CPHON Care of the Pediatric Hem/Onc Exam 106 Questions with Verified Answers
Professional Performance - CORRECT ANSWER Responsible for ongoing
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Cancer care constantly changing, need to stay up to date on new protocols, chemo agents, symptom management, and safety issues
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Scope and Standards of Nursing Practice - CORRECT ANSWER Assessment, Diagnosis, Outcomes, Planning, Implementation, Evaluation, Quality of Practice, Education, Prof Practice Evaluation, Collegiality, Collaboration, Ethics, Research, Resource Utilization, Leadership
Regulatory Standards and Guidelines - CORRECT ANSWER Stay up to date on state nursing licensure guidelines
Comply with scopes of nursing practice/meet requirements for CPHON renewal
Clinical Trials - CORRECT ANSWER designed to answer a specific medical question
protocols - serve as a comprehensive document to guide treatment management
Phase 1 CT - CORRECT ANSWER determine max tolerated dose (MTD) of drug/agent or combo of agents
starting dose in peds is usually 80% MTD in adults
treatment toxicities and pharmokinetics described from Phase 1 data
usually small trial 12-25 pts
Phase 2 CT - CORRECT ANSWER determine efficacy of the new agent/treatment in treating specific types of cancer
disease specific, based on pharmacologic data
all pts must have measureable disease, normal organ function, reasonable life expectancy, and good performance status
usually best for pts who have not undergone intensive treatment
Phase 3 CT - CORRECT ANSWER assess overall response, survival, and quality of life of newly diagnosesed pts with the new tx plan
determine if treatment is equivalent or superior to current standard treatment
large number of patients
Phase 4 CT - CORRECT ANSWER further investigate long-term safety and efficacy of a treatment
takes place after new tx/drug is approved for standard use
usually less common in peds onc
decrease side effects, toxicities, and late effects while producing acceptable cure rates
Research - CORRECT ANSWER must comply with federal guidelines
IRB
parents/pts must sign informed consent that is IRB approved
children of appropriate age should provide assent
Elements of Informed Consent - CORRECT ANSWER Dx and tx reccomendations in lay terms
Alternative options (including not treating or participating in research)
benefit/burden of treatment options
purpose of research/any compensation
decision maker must be able to: - CORRECT ANSWER receive information, weigh it out in accordance with their medical situation and one's own values, communicate the choice
Immunizations - CORRECT ANSWER inactivated vaccines = safe (can be ineffective, host is unable to develop cell mediated response)
NO MMR/varicella, live vaccines only in select circumstances
vaccines for family members/siblings - all family members, household contacts, healthcare workers should be immunized
Health Promotion - CORRECT ANSWER ensure health teaching and health promotion - ongoing education for optimal health and to prevent illess, establishing relationship with pt and family, developing a trusting relationship, arranging interpreter sevices when indicated, provide information as needed to not overwhelm pt and caregiver, encourage pt and caregiver to ask questions
Transition of Care - CORRECT ANSWER ensure once tx is complete family and/or pt can verbalize importance of follow up visits (as indicated by disease and tx received)
care coordination with pediatrician and nursing staff
education of school nurses and school staff - pt safety issues (physical limitations, fever guidelines, med admin, any restrictions).
