Microsoft word - chemotherapy

Christy Lee Fenton
NURSG 1013 Pharmacology
Instructor: Betty Sue Hinkson, MSN
September 20, 2012
Module 4, Chemotherapy
1. State the activity in normal cell growth cycles by completing the following table:

Cell resting state (ATI immune system tutorial). Cells remain in this phase or return to the cell Cell prepares for DNA synthesis (ATI immune system tutorial). This stage lasts 15-18 hours tutorial). Lasts 10-20 hours, the DNA doubles Cell prepares for mitosis (ATI immune system tutorial). Lasts approximately 3 hours, post synthesis stage in which cell prepares for Mitosis occurs. (ATI immune system tutorial) Cell division produces two identical cells and takes approximately 1 hour. (Text page 511) 2. Define the following
A. Generation Time is: The time that is required for a cell to complete one full growth cycle (http://www.encyclopedia.com/topic/generation_time.aspx) B. Growth Fraction is: ratio of dividing cell to resting cells (ATI immune system C. Mitotic Index is: In a population of cells, the ratio of the number of cells undergoing mitosis (cell division) to the number of cells not undergoing mitosis (http://www.cancer.gov/dictionary?CdrID=386225) D. Doubling Time is: doubling time; the time it takes for a cancerous tumor to double in 3. Differentiate the timing of action of Antineoplastic Agents by completing the
following.
CCS drugs work at a specific phase in the cell cycle.
They are most effective against rapidly growing cancer cells. They negatively affect the cancer cells when they are actively dividing. (Page 516 of text) CCNS drugs work during any phase of the cell cycle,
including the G0 phase where they work best. These include the alkylating drugs (although some of these are CCS drugs also), anti-tumor antibiotics, and 4. List examples, action and side effects for each drug class.
break up DNA strands or slow thrombocytopenia, vesication (Text remission, some shrink cancer (Text page 534). Irritation at injection site, fatigue, flu antiviral, immunomodulatory, nausea, vomiting, diarrhea, alopecia, 5. Name 5 obstacles to successful chemotherapy.
A. Multi drug resistance (MDR), malignant tumors often develop resistance to chemo B. Gene amplification, genes produce many copies of its self which leads to over production of protein and makes chemo drugs less effective. C. Some cancer cells develop the ability to repair their own DNA previously damaged by D. Some cancer cells produce a P-glycoprotein (P-gp) in the cell membrane which pumps the chemotherapy right out of the cancer cell before it is effective. E. Certain cancer tumors cells have natural resistance to chemo agents making the drugs 6. Define the following
A. Intermittent therapy is: Example of intermittent therapy is taking a drug for 7 days and then resting without drug treatment for 7 days. The resting period allows time for good cells and tissues to recover. The treatment is cost effective and reduces toxicity. B. Combination Chemotherapy is the use of two or more chemo agents/modalities to treat cancer: chemo drugs combined and used alone or in conjunction with radiation, surgery and biologic response modifiers. Multiple combinations of chemo agents are used to kill all phases of cell cycles and are considered tumoricidal. Two or more drugs (CCS and CCNS) used together can have a significant synergistic effect decreasing drug resistance and increasing the destruction of cancer cells and tumors (Text Page 518). C. Methods to optimize dosage schedules are: Drug treatment delivery methods to optimize benefits with shorter delivery and less toxicity. D. Regional drug delivery is: Targeting drug delivery to a specific tumor or location to Note: Out of all of the above, only B could be found in the National Cancer institute web Case study
