CHEMOTHERAPY

"Use of antineoplastic drugs to destroy cancer cells by interfering with cellular functions like replication and DNA repair."

What is chemotherapy?

"Cellular replication and DNA repair."

What cellular functions do chemotherapy drugs interfere with?

"Systemic disease rather than localized lesions amenable to surgery or radiation."

What type of disease is chemotherapy primarily used for?

Cure, control, and palliation.

What are the three main goals of chemotherapy?

"Chemotherapy given before surgery or radiation to reduce tumor size."

What is neoadjuvant chemotherapy?

"To destroy any remaining tumor cells after surgery."

What is the purpose of adjuvant chemotherapy?

"As the main treatment for some leukemias and lymphomas."

When is primary chemotherapy used?

1. Widespread disease

2. High risk of undetectable disease

3. Tumor cannot be resected and is resistant to radiation therapy."

List three clinical scenarios when chemotherapy is recommended.

"To destroy all malignant tumor cells without excessive harm to normal cells."

What is the main objective of chemotherapy?

"Ratio of dividing (proliferating) cells to resting cells."

Define growth fraction in chemotherapy context.

"Actively dividing (proliferating) cells."

Which tumor cells are most sensitive to chemotherapy?

"Nondividing cells; they can later begin dividing and cause disease relapse if not destroyed."

Which tumor cells are least sensitive and why is this important?

"To kill nondividing tumor cells as they enter active division phases."

Why are repeated chemotherapy cycles used?

No, it affects both cancerous and normal cells.

Does chemotherapy kill only cancer cells?

"Drugs that act during specific phases of the cell cycle."

What are cell cycle-specific chemotherapy agents?

"Drugs that act independently of the cell cycle phases."

What are cell cycle-nonspecific chemotherapy agents?

Topoisomerase inhibitors, antimetabolites, mitotic spindle inhibitors

What are examples of cell cycle-specific drugs?

Alkylating agents, nitrosoureas, antitumor antibiotics, hormonal agents, miscellaneous agents.

What chemical groups classify nonspecific chemotherapy agents?

"Enhance chemotherapy effects or protect normal cells from damage."

What is the role of adjunct chemotherapeutic agents?

"A folic acid analog that enhances fluorouracil's effect and rescues normal cells from methotrexate toxicity."

What is leucovorin and its function?

They induce DNA strand breaks by binding topoisomerase enzymes, preventing cell division.

How do topoisomerase inhibitors work?

Bone marrow suppression, diarrhea, nausea, vomiting, flu-like symptoms, rashes, hepatotoxicity.

What side effects are associated with topoisomerase inhibitors?

Inhibit biosynthesis of nucleic acids needed for DNA and RNA synthesis, blocking DNA replication and repair.

How do antimetabolites function?

Nausea, vomiting, diarrhea, bone marrow suppression, stomatitis, renal toxicity, hepatotoxicity, hand-foot syndrome.

Side effects of antimetabolites?

"M phase (mitosis)."

What phase do mitotic spindle inhibitors target?

Plant alkaloids, taxanes, and epothilones.

Name types of mitotic spindle inhibitors.

Nausea, vomiting, bone marrow suppression, peripheral neuropathies, hypersensitivity, alopecia, mucositis, hepatotoxicity.

What are side effects of mitotic spindle inhibitors?

By bonding with DNA, RNA, and proteins, impairing replication and function leading to cell death.

How do alkylating agents kill tumor cells?

Bone marrow suppression, nausea, vomiting, stomatitis, alopecia, gonadal suppression, renal toxicity, secondary malignancies.

Side effects of alkylating agents?

"They can cross the blood-brain barrier."

What makes nitrosoureas unique among chemotherapy agents?

"Delayed and cumulative myelosuppression (especially thrombocytopenia), nausea, vomiting, pulmonary, hepatic, and renal damage.

Side effects of nitrosoureas?

"Bind DNA to interfere with DNA and RNA synthesis."

What is the mechanism of antitumor antibiotics?

"Bone marrow suppression, nausea, vomiting, alopecia, anorexia, cardiac toxicity, red urine, pulmonary fibrosis.

Side effects of antitumor antibiotics?

"Bind to hormone receptor sites to alter growth, block estrogen binding, inhibit RNA synthesis, and suppress cytochrome P450.

How do hormonal agents work in chemotherapy?

"Hypercalcemia, jaundice, appetite changes, masculinization/feminization, sodium/fluid retention, nausea, hot flashes, vaginal dryness.

List common side effects of hormonal agents.

"Prevents or lessens toxic effects caused by folic acid deficiency induced by methotrexate."

How does leucovorin help patients treated with methotrexate?

"Body surface area, weight, prior treatment response, organ function, and lab results.

What criteria affect chemotherapy dosing?

