CPHON Exam 93 Questions with Verified Answers
G1 - CORRECT ANSWER The first gap, or growth phase, of the cell cycle, consisting of the portion of
... [Show More] interphase before DNA synthesis begins. Cell grows larger and produces ribosome and proteins.
S - CORRECT ANSWER All 46 chromosomes are replicated in the cells nucleus
G2 - CORRECT ANSWER The second gap, or growth phase, of the cell cycle, consisting of the portion of interphase after DNA synthesis occurs. DNA is condensed into rod form .
(M) Mitosis - CORRECT ANSWER Mitosis. Cells physically divides into two daughter cells, each with its own nucleus and identical chromosomes.
G0 - CORRECT ANSWER Resting phase and Not succeptible to chemotherapy as it in not in active cell cycle. Preforming it's programmed function. Will either die or repair DNA.
Cyclin dependent kinases (CDKs) - CORRECT ANSWER Stimulate the cell to proceed into the next phase of the cell cycle.
Check points - CORRECT ANSWER Occur at G1, G2, and Mitosis; uses chemical and physical signals to monitor the growth of cells. In normal cells if DNA defects are found, progression through the cell cycle is halted. Errors that cannot be repaired result in cell death (apoptosis). In cancer cells these check points may be defective resulting in uncontrolled proliferation.
Apoptosis - CORRECT ANSWER Natural cell death and removal by phagocytes. Each normal cell has a limited number of cell divisions. Malignant cells have lost the ability to undergo apoptosis, resulting in immortalization. Inducing apoptosis to these cells via necrosis is the goal of cancer treatments.
Proto-oncogenes - CORRECT ANSWER normal cellular genes that are important regulators of normal cellular processes, they promote growth. alterations in the expression of these cells result in oncogenes
Oncogenes - CORRECT ANSWER genes that cause cancer by blocking the normal controls on cell reproduction. Activity of oncogenes produces a constant signal for production in the cell cycle and cause the cell to grow out of control. MYCN associated with neuroblastoma
Tumor Supressor Gene - CORRECT ANSWER A gene whose protein product inhibits cell division, thereby preventing the uncontrolled cell growth that contributes to cancer. If these genes are damaged or absent, cells lack the appropriate growth inhibiting factors and grow out of control. P53 gene
p53 - CORRECT ANSWER tumor suppressor gene. Most often mutated in cancers.
Hallmark of cancer - CORRECT ANSWER Increase in genetic instability and mutation rates. Dividing malignant cells rapidly acquire gentic changes , so tumors are similar but not identical. This means that with variability in cells one chemotherapy agent may not be effective against all tumor cells.
Hematopoietic stem cell - CORRECT ANSWER cell in the bone marrow that gives rise to all types of blood cells (neutrophils, monocytes, lymphocytes, erythrocytes, and platelets).
Lymphoid lineage - CORRECT ANSWER B cells, T cells, NK cells. B cells from the bone marrow, T cells from the thymus
myeloid lineage - CORRECT ANSWER A subset of bone-marrow derived cells comprising granulocytes, monocytes, and macrophages.
Immune Response - CORRECT ANSWER The body's defensive reaction to invasion by bacteria, viral agents, or other foreign substances. May play a role in the prevention of many cancers.
3 layers of the immune response - CORRECT ANSWER 1) physical barrier (mucous membranes and skin)
2) innate or nonspecific immune system
3) adaptive or acquired immune system
Physical barrier immune system - CORRECT ANSWER Skin and mucous membranes. Interruption of the integrity of these barriers provides a portal of entry for infectious agents.
Innate or passive immunity - CORRECT ANSWER Rapid, nonspecific response to invading pathogens. Neutrophils are the first at the site of infection, providing nonspecific phagocytosis and bacterial ingestion. Possess when we are born.
