Pharma --Antineoplastics--Drugs and their classes

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1

Most cells in the human body are in the

G0 phase/dormant

2

Cell cycle specific drugs are most effective against

rapidly growing cancers

3

The percent of rapidly dividing cells

growth fraction

4

Anticancer drugs are more effective against cancers with a high

growth fraction

5

Which cancers have a high growth fraction?

leukemias and lymphomas

6

solid tumors have a low growth fraction and therefore

respond poorly to anticancer drugs

7

Solid tumor cancers require

high dose chemo to overcome the low growth fraction

8

why do tumors slow in growth as they get larger?

the blood supply decreases

9

What is needed for anticancer cells to be effective and access their target?

adequate vascularization

10

Put the phases of the cell cycle in order

S

Mitosis

G1

G2

G0

G0-->G1-->S-->G2-->Mitosis

11

How can chemo be administered?

-Topically

-Intrathecally

-Intraventricularly

-IM

-IV

-PO

-Intraperitoneal

-Subcut

-Intrapleural

-intraarterially

12

Benefits to multidrug therapy

-less resistance

-multiple cell cycle hits

-synergistic effects

-enhances tumoricidal activity

13

Anticancer drugs affect which healthy cells most

rapidly dividing--skin and hair

14

Myelosupression occurs when

bone marrow is supressed--RBC/WBC/platelets

15

What is cyclophosphamide (Cytoxan) used to treat?

-leukemia

-breast cancer

16

WHat is fluorouracil (5-FU) used to treat?

breast

GI

Head & neck

basal cell carcinoma (Topical)

17

Fluororocil (5-FU) is NOT given

PO because bioavailability is unstable

18

What natural supplement promotes cancer growth?

Mistletoe

19

What supplement has "blood fighting" properties that can increase bleeding risk?

Astralagus

20

What does doxorubicin treat?

Solid and hematogenous tumors

21

What type of solid tumor does doxorubicin not treat?

Acute myelogenous leukemia because of risk of stomatitis and cardiotoxicity

22

Doxorubicin is only given

IV

23

What causes the dose limit is vincristine?

neurotoxicity

24

A major concern with vincristine?

numerous drug interactions

25

Why are corticosteroids used in cancer treatment?

To manage inflammation associated with tumor growth

26

Other than skin and hair, what tissues suffer during chemo treatment?

-reproductive

-GI

-mucosa

-bone marrow

27

What is the NADIR?

The time at which blood counts are the lowest

28

When does the NADIR typically happen?

7-10 days after treatment

29

Ankylating drugs are effective in all phases, but they are MOST effective during

G0- dormant

30

Ankylating drugs given in high doses can cause permanent damage to

bone marrow, causing acute leukemia

31

Low RBC resulting from chemo can manifest with

-fatigue/SOB

-hypotension/oliguria

-cyanosis

-mental status change

32

Anemic cancer patients should be provided with proper pain relief because

pain increases oxygen demand

33

What can be given to increase WBC counts in cancer pts?

Colony stimulating factors like filgrastim

34

How to prevent bleeding in thrombocytopenic cancer pts?

-Avoid invasion- like rectal temp

-avoid aspirin/anticoagulants

-monitor counts and signs of bleeding

35

What causes anorexia related to chemo?

-bitter taste

-pain

-nausea

-fatigue

-altered taste

36

Why do antineoplastics cause N/V?

they stimulate the CTZ

37

Which chemo drugs are most likely to cause diarrhea?

alkylating agents

antitumor antibiotics

antimetabolites

38

Other than cancer, what can cyclophosphamide treat?

Lupus nephritis

39

When using IV cyclophosphamide, what must be assesses?

infiltration, as this drug is a severe vesicant that will cause tissue necrosis

40

The pt must be very well __________ while taking cyclophosphamide in order to avoid ______________

hydrated

hemorrhagic cystitis

41

Pts on cyclophosphamide must be continually assessed for

Cardiomyopathy

-hemorrhagic cystitis

SIADH

42

How does cyclophosphamide affect the skin?

increased pigmentation of skin and nail beds

43

Antimetabolites are Cell cycle specific to which phase?

S phase

44

Which antimetabolite can be cytotoxic in multiple cell cycle phases?

5-Fu/Fluororicil

45

Pts should take oral cyclophosphamide ___________- to avoid ____________

early in the day

accumulation in the bladder

46

If platelets arelower than 50,000 mm3

a soft toothbrush should be used

47

In order to alkalize urine, pts should eat diets low in

purines (which are found in organ meats, beans, peas)

citric acid

48

Which herbs interfere with chemo?

ginseng

st johns wort

49

Therapy should be stopped if which labs are present

WBC <3500

platelet <100,000

50

How do antitumor antibiotics work?

by interfering with DNA replication and RNA transcription of cancer cells

51

Most Antitumor antibiotics works in which cell cycle phases?

all

52

Antitumor antibiotics may cause

vesication (tissue blistering)

53

Doxorubicin has a higher chance of causing what than other antitumor antibiotic anthracyclines?

