Anti-neoplastic Drugs
What is metastasis?
-- Cells break away from the tumor and form a secondary tumor somewhere else in the body.
What is neoadjuvant tx with chemotherapeutic drugs?
-- PRE-OP TO REDUCE TUMOR SIZE
What is adjuvant tx with chemotherapeutic drugs?
-- POST-OP TO DESTROY REMAINING CELLS
What is primary therapy with chemotherapeutic drugs?
-- For leukemia or lymphoma
What drug is contraindicated in pts taking Tamoxifen?
-- WARFARIN
What is the difference between benign and malignant tumors?
-- Benign: Well-differentiated cells, cluster in a single mass, slow growing, encapsulated, do not metastasize, do not cause death unless the location of the tumor affects vital organs.
-- Malignant: Less differentiated, Erratic growth, Fast growing, Secrete abnormal proteins, Have to ability to Metastasize: Cells break away from the tumor and form a secondary tumor somewhere else int the body.
What is the goal of chemotherapy?
-- Kill tumor cells with repeated doses of chemo over a prolonged period to eradicate enough of the tumor so any lingering cells will be destroyed by the immune system.
What is Vesicant chemo?
-- Drugs that cause blistering and other tissue injury that may be severe and can lead to tissue necrosis (tissue death).
How do ports help pts receiving chemo?
-- Easy access to a large vessel, and less likely to have AE's from the chemo. Infuse chemo, or draw blood from pts.
-- Risk of infection---->Sepsis
(1) How is Tamoxifen used in Breast cancer?
(2) What type of breast tumor will this drug be used for?
(3) What are the common AEs of Tamoxifen?
(If you get these all correct, 300 more points will be added)!
(1) Tx and Prevent Breast cancer
MOA: Estrogenic agonist and antagonist effects in different parts of the body
(2) Hormone positive best cancer (needs estrogen and/or progesterone to grow)
(3) HOT FLASHES, IRREGULAR PERIODS, VAGINAL DISCHARGE
What are common AEs of chemo?
-- Bone marrow suppression
-- Anorexia
-- N/V
-- Gi disturbances
-- Alopecia
-- Avoid pregnancy!
What are neutropenic precautions and what pts should we use them for?
-- No sick visotors or personnel
-- No plants or fresh fruit or veggies
-- STRICT HAND WASHING BEFORE PT CARE
-- Private room w/ closed door
-- No gowns or gloves required
-- No special precautions must be taken with articles leaving the room
What assessments are important to pts who are receiving chemo?
-- Infection, Bleeding, Skin problems, Pain, Fatigue, Psychosocial status, Body image
(1) How is Cisplatin given?
(2) What are the AEs of Cisplatin?
(If you get these correct, 200 more points will be added)!
(1) IV Intra-arterial, Intraperitoneal
(2) SIGNIFICANT NEPHROTOXICITY, SECONDARY MALIGNANCY, TUMOR LYSIS SYNDROME
(1) What is Doxorubicin used to tx?
(2) What is the nickname for Doxorubicin?
(3) What are the significant AEs of Doxorubicin?
(If you get these all correct, 300 more points will be added)!
(1) Tx Soft tissue and Bone sarcomas and Cancers of the Breast, Overy, Bladder and Thyroid, Lymphoblastic leukemia, Acute myeloblastic leukemia, Hodgkin lymphoma, and Small cell lung cancer
(2) Adriamycin
(3) Cardiomyopathy and HF
Others include: Bone marrow suppression, Alopecia, N/V
(1) What is Tumor Lysis syndrome?
(2) What are the 3 chemical abnormalities seen in Tumor Lysis Syndrome?
(3) How do we prevent Tumor Lysis Syndrome?
(If you get all questions correct, 200 more points will be added)!
(1) A common metabolic complication of chemo for rapidly growing tumors. Characterized by the presence of excessive cellular waste products and electrolytes, including uric acid, phosphate, and potassium, and by reduced serum calcium levels.
-- Emergency!!
-- Positive sign that cancer tx is effective
-- Cancers with high tumor burden
-- S/S: N/V, Edema, Cardiac dysrhythmias, Seizures, Gout
(2) Hyperkalemia, Hyperuricemia, Hyperphosphatemia with secondary hypocalcemia
(3) Prevention: Hydration 3000-5000 mL per day before and after tx
What should the nurse consider when taking care of a pt who is receiving chemo?
-- Cancer type
-- Quality of life
-- Quantity of life
-- Characteristics of the pt
-- Tx goals
-- combination therapies
-- Involves: assessment, nursing diagnoses and interventions, client and family teaching
Why do we pre-medicate pts receiving Paclitaxel?
-- Premedicated with dexamethasone, diphenhydramine, famotidine, a steroid since many pts don't tolerate the infusion and experience hypersensitivity d/t the water-insoluble formula mixed with castor oil
-- Extravasation Warning!!!
What is the black box warnings for Paclitaxel?
-- HYPERSENSITIVITY REACTIONS AND BONE MARROW SUPPRESSION
(1) What types of cancer is Vincristine used to tx?
(2) What is the warning for Vincristine?
(3) What type of drug is vincristine and why do we have to monitor for extravasation?
(If you get all these correct, 200 more points will be added)!
(1) Blood cancers (ALL, CML, lymphomas)
(2) NEVER DISPENSE WITH A SYRINGE INTRATHECAL
(3) VESICANT--MONITOR FOR EXTRAVASATION
What is the difference between cell cycle specific chemos and cell cycle nonspecific chemos?
-- Cell cycle specific:
- antimetabolites
- purine antagonists
- Topoisomerase l Inhibitors
- antineoplastic enzymes
--Cell Cycle non-specific
- Alkylating drugs
- Cytotoxic antibiotic Antineoplastic drugs
- Hormonal antineoplastics
How does Methotrexate work?
-- Inhibits an enzyme responsible for converting folic acid to folate
-- IND: Breast, Head and Neck, Lung, ALL, Non-Hodgkin Lymphoma, RHEUMATOID ARTHRITIS, PSORIASIS
-- Cause death of rapidly replicating cells, inhibits folic acid metabolism-prevents cell replication, and has immunosuppressive effects.
What are the indications for Fluorouracil?
-- Breast, Colon, Pancreatic, Gastric, Superficial basal cell skin cancer (Topical)
What are the indications for Paclitaxel?
-- Breast, Ovarian, Non-small cell lung cancer, Kaposi Sarcoma
What are important AE of Paclitaxel?
-- PERIPHERAL NEUROPATHY
-- Others include: N/V/D, Bone marrow suppression, PE, Alopecia, Mucositis, Myalgia, and Weakness