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A nurse is caring for a client who has breast cancer and asks why the treatment plan contains a combination therapy of cyclophosphamide, methotrexate, and fluorouracil. The response by the nurse should include that combination chemotherapy is used to do which of the following? (Select all that apply)
1. Decrease medication resistance
2. Attack cancer cells at different stages of cell growth
3. Block chemotherapy agent from entering healthy cells.
4. Stimulate immune system
5. Decrease injury to normal body cells
1. Decrease medication resistance
2. Attack cancer cells at different stages of cell growth
5. Decrease injury to normal body cells
A nurse is preparing to administer cyclophosphamide IV to a client who has Hodgkin's disease. Which of the following medications should the nurse expect to administer concurrently with the chemotherapy to prevent an adverse effect of cyclophosphamide?
1. Uroprotectant agent, such as mesna
2. Opioid, such as morphine
3. Loop diuretic, such as furosemide
4. H₁ receptor antagonist, such as diphenhydramine
1. Uroprotectant agent, such as mesna
A nurse is preparing to administer leucovorin to a client who has cancer and is receiving chemotherapy with methotrexate. Which of the following responses should the nurse use when the client asks why leucovorin is being given?
1. "Leucovorin reduces the risk of a transfusion reaction from methotrexate."
2. "Leucovorin increases platelet production and prevents bleeding."
3. "Leucovorin potentiates the cytotoxic effects of methotrexate"
4. "Leucovorin protects healthy cells from methotrexate's toxic effects."
4. "Leucovorin protects healthy cells from methotrexate's toxic effects."
A nurse is teaching a client who has breast cancer about tamoxifen (Nolvadex). Which of the following adverse effects of tamoxifen should the nurse discuss with the client?
A. Irregular heart beat
B. Abnormal uterine bleeding
C. Yellow sclera or dark-colored urine
D. Difficulty swallowing
B. Abnormal uterine bleeding
A nurse is caring for a client who is being treated with interferon alfa-2b for malignant melanoma. For
which of the following adverse effects should the nurse monitor? (Select all that apply.)
A. Tinnitus
B. Muscle aches
C. Peripheral neuropathy
D. Bone loss
E. Depression
B. Muscle aches
C. Peripheral neuropathy
E. Depression
A nurse is caring for a client who receives rituximab (Rituxan) to treat non-Hodgkin's leukemia and who asks the nurse how rituximab works. The appropriate reply by the nurse is that rituximab destroys cancer cells by
A. blocking hormone receptors.
B. increasing immune response.
C. binding with specific antigens on tumor cells.
D. stopping DNA replication during cell division.
C. binding with specific antigens on tumor cells.
Agents are non-toxic to cells
Non-cytotoxic chemotherapy
Are effective against tumors that are supported or suppressed by hormones
Hormone agents
Cause an increase in a hormone that suppresses another hormone required for a tumor to grow. The use of androgenic hormones in a client who has estrogen-dependent cancer can suppress the growth of this type of cancer. Conversely, the use of estrogenic hormones for testosterone-dependent cancer can suppress the growth of this type of cancer.
Hormone agents
Block certain hormones and can be effective against tumors that require a particular hormone for support
Hormone antagonists
Act as immunostimulants to enhance the immune response and reduce the proliferation of cancer cells.
Biological response modulators
Are antibodies or small molecules that attach to specific target sites to stop cancer growth without injuring healthy tissue.
Targeted antineoplastic agents
Common side effects of chemotherapeutic drugs:
non-hormonal contraceptive
Check for pregnancy before starting chemo (Caution - Some birth control can make cancer worse)
Reproductive Toxicity
Common side effects of chemotherapeutic drugs:
Put on cold caps on the head because it causes vasoconstriction and so less of the chemo drugs can go to the scalp and to help prevent hair loss
Alopecia
Common side effects of chemotherapeutic drugs:
Monitor ALT (5-40) and AST (8-20)
Treat with reglan for n/v
Hepatotoxicity (Liver)
Common side effects of chemotherapeutic drugs:
CBC, bleeding, infections
No food from home (needs to be eaten within 2 hrs.)
No fresh fruit/vegetables
Bone Marrow suppression
Common side effects of chemotherapeutic drugs:
Breakdown of cancer cells leads to nephrotoxicity
Tumor Lysis Syndrome
Common side effects of chemotherapeutic drugs:
Tumor Lysis Syndrome
Nephrotoxicity (Renal)
Common side effects of chemotherapeutic drugs:
Nausea, Vomiting, Anorexia, Ulcerative Stomatitis
Administer 3 antiemetics before chemo
GI
What are the three antiemetics prescribed before chemo?
Ondansetron (Zofran)
Metoclopramide (Reglan)
Prochlorperazine (Phenothiazine)
What can be given to cause vasoconstriction so that a less amount of chemo goes to the mount, which can cause stomatitis?
Ice chips
If this happens, monitoring:
BUN (10-20)
Creatinine (0.6-1.2)
I/O 30 ml/hr, but if critical use 0.5 ml/kg/hr
Daily Weights (with the same clothes)
Tumor Lysis Syndrome
Stops cell reproduction needed for the synthesis of DNA by inhibiting folic acid conversion
Methotrexate
This medication can cause:
gastric ulcers
Renal damage due to hyperuricemia (abnormally high level of uric acid in the blood)
Methotrexate
What medications should you administer if uric acid is too high from a complication of Methotrexate?
Allopurinol
What medication is Leucovorin given because of toxicity?
Methotrexate
This medication is a folic acid derivative and given as a chemotherapy protective drug that enters healthy cells and blocks methotrexate.