Adaptive immune system - CORRECT ANSWER Specific and a delayed/slower lymphocyte response to specific antigens. T cells and B cells. Page 15
MYCN amplification - CORRECT ANSWER key risk stratifier for treatment/therapy in neuroblastoma; technique by which MYCN protein drives cells into the cell cycle; leading to extra MYCN protein; detected by FISH
I-MIBG - CORRECT ANSWER Absorbed by tissues containing adrenergic nerves and us sued in then diagnosis, staging, and follow up of neuroblastoma. It is taken up by an active tumor, minimizing the false-positive results that may show in a bone scan. After the tracer is administered, patients are seen 24, 48, and 72 hours for imaging. To protect the thyroid from radiation exposure, all receive potassium iodine drops 1 day prior and 5-10 days after.
Bone marrow aspirate or biopsy - CORRECT ANSWER Obtained when Hugh suspicion of leukemia or lymphoma exists or when a solid tumor may have spread to the bone marrow
lumbar puncture (LP) - CORRECT ANSWER inserting a needle into the lumbar region of the spine in order to collect spinal fluid, commonly called a "spinal tap" for suspected leukemia, NHL, and certain brain tumors to evaluate for malignant cells in the CSF. L3-L4 or L4-L5
PET-MRI - CORRECT ANSWER PET scanners have been combined with CT or MRI to produce a fused image that superimposes the metabolic activity information of the PET over the physical detail of the CT or MRI.
SUVs (PET scan) - CORRECT ANSWER The amount of metabolic activity is reported in Standard uptake values; if higher than 3.4 are consistent with malignancy
Pharmacodynamics - CORRECT ANSWER what the drug does to the body; the binding of the drug to the receptor, effects beyond the receptor site, and chemical interactions
- morphine bonds to receptors on neurons to block the pain signals, or nalaxone bonds to the same receptors to prevent morphine from binding
- other drugs do not bind to receptors such as antacids or mesna binding to acrolein
Pharmacokinetics - CORRECT ANSWER what the body does to the drug (absorption, distribution, metabolism in the liver, excretion by the kidneys)
Therapeutic range for drugs - CORRECT ANSWER Range of the serum concentration of the drug that can achieve the desired effect without the occurrence of dose limiting toxicities
Pharmacogenetics - CORRECT ANSWER The study of the persons genetic make up affects the persons response to drug therapy
Multimodal approach of therapy - CORRECT ANSWER Gold standard; options include surgery, chemotherapy, biotherapy, radiation therapy, and hematopoietic stem cells transplant. Using a combination of 2 or more
surgery - CORRECT ANSWER Used in various aspects of cancer management including diagnosis and staging (biopsy), treatment (reduce tumor burden) and supportive care.
Surgical complete resection - CORRECT ANSWER Removal of all visible and microscopic evidence of the tumor so that no tumor or even minimal residual tumor is left behind
Surgical Gross total resection - CORRECT ANSWER Removal of all visible tumor, but microscopic disease may still be present
surgical debulking - CORRECT ANSWER Partial resection, involves resection of a portion of the tumor because the entire mass cannot be completely or safely removed. Helps to decrease pressure on spine or other vital organs.
Chemotherapy - CORRECT ANSWER Designed to kill malignant cells at different phases of the cell cycle. Effects on the bone marrow include anemia, neutropenia, thrombocytopenia. Effects on the GI tract include mucositis, nausea, vomiting, constipation, diarrhea. Cute is accomplished with eliminating all measurable disease; control prolongs survival by slowing tumor growth but does not totally elongate disease; palliative relieves symptoms
radiation therapy - CORRECT ANSWER Target the tumor for destruction while sparing surrounding tissues. Aims high energy particles or waves at targeted tumors to cause DNA to break, cause a stop to cell division to kill the cells in the tumor
MIBG + I-131 - CORRECT ANSWER MIBG Compound combined with radioactive iodine I-131 to deliver targeted radiation therapy to treat high risk neuroblastoma
Side effects of radiation therapy - CORRECT ANSWER Acute and long-term site-specific changes: Vary according to site
-Local skin changes with erythema, hyperpigmentation, ulceration and hair loss
-Altered taste sensations
-headache, radiation somnolence, edema, increase need sleep
- dry eyes
- pericarditis, myocarditis
- radiation pneumonitis
- mucositis, nausea, vomiting, diarrhea, anorexia, malnutrition
- myleosupression, anemia, thrombocytpoenia
immunotherapy - CORRECT ANSWER This therapy assists the immune system in detecting and fighting cancer cells. Cytokines help rev up the immune system: interleukins, interferons, and growth factor
Immunoglobulins - CORRECT ANSWER Secreted antibodies.
