Pharmacology Unit II: Cancer Chemo – Flashcards
Unlock all answers in this set
Unlock answersquestion
what is cancer and when does it develop
answer
group of diseases characterized by uncontrollable cellular growth develops when normal cells are transformed by chemicals, viruses, or radiation and become resistant to appropriate cell division
question
defeine carcinogenesis
answer
process by which a normal cell is transformed into a cancerous cell
question
deinfe tumor promoters
answer
agents the influence the cancer cell
question
define oncogenes
answer
genes that are activated in human cancers and override regulation and drive cell proliferation
question
define malignant
answer
cells occupy space, take blood and nutrients away from normal tissues and serve no useful purpose
question
characteristics of neoplastic cells
answer
- persistant proliferation - invasive growth - formation of metastases - immortality - etiology of cancer
question
most common cancers
answer
solid tumors or breast, lung, prostate, colon, and rectum
question
growth fraction of common cacners
answer
low, respond poorly to drugs
question
rarer cancers
answer
lymphatic leukemia, Hodgkin's disease, certain testicular cancers
question
growth fraction of rarer cancers
answer
high, respond well to drugs because usually find early, quick and able to eradicate
question
normal cell reproduction
answer
- constantly reproduce in a predetermined sequence of events in response to need and stop when need is met
question
which cells are effected most when eradicating cells with chemo?
answer
those w/high reproduction rates (skin, GI tract)
question
how many phases in cell cycle?
answer
4
question
cell-specific phase-specific drugs
answer
toxic only to cells that are in particular phase - must be in blood continuously over a long time
question
cell-specific phase - non specific drugs
answer
can act during any phase of the cell cycle
question
3 steps of metastases
answer
cancer cells: 1. invade surrounding tissues/vessels 2. are transported by circulatory system to distant sites 3. reinvade and grow at new location
question
how many cancer cells do there have to be for cancer to be detectable?
answer
1 billion
question
3 cancer treatment modalities
answer
1. surgery 2. radiation 3. drug therapy (for disseminated cancers)
question
obstacles for successful chemo
answer
- toxicity to normal calls - cure requires 100% cell kill - absence of truly early detection - solid tumors respond poorly to drugs - drug resistance - heterogeneity of tumor cells - limited drug access to tumor cells
question
strategies for achieving max benefit from chemo
answer
- intermittent chemo (4-6 week period, hold off 2 weeks then come back) - combo chemo - optimizing dosing schedule
question
how to make the decision to treat cancer
answer
- benefits must outweigh the risks - patient must be given some idea of the benefits of proposed therapy - cure, prolongation of life, palliation should be possible
question
cancer chemo is more effective against big/small tumors?
answer
small
question
combo/single agent chemo produces a higher cell kill rate?
answer
combo
question
goal of chemo
answer
- to decrease the size of neoplasm so that the human immune system can deal with it - may include curing disease, decreasing tumor size, relieving symptoms, killing metastasis cells, or prolong life
question
cancer chemo cannot be justified unless:
answer
benefits outweigh potential hazards
question
combo chemo considerations:
answer
- each should be effective against specific cancer when used alone - each should have a different site of action & act at different point in cell cycle - each should have different organ toxicity (liver or kidney), or occur at different times - very few anticancer drugs are used alone - adding tissue-specific drugs allows for more anticancer effect - less likely to cause drug resistance - consecutive doses kill %age of tumor cells remaining after earlier dose
question
4 drug classes of chemo
answer
1. cytotoxic agents 2. hormone & hormone antagonists 3. biologic respons modifiers 4. targeted drugs
question
what's the largest class of anticancer drugs?
answer
cytotoxic
question
cytotoxic cancer drugs act directly on...
answer
cancer cells and healthy cells to cause their death
question
what are hormonal agents used mostly for?
answer
breast cancer and prostate cancer - mimic or block actions of exogenous hormones
question
what do biologic response modifiers do?
answer
enhance immune attack against cancer cells
question
what do targeted drugs do?
answer
bind with specific molecular targets on cancer cells to suppress tumor growth and promote cell death
question
what do glucocorticoids do?
answer
suppress the immune system, therefore effects body's ability to fight off drugs trying to eradicate chemo drugs
question
what are glucocorticoids used for?
answer
- immune system suppression - suppressing chemo-induced n/v - reduce cerebral edema - reduce pain - suppression of hypercalcemia in steroid responsive tumors - can improve appetite & promote weight gain
question
what is the most common type of cancer among US men?
answer
prostate cancer
question
prostate cancer chemo:
answer
slows disease progression and increase comfort - lower testosterone production - block testosterone receptors w/drugs
question
most common cancer effecting women in US?
