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Flashcards in CA Tx Deck (19):
1

What are the classes of chemotherapy drugs?

Alkylating Agents

Antimetabolites

Mitotic inhibitors

Anthracyclines

Topoisomerase inhibitors

Miscellaneous

2

Alkylating Agents:
-MOA
-class SE
-what are the the sub-classes

MOA: directly damage DNA to keep cell from reproducing, works in ALL phases of cell cycle.

SE: nausea, vomiting, myelosuppression, alopecia
*Leukemia in rare cases.

Sub-classes:
-nitrogen mustards
-platinum analogs
-tiazenes
-misc.

3

Alkylating Agents- Nitrogen Mustards:
-drugs
-SE

Drug: cyclophosphamide (Cytoxan)

SE:
-hemorrhagic cystitis:
--sheds large segments of bladder mucosa leading to prolonged hematuria. Potentially leading to urinary obstruction (Clots)

4

Alkylating Agents-Platinum analogues
-drugs
-SE
-what can be given prophylactically to prevent SE?

Drugs: cisplatin (platinol)

SE:
-neurotoxicity: peripheral neuropathy, ototoxicity that can lead to deafness

-nephrotoxicity; pt must be vigorously hydrated prior during and after admin of drug

Amifostine is given IV to protect against SE from cisplatin.

5

Antimetabolites
-MOA
-SE
-what are the sub-classes?

MOA: Interfere with DNA and RNA growth, damage cells during the S phase when cells chromosomes are being copied.

SE:
-myelosuppression
-n/v
-mucositis
-dermatologic (rash, injection site rxn, dermatitis, pruritis)

Sub-classes:
-foalte antagonists (methotrexate)
-purine analogs (Mercaptopurine)
-Pyrimidine analogs (Fluorouracil, gemcitabine)

6

Antimetabolite-Folate Antagonists
-drugs
-SE
-what can be given prophylactically to prevent SE?

Drug: methotrexate (MTX; Trexall)

SE:
-myelosuppression
-mucositis
-decreased renal clearance

Leucovorin is given to reverse toxic effects of MTX otherwise the pt may die.

7

Mitotic Inhibitors:
-MOA
-subclasses
-SE

MOA: work by altering DNA inside CA cells to keep them from growing and mulitplying, work by stopping mitosis in the M phase BUT CAN DAMAGE CELLS in ALL phases of cell cycle

Sub-classes:
-vinca alkaloids
-taxanes
-epothilone
-anthracyclines

SE:
-myelosuppression, anaphylactic rxn, peripheral neuropathy*

8

Mitotic Inhibitors-Taxanes
-drugs

Drug: Paclitaxel (Taxol)

9

Mitotic Inhibitors-Vinca Alkaloids:
-drugs
-SE

Drug: Vincristine (Oncovin)

SE:
-neuropathy: paresthesias in fingers and toes
-constipation

10

Mitotic Inhibitor-Anthracyclines:
-drugs
-SE
-what baseline tests need to be done before starting this medication?

Drugs:
-daunorubicin (Cerubidine)
-doxorubicin (adriamycin)

SE:
-Cardiotoxicity leading to systolic CHF (MC associated with adriamycin)
**may be irreversible

Baseline tests: MUGA scan to calculate Ejection fraction, must be greater than 50% for this medication.

11

Topoisomerase Inhibitors:
-MOA
-subclasses of drugs
-SE

MOA: inhibit topoisomerases in S phase. (inhibit replication)

Drug subclass:
-Topoisomerase 1 inhibitors (Topotecan)
-Topoisomerase 2 inhibitors: (etoposide)

SE:
-myelosuppression, alopecia, GI toxicity

12

Miscellaneous Drugs:
-drug names?

Drugs:
-actinomycin-D
-bleomycin

13

SE of Bleomycin?

-edema of the interphalangeal joints and hardening of the skin on the palms and soles of the feet.