IgG: maintains the body's defense against infection
IgM: first antibody to appear with antigen exposure
IgA: immune function of mucous membranes and helps prevent infection in nose and lungs
IgE: Secretion of histamine during hypersensitivity reaction
IgD: function unknown
Tumor response: complete - CORRECT ANSWER Absense of all signs and symptoms of tumor
Tumor response: partial - CORRECT ANSWER Reduction in the tumor burden without development of new tumor
tumor response: stable disease - CORRECT ANSWER No significant change in primary or metastatic tumor size
Tumor response: progressive disease - CORRECT ANSWER Increase in size of the existing tumor or appearance of new disease
Tumor response: relapse - CORRECT ANSWER Tumor growth after complete response or new tumor growth after a partial response
MRD (minimal residual disease) - CORRECT ANSWER Measurement for leukemia; for ALL, MRD levels greater than or equal to 0.01% at the end of induction is associated with high risk for relapse and considered MRD positive. They will be given more intense induction therapy than those who are MRD negative
Subjective response to treatment - CORRECT ANSWER Child's or parents perception of how the disease and treatment affect the child's daily life. Measured on lansky or karnofsky scale
Phase 1 clinical Trial - CORRECT ANSWER Primary goal is to determine safety. Determining the maximum tolerated dose of an investigational drug or combination of drugs using a recommended administration schedule and identifying dose limiting toxicities. Intent is not to cure. Participants have advanced disease and other therapies have failed. Adequate organ function is essential because toxicities will be measured by organ function.
Phase 2 clinical trials - CORRECT ANSWER Primary goal to determine efficacy of a new agent. Studies are disease specific and are based on biochemical or pharmological data, preclinical screening in tumor lines, or suggestion of the agents anti tumor activity in phase 1. To determine drug activity against a specific disease and to validate dosage and toxicity data. Not curative but to collect data about the drug, side effects, and how they might be used to treat cancer.
Stage 3 clinical trial - CORRECT ANSWER To compare the new agent to the standard treatment. Tested as single agents or combined with other agents. Example: blind vs standard treatment.
thousands of patients are randomized. To see if the new treatment is superior to the standard. Intent is to cure.
Phase IV clinical trials - CORRECT ANSWER After the agent is made available on the commercial market and focus on effectiveness in the general population. Ongoing evaluation of side effects and drug safety.
Informed consent - CORRECT ANSWER Before enrolling in a clinical trial, each participant or their representative must give permission to th investigators to administer the study drug, collect biospecimens, and collect data related the drug and its side effects. The participants must give consent voluntarily and must understand the details of the study. The discussion includes: purpose, procedures, risk/benefits, patient rights, and treatment options. Can be given by anyone over 18 or assent when the child is over the age of 7 years. Components: time to read the document, opportunities to ask questions, and access in any language.
Biospecimens - CORRECT ANSWER Samples of blood or tissue obtained from a patient that can be used to obtain research data about the pri their undergoing a clinical trial. Can be frozen and stored for future research, but families have the right to know if they will be stored for this.
Role of the nurse in informed consent - CORRECT ANSWER Ensure that the treatment plan is discussed at the patient and family's education level, provide time for questions, and confirm that the basic required and individual informed consent elements are reviewed.
Conventional cytotoxic agents - CORRECT ANSWER Classified according to chemical structure, biological source, mechanism of action, and physiologic effect on the cell. The effects on th cell cycle are classified as cell cycle specific or cell cycle nonspecific.