A 63 year old African-American woman, recently diagnosed with breast cancer, is scheduled to receive combination chemotherapy consisting of IV fluorouracil (5-FU, Adrucil), doxorubicin (Adriamycin), and cyclophosphamide (Cytoxan). This therapy is designated by the acronym FAC (fluorouracil, Adriamycin, Cyclophosphamide). The client’s treatment regimen consists of the following: This cycle is to be repeated every 21 days for 6 cycles. 1. Differentiate the drug actions of fluorouracil (5-FU, Adrucil), doxorubicin (Adriamycin), and cyclophosphamide (Cytoxan). Cancer of breast, cervix, colon, liver, ovary, Given in combination with levamisole after surgical resection in clients with Duke’s synthetase production, thereby inhibiting Breast, bladder, ovarian and lung cancers; leukemias; lymphomas, soft tissue and bony synthesis; has immunosuppressant activity. Breast, lung, ovarian cancers; Hodgkin’s alkylating drugs disease; leukemias; lymphomas. An immunosuppressant agent. Mode of action: 1. What side effects and adverse reactions should the nurse assess for during Why would assessment of the cardiac, GI, and genitourinary systems be important A: Adverse reactions/toxicity, potentially affecting the cardio, renal, hemo, and 2. What is the maximum lifetime dose for doxorubicin (Adriamycin)? A: 550 3. Describe the early signs of cardiac toxicity that might be seen days to months after the administration of doxorubicin (Adriamycin). A: Heart murmur, fatigue, SOB, swelling/edema in extremities. 4. Briefly explain why hydration would be important during this drug regimen. A: Doxorubicin is excreted through the urine thus it can impair renal function. When taken with cyclophosphamide, a vesicant which can cause necrosis if it infiltrates into the tissue, the patient should be well hydrated to prevent hemorrhagic cystitis. MESNA, a chemo protectant, should also be given to inactivate urotoxic metabolites in the bladder to minimize damage. (Text page What nursing interventions would be appropriate when caring for this client? A: Monitor blood, urea, nitrogen (BUN) and creatinine prior to administration and during period of medication and after as prescribed by physician. Handle drug using precautions, monitor IV site frequently, administer antiemetic 30 to 60 minutes before giving drug, hydrate client orally and through IV before administering, monitor intake and output strictly, assess for symptom of dysuria and hematuria, maintain strict medical asepsis during dressing changes and 5. Describe the teaching that the nurse would provide to the client and her family. A: The RN will emphasize protective precautions, teach family and client s/s of cardiac dysfunction, teach the client about changes in urine color and to drink lots of water, alopecia occurs with doses .50mg/m2 ( hair will begin to grow back several months after therapy is complete), advise client no to have or visit people with respiratory infections, use birth control and to avoid pregnancy for 2 years after completion of treatment, promptly report infections – bleeding – bruising – anemia – fatigue – SOB – orthostatic hypotension. In addition the RN will explain to the patient the need to take cyclophosphamide early in the day to prevent toxicity and infiltration, remind patient to consult with physician before administration of vaccines, advise patient that this drug is excreted in breast milk and that testicular atrophy and olgospermia/azospermia 6. After two cycles of chemotherapy, the client complains that her mouth feels sore, and it hurts to eat. Which chemotherapy agent is most likely responsible for this A: Both Fluorouracil and Doxorubicin cause stomatitis; however stomatitis is an early sign of toxicity with Flurouracil (Text pages 523,524,528,531). What nursing interventions would be initiated to address this problem? A: Good oral hygiene, soft tooth brush, waxed dental floss and mouth rinses with normal saline every 2 hours (Text pages 528, 532). 7. Analyze protective measures necessary to avoid accidental exposure to chemotherapy agents during administration. A: The hospital has special PPE for caring for patients on Chemo precautions which includes a special blue gown and heavier gloves or double glove and protective eye wear. These items should be worn when administering medication and handling bodily fluids or items with bodily fluids. Special containment is also used to dispose of items that are contaminated or come in contact with bodily 8. The client calls the outpatient oncology clinic and tells the nurse that she has a temperature of 38.3 C. What actions should the nurse take to address this issue? A: Patient should always report s/s of fever, chills and elevated temp. as these may be signs of a reaction or infection. The RN should ask the patient to come into the clinic to be seen by the physician and have blood work done; CBC and BMP. The RN should report to the physician.

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