"When lab values or patient symptoms indicate dangerous or unacceptable toxicity."

When is chemotherapy dosage modified?

"Standard-dose, dose-dense (more frequent), and myeloablative (for HSCT).

Name the types of chemotherapy treatment regimens.

"To prevent irreversible organ damage (e.g., doxorubicin’s 550 mg/m² lifetime limit due to cardiotoxicity).

Why is there a maximum lifetime dose limit for some chemotherapy drugs?

Oral, intravenous, intramuscular, intrathecal, intra-arterial, intracavitary, intravesical, topical.

List common routes of chemotherapy administration.

Leakage of chemotherapy drugs from veins into surrounding tissues, causing inflammation and damage.

What is extravasation in chemotherapy?

"Drugs that cause severe tissue injury and necrosis if leaked outside veins."

What are vesicant drugs in chemotherapy?

"High risk of tissue necrosis and severe damage."

Why should vesicant chemotherapy never be given in hand/wrist veins?

"Forearm using soft plastic catheter for short duration infusions."

Where should peripheral vesicant chemotherapy be administered?

Right atrial silastic catheters, implanted venous access devices, or PICCs.

What devices are recommended for frequent or prolonged vesicant chemotherapy?

Unexpected immune reaction with symptoms like rash, fever, hypotension, wheezing, and syncope.

What is a hypersensitivity reaction (HSR) in chemotherapy?

Rash, urticaria, fever, hypotension, cardiac instability, dyspnea, wheezing, throat tightness, syncope.

What symptoms indicate HSR?

"Immediate within 1 hour of infusion; delayed hours after infusion."

When do immediate and delayed HSRs occur?

Yes, repeated exposure increases likelihood of reaction.

Does the risk of HSR increase with repeated exposure?

Most common chemo side effect, lasting 24-48 hours or delayed up to a week post-treatment.

What is chemotherapy-induced nausea and vomiting (CINV)?

Activation of serotonin and dopamine receptors, and stimulation of peripheral autonomic and vestibular pathways.

What causes CINV?

Good oral hygiene, hydration assessment, antiemetics, ice chips, and scheduled medications.

What nursing care is recommended for CINV?

Begins 2-3 weeks after treatment, hair regrowth may start around 8 weeks post-treatment.

When does alopecia from chemotherapy start and how long does it last?

Wigs, caps, scarves, and pre-emptive haircut options.

What supportive care is offered for alopecia?

Routine mouth inspections, oral care, avoid spicy/citrus foods, ice chips, soft bland diet, soft toothbrush, topical lidocaine for adults.

How is stomatitis managed in chemotherapy patients?

Taste changes making food taste metallic, especially meat.

What causes anorexia in chemotherapy patients?

Comfortable positioning, good hygiene, and attractive food presentation.

Nursing care for anorexia includes?

"Pallor and fatigue."

What are signs of anemia in chemotherapy patients?

"Schedule rest periods and administer erythropoietin as ordered."

Nursing care for anemia includes?

Signs of infection like fever, cough, and abnormal lung sounds

What are signs of leukopenia?

Infection control measures, hand hygiene, no flowers.

Nursing care for leukopenia?

Bleeding in skin and mouth, blood in stool, urine, or vomit.

What are signs of thrombocytopenia?

Avoid shaving, gentle oral care, no suppositories/enemas, avoid sexual activity.

Nursing care for thrombocytopenia?

• C-Check phlebitis/extravasation

• H-High calorie/protein diet

• E-Encourage hydration

• M-Monitor CBC

• O-Oral care

• T-Teratogenic

• H-Hair loss

• E-Encourage counseling

• R-Report complications

• A-Administer antiemetics

• P-Practice aseptic technique

• Y-Wear gloves

What does the chemotherapy safety acronym “CHEMOTHERAPY” stand for?

Biological safety cabinet (Class II or III), closed system transfer devices, leak-proof containers, needleless systems.

What safety equipment is required when preparing chemotherapy?

Surgical N-95 respirator, eye and face protection (face shield and goggles).

What PPE is needed if no biological safety cabinet is available?

Double-layer powder-free gloves, long-sleeve disposable gowns made of impermeable materials.

What PPE should be worn when handling chemotherapy or contaminated materials?

Place in closed, labeled, puncture- and leak-proof containers.

How should linens contaminated with chemotherapy be handled?

Dispose in closed, labeled, puncture- and leak-proof containers.

How should chemotherapy waste be disposed?

"Wash hands thoroughly with soap and water."

What hygiene is essential after handling chemotherapy gloves?

Gowns, gloves, absorbent materials, hazard signs.

What should chemotherapy spill kits include?

SOPs for handling/preparation/disposal, spill management, contaminated material disposal, competency training, medical monitoring, root cause analysis.

What should a chemotherapy safety quality improvement program include?