educate teachers and peers about disease/treatment
Chemotherapy - CORRECT ANSWER prevent cancer cells from dividing, metastisizing, and causing damage to body
prevents proliferation of cancer cells
cancer cells lose usual mechanisms for controlling growth
chemo forces apoptosis
multimodal - CORRECT ANSWER chemo and radiation/surgery or all three
combination - CORRECT ANSWER use of more than one chemo for treatment
regional or sanctuary - CORRECT ANSWER given directly into area where cancer cells may not be reached bc its hiding (I.e. IT)
adjuvant - CORRECT ANSWER chemo after another type of therapy like surgery/radiation
neoadjuvant - CORRECT ANSWER chemo given preop for debulking of large tumors
Alkylating Agents - CORRECT ANSWER Cause DNA disruption that interfere with replication and transcription
Inhibit/interfere w/ dna synthesis
some agents cross blood/brain barrier
MAJOR Toxicities: GI, hematopoietic, reproductive, 2ndary malignancies
Cell cycle non-specific but most active in the G0 phase
Cyclophosphamide
Ifos
Cisplatin
Carboplatin
Oxaliplatin
Lomustine (CCNU)
Busulfan
Carmustine (BCNU)
Procarbazine
Temozolimide
Dacarbazine
Thiotepa
Mechlorethamine (nitrogen mustard)
Melphalan
Antimetabolites - CORRECT ANSWER Similar to normal cellular metabolites needed for cell function, but these interfere with actual enzyme production
most agents are cell cycle specific - S phase
Inhibit production of the enzymes or cause nonfunctional end products
5FU
6MP
6TG
Pentostatin
Hydroxyurea
Methotrexate
Trimetrexate
Cytarabine
Gemcitabine
Fludarabine/Cladribine
Clofarabine/Nelarabine
Anthracyclines - CORRECT ANSWER Highly colored
Cause free radical formation and topoisomerase inhibition
Binds with DNA to inhibit DNA/RNA synthesis
Dauno
Doxo
Mitoxantrone
Mitomycin
Antitumor Antibiotics (subclass of Anthracylcines) - CORRECT ANSWER Natural agents synthesized by bacteria and fungi
Interfere with cell metabolism (DNA and RNA synthesis)
Cell cycle non speficic
Dactinomycin
Bleomycin
Idarubicin
Mitoxantrone
Doxo
Plant Derivatives - CORRECT ANSWER Derived from compounds extracted from plants
Causes DNA breakdown
Cell cycle specific - predominantely M phase, G0, G1, S
cause mitotic arrest, DNA strand breakage/death
neuro/GI tract/reproductive, seondary malignancy - major toxicities
Vinca alkaloids (tubulin interactive agents)
(block microtubule assembly, preventing cell division, G2 and M phase)
Vincristine, Vinblastine, Vinorelbine, Vindesine
Taxanes (Bind to microtubules and inhibit the disassembly that completes mitosis and cell function)
(active in G2 and M phases)
Paclitaxel, Docetaxel
Epidodophyllotoxins (inhibit topoisomerase II, cause DNA damage and breaks in DNA strands) (active in G2 and S phase)
Etop, Teniposide
Campothecins (semisynthetic agents and inhibit topisomerase I, causing breaks in DNA strands)
(active in S phase)
Topotecan, Irinotecan
Hormones - CORRECT ANSWER Enter cell and bind with cytoplasm
Enter cell nucleus, bind with DNA, interfere with transcription
Dex, pred, hydrocortisone
Misc - CORRECT ANSWER Mechanism not understood, or don't fit into any other category
inhibit dna/rna/protein synthesis
Asparaginase (cell cycle non-specific)
Retinoids
Imatinib
Hydroxyurea (S phase)
Procarbazine (G2 phase)
Avastatin
Thalidomide
Targeted Therapies: Biologic Response Modifiers - CORRECT ANSWER Monoclonal Antibodies
Cytokines
Tyrosine Kinase Inhibitors
Stimulates the body's immune system to eliminate tumor cells
Agents selectively attack targeted pathways and tumor-receptor sites
Normal cells and processes are not affected
Monoclonal Antibodies - CORRECT ANSWER Immunoglobulin molecules that bind to a unique target site on a specific antigen
Can be used alone or with other drugs, toxins, or radionuclides
Radiographic isotopes can be attached to the MAB to detect some cancers
Gemtuzumab
Daclizumab
Infliximab
Etanercept
Alemtuzumab
Ch 14.18 chimeric MoAb anti-GD2
