name the 4 phases of the cell cycle
G1 Phase
S Phase
G2 Phase
M Phase<\/p>\n\n\n\n
name the 4 stages of mitosis
Prophase
Metaphase
Anaphase
Telophase<\/p>\n\n\n\n
Which is the longest phase of the cell cycle, lasting about 10 hours
S Phase<\/p>\n\n\n\n
What is the shortest phase of the cell cycle
M Phase (Mitosis)<\/p>\n\n\n\n
these cells have receptors that determine if cells of cells they encounter are self or non-self. Their role is to destroy non-self cells
Natural Killer Cells<\/p>\n\n\n\n
Mitosis phase in which Nuclear envelope has disappeared, and chromosomes move toward the cell equator. Sister chromatids have not separated. The metaphase checkpoint ensures that the chromosomes are aligned properly before separation.
Metaphase<\/p>\n\n\n\n
Mitosis phase in which Centrioles move toward opposite poles, and the nuclear envelope breaks down.
Prophase<\/p>\n\n\n\n
Mitosis phase in which Two sister chromatids separate into chromosomes.
Ananphase<\/p>\n\n\n\n
Mitosis phase in which Nuclear envelope has disappeared, and chromosomes move toward the cell equator. Sister chromatids have not separated. A checkpoint ensures that the chromosomes are aligned properly before separation.
Metaphase<\/p>\n\n\n\n
During which phase of the cell cycle does DNA replication occur
S Phase<\/p>\n\n\n\n
proteins that control the cell cycle
cyclins<\/p>\n\n\n\n
pluripotent stem cell
Cell capable of giving rise to any of the specialized cell types in the body.<\/p>\n\n\n\n
nonspecific immunity
phagocytosis and inflammation (2nd line of defense – Also 1st line of defense skin\u2026)<\/p>\n\n\n\n
_<\/em><\/strong> precursors, or “pre-cells,” mature into red blood cells (RBCs), platelets, and white blood cells (WBCs). _<\/strong> precursors, or “pre-cells,” mature into specialized WBCs called lymphocytes. During which phase of the cell cycle do cells enlarge and pass a checkpoint that determines the cell is ready to divide During which phase of the cell cycle do cells enlarge and pass a checkpoint that determines the cell is ready to divide three types of granulocytes _<\/em><\/strong>, including Natural killer cells, granulocytes and macrophages are the second line of defense in the immune system (after skin, mucus membranes and gut flora) nonspecific immunity Learned specific immunity 2 types of lymphocytes important tumor suppressor gene, sometimes called the “suicide gene.” Resources LESSON 1: Cell cycle mitosis apoptosis hematopoiesis Principles of Biotherapy: p51-95 immunology immune responses cytokines vaccines for cancer prevention filgrastim aka neupogen tbo-filgramstim\/ pegfilgrastim palifermin sargramostim IFN gamma aldeleukin oprevelkin plerixafor sipuleucel rituximab immune system malignant tumor (cancer) Approaches to treatment neoadjuvant adjuvant myeloblation nonmyeloblative LESSON 2: Alkylating Agents platinum based chemo -carboplatin- risk with age >65, harder on kidney function. over shorter period of time, nausea within first 24 hours. neuro tox<\/p>\n\n\n\n cyclophasmide iphosphamide nitrosureas Lesson 3: Antimetabolites inhibit DNA and RNA synthesis – can cause myelosuppression, GI toxicities, phospotsensitiivty, hand foot syndrome, vigorous I V hydration to prevent tumor lysis<\/p>\n\n\n\n 5 fluorouracil (5 FU) methotrexate azacitidine Lesson 4 A cautionary tale about routes intrathecal chemo vincristine Lesson 5 Antitumor Antibiotics nonanthracycline: actinomycin, mitomycin, bleomycin<\/p>\n\n\n\n doxorubicin -nausea\/ vomiting, mucositis, diarrhea, myelosupression, hepatic impairment, secondary cancer<\/p>\n\n\n\n -cardiac: SOB< skipped beats, weight gain -myelosuppress: oral temp daily, report >100.5 dexrazoxane bleomycin Lesson 6 symptoms that can be dose limiting HEC: highly emetogenic – carmustine, cisplatin, cyclophosphamide, daarbazine, mechlorethamine, streptozocin<\/p>\n\n\n\n CINV Antiemetics neurokinin antagonists- aprepitant, fosaprepitant<\/p>\n\n\n\n steroids: dexamethasone<\/p>\n\n\n\n Cutaneous Side effects of chemo myelosuppression NEUTROPENIA: risk of infection. fever >100.2 sign of infect THROMBOCYTOPENIA: injury or loss of stem cell – suppression of platelets. petechiae, bruise, headache, hypotension, prolonged bleeding<\/p>\n\n\n\n ANEMIA: presents later dyspnea, fatigue, dizziness, headache -treatment: iron supp, bleed correction, transfusion, oxygen<\/p>\n\n\n\n Neutropenia polys + bands x WBC \/100 GI Toxicities mucositis- can occur from the mouth to the anus Acute Infusion Reactions anapylaxis- acute, severe inflammatory response that is sudden and systemic – dyspnea, hypotension and loss of conscious<\/p>\n\n\n\n GIVE benadryl or hydrocortisone, close vitals, STOP, maintain airway, resuscitation meds<\/p>\n\n\n\n Type 1 reactions Type IV reaction Lesson 7 safety issues: cumulative dose Lesson 8: safety issues: extravasation and vesicant admin NO PIVs in hand, wrist or AC – dont place below a recent venipuncture site NO BLOOD RETURN NO USE<\/p>\n\n\n\n IV access selection PORT: should get a blood return<\/p>\n\n\n\n venous irritation lesson 9: plant alkaloids vinca alkaloids given IV and should never be given intrathecal<\/p>\n\n\n\n Paclitaxel: shoud be stored in glass – through in line filter<\/p>\n\n\n\n Cabazitaxel: use in line filter<\/p>\n\n\n\n Nap paclitaxel: premeds not required<\/p>\n\n\n\n extravasation of plant alkaloids lesson 10: biotherapy targeted therapy: uses drugs or other substances to identify and attack cancer cells<\/p>\n\n\n\n GOALS: disease cure, improve response or increase disease survival, control or stabilize disease, mtainain or enhance live<\/p>\n\n\n\n CATEGORIES: cytokines, monoclonal antibodies (conjugated and unconjugated), small molecule inhibitors, antibody durg conjugates, vaccines<\/p>\n\n\n\n Biotherapy terms Targeted Therapies attack many different targets – block angiogensis, block signals in or outside of the body, deliver toxic substances to the cell, stimulate the body’s immune system<\/p>\n\n\n\n Include: hormone therapies, signal transduction inhibitors, apoptosis inducers, angiogenesis inhibitors, immunotherapies<\/p>\n\n\n\n HORMONE THERAPY: adds, blocks, or removes hormones from the body to help slow the growth of cancer cellls<\/p>\n\n\n\n SIGNAL TRANSDUCTION INHIBITOR: block signal transduction<\/p>\n\n\n\n MONOCLONAL ANTIDOES: end in mab- rituximab, panitumab<\/p>\n\n\n\n SMALL MOLECULES tyroisine kinase inhibitors: end in tinib: oral agents. be aware of adherence and interactions kinase inhibitors: oral agents<\/p>\n\n\n\n hedgehog pathway inhibitors: controls cell division of adult stem cells and cell differentiation. oral agents. be aware of adherence and interactions<\/p>\n\n\n\n IMMUNOTHERAPIES monoclonal antibodies nonspecific immunotherapies adoptive cell therapy lesson 11: safety issues, safe handling is about YOU too risks of occupational exposure -air samples, floors, drug vials, prep areas, skin under gloves<\/p>\n\n\n\n hierarchy of controls drug administration oral: gloves, directly into a med cup<\/p>\n\n\n\n double ID name, DOB, date of admin, name, route, total dose and total volume, date and time prepared\/ expired<\/p>\n\n\n\n apply gloves, gown, and then re glove over cuffs<\/p>\n\n\n\n postadministration precautions HANDLING body fluids of patients who have recieved chemo: gown and double glove, face shield if splash<\/p>\n\n\n\n at home: wear gown with back closure, double glove, double wash apart from laundry, detergent<\/p>\n\n\n\n management of spills lesson 12: changing gears, administration of chemo and biotherapy assess patients readiess to learn, health literacy, preferred method of learning, barriers to learning<\/p>\n\n\n\n is this the right treatment plan? goal of treatment? venous access? side effects to addres before?