PHARM WEEK 4

What does growth fraction measure?

Number of dividing cells ÷ resting cells (high growth fraction → chemotherapy works better).

Which cancers respond best to chemotherapy?

Leukemias + lymphomas (many cells divide quickly).

Why are solid tumors often harder to treat with chemotherapy?

They usually have a low growth fraction (fewer cells actively dividing).

Why does chemotherapy cause hair loss, GI upset, and bone-marrow suppression?

It damages all fast-dividing cells (cancer + hair + GI lining + bone marrow).

What happens during G₀?

Cell rests (not dividing).

What happens during G₁?

Cell prepares to copy DNA.

What happens during S phase?

DNA is copied (S = Synthesis).

What happens during G₂?

Cell prepares for mitosis.

What happens during M phase?

Cell divides (M = Mitosis).

What is an easy cell-cycle mnemonic?

“Rest → Grow → Synthesize → Get ready → Multiply” (G₀ → G₁ → S → G₂ → M).

What is a cell-cycle-specific drug?

Drug that works during a certain phase (methotrexate + 5-FU → S phase; vinca drugs → M phase).

What is a benign tumor?

Slow-growing + does not metastasize (spread).

What is a malignant tumor?

Grows quickly + invades tissue + may metastasize.

What is a carcinoma?

Cancer of epithelial tissue (skin + organ linings).

What is a sarcoma?

Cancer of connective tissue (bone + muscle).

What is leukemia?

Cancer that starts in blood-forming bone marrow.

What is lymphoma?

Cancer that starts in the lymphatic system (lymph nodes + spleen + lymph tissue).

What is a glioma?

Cancer of glial cells in the CNS.

What is the difference between leukemia and lymphoma?

Leukemia → starts in bone marrow; lymphoma → starts in lymphatic tissue.

What is mesenchyme?

Early tissue that develops into bone + muscle + connective tissue.

What treatment kills rapidly dividing cells?

Chemotherapy.

What treatment attacks a specific cancer molecule?

Targeted therapy (examples: imatinib + trastuzumab).

What treatment blocks hormones that help cancer grow?

Hormonal therapy (examples: tamoxifen + letrozole).

What treatment helps the immune system attack cancer?

Immunotherapy (examples: pembrolizumab + nivolumab).

Why are several chemotherapy drugs used together?

Different drugs attack different phases/MOAs → ↑ cancer kill + ↓ resistance + lower individual doses.

Why can chemotherapy cause tumor lysis syndrome (TLS)?

Rapid cancer-cell death → cell contents enter blood → electrolyte problems + ↑ uric acid.

Why does uric acid increase after massive cancer-cell death?

DNA breaks down → uric acid forms.

How can chemotherapy-related uric acid damage the kidneys?

Uric acid crystals collect in kidneys → ↓ urine output + acute kidney injury.

How is kidney injury from high uric acid prevented?

IV fluids + allopurinol.

How does allopurinol work?

Blocks new uric acid formation.

Which findings suggest tumor lysis syndrome?

Weakness + confusion + dysrhythmias + seizures + ↓ urine output + abnormal electrolytes → notify provider immediately.

What class is cyclophosphamide (Cytoxan)?

Alkylating agent (nitrogen mustard).

How do alkylating drugs kill cancer cells?

Cross-links DNA → prevents DNA replication + cell division.

What is the easiest alkylating-drug mnemonic?

“Alkylators add glue” → DNA strands stick together.

Are alkylating drugs cell-cycle specific?

No → damage DNA during any phase (including G₀).

Why might alkylating damage during G₀ not cause immediate cell death?

Damage becomes deadly when the cell later tries to copy DNA + divide.

How does cyclophosphamide work?

Cross-links DNA → stops replication + cell division.

Which cancers may cyclophosphamide treat?

Leukemias + Hodgkin lymphoma + multiple myeloma.

What is cyclophosphamide’s signature toxicity?

Hemorrhagic cystitis (bleeding/inflammation of bladder).

“Cyclo → cystitis.”

What is the cyclophosphamide mnemonic?

“Cyclo → cystitis.”

How can hemorrhagic cystitis be prevented?

Adequate hydration + frequent urination + monitor urine for blood.

A patient taking cyclophosphamide develops blood in the urine. What should the nurse do?

Notify provider + assess urine output/hydration → suspect hemorrhagic cystitis.

What labs are monitored with cyclophosphamide?

CBC + kidney function + liver function.

What pregnancy teaching is given for cyclophosphamide?

Use contraception during treatment and for the recommended time afterward.

What class is cisplatin (Platinol)?

Platinum alkylating-like agent.

How does cisplatin work?

Cross-links DNA → stops replication → cancer-cell death.

Which cancers may cisplatin treat?

Testicular + ovarian + bladder + lung + head/neck cancers.

What are cisplatin’s major toxicities?

Nephrotoxicity + ototoxicity + severe N/V + neuropathy + bone-marrow suppression.

What is the cisplatin mnemonic?

“CISplatin → kidneys + ears.”

What is the priority action before cisplatin?

Give vigorous hydration → protects kidneys (prevent nephrotoxicity).

What should the nurse monitor during cisplatin therapy?

