Study Island – Pharmacology: Chemotherapy – Flashcards
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D. The patient most likely has at least one other unrelated condition. Explanation: Older adults are more likely than younger adults or children to have more than one medical condition as a simple consequence of aging. This means that a patient may be taking several drugs at a time to treat different conditions. It is important for doctors to know which drugs a patient is taking to prevent drug-drug interactions.
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A 70-year-old man has lymphoma. Based on this patient's age, which of the following statements is true? A. The patient is unlikely to comply with his drug therapy. B. The patient cannot receive anticancer drugs through a central line. C. The patient will require higher doses of anticancer drugs. D. The patient most likely has at least one other unrelated condition.
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5-fluorouracil Explanation: Patients receive leucovorin, a folic acid analog, by injection. This drug helps increase the effects of 5-fluorouracil when patients take them together. This means the patient will need a lower dose of 5-fluorouracil to obtain therapeutic effects of this drug. Patients may conversely receive a very high dose of methotrexate and then receive something called a leucovorin rescue in which the leucovorin protects the healthy cells from the damaging effects of the high dose of methotrexate.
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If a cancer patient takes this cytotoxic drug in conjunction with leucovorin, the patient will require lower doses of this cytotoxic drug. What cytotoxic drug is described?
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C. Cytotoxic agents Explanation: While all of these examples may be utilized in cancer treatment, drugs called cytotoxic agents are those most commonly used in the treatment of cancer. The root "cyt/o" means cell and "tox/o" means poison; therefore cytotoxic drugs are toxic to cells within the body. Cancer refers to a series of disorders that damage the body at the cellular level. As a pharmacy technician, you may hear the terms cancer chemotherapy, or simply chemotherapy, used to mean cytotoxic drugs.
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Which of the following drug classes are used most frequently in the treatment of cancer? A. Hormone agonists B. Hormones C. Cytotoxic agents D. Biologic response modifiers
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C. The patient will have postsurgery chemotherapy. Explanation: Adjuvant therapy refers to a secondary treatment with cancer chemotherapy. Adjuvant therapy begins once the patient has completed his or her primary treatment. For example, surgery to remove the patient's tumor would be the primary treatment; beginning a course of treatment with the drug tamoxifen would be a form of adjuvant therapy.
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A patient with breast cancer is about to begin adjuvant therapy as part of her treatment plan. This most likely means the patient will do which of the following? A. The patient requires radiation therapy. B. The patient has finished her drug treatment. C. The patient will have postsurgery chemotherapy. D. The patient will have surgery.
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D. A class II laminar flow biological safety cabinet Explanation: A class II laminar flow biological safety cabinet is necessary during the preparation of cytotoxic drugs because it ensures the sterility of the product while at the same time protecting the pharmacist or pharmacy technician from contact with the drug. It works by containing the drug and filtering incoming and exhaust air through a HEPA filter which is vented outside. In addition to protecting pharmacy personnel from accidental splashes, it also prevents them from inhaling an aerosolized drug.
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Which of the following is most important when preparing cytotoxic drugs? A. A horizontal laminar flow work bench B. A clutter-free compounding area C. A room with a HEPA filter D. A class II laminar flow biological safety cabinet
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They cause severe skin injury. Explanation: Vesicant drugs cause severe skin injury. The actual definition is an agent that causes blistering. Because of this extreme adverse effect, patients receive vesicant drugs through IV. However, it is important for nurses or other healthcare professionals to monitor the site of IV administration for extravasation, or leakage of the drug into the surrounding tissue, because this would lead to injury.
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The anticancer drugs vincristine and mitomycin are known as vesicants. What does this mean?
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C. Cisplatin Explanation: Platinum compounds are anticancer drugs that contain platinum. They destroy cancer cells by altering the structure of DNA cancer cells, similar to alkylating agents. Patients with advanced bladder cancer, testicular cancer, and ovarian cancer may take cisplatin. Examples of platinum compounds include cisplatin, carboplatin, and oxaliplatin. It may be helpful to remember that each of the compound names includes the word "platin."
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Which of the following drugs that is used in cancer treatment is referred to as a platinum compound? A. Topotecan B. Cyclophosphamide C. Cisplatin D. Bleomycin
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By injection Explanation: Patients with certain types of cancer may take the drug palifermin (Kepivance) prophylactically to ease the severity of stomatitis, which is the inflammation of the mucous linings of the mouth and throat that is a common side effect of chemotherapy. It is administered by intravenous injection only.