<\/p>\n\n\n\n Administration considerations SQ: ease, well tolerated, inconsistent absorption, increased fat could increase risk of misplacement. pain\/ bleed\/ bruising<\/p>\n\n\n\n IM: rapid absorption, can cause nerve damage, tissue necrosis, PPE, insert at 90 deg angle, avoid massage<\/p>\n\n\n\n intraperitoneal: catheter or IP port. directly into peritoneal cav, infection risk, abdominal pressure, bleeding, diarrhea, per, infection, anaphylaxis<\/p>\n\n\n\n intrathecal: CNS malignancies,methotrexate and cytarabine – surgical procedure, lumbar puncture is invasive<\/p>\n\n\n\n intrapleural<\/p>\n\n\n\n intravesicular: bladder cancer<\/p>\n\n\n\n intra aterial<\/p>\n\n\n\n IV – continuous or push (through fre flowing IV, attach at injection port, aspirate for blood, slowly admin at a rate of 1-2ml\/min central venous catheters – blood return before during and after<\/p>\n\n\n\n symptoms of extravasation Pretreatment care VERIFICATION: checking that prescribed doses are WNL, appropriate time intervals between treatments, route, volume and rate are clearly stated, review labs, ensure questions addressed -printed drug reference, current evidence based guideleine, step by step checklist<\/p>\n\n\n\n for HIGH DOSE: risk of cardiac toxicit, neuro checks with high dose cytarabine (risk of cerebellar toxicity) high methotrexate given with leucovorin, myeloblation<\/p>\n\n\n\n Pre Administration<\/p>\n\n\n\n Recommendations to Prevent Errors Vascular access devices IV considerations dosing- metric system: mg, mg\/kg, AUC and mg\/m2<\/p>\n\n\n\n weight based: based on body weight – weight on day of delivery is crucial<\/p>\n\n\n\n BSA dosing: m2<\/p>\n\n\n\n AUC: area under the curbe- carboplatin, drug concentration in the blood over a period of time, renal function part of calc<\/p>\n\n\n\n special considerations: older adults and young kids, poor nutrition, obese, prior radiation or chemo, comorbid conditions, myelosuppression<\/p>\n\n\n\n lesson 13: introducting bisimilars -they have no meaningful difference that alter efficacy or safety from reference prod benefit: cost- far less expensive to produce than trade drug and reduce cancer care cost<\/p>\n\n\n\n most expensive antineoplastics: bevacizumab, rituxin, trastuzumab<\/p>\n\n\n\n neupogen first biosimilar<\/p>\n\n\n\n nursing indication for biosimilar side effects not always the same<\/p>\n\n\n\n lesson 14: legal and ethical issues related to cancer document: calls to different agencies to find assistance for home therapy, meeting with home health nurse for prep, call to patient to notify that WBC low, location of PIV< conco with onc about DNR status, discussion with wife about birthday party<\/p>\n\n\n\n pretreatment assessment Patient PREP: inform, verbally review plan, provide a detailed explanation to the patient, family and caregiver, confirm name and ID< baseline vitals<\/p>\n\n\n\n PREP: PPE, infusion pump, ensure product match full name, ID, date of admin, generic name, route of admin, total dose,volume, date and time<\/p>\n\n\n\n CHEMO ADMIN: confirm plan with patient ETHICS lesson 15: putting it all together Patient Education and care coordination RCHOP (rituxin, cyclophsos, doxorubicin, vincristine, prednisone ) -cause neutropenia- dec in WBC that help fight infection. hand hygeine and stay away fro sick<\/p>\n\n\n\n Rituxin cyclophosphamide Doxorubicin vincristine prednisone Common questions mononucal antibodies: agents that come from humans or mouse or both- they search out proteins on the cels surface. NK cells destroy the tumor like mABS- mABS ma cause harm to cells that are marked whereas chemo attacks all cells -adjuvant therapy: given following treatment to target minimal residual disease<\/p>\n\n\n\n use barrier methods following 48 hours of cehmo<\/p>\n\n\n\n NADIR: time when neutrophil count is the lowerst- varies by drug but is usually 7-10 days folowing treatment<\/p>\n\n\n\n Treatment planning Lesson 1: Foundations to Set the Stage<\/p>\n\n\n\n Focusing on Cellular Structure and Function<\/p>\n\n\n\n The Normal Cell Cycle -Cell nucleus regulates these processes by gathering and processing complexes molecular information<\/p>\n\n\n\n Interphase and Mitotic Phase During interphase: 1: First growth phase (G1 or first gap)<\/p>\n\n\n\n 2: Synthesis phase (S phase)<\/p>\n\n\n\n 3:Mitotic Phse (M phase)<\/p>\n\n\n\n First Growth Phase (G1 or first gap) -reproduce RNA<\/p>\n\n\n\n -“quality assurance” test that the cell will be ready to synthesis DNA<\/p>\n\n\n\n -Length of time is variable, can be from hours to days<\/p>\n\n\n\n Synthesis Phase (S phase) -Results in the formation of identical pairs of DNA (chromatids)<\/p>\n\n\n\n -which are attached a t the centromere<\/p>\n\n\n\n -lasts 2-10 hours<\/p>\n\n\n\n Mitotic Phase (M phase) -takes about 30-60 minutes<\/p>\n\n\n\n Major points of cell regulation are entry and exit from -S Phase<\/p>\n\n\n\n -G2 checkpoint<\/p>\n\n\n\n -M phase<\/p>\n\n\n\n Restriction Point -During this time, cells pass through a transition phase known as a restriction point<\/p>\n\n\n\n -Extracellular growth factors trigger reentry into G1, and GF are required to send the cells past the restriction point, or the point of no return<\/p>\n\n\n\n G0 Phase (resting phase) -Most cells in the human body reside in G0<\/p>\n\n\n\n -Exceptions to this are those that are (Resting in G0 phase) -granulocytes<\/p>\n\n\n\n -and the epithelium of the GI tract<\/p>\n\n\n\n Cell Cycling Time Cell cycle video and image Check points in the Cell Cycle: Keeping it All Under Control -Variation in duplication or distribution of chromosomes during cell division can alter the genetic information passed on to daughter cells, leading to cellular dysfunction and disease, such as cancer<\/p>\n\n\n\n -These checkpoints monitor for DNA integrity and control progression through mitosis<\/p>\n\n\n\n Progression through the cell cycle is controlled through two proteins:<\/p>\n\n\n\n -Cyclin-CDK complex allows the cell to progress through each phase of the cell cycle<\/p>\n\n\n\n Locations of proteins Cyclins (D, E, A, B) and CDKs -Early S: Cyclin E and CDK 1\/2<\/p>\n\n\n\n -Late S: Cyclin A and CDK 1\/2<\/p>\n\n\n\n -G2: CDK 1\/2 and cyclin A<\/p>\n\n\n\n -Before M: CDK 1 and Cyclin B<\/p>\n\n\n\n Inhibitory proteins -An example of an inhibitory protein is p53 (AKA TP53)<\/p>\n\n\n\n DNA Damage Checkpoints -The retinoblastoma protein (Rb), p53, and p21 are some of the most well-understood inhibitory proteins (IP)<\/p>\n\n\n\n Inhibitory proteins p53 -Will increase when DNA damage is present<\/p>\n\n\n\n -Protects against inappropriate signal proliferation<\/p>\n\n\n\n -sometimes called the “suicide gene”<\/p>\n\n\n\n M Phase