Cell cycle specific agents - CORRECT ANSWER Exert an effect during a specific phase of the cell cycle with the maximal effect on the rapidly diving cells. Promote cell death during the active phase of the cell cycle, most often the S and M phases. Given in divided doses over multiple days or a continuous infusion. Giving at multiple time points ensures that they reach the maximum number of cells during the specific phase they target.
Cell cycle nonspecific agents - CORRECT ANSWER Act against cancer cells during all phases of the cell cycle, including the resting phase (G0). They are effective against proliferating and nonproliferating cancer cells because they pr9mtoe death during both active and dormant phases of the cell cycle. These agents are dose dependent (most effective as a bolus).
Cell cycle specific agents (chemo) - CORRECT ANSWER MTX, 6MP, thioguanine, clofarabine, nelarabine, fuldarabine, azacitidine, ARC, gemcitabine, irinotecan, topotecan, VP, vinblastine, VCR, vinorelbine, docetaxel, packitaxel, bleomycin, hydroxyurea
Cell cycle nonspecific agents (chemo) - CORRECT ANSWER Cytoxan, ifosfamide, melphalan, carmustine, lomustine, busulfan, thiotepa, cisplatin, carboplatin, temozolomide, daunorubicin, doxorubicin, idarubicin, dactinomycin, mitoxantrine, dexamethasone, hydrocortisone, methlyprednisolone, prednisone, Erwinia, PEG
Alkylating agents - CORRECT ANSWER Cell cycle nonspecific and stop tumor growth by causing DNA strands to break and mispairing of bases in DNA resulting in interference of replication and transcription.
Cytox, ifosfamide, melphalan, carmustine, lomustine, busulfan, thiotepa, cisplat8n, carboplatin.
antimetabolites - CORRECT ANSWER Structurally similar to cellular metabolites (such as folic acid) that are necessary for cell function and replication. They interfere with normal cell metabolism, interacting directly with specific enzymes by inhibiting production of enzymes or by oriduving a nonfunctional end product. Prevent th building blocks of DNA from being incorporated in DNA and RNA during the S phase.
MTX, 6MP, thioguanine, clofarabine, fludarabine, nelarabine, fluroiracil, azacitadine, ARC, gemcitabine.
Topoisomerase inhibitors - CORRECT ANSWER Interfere with the action of topoisomerase enzymes (I and II) which control changes to DNA structure, causing beaks and blocking ligation of distrusted stands of DNA during the cell cycle which leads to apoptosis and death. Can be either cell cycle specific or cell cycle nonspecific.
Specific: Topotecan, irinotecan, etoposide.
nonspecific: daunrubicin, doxorubicin, idarubicin, dactinomycin, mitazantrone.
Tubulin inhibitors - CORRECT ANSWER Wide range of anti tumor activity in pediatric cancers (ALL, solid tumors, CNS tumors). These drugs affect the microtubules, which are necessary for mitosis, cellular transport, cell shape maintenance and cell signaling.
Vinblastine, VCR, vinorelbine, paclitaxel, docetaxel.
Miscellaneous agents (chemo): corticosteroids - CORRECT ANSWER Corticosteroids:prednisone, dexamethasone, prednisolone. Treatment of ALL, NHL, HL, and brain tumors. Used as supportive care with N/V, elevated ICP, anorexia, hypercalcemia. Corticosteroids enter the cell nucleus, bind with DNA and modify the transcription process to induce apoptosis by binding to intracelkular glucocorticoid receptors. Continuous exposure by steroids for hours to days is needed to cause apopotosis in ALL.
Miscellaneous Agents: Aspariginases - CORRECT ANSWER Erwinia-asparignase or PEG-asparignase
-used for ALL and lymphoblastic lymphomas.
- asparignase is a cell cycle nonspecific enzyme produced by bacteria (e.coli) that inhibits DNA, RNA and protein synthesis by hydroxyzine serum asparagine into the nonfunctional products of ammonia and aspartic acid. Asparagine is what cellss need for protein synthesis.