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A hospital pharmacy receives a drug order for palifermin (Kepivance) for a cancer patient. How is this drug administered?
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She has severe rheumatoid arthritis. Explanation: While methotrexate treats certain types of cancer, it is also effective for severe cases of rheumatoid arthritis (RA). When used for the treatment of RA, this drug is considered a disease-modifying antirheumatic drug (DMARD). Patients generally receive a dose of Rheumatrex (methotrexate) once a week, either by mouth or by injection.
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Although the patient does not have cancer, she has a prescription for methotrexate. Why would this patient have a prescription for this drug?
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A. They are only effective at a particular phase of the cell cycle. Explanation: Cell cycle specific (CCS) drugs are often used in cancer treatment. As their name suggests, they are effective at different parts of the cell cycle. This means, for example, that some CCS drugs may interfere with DNA synthesis while other CCS drugs may prevent mitosis, or cell division.
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Which of the following is true about cell cycle specific (CCS) drugs? A. They are only effective at a particular phase of the cell cycle. B. They are typically administered to outpatients. C. They do not cause many adverse effects. D. They are most effective during the metaphase of the cell cycle.
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A. Antineoplastics Explanation: Drugs used in cancer treatment have a range of mechanisms of action. As a whole, they are known as antineoplastics, with the prefix "anti-" meaning "against" and the term "neoplasm" meaning "new growth." Thus, antineoplastic drugs are designed to work against malignant (cancerous) neoplasms.
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As a group, anticancer drugs are known by which of the following terms? A. Antineoplastics B. Alkylating agents C. Antimetabolites D. Chemotherapeutics
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B. Herpes simplex type I Explanation: Many things can cause cancer, including exposure to carcinogens or cancer-causing substances such as UV light, x-rays, tobacco smoke, and even some drugs. Other possible causes of cancer include certain pathogens (bacteria and viruses) and heredity.
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Which of the following would not be considered a carcinogen? A. Arsenic B. Herpes simplex type I C. Tobacco smoke D. UV light
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A. Cornea Explanation: Anticancer drugs cause a range of adverse effects because they harm both healthy and cancerous cells within the body. Certain body tissues are more susceptible to harm than others. These include cells that normally grow more rapidly than others, such as the bone marrow, hair follicles, gastrointestinal epithelium (lining), and cells that make sperm.
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Cytotoxic drugs are least likely to have a toxic effect on which of the following body tissues? A. Cornea B. Hair follicles C. Bone marrow D. GI epithelium
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Breast and prostate Explanation: Hormonal agents work by either blocking or mimicking the actions of hormones within the body. In cancer treatment, they are used most frequently to treat breast and prostate cancer. For example, gonadotropin-releasing hormone (GnRH) agonists block the testes' production of androgens, while antiestrogens block the production of estrogen.
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Hormonal agents are most often used in the treatment of which types of cancer?
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B. Alopecia Explanation: Cancer chemotherapy has many serious side effects. While alopecia, or hair loss, is likely one of its most emotionally and psychologically upsetting consequences, it will not cause the patient serious physical harm. As a pharmacy technician and health care professional, you must be mindful of how upsetting alopecia may be for your patients and treat them with consideration.
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Which of the following common side effects of cancer chemotherapy is least physically harmful to a patient? A. Anemia B. Alopecia C. Thrombocytopenia D. Neutropenia
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C. Nucleotide analogs Explanation: Antimetabolites are analogs of natural metabolites. This means they are structurally similar to a natural substance, such as folic acid. They are useful in cancer treatment because some of the cancer cells will attach to the antimetabolite drug, instead of to the real metabolite, and be unable to replicate. Folic acid analogs, purine analogs, and pyrimidine analogs are all examples of antimetabolites that are used to treat cancer.
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Which of the following is not one of the subcategories of antimetabolite used in cancer treatment? A. Folic acid analogs B. Pyrimidine analogs C. Nucleotide analogs D. Purine analogs
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C. They only target neoplastic cells within the body. Explanation: While anticancer drugs are meant to target neoplastic, or cancerous cells, they unfortunately target healthy, normal cells as well. This is because cancerous and noncancerous cells resemble each other, making it impossible for drugs to target only the cancerous cells. Oncologists, physicians, and other medical personnel who treat cancer need to be mindful that the drugs they are prescribing for cancer patients will destroy healthy cells along with malignant ones.
