Pharm Chapter 33: Targeted Therapies to Treat Cancer

Key Term: mTOR kinase inhibitors

A class of drugs that inhibit the mechanistic target of rapamycin (mTOR)

Key Term: Suppressor gene

A gene that suppresses the phenotypic expression of another gene

Key Term: Signal transduction

Also known as cell signaling. The transmission of molecular signals from a cell's exterior to its interior. Signals received by cells must be transmitted effectively into the cell to ensure an appropriate response. This step is initiated by cell-surface receptors.

Key Term: Monoclonal antibodies (MABs)

Antibodies produced by a single clone of cells or a cell line and consisting of identical antibody molecules

Key Term: Signal transduction inhibitors (STIs)

Block signals to cancerous cells by blocking signals passed from one molecule to another. Work at sites that are on the cell surface, at the intracellular level, or in the extracellular domain.

Key Term: Apoptosis

Cell death

Key Term: Small-molecule compounds

Chemicals that are small enough to have an intracellular effect, targeting the internal structures of cells. Include inhibiting enzymes, inducing apoptosis, and inhibiting formation of new vasculatures (angiogenesis)

Key Term: Multikinase inhibitors (MKIs)

Chemicals that directly inhibit the activity of multiple kinase enzymes in cancer cells

Key Term: Targeted therapy

Cornerstone of precision medicine because it directs the treatment according to the person's genes and proteins. Targeted therapies are specific, deliberate, and cytostatic

Key Term: Cytotoxic

Directly damages or kills normal cells and cancer cells

Key Term: Tyrosine kinase inhibitors (TKIs)

Drugs that inhibit tyrosine kinases and primarily exert their effects on an enzyme known as BCR-ABL tyrosine kinase

Key Term: Tyrosine kinase (TK)

Enzyme that activates other substances by adding a phosphate group to them (phosphorylation)

Key Term: Cyclins

Family of proteins that stimulate the cell to move through the cell cycle. They are the products of oncogenes.

Key Term: Cellular checkpoints

Function of which is to determine whether a cell has completed the necessary steps prior to progressing in the cell cycle. 3 checkpoints: one between the G1 and S phase, one between G2 and mitosis, and one during mitosis.

Key Term: Cellular communication

Mechanism by which cell-to-cell communication occurs locally or remotely by signaling molecules to maintain homeostasis, regulate growth and division, develop and organize into tissues, and coordinate cellular functions

Key Term: Proteasome

Multienzyme complexes that degrade proteins intracellularly

Key Term: Telomeric DNA

Shortens with each cell division, eventually halting the dividing of the cells

Key Term: Transduction pathways

Signaling cascades

Key Term: Transcription factors

Substances that enter the nucleus and signal the cell to begin mitosis

Key Term: Mitosis

The process by which the nucleus divides in eukaryotic organisms, producing two new nuclei that are genetically identical to the nucleus of the parent cell

The nurse is caring for a patient who has been ordered a treatment regimen for colorectal cancer. The nurse brings the consent form to the patient to sign prior to initiating the treatment, and the patient tells the nurse, "I really don't understand why I can't be treated with vitamins and nutritional therapy." What is the nurse's priority action? a. Contact the health care provider. b. Schedule an instructional session with the dietician. c. Encourage the patient to sign the consent form. d. Discuss the treatment regimen with the pharmacist.

a. Contact the health care provider. *The health care provider should be contacted since the patient cannot sign the informed consent form for treatment. It is the health care provider's responsibility, not the pharmacist's nor the dietician's, to make certain that the patient understands the reason for treatment. The nurse should not encourage the patient to sign the consent form when the patient does not understand the reason for treatment.

Which instruction is important for the nurse to include when teaching a patient about imatinib therapy? a. Don't drink grapefruit juice while taking this drug b. Go immediately to the ED if you develop a headache while taking this drug c. This drug will only work for about 2 months before your cancer develops resistance to it d. Be sure to take this drug on an empty stomach, either 1 hour before or at least 3 hours after eating

a. Don't drink grapefruit juice while taking this drug

The nurse admits a patient diagnosed with metastatic colorectal cancer. The nurse anticipates that the health care provider will order which medication? a. Panitumumab b. Bortezomib c. Dasatinib d. Rituximab

a. Panitumumab

The nurse is completing an admission assessment for a patient diagnosed with pancreatic cancer who is prescribed erlotinib. The patient is currently being treated for an infection with clarithromycin. What is the nurse's initial intervention? a. Administer diphenhydramine (Benadryl). b. Contact the health care provider. c. Administer acetaminophen (Tylenol). d. Hold the Iressa until the patient's course of clarithromycin is completed.

b. Contact the health care provider. *Clarithromycin inhibits the liver microsomal CYP3A4 enzyme, which increases the blood levels of erlotinib. The health care provider will need to make a decision about starting the medication. Diphenhydramine (Benadryl) is frequently used as a premedication for intravenous chemotherapy; however, this intervention will not be implemented until the health care provider has had an opportunity to decide about starting the erlotinib. Acetaminophen (Tylenol) will likely be avoided with this patient because the patient should be monitored for fever.

