Pharm week 4 study guide real

Oncology Foundations and Safety

What is growth fraction?

The ratio of actively dividing cells to resting cells in a tumor.

Which cancers usually respond best to chemotherapy?

Leukemias + lymphomas because many cells are rapidly dividing.

Why are solid tumors often less sensitive to chemotherapy?

They usually have fewer actively dividing cells.

Why does chemotherapy damage bone marrow, hair + GI tissue?

These normal tissues also divide rapidly.

What occurs during G0?

The cell rests.

What occurs during G1?

The cell prepares to copy DNA.

What occurs during S phase?

The cell copies DNA.

What occurs during G2?

The cell prepares for mitosis.

What occurs during M phase?

Mitosis (cell division) occurs.

What is chemotherapy?

Drugs that kill rapidly dividing cells (cancer cells + some healthy cells).
cyclophosphamide, cisplatin, doxorubicin.

Why are chemotherapy drugs combined?

They attack cancer in different ways, increase cell killing + reduce resistance.
(cyclophosphamide, cisplatin, doxorubicin)

What is targeted cancer therapy?

Treatment aimed at a specific cancer receptor or molecule.

(imatinib, trastuzumab)

What is hormonal cancer therapy?

Treatment that blocks hormones needed by certain cancers ((tamoxifen, letrozole)

What is immunotherapy?

Helps the immune system recognize + attack cancer (pembrolizumab, nivolumab)

Why can chemotherapy cause hyperuricemia?

Rapid cancer-cell death increases uric acid.

How is chemotherapy-related hyperuricemia prevented?

IV fluids + allopurinol.

What is tumor lysis syndrome?

Rapid cancer-cell destruction causes dangerous metabolic changes + possible kidney injury.

What does chemotherapy-related bone marrow suppression cause?

Anemia, neutropenia + thrombocytopenia.

What is the priority risk of neutropenia?

Infection.

What is the priority risk of thrombocytopenia?

Bleeding.

Which chemotherapy finding requires immediate reporting?

Fever or signs of infection.

What should be checked before chemotherapy?

CBC, kidney/liver function + signs of infection, bleeding or drug-specific toxicity.

Why is hydration important during chemotherapy?

Promotes drug + uric-acid excretion and reduces kidney injury.

What PPE is used for chemotherapy or contaminated body fluids?

Chemotherapy-rated gloves, protective gown + facility-required PPE.

How should a chemotherapy spill be managed?

Restrict the area and use a chemotherapy spill kit.

Why may the toilet be flushed twice after chemotherapy?

Body fluids may contain active chemotherapy.

How are chemotherapy-contaminated items handled?

Place them in designated hazardous-drug containers or hampers.

Which findings suggest chemotherapy ototoxicity?

Tinnitus, ringing/roaring + hearing loss.

Which findings suggest peripheral neuropathy?

Tingling, numbness, pain + weakness.

What is chemotherapy-related stomatitis?

Painful inflammation + ulcers in the mouth.

What teaching helps prevent stomatitis?

Use gentle oral care + a soft toothbrush; report severe ulcers or difficulty drinking.

Antineoplastic Drugs

What class is cyclophosphamide (Cytoxan)?

Alkylating agent (nitrogen mustard).

How does cyclophosphamide work?

Cross-links DNA and prevents cancer-cell division.

What is cyclophosphamide used for?

Leukemias, lymphomas + multiple myeloma.

What are cyclophosphamide’s major adverse effects?

Bone marrow suppression, alopecia + hemorrhagic cystitis.

How is hemorrhagic cystitis prevented with cyclophosphamide?

Maintain adequate hydration and monitor urine for blood.

What should be monitored with cyclophosphamide?

CBC, kidney function, liver function + urine.

What is the cyclophosphamide memory clue?

“Cyclophosphamide can cause cystitis.”

What class is cisplatin?

Platinum alkylating agent.

How does cisplatin work?

Binds DNA and prevents normal replication.

What are cisplatin’s major adverse effects?

Severe nausea/vomiting, nephrotoxicity, ototoxicity, neuropathy + bone marrow suppression.

What should be done before cisplatin?

Give vigorous hydration and assess kidney function.

Which cisplatin finding requires immediate reporting?

Ringing in the ears or hearing loss.

What is the cisplatin memory clue?

“Cisplatin: kidneys + ears.”

What class is methotrexate (MTX)?

Antimetabolite-antifolate + DMARD.

How does methotrexate work?

Blocks folic-acid activity and disrupts DNA synthesis during S phase.

What is methotrexate used for?

Several cancers + rheumatoid arthritis.

What is methotrexate’s major adverse effect?

