PRINCIPLES OF CHEMOTHERAPY
Which are the cancer cells that respond BETTER to chemotherapy, those with a HIGH growth fraction or those with a LOW growth fraction?
HIGH growth fraction cells respond better to chemo, meaning they are most easily killed by it, since they replicate more rapidly (and most chemo drugs target a particular stage in the cell replication cycle, not the dormant (G-zero) phase)
TRUE OR FALSE: While chemo drugs are "nonselective," newer research has developed other types of drugs that are "targeted" and able to bind specifically with cancer cells and destroy them
TRUE
In the unit, the major players that are the focus of intensive research into "targeted drugs" are the "-MABs" (like rituximab) and "-NIBs" (like imatinib)
Which are the TWO SPECIFIC types of cancer that were described in this unit as being treated by drugs that are "hormonal agents" (SELECT ALL THAT APPLY):
(a) breast cancer
(b) colon cancer
(c) prostate cancer
(d) bone cancer
(e) liver cancer
(A) BREAST CANCER
and
(C) PROSTATE CANCER
A patient receiving chemotherapy for the very first time is concerned about when they might expect to experience hair loss (ALLOPECIA), and whether or not that hair loss may be permanent. What do you tell them about the timing and duration of this expected side effect?
Allopecia normally starts SEVEN TO TEN DAYS after the start of chemo treatment. It may take up to several months after the very last dose of chemo treatments before the hair grows back, but the condition is generally NOT PERMANENT, it is just TEMPORARY
TRUE OR FALSE: It is important to "tighten down" and "closely watch" IV sites and connections during all types of IV chemotherapy due to the bodily harm that may arise if chemo drugs do not properly get delivered into the proper channels
TRUE
Note: This includes not only "extravasation" outside the veins and under the skin, but also chemo medicine that may leak onto the skin of a patient and/or touched by others who are not the patient
Explain the meaning of the term "NON-SELECTIVE" when it comes to general principles of cancer chemotherapy drugs
"Non-selective" means that most chemo drugs CANNOT target cancer cells only, they tend to affect BOTH malignant (cancer) cells AND healthy body cells at the same time. The level of toxicity of the chemo med to healthy cells is "dose limiting," meaning that the chemo dose is calibrated by the specialist to cause the highest number of cancer cells possible to be killed without going so far as to killing at the same time so many healthy cells that the patient would die from the treatment.
While a patient is given "intermittent dosing" of chemo which gradually lowers the level of cancer cells, they may also be given a class of cytoprotectant drugs called "hematopoietic factors" to help protect the patient's native cells. LIST AT LEAST ONE SPECIFIC EXAMPLE of this type of drug mentioned in this week's unit, and mention what it does to help the patient
*filgrastim (Neupogen): stimulates neutrophil production
*epoetin alfa (Epogen): stimulates RBC production
The drug very commonly used to treat breast cancer after the surgical excision of any tumors found is called tamoxifen (Soltamax). Name the OTHER drug (both generic and Trade names for this drug) mentioned in this week's unit that is an anti-estrogen agent used to treat breast cancer post-excision?
BONUS: Is this "other" drug a SERM or an Aromatase Inhibitor?
anastrozole (Arimidex)
BONUS: anastrozole (Arimidex) is an Aromatase Inhibitor, blocking an enzyme (aromatase) that catalyze the production of estrogen in people who have ovaries, which thereby reduces levels of estrogen in the blood of people who have ovaries
The goal of chemotherapy is to be as effective as possible with tolerable side effects. Particular SEs vary with the medications used; some increase RF infection, and some cause anemia, hair loss, or nausea. All of these can be managed effectively, and several meds can help prevent or minimize side effects. LIST AT LEAST ONE MED that can be given to minimize NAUSEA for a patient on chemo
ANTIEMETICS include:
*Glucocorticoids like prednisolone (Prednisone)
*5HT3 recepter antagonist like ondansetron (Zofran)
*Substance p receptor antagonist like fosaprepitant (Emend)
*Antipsychotics like haloperidol (Haldol)
or olanzapine (Zyprexa)
TRUE OR FALSE: A nurse who happens to be pregnant (or is actively trying to get pregnant) should not deliver chemo medications to a patient due to the risk for potential harm to the fetus
TRUE
Almost all chemo meds are teratogens, potentially causing significant harm to a growing fetus
Aside from removing PART of a tumor from the body, explain how surgical DEBULKING works as a strategy to assist chemotherapy treatment
Debulking removes many malignant (cancerous) cells that are in the "resting phase" (G-zero, aka what Christine calls "cellular siesta") in a larger malignant tumor. In response to this surgical excision, soon after many cancerous cells that WERE in G-zero that are left behind in the patient are thereby caused to go into active cellular replication phases again (a process called "recruitment") during which chemotherapy can target these cancer cells again more effectively
LIST AT LEAST ONE TYPE OF VACCINE that a patient can be given to PREVENT CANCER
*HPV
*Hep B
Other vaccines are under development to prevent pancreatic cancers, melanoma...
Name the hormonal agent that can be given to a patient who has prostate cancer as an IM injection just once every ONE TO SIX MONTHS
BONUS: Explain this drug's Method of Action
leuprolide acetate (Lupron Depot)
BONUS: Lupron decreases androgen production in a patient with a prostate, thus reducing their testosterone levels to "castration" levels (causing them to be infertile, but also cutting off the growth of prostate cancer cells)
Since chemo medications may significantly lower platelet levels in the patient, what types of special precautions should the nurse teach the patient about (and what special steps might the nurse themselves take)?
