oncology exam review

UW Oshkosh Pharmacology II Module 5: alkylating agents, antimetabolites, antibiotics, plant alkaloids, and medications for pain

an example of an alkylating agent

cyclophosphamide

what does cyclophosphamide treat?

broad

what is cyclophosphamide’s dose limiting toxicity?

myelosuppression

4 side effects of cyclophosphamide

acute hemorrhagic cystitis, alopecia, severe nausea, and vomiting

an example of a platinum compound

cisplatin

what does cisplatin treat?

bladder, ovarian, and testicular cancer

what is cisplatin’s dose limiting toxicity?

renal impairment

subcategory of antimetabolites

folic acid analogues

an example of a folic acid analogue

methotrexate

what does methotrexate treat?

choriocarcinoma and non hodgkin’s lymphoma

what is methotrexate’s 2 dose limiting toxicities?

myelosuppression and pulmonary infiltrates

first subcategory of antitumor antibiotics

anthracyclines

an example of an anthracycline

doxorubicin

what is doxorubicin’s dose limiting toxicity?

cardiotoxicity

2 side effects of doxorubicin

red coloring agent and vesicant

second subcategory of antitumor antibiotics

non anthracyclines

an example of a non anthracycline

dactinomycin

what is dactinomycin’s dose limiting toxicity?

myelosuppression

side effect of dactinomycin

vesicant

what does doxorubicin and dactinomycin treat?

rhabdomyosarcoma and wilm’s tumor

first subcategory of mitotic inhibitors

vinca alkaloids

first example of a vinca alkaloid

vincristine

what does vincristine treat?

broad

what is vincristine’s dose limiting toxicity?

peripheral neuropathy

second example of a vinca alkaloid

vinblastine

what does vinblastine treat?

breast cancer, karposi’s sarcoma, lymphoma, small cell lung cancer, and testicular cancer

what is vinblastine’s dose limiting toxicity?

myelosuppression

second subcategory of mitotic inhibitors

taxanes

an example of a taxane

paclitaxel

what does paclitaxel treat?

breast cancer

what is paclitaxel’s dose limiting toxicity?

myelosuppression

severe side effect of paclitaxel

hypersensitivity reaction

what 3 medications are used to treat a hypersensitivity reaction?

dexamethasone, diphenhydramine, and famotidine

an example of a topoisomerase inhibitor

irinotecan

what does irinotecan treat?

cervical, ovarian, and refractory small cell lung cancer

what is irinotecan’s dose limiting toxicity?

myelosuppression

an example of a miscellaneous cytotoxic agent

asparaginase

what dose asparaginase treat?

acute leukemia

what is asparaginase’s 7 dose limiting toxicities?

anaphylaxis, CNS depression, severe nausea, vomiting, liver impairment, pancreas impairment, and renal impairment

an example of an antiestrogen drug (breast cancer drug)

tamoxifen

what does tamoxifen treat?

breast cancer in high risk females

2 adverse effects of tamoxifen

increased risk of endometrial cancer and blood clots

2 side effects of tamoxifen

hot flashes and menstrual irregularities

should SSRI’s be taken with tamoxifen?

no, they decrease the effect of tamoxifen

an example of an aromatase inhibitor (breast cancer drug)

anastrozole

what does anastrozole treat?

estrogen receptor positive breast cancer in post menopausal women

3 adverse effects of anastrozole

fractures, musculoskeletal pain, and osteoporosis

how does anastrozole compare to tamoxifen?

anastrozole is more effective and has no risk of endometrial cancer

4 example of drugs for prostate cancer

androgen receptor blockers, CYP17 inhibitors, gonadotropin releasing hormone agonists, and gonadotropin releasing hormone antagonists

7 side effects of drugs for prostate cancer

decreased libido, decreased muscle mass, erectile dysfunction, gynecomastia, myocardial infarction, new onset diabetes, and stroke

first example of an immunostimulant

cetuximab

what does cetuximab treat?

metastatic colon cancer and cancers of the head and neck

severe side effect of cetuximab

hypersensitivity reaction

8 signs of a hypersensitivity reaction

airway obstruction, cardiopulmonary arrest, hypotension, interstitial lung disease, loss of consciousness, myocardial infarction, rash, and shock

second example of an immunostimulant

interleukin-2

what does interleukin-2 treat?

melanoma and renal cancer

5 side effects of interleukin-2

chills, fever, hypotension, nausea, and vomiting

severe side effect of interleukin-2

capillary leak syndrome

4 signs of capillary leak syndrome

anasarca, decreased urination, hypotension, and weight gain

what 5 patient populations should not receive interleukin-2?

impaired cardiac, CNS, liver, pulmonary, and renal function

third example of an immunostimulant (bladder cancer drug)

BCG vaccine

how do you administer the BCG vaccine?

directly into the bladder via catheter

what 4 patient populations should not receive the BCG vaccine?

immunocompromised, have a known UTI, have a fever of unknown origin, and HIV+

what 2 considerations should the nurse make before handling urine from a patient who received the BCG vaccine?

urine 6 hours post op must be disinfected and labeled as infectious waste

5 examples of nonopioids for pain management from cancer

acetaminophen, aspirin, celecoxib, ibuprofen, and naproxen sodium

2 side effects of NSAIDS (aspirin, celecoxib, ibuprofen, and naproxen sodium)

excess bleeding and renal impairment

3 examples of opioids for pain management from cancer

fentanyl, morphine, and oxycodone

5 side effects of opioids

constipation, nausea, respiratory distress, sedation, and vomiting

why is morphine good for end of life care?

relieves respiratory distress and anxiety

7 categories of adjuvant agents for pain management from cancer

antiseizure drugs, bisphosphonates, CNS stimulants, glucocorticoids, SNRI’s, TCA’s, and topical anesthetics

an example of an antiseizure drug for pain management from cancer

carbamazepine

2 examples of bisphosphonates for pain management from cancer

pamidronate and zoledronic acid

an example of a CNS stimulant for pain management from cancer

methylphenidate

2 examples of glucocorticoids for pain management from cancer

dexamethasone and prednisone

an example of a SNRI for pain management from cancer

duloxetine

an example of a TCA for pain management from cancer

amitriptyline

an example of a topical anesthetic for pain management from cancer

lidocaine patch