Creatinine/BUN + urine output + hearing + sensation + CBC/electrolytes.

Which cisplatin finding is most urgent?

↓ urine output or ↑ creatinine → possible kidney injury.

A patient receiving cisplatin reports ringing in the ears. What should the nurse do?

Hold/stop as appropriate + notify provider → possible ototoxicity.

Before cisplatin, the patient has elevated creatinine and low urine output. What should the nurse do?,

Hold the drug + notify provider.

What teaching should a patient receiving cisplatin understand?

Report ↓ urine + hearing changes + ringing in ears + numbness/tingling.

What class is methotrexate (MTX)?

Antimetabolite → antifolate.

How does methotrexate work?

Blocks folic acid → stops DNA synthesis.

Which cell-cycle phase does methotrexate affect?

S phase (DNA synthesis).

What is the methotrexate mnemonic?

“MTX stops Synthesis.”

Besides cancer, what condition may methotrexate treat?

Rheumatoid arthritis.

What are methotrexate’s major adverse effects?

Bone-marrow suppression + thrombocytopenia/bleeding + hepatotoxicity; alopecia may occur.

What should a patient avoid while taking methotrexate?

Pregnancy + alcohol.

Why should alcohol be avoided with methotrexate?

Both damage the liver → ↑ hepatotoxicity.

What labs are monitored with methotrexate?

CBC + kidney function + liver function.

A patient taking methotrexate develops fever and mouth sores. What should the nurse do?

Notify provider → possible toxicity + bone-marrow suppression + infection.

What class is 5-fluorouracil (5-FU)?

Antimetabolite → pyrimidine analog.

How does 5-FU work?

Blocks thymidylate formation → no DNA synthesis.

Which cell-cycle phase does 5-FU affect?

S phase.

What cancers commonly receive 5-FU?

Mainly solid tumors; also used as adjuvant therapy.

What adverse effects occur with 5-FU?

Bone-marrow suppression + infection risk + ↓ appetite + alopecia + N/V.

What should the nurse monitor with 5-FU?

CBC + electrolytes + kidney function + infection/bleeding.

What class includes doxorubicin and daunorubicin?

Antitumor antibiotics → anthracyclines.

How do anthracyclines work?

Damage DNA → stop cancer-cell growth → apoptosis.

What is doxorubicin’s signature toxicity?

Cardiotoxicity (mnemonic: Doxo damages the heart).

What is the doxorubicin mnemonic?

“DOXO damages the pump.”

What heart problems can doxorubicin cause?

Dilated cardiomyopathy + heart failure + ↓ LVEF.

What does LVEF tell the nurse?

How well the left ventricle pumps blood (↓ LVEF → weaker pumping).

Which history is most concerning before doxorubicin?

Heart failure or cardiomyopathy.

What should be checked before and during doxorubicin therapy?

Cardiac function/LVEF + heart-failure symptoms.

Which findings suggest doxorubicin cardiotoxicity?

Dyspnea + crackles + edema + rapid weight gain + fatigue + ↓ LVEF.

A patient receiving doxorubicin develops dyspnea and edema. What is the priority action?

Hold/stop as appropriate + notify provider → possible heart failure.

What expected color change may occur with doxorubicin?

Red/reddish-orange urine + sweat + tears.

Why does doxorubicin cause reddish-orange urine?

The drug itself is red (usually expected + temporary).

When is red urine after doxorubicin concerning?

When it persists or occurs with pain/bleeding signs → assess for hematuria.

What labs are monitored with anthracyclines?

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

What class includes vincristine and vinblastine?

Vinca alkaloids → mitotic inhibitors.

How do vinca alkaloids work?

Disrupt microtubules during mitosis → M-phase arrest + apoptosis.

What is vincristine’s main toxicity?

Neurotoxicity/peripheral neuropathy.

(mnemonic: VinCRISTINE → CRIppled nerves).

What is the vincristine mnemonic?

“VinCRISTINE → CRIppled nerves.”

What is vinblastine’s main toxicity?

Bone-marrow suppression.

What is the vinblastine mnemonic?

“VinBLASTine BLASTS bone marrow.”

How are vincristine and vinblastine different?

Vincristine → more nerve damage; vinblastine → more bone-marrow suppression.

Which findings suggest vinca-drug neurotoxicity?

Tingling + numbness + burning pain + muscle weakness + unsteady gait + ↓ reflexes.

A patient receiving vincristine develops muscle weakness. What should the nurse do?

Notify provider → possible neurotoxicity.

Why is central venous access preferred for vinca drugs?

Extravasation can cause severe tissue damage.

What is the most important vincristine administration warning?

IV only; never give intrathecally (fatal).

What class is tamoxifen (Soltamox)?

Selective estrogen receptor modulator (SERM).

How does tamoxifen treat breast cancer?

Competes with estrogen at receptors → slows estrogen-dependent tumor growth.

Who may receive tamoxifen?

Premenopausal + postmenopausal patients with ER-positive breast cancer; may prevent cancer in high-risk patients.

What are tamoxifen’s most serious risks?

DVT + PE + uterine/endometrial cancer

DVT; sudden dyspnea/chest pain → PE; abnormal vaginal bleeding → uterine cancer.