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
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
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
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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