Checkpoints If the chromosomes are not properly aligned, division is not allowed to continue<\/p>\n\n\n\n Immunity<\/p>\n\n\n\n Cells of the Immune System<\/p>\n\n\n\n Pluripotent Stem Cell -A stem cell that can differentiate into any cell type except for extraembryotic tissue, does not yet have a function<\/p>\n\n\n\n Myeolid Precursor Cells Lymphoid Precursor Cells Lines of Defense: The Immune System’s Response to Attack 1: Innate Innate Immunity -Does not retain memory of the entity<\/p>\n\n\n\n -Involves the following: Adaptive Immunity -leads to immune system memory<\/p>\n\n\n\n -Humoral immunity<\/p>\n\n\n\n -Cell-mediated immunity<\/p>\n\n\n\n -Regulatory T-cells<\/p>\n\n\n\n Humoral Immunity B-Cell -Can recognize antigens whether they are freely circulating in the blood or attached to surface of a microbe<\/p>\n\n\n\n -When dividing, can become plasma cells which will then begin secreting antibodies that are unique to that antigen<\/p>\n\n\n\n Plasma Cells -Some will go to the BM where they will continue to secrete antibodies sometimes for years<\/p>\n\n\n\n Cell-Mediated Immunity -more effective against antigens within cells<\/p>\n\n\n\n Regulatory T-cells AKA suppressor T-Cells T-Cell -Recognize phagocytized fragments of an antigen that are put on the surface of antigen-presenting cells<\/p>\n\n\n\n Helper T-Cells (CD4+) -Help B Cells to respond<\/p>\n\n\n\n -rapidly divide, in an effort to stay ahead of the antigen dividsion<\/p>\n\n\n\n -some will turn into effector cells, which secrete different kinds of cytokines<\/p>\n\n\n\n -respond similarly to B-Cells<\/p>\n\n\n\n Cytotoxic T-Cells (CD8+) -rapidly divide, become mature cells, and start killing antigens<\/p>\n\n\n\n Cytokines -Tasked with eliminating the antigen<\/p>\n\n\n\n -Multifunctional subsances having proinflammatory, anti-inflammatory, and regulatory functions in the immune system<\/p>\n\n\n\n Cytokines Include.. -Tumor necrosis factors<\/p>\n\n\n\n -Transforming GFs<\/p>\n\n\n\n -Interleukins (IL -1, -2, -3, -4, -6, -8, -10, and -15)<\/p>\n\n\n\n -These cytokines regulate antibody production and the functions of B and T cells as well as interact with antigen-presenting cells and NKCs<\/p>\n\n\n\n Benign Tumors -Do not invade neighboring tissue<\/p>\n\n\n\n -DO not metastasize to distant sites<\/p>\n\n\n\n -the cells well differentiated in that they look like the parent cell<\/p>\n\n\n\n Characteristics of Cancer Cells -Cell structure is different from parent tissue (no as well differentiated)<\/p>\n\n\n\n -Cell division is uncontrolled<\/p>\n\n\n\n -Cells are loosely adherent without contact inhibition<\/p>\n\n\n\n -Cells are able to invade neighboring tissue<\/p>\n\n\n\n -Cells can migrate and metastasize to distant sites<\/p>\n\n\n\n -Can stimulate the development of new blood vessels to supply the tumor (angiogenesis)<\/p>\n\n\n\n Proto-oncogene -large family of genes that code for proteins and enzymes that turn on the cell cyle<\/p>\n\n\n\n Oncogene Examples of oncogoenes<\/p>\n\n\n\n -EGFR inhibitor therapies are known to cause cutaneous reactions<\/p>\n\n\n\n Tumor suppressor genes -in the presence of malignancies, they bind to DNA with intention of repairing or activating apoptosis<\/p>\n\n\n\n -for it to be turned on it must be expressed or “opened” in the DNA helix so that it can be transcribed or copied<\/p>\n\n\n\n p53 -activates apoptosis when the cell is damaged beyond repair or too old to function<\/p>\n\n\n\n -more than 50% of solid tumors, the gene is mutated and unable to perform its normal function<\/p>\n\n\n\n Growth Signals Signal transduction Signal transduction steps<\/p>\n\n\n\n Dimerization<\/p>\n\n\n\n Protein tyrosine kinases phosphorylates -the message is now send via a “bucket bridage”, or passing the message from one molecule to other signaling molecules until the message gets first into the cell nucleus<\/p>\n\n\n\n -where it is transcribed<\/p>\n\n\n\n Pathways mitogen-activating protein kinase (Raf-1\/MAPK) pathway -decrease disease-free survival time in some pts<\/p>\n\n\n\n mammalian target of rapamycin (mTOR) survival pathway -role in angiogenesis<\/p>\n\n\n\n phosphoinositide 3-kinases (PI3K) Neoadjuvant Treatment -examples: chemo, radiation therapy, hormone therapy<\/p>\n\n\n\n Adjuvant therapy -Examples: chemo, radiation therapy, hormone therapy, targeted therapy, or biologic therapy<\/p>\n\n\n\n Dose density -reduction of time between treatments to achieve higher concentration than in a standard treatment plan<\/p>\n\n\n\n Dose intensity -smaller doses of chemotherapy given more frequently<\/p>\n\n\n\n Relative dose intensity (RDI) Oral Chemotherapy Nonadherence Overadherence Factor affecting adherence Lesson 2: Alkylating Agents<\/p>\n\n\n\n Alkylating Agents Alkylating Agent Subgroups -Platinum-based (cisplatin{Planitol}, carboplatin{Paraplatin}): do not possess an alkyl group<\/p>\n\n\n\n -nitrosoureas<\/p>\n\n\n\n Nitrosoureas -able to cross the blood-brain barrier (effective in treating some brain tumors, melanomas, lymphomas)<\/p>\n\n\n\n -Carmustine (BiCNU) -pulmonary monitoring recommended<\/p>\n\n\n\n Carboplatin (Paraplatin) -possibility for a hypersensitivity reaction which is rash, urticaria, erythema, pruritis, rarely bronchospasm and hypotensision<\/p>\n\n\n\n -notify RN if itching, scratchy throat, difficulty breathing, rash<\/p>\n\n\n\n -Blood count, particularly platelets, monitored because thrombocytopenia is a dose-limiting toxicity<\/p>\n\n\n\n -Oral dosage: 1-5mg\/kg\/day<\/p>\n\n\n\n Cisplatin (Planitol) -nephrotoxic (IV hydration 2-3 L per day) -ovarian and testicular<\/p>\n\n\n\n Cyclophosphamide (Cytoxin) -hemorrhagic cystitis (dysuria, hematuria, hemorrhage)<\/p>\n\n\n\n -DC treatment if hemorrhagic cystitis<\/p>\n\n\n\n -adequate hydration<\/p>\n\n\n\n Oxaliplatin -irritant and vesicant, extra caution with the IV site<\/p>\n\n\n\n -peripheral neuropathy is a dose-limiting side effect (exacerbated by cold temperatures)<\/p>\n\n\n\n -avoid cold drinks and foods, wearing gloves and warm shoes<\/p>\n\n\n\n -avoid breathing cold air<\/p>\n\n\n\n Intrathecal Chemotherapy -Often used to treat leukemia and lymphoma that has spread to the CNS since most IV chemo does not cross the blood-brain barrier<\/p>\n\n\n\n -only MTX and cytarabine via this route<\/p>\n\n\n\n -IT hydrocortisone is often given at the same time to reduce inflammation<\/p>\n\n\n\n -MUST be preservative free to avoid CNS irritation<\/p>\n\n\n\n Chemotherapy-Induced N\/V (CINV) Risk factors Types of CINV -Delayed: from 24 hour – 5 days after<\/p>\n\n\n\n -Breakthrough: Occurring despite treatment<\/p>\n\n\n\n -Anticipatory: triggered by taste, odor, memories, visions, anxiety r\/t chemo<\/p>\n\n\n\n -Refractory: occurring despite subsequent cycles when treatment failed in earlier cycles<\/p>\n\n\n\n Prevention\/Treatment of hand foot syndrome -take cool showers<\/p>\n\n\n\n -avoid exposure to sources of heat, such as using saunas or sitting in the sun<\/p>\n\n\n\n -avoid activities that cause unnecessary force or friction on the hands or feet, such as running or aerobics<\/p>\n\n\n\n -avoid contact with harsh chemicals used in detergents and household cleaning products<\/p>\n\n\n\n -avoid activities that