Cytokines - CORRECT ANSWER Naturally occurring proteins that regulate immune response
3 classes - interferons, interleukins, hematopoietic growth factors
Cytokines - interferons - CORRECT ANSWER direct proliferative effect on tumor cells
ability to activate NK cells
administered SQ, IM, and IV
alpha interferon
beta interferon
gamma interferon
Cytokines - interleukins - CORRECT ANSWER Natural proteins produced by macrophages or activated t cells that act as messengers between cells in the immune system
SQ and IV routes
IL-2, IL-11
Cytokines - Hematopoietic Growth Factors - CORRECT ANSWER responsible for the differentiation and maturation of blood cells
help shorten the length of myelosuppression following chemo or due to disease
epoetin, darbopoeitin, oprevekin
granulocyte-macrophage colony stimulating factors (GMCSF)
granulocyte stimulating factor (GCSF)
pegfilgrastim
Protein Tyrosine Kinase Inhibitors - CORRECT ANSWER catalyze the phosphorylation of tyrosine which occurs when phosphate is moved from ATP to the amino acid tyrosine
proetin tyrosine kinase serves as an on/off switch for signal transduction
signal transduction regulares key cell functions like proliferation, metabolism, apoptosis
protein kinases are overexpressed in many cancers so the inhibitors help turn off the switch
vaccines - CORRECT ANSWER stimulate an immune response to foreign antigens
some viruses may lead to cancer so stimulating the immune response should prevent the virus from being able to infect the pt
gardasil - prevents HPV which can lead to cervical cancer and genital warts
hep b - prevents some liver cancers assoc with hep b virus
safe handling - CORRECT ANSWER USP 797 and USP 800 guidelines
PPE (chemo safe gowns, double gloves, mouth and eye protection)
luer lock (closed system transfer device preferred)
primed tubing under hood (preferred)
soiled items require designated containers for disposal depending on state
body fluids are cytotoxic for 48 hrs
vesicants - CORRECT ANSWER tissue injury and necrosis
CVC admin
communicate w/ pt during admin
observe for redness/swelling/blood return
extravasation - CORRECT ANSWER SLAPP
stop infusion
leave needle
aspirate
pull needle
provider notify
document/pictures
assess comfort
antidote if applicable
Hot pack - CORRECT ANSWER etop
oxolyplatin
vinblastine
most others cold
vesicants - CORRECT ANSWER dactinomycin
dauno
idarubicin
mechlorethamine
mitoxantrone
vinblastine
vincristine
irritants - CORRECT ANSWER cisplatin, dacarbazine
gene therapy - CORRECT ANSWER replacing, removing, or introducing genetic materials into cells
gene repair, marking, angiogenesis inhibitors, and immunotherapy to produce a therapeutic effect
could be less toxic
diadvantage = current innability to target every tumor cell
types of gene therapy - CORRECT ANSWER gene transfer: one or more genes into a cell, first minipulated in a lab and then transferred into a pt
somatic transfer: corrected genes into nonreproductive human cells
germ cell transfer: insertion of genetic material into sperm/egg *controversial*
prodrug metabolizing enzyme: inserting genes into cancer cells to convert prodrug cytotoxins
oncolysis: virus genetically modified to replicate only in cancer cells
angiogenesis inhibitors: block new blood vessel formation (effective in very vascular tumors)
vaccine therapy: can induce antitumor responses
studies are small and larger studies with long term effects are still ongoing
complications--> experiemental and still establishing safety and toxicity, long term monitoring needed, many are still in clinical trial, ethical considerations
nuring interventions--> know what drugs/agents were given as some have late effects, review every med that you give/every med pt has received - helps to be prepared for side effects, frequent pt assessments, know safe handling precautions
Radiation Therapy - CORRECT ANSWER used alone or as combination
high energy waves/particles to eliminate cancer cells