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Which of the following statements about anticancer drugs is false? A. They are most effective against proliferating cells. B. They are less effective on solid tumors than on leukemias. C. They only target neoplastic cells within the body. D. They may eventually cause drug resistance.
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B. Reglan (metoclopramide) Explanation: Doctors may prescribe the drug Reglan to ease the nausea associated with cancer chemotherapy. This drug is a prokinetic agent which works by making food travel more quickly through the digestive system.
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A hospital pharmacy receives a drug order for an antiemetic for a cancer patient. The order would be for which of the following drugs? A. Adriamycin (doxorubicin) B. Reglan (metoclopramide) C. VePesid (etoposide) D. Epogen (epoetin alfa)
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A. Periwinkle plant Explanation: Certain drugs that originate from plant extracts are used to treat cancer. These include the vinca alkaloids, which come from the periwinkle (vinca rosea) plant, and the taxanes, which come from the bark of the Pacific yew tree. These drugs, known as mitotic inhibitors, kill cancer cells by stopping cell division during the M, or mitosis, phase.
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The vinca alkaloid Oncovin (vincristine) originates from which of the following? A. Periwinkle plant B. Slippery elm bark C. Pacific yew D. May apple
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B. Biologic response modifiers Explanation: Roferon-A (interferon alfa-2a) is an immunostimulant that works by stimulating the body's immune response, so it is a biologic response modifier. These drugs work by altering the way a patient's body reacts to cancer. For example, Roferon-A improves the body's immune system response to cancer cells while also preventing cancer cells from spreading, or proliferating, within the body.
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Roferon-A is an example of an immunostimulant that is used to treat certain types of cancer. Based on this information, this drug most likely belongs to which category of anticancer drugs?
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Prostate cancer Explanation: Flutamide is an example of a hormonal agent that is used to treat prostate cancer. Patients usually take this drug, which comes as a capsule, in conjunction with a luteinizing hormone-releasing hormone agonist, or LHRH.
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A patient arrives at the pharmacy with a prescription for flutamide. What is this drug used to treat?
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B. Alkylating agents Explanation: Alkylating agents work by attaching to the DNA strands of cancer cells, which is called alkylation. Once attached, they permanently coordinate to the DNA's structure and make it difficult or impossible for the tumor cells to replicate. Cyclophosphamide (Cytoxan) is the drug prototype for alkylating agents. Patients who are being treated for lymphomas, leukemias, breast cancer, and other types of cancers may have a prescription for this drug.
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Which of the following categories of drugs used to treat cancer works by changing the shape of DNA in cancer cells? A. Hormones B. Alkylating agents C. Antitumor antibiotics D. Antimetabolite agents
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B. Hyperuricemia Bone marrow suppression (BMS) is a serious adverse effect of cancer chemotherapy with cytotoxic drugs. BMS occurs when cytotoxic drugs kill different types of blood cells within the bone marrow. This may lead to anemia, or the loss of red blood cells (erythrocytes). It may also cause excessive bleeding, a condition called thrombocytopenia that is caused by a reduction in platelets. Finally, it may cause neutropenia, or a loss of neutrophils which places a patient at risk for serious infection. Hyperuricemia is a condition caused by excessive uric acid in the blood.
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Which of the following conditions that may be caused by cytotoxic drugs is not an example of bone marrow suppression? A. Neutropenia B. Hyperuricemia C. Anemia D. Thrombocytopenia
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D. Antimetabolite Explanation: Methotrexate is an antimetabolite. Its mechanism of action is to interfere with cancer cells' ability to synthesize DNA, which disrupts their metabolic pathways and ultimately destroys them. Methotrexate specifically interferes with the cancer cells' synthesis of folic acid; it is therefore called a folic acid analog. Patients with certain types of cancers, such as lung, breast, or lymphoma may take methotrexate. This drug may also be used to treat severe cases of both rheumatoid arthritis and psoriasis.
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The drug methotrexate is categorized as which of the following? A. Antitumor antibiotic B. Hormone C. Alkylating agent D. Antimetabolite
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Protection against genital human papillomavirus (HPV) Explanation: Female patients may be vaccinated with Cervarix to protect them against the genital human papillomavirus (HPV). This virus causes cervical cancer in about 10,000 women in the U.S. according to the National Institutes of Health (NIH). This vaccine stimulates the body's immune system to fight off HPV. Gardasil is another vaccine that works in a similar way to Cervarix.