require you to press your hand against a hard surface<\/p>\n\n\n\n -elevate your hands and feet when sitting or lying down<\/p>\n\n\n\n -gently apply skin care creams to keep hands moist<\/p>\n\n\n\n -wear loose-fitting, well ventilated shoes<\/p>\n\n\n\n Nadir -typically, but not always, occurs 7-10 days after the cycle is administered<\/p>\n\n\n\n Neutropenia -less than 1000\/mm3 with the expectation that the count will drop below 500 in the next 48 hours<\/p>\n\n\n\n Neutopenia RF -hx of neutropenia with previous chemo<\/p>\n\n\n\n -previous chemo or radiation<\/p>\n\n\n\n -hematologic malignancy, uncontrolled or advanced cancer, or lung cancer<\/p>\n\n\n\n Neutropenic Fever -temp of 38 lasting 1 hour<\/p>\n\n\n\n Absolute Neutrophil Count<\/p>\n\n\n\n Mucositis -affects 40-100% of pts<\/p>\n\n\n\n Stomatitis Xerostomia Hypersensitivity Reaction (HSR) IgE-mediated T-Cell–Mediated Type 1 HSR early S\/SX Type IV HSR Lesson 7: Cumulative Dose<\/p>\n\n\n\n Cumulative dose Cumulative lifetime dose -total amount of specific antineoplastic agents that can be safely given over the course of a pt’s lifetime<\/p>\n\n\n\n Extravasation Irritant Vesicants Vesicants in PIVs -Do NOT place the IV below a recent ventipuncture site used (<24 hours)<\/p>\n\n\n\n -Use a flexible IV catheter<\/p>\n\n\n\n When a vesicant extravasation occurs or is suspected, take the following steps:<\/p>\n\n\n\n Managing Non-DNA Binding Vesicant Extravasation -Do not bind to DNA in healthy cells when they extravasate into tissue. Indirect effect on healthy tissue<\/p>\n\n\n\n -Treat with heat, elevation, and hyaluronidase local injection (spreads the vesicant through the tissue for faster metabolism of the vesicant agent)<\/p>\n\n\n\n -Usually results in less tissue damage<\/p>\n\n\n\n -Improves over a short period of time (days to weeks(<\/p>\n\n\n\n Management of DNA-Binding Vesicant Extravasation -Binds to DNA in healthy cells when they extravasate into tissue<\/p>\n\n\n\n -When not immediately treated with dexrazoxane, the vesicant remains in the tissue and invades adjacent healthy tissue<\/p>\n\n\n\n -Likely to result in more tissue damage<\/p>\n\n\n\n -Left untreated, extravasations become larger and deeper, worsening over time (weeks to months)<\/p>\n\n\n\n Lesson 11: Targeted Therapy<\/p>\n\n\n\n How targeted therapy and chemo differ -chemo has more SEs<\/p>\n\n\n\n -targeted therapy ae chosen and designed to interact with their target on or within the cells, whereas chemo were IDed becaused they kill cells<\/p>\n\n\n\n -targeted therapies are often cytostatic (they block tumor cell proliferation) whereas chemo agents are cytotoxic (kill tumor cells)<\/p>\n\n\n\n Goals of targeted therapy -improving overall response or increase disease-free survival when used in combination with conventional therapies<\/p>\n\n\n\n -controlling or stabilizing disease<\/p>\n\n\n\n -maintaining or enhancing quality of life<\/p>\n\n\n\n -decreasing the severity of toxicities from other therapies<\/p>\n\n\n\n Receptor Monomer Ligand Ligand Binding Dimerization Kinase phosphorylation targeted therapies work by doing the following<\/p>\n\n\n\n BCR\/ABL -gene abnormality called the Philadelphia chromosome seen in CML and ALL<\/p>\n\n\n\n VEGF mTOR -a protein that tells cells when to grow, divide, and survive<\/p>\n\n\n\n Two ways that angiogenesis inhibitors work<\/p>\n\n\n\n Small Molecule Compound Targeted Therapies -targets located inside the cell because these gents are able to enter cells more easily<\/p>\n\n\n\n -intracellular<\/p>\n\n\n\n -most given orally<\/p>\n\n\n\n Monoclonal Antibody Targeted Therapy<\/p>\n\n\n\n -relatively large in size and therefore usually cannot enter cells<\/p>\n\n\n\n -extracellular or transmembrane<\/p>\n\n\n\n -man made version of antibodies that are designed to attack a very specific target on cancer cells<\/p>\n\n\n\n -usually from mice<\/p>\n\n\n\n Lesson 12: Immunotherapy<\/p>\n\n\n\n Immunotherapy works by -stopping cancer from spreading to other parts of the body<\/p>\n\n\n\n -helping the immune system recognize cancer cells and increase its effectiveness at eliminating cancer cells<\/p>\n\n\n\n Passive Immunotherapy -require repeated administration to be effective<\/p>\n\n\n\n -includes monoclonal antibodies and cytokines<\/p>\n\n\n\n Active Immunotherapy -mount an immune response against the tumor and hopefully remember the cancer cells long after treatment has stopped<\/p>\n\n\n\n -includes cancer vaccines<\/p>\n\n\n\n Specific Immunotherapy -examples are mAbs and cancer vaccines<\/p>\n\n\n\n Nonspecific Immunotherapy -given adjuvantly to other anticancer treatment drugs<\/p>\n\n\n\n -examples are cytokines, interleukins, and checkpoint inhibitors<\/p>\n\n\n\n Lesson 13: Safe Handling<\/p>\n\n\n\n Hierarchy of Hazard Controls aimed at reducing worker exposure<\/p>\n\n\n\n -substitute a less toxic substance for the hazardous material<\/p>\n\n\n\n -not feasible with drug therapy<\/p>\n\n\n\n -use of machines or equipment that isolate or contain the hazard to reduce worker exposure<\/p>\n\n\n\n -Examples: biosafety cabinets and closed-system drug-transfer devices<\/p>\n\n\n\n -safe handling policies<\/p>\n\n\n\n -procedures<\/p>\n\n\n\n -work practices<\/p>\n\n\n\n -education and training of those responsible for HD handling<\/p>\n\n\n\n -consisting of garments that provide barriers to protect workers from HDs<\/p>\n\n\n\n -places the primary responsibility for protection on the worker<\/p>\n\n\n\n Donning PPE<\/p>\n\n\n\n Doffing PPE<\/p>\n\n\n\n 5.remove inner gloves<\/p>\n\n\n\n True statements related to drug dose calculation and administration -Pts who have had previous radiation therapy or chemo are considered special populations with regard to a potential need for dose modification<\/p>\n\n\n\n -The AUC calculation is used for carboplatin dosing<\/p>\n\n\n\n -Children may metabolize drugs differently than adults; dose modifications are possible<\/p>\n\n\n\n What is a monoclonal antibody, and how is it different from chemo? -mAbs search out proteins on the cells surface<\/p>\n\n\n\n -mAbs recognize and bind to specific anatigens on the cells surface<\/p>\n\n\n\n -natural killer cells and\/or cytotoxic proteins of the immune system recognize and destroy the marked tumor cells<\/p>\n\n\n\n -mAbs can also directly induce cell death as well<\/p>\n\n\n\n -One of the biggest differences is that mAbs cause harm only to those cells that are marked or binded<\/p>\n\n\n\n –<\/p>\n\n\n\n Should I avoid my grandchildren and other family members when I am getting treatment? -Hugging, kissing, and spending time together while eating are all safe activities<\/p>\n\n\n\n -Safety with bodily fluids is necessary for the first 48 hours after receiving chemo<\/p>\n\n\n\n Can I be intimate with my partner during treatment? -traces of chemo may be present in vaginal fluid for up to 48 hours after treatment<\/p>\n\n\n\n -use of a barrier is recommended for this reason for at least the first 48 hours<\/p>\n","protected":false},"excerpt":{"rendered":" name the 4 phases of the cell cycleG1 PhaseS PhaseG2 PhaseM Phase name the 4 stages of mitosisProphaseMetaphaseAnaphaseTelophase Which is the longest phase of the cell cycle, lasting about 10 hoursS Phase What is the shortest phase of the cell cycleM Phase (Mitosis) these cells have receptors that determine if cells of cells they encounter […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[],"tags":[],"class_list":["post-109660","post","type-post","status-publish","format-standard","hentry"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/109660","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=109660"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/109660\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=109660"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=109660"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=109660"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Myeloid<\/p>\n\n\n\n