Miscellaneous agents: arsenic and bleomycin - CORRECT ANSWER Arsenic trioxide
belomycin: binds to DNA to cause breaks with an iron free radical reaction
Adjuvant chemotherapy - CORRECT ANSWER Chemotherapy that is administered after another modality, such as surgery, has been used to control the primary tumor. The goal is to remove the bulk of the tumor at the beginning of therapy and then use systemic chemo to prevent reoccurrence by destroying any remaining microscopic disease and any possible mets. Used in patients who are at risk for relapse or mets despite local control with surgery or radiation. Standard treatment of Wilms tumor.
Neoadjuvant chemotherapy - CORRECT ANSWER Chemotherapy that is given before the definitive modality (surgery, radiation) against the primary tumor. Goal is to reduce size and control micromets before surgery. Standard treatment for osteosarcoma and Ewing's.
Gompertzian Model of Tumor Growth - CORRECT ANSWER Provides rationale for using adjuvant or neoadjuvant chemotherapy.
- initially when tumors are smaller, they grow quickly. Rapid growth occurs when the tumor is not detectable. As the tumor grows, the supply of oxygen and nutrients becomes insufficient leading to a decrease blood supply and slowing of the cell cycle and proliferation. At this time the cell enters G0 the resting phase and chemotherapy agents don't work.
-chemo is more effective when given after diagnosis (neoadjuvant) or soon after surgery (adjuvant) at a time when the tumor is smaller and more proliferative. As the rate of growth decreases and fewer cells proliferate, adjuvant and neoadjuvant chemo becomes less effective.
- the longer time between chemo cycles, the greater chance for tumor regrowth.
Concomitant chemotherapy - CORRECT ANSWER Administered in conjunction with another modality and during this same timeframe. Chemotherapy + radiation. Radiation sensitizer chemotherapy.
Radiation sensitizers - CORRECT ANSWER They enhance the effects of radiation therapy. Gemcitabine and 5-fluorouracil.
Conditioning chemotherapy - CORRECT ANSWER Administration of high doses of chemotherapy before a stem cell transplant. Eradicate the bone marrow in preparation for infusion of new stem cells.
Sanctuary chemotherapy - CORRECT ANSWER Chemotherapy that is given in to an area where malignant cells may be located but are not readily accessible to systemic chemotherapy.
- IT chemo: leukemia cells can cross the BBB, but systemic chemotherapy cannot.
Palliative chemotherapy - CORRECT ANSWER Used in end of life care when the goal is not to cure, but rather prolong life and reduce pain and suffering. Antitumor effect with limited toxicities
- oral VP with brain tumors
Dose intensity of chemotherapy - CORRECT ANSWER Goal of treatment is to give the maximum tolerated dose with as few delays in treatment as possible. When tumors have les time to regrow between treatments, the remaining tumor cells are susceptible to chemo.
- total amount of chemo given in a fixed amount of time (one cycle)
Reaching increased dose intensity of chemo - CORRECT ANSWER O1) increased dose of chemo (escalating dose of MTX regimen)
2) interval compression or dose dense: decreasing the interval between cycles
3) metronomic chemo: oral chemo given without breaks
- better outcomes but also increases Sid effects
Combination chemotherapy - CORRECT ANSWER Use of two or more drugs simultaneously or in sequence to overcome drug resistance. Superior to single dose agents because it produces high tumor response rate, increases duration of remission, synergistic cytotoxic effects, and prevents or delays acquired resistance to initially responsive tumors.
- exert effects at different phases of the cell cycle.
Goldie Coleman Hypothesis - CORRECT ANSWER Giving a combination of several drugs together during a cycle of chemotherapy will decrease the possibility of that tumor cell developing acquired resistance.
