Cancer and Chemotherapy
Define neutropenia and name one drug used for its management.
↓Neutrophils; managed with filgrastim (Neupogen) or pegfilgrastim (Neulasta)
Define atelectasis and give one cause.
Collapse of alveoli; may result from hypoventilation or mucus plug
Define AKI and one common cause.
Sudden loss of kidney function; caused by hypovolemia, nephrotoxic drugs, or obstruction
Define sepsic shock. What is the difference between SIRS and sepsis?
Septic shock is the most severe form of sepsis, leading to dangerously low blood pressure and inadequate tissue perfusion, even after adequate fluid resuscitation.
Sepsis = SIRS + confirmed/suspected infection
At what CD4 count is AIDS diagnosed?
<200 cells/mm³
Common sign of anemia caused by chemotherapy and one drug used to treat it?
Fatigue, pallor; epoetin alfa or darbepoetin alfa.
What is the key sign of tension pneumothorax?
Tracheal deviation to unaffected side (mediastinal shift)
What is the function of sevelamer (Renagel)?
Phosphate binder for CKD; prevents hyperphosphatemia
What nursing action is priority if septic shock is suspected?
Obtain cultures, start broad-spectrum antibiotics, and begin IV fluids
Which stage of HIV involves flu-like symptoms and high viral load?
Stage 1 (acute infection)
Explain the purpose and components of “Magic Mouthwash.”
Treats mucositis; includes antacid, antihistamine, lidocaine, nystatin, steroid, +/- antibiotic
What differentiates transudative vs exudative pleural effusion?
Transudate – low protein (HF); Exudate – high protein (tumor/infection)
Explain how ACE inhibitors help nephrotic syndrome.
↓ glomerular pressure → ↓ proteinuria
Which lab marker indicates anaerobic metabolism?
Serum lactate > 2 mmol/L
What are 3 common adverse effects of long-term ART therapy?
Hepatotoxicity, nephrotoxicity, osteopenia, fat redistribution sydrome (lipodystrophy), dyslipidemia, insulin resistance
What is tumor lysis syndrome and which drug reduces uric acid buildup?
Rapid cancer-cell death → ↑K⁺, ↑uric acid, ↓Ca²⁺; treat with allopurinol or rasburicase
Name one prostacyclin analogue and describe its MOA.
Epoprostenol (Flolan) – vasodilates pulmonary arteries by ↑cAMP
Compare finasteride vs tamsulosin for BPH
Finasteride = 5-α reductase inhibitor (↓DHT, shrinks prostate); Tamsulosin = α-blocker (relaxes smooth muscle)
Name the first-line vasopressor for septic shock and its MOA.
Norepinephrine (Levophed) – α-adrenergic agonist causing potent vasoconstriction
What is the MOA for zidovudine (AZT, Retrovir)?
Blocks addition of further nucleosides and terminates viral replication (acts as a counterfeit base for the HIV enzyme reverse transcriptase)
What is tumor lysis syndrome and how is it managed (2 examples)?
TLS: Rapid death of cancer cells leading to release of intracellular contents (K, phosphorus, nucleic acids) into blood
Mx: Uric acid management - Allopurinol, Rasburicase
Hydration - IV fluid/↑Po fluid intake
Correct electrolyte imbalances
Dialysis
Which four medications treat tuberculosis and what are two nursing teaching points?
INH, Rifampin, Pyrazinamide, Ethambutol; take full course, watch liver function & orange body fluids
Why might epoetin alfa be prescribed for CKD?
Treats anemia from ↓erythropoietin production
A 65-year-old patient presents with a temperature of 101.8 °F (38.8 °C), confusion, and a blood pressure of 88/46 mm Hg. Which three laboratory values are abnormal, and what do they indicate about the patient’s condition?
WBC: 14,200 mm^3
Serum Lactate: 3.9 mmol/L
Procalcitonin: 0.09 ng/mL
Creatinine: 1.0 mg/dL
Platelets: 180,000/mm^3
Bilirubin: 2.1 mg.dL
WBC 14,200 /mm³: Leukocytosis due to systemic inflammatory response (infection). Normal = 4,000-10,000
Serum lactate 3.9 mmol/L: Evidence of tissue hypoxia and anaerobic metabolism. Normal = 0.5-2 mmol/L
Bilirubin 2.1 mg/dL: Hepatic dysfunction secondary to poor perfusion (“shock liver”). Normal = 0.2-1.2 mg/dL
What is the mechanism for these drug classes:
NRTI | NNRTI | PI | INSTI
NRTI – chain termination; NNRTI – binds RT enzyme; PI – blocks protease cleavage; INSTI – prevents viral DNA integration