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Flashcards in Treatment Deck (120):
1

Define Growth Factor

Proportion of cells in a tumor actively involved in cell division

2

Define Generation Time

Length of a cell cycle

3

Define Resting Phase

Cells do not engage in synthetic activity

4

Cell Cycle Specific Chemotherapy Mode of Action

Kills in specific phase of cell cycle
Useful in tumors with high growth index

5

Cell Cycle Non-specific Chemotherapy Mod of Action

Kills in all phases
Useful in tumors with low growth index

6

Which part of the cell cycle does Nitrosoureas act on?

G0 State

7

Which part of the cycle does Asparaginase & Actinomycin D act on?

G1

8

Which medications act on the S phase of the cell cycle?

Antimetabolites
Antifolates
Antipyrimidines
Antipurines

9

Which part of the cell cycle does Bleomycin act on?

G2

10

Which part of the cell cycle does Vinca alkaloids act on?

Mitosis

11

Which medications are phase non-specific?

Alkylating agents
Antitumor antibiotics
Other (cisplatin)

12

What are the 3 modalities for treatment of cancer?

Surgery: definitive, staging, palliative
Chemotherapy: IV vs. oral, neoadjuvent vs. adjuvent
Radiation: definitive, salvage, palliative

13

Define Definitive

Treatment plan that has been chosen as the best one for the patient after all other choices have been considered

14

Define Palliative

Relieving or soothing the symptoms of a disease without producing a cure

15

Means of Administering Systemic Chemotherapy

Intravenously
Injection
Intraperitoneal
Orally
Topically

16

What are the classes of chemotherapy drugs?

Alkylating agents
Antimetabolites
Mitotic inhibitors
Anthracyclines
Topoisomerase inhibitors
Miscellaneous

17

MOA of Alkylating Agents

Directly damage DNA to keep the cell from reproducing
Work in ALL phases of cell cycle

18

What types of cancers are treated with alkylating agents?

Leukemia
Lymphoma
Hodgkin's disease
Multiple myeloma
Sarcoma
Lung
Breast
Ovarian

19

Alkylating Agent Primary Toxicities

N/V
Myelosuppression
Alopecia

20

Classes of Alkylating Agents

Nitrogen mustards
Platinum analogs
Tiazenes
Miscellaneous

21

Nitrogen Mustards Medications (Alkylating Agents)

Mechlorethamine (nitrogen mustard)
Cyclophosphamide (Cytoxan)
Ifosfamide (Ifex)

22

Cyclphosphamide (Cytoxan) SE

Hemorrhagic Cystitis

23

Hemorrhagic Cystitis

May shed large segments of bladder mucosa
May lead to urinary obstruction
Concentrated urine may cause severe bladder damage
Increase fluid intake before & after infusion & empty bladder frequently

24

Platinum Analogues Medications (Alkylating Agents)

Carboplatin (Paraplatin)
Cistplatin (Platinol)
Oxaliplatin (Eloxatin)

25

Cisplatin (Platinol) SE

Nephrotoxicity
Neurotoxicity
Ototoxicity

26

What labs do you need to follow with cisplatin?

CBC
CMP

27

Ways to Prevent Nephrotoxicity with Cisplatin

Vigorously hydrated prior, during, & after administration
Amifostine

28

Ways to Preven Neurotoxicity with Cisplatin

Amifostine

29

What cancer is there a possibility of developing with the use of alkylating agents?

Leukemia: due to damaged DNA, can cause long-term damage to the bone marrow

30

MOA of Antimetabolites

Interfere with DNA & RNA growth by substituting for the normal building blocks of RNA & DNA
Damage during the S phase

31

What are antimetabolites used to treat?

Leukemias
Breast CA
Ovarian CA
Intestinal tract CA

32

Primary Antimetabolite Toxicities

Myelosuppression
N/V
Mucositis
Dermatologic (rash, injection site reaction, dermatitis, pruritis)

33

Classes of Antimetabolites

Folate antagonists
Purine analogs
Pyrimidine analogs

34

Folate Antagonist Medication

Methotrexate (MTX, Trexall)

35

Purine Analog Medication

Mercaptopurine (6-MP, Purinethol)

36

Pyrimidine Analog Medications

Fluorouracil (5-FU)
Gemcitabine (Gemzar)

37

Methotrexate (MTX; Trexall) Toxicity

Myelosuppression
Mucositis
Damage to liver & kidney

38

What medication can help reverse the toxic effects of MTX?

Leucovorin

39

Methotrexate (MTX; Trexall) & Effusions

Methotrexate will go into the effusions and leak out continuously exposing normal tissue to the drug

40

What can help prevent crystallization of the urine in methotrexate use?

