ONS Chemotherapy Immunotherapy Certificate Questions With Correct Answers

ONS Chemotherapy Immunotherapy Certificate 3 major phases of cell division: - ANS Interphase Mitotic phase Cytokinesis 3 steps of interphase: - ANS First growth phase (G1) Synthesis phase (S phase) Second growth phase (G2) 4 phases of mitosis: - ANS Prophase Metaphase Anaphase Telophase Innate immunity: - ANS Non-specific response, either: 1. Barrier (skin, mucous membranes, flora of skin/gut) 2. Cellular components (phagocytes, natural killer cells, granulocytes, macrophages) Adaptive immunity: - ANS Follows innate immunity if unsuccessful. Memory immunity, including: 1. Humoral immunity (production of antibodies or immunoglobulins) 2. Cell mediated immunity (dependent upon T cells) 3. Regulatory T -cells (prevent autoimmune reactions and limit inflammatory responses) Define mutations - ANS Variations in the nucleotide sequence of a gene 3 main goals of treatment: - ANS Cure Control Palliation Define neoadjuvant therapy - ANS Treatment is given prior to surgery to shrink the tumor Define adjuvant therapy - ANS Additional cancer treatment given after the primary treatment to lower the risk that the cancer reoccur Define conditioning/preparative therapy - ANS Treatments used to prepare a patient for stem cell transplantation 2 types of conditioning therapies: - ANS Myeloablative Nonmyeloablative Define dose density - ANS Drug dose per unit of time Define dose intensity - ANS Amount of drug delivered over time How is relative dose intensity (RDI) calculated? - ANS By comparing the dose that the patient ACTUALLY received to the planned dose of the standard regimen How do alkylating agents work? - ANS By causing a break in the DNA helix strand, interfering with DNA replication and causing cell death 3 subcategories of alkylating agents: - ANS 1. Nitrogen mustards 2. Platinum-based agents (do not possess an alkyl group but still termed alkylating agents as they work similarly) 3. Nitrosoureas Most common subcategory of alkylating agents: - ANS Nitrogen mustards Common alkylating agents: - ANS Cyclophosphamide (Cytoxan) Ifosfamide (Ifex) Bendamustine (Treanda) Common platinum-based agents: - ANS Cisplatin (Platinol) Carboplatin (Paraplatin) What is unique about nitrosoureas agents? - ANS Able to cross the blood-brain barrier; can be effective in treating some brain tumors Common nitrosoureas agents: - ANS Carmustine (BiCNU) Lomustine (CeeNu) Streptozocin (Zanosar) Hypersensitivity can occur with late doses of: - ANS Carboplatin These agents are typically categorized as highly emetogenic: - ANS 1. Alkylating agents 2. Nitrosoureas Pre-administration labs for alkylating agents and nitrosoureas: - ANS BUN Creatinine CBC w/ diff What is the medication Mesna used for? - ANS Bladder protectant with administration of cyclophosphamide or ifosfamide Instruct pts receiving ________ to avoid exposure to cold air and consuming cold fluids for 3-4 days following treatment - ANS Oxaliplatin How do antimetabolites function? - ANS By blocking DNA and RNA growth by interfering with enzymes needed for normal cell metabolism Antimetabolites work in the ___ phase. - ANS S What types of cells are best affected by antimetabolites? - ANS Cells with high division rates Common side effects of antimetabolites: - ANS Myelosuppression GI toxicities Photosensitivity Hand-foot syndrome Common antimetabolite drugs: - ANS Azacitidine Capecitabine 5-FU Cytarabine Decitabine Methotrexate The institute for Safe Medication Practices recommends what route of administration for vincristine? - ANS IV piggyback via gravity Anthracycline antitumor abx work by: - ANS Interfering with enzymes necessary for DNA to replicate in ALL phases of the cell cycle The two major classifications of antitumor antibiotics are: - ANS Anthracyclines Non-anthracyclines Common anthracycline antitumor abx: - ANS Daunorubicin Doxorubicin Epirubicin Idarubicin The antitumor abx ___________ is not an anthracycline, but has anthracycline-type properties. - ANS Mitoxantrone Common non-anthracycline antitumor abx: - ANS Actinomycin D Mitomycin C Bleomycin Monitoring necessary with doxorubicin: - ANS Vesicant --> extravasation Cardiac function Lifetime dose tracking (cardiotoxicity) Lifetime dose of doxorubicin should not exceed: - ANS 550 mg/m^2 What cardiac protectant medication can be administered prior to doxorubicin? - ANS Dexrazoxane Significant side effects of doxorubicin