DNA broken, prevents cell replication
oxygen is essential for effective cell death
goal = effective death while minimizing effects
Hgb needed to be 10-12 typically
ALARA - as low as reasonable achievable
Radiation Types - CORRECT ANSWER external beam : 2 beams are aimed at the site, use xrays, gamma rays, or electrons
brachytherapy : radioactive seeds implanted into the tumor bed to offer localized tx
conformal therapy: 3D to deliver radiation that contours the tumor area
Intensity-modulated radiation therapy: delivers varying intensity in the same field
intraoperative: single dose of radiation to the exposed tumor
proton radiation: proton charge particle beam that delivers energy over a distance, conforms to tumor, with decreased radiation to normal tissue
stereotactic: high dose radiation via a focused beam to small area
Radiation Effects - CORRECT ANSWER R/t radiation field, age, and if chemo is used
some chemo = radiosensitive
Usually effects are limited to the area irradiated
acute reactions = during, subacute 3-9 mo later, late effects 1 year later
biggest SE= fatigue
GENERAL: myelosuppression (depending on area and use of chemo)
CNS: neuro and functional impariment, HA, n/v, somnolence (not reccomended for kids under 3 d/t incomplete myelination)
Spinal cord: myelopathy, pain
Salivary glands/oral cavity: swelling, pain, taste, dental disturbances, erythema, loss of permanent teeth, feeding issues
Esophagus: dysphagia
Stomach: N/V
Liver: enlargement, tenderness, transaminitis
Intestines: n, cramping, obstruction, malabsorption, diarrhea, rectal ulceration
Pulmonary: pneumonitis
Cardiac: heart disease (usually w/ chemo), pericardial effusion
Urinary: nephritis, HTN, edema, raidation cystitis
Reproductive: fertility
Hematopoietic: CBC effects if RT to large area of marrow
Bones: slowed rate
Skin: desquamation, pain, hair loss, rash burn
nursing interventions for raidation - CORRECT ANSWER know area being radiated to help with side effects
feeding issues from abdomen, pelvis, throat, mouth
focused assessment
identify symptom related interventions
prepare for late effects 3, 9, 12 mo down road
Surgery - CORRECT ANSWER biopsy- fine needle aspiration or core needle biopsy
staging
complete resection
debulking
surgery for complications - CORRECT ANSWER debriedment: removal of necrotic tissue that impairs wound healing
palliation: support, symptom management, pain control
supportive care: access device placement
surgery considerations - CORRECT ANSWER ABC, fluid shifts, fever management, tube management, abx, pain manageemtn
HSCT - CORRECT ANSWER replace diseased, absent, damaged stem cells with healthy hematopoietic progenitor cells
allogenic - CORRECT ANSWER used if pt's bone marrow is affected (leukemia)
autologus - CORRECT ANSWER provide HPC rescue after large doses of chemo/radiation (solid tumors)
HPC collected from pt and preserved for later use
Allogenic - CORRECT ANSWER collected from donor (preferably sibling)
synergenic - CORRECT ANSWER identical twin (comparable to autologous)
HLA typing - CORRECT ANSWER used in allogenic and taken from a matched related donor (HLA 6/6) or matched unrelated (HLA 6/6 or 5/6)
sometimes cord blood can be used as a stem cell source if availble
more HLA match, less chance of GVHD
sometimes a little GVHD isnt bad bc it will attach reamining tumor cells
advantages and disadvantages of allogenic HSCT - CORRECT ANSWER allogenic: pros = healthy source of cells, easy donor access
cons = some GVHD, low chance of sibling match (30%)
mismatch: pros = healthy source of cells, easy donor access, availble donor for most pts
cons = increased risk of GVHD, risk of graft failure
matched unreleated: pros = health cells, cons = GVHD, waiting time, ethnicity, expense donor charges
cord blood: pros = healthy source of cells, easy, no risk to donor, more diverse HLA
cons= limited number of cells, increased time to engraftment, potential trnsmission of genetic disease