Vigorous hydration & bicarbonate

41

Drugs that may impair methotrexate (MTX) excretion

ASA
NSAIDs
Amiodorone
Omeprazole
PCN
Phenytoin
Sulfa compounds

42

MOA of Mitotic Inhibitors

Altering the DNA inside cancer cells to keep them from growing & multiplying
Stops mitosis from happening

43

What are mitotic inhibitors also known as?

Anti-tumor antibiotics
Antimicrotubules

44

Classes of Mitotic Inhibitors

Vinca Alkaloids
Taxanes
Epothilone
Antracyclines

45

Mitotic Inhibitor Toxicities

Myelosuppression
Anaphylactic reactions
Peripheral neuropathy

46

Types of Cancer Mitotic Inhibitors Treat

Breast
Lung
Myelomas
Lymphomas
Leukemias

47

Taxane Medications

Paclitaxel (Taxol)
Docetaxel (Taxotere)

48

Epothilone Medications

Ixabepilone (Ixempra)

49

Vinca Alkaloid Medications

Vinblastine (Velban)
Vincristine (Oncovin)
Vinorelbine (Navelbine)

50

Where do the Vinca Alkaloids act?

Interfere with M phase

51

Vincristine (Oncovin) SE

Neuropathy: paresthesias in fingers and toes; distal to proximal; constipation

52

Anthracyclines Medication

Daunorubicin (Cerubidine)
Doxorubicin (Adriamycin)
Idarubicin
Epirubicin

53

Anthracyclines SE

Cardiotoxicity: systolic CHF; acute, subacute, late

54

Risk Factors for Cardiotoxicity

High cumulative dose
Age >70
Previous/current chest radiation
Cardiac disease

55

Scan to determine ejection fraction with anthracyclines

MUGA

56

MOA of Topoisomerase Inhibitors

Interfere with topoisomerases
Help separate strands of DNA to be copied in the S phase

57

Topoisomerase I Inhibitor Medications

Topotecan

58

Topoisomerase II Inhibitor Medications

Etoposide

59

Topoisomerase Inhibitors Treat Which Cancers

Leukemias
Lung
Ovarian
Gastrointestinal

60

Topoisomerase Inhibitors SE

Myelosuppression
Alopecia
GI toxicity

61

What medications can increase the risk of a second cancer (AML)?

Topoisomerase II inhibitors

62

Examples of Miscellaneous Agents

Actinomycin-D
Bleomycin

63

Bleomycin (Blenoxane) SE

Edema of interphalangeal joints
Hardening of the skin on the palms & soles
Anaphylactic or serum sickness
Pulmonary fibrosis
Hypotensive reaction

64

What to watch for with pulmonary fibrosis?

Cough
Dyspnea
Infiltrates

65

What are targeted therapies?

Newer drugs that attack cancer cells more specifically than traditional chemotherapy drugs

66

Targeted therapies are most effective in what cancers?

Non-Hodgkin's lymphoma
Leukemia
Lung CA
Breast CA

67

Example of Targeted Therapy

Imatinib (Gleevec)

68

MOA of Differentiating Agents

Act on the cancer cells to make them mature into normal cells

69

Examples of Differentiating Agents

Retinoids, tretinoin (ATRA or Atralin)
Bexarotene (Targretin)
Arsenic trioxide (Arsenox)

70

MOA of Hormone Therapy

Change the action or production of female or male hormones
Making the cancer cells unable to use the hormone needed to grow

71

Classes of Hormone Therapy

Anti-estrogens
Aromatase inhibitors
Progestins
Estrogens
Anti-androgens
Gonadotropin-releasing hormone

72

Example of Anti-Estrogen Agent

Tamoxifen

73

Example of Aromatase Inhibitors

Anastrozole (Arimidex)

74

Example of Anti-Androgen

Bicalutamide (Casodex)

75

Example of Gonadotropin-Releasing Hormone

leuprolide (Lupron)

76

Types of Immunotherapy

Active immunotherapy
Passive immunotherapy

77

Define Active Immunotherapy

Stimulate the body's own immune system to fight the disease

78

Define Passive Immunotherapy

Doesn't rely on the body to attack the disease
Man made monoclonal antibodies

79

Define Checkpoint Inhibitor

New monoclonal antibody that works by blocking the signal that cancer cells send out telling the immune system not to attack
Allows immune system to recognize the tumor

80

Cancers that Respond to Immunotherapy

Melanoma
Kidney CA
Lung CA

81

Examples of Active Immunotherapy

Rituximab (Rituxan)
BCG

82

Define Chemotherapy Cycle

Involves a dose of one or more drugs followed by several days or weeks without treatment

83

Why are chemotherapy cycles separated by a certain amount of days?