Stomatitis

Cardiotoxicity (especially IV)

54

What is the max dose of Doxorubicin due to cardiotoxicity?

550 mg/m2

55

Fluorouracil can do what?

Cross the BBB

56

Pts of Fluorouracil should avoid alcohol mouthwash and do what instead?

rinse with saline every two hours

57

Grapefruit should not be eaten/drank while on

Doxorubicin

58

Doxorubicin may discolor

urine to pink or red

59

Plant alkaloids are

cell cycle specific

60

How do plant alkaloids work?

interfere with cell functions during mitosis (antimicrotubules)--- leads to apoptosis

61

Doxorubicin causes complete

alopecia

62

Drugs used as a cytoprotectant against doxorubicin?

Dexrazoxane-- prevents cardiotoxicity

63

Skin integrity is a concern with all antineoplastics, but especially

Doxorubicin

64

Doxorubicin must be given through a

large bore, quickly running IV infusion

65

What plant is Vincristine made from?

Periwinkle

66

What is the dose limiting property of vincristine?

Neurotoxicity

67

Does Vincristine cross the BBB?

Noooope

68

Neuropathy occurs with ________ in as little as a weekly dose, but _________

vincristine

it will resolve within a week

69

Vincristine side effects are different from other antineoplastics in that

it is mostly various neurological side effects

-bowel/bladder issue

-sensory loss

-deep tendon reflex loss

-paresthesia

-difficulty walking

-hyporeflexia

-muscle wasting

70

Nonneurological effects of Vincristine

-bladder atony

-hepatic venoocclusive disease

-bronchospasm

-transient cortical blindness/optic atrophy

71

IV vincristine administration must include monitoring for

extravasation

can occur 3-4 wks after administration!

72

Constipation and electrolyte imbalance are a major concern and must be avoided with

Vincristine

73

For a pt on vincristine, __________ must be monitored closely to avoid renal toxicity and electrolyte imbalances

hydration

74

Exogenous estrogen can do what for a cancer pt

slow the rate pf prostate cance

75

Exogenous androgen opposes the activity of

estrogen

76

Epoetin alpha may cause

MI

Thromboembolism

stroke

77

Most targeted therapies are either

small molecules or monoclonal antibodies

78

Rituximab

Monoclonal antibody

targeted therapy

79

How do targeted therapies work

they clock signal transduction and stop cancer spread by causing cell death

80

Epoetin Alpha (Procrit, epogen) side effects

antibody formation

-HTN/HA

-bronchospasm/cough

-arthralgia/myalgia

-flulike symptoms

81

Erythropoietin stimulators (procrit/epogen) increases risk of death if hgb is

>11 g/dl

82

Filgastrim (Neupogen/neulasta) side effects

antibody formation

-rash

-periph edema/HA

-chest pain/dysrhythmias

-pulmonary disorders/Dyspnea

-elevated hepatic enzymes

-N/V

-alopecia

83

Filgastrim stimulates what cells to proliferate?

Neutrophils

84

Interleukins signal

T and B lymphocytes

85

Most pts on Erythropoietin colony stimulating factor will need _______- so monitor _______

supplemental iron

ferritin labs

86

Pts on biological response modifiers should have which systems evaluated

-pulmonary

-cardiac

-renal

-hepatic

87

Risks of bio response modifiers

-anaphylaxis/allergies (MONITOR SKIN)

-emotional instability

-cardiac/circulatory issues

-pulmonary issues

-seizures

88

Bio response modifiers may cause

histamine effects--use tylenol and Benadryl to treat chills and fever resulting

89

Side effects of bevacizumab

-HTN

-proteinuria

-HA

-taste alteration

-rectal hemorrhage

-lacrimation disorder

90

__________ should be assessed before starting bevacizumab

SKIN--during treatment as well

hepatic/renal function

pulmonary/cardiac function

--Clotting and immunity may be altered

91

All monoclonal antibodies (ie bevacizumab) are given

IV because the GI tract alters the structure

92

4 requirements for effective monoclonal antibodies

-target antigens are on tumor cell surface

-antigens do not spread into the blood stream

-antigens occur in high numbers

-antigens play a role in tumor cell survival

93

Side effects of monoclonal antibodies are related to

activation of the immune system

location of the antigen

type of MAb

94

Monoclonal antibodies are made from

mouse or human or mix

(human is more effective)

95

Side effects of MAB rituximab

bone marrow suppression/pancytopenia

tumor lysis syndrome

hypotension

joint and muscle pain

96

Mab rituximab should not be used in patients with

-hx of hep B

-current infection

-renal/cardiac/hepatic disease

-pulmonary fibrosis

-breastfeeding

97

Potential problems with the use of monoclonal antibodies

-fluid electrolyte imbalance

-altered clotting

-decreased immunity

-cardiac/liver/renal

-skin concerns

98

While on monoclonal antibodies, __________ should be avoided

hepatotoxins (boooooze)

pregnancy (for 12 months after treatment)

breastfeeding (for 60 days after)

99

Patients on monoclonal antibodies should immediately report

convulsions, persistent headache

reduced eyesight/blurred vision

HTN