more advantages/disadvantages - CORRECT ANSWER autologous: pros= self, no GVHD, cons = no graft vs. leukemic effect, possible tumor contamination
syngeneic: pros= helathy source of cells, cons=some risk of GVHD
30% chance of getting a sibling with perfect match - CORRECT ANSWER
matched unrelated donor - CORRECT ANSWER 5-6/6 HLA match
parents typically 3-5/6 match - CORRECT ANSWER
HSCT Process - CORRECT ANSWER HPCs collected from marrow, peripheral blood, or placenta/umbilical cord
harvest (marrow) - process of remocing HPCs from donor's posterior/anterior illiac crest
harves (peipheral stem cell) - cells collected through catheter by apheresis machine, HPCs removed on basis of weight
cord blood: newborns cord and placenta right after birth
purging performed to remove tumor cells in autologous, t cell depletion
allogenic, t cell depletion
fresh stem cells - CORRECT ANSWER collected from allogenic donor and infused within 48 hrs, filitration and irriadaition should not be perfomed
given at slow pace over 2-4 hrs
frozen stem cells - CORRECT ANSWER autologous donor
alkakline base fluids 4-12 hrs before infusion
preserved with DMSO-- excreted through lungs for 24-48 hours, garlic breath. can also cause bradycardia or other arrhythmias
other side effects: hemoglobinuriea, micopulmonary emboli, and infection
administered IV in rapid manner, should not be filterd or irradiated
fluids for 12-24 hours after to maintain adequate perfusion and urine output, urine alkaline for 12-24 hours
Donor Eval - CORRECT ANSWER able to tolerate procedure
4 mo - 65 years old
National Marrow Program
Physical Exam
Health history
CBC, CMP, coag, ID, testing for HIV/hepatitis
Cross match
HLA typying
Pregnancy test
psyc eval
Recepient history - CORRECT ANSWER similar to donor but with : organ function tests, CXR, echo, PFTs, neuropsych testing, sperm bank/egg harvesting
Preparative Regimen - CORRECT ANSWER eradicate tumor cells
immunosuppress pt to prevent rejection
reduce risk of GVHD
prep bone barrow for space to allow healthy cells to grow
4-10 days
use of chemo, radiation, or combo to clear bone marrow
Cell infusion process - CORRECT ANSWER frozen = mostly autologous transplant, cord blood transplant, infused rapid via IV, smells like creamed corn
fresh = allogenic transplants within 48 hrs of collection, slow IV infusion over 2-4hrs
frequent vital signs
watch for allergic reaction
premeds:
frozen = antihistamine, antiemetic, steroid, diuretic, fluids
fresh = antihistamine, steroid, diuretic, hydration
HSCT complications - CORRECT ANSWER GVHD, graft failure
high infection risk, toxicities from conditioning regimen
complication depend on donor type, organ compromise, degree of immunosuppression
early= conditioning regimen and between start of conditioning to engraftment (first few weeks of transplant)
intermediate = engraftment and prolonged immunosuppression (100 days post HSCT)
anything over 100 days are late
HSCT complications - early - CORRECT ANSWER bone marrow suppression
n/v/diarrhea/anorexia/mucositis
infection
skin changes
renal insuffiency
hemorrhagic cystitis
veno-occlusive disease
seizures
capilarly leak syndrome
HSCT complications - intermediate - CORRECT ANSWER infection (bacterial, viral, fungal)
graft failure (body recognizes the cells as foreign)
GVHD (new cells recognize the body as foreign)
pulmonary (CMV, pneumonia, intersitisal, pneumonitis, BOOP- bronchiolitis obliterans organizing pneumonia, restrictive lung disease)
GVHD - CORRECT ANSWER immune response where donor recognizes recepient antiens as foreign and causes inflammatory atach
risk factors : HLA disparity, recpients age, number of cells infused
target organs (acute) : skin, liver, gut, lungs (more rare)
chronic: above organs and/or: liver, lungs, eyes, mouth, vaginal mucosa
acute and/or chronic
red, maculopapular rash on palms and soles
spreads from head to trunk then lower extremities