Lymphoid<\/p>\n\n\n\n
G2 phase<\/p>\n\n\n\n
G2 phase<\/p>\n\n\n\n
neutrophils, eosinophils, basophils<\/p>\n\n\n\n
Phagocytes<\/p>\n\n\n\n
phagocytosis and inflammation (2nd line of defense)<\/p>\n\n\n\n
3rd line of defense which includes antibodies and lymphocytes<\/p>\n\n\n\n
T cells and B cells<\/p>\n\n\n\n
p53 gene<\/p>\n\n\n\n
nccn.org
cancer.org<\/p>\n\n\n\n
g1- increase in size
s- dna replicated
g2- cell enlarge and ready to divide
m phase- 2 hours<\/p>\n\n\n\n
4 stages, prophase, metaphase, anaphase, telophase
-chemo targets certain points in the process<\/p>\n\n\n\n
programmed cell death<\/p>\n\n\n\n
formation of blood cells & how cells differentiate
-myeloid: pre cells mature into RBCs, platelets and WBCs
-lymphoid: pre cells- mature into WBCS<\/p>\n\n\n\n
-defense against foreign organisms, homeostasis (destroy aged cells), surveillance<\/p>\n\n\n\n
innate: primary line of defense, non specific, no memory
adaptive: secondary line of defence with specific memry<\/p>\n\n\n\n
-effect growth and differentiation of WBC
-interferons, tumor necrosis factors, growth factos and interleukins
-small protein molecules released by cells throughout body providing comunication between cells of the immune system
-regular antiboddy production and function of b cells<\/p>\n\n\n\n
-hep B prevents hepatitis and hepatocellular carcinoma
-hpv vaccine<\/p>\n\n\n\n
SC or IV to derease infection in patients with neutropenic fever associated with myelosuppressive anticancer treatments for nonmyeloid malignancies<\/p>\n\n\n\n
reduce duration of neutroenia in patients with non myeloid malignancies<\/p>\n\n\n\n
IV to dec incidence of oral mucositis in patients with hem malignanies before BMT<\/p>\n\n\n\n
aka leukine – patients with AML following chemo to shorten neutrophil recovery and reduce incidence of infection<\/p>\n\n\n\n
reduce frequency and severity o infections related to granulomatous disease<\/p>\n\n\n\n
treat renal cell carcinoma and metastatic melanoma<\/p>\n\n\n\n
prevent severe thrombocytopenia and refuce need for platelet transfusions in patients with nonmyeloid malig<\/p>\n\n\n\n
with filgrastim to mobilize hematopoeitc stem cells for collection from peripheral blood of patients<\/p>\n\n\n\n
castrate resistant prostate cancer<\/p>\n\n\n\n
rituxan- treatment of relapsed or refractory low grade follicular b cell NHL_ first line traetment in combo with chemo in patients with response
-can treat severe rheumatoid arthritis
-can have severe reactions (hypotension, urticaria, angiodema, hypoxia, rigors, dyspnea, chills, fever, nausea, rash, renal tox)
-premed with tylenol and benadryl
-slow infusion to resolve some side effects, side effects reduce with each infusion<\/p>\n\n\n\n
1st line: skin , ucous membrane, gut flora
second line: phagocytes:
3rd line antibodies, t and b cells<\/p>\n\n\n\n
cell strcuture different from parent tissue, cell division uncontrolled, loosely adherent, invade neighboring tissue, establish blood vessels<\/p>\n\n\n\n
cure: prolonged absence of disease
control: no further growth
and palliation : comfort<\/p>\n\n\n\n
therapy in the first step to shrink a tumor before the main treatment) surgery is given
-chemo, radiation, hormone therapy<\/p>\n\n\n\n
therapy given afer primary treatment to lower risk of cancer coming back
-chemo, radiation, hormone, targeted and biologic therapy<\/p>\n\n\n\n
obliteration of bone marrow with chemo in prep for blood stem cell or bone marrow trasnplant to destroy blood forming cells in the marrow and reduce tumor burden – destroy immune system so it cannot attack donated cells after transplant<\/p>\n\n\n\n
not as intense, chemo doses are not as intense<\/p>\n\n\n\n
-cytoxan
-ifosframide
-bendamustine<\/p>\n\n\n\n
consideration on age, kidney function, and concurrent use of radiation. both can cause nausea, vomiting, hearting loss, kidney function damage, electrlyte disturb. CBC chem panel and mag checked
-cisplatin: admin over longer period of time. nausea can last over a week<\/p>\n\n\n\n
hair loss 10-14 days post treatment
-can be given peripherally
-hemmorhagic cystitis – hydration is key, high dose may need bladder protection
-easier to give than iphosphamide<\/p>\n\n\n\n
neuro changes can occur- personality changes can occur, neuro checks before
central line only
-need a bladder protective agent 100% of the time<\/p>\n\n\n\n
cross blood brain barrier – can treat brain tumors. alkylating agents
-pulmonary monitoring<\/p>\n\n\n\n
-azacitidine
-capacitabine
-fluorouracil
-cytarabine
-decitabine
-methotrexate<\/p>\n\n\n\n
-IV oral topic and opthalmic formalation
-can cause hyperpigmentation, increased mucositis, photosensitivity, diarrhea
-capcytobine is the oral form – needs to be taken 2x day, hand foot syndrome can occur
-INR monitoring<\/p>\n\n\n\n
antimetabolite, cell cycle specific to S phase
-cleared in kidneys – effects: hepatotox, renal tox, mucositis, nausea, myelosuppression, pneumonitis, photosensitivity, neurotoxicity, infertility
-yellow in color. renal function, hydrate 2-3L\/ day, no alcohol use, sun exposrue, folic acid, avoid effusions<\/p>\n\n\n\n
for treatment of myelodysplastic syndrome: group of cancers in which immature blood cells do not mature (SOB and fatigue are markers)<\/p>\n\n\n\n
intrathecal chemo- injects chemo directly into the subarachnoid space so it reaches the CNA
-leukemia and lymphoma spreading to CNS since most chemo does not cross blood brain barrier<\/p>\n\n\n\n
ONLY methotrexate and cytarabine can be given IT
-IT hydrocorisone given at same time to reduce inflammation<\/p>\n\n\n\n
dilute in 20mL minibag and infuse over short time- IVP not reommended
vinblastine -dilute in 25-50 ns<\/p>\n\n\n\n
-anthracyclines: interfere with enzymes for DNA to replicate, work phases of the cell cycle
lifetime dose limites because they are cardiotoxic
-daunorubicin, doxorubicin, epirubicin, idarubicin<\/p>\n\n\n\n
vesicant
extravasation possible- must eval cardiac funciton, ongoing cardiac monitoring, hypersensitivity risk<\/p>\n\n\n\n
GI: nausea vomiting diarrhea, inspect mucosa
neuro: numbness\/ tingling, burning
GU: change in color of urine<\/p>\n\n\n\n
cardiac protectant given before<\/p>\n\n\n\n
antitumor antibiotic – lifetime dose warning
-can cause hypersensitivity, skin reaction
-report SOB< skin issues, protect from sun<\/p>\n\n\n\n
chemo induced nausea and vomiting
-lead to dehydration, dec functional status, increased costs and withdrawal from treatment
-70% patient will experience.