are: - ANS Cardiotoxicity N/V Mucositis Diarrhea Severe myelosuppression Hepatic impairment Secondary cancers Monitoring necessary with bleomycin: - ANS Pulmonary toxicity Hypersensitivity reactions (esp. in lymphoma patients) Cutaneous reactions Lifetime dose tracking (pulmonary toxicity) Pulmonary fibrosis is possible when the lifetime dose of bleomycin exceeds: - ANS 400 units What 6 patient characteristics make CINV more likely? - ANS 1. Younger than 50 years 2. Hx of low alcohol intake 3. Female gender 4. Hx of morning sickness during pregnancy 5. Prone to motion sickness 6. Previous chemotherapy Types of CINV: - ANS Acute Delayed Breakthrough Anticipatory Refractory Define acute CINV - ANS Occurring within 24 hours of chemotherapy Define delayed CINV - ANS Occurring from 24 hours to 5 days after treatment Define breakthrough CINV - ANS Occurring despite treatment Define anticipatory CINV - ANS Triggered by taste, odor, memories, visions, or anxiety related to chemotherapy Define refractory CINV - ANS Occurring during subsequent cycles when treatment failed in earlier cycles Highly emetogenic chemo (HEC) causes CINV in more than ___% of patients - ANS 90 Moderately emetogenic chemo (MEC) causes CINV in patients ___% to ___% of the time - ANS 30-90 Patients on low-potential emetogenic chemo develop CINV ___% to ___% of the time - ANS 10-30 Minimal-risk emetogenic chemo causes CINV less than ___% of the time - ANS 10 Common IV HEC drugs include: - ANS Carmustine Cisplatin Cyclophosphamide Dacarbazine Mechlorethamine Streptozosin Common IV MEC drugs include: - ANS Carboplatin Cytarabine Daunorubicin Doxorubicin Epirubicin Idarubicin Ifosfamide Irinotecan Oxaliplatin Common low-potential IV emetogenic chemo drugs include: - ANS 5-FU Cytarabine Docetaxel Etoposide Gemcitabine Methotrexate Mitomycin C Mitoxantrone Paclitaxel Pemetrexed Common minimal-risk IV emetogenic chemo drugs include: - ANS Bleomycin Bevacizumab Bortezomib Busulfan Cetuximab Fludarabine Trastuzumab Vinca alkaloids The 2 most important neurotransmitters involved in vomiting are: - ANS 1. Serotonin 2. Substance P Describe the peripheral pathway of CINV - ANS Primarily occurs in the GI tract Associated with acute CINV Neurotransmitter --> serotonin Describe the central pathway of CINV - ANS Primarily occurs in the brain Associated with delayed CINV Neurotransmitter --> Substance P Common serotonin 5-HT3 antagonists used for CINV: - ANS Dolasetron Granisetron Ondansetron Palonosetron Common neurokinin-1 antagonists used for CINV: - ANS Aprepitant Fosaprepitant Common steroids used for CINV: - ANS Dexamethasone 2 types of therapies that commonly have cutaneous reactions: - ANS 1. EGFR inhibitor therapies 2. Antimetabolites Most-common cutaneous reaction seen with 5-FU and Capecitabine: - ANS Palmar-plantar erythrodysesthesia AKA hand-foot syndrome Antimetabolites that commonly cause cutaneous reactions: - ANS 5-FU Capecitabine (Xeloda) Define myelosuppression - ANS Bone marrow activity is decreased, resulting in fewer RBCs, WBCs and platelets If severe: myeloablation The most common dose-limiting toxicity of chemotherapy - ANS Myelosuppression Define nadir, and when does it occur? - ANS The point at which blood cell counts are at their lowest following a treatment cycle. Typically occurs 7-10 days following cycle NCCN defines neutropenia as an ANC < _______/mm^3 - ANS 500 Risk factors for developing neutropenia include: - ANS > 65 years old Hx of neutropenia with previous chemotherapy Hx of chemotherapy or radiation treatment Hematologic malignancy Uncontrolled/advanced cancer Lung cancer Define neutropenic fever - ANS Fever of 101 F or greater one time OR Fever of 100.4 F lasting one hour or longer ANC calculation - ANS (% polys + % bands) x (WBC)/100 Normal WBC count - ANS 4,500-10,000 Normal neutrophil count - ANS 54%-62% of WBC An ANC of less that _____ is considered a risk for infection - ANS 1,000 Define thrombocytopenia - ANS Low platelet count Symptoms of thrombocytopenia - ANS Petechiae or easily bruising Headaches Hypotension and tachycardia Prolonged bleeding (gums, menstruation) Define anemia - ANS Deficiency of RBC or hemoglobin in the blood Symptoms of anemia - ANS Dyspnea Fatigue Dizziness Headaches Acute diarrhea lasts: - ANS 1-2 days and resolves on its own Persistent diarrhea lasts: - ANS 2-4 weeks Chronic diarrhea lasts: - ANS > 4 weeks Common constipation-causing agents: - ANS Vinca alkaloids (vincristine and vinorelbine) Thalidomide Lenalidomide Bortezomib Define mucositis - ANS Inflammation of the mucous membranes lining the digestive tract from mouth to anus Define stomatitis - ANS Inflammatory conditions of the mouth specifically AKA oral mucositis Define xerostomia - ANS Dryness of the mouth caused by damage to or dysfunction of the salivary glands Common diarrhea-causing agents: - ANS Irinotecan 5-FU Paclitaxel Dactinomycin Capecitabine Hypersensitivity reaction (HSR) versus anaphylaxis - ANS HSR- localized tissue injury; generalized Anaphylaxis- severe inflammatory response; systemic; caused by histamine release Immediate HSR can occur: - ANS Within 5 minutes of start of infusion to 6 hours following infusion Delayed HSR can occur: - ANS Days or weeks after immediate HSR window Risk factors for HSR and anaphylaxis: - ANS Administration of a known HSR causing agent Hx of allergies Hx of hypersensitivity or anaphylaxis Premedications not ordered/administered First thing to do if a HSR occurs: - ANS STOP THE INFUSION IMMEDIATELY Define cumulative dose - ANS Total dose of an antineoplastic agent or radiation after repeated exposure to the treatment Define single dose - ANS Recommended dose of one antineoplastic agent given at a single point in time Define course dose (AKA divided dose) - ANS Recommended dose of one antineoplastic agent given over a defined period of time Define extravasation - ANS Leak of a drug capable of causing tissue damage from the intended vessel into the surrounding tissue or unintended sites Agents classified as irritants can cause: - ANS Inflammation Pain Burning ** Rarely cause tissue necrosis comparable to vesicants Agents classified as vesicants can cause: - ANS Blistering Significant pain Tissue damage and destruction **Lead to tissue death Define infiltration - ANS Leakage of non-vesicant/non-irritant solutions into surrounding tissue Common plant alkaloids: - ANS Etoposide Docetaxel Paclitaxel Vinblastine Vinorelbine Vinca alkaloids are ALL administered _(1)_ and should NEVER be administered _(2)_, as this will result in patient death - ANS 1. Intravenously 2. Intrathecally How does hormone therapy work? - ANS Attempts to add, block, or remove hormones from the body to interrupt cancer cell division LHRH agonists MOA - ANS Produce an initial increase in LH and FSH, which can cause a flare. Then lower testosterone made by testicles and estrogen & progesterone made by ovaries *Prostate cancer *Estrogen receptor-positive, premenopausal metastatic breat cancer LHRH antagonists MOA - ANS Directly inhibits pituitary from releasing LH and FSH *No tumor flare Most common type of breast cancer - ANS Hormone receptor (HR)-positive breast cancer Aromatase inhibitors MOA - ANS Block the enzyme aromatase, which turns the hormone androgen into small amounts of estrogen in the body **Less estrogen is available to stimulate growth of HR-positive breast cancer cells 2 types of aromatase inhibitors - ANS 1. Steroidal (irreversible) 2. Nonsteroidal (reversible) 3 aromatase inhibitors - ANS Anastrozole Letrozole Exemestane Common side effects of aromatase inhibitors (AI): - ANS Fatigue N/V* Weakness HA* Insomnia Dizziness Hot flashes* Weight gain* Higher cholesterol Increased sweating* Bone/joint pain* Selective ER downregulators (SERDs) MOA - ANS Binding to and degrading ER Common SERD - ANS Fulvestrant Selective ER modulators (SERMs) MOA - ANS Blocking and downregulating ERs *Can function as ER agonists, antagonists, or mixed agonist-antagonists *Can activate or block estrogen Common SERMs - ANS Tamoxifen Raloxifine Bazedoxifine Antiandrogens MOA - ANS Keeps androgens from binding to androgen receptors found in prostate cancer cells (and in some other tissue cells) Androgen synthesis inhibitors MOA - ANS Stop the adrenal glands from producing androgens Common androgen synthesis inhibitors - ANS Ketoconazole Aminoglutethimide Abiraterone acetate CYP17 inhibitors MOA - ANS Inhibit the key enzyme that catalyzes biosynthesis of androgens from all sources Common CYP17 inhibitors - ANS Abiraterone Orteronel Adrenolytic agents MOA - ANS Suppress testicular and adrenal steroidogenesis, rapidly reducing testosterone levels Define receptor - ANS Molecule inside/on surface of a cell that binds to a specific substance and causes a specific effect in that cell Define monomer - ANS Molecule that can be bonded to other identical molecules to form a polymer Define ligand - ANS Molecule that binds to a receptor to exert a biologic effect Define ligand bonding - ANS Process by which ligand attaches to specific receptor site and activates receptor, activating the signaling pathway Define dimerization - ANS 2 monomers that are side-by-side on cell surface are paired and activated by a ligand, which causes a series of signals Define kinase - ANS Enzyme that adds phosphates to other molecules, causing other molecules in the cell to become either active or inactive Define phosphorylation - ANS Activation of a chemical process to initiate signaling Targeted therapies work by: - ANS 1. Blocking angiogenesis 2. Blocking signals inside or outside the cell 3. Delivering toxic substances to the cell 4. Simulating the body's immune system __________ has been described as a way to "fire up the immune system's response to cancer" - ANS Immunotherapy Immunotherapy works by the following 3 ways: - ANS 1. Stopping or slowing the growth of cancer cells 2. Stopping cancer cells from spreading to other parts of the body 3. Helping the immune system recognize cancer cells and increase its effectiveness at eliminating cancer cells What sets immunotherapy apart from traditional chemotherapy? - ANS Highly specific Trained to remember cancer cells Immunotherapy categories: - ANS Passive Aggressive Specific Nonspecific Passive immunotherapy MOA - ANS Administered to initiate an antitumor effect *Do not result in any immunologic memory Examples of passive immunotherapy - ANS Monoclonal antibodies Cytokines Active immunotherapy MOA - ANS Mount an immune response against tumor *Should remember cancer cells long after treatment has stopped Examples of active immunotherapy - ANS Cancer vaccines Specific immunotherapy MOA - ANS Target tumor markers or tumor-associated antigens (TAAs) to kill cancer cells Examples of specific immunotherapy - ANS mAbs Cancer vaccines Nonspecific immunotherapy MOA - ANS Stimulate a large immune response *Given adjuvantly to other anticancer treatment drugs Examples of nonspecific immunotherapy - ANS Cytokines, interleukins, checkpoint inhibitors 2 different ways that immunotherapies work against cancer: - ANS 1. Triggering the immune system to destroy cancer cells 2. Boost immune system's ability to fight cancer 6 main types of immunotherapy - ANS 1. Monoclonal antibodies 2. Immune checkpoint inhibitors 3. Cancer vaccines 4. Nonspecific immunotherapies 5. Adoptive cell therapy (CAR T-cell therapy) 6. Oncolytic virus therapy mAbs MOA - ANS Mark cancer cell surface receptor/antigen to make the cell visible to the immune system to destroy Different types of mAbs used in treatment of cancer - ANS Naked mAbs Conjugated monoclonal antibodies Bispecific monoclonal antibodies mAbs ending in "-ximab" source - ANS Chimeric human-mouse mAbs ending in "-zumab" source - ANS Humanized mouse mAbs ending in "-umab" source - ANS Fully human mAbs ending in "-omab" source - ANS Murine mouse Immune checkpoint inhibitors MOA - ANS Prevent cancer cells from turning off T cells --> allows T cells to infiltrate a tumor and stop it from growing Immune checkpoint inhibitors initially cause tumors to swell, making it appear as if the tumor is growing. This is called _____________ - ANS Pseudoprogression 2 main types of cancer vaccines - ANS Preventative/prophylactic Treatment/therapeutic Nonspecific immunotherapies MOA - ANS Stimulating the immune system in a general way, hopefully leading to a better immune response against cancer cells Adoptive cell therapy MOA - ANS T cells collected from patient T cells grown in laboratory *This increases amount of T cells able to kill cancer cells or fight infections* T cells given back to patient to help immune system Oncolytic virus therapy MOA - ANS Naturally occurring or genetically engineered virus that can infect and kill a cancer call without harming normal cells Common side effects of immunotherapies - ANS Fatigue Diarrhea Colitis Musculoskeletal pain Dermatitis Common treatment for immunotherapy side effects - ANS Corticosteroids Results of immunotherapy agents most commonly occur between ____________ after starting therapy - ANS 12-16 weeks Hierarchy of controls when controlling workplace hazards - ANS Elimination Substitution Engineering controls Administrative controls PPE 4 different types of medication dosing: - ANS 1. Fixed doses 2. Weight-based doses 3. Body surface area (BSA) doses 4. Area under the curve (AUC) doses