The patient has been ordered treatment with bortezomib (Velcade). The nurse recognizes that this medication is most often used to treat which cancers? a. Hepatocellular cancer and advanced renal cell carcinoma b. Mantle cell lymphoma and multiple myeloma c. Chronic lymphocytic leukemia d. Colorectal cancer and head and neck cancers

b. Mantle cell lymphoma and multiple myeloma

Which is the priority nursing diagnosis for patients receiving epidermal growth factor receptor inhibitors? a. Risk for thrombocytopenia r/t bone marrow suppression and neutropenia b. Risk for impaired skin integrity r/t skin side effects c. Risk for injury r/t reduced platelet activity d. Disturbed body image r/t alopecia

b. Risk for impaired skin integrity r/t skin side effects

A patient receiving a targeted therapy asks the nurse why St. John's wort must be avoided. What is the nurse's best response? a. This herbal drug increases blood levels of most targeted therapies and increases the risk for severe side effects or adverse reactions b. This herbal drug decreases blood levels of most targeted therapies and reduces their effectiveness c. Targeted therapies increase blood levels of St. John's wort, increasing the risk of an overdose of this herbal agent d. Targeted therapies bind with St. John's wort in the intestinal tract, preventing absorption of both the drug and the herbal agent

b. This herbal drug decreases blood levels of most targeted therapies and reduces their effectiveness

The patient is prescribed gefitinib (Iressa). The nurse recognizes that this medication will be given a. once daily by IV. b. once daily by mouth. c. twice daily by injection d. twice daily by IV.

b. once daily by mouth.

A patient is prescribed temsirolimus (Torisel) for treatment of breast cancer. Which teaching is a priority for this patient? a. "Take this medication only in the morning." b. "Take metoclopramide (Reglan) with each dose of this medication." c. "Do not take this medication with grapefruit juice." d. "Take this medication with a full glass of water."

c. "Do not take this medication with grapefruit juice."

The patient has been ordered treatment with alemtuzumab (Campath). The nurse recognizes that this medication is most often used to treat which cancers? a. Hepatocellular cancer and advanced renal cell carcinoma b. Mantle cell lymphoma and multiple myeloma c. Chronic lymphocytic leukemia d. Colorectal cancer and head and neck cancers

c. Chronic lymphocytic leukemia

A nurse is monitoring several patients undergoing chemo. Which of the following classes of targeted therapy would cause the nurse the most concern in regard to a possible infusion reaction? a. Tyrosine kinase inhibitors b. Multikinase inhibitors c. Monoclonal antibodies d. Proteasome inhibitors

c. Monoclonal antibodies

Which action is most important for the nurse to teach a patient taking tositumomab? a. Avoid drinking alcohol for 1 week after receiving this drug b. Avoid smoking cigarettes for the entire treatment period c. Use a separate bathroom and sit while urinating for 1 week after receiving this drug d. Be sure to take this drug on an empty stomach, either 1 hour before or 2 hours after eating

c. Use a separate bathroom and sit while urinating for 1 week after receiving this drug

A patient taking imatinib voices concern about gaining 5 pounds in the past week. The nurse explains, knowing that: a. Weight gain is an expected side effect of this drug because it increases the appetite b. Weight gain is an indication of slow metabolism and possible hypothyroidism c. Weight gain is an indication of water retention and possible renal impairment d. Weight gain is an indication of a drug interaction between imatinib and loop diuretics

c. Weight gain is an indication of water retention and possible renal impairment

The patient has been ordered gefitinib (Iressa) in the treatment of non-small cell lung cancer. After receiving three doses of the medication, the patient complains to the nurse of experiencing a skin rash. The nurse recognizes that this symptom is indicative of: a. an overdosage of the medication. b. an allergic reaction to the medication. c. an expected side effect of the medication. d. a progression of the cancer.

c. an expected side effect of the medication. *A skin rash is known to be a side effect that is typically experienced with this medication.

The nurse is caring for a patient who has been diagnosed with metastatic breast cancer. The nurse receives an order to administer dasatinib (Sprycel). What is the nurse's priority action? a. Contact the pharmacist regarding administering the medication. b. Start an IV as part of preparing to administer the medication. c. Administer ordered premedications prior to giving the drug. d. Contact the health care provider regarding the medication.

d. Contact the health care provider regarding the medication. *The nurse should contact the health care provider regarding use of this medication, since it is most frequently ordered to treat leukemia rather than metastatic breast cancer.

The patient is prescribed erlotinib (Tarceva). The nurse recognizes that this medication is most frequently used to treat which cancer? a. Metastatic breast cancer b. Hepatocellular cancer c. Colorectal cancer d. Non-small cell lung cancer

d. Non-small cell lung cancer *Erlotinib (Tarceva) is used to treat non-small cell lung cancer as well as pancreatic cancer.

A patient taking sunitinib reports that the skin on her hands and feet is red, painful, and has some blisters. What is the nurse's best action? a. The only action needed is to document the finding because this is a mild side effect b. Advise the patient to wear gloves and mittens when going outdoors in cold weather c. Advise the patient to avoid getting her hands wet and touching food d. Notify the oncologist to determine if a dosage reduction is needed

d. Notify the oncologist to determine if a dosage reduction is needed

Which activity has a higher priority for the nurse to advise the patient to avoid while taking ixazomib? a. Drinking alcoholic beverages b. Taking aspirin or aspirin-containing drugs c. Socializing in crowds or with persons who are ill d. Taking the drug 1 hour before or 2 hours after food

d. Taking the drug 1 hour before or 2 hours after food

A patient undergoing chemo for breast cancer asks why she is not receiving trastuzumab like her sister. What is the nurse's best response? a. Your breast cancer cells are estrogen-receptor positive, and targeted therapy is not needed b. You are much older than your sister and would not tolerate the treatment well c. The drug is expensive, and your insurance doesn't cover it d. Your cancer cells do not have the target for trastuzumab

d. Your cancer cells do not have the target for trastuzumab