Allow normal cells time to recover from drug SE

84

Define Adjuvent Chemotherapy

Set course given to patients with no evidence of disease after surgery or radiation

85

Define Neoadjuvent Chemotherapy

Aims at eradicating micrometastatic disease or reduce inoperable disease

86

Define Induction Chemotherapy

Combination chemotherapy given in high dose to cause a remission

87

Define Maintenance Chemotherapy

Long term, low dose regimen given in remission
Helps to maintain remission

88

Define Ionizing Radiation

Production of free hydrogen ions & hydroxyl radicals

89

Acute Toxicities of Skin Radiation

Erythema
Dry desquamation
Moist desquamation

90

Subacute Toxicity of Skin Radiation

Hyperpigmentation

91

Late Toxicities of Skin Radiation

Hypopigmentation in the treatment field
Telangiectasis (spider veins)
Fibrosis

92

Acute Toxicities of Brain Radiation

Fatigue
Hair loss
Erythema of the skin
Desquamation

93

Late Toxicities of Brain Radiation

Cognitive dysfunction
Edema
Necrosis

94

Acute Toxicities of Head/Neck Radiation

Mucositis
Taste dysfunction
Pain
Xerostomia

95

Signs/Symptoms of Mucositis

Odynophagia
Dehydration
Weight loss

96

Late Toxicities of Head/Neck Radiation

Permanent xerostomia
Soft tissue fibrosis
Osteoradionecrosis of the mandible
Dysphagia
Pharyngeal stricture

97

Acute (Common & Temporary) Toxicities of Breast Radiation

Skin Redness
Dry desquamation
Moist desquamation
Pain: OTC analgesics, narcotics
Fatigue

98

Late (Uncommon & Permanent) Toxicities of Breast Radiation

Fibrosis
Hyperpigmentation
Cosmetic failure
Rib fracture (rare)
Pneumonia (rare)
Cardiac (rare)
Secondary malignancies (rare)

99

Acute Toxicities of Lung Radiation

Esophagitis
Cough
Skin Reaction
Fatigue

100

Ways to Treat Esophagitis

Mucosal anesthetics
Agents that coat the surface
Liquid analgesics

101

Ways to Treat Cough as a Toxicity of Lung Radiation

Antitussives with or without codeine
Bed rest
Bronchodilators
Corticosteroids

102

Late Toxicities of Lung Radiation

Radiation pneumonitis
Pulmonary fibrosis
Esophageal stricture
Brachial plexopathy

103

Acute Toxicities of Esophageal Radiation

Esophagitis
Modest skin tanning
Fatigue
Weight loss
Diarrhea
N/V

104

Late Toxicities of Esophageal Radiation

Esophageal stricture & stenosis
Perforation
Pneumonitis

105

What percentage of patients develop esophageal stricture & stenosis in esophageal radiation treatment?

>60%

106

Signs/Symptoms of Esophageal Perforation

Substernal chest pain
Elevated pulse
Fever
Hemorrhage

107

Acute Toxicities of Abdominal, Stomach, Pancreas, or Hepatobiliary Radiation

Dyspepsia: PPI
Anorexia
Nausea: prophylactic zofran
Fatigue

108

Late Toxicities of Abdominal, Stomach, Pancreas, or Hepatobiliary Radiation

Bowel obstruction
Worsening DM secondary to worsening pancreatic function
Liver/Kidney issues

109

Acute Toxicities of Pelvic Radiation

Diarrhea
Rectal irritation
Urinary symptoms
Fatigue

110

Medications to Treat Diarrhea

Imodium
Lomotil

111

Signs/Symptoms of Rectal Irritation in Pelvic Radiation

Pain
Bleeding

112

Urinary Symptoms with Pelvic Radiation

Frequency/urgency
Dysuria
Nocturia
Retention

113

Late Toxicities of Pelvic Radiation

Persistent urinary symptoms
Bowel changes
Erectile dysfunction

114

Persistent Urinary Symptoms in Pelvic Radiation

Frequency
Nocturia
Incontinence with stress

115

Bowel Changes in Pelvic Radiation

Loose stools

116

Acute Toxicities of Anal Radiation

Skin reactions: dry or moist desquamation
Leukopenia
Thrombocytopenia
Proctitis
Diarrhea
Cystitis

117

Subacute & Late Toxicities of Anal Radiation

Chronic diarrhea
Rectal urgency
Sterility
Impotence
Vaginal dryness
Vaginal fibrosis
Possible decreased testosterone

118

Toxicities of GYN Radiation

Cystitis
Proctitis
Fistula: rectovaginal, vesicovaginal
Vaginal ulceration or necrosis
Vaginal stenosis
Skin reactions

119

What is the only systemic toxicity with radiation?

Fatigue

120

What is degree of damage dependent on?

Types of radiation used
Total dose administered
Field size/fractionation