Initiate BLEEDING PRECAUTIONS, including but not limited to:
soft toothbrush; electric rather than standard razor; exercise extra caution when walking, handling knives, monitor excrement for blood, avoid aspirin or other NSAIDs, report significant new bruising, etc
Nurses should: place a "BLEEDING PRECAUTIONS" sign on the door (if patient is in the hospital); avoid IM injections; hold anticoagulant medications such as apixaban (Eloquis) or enoxaparin (Lovenox)
Which is the best way to know ahead of time whether a chemo med that a nurse will be giving to a patient via peripheral IV is a VESICANT, potentially very harmful to the patient's surrounding tissues if allowed to escape from the vein (aka "extravasation")
(a) look the drug up in a current (electronic) drug guide
(b) ask the charge nurse who has years of experience
(c) look in the patient's electronic medical record (EMR)
(d) memorize the list of vesicants your institution gives you
(A) LOOK THE DRUG UP IN A CURRENT (ELECTRONIC) DRUG GUIDE
While some units may give a list of the most common vesicants that they expect their nurses to know, this week's lecture stressed the point: DO NOT ATTEMPT TO MEMORIZE such a list, for not only may it not be complete, and your memory might not be perfect, but things change rapidly in the field of medicine and you need to consult the most current of references for such a high-stakes topic
Which of the following types of cancers would respond the best to most types of chemotheraphy? BONUS: Which would most likely respond least well?
(a) breast cancer tumor
(b) prostate cancer tumor
(c) bone cancer
(d) brain cancer
(C) BONE CANCER would tend to respond the best to chemotherapy since they have HIGH growth fractions (meaning they replicate rapidly). Blood cancers such as leukemias would also be in this category.
BONUS: (D) BRAIN CANCER would tend to respnd the worst to most types of chemotherapy, since most chemo drugs cannot cross the Blood Brain Barrier -- the exception being those specialized drugs that can be delivered straight into the CSF "intrathecally"
List AT LEAST ONE LAB VALUE and AT LEAST ONE VITAL SIGN that should be monitored for a patient who is taking epoetin alpha (Epogen), and explain why
*MONITOR BLOOD PRESSURE due to RF hypertension
*MONITOR SERUM IRON LEVELS due to the drug not being effective at stimulating RBC production if the patient is iron-deficient
The drug tamoxifen (Soltamax) carries with it a Black Box Warning (BBW). What types of "serious and life threatening events" does this BBW caution about as potential ARs of this drug?
Serious and life threatening events for a patient taking tamoxifen (Soltamax) include:
*UTERINE MALIGNANCIES (that is, cancers of the uterus and/or uterine cervix)
*PULMONARY EMBOLISMS
*STROKE /CVA
How long after the initiation of chemotherapy is the patient receiving that treatment at the HIGHEST risk for developing an infection (and thus in greatest need for very careful and strict neutropenic precautions)?
(a) one day
(b) ten days
(c) twenty days
(d) thirty days
(B) TEN DAYS
The range given in lecture is "10-14 days" after the initiation of chemo, at which time the patient reaches their "nadir" (lowest point) of neutrophils, cells needed to begin actively fighting off infections. This state of low levels of neutrophils in the patient's blood serum (aka "neutropenia") is the central reason for strict "neutropenic" precautions
When a patient is receiving chemotherapy and still under chemo precautions, describe special requirements needed in general for the disposal of body wastes
BONUS: Describe the particular steps needed to be taken by the nurse or others when FLUSHING THE TOILET used by a patient under chemo precautions?
DISPOSE ALL MATERIALS IN A SPECIAL "CHEMO BAG" and DISPOSE IN PROPER CONTAINERS (we were told in lecture that at RiverBend they are YELLOW in color)
BONUS: To flush the toilet, it should first be covered by an absorbent "chucks" pad, then the toilet should be flushed TWICE, ideally as the person flushing it exits out of the room quickly each time the process of flushing happens)
What is the smallest number of cancer cells in the body that can generally be detectable by most types of scans (the "smallest detectable" threshold)?
BONUS: What SIZE of tumor -- measured in mcg, mg, grams or kilograms -- does one tend to see appearing in the host body when at that particular threshold (that number of cancer cells in the body)?
ONE BILLION
BONUS: ONE GRAM (see the table included in the lecture slides after the slide titled "Is Cure Possible?"
What is the MAXIMUM amount of time that a patient can be on the Selective Estrogen Receptor Modulator (SERM) called tamoxifen (Soltamax) before they should be switched to an Aromatase Inhibitor instead?
TEN YEARS
Name the TWO drugs that are often COMBINED for the treatment of prostate cancer
flutamide (Eulexin)
and
leuprolide acetate (Lupron Depot)
MUCOSITOSIS is another common SE to be expected, which usually lasts 7-10 days and may interfere with one's nutrition, lead to oral ulcers, oral infection, bleeding, or mouth pain. LIST AT LEAST THREE ELEMENTS OF PATIENT TEACHING you can give to a patient in anticipation of them experiencing MUCOSITOSIS
*BRUSH TEETH WITH A SOFT TOOTHBRUSH
*RINSE MOUTH SEVERAL TIMES A DAY
*ENCOURAGE DRINKING OF FLUIDS
*ENCOURAGE EATING SOFT, BLAND, COLD FOODS
*FLOSS ONCE PER DAY
*INSPECT MOUTH DAILY
*TAKE MEDS FOR PAIN OR INFECTION, PER DOCTORS ORDERS & INSTRUCTIONS
Chemo-therapeutic precautions are designed to protect themselves, the rest of the care team, the patient, family members, and other visitors from the dangers of toxic chemo treatments. TYPICALLY, how long after the last dose of chemo treatment are "Chemo Precautions" normally removed/lifted?
(a) 12 hours
(b) 24-36 hours
(c) 36-48 hours
(d) 48-72 hours
(e) one week
(D) 48-72 HOURS after the LAST DOSE OF CHEMO is given (NOT since the treatment was initiated/first dose was given)