1. Normal cells
    • rate of growth matched to cell death
    • Growth fraction: measure of the number of cells undergoing mitosis in a tissue.
  2. Apoptosis
    Cell death
  3. cancer cells
    • Tumor cells escape signal to die and achieve immortality.
    • don't contribute to function of a organ
    • Proliferate despite lack of growth initiating signals.
  4. Benign
    • grows slowly
    • rarely have necrosis
    • function similar to host organ
  5. malignant
    • grow rapidly
    • have necrotic areas
    • dysfunctional
  6. Success of chemotherapy
    • Cure: free of cancer for a period of time
    • Palliation: measurement of the patients quality of life.
  7. Cancer treatments?
    • Antineoplastic: cell cycle specific
    • cell cycle non-specific
    • adjuvant chemotherapy: antineoplastics after surgery or radiation.
    • myeloablation: complete destruction of hematopoietic bone marrow cells
  8. Cancel cells and drug resistance?
    • They're adaptive-mutate to resist drugs
    • Cells can repair DNA damage from chemo
    • Cell membrane prevent drugs from working.
    • Gene amplification leading to overproduction of protein-making drug less effective.
  9. Growth fraction?
    • Number of cells undergoing mitosis in a tissue
    • Dependent on location of cancerous cells. Some cells proliferate faster then others.
  10. how to improve success of chemo?
    • dosing schedules
    • combination chemo
    • route of admin: Po, IV, Intrathecal, intrarterial, intraperitoneal, intravesicular.
  11. Cancer treatment SE?
    • anemia
    • neutropenia
    • thrombocytopenia
    • N/V
    • constipation or diarrhea
    • hair loss
    • stomatitis
    • pain
    • anxiety
  12. Toxic effects of antineoplastics and which systems are affected the most?
    • hematologic: myelosuppression: bone marrow suppression-Nadir: lowest point of RBC and WBC/platelets.
    • gastrointestinal: emetic potential, Mucositis, cachexia
    • Cardiopulmonary: doxorubicin/bleomycin.
    • urinary: may lead to renal failure
    • Reproductive: infertility
  13. Safe handling of chemotherapy drugs?
    • Prevent skin absorption
    • prevent inhalation by wearing masks
    • appropriate management of pt.s bodily fluids.
  14. Major classification of antineoplastics?
    Need to know for exam
    • alkylating agents: cyclophosphamide (Cytoxan)
    • antimetabolites: methotrexate (Rheumatrex)
    • antitumor antibiotics: doxorubicin (adriamycin)
    • Hormones: tamoxifen
    • plant alkaloids: vincristine (Oncovin)
    • biologic response modifiers and monoclonal antibodies.
  15. Alkylating agents
    • Alters the shape of DNA double helix
    • prevent DNA from duplicating
    • kills cancer cells when they divide
    • myelosuppression
    • alpecia
    • strong vessicant
    • secondary malignancy: increased risk of causing other cancer. 
    • broad spectrum: lymphomas, myelomas, leukemias, pancreatic, testicular, ovarian, breast.
  16. Cyclophosphamide (Cytoxan)
    • Therapeutic class: alkylating agent
    • Preg cat: D
    • MOA: Cell cycle non specific- causes cross linking of DNA strands-prevents cell division.
    • Indications: Cancers...
    • Contraindications: Many, but mainly hepatic impairment or other impairments of your body that this drug will effect. 
    • Adverse effects: alopecia, disorder of ksin pigmentation, N/V, cardiotoxicity, CHF, many...
    • Alert: Void frequently to prevent bladder irritation.
  17. Antimetabolites Adverse effects?
    • fatal bone marrow toxicity at high dose
    • hemorrhage, nausea, vomiting, anorexia, GI ulcerations, intestinal bleeding.
    • Contraindicated in pregnancy, hepatic, cardiac, renal insufficiency, myelosuppression and blood dyscrasia. 
    • Avoid preg. for 6 months after therapy.
  18. methotrexate (Rheumatrex)
    • Therapeutic class: antimetabolite 
    • Preg cat: x
    • MOA: blocks synthesis of folic acid Vitamin B)=powerful immunosuppressive.
    • Indications: Used for cancers and diseases that have an over-reactive immune system. 
    • Contraindications: hepatic impairment, blood dyscrasias, severe COPD
    • Adverse: N/V, myelosuppression, pulmonary toxicity.