answer
breast cancer
question
principle treatments of of breast cancer
answer
- surgery - radiation - cyctotoxic drugs - hormonal drugs
question
drugs for breast cancer
answer
- Nolvadex - evista
question
obstacles to successful treatment w/chemotherapy
answer
- drug toxicity - need to kill 100% of cancer cells - growth fraction of tumor - absence of early detection - drug resistance and heterogeneity of tumors - host defenses - pharmokinetics of delivery of drug
question
how are host defenses obstacles?
answer
chronic disease associated with cancer will impact how well their response is
question
patient teaching guidelines
answer
1. keep all appointment 2. avoid exposure to infection 3. improve intake of nutritious foods/well hydrated 4. electric razor to avoid bleeding 5. purchase wigs 6. take effective contraception 7. takes meds to avoid side effects 8. patient/family teaching 9. evaluate response
question
what do cytoprotective agents do?
answer
reduce adverse effects of cytotoxic drugs
question
cytoprotective agents have been developed to:
answer
protect certain body cells from 1+ of the adverse effects and allows more optimal dose and schedule (no not treat/prevent ALL diverse effects of cytotoxic drugs, and may have side effect of own)
question
5 cytoprotectice agents
answer
1. epoetin 2. neupogen 3. neumega 4. leukine 5. neulasta
question
what is epoetin used for?
answer
stimulates bone marrow to produce RBCs
question
what is neupogen used for?
answer
treatment of chemo-indued neutopenia
question
what is neumega used for?
answer
prevent thrombocytopenia
question
what is leukine used for?
answer
decrease neutropenia & risk of infection
question
what is neulasta used for?
answer
increase # of leukocytes
question
5 drugs used in the supportive therapy of cancer patients
answer
1. allopurinol (used in gout - inhibits uric acid formation) 2. analgesics (relieve pain) 3. antimetics 4. drugs to control direct drug toxicity 5. drugs to control hypercalcemia
question
2 major toxicities of cancer chemotherapy
answer
1. bone marrow suppression (neutropenia, thrombocytopenia, anemia) 2. digestive tract injury stomatitis (n/v, diarrhea) 3. myleosuppression
question
other major side effects of cancer chemotherapy
answer
- alopecia - hyperuricemia - reproductive toxicity - local injury from extravasation - unique toxicities - carcinogenesis
question
what is myelosuppression
answer
an expected & signification adverse effect of most antieoplastic therapy - the extant of hematopoietic depression depends on nadir of cell line and survival of cells - may result in granulocytopenia & thrombocytopenia (both life-threatening)
question
general guidelines for managing chemo induced emesis
answer
1. determine emetogenis potential of drug 2. when combo agents are given, give antiemetic appropriate for the chemotheraputic agent with the highest risk 3. for acute emesis, the agents with the highest TI are the seretonin antagonists 4. oral route is as effective as the IV route 5. for acute emesis with high rush agents, the combo of seretonin antagonist and cortocosteroid is recommended
question
chemo complications
answer
- anorexia - alopecia - mucositis - infection - fatigue - bleeding - extravasations - hyperuricemia - pain - constipation
question
define anorexia (r/t chemo)
answer
loss of appetite usually bc of a bitter taste in mouth
question
define alopecia (r/t chemo)
answer
varying degrees of hair loss may occur after the 1st/2nd treatment
question
define mucositis (r/t chemo)
answer
prone to super infections
question
define infection (r/t chemo)
answer
low WBC (neutropenia-- neutraphils are primary WBC that fights infection)
question
define bleeding (r/t chemo) treatment?
answer
low platelet count (thrombocytopenia) treatment: transfusion
question
define extravasation (r/t chemo) treatment?
answer
sluffing off of skin treatment: oil, vasoline lotion
question
treatment of hyperuricemia
answer
allopurina
question
treatment of pain
answer
opiods/analgesics
question
treatment of constipation
answer
stool softner, high fiber diet and water
question
avoid drug interactions involving:
answer
cytochrom P-450 metabolism
question
P-450 works in which organ?
answer
liver
question
the dose of certain drugs needs adjustment if there is impairment in the ____ or the ____.
answer
kidney (renal) of liver (hepatic)
question
liver (hepatic) lab tests:
answer
AST ALD
question
kidney (renal) lab tests:
answer
BUN creatine
question
guidelines for handeling cytotoxic antieoplastic drugs:
answer
- do not prepare drugs in eating area - avoid eye contact with solution by wearing gloves, eye protectors, protective clothing's - wear mask to avoid inhaling th powder form of a drug - dispose of contaminated materials - wear gloves when handling patients' bedding, clothing, blood/body fluids - follow procedures for cleaning spills
question
cancer drugs in children are based on:
answer
weight
question
older adults are at a higher risk for:
answer
infection and toxicity start low, go slow
question
be extremely cautious in ___ & ___ impaired patients
answer
renal and hepatic
