Chemo Drugs and Biologic and Immune Modifiers -Pharm Exam 2

Clients who have received an organ transplant need to receive immunosuppressant treatment for this amount of time

lifelong

-kin tocilizumab anakinra cause capillary leak syndrome results in massive fluid retention leading to: respiratory distress, heart failure, sudden weight gain, myocardial infarction, dysrhythmias

interleukins

Administration of vincristine via this route is considered to be virtually always fatal

intrathecally

This rescue medication is administered in combination with methotrexate in high doses

leucovorin

provides body with active folic acid

leucovorin rescue

how much of a pop must be immunized for herd immunity?

95%

A common adverse effect of immunosuppressants taken PO is oral candidiasis. Which of the following medications can be used to treat this?

Nystatin

There are many indications for immunosuppressant therapy. Which of the following is NOT an indication for this class of medication?

Cancer

The client is prescribed an IV chemotherapeutic drug. The nurse bases their actions on which of the following?

Chemotherapeutics are considered vesicants

This drug class works by modifying the rheumatoid arthritis disease process

DMARDS

resting phase

G0 (5)

second gap phase, cell prepares to divide

G2 phase (3)

first gap phase, cell increases in size

GI phase (1)

The nurse is reviewing the laboratory results of a client with leukemia who has received a regimen of antimetabolite chemotherapy. Which laboratory finding is indicative of the massive cell destruction that occurs with the chemotherapy?

Increased uric acid level

What are important precautions a nurse should teach a client receiving an immunosuppressant?

Keep follow-up appointments for laboratory assessments; take precautions to avoid getting pregnant; avoid crowds

mitosis, cell reproduction

M phase (4)

The nurse is assisting with creating a plan of care for a client with pancytopenia as a result of chemotherapy. The nurse would suggest including which in the plan of care?

Restricting fresh vegetables within the client's diet; applying a face mask when outside of the room

synthesis phase, cell copies DNA

S phase (2)

Unusual or serious reactions to immunizing medications should be reported to this program

VAERS

Why does organ rejection occur?

WBC's recognize the donated organ as foreign

Capillary leak syndrome can result in significant toxicity of this medication

aldesleukin

cisplatin cyclophosphamide mechlorethamine

alkylating drugs

preventing protein synthesis by inhibiting transcription

alkylating drugs

This term refers to the damage to hair follicles caused by antineoplastic medications

alopecia

Loss of erythrocytes (RBC) à Anemia *Monitor for pallor, fatigue, SOB, dizziness, hypoxemia, & activity intolerance

anemia chemotherapy

measure of how many antibodies to a given antigen are present in the blood. used to assess whether enough antibodies are present to protect the body effectively against particular pathogen

antibody titer

antagonize actions of cell metabolites such as folic acid

antimetabolites

§Folate (folic acid) antagonists §Methotrexate, pemetrexed, pralatrexate §Purine antagonists §Fludarabine (F-AMP), mercaptopurine (6-MP), thioguanine (6-TG), cladribine, pentostatin §Pyrimidine antagonists §Fluorouracil, cytarabine, capecitabine, floxuridine, gemcitabine All result in interruption of DNA and/or RNA synthesis

antimetabolites

asparaginase pegaspargase erwinia asparginase monitor for hyperglycemia

antineoplastic enzymes

relatively harmless antigen is injected, prompts immune system to actively produce antibodies ready to fight injected antigen

artificial active

immunoglobulin are injected. Immune system is bypassed

artificial passive

This term describes toxoids that have been rendered nontoxic

attenuated

Cytokine release syndrome is associated with the use of this medication

basiliximab

angiogenesis inhibitor

bevacizumab

genetically engineered and produced from living cells -usually work faster than non-biologic. Are given when non-biologic ones are non-effective -mab risk for infection

biologic DMARDs

Loss of thrombocytes (Platelet) à Thrombocytopenia *Monitor for bruising, petechiae, & bleeding gums

bleeding chemotherapy

Nearly all immunosuppressant drugs are toxic to which of the following?

bone marrow

antineoplastics

cancer drugs

Large doses of doxorubicin are associated with this adverse effect

cardiomyopathy

heart failure, cardiomyopathy

cardiovascular effects of cancer drugs

Bone marrow suppression GI injury Hair follicle injury

chemo adverse effects

This term is used to refer to the treatment of cancer with the use of medications

chemotherapy

Glucocorticoids, calcineurin inhibitors, antimetabolites, biologics

classes of immunosuppressants

promotes growth of blood cells and helps stem cells to differentiate into different blood cell types. -Is natural by bone marrow, but diminished when chemo is administrated --stim

colony-stimulating factors (hematopoietic)

no styrofoam containers, no grapefruit juice

cyclosporine considerations

The client has been prescribed 4 cycles of chemotherapy with doxorubicin ( ) and cyclophosphamide ( )

cytotoxic antibiotic; alkylating drug

-cin

cytotoxic antibiotics

intercalation of DNA to kill cells

cytotoxic antibiotics

What would typically be found in a flu vaccine?

dead or weakened flu virus

Which of the prescribed medications is only given via IV

doxorubicin

Immunizing medications are contraindicated in those with an allergy to this food

eggs

stimulate bone marrow to produce RBC's alfa

eryhtropoietic drugs (hematopoietic drugs)

