Cancer Treatments and Therapies, Exams of Nursing

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FUNDAMENTALS OF CHEMOTHERAPY IMMUNOTHERAPY

ADMINISTRATION EXAM ACTUAL 200 QUESTIONS AND ANSWERS

WITH SOME RATIONALES | ACCURATE AND EXPERT VERIFIED

FOR GUARANTEED PASS | GRADED A | LATEST UPDATE 2024 |

CONTAINS A STUDY GUIDE AT THE END

Which statement by a patient indicates the need for additional teaching regarding the side effects doxorubicin? "I need to report any..." A. Fever above 100. B. Shortness of breath C. Changes in the color of urine D. Sudden weight gain

C. Changes in the color of urine*

A patient reports leaking at the chemotherapy infusion site. After assessing and warning others, the nurse: A. Consults the pharmacist for instructions B. Relocates the patient to another room C. Contacts the physician for additional orders. D. Retrieves the hazardous medication spill kit.*

D. Retrieves the hazardous medication spill kit.*

A patient on flourouracil reports flaky, painful hands. What does the nurse suspect? A. Flair reaction to the treatment. B. Holt-Oram syndrome C. Palmar-plantar erythrodysesthesia* D. Hypersensitivity reaction

C. Palmar-plantar erythrodysesthesia*

Which of the following information is included in a sorafenib teaching plan? A. Agent is an IV medication that does not require routine premedications. B. Doses are taken at least 1 hour before or two hours after a meal.* C. Elevated calcium levels are monitored after the first and before the third cycles. D. Baseline ejection fraction is obtained prior to initial treatment.

B. Doses are taken at least 1 hour before or two hours after a meal.*

The lifetime cumulative doxorubicin dose is 450 mg/m2 when a patient has received: A. Chest irradiation B. Bleomycin C. Bracytherapy D. Rituximab*

A. Chest irradiation

Oncogenes occur when there is mutation in the: A. DNA* B. Epidermal growth factor C. RNA D. Vascular endothelial growth factor

A. DNA*

Which of the following statements indicates understanding of dose adjustments for adverse events related to checkpoint inhibitors? A. Dose reductions are based on the severity of the adverse events* B. Steroid therapy should be discontinued to effectively control side effects. C. To treat more severe adverse reactions, the medication is either withheld or discontinued. D. The dose id permanently discontinued for grade 1 and 2 toxicities.

A. Dose reductions are based on the severity of the adverse events*

What is the total lifetime dose of doxorubicin that can be administered to a patient who received prior chest irradiation? A. 550 mg/m B. 450 mg/m2* C. 900mg/m D. 400 mg/m

B. 450 mg/m2*

A patient is scheduled to begin cetuximab. The nurse should teach the patient about the importance of using: A. Alcohol based cleansers B. Hypoallergenic moisturizers C. Pure petrolleum D. Benzoyl peroxide gel

C. Pure petrolleum*

Which of the following medications is known to be carcinogenic to humans? A. Streptozocin B. Bleomycin C. Melphalan D. Daunorubicin

C. Melphalan

Which of the following actions could help improve adherence to oral chemotherapeutic medications? A. Providing the benefits of adherence at the first clinic appointment.

B. Teaching the patient how to use a pillbox to store medication. C. Encouraging the patient to move in with a family member. D. Ongoing collaboration between the patient and healthcare team.

B. Teaching the patient how to use a pillbox to store medication.

A patient with a history of receiving chest radiation is scheduled to receive a second cycle of doxorubicin. The nurse notes that the patient's cumulative dose of doxorubicin before this cycle is 440mg/m2. The nurse's initial response is to: A. Anticipate a referral for the patient to cardiology B. Notify the physician of the cumulative dose. C. Cancel the patient's chemotherapy appointment D. Administer the chemotherapy as ordