Cancer Ch. 45, 46 (part of quiz 3)

Nadir

lowest point that an individual's blood cell count will reach as a side effect

Mitotic Inhibitors

natural products obtained from the plant such as vinca alkaloids (periwinkle), taxanes

Cancer: Alkylating Drugs Mechanism of Action Examples? Adverse Effects? Hydration can prevent _.

Alter the chemical structure of the cells' DNA cisPLATIN (Platinol) cycloPHOSPHAMIDE (Cytoxan) GI tract, myelosuppression and alopecia Nephrotoxicity, peripheral neuropathy, ototoxicity cyclophosphamide (Cytoxan)—hemorrhagic cystitis Extravasation causes tissue damage and necrosis Nephrotoxicity

Chemotherapy 2 groups based on where in the cellular life cycle they work

Cell cycle-nonspecific (CCNS) Cell cycle-specific (CCS) Some drugs have characteristics of both

A pregnant woman has been diagnosed with cancer and is meeting with her oncologist to plan treatment. Which statement about chemotherapy and pregnancy is true? She will have to wait until the baby is born before starting chemotherapy. The greatest risk of fetal harm from chemotherapy is during the third trimester. Chemotherapy treatment during the second or third trimester poses less risk to the fetus. Chemotherapy is unsafe during pregnancy, but radiation therapy is safe in low doses.

Chemotherapy treatment during the second or third trimester poses less risk to the fetus.

Chemotherapy

Pharmacologic treatment of cancer Antineoplastic drugs

Cancer: Cytotoxic Antibiotics Mechanism of action?

active

Cancer Nursing Implications:In general: Monitor closely for _. Keep _, _, and _ drugs on hand Monitor closely for complications associated with _. These include _, _, and _. Cytoprotective drugs may be used to _. IV amifostine to reduce _ associated with cisplatin. IV or PO allopurinol to reduce _.

anaphylactic reactions epinephrine, antihistamines, and antiinflammatory drugs bone marrow suppression Anemia, thrombocytopenia, neutropenia reduce toxicities renal toxicity hyperuricemia

Cancer Drugs Antineoplastic Medications: Cell Cycle Non Specific _ drugs (CCNS)-_drugs and_ drugs CCNS drugs are _ in all phases of the cell cycle

antineoplastic Alkylating drugs Cytotoxic antibiotics active

Chemotherapy Nursing Implications: Assess.. Follow..

baseline blood counts before administering antineoplastic drugs specific administration guidelines for each antineoplastic drug

Always do cultures _ giving Tylenol/antibiotics

before

Mitotic Inhibitors Mechanism of Action all work shortly...

before/during mitosis and this retard cell division

Which cytotoxic antibiotic does the nurse identify as most likely to cause pulmonary fibrosis? plicamycin mitoxantrone mitomycin bleomycin

bleomycin

Cancer Nursing Implications: Asses baseline _ before administering _ drugs. Follow specific administration guidelines for each _ drug. Alkylating drugs: Monitor for expected effects of _. Expect _,_,_,_. Hydration=_. Reporting ringing/roaring in the ears- possible _. Report tingling, numbness, or pain in extremities-_ may occur.

blood counts antineoplastic drugs antineoplastic bone marrow suppression nausea, vomiting, diarrhea, stomatitis nephrotoxicity ototoxicity peripheral neuropathies

Cancer Nursing Implications Cytotoxic antibiotics: Expect _ (5) Monitor _ status, since _ fibrosis may occur. Monitor for _, _ Monitor _ status Daunorubicin may turn the urine a _ color.

bone marrow suppression, nausea, vomiting, diarrhea, stomatitis pulmonary, pulmonary nephrotoxicity, liver toxicity cardiovascular reddish

When handling and administering vesicant drugs the nurse will: double-flush the patient's bodily secretions in the commode. use sterile towels to clean up after chemotherapy spills. mix chemotherapeutic drugs in the patient's room. teach the patient how to administer parenteral chemotherapeutic drugs.

double-flush the patient's bodily secretions in the commode

Mitotic Inhibitors Adverse Effects

extravasation (several specific antidotes can be used) hair loss, nausea, vomiting, myelosuppression liver, kidney, lung toxicities convulsions (sudden irregular movement of limb)