Leucovorin
This medication can treat anemia caused by a lack of folic acid.
Leucovorin
This incorporates into the DNA, then inhibits DNA and RNA synthesis of cancer cells which results in the death of rapid malignant cells
Cytarabine
This medication can cause Arachnoiditis (Inflammation of the brain; arachnoid space)
Indications include nausea, headache, fever
Cytarabine
What medication can treat Arachnoiditis?
Dexamethasone
What medication can cross the BBB?
Cytarabine
What medication interrupts the action of adenine and guanine present in DNA and RNA for the synthesis of the purine nucleotides needed to incorporate into the nucleic acid molecules.
Mercaptopurine
What medication binds to DNA, altering its structure; therefore, inhibits synthesis of DNA and RNA (intercalation).
Doxorubicin
What medication can cause:
Cardiac changes and ECG changes
Red coloration to urine and sweat
Doxorubicin
Is Methotrexate cytotoxic or non-cytotoxic?
A. cytotoxic
B. non-cytotoxic
A. cytotoxic
Is Cytarabine cytotoxic or non-cytotoxic?
A. cytotoxic
B. non-cytotoxic
A. cytotoxic
Is Mercaptopurine cytotoxic or non-cytotoxic?
A. cytotoxic
B. non-cytotoxic
A. cytotoxic
Is Doxorubicin cytotoxic or non-cytotoxic?
A. cytotoxic
B. non-cytotoxic
A. cytotoxic
Is Dactinomycin cytotoxic or non-cytotoxic?
A. cytotoxic
B. non-cytotoxic
A. cytotoxic
Is Vincristine cytotoxic or non-cytotoxic?
A. cytotoxic
B. non-cytotoxic
A. cytotoxic
Is Paclitaxel cytotoxic or non-cytotoxic?
A. cytotoxic
B. non-cytotoxic
A. cytotoxic
Is Cyclophosphamide cytotoxic or non-cytotoxic?
A. cytotoxic
B. non-cytotoxic
A. cytotoxic
Is Carmustrine cytotoxic or non-cytotoxic?
A. cytotoxic
B. non-cytotoxic
A. cytotoxic
Is Cisplatin cytotoxic or non-cytotoxic?
A. cytotoxic
B. non-cytotoxic
A. cytotoxic
Is Topotecan cytotoxic or non-cytotoxic?
A. cytotoxic
B. non-cytotoxic
A. cytotoxic
Is Asparaginase cytotoxic or non-cytotoxic?
A. cytotoxic
B. non-cytotoxic
A. cytotoxic
Is Hydroxyurea cytotoxic or non-cytotoxic?
A. cytotoxic
B. non-cytotoxic
A. cytotoxic
Is Procarbazine cytotoxic or non-cytotoxic?
A. cytotoxic
B. non-cytotoxic
A. cytotoxic
With this medication, heart failure secondary to cardiomyopathy (enlarged heart) (any disorder that affects the heart muscle) can occur months to years after treatment
Doxorubicin
This medication can turn urine and sweat a red coloration, which is undesirable but not harmful.
Doxorubicin
Binds to DNA, altering its structure; therefore, inhibits RNA synthesis. DNA synthesis is not suppressed
Dactinomycin
What medication can cause severe tissue damage?
Dactinomycin
What medication should you Use a central line for infusion (PICC Line or Porta Cath)?
Dactinomycin
What medications can cause stomatitis?
Dactinomycin
What medication stops cell division during mitosis and is useful in combination with other chemotherapy medications?
Vincristine
What medication is not bone marrow toxic?
Vincristine
What medication can cause nerve injury?
Vincristine
This medication can cause injury to the autonomic nerves (manifested by constipation, urinary hesitancy)
Peripheral neuropathy (paresthesia, decreased reflexes, and sensory loss)
Vincristine
This medication stops cell division during mitosis and inhibits cell division and produces apoptosis (programmed cell death)
Paclitaxel
What medication:
Kills rapid growing cells by alkylation of DNA and RNA synthesis
Cell cycle non-specific, however, these medications are more toxic to dividing cells, especially those that divide rapidly
Cyclophosphamide
This medication can cause acute hemorrhagic cystitis (bleeding in the bladder)
Cyclophosphamide
Mesna is given as an uroprotectant agent that
detoxifies metabolites to reduce hematuria for this medication
Cyclophosphamide
What medication kills rapidly growing cells by interrupting DNA and RNA synthesis?
Carmustrine
This medication crosses the blood-brain barrier. Therefore, is especially useful against primary and metastatic tumors of the brain.
Carmustrine
This medication can cause pulmonary fibrosis.
Monitor lung function (listen to lung fields, Xray)
Treat with glucocorticoids
Carmustrine
What medication kills rapidly growing cells by interrupting DNA and RNA synthesis?
Cisplatin
This medication is highly emetogenic (extreme nausea and vomiting)
Nausea and vomiting begin within one hour after dosing and can persist for several days
Cisplatin
This medication can cause hearing loss, which can be permanent
Monitor for tinnitus and hearing loss
Cisplatin
Interrupts DNA synthesis by making a cut in the DNA strand, thus altering its shape.
Topotecan
Kills cancer by interrupting protein synthesis in leukemia cells.
Asparaginase
This helps to break down toxic ammonia within cells, is important for protein modification, and is needed for making a certain molecule that transmits signals in the brain (a neurotransmitter)
Asparaginase
This medication can cause hypersensitivity reaction, usually within the first 15 minutes of their first infusion.
Asparaginase
This medication can cause fatal anaphylaxis.
Have an anaphylaxis kit and resuscitation equipment readily available
Asparaginase