-pulmonary fibrosis

-hypotensive rxn

14

Targeted Therapies:
-MOA
-Drug name


Differentiating agents:
-MOA
-drugs

Hormone Therapy:
-MOA
-drugs

MOA: attack cancer cells more specifically than traditional chemotherapy drugs.

Drug: Imatinib (Gleevec)

Differentiating agents:
-MOA: act on cancer cells to make them into mature normal cells.
-drugs: Retinoids (Tretinoin)

Hormone therapy:
-MOA: work by making the cancer cells unable to use the hormone they need to grow or by preventing the body from making the hormone.

these drugs are used to slow the growth of breast, prostate, and endometrial CA which normally grow in response to natural sex hormones in the body

Drugs:
-anti-estrogens: Tamoxifen
-Aromatase inhibitors: anastrozole
-Progestins (Megace)
-Estrogens
-Anti-androgens: Bicalutamide
-Gonadotropin-releasing hormone: Leuprolide (Lupron)

15

Immunotherapy:
-what are the two types of immunotherapy?
-drugs

Types:
-active immunotherapy: stimulate bodys own immune system to fight dz

-passive immunotherapies: do not rely on body to attack dz, abys created outsidde the body and given to fight CA.

Drugs:
-Rituximab (Rituxan) (Active immunotherapies)

16

Define:
-adjuvant
-neoadjuvant
-induction
-maintenance

Adjuvant: set course given to pts with no evidence of dz after surgery or radiation

neoadjuvant: aims at eradicating micrometastatic dz or reduce inoperable dz

Induction: combination chemotherapy given in high dose to cause a remission

Maintenance: aka consolidation, long term, low dose regimen given in remission (maintains remission by inhibiting growth of remaining CA cells)

17

Radiation Therapy
-what is this?
-determination of dose?

What: use of high energy radiation from x-rays, gamma rays, neutrons, protons, to kill cancer cells and shrink tumors. Production of free hydrogen ions and hydroxyl radicals

Dose:
-tumors have individual radiobiologic characteristics

18

Toxicity of Radiation:
- Toxicity of skin
- Toxicity of Brain
- Toxicity of Head/Neck
- Toxicity of Breast
- Toxicity of Lung

SE:
Skin:
-erythemia
-dry desquamation
-moist desquamation
-hyperpigmentation (early)
-hypopigmentation, telangiectasias, fibrosis (late)

Brain:
-acute: fatigue, hair loss
-late: cognitive dysfunction, edema, necrosis

Head Neck:
-acute: odynophagia, dehydration, wt loss, taste dysfunction, pain, xerostomia
-late: permanent xerostomia, soft tissue fibrosis, dysphagia, pharyngeal stricture

Breast:
Acute:
-erythema*
-dry/moist desquamation
-pain
-fatigue
Late:
-fibrosis
-hyperpigmentation
-cosmetic fx
-rib fx
-pna

Lung:
-esophagitis
-cough
-skin rxn
-fatigue
Late:
-pneumonitis
-pulm fibrosis
-esophageal stricture

19

Radiation Toxicity:
- Toxicity Esophageal
- Toxicity of Abd, Stomach, pancreas, hepatobiliary
- Toxicity of Pelvis
- Toxicity Anal
-Toxicity GYN

Esophageal:
-esophagitis
-skin tanning
-fatigue
-wt loss
-diarrhea
-n/v
LATE:
-esophageal stricture & stenosis
-perforation
-pneumonitis

Abd:
-dyspepsia
-anorexia
-nauseea
-fatigue
LATE:
-bowel obstruction
-worsening of T2DM
-Liver/kidney probs

Pelvis:
-diarrhea, rectal irritation, urinary sx, fatigue
LATE:
-persistent urinary sx
-bowel changes
-ED

ANal:
-skin rxn
-leukopenia
-thrombocytopenia
-proctisis
-diarrhea, cystisis
LATE:
-chronic diarrhea, rectal urgency, sterility, impotence, vaginal dryness/fibrosis


GYN:
-cysitis, proctitis, fistula
-vaginal ulceration, vaginal stenosis
-skin rxn