RISK Factors: younger, history of low alcohol consumption, female, morning\/ motion sickness<\/p>\n\n\n\n
chemo infuced nausea vomiting- vomiting center is central area responsible for CINV
-patient are at risk for 2-3 days after last dose of cheom<\/p>\n\n\n\n
serotonin antagonists
-dolasetron, granisetron, ondansetron, palonosetron<\/p>\n\n\n\n
5FU and capecitabine has been noted to cause the worst skin resactions
-hand foot syndrome
-palmar plantar erythrodysesthesia – painful- flaking swelling blisters and sores
avoid hot water, impacton feet and rubbing<\/p>\n\n\n\n
suppression of bone marroe, red blood and platelets
NADIR: point at which blood cell counts are at the lowest after treatemtn. usually 7-1 days after cyce
neutrophils heavily affected
platelets follow
erythrocyte loss appears later<\/p>\n\n\n\n
ANC reliable method to dtermine risk – 4,500-10,000 is normal WBC. ANC <1000 risk of infeciton<\/p>\n\n\n\n
know when to expect the nadir
7-10 days after treatment. up to 6 weeks with some treatment
-ANC: reliable method to determine infcetion risk<\/p>\n\n\n\n
fever >100.4 sign of infection<\/p>\n\n\n\n
diarrhea, constipation induced by chemo is common – can cause fecal impaction<\/p>\n\n\n\n
stomatitis- inflam of mouth
xerostomia- dryness of the mouth<\/p>\n\n\n\n
hypersensitivity- uniphasic- immediate
biphasic- 1-72 hours later<\/p>\n\n\n\n
pruritus, restless, agitation, impending doom, fever, flushing, chills, urticaria, edema, rash, nausea, dyspnea, wheeze, hypotension, beonchospasm<\/p>\n\n\n\n
cell mediated, delated. pneumonitis, mucositis, granuloma, GVH<\/p>\n\n\n\n
cumulative dosing can result in neurotox and nephrotox, alkylating, myelotox, hepatotox, cardio tox, pulmonary and GI tox<\/p>\n\n\n\n
leak of antineoplastic meds from the vessel in which it is being administered into the surrounding tissue – non DNA binding remain in local area, DNA binding lead to tissue destruction
-cytotoxic drugs are classified as irritants and vesicant – irritants cause inflammation, burning or pain . vesicants can cause local blisters and xtensive damage to the tissues<\/p>\n\n\n\n
CHECK for blood return: 3ML of blood in 3 seconds. larger syringe diameter exerts less pressure on walls of catheter<\/p>\n\n\n\n
determine dration of treatment- for peripheral access, small gauge plastic cannula is more suitable. alternative IV site from one arm to the other to preserve the veins
-CVADs<\/p>\n\n\n\n\n
low pH, blood return may be present<\/p>\n\n\n\n
-etoposide, docetaxel, paclitaxel, vinblastine, vinorelbine<\/p>\n\n\n\n
topotecan and etoposside- irritants
-vinorelbine and irinotecan: irritants with vesicant properites: discoloration of sin, rash, phlebitis, urticaria, blistering, skin sloughing<\/p>\n\n\n\n
treatment that uses substances made from living organisms to treat disease – stim or suppress the immune system to help fight cancer, infection and diseases. some attack specific cancer cells which keep them from growing<\/p>\n\n\n\n
receptor: molecule in surgace that binds to a specific substance causing effect in that ell
-monomer- molecule that can join with others to form a larger structure called a polymer
-ligand: forms a complex with another to exert a biological effect
-ligand binding: attaches to receptor site and activates that receptor
-dimerization: signals
-kinase: adds chemicals to other molecules, causing other molecules to becomes active or inactive
-phosphorylation: activation of a chemical process to initiate signaling
-signaling pathways: group of molecules that work together to control a cell function<\/p>\n\n\n\n
extracellular: target receptors on the outside of the cell
-intracellular: target and interfere with processes inside the cell<\/p>\n\n\n\n
located in the cell because these agents enter more easily
-get into the cell, interfere with the internal components and disrupt the function, causing cell death<\/p>\n\n\n\n
-erlotinib, sunitinib, ponatinib, imatinib, dasatinib, ibrutinib<\/p>\n\n\n\n
trigger immune system to destroy cancer cells- make cell visible for immune system to destroy
-others help boost the immune systems ability to fight cancer.
include: monoclonal, immune checkpoint inhibitors, cancer vaccines, non specific immunotherapies, adoptive cell therapy, oncolytic virus therapy<\/p>\n\n\n\n
man made versions of immune system proteins, used to treat cancer because they are designed to attack a part of a cancer cell<\/p>\n\n\n\n
use proteins taht normally help regulare immune system to enhance the bodies immune response
-cytokines: interleukins
-interferons<\/p>\n\n\n\n
help immune system fight diseases such as cancer and infections<\/p>\n\n\n\n
carcinogens- a lot of cancer treatment drugs<\/p>\n\n\n\n
routes of absorption- dermal, mucous membranes, inadvertent ingestions, inhalation, injection<\/p>\n\n\n\n
anticipating, recognizing, evaluating and controlling workplace conditions that may cause injury or illness
-industrial hygiene uses the principle of hierarchy of controls when determining how to control a workplace hazard<\/p>\n\n\n\n
always remove first set of gloves before touching pump
-connect secondary tubing to allow for flushing of tubing
-place pad under work area, gauze around syringe connections for IVP, pad nder work area when attaching needles for SQ<\/p>\n\n\n\n
-excreted in urine, breast milk, stool vomit, sweat, semen and vaginal secretions, saliva, other bodily fluids for 48 hrs (some drugs up to 5 days)<\/p>\n\n\n\n
chemo spill kit- sign warning others, use PPE, chemo gown, respirator\/ goggles, double glove- use absorbant pads and out in spill bag, use neutralizing solution and wipe, then wipe with water, remove PPE
-place bag in chemo waste contrainer<\/p>\n\n\n\n
nurses responsibility: is vascular access device intended for appropriate use? will they adhere? is the plan appropriate? additional referrals? is drug vesicant? is tracking in place for lifetime dose limit?<\/p>\n\n\n\n
routes: oral- convenient, decreased time in hospital, expensive, and difficulty with adherence, inconsistent adborption- food drug interactions
nursing: verify dose, PPE, no crushing (pharmacist must do so if NG)<\/p>\n\n\n\n
-vesicant chemo admin: remain with patient through entire infusion if giving through PIV, limit to IV push or short infusion less than 30-60, no PIV for continuous. verify blood return every 2-5 mL for IVP, 5-10 min during short infusion<\/p>\n\n\n\n
swelling, loss of blood return, report of pain or burning. discontinue at first sign<\/p>\n\n\n\n
patient education – explain diagnosis and treatment, empower participation, identify sympt to report, promote coping skills<\/p>\n\n\n\n
*verbal and phone chemo not allowed<\/p>\n\n\n\n\n
-need 2 nurses to verify dose calc
-ONS chemo safety standards requries reference to method of dose calc<\/li>\n<\/ul>\n\n\n\n
-lack of method followed consistently, lab values, wrong prep methods, wrong sequence\/ dose or route, schedule or timing, omissions, wrong rate or IV pump misprogram, wrong patient<\/p>\n\n\n\n
PIV, midline, PICC, nontunneled central catheter, tunneled central catheter, implanted port, temp apheresis or hemodialysis, tunneled apheresis<\/p>\n\n\n\n
no IV pump with PIV< stay with patient, less than 30-60 min infusions, blood return every 205 mL for IVP, 5-10 for short infusions<\/p>\n\n\n\n
Biosimilars: group of medicine products developed to mimic other drugs used for different indications
-biological product: vaccines, monoclonal antibodies, gene therapies, cellular therapies, blood and blood product<\/p>\n\n\n\n
biologic product is biosimilar to reference prod and can be expected to produce the same clinical results<\/p>\n\n\n\n
know if it is being used – confer with pharmacist to determine if available
-build safety profile
-know interchangeable policy<\/p>\n\n\n\n
nurse is the last safeguard between appropriate accurate and safe dosing.