blister formation, desquamation
watery, green diarrhea with pieces of bowerl, abdoinal pain, elevated bili
biopsy to confirm
treatment aimed at immunosuppression - MTX, ritux, steroids, radiation, itracim
staging and grading - CORRECT ANSWER organs (skin, liver and gut) staged from +1 to +4 depending on severity
complications (late) - CORRECT ANSWER immunosuppression and infections
chronic GVHD
bronciolitis obilterans syndrome
cataracts
endocrine dysfunction (thyroid dysfunction, growth/deve delays, ovarian/testicular dysfunction)
secondary cancers
disease recurrence
HSCT Discharge - CORRECT ANSWER ANC > 500
Afebrile
Off abx IV
able to take oral meds
oral intake
family can care for pt (lines, feeding, tube, med mgmt)
transplant complications resolved
how to get in touch with team
appropriately take temp
struct follow up adherence
HSCT follow up - CORRECT ANSWER frequency of CBC, visit depends on complications, transplant type, and engraftment status
labs checked frequently for first 3 months
tests: CBC, CMP, immune function, thyroid function, reproductive hormones, PFTs, cardiac function, eye exam, kidney/liver function, neyrpsychological tests
blood product therapy - CORRECT ANSWER sickel cell needs sickled NEGATIVE blood
restores blood volume, improve oxygen carrying capacity, corrects coagulopathies, and/or replace plasma protein
transfusion parameters: dictated by disease and institution
packed RBCs - CORRECT ANSWER improve tissue oxygenation and correct anemia
<7 (normal hgb is 10)
cross matching within 72 hrs ABO identical and Rh compatible
each unit is 2-3 hrs, within 4 hrs
special prep of blood products - CORRECT ANSWER irridated -- t cells destroyed so no immune response
leukocytes reduced-- indicated for those receiving chemo/febrile reactions
CMV negative -- CMV can cause death and infection in immunosuppressed pts
Plts - CORRECT ANSWER normal value is 100,000
given when actively bleeding or less than 10
prophalycticaly with brain tumors or when less than 50 for surgery/procedures
infused as fast as tolerated
abo and rh match preferred
FFP - CORRECT ANSWER clear fluid remaining when RBCs removed from whole blood
contains plasma proteins and coag factors
used to repalce coag factors in bleeding pts (DIC, liver failure)
2-4 hr transfusion, could be faster
Albumin - CORRECT ANSWER treat pts with hypovolemia and hypoproteninema
use in caution with children suscetible to fluid overload
transfuse 1-2ml/min for 5% albumin product
Cryoprecipirate - CORRECT ANSWER prepared by thawing FFP
replaced fibrinogen and clotting fator deficencies
contains factor VIII and XIII, firbinogen, and von willebrand factors
infuse in 1-2 hrs
complications of transfusions - CORRECT ANSWER febrile response, allergic reaction, circulatory overload, and sepsis
Clotting Factors - CORRECT ANSWER VIII and IX used to treat clotting deficiencies
cross matching not required
5-15 min
1u/kg of VIII replaces factor by 2%
1u/kg of IX replaces factor by 1%
can use for bleeding of prophylaxisis
draw up from vial with filter needle
recombinant products - viral clearance, inactivation, have human albumin (recombinate)
advanced generation - no albumin (Advate)
extended half life/pegylated - (Adynovate)
plasma derived - donor screen safe, contain human plasma
DDAVP - synthetic vasopressin
antifibrinolytic agents - Amicar
Nursing care for hemophilia - CORRECT ANSWER early tx, prophylaxisis, recognize bleeds
comprehensive care - MD, PT, RN SW, genetics
RICE
independence at home
use the specific brand of factor ordered, cannot change
apheresis/transfusion therapy - CORRECT ANSWER previous history of stroke, abnormal TCD, severe complications from uncontrolled SCD
transfused monthly, typically apheresis or transfusion/phlebotomy to decrease HGBS
iron chleation due to frequent transfusions - Jadenu, Exjade, Defearsiro
Transfusion - phlebotomy, exchange transfusion - CORRECT ANSWER ppl with iron overload need therapeutic phlebotomy