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Why is the drug Cervarix prescribed?
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B. That tamoxifen may increase a woman's risk of endometrial cancer Explanation: Following clinical trials, the FDA approved tamoxifen, sold as Nolvadex, for cancer prevention in women who are at high risk of developing breast cancer. However, because it poses a risk of causing endometrial cancer, DVT, and pulmonary embolism, this drug is not an appropriate choice for all women. The pharmacist should counsel this patient to discuss her risk level with her doctor.
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A woman with a family history of breast cancer arrives at the pharmacy with a question for the pharmacist about taking tamoxifen to prevent breast cancer. It is important for the patient to know which of the following? A. That tamoxifen has been removed from the market because it causes DVT B. That tamoxifen may increase a woman's risk of endometrial cancer C. That tamoxifen will only help prevent breast cancer post-menopause D. That tamoxifen is only effective in treatment of HER2 positive cancer cells
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B. Cisplatin Explanation: While killing cancer cells, anticancer drugs also harm healthy cells within the body. Some drugs have a higher risk of toxicity to specific areas within the body. For example, the platinum compound cisplatin, sold under the trade name Platinol-AQ, is known to cause severe kidney damage, or renal toxicity, as well as hearing loss. For this reason combination drug therapies do not include drugs with overlapping toxicities.
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Which of the following anticancer drugs is toxic to the kidneys? A. Vincristine B. Cisplatin C. Doxorubicin D. Bleomycin
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D. Tamoxifen Explanation: Tamoxifen, sold as the trade name Nolvadex, is an anti-estrogen drug. It is commonly used to treat breast cancer that has spread to other parts of the body, or as an adjuvant therapy following surgery. Patients take this drug as a tablet by mouth. The FDA has also approved its use to prevent breast cancer in women with a family history of the disease.
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Which of the following is an anti-estrogen drug used in the treatment of breast cancer? A. Flutamide B. Estropipate C. Medroxyprogesterone acetate D. Tamoxifen
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A. They have a high level of toxicity to healthy cells. Explanation: Hormonal agents used to treat cancer target specific hormone receptors in body tissues. This characteristic makes them less toxic to healthy cells than other anticancer drugs that are not specifically targeted to specific hormone receptors. However, this does not mean that anticancer hormonal agents do not cause adverse effects of their own. For example, while the drug tamoxifen may prevent breast cancer, it may also cause endometrial cancer, DVT, and pulmonary embolism.
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Which of the following statements about hormonal anticancer drugs is false? A. They have a high level of toxicity to healthy cells. B. They act on specific hormone receptors in body tissues. C. They are frequently used in adjuvant cancer treatment. D. Their effectiveness is not tied to a certain cell cycle phase.
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C. Using a combination of drugs means that patients will not need surgery. Explanation: Many cancer patients take more than one anticancer drug at a time during the course of their treatment. However, for this approach to be effective, each drug must have a different mechanism of action, or work against the malignant cells in a different way. This helps kill more cancer cells at a time. It is also important that the different drugs do not share the same toxic effects. For example, administering two drugs that cause neutropenia, or a reduction of white blood cells, to a patient could have serious or deadly consequences.
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Which of the following would not be considered a benefit of using a combination of drugs to treat cancer? A. It is less likely that drug resistance will develop when using multiple drugs. B. Using multiple drugs at once will kill more cancer cells than using one drug. C. Using a combination of drugs means that patients will not need surgery. D. Using a combination of drugs ultimately harms fewer healthy cells.
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D. Wash the area with soap and water, then see her physician. Explanation: Pharmacy personnel, physicians, nurses, and anyone else who comes into contact with hazardous cytotoxic drugs must follow strict precautions to avoid injury. Remember, these drugs are intended to kill cells. In the example above, the pharmacy technician should first wash the affected area with soap and water and then seek an evaluation by her doctor. Abrading the area is not recommended because it could cause further injury to the tissue.
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A pharmacy technician who is preparing a cytotoxic drug has accidentally spilled some of it on her skin. She should do which of the following? A. Wash the area with soap, then use isopropyl alcohol to further clean the area. B. Use a scrub brush to abrade the area, then clean the area with isopropyl alcohol. C. Use a scrub brush to abrade the area, then see her physician. D. Wash the area with soap and water, then see her physician.