legal issues: med erros, unintended cytotoxic drug exposure, poor handling, spill, inadvertent exposure to the patient<\/p>\n\n\n\n
patient history, diagnosis, MH\/PSH, allergies, med review, symptoms, distress (need for social workers, counselors, religion), pain, fatigue
-height, weight, labs, diagnostic test (cardiac EF, etc), cancer during pregnancy, practices that promote safety, treatment plan, confirm order: 2 patient ID< date of admin, diagnosis, regimen, duration of treatmnet, cycle, criteria, allergies, dose calc, drug dose, route\/ rate, length of infusion, supportive care<\/p>\n\n\n\n
PPE double check 2 patient IDs, drug name, dose, volume, rate, route, cycle, two signatures, rate setting, consent
-proper route, monitor patient immediate comp, document drug, patient ed and follow up<\/p>\n\n\n\n
end of life, right to refuse or refuse consent, whether its truly infromed, conflicts, treatment of plan, patient advocacy challenge, confidentiality, scientific integrity, standards of practice, boundaries, issues related to investigational research<\/p>\n\n\n\n
-patient education and care coordination
-treatment planning
-preparation and administration<\/p>\n\n\n\n
-enables active participation, provides explanation of disease and treatment, enables verbalization of understanding of treatment goals, improves quality of life, decrease costs, increase satisfaction
-education: name, rationale, side effects, meds to treat side effects, how to contact physician, testing – DOCUMENT<\/p>\n\n\n\n
can cause serious reaction usually in first dose- monitor closely for issues: report SOB, feeling of throat closing, chest pain, itching, watching heart, blood pressure, confusion\/ agitation<\/p>\n\n\n\n
can cause hemmorhagic cystitis- irritation and inflammation of bladder that can lead to bleeding. watching for blood in urine, drink extra fluids, pee a lot and pee before bed<\/p>\n\n\n\n
chemo that can damage the heart with a lot of it- monitor cumulative dose- in a lifetime. limit to this amount. MUGA scan to eval heart. before recieving drug. vesicant- irritating and damage skin and tissues id leaks, watch IV and skin close<\/p>\n\n\n\n
cause constipation and neuropathy- notify.<\/p>\n\n\n\n
steroid to reduce inflammation and lower immune response. used as part of many different chemo regimens. side effects that can cause high blood sugar, increased agitation or irritability, insomnia<\/p>\n\n\n\n
multiple drugs because cancer cells grow by going through cell cycle and dividing into more cells- different drugs work in different stages – this helps decrease possibility of drug resistance when cancer becomes smart and is less effected by meds<\/p>\n\n\n\n
-this is why chemo has effects on normal cells like hair follicles, oral,GI mucosa, blood cells etc<\/p>\n\n\n\n
-social history could be barrier – risk of distress if no support , cats in home risk with handling is neutropenic
-history of asthma could be concerning
-use NCCN guidelines, research studies, protocols and chemoregimen to evaluate drug, dose and schedule<\/p>\n\n\n\n
-The cell cycle refers to the ordered seres of processes of DNA replication and mitosis, or cell division<\/p>\n\n\n\n
Cell division produces two identical cells through these two major phases<\/p>\n\n\n\n
Cell grows and DNA is replicated through the following three steps:<\/p>\n\n\n\n
-cells increase in size<\/p>\n\n\n\n
-DNA replicates<\/p>\n\n\n\n
-Replicated chromosomes are aligned, separated, and move into 2 new, identical daughter cells<\/p>\n\n\n\n
-G1 checkpoint<\/p>\n\n\n\n
-The transition from the resting phase into an actively dividing phase (G0-G1) is a point where cellular transformation can occur<\/p>\n\n\n\n
-After mitosis, cells may enter back into the G1 phase or go into a resting phase, known as G0<\/p>\n\n\n\n
-Exceptions to this are those that are metabollically active, such as<\/p>\n\n\n\n
Amount of time from mitosis to mitosis<\/p>\n\n\n\n
http:\/\/highered.mheducation.com\/sites\/0072495855\/student_view0\/chapter2\/animation__how_the_cell_cycle_works.html<\/p>\n\n\n\n
-The cell cycle is carefully controlled through a series of checkpoints<\/p>\n\n\n\n\n
-(G0-G1) : Cyclin D and CDK 4\/6<\/p>\n\n\n\n
-prevent progression of the cycle when DNA damage is detected<\/p>\n\n\n\n
-If DNA damage is present, cells are programmed to stop dividing or undergo apoptosis (programmed cell death)<\/p>\n\n\n\n
-Levels of this IP regulate several important target genes<\/p>\n\n\n\n
When the cells prepare to divide, the chromosomes line up in the mitotic spindle.<\/p>\n\n\n\n
-The cells of the immune system are created in the bome marrow from what is know as a _<\/em><\/p>\n\n\n\n
Mature into:
-RBCS
-Plts
-WBCs (Granulocytes)<\/p>\n\n\n\n
Mature into:
-Specialized WBCs called lymphocytes (Agranulocytes)<\/p>\n\n\n\n
Consists of 2 types of immunity:<\/p>\n\n\n\n
2: Adaptive<\/p>\n\n\n\n
-First line of defense against a pathogen<\/p>\n\n\n\n
(skin, mucous membranes, and normal flora of the skin and gut)
(Cellular components such as phagocytes, natural killer cells, granulocytes, and macrophages)<\/p>\n\n\n\n\n
1.Cells that engulf and destroy invader<\/li>\n\n\n\n
Eosinophils – parasites
Basophils – release histamine to stimulate immune response)<\/li>\n\n\n\n
-Stimulated if innate immunity is insufficient<\/p>\n\n\n\n
-B-Cells
-Memory B-Cells
-Plasma act to produce immunoglobulins (Igs) or antibodies<\/p>\n\n\n\n
-each one is programmed to make one specific antibody<\/p>\n\n\n\n
-some plasma cells will undergo apoptosis<\/p>\n\n\n\n
Depends upon cytotoxic T cells and helper T cells and their cyokinds<\/p>\n\n\n\n
regulate the immune response to prevent autoimmune reactions and limit inflammatory responses<\/p>\n\n\n\n
-Can only recognize antigens when they are presented to them by “presenting cells”<\/p>\n\n\n\n
-help other T-Cells by secreting chemicals<\/p>\n\n\n\n
-Directly kill cells for which they are activated to kill<\/p>\n\n\n\n
-Secreted by lymphocytes<\/p>\n\n\n\n
-Interferons (IFNs)<\/p>\n\n\n\n
-encapsulated and grow in an orderly manner with smooth edges<\/p>\n\n\n\n
-Malignant tumors are not encapsulated<\/p>\n\n\n\n
-regulate normal cell growth and division<\/p>\n\n\n\n
when mistakes in copies of DNA can occur, if a mutation occurs next to a proto-oncogene, it can “turn on” and become a __<\/strong><\/p>\n\n\n\n\n
\n
-act like brakes in a car, slowing down or stopping cell growth and division<\/p>\n\n\n\n
-“sucidie gene”<\/p>\n\n\n\n
-cancer cells are able to find their own growth signals making them self-sufficient<\/p>\n\n\n\n