  19. Antitumor antibiotics
    Most are cell-cycle non-specific
    • bleomycin, adriamycin, actinomycin
    • bind to DNA, preventing DNA-RNA synthesis
  20. doxorubicin (Adriamycin)
    • Therapeutic class: Antitumor antibiotics
    • Preg cat: 
    • MOA: Bind to DNA-preventing DNA-RNA synthesis. decreasing cell replication.
    • Indications: acute lymphoid leukemia, AML, Aids related kaposi, breast cancer.....antineoplastic...many cancers.
    • contraindications: hepatic impairment, myelosuppression, MI-insufficiency.
    • adverse: Turns urine/tears red, temporary infertility, secondary malignancy, N/V, rash, mucositis, excessive lacrimation, cardiotoxic.
    • Alerts: neutropenic precaution, monitor cardiac function-3lead, observe s/s hepatic dysfunction, very good oral hygiene.
    • alerts:
  21. Vincristine (Oncovin)
    Vinca alkaloids.
    • Cell-cycle specific
    • Vincristine: derivative of periwinkle plant-vinca alkaloids.
    • MOA: blocks formation of mitotic spindle during mitosis( prevents cell division) 
    • Indications: hodgkin/ non-hodgkin lymphomas, leukemia, kaposi sarcoma, wilms tumor(found on kidneys-young children), bladder carcinoma, breast carcinoma.
    • Contraindications: charcot-marie-tooth syndrome. Intrathecal use
    • Alert: Very toxic and therapeutic doses have serious side effects.
    • Adverse: Neurotoxic: paraesthesia/neuropathies-major dose limiting effect.
    • myelosuppression 
    • N/V, Stomatitis, abdominal pain, vesicant.
  22. Hormones and hormone antagonists
    • treat hormone sensitive tumors
    • Block substanes neccessary for tumor growth
    • corticosteroids
    • gonadal hormones
    • estrogen hormones
    • androgen hormones
  23. Tamoxifen citrate
    Antiestrogen to prevent tumor growth.
    • therapeutic class: estrogen receptor blocker
    • MOA: blocks estrogen receptor on the breast, but activates estrogen receptors elsewhere. increases mineral density of bone and lowers LDL levels.
    • Indications: Breast cancers that require estrogen to grow.
    • Contraindications: concomitant use of anticoagulant therapy. increases risk of ductal carcinoma. DVT, PE. 
    • Adverse: hot flashes, fluid retention, increases rates of endometrial cancer.
    • Also approved for prophylaxis of breast cancer....
  24. Biologic response modifiers (BRM)
    • Stimulates bodys immune system to kill tumor cells.
    • BRM: Immunostimulant (interferon, interleukins). 
    • some dampen immune system (monoclonal antibodies)
  25. BRM
    • Interferon: natural protein produced by T-cells in response to a viral infection.
    • interferon alfa 2-A and 2-B used to treat hepatitis B and C, kaposi sarcoma, hairy cell leukemia, chronic myelogenous leukemia
    • Interleukin 2: activates cytotoxic lymphocytes and promotes action of the immune response. adesleukin is an example.
  26. Monoclonal antibodies (MAB)
    • molecularly targeted agents
    • require that the tumor cells have specific protein receptors.
    • Binds to CD20 cell surface antigen of B-lymphocytes. 
    • Adverse: myelosuppression, pancytopenia, tumor lysis syndrome(ARF), hypotension, night sweats, joint and muscle aches.
  27. Reducing SE of chemo?
    colony stimulating factors as well
    • Antiemetics (zofran)
    • RBC stimulates: Epotein/epogen
    • neutrophil stimulates: neupogen 
    • platelet stimulates: neumega
    • Laxatives and stool softeners.
    • Granulocyte-macrophage colony stim factor-increases production of macrophages.
  28. Know these prototype drugs....
    • —cyclophosphamide, (Cytoxan)
    • doxorubicin (Adriamycin)
    • methotrexate (Rheumatrex)
    • vincristine (oncovin)
    • tamoxifen
  29. Cell cycle non specific chemo drugs? what do they do? how do they work?
    Are able to kill a cell during any phase of cell cycle replication. these are usually given in a bolus over 20 mins.
  30. Cell cycle specific chemo drugs? what do they do? how do they work?
    are only able to kill a cell during a specific phase, not during the resting phase. These are usually given in divided doses to increase efficacy
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