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B. Aromatase inhibitors Explanation: Cytotoxic drugs work by killing cancer cells within the body. They also have the unfortunate effect of killing healthy cells as well, which leads to toxic effects in cancer patients and to hazards for healthcare professionals who handle the drugs as part of patient care. Aromatase inhibitors, on the other hand, are an example of hormonal agents that are used to treat some forms of cancer. Instead of killing cells, these drugs either block or mimic specific hormones produced by the body.
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Which of the following drugs used to treat cancer is not a cytotoxic drug? A. Antimetabolites B. Aromatase inhibitors C. Mitotic inhibitors D. Alkylating agents
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D. IV Explanation: Because antitumor antibiotics are poorly absorbed by the gastrointestinal (GI) system, they are administered to patients by IV. Antibiotic drugs in this category are more toxic than regular antibiotics, so their use is restricted to treating both solid tumors and some disseminated cancers, such as leukemias.
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Antitumor antibiotics are administered to patients through which of the following routes? A. IM B. IV and PO C. IM and TD D. IV
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C. Bone marrow depression Explanation: Bone marrow depression, or dangerously low blood cell level counts, is a major side effect of antineoplastic drugs. This occurs because the drugs cannot discriminate between normal and abnormal cells, so normal bone marrow cells are destroyed as a result of the cancer treatment. Other healthy cells that are typically damaged by antineoplastic drugs include hair follicles, mucous membranes in the GI tract, and germinal epithelial cells, or the cells responsible for reproduction in females and males.
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Which of the following is a major side effect of antineoplastic drugs? A. Anaphylaxis B. Hemorrhagic cystitis C. Bone marrow depression D. Hypertension
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A. Breast Explanation: Patients with breast cancer may receive fulvestrant, sold under the trade name Faslodex, by injection. More specifically, this drug is effective in treating hormone receptor positive breast cancer that has not responded well to treatment with antiestrogen drugs. Patients using this medication also need to have completed menopause in order for the drug to be effective.
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The drug fulvestrant is used to treat which of the following cancers? A. Breast B. Ovarian C. Testicular D. Prostate
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To treat nausea related to chemotherapy Explanation: Chemotherapy may cause a number of side effects in patients, including nausea and vomiting. While Compazine (prochlorperazine) is categorized by the FDA as an antipsychotic, it is also used as an antiemetic in cancer treatment because it is helpful in preventing the side effect of severe nausea and vomiting. Patients who take an antiemetic while on chemotherapy may be more likely to comply with their drug treatment because the antiemetic eases the debilitating effects of cytotoxic drugs.
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A cancer patient with Hodgkin's disease arrives at the pharmacy with a prescription for Compazine (prochlorperazine). Why would the patient be taking this drug?
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A. Antimetabolites Explanation: Antimetabolites are antineoplastic drugs that interfere with the production of DNA, RNA, and proteins the cells need to reproduce in cells that are involved in metabolism. They are most often used to treat malignant tumors and hematologic cancers, like leukemia.
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Which category of antineoplastic drugs affects the production of DNA? A. Antimetabolites B. Alkylating agents C. Antibiotics D. Hormonal agents
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D. Antitumor antibiotics Explanation: Doxorubicin is an example of an antitumor antibiotic. Drugs in this group work by altering the DNA structure of cancer cells, preventing them from replicating. Patients receive this drug through IV infusion. Some brand names for doxorubicin are Adriamycin PFS, Adriamycin, Doxil, and Rubex.
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Doxorubicin may be categorized as belonging to which of the following groups? A. Antimetabolites B. Alkylating agents C. Mitotic inhibitors D. Antitumor antibiotics
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Sarcoma Explanation: Cancer that is found in bone or muscle tissue is referred to as a sarcoma. The word root "sarc/o" means flesh, and the suffix "-oma" means tumor. Medical professionals name cancerous tumors based on their location in the body. For example, chondrosarcoma is cancer of the cartilage
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What is the term for a type of cancer that is found in bone or muscle tissue?
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C. Mitotic inhibitors Explanation: Docetaxel is an example of a mitotic inhibitor. This drug class is further subdivided into taxanes, including docetaxel, and vinca alkaloids, including vinblastine. Patients receive docetaxel through IV injection. It is used frequently in the treatment of prostate cancer.
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The drug docetaxel is an example of which of the following cytotoxic drug classes? A. Antimetabolites B. Alkylating agents C. Mitotic inhibitors D. Platinum compounds
