anti-cancer chemo kills cells progressing through the _____ phases of ________ cell cycle
active
reproductive
what is no aptoptosis (physiologic cell death) and cells grow called?
malignancy
what are 3 commonly used anticancer agents?
methotrexate
5-fluorouracil
doxorubicin
what is a new anticancer agent?
monoclonal antibody therapy
trastuzumab (Herceptin) inhibit proliferation of breast cancer cells. What kind of therapy is this?
monoclonal antibody therapy
what is an ADE of suppression of bone marrow?
increased susceptibility to infection
what is an ADE of GI disturbance?
nausea
what is an ADE of cutaneous manifestations?
alopecia (does NOT affect dental tx)
what is an oral manifestation ADE?
mucositis
what is the term to describe physiologic programmed cell death called?
apoptosis
what is the MOST COMMON ORAL COMPLICATION?
mucositis
drugs associated with oral manifestations from chemo are: 3
fluorouracil
interferon
methotrexate
what is the MAJOR concern of mucositis?
painful
systemic infection
erythema
ulceration
what are the most feared complication
candida species
may spread to other sites
noncandidal infections on the rise?
fungal infections
which dna viruses are the most frequent cause of viral infection? how many days for recurrent infection?
herpes simplex virus infections
7-14 days
what may reduce platelet formation, inducing thrombocytopenia
gingival bleeding or submucosal called?
hemorrhage
_________ contributes to pt's discomfort and risk of infection. it contributes to oral _______ and opportunistic bacterial pathogens
xerostomia
candidiasis
which oral manifestations are neurologic complications of pain and neuropathy? 3
mucosistis
xerostomia
infection
what is a chemotherapy induced neuropathy?
alkaloids
poor oral health will result in _____
what has severe oral complications
reduced ability to receive adequate doses of chemo?
ONJ osteonecrosis of the jaw
these are preventive strategies BEFORE chemo: 2
oral examination
radiographic evaluation
what percentage of pt's may experience acute or chronic complications from chemo?
40%
what is the basis for future comparisons and assists in monitoring and tx of oral complications? 3
dental exam with surgical and restorative care
proper oral hygiene procedures/instructions
perio exam and tx
t/f during all surgical procedures and hygiene appt should be treated 10 days before neutropenia
true
teeth nonrestorable or with severe periodontal involvement before initiation of therapy should be ______
removed
who determines what should be done for an antibiotic prophy?
physician
t/f determine specific regimen in close consultation with managing physician-severe neutropenic-specific to microbes (antibiotic prophy)
true
when using topical agents with mucositis, what is inhibited?
cox 1 inhibitors
what are the three topical anesthetic agents that will comfort the pt with mucositis? 2
viscous lidocain
dyphenhydramine syrup
what may be combined with coating agents -miracle mix for mucositis?
aluminum hydroxide (milk of magnesia, Mylanta)
what are cox- 1 inhibitors cx with viscous lidocaine and diphenhydramine syrup
APAP and opioid receptor agonists in combo
what is the MOST neutral and least damaging mouthwash?
Saline
for OHI of saline it should ___ tsp salt in ___ oz water. _____x/day for ____days
1/2 tsp
8oz
5-6 days
what does salt water do?
help kill the bacteria
with mucositis, remove dental plaque with ___ _____ brush, avoid products irritating to ____ tissues, clean teeth every ____ hours(q4h), and _____ from wearing removable prostheses, eat soft, bland diet
soft bristle
soft
refrain
how often should cleansing be performed with mucositis?
every 2-4 hours
what is a modified mechanical approach for mucositis?
disposable sponge, gauze, cotton swab soaked in non-alcohol chlorhexidine .12%
what is the MOST FREQUENTLY RECOMMENDED AGENT for a fungal infection?
FLUCONAZOLE (nystatin is no longer recommended in myleosuppression)
what is the drug of last resort for non-responsive fungal infections?