Bone marrow suppression.

Which findings suggest methotrexate bone marrow suppression?

Fever, sore throat, unusual bruising or bleeding.

Which labs are monitored with methotrexate?

CBC, kidney function + liver function.

Why should alcohol be avoided with methotrexate?

It increases liver-injury risk.

Can methotrexate be used during pregnancy?

No; it can cause fetal harm.

What pregnancy teaching applies to methotrexate?

Avoid pregnancy during therapy + for at least 6 months after treatment

What is the methotrexate memory clue?

MTX: monitor blood, kidneys + liver.”

What class is doxorubicin (Adriamycin/Doxil)?

Anthracycline antitumor antibiotic.

How does doxorubicin work?

Damages cancer cells and triggers cell death.

What is doxorubicin’s most serious adverse effect?

Cardiotoxicity (cardiomyopathy + heart failure).

What should be checked before + during doxorubicin?

Cardiac function, including LVEF.

Which findings suggest doxorubicin cardiotoxicity?

Dyspnea, crackles, edema, fatigue + decreased LVEF.

Which labs are monitored with doxorubicin?

CBC, electrolytes, kidney/liver function + uric acid.

What expected discoloration occurs with doxorubicin?

Red-orange urine, sweat + tears.

What is the doxorubicin memory clue?

“DOXO damages the heart + dyes fluids red.”

What class is vincristine (Oncovin)?

Vinca alkaloid + mitotic inhibitor.

How does vincristine work?

Disrupts microtubules and stops mitosis during M phase.

What is vincristine’s major toxicity?

Neurotoxicity, especially peripheral neuropathy.

Which findings suggest vincristine neurotoxicity?

Tingling, numbness, burning pain, muscle weakness + decreased reflexes.

What should be assessed before vincristine?

Neurologic status + muscle strength.

How do vincristine and vinblastine differ?

Vincristine affects nerves; vinblastine suppresses bone marrow more.

Why is reliable IV access needed for vincristine?

Leakage into tissue can cause severe injury.

What is the vincristine memory clue?

“Vincristine causes a nerve crisis.”

Immune Response and Inflammation Foundations

What is innate immunity?

Immediate, nonspecific protection present at birth (skin, inflammation, neutrophils + macrophages).

What is adaptive immunity?

Antigen-specific protection that develops after exposure or vaccination and forms memory.

How do B cells protect the body?

They become plasma cells and produce antibodies (humoral immunity).

How do T cells protect the body?

They directly attack infected or abnormal cells and control cell-mediated immunity.

What is the B-cell vs T-cell memory clue?

“B builds antibodies; T targets cells.”

What do natural killer (NK) cells do?

Destroy cancer cells + virus-infected cells without prior exposure.

What is chemotaxis?

Chemical attraction of neutrophils + macrophages to injured or infected tissue.

What does histamine cause during inflammation?

Vasodilation + increased capillary permeability

What is the purpose of inflammation?

Destroy pathogens, remove damaged cells + begin healing.

What is the difference between acute and chronic inflammation?

Acute inflammation is short-term and protective; chronic inflammation can cause tissue damage.

What do interferons normally do?

Prevent viral replication + suppress some malignant-cell growth.

What do interleukins normally do?

Allow leukocytes to communicate and regulate immune activity.

What does tumor necrosis factor (TNF) do?

Promotes inflammation and can inhibit tumor growth.

Anti-inflammatory and Antiarthritis Drugs

What is a DMARD?

A disease-modifying antirheumatic drug that slows rheumatoid arthritis progression + joint destruction.

How are DMARDs different from NSAIDs?

DMARDs slow the disease; NSAIDs mainly relieve pain + inflammation.

What is the DMARD memory clue?

“DMARD = Disease Modification.”

What class is salsalate?

Salicylate anti-inflammatory drug.

What is salsalate used for?

Pain, fever + inflammation.

How do salicylates work?

Decrease prostaglandin production, reducing pain, fever + inflammation.

What are the major adverse effects of salicylates?

GI irritation/bleeding, kidney injury + salicylate toxicity.

Which finding suggests salicylate toxicity?

Tinnitus (ringing or roaring in the ears).

Which clients require caution with salicylates?

Clients with bleeding disorders, kidney impairment, pregnancy or upcoming surgery.

Why may salicylates be stopped before surgery?

They increase bleeding risk.

What is the salicylate memory clue?

SAL: Stomach irritation, Auditory ringing + Longer bleeding.”

What class is diclofenac (Voltaren/Cataflam/Flector)?

NSAID (acetic-acid derivative).

How does diclofenac work?

Blocks COX enzymes and decreases prostaglandin production.