Routes of delivery for chemotherapy - CORRECT ANSWER Systemic: oral, IM, SubQ, and IV
local: topical for cutaneous malignancies, intraventricular (Ommaya), intrathecal (CNS), intrapleural (chest tube), intraperitoneal (catheter ornport into the peritoneal cavity), intrahepatic (port or pump for liver mets), intra-arterial (catheter for specific tumor sites used for retinoblastoma or osteosarcoma), and intravesicular (bladder catheter)
Arsenic Trioxide (Trisenox) - CORRECT ANSWER - cell cycle nonspecific; APL
- special considerations: APL differentiation syndrome: fever, Wright gain, SOB, musculoskeletal pain= treat with steroids and diuretics. maculopapular rash over neck and torso (resolves when drug is discontinued)
- use with drugs that also prolong QT can increase risk of fatal arrhythmias
- nursing actions: infuse 1-2 hours and slow to max 4 hours if vasomotor reaction occurs.
- labs and tests: baseline ECG and then weekly, baseline electrolytes (Mg and K) and then weekly, CBC, coags
PEG- asparaginase - CORRECT ANSWER Cell cycle nonspecific; ALL and lymphoblastic leukemia; IM or IV
- half life is 5-7 days
- common side effects: allergic (local or systemic), pain at injection site, coag abnormalities.
-occasional side effects: hyperglycemia, liver function abnormalities. Pancreatitis, anaphylaxis.
- call after discharge if s/s of allergic reaction, abdominal pain, N/V, increased thirst, bleeding.
- Nursing actions: monitor patient for allergic reaction, have emergency equipment.
-labs: coag, CBC, amylase/lipase, liver function, renal function
Asparaginase Erwinia - CORRECT ANSWER - 6 doses per 1 dose of PEG asparaginase (switched to this if issues with PEG)
- cell cycle nonspecific for ALL or lymphoblastic leukemia; IV or IM
- common side effects: N/V, abdominal pain.
- occasional: allergic reaction, anaphylaxis, urticaria.
Rare: pancreatitis, increase in LFTs.
- call after discharge if s/s of reaction, abdominal pain, N/V, increased thirst, bleeding, mental status change.
- Nursing actions: monitor for reaction
-labs: coag, CBC, amylase/lipase, liver function, electrolytes.
Azacitadine (vidaza) - CORRECT ANSWER -Antimetabolite or cell cycle specific
- Leukemia or MDS; subQ or IV
- common: N/V, diarrhea, constipation, heartburn, pancytopenia, fever, mucositis.
- rotate injection sites and may be red for 72 hours.
-Nursing action: SubQ dose must be inverted several times and rolled between palms for 30 seconds immediately prior to admin. IV must be completed 1 hour after vial reconstituted
-labs: CBC, electrolytes, Liver function, renal function
Bleomycin sulfate (blenoxane) - CORRECT ANSWER -cell cycle specific (G2, M)
- Lymphoma; SubQ, IM, IV
- common: fever, chills, hyperpigmentation of finger nails, mucositis, pruritus, raynaud phenom.
Rare:allergic reaction, pulmonary fibrosis
-lower doses may be given with concurrent pulmonary radiation, test doses may be given with initial dose, pulmonary function tests should be done at baseline and throughout therapy, no scuba diving and situations with 100% O2 because high concentration oxygen exacerbates bleomycin pulmonary toxicity.
-Nursing action: infuse IV over at least 10 min. Monitor for allergic reaction and have emergency equipment at bedside.
-labs: renal function, CBC, chest X-ray, pulmonary function
Busulfan - CORRECT ANSWER -alkylating agent, cell cycle nonspecific
- CML, HSCT prep (solid tumor, leukemia)
- PO or IV; irritant potential
- common: myleosupression, bronzing of the skin, fever, tachy, chest pain
occasional: seizure with HD admin, VOD, hyperbilirbin, hemorrhagic cystitis
- rare: ovarian failure
- prophylactic anticonvulsant may be used with HD therapy; with HSCT, a test dose is given and labs drawn (PKs) to determine treatment dose.
-nurse actions: IV over 2-3 hours. Not compatible with CSTDs and may dissolve them
-labs: CBC, liver function with bilirubin, PKs
Carboplatin (paraplatin) - CORRECT ANSWER -alkylating agent, cell cycle nonspecific
- solid tumors; IV
- common: N/V, myleosupression, electrolyte abnormalities
- occasional: hypersensitivity reaction (risk increases with each dose given) with bronchospasms and hypotension, hepatotoxicity, renal toxic, ototoxic -aluminum reacts with carboplatin causing precipitate and loss of potency, so no IV sets with aluminum or needles.