-the communication or passage of a message telling the cell to do a biologic process, such as make a protein, divide, or make new blood vessels<\/p>\n\n\n\n\n
\n
-turned on by giving up a phosphate molecule<\/p>\n\n\n\n
many pathways and crossalks signaling btw and among the different pathways, and they all have the power to control cell behavior in one way or another<\/p>\n\n\n\n
-shown to decrease the benefits of some cancer drugs<\/p>\n\n\n\n
-play a role in resistance to some chemotherapy agents in certain pts by keeping cells that have been exposed to chemotherapy from undergoing apoptosis<\/p>\n\n\n\n
-transduction enzymes that activate Akt, leading to cell survival, increased cell proliferation, and growith<\/p>\n\n\n\n
-treatment given as a first step to shrink a tumor before the main treatment, usually surgery<\/p>\n\n\n\n
-additonal cancer treatment given after the primary treatment to lower the risk that the cancer can recur<\/p>\n\n\n\n
-refers to the drug dose per unit of time<\/p>\n\n\n\n
-amount of drug delivered over time<\/p>\n\n\n\n
-calculated by comparing the dose that the pt received to the planned dose of the standard regimen<\/p>\n\n\n\n
-greater challenge to adherence because the responsibility falls on the pt and caregiver<\/p>\n\n\n\n
-pt takes too few or too many pills<\/p>\n\n\n\n
-when a pt believes a dose was missed or that “more is better”, too much medication may be taken, leading to increased toxicity<\/p>\n\n\n\n
-provider relationship
-side effects
-necessity
-routinization
-support
-lifestyle fit
-cost
-medication knowledge
-pill burden
-regiment complexity<\/p>\n\n\n\n
-function by causing a break in the DNA helix strand, causing interference with DNA replication, which results in cell death<\/p>\n\n\n\n
-Nitrogen mustards (cyclophosphamide{Cytoxin}, ifosfamide{Ifex}, bendamustine{Treanda})<\/p>\n\n\n\n
-subgroup of alkylating agents<\/p>\n\n\n\n
-Lomustine (CeeNu)
-Streptozocin (Zanosar)<\/p>\n\n\n\n
-Alkylazing agent<\/p>\n\n\n\n
-Alkylating agent<\/p>\n\n\n\n
-severe N\/V<\/p>\n\n\n\n
-Alkylating agent)<\/p>\n\n\n\n
-Alkylating agent<\/p>\n\n\n\n
-injects chemo directly into the subarachnoid space so it reaches the CNS<\/p>\n\n\n\n
-younger
-have a hx of low or no alcohol consumption
-are female
-hx of morning sickness
-prone to motion sickness
-have had chemo previously<\/p>\n\n\n\n
-Acute: occurring within 24 hours<\/p>\n\n\n\n
-limit exposure of hands and feet to hot water<\/p>\n\n\n\n
-point at which blood cell counts are at their lowest following treatment<\/p>\n\n\n\n
-ANC of less than 500\/mm3 or<\/p>\n\n\n\n
-older than 65<\/p>\n\n\n\n
-temp of 38.3 or greater one time<\/p>\n\n\n\n\n
-inflammation of the mucous membrane lining the digestive tract from mouth to anus<\/p>\n\n\n\n
-specifically inflammatory conditions of the mouth<\/p>\n\n\n\n
-dryness of the mouth caused by damage to or dysfunction of the salivary glands<\/p>\n\n\n\n
-body mounts an immunologic response to a foreign substance or antigen, resulting in local tissue injury<\/p>\n\n\n\n
-immediate (within 5 minute) HSR, present like classic allergic reactions<\/p>\n\n\n\n
-Delayed hypersensitivity reactions, can occur any time after the immediate hypersensitivity window, even days or weeks<\/p>\n\n\n\n
-pruritus
-restlessness, agitation, anxiety, feeling of impending doom
-fever, flushing, chills
-urticaria (hives)
-maculopapular rash
-edema of hands, face, and feet
-N\/V
-dyspnea, wheezing, bronchospasm
-hypotension, cyanosis
-circulatory and respiratory collapse<\/p>\n\n\n\n
-pneumonitis
-mucositis
-contact dermatitis
-granulomas
-Graph vs host disease<\/p>\n\n\n\n
total amount of one antineoplastic agent given to the pt, adding up each time that the pt has received it<\/p>\n\n\n\n
-“cumulative dose should not exceed\u2026”<\/p>\n\n\n\n
-leak of a drug capable of causing tissue damage from the vessel in which it is being administered into the surround tissue<\/p>\n\n\n\n
-causes inflammation, pain, and burning but rarely causes tissue necrosis<\/p>\n\n\n\n
-causes blistering and significant pain and tissue damage and destruction, leading to tissue death<\/p>\n\n\n\n
-Do not use IV in hand, wrist, AC areas<\/p>\n\n\n\n\n
-Vinca Alkaloids (vincristine, vinblastine)<\/p>\n\n\n\n
–Anthracyclines (doxorubicin, epirubicin, daunorubicin, idarubicin)<\/p>\n\n\n\n
-targeted therapies act on specific molecular targets on or within the cells that are associated with cancer, whereas standard chemo act on all rapidly dividing cells<\/p>\n\n\n\n
-disease cure when used as primary or adjuvant therapy<\/p>\n\n\n\n
-molecule inside or on the surface of a cell that binds to a specific substance causes a specific effect in that cell<\/p>\n\n\n\n
molecule that can join with other identical monomers to form a structure called a polymer<\/p>\n\n\n\n
a substance that forms a complex with another biomolecule to exert a biologic effect<\/p>\n\n\n\n
process by which the ligand attaches to a specific receptor site and activates that receptor, activating the signaling pathway<\/p>\n\n\n\n
two monomers that are side-by-side on the surface of the cell are paired and activated by a ligand, which causes a series of signals<\/p>\n\n\n\n
type of enzyme that adds chemicals called phosphates to other molecules such as sugars or proteins causing other molecules in the cell to become either active or inactive<\/p>\n\n\n\n
activation of a chemical process to initiate signaling<\/p>\n\n\n\n\n
-fusion protein tyrosine kinase formed with a gene translocation occurs between gene 9 and 22<\/p>\n\n\n\n
this is the primary angiogenic factor produced by cells<\/p>\n\n\n\n
-target of rapamycin<\/p>\n\n\n\n\n
-end in -ib<\/p>\n\n\n\n\n
-stopping or slowing the growth of cancer cells<\/p>\n\n\n\n
-initate an antitumor effect but do not result in any immunologic memory<\/p>\n\n\n\n
-capitalize on the immune system’s ability to remember a foreign invade<\/p>\n\n\n\n
-capitalize on tumor markers to specifically target and kill cancer cells<\/p>\n\n\n\n
-do no target cancer cells alone but rather stimulate a large immune response<\/p>\n\n\n\n\n
-highest level of protection from a hazardous exposure<\/li>\n<\/ol>\n\n\n\n\n
-second highest level of protection<\/li>\n<\/ol>\n\n\n\n\n
-third level of protection<\/li>\n<\/ol>\n\n\n\n\n
-lowest form of protection<\/li>\n<\/ol>\n\n\n\n\n
\n
\n
-the AUC calculation incorporates renal function as part of the equation<\/p>\n\n\n\n
-mAbs are agents that are derived from human or mouse antibodies or a combination of the two<\/p>\n\n\n\n
-it is perfectly safe for you to have contact with your loved ones while getting treatment<\/p>\n\n\n\n
-you should definiely check with your HCP first to be sure<\/p>\n\n\n\n