conditions that cause iron overload include:
SCD
polycythemia
transplant
therapuetic phlebotomy (takes about 500 ml of blood or less, about 1 cup)
after blood taken, pt gets the same amount of saline solution or blood through the IV or central line, replaces the blood volume
hydroxyurea - CORRECT ANSWER increases fetal hemoglobin
frequent lab monitroing for toxicity and effectiveness
will see a lowered ANC, lower retic and Increased MCV
Heparin - CORRECT ANSWER binds to and potentiates antithrombin III, inactivates thrombin and factor xa
administered sq or iv
iv effective immediately
monitor UFH level
easily reversed
side effects: HIT, bleeding, hypersensitivity
LMWH - CORRECT ANSWER inhibits factor xa
given every 12 hrs sub q
more predictiable than heparin
<2 months, .5mg/kg q12
>/= 2 mo, 1mg/kg q12
Coumadin (warfarin) - CORRECT ANSWER blocks vitamin K reductase enzyme
monitored by PT/INR testing - goal for INR to be 2-3
requires frequent monitoring/dose adjustments
more interactions with other meds
vitamin K rich foods should be eaten in consitent amounts (spinach)
NOACs (novel oral anticoagulants) - CORRECT ANSWER Rivaroxaban (Xarelto)- small molecular factor Xa inhibitor
Dabigatran (Pradaxa) - direct thrombin inhibitor
Apixiban (Eliquis) - direct factor Xa inhibitor
benefits = predicible, no lab monitoring
negatives = no direct reversal agent
nursing considerations for anticoags - CORRECT ANSWER bleeding is most important side/adverse effect, monitor for increased brusing/bleeding
educate family about administering meds, avoiding high risk activities, monitor clot progression, monitor and prevent post thrombotic syndrome
cell cycle - CORRECT ANSWER G0- resting phase, cells are not dividing
G1 - postmitotic phase, enzymes necessary for DNA synthesis produced, protein and RNA synthesis
Synthesis S- cellular DNA duplicated
G2 - premitotic phase, precursors of mitotic spindle produced
M - mitosis, cell division
cell kill hypothesis - CORRECT ANSWER % of cells killed with each chemo cycle, ultimately only a few cells remain, immune system destroys remaining, rationale for multiple cycles
cell cycle specific - CORRECT ANSWER greatest effect on actively dividing cells
not active in G0 phase
greatest action in divided doses or continous infusion
cytotoxic effects occur when cell repair OR division attempted
cell cycle NONspecfici - CORRECT ANSWER work in any phase
active in G0
greatest action when administered as bolus
cytotoxic effects occur when cell division attempted
damage/interfere with DNA - CORRECT ANSWER nitrosurease
antimetabolites
alkylating agents
antitumor antibodies
cause cell cycle phase arrest - CORRECT ANSWER plant alkaloids
interfere with protein synthesis - CORRECT ANSWER hormonal agents
interfere with development of blood vessels - CORRECT ANSWER angiogenesis inhibitors
biologic resposne modifiers - CORRECT ANSWER interferon/inerleukins
GCSF
cell cycle specific - CORRECT ANSWER kill cells that are actively dividing during specific phases of cell cycle
antimetabolites
plant alkaloids
asparaginase/dacarbazine
cellcycle nonspecific - CORRECT ANSWER affect cells regardless of phase
alkylating agents
nitrosurease
antitumor antibiotics
hormones
steroids
misc
CAR T - CORRECT ANSWER chimeric antigen receptor therapy
immunotherapy that uses altered T cells to attack spefici cancer cells
NHL, ALL
pts blood collected, t cells separated from it, these cells are then re-engineered to grow chimeric antigen receptors and then injected back into body to target specific cancer cells
considered a living drug bc the altered t cells will continue to reproduce to kill more cancer cells. increases the risk of developing cytokine syndrome
major risk of cytokine release syndrome - fever, body aches, fatigue, headache, chills, nausea, and diarrhea
severe SE: hypotension, tachy, dysrhythmias, heart failure, hypoxia [Show Less]