung cancer, others.
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Topoisomerase 1 inhibitors (Topotecan, and Irinotecan) adverse effects?
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Topotecan: Bone metastasis, mild to moderate N/V/D, HA, rash, muscle weakness, cough. Irinotecan: More severe... Cholinergic diarrhea (real bad), moderate risk of N/V, and hematologic effects.
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What are antineoplastic enzymes?
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They're synthesized using cultures of bacteria and recombinant DNA technology, which produces this enzyme..... It is isolated and purified for clinical use.
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What are 3 examples of antineoplastic enzymes and what are they used for?
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Asparaginase: Acute lymphocytic leukemia Pegaspargase: Basically the same thing as Asparaginase, but this is prescribed to those who have an allergy to Asparaginase. Erwinia Asparaginase: Available only by special request from National Cancer Institute for patients who have developed allergic reactions to E-Coli based Asparaginase.
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Antineoplastic enzymes indications?
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Acute lymphocytic leukemia.
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Antineoplastic enzymes adverse effects?
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Impaired pancreatic funciton, which can lead to hyperglycemia and severe or fatal pancreatitis, dermatologic, hepatic, GI/GU, neuro, musculoskeletal, and CV.
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Nursing implications:
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Fever is early sign of infection, so take temperature at least q 4 hours during periods when patient is at risk of infection. Make sure foods that these patients are cooked well and are clean and all that good stuff.... also avoid patients who recently have been vaccinated (like herpes zoster, since it is a live vaccine). Remember, anemia may result in fatigue.
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When do antiemetics work best?
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If given 30-60 minutes BEFORE chemotherapy is started.
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If stomatitis occurs in patient receiving chemo drug, then make sure you do what all interventions?
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Examine mouth for bleeding and stuff, oral hygiene before and after eating, avoid lemon/glycerin/undiluted peroxide or alcohol containing products, use soft bristle toothbrush, avoid spicy/acidic/hot foods/alcohol/tobacco.
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True or false, women of childbearing age will need to use a nondrug form of contraception during cancer therapy?
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True.
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The nurse is caring for a patient who received chemotherapy 24 hours ago. The patient's white blood cell count is 4,400 mcL. Which symptom, if experienced by the patient, should the nurse report to the prescriber immediately? Fatigue Diarrhea Fever Nausea and vomiting
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Fever
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The nurse identifies which of the following as the most significant neurotoxin of the cytotoxic drug class? paclitaxel (Taxol) docetaxel (Taxotere) vincristine (Vincasar PFS) etoposide (Toposar)
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Vincristine (Vincasar PFS)
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Which condition does the nurse anticipate when assessing a patient with tumor lysis syndrome? Hyperuricemia Hypophosphatemia Hypokalemia Hypercalcemia
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Hyperuricemia
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A patient who is receiving high-dose chemotherapy with methotrexate is also receiving leucovorin. The purpose of the leucovorin is to? produce an additive effect with the methotrexate by increasing its potency against the cancer cells. reduce the incidence of cardiomyopathy caused by the methotrexate. add its antiinflammatory effects to the treatment regimen. reduce the BMS caused by the methotrexate.
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Reduce the BMS caused by the methotrexate Rationale: Leucovorin "rescue" is prescribed to reduce the BMS that is associated with high-dose methotrexate therapy.
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A pregnant woman has been diagnosed with cancer and is meeting with her oncologist to plan treatment. Which statement about chemotherapy and pregnancy is true? She will have to wait until the baby is born before starting chemotherapy. The greatest risk of fetal harm from chemotherapy is during the third trimester. Chemotherapy treatment during the second or third trimester poses less risk to the fetus. Chemotherapy is unsafe during pregnancy, but radiation therapy is safe in low doses.
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Chemotherapy treatment during the second or third trimester poses less risk to the fetus.
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When working with a patient who is neutropenic, the nurse identifies which as the most effective measure to prevent the patient from developing an infection? Administer prophylactic antibiotics. Stop administration of the chemotherapeutic drug. Perform hand hygiene. Vaccinate the patient to prevent bacterial infection.
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Perform hand hygiene.
