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