This complication of intravenous chemotherapy results when the medication leaks into the surrounding tissue

extravasation

aromatose inhibitors -anastrozole, aminoglutethimide selective estrogen receptor modulators -tamoxifen, toremifene progestings -megestrol, medroxyprogesterone androgens -fluoxymesterone, testolactone Estrogen Receptor Antagonist -fulvestrant require estrogen

female-sepcific neoplasms

This form of the influenza vaccine is specifically intended to be administered to older adult clients.

fluzone

*Monitor for GI bleed for this reason & also b/c pt has decreased platelets à Coffee ground emesis & black, tarry stools

gastric ulcers chemo

Vaccines are contraindicated in patients who:

have a weakened immune system

Trastuzumab carries a black box warning concerning the failure of this organ

heart

Biologic response-modifying drugs work in part by enhancing this function

hematopoietic

promote synthesis of various blood components

hematopoietic drugs

alter immune response to malignant tumor cells

immunomodulating drugs

rheumatoid arthritis, systemic lupus erythematosus, crohn's disease, MS, myasthenia gravis, psoriasis

immunosuppressants

These medications are mainly prescribed in order to prevent organ rejection

immunosupressants

Loss of neutrophils (WBC) à Neutropenia *Monitor for fever- Principle early sign of infection *Ensure proper hand hygiene *Avoid large crowds & contact with infected people *Wash produce well & cook all foods well à No fresh fruits/vegetables *No fresh cut flowers in pt room

infection prevention chemo

cytotoxic antibiotics interact with DNA through this process

intercalation

These are proteins that are considered to be immunomodulating, antitumor, and antiviral

interferons

antiviral -protect human cells from virus attack antitumor -prevent cancer cells from dividing and replicating immunomodulating -stimulation (increase immune response by promoting activity) or suppression (inhibit the immune system from working) of the immune system

interferons

Being vaccinated with this type of bacteria or virus provides disease immunity that is lifelong

liver

which organ is responsible for the "first-pass" effect

liver

antiandrogens -bicalutamide, flutamide, nilutamide requires testosterone

male-specific neoplasms

This drug is used in both the treatment of cancer as well as the treatment of rheumatoid arthritis in smaller doses

methotrexate

prevent cell division

mitotic inhibitors

§Vinca Alkaloids §Vinblastine, Vincristine, & Vinorelbine §Taxanes §Paclitaxel, Docetaxel, Cabazitaxel, & Eribulin

mitotic inhibitors

able to specifically target cancer cells and have minimal effect on healthy cells -fewer adverse effects than traditional antineoplastic meds -mab

monoclonal antibodies

muscle weakness

musculoskeletal adverse effects of cancer drugs

This is another term used to describe the bone marrow suppression associated with antineoplastics

myelosuppression

hydration can prevent, push fluids

nephrotoxic adverse effects of cancer drugs

Cisplatin is associated with this significant adverse effect

nephrotoxicity

seizures, peripheral neuropathy, HA, drowsiness, CNS depression

neurologic effects of cancer drugs

usually prescribed first but take weeks-months to take effect -often will be given NSAIDs during this initial period methotrexate, leflunomide, hydroxychloroquine, sulfasalazine

non-biologic DMARDs

Immunosuppressant drugs place the client at risk for this type of infection

opportunistic

monitor for tinnitus

optic/otic adverese effects of cancer drugs

Antineoplastic enzymes are uniquely associated with impairment of this organ

pancreas

This type of immunization is administered when antivenin, antitoxins, or immunoglobulins are given

passive

To prevent infection, a patient recently exposed to a friend with hepatitis is administered gamma, globulins. This type of immunity is called ______ immunity

passive

promote the production of platelets oprelvekin romiplostim

platelet-promoting drugs

pulmonary fibrosis, pneumonitis

pulmonary adverse effects of cancer drugs

Hydroxyurea is administered in combination with this therapy to treat squamous cell carcinoma

radiation

muscle aches, bone pain, fever, flushing

side effects of hematopoietic drugs

fatigue, fever, chills, headache, myalgia, anorexia, dizziness, nausea, vomiting, diarrhea

side effects of interferons

antimetabolites can cause

stevens-johnson syndrome

The client receiving antineoplastic therapy may be instructed to regularly rinse their mouth with water due to this adverse effect

stomatitis

Mouth/lip inflammation *Monitor for mouth sores *Meticulous & frequent PO care à Soft toothbrush, ETOH-free mouthwash, warm saline PO rinse can help decrease discomfort *Avoid foods of extreme temps or that are rough in texture

stomatitis chemotherapy

This type of drug therapy includes medications that are able to identify particular molecules involved in cancer cell growth

targeted

impair DNA function

topoisomerase 1 inhibitors

topotecan irinotecan inhibit proper DNA function

topoisomerase 1 inhibitors

weakened or "attenuated" antigen. stimulate immune system to produce antibodies diptheria and tetanus

toxoids

Infiximab carries a black box warning regarding fatal cases of this disease

tuberculosis

suspensions of live, attenuated, or killed microorganisms stimulate immune system to produce antibodies live virus=lifelong immunity killed bacteria=partial immunity

vaccines