- elimination dependent on GFR
- thrombocytopenia is dose limiting toxicity, platelet nadir is 3 weeks
- audiograms should be preformed at baseline and follow up
-synergistic with radiation and used as radiation sensitized in many CNS protocols
-nurse: admin over 15-60 min, watch for hypersensitivity
- labs: audiogram, liver and renal function, UA, CBC, electrolytes
Carmustine (BCNU) - CORRECT ANSWER -alkylating agent, cell cycle nonspecific
-solid tumors, IV, irritant/vesicant
- common: burning with peripheral administration, N/V, myleosupression, late pulmonary dysfunction, anorexia.
- occasional: facial flushing, liver dysfunction, stomatitis.
Rare: secondary malignancies
- delayed myleosupression, platelet nadir is 4 weeks and neutrophils 4-6 weeks; N/V soon after treatment and last hours to days
- nurse: infuse 1-2 hours, avoid extravastion, avoid rapid infusion (burning and hypotension), check BP when high dose given
-labs: CBC, liver and renal function, pulmonary function
Cisplatin (platinol) - CORRECT ANSWER -alkylating or cell non specific agent
- solid tumors, IV
-irritant/vesicant concentrations > .4mg/mL
- common: delayed nausea/vomiting, frequency hearing loss, myleosupression, anorexia
-occasional: electrolyte abnormalities, loss in normal hearing range
- considerations: synergistic with radiation, aluminum reacts with cisplatin causing precipitate and loss potency
- nurse: premed with antiemetics, cause delayed nausea/vomiting so ensure antiemetics are at home, prehydration less than or equal to 1.010 and U/O to 3mL/kg/hr, administer mannitol or oasis to ensure good U/O, audiometric testing at baseline and follow up
-labs: audiogram, GFR or urine creatinine, renaland liver function
Cladribine (leustatin) - CORRECT ANSWER - antimetabolite and cell cycle specific
- leukemia or LCH; IV irritant
- common: nausea, myleosupression, fever, fatigue, rash
- occasional: vomiting, anorexia, cough
-rare: skin rash, abnormal breath sounds, headache
- considerations: increased risk of infection, dilute in NS not D5 (it increases degradation of the drug)
- nurse: infuse 1-2hr or continuous, monitor for fever or injection site reaction
labs: liver and renal function, creat8nine clearance before first dose
Clofarabine (clolar) - CORRECT ANSWER - antimetabolite and cell cycle specific
- acute leukemia, IV
- common: pericardial effusion, hypotension, tachycardia, edema, fever, prolonged myleosupression (increases risk infection)
-rare: SIRS, CRS
-considerations: continuous IVF during administration and use of ppx steroids to prevent or lessen SIRS or CRS (30 min prior to infusion) + CRM
- nurse: infuse over 2 hrs, monitor BP, HR and RR, monitor for signs of TLS or CRS, avoid use of nephrotixic drugs. BID weight and strict I/O
Corticosteroids (prednisone, dexamethasone, hydrocortisone, methylprenisone) - CORRECT ANSWER - cell cycle nonspecific; PO or IV
-leukemia, lymphoma
- dexamethasone: antinausea, premed, allergic rx
- prednisone: anti inflammatory
-common: mood swings, acne, immunosuppression, hyperhagia
-occasional: poor wound healing, upset stomach, hyperglycemia
-rare: AVN
- < 10 years dexamethasone or > 10 years prednisone
- considerations: used synergistic with induction chemo to treat leukemia as they have a direct lyric effect on tumor cells (can induce remission but cannot maintain as single agent), mask fever or infection
-nurse: reduce sodium intake, observe hyperglycemia, administer with meals or snacks or administer PPI, do not crush because of bitter taste, infuse IV dex slow to avoid perinatal burning [Show Less]