The nurse is caring for a patient who received chemotherapy 24 hours ago. The patient's white blood cell count is 4,400 mcL. Which symptom, if experienced by the patient, should the nurse report to the prescriber immediately? Fatigue Diarrhea Fever Nausea and vomiting

fever

Steven Johnson Syndrome

flu-like symptoms, followed by a painful red or purplish rash that spreads and blisters

Antimetabolites

folate (folic acid) antagonists purine antagonists pyrimidine antagonists

Chemotherapy Nursing Implications: Implement measures to monitor and prevent _ in patients with neutropenia or leukopenia Implement measures to monitor and prevent_ in patients with thrombocytopenia or anemia Keep in mind that _ may result in severe _. Monitor for _. Anticipate _ and _ and implement measures to reduce these side effects Antimetics often work better if given _ to _ minutes before chemotherapy.

infection in patients with neutropenia or leukopenia bleeding in patients with thrombocytopenia and anemia anemia, fatigue stomatitis nausea and vomiting 30-60

Chemotherapy Nursing Implications: Women of childbearing age will need to use a _ form of contraception during therapy.

non drug

Cancer Nursing Implications Monitor for _ emergencies. Monitor what other 10 things?

oncologic infections Allergic reactions Stomatitis with severe ulcerations Bleeding Metabolic alterations Bowel irritability with diarrhea Renal, liver, pulmonary, cardiac toxicity

When working with a patient who is neutropenic, the nurse identifies which as the most effective measure to prevent the patient from developing an infection? Administer prophylactic antibiotics Stop administration of the chemotherapeutic drug Perform hand hygiene Vaccinate the patient to prevent bacterial infection

perform hand hygiene

Cancer Extravasation: Can result in _. Prevention and continuous monitoring of the _ is essential. If suspected: Stop the _ immediately and contact prescriber. Leave _ in place. Aspirate any _ or _ from the catheter. Consult guidelines or the pharmacist regarding _. Application of _ or _ packs and/or sterile _, and _ and _ of affected limb. Thoroughly _ the extravasation incident. Consult facility _ and _.

permanent damage IV site infusion intravenous catheter residual drug, blood antidotes hot or cold occlusive dressings elevation, rest document protocol, guidelines

Extravasation

process by which any liquid (fluid or drug) accidentally leaks into the surrounding tissue

A patient who is receiving high-dose chemotherapy with methotrexate is also receiving leucovorin. The purpose of the leucovorin is to: produce an additive effect with the methotrexate by increasing its potency against the cancer cells. reduce the incidence of cardiomyopathy caused by the methotrexate. add its antiinflammatory effects to the treatment regimen. reduce the bone marrow suppression caused by the methotrexate.

reduce the bone marrow suppression caused by the methotrexate.

Tumor Lysis Syndrome

large amounts tumor killed

NKDA

no known diagnosed allergies

The nurse identifies which of the following as the most significant neurotoxin of the cytotoxic drug class? paclitaxel (Taxol) docetaxel (Taxotere) vincristine (Vincasar PFS) etoposide (Toposar)

vincristine (Vincasar PFS)

Cancer Cytotoxic Adverse Effects?

All can produce bone marrow suppression, except bleomycin Hair loss, nausea and vomiting Pulmonary fibrosis and pneumonitis (bleomycin) Liver, kidney, and cardiovascular toxicities Heart failure—cardiomyopathy (daunorubicin)

Myelosuppression

Bone marrow suppression (BMS) Bone marrow depression (BMD)

Chemotherapy Dose Limiting Adverse Effects

GI tract and bone marrow alopecia, nadir, extravasation emetic potential myelosuppression targeted drug therapy

Healthy, normal human cells

Hair follicles GI tract cells Bone marrow cells

Antimetabolites Adverse Effects

Hair loss, nausea and vomiting, myelosuppression Neurologic, cardiovascular, pulmonary, hepatobiliary, GI, genitourinary, dermatologic, ocular, otic, and metabolic toxicity Tumor lysis syndrome Palmar-plantar dysesthesia (also called hand-foot syndrome) Stevens-Johnson syndrome toxic epidermal necrolysis

Which condition does the nurse anticipate when assessing a patient with tumor lysis syndrome? Hyperuricemia Hypophosphatemia Hypokalemia Hypercalcemia

Hyperuricemia

Cancer Drugs: Antineoplastic Medications

Narrow therapeutic index Drug resistance Combination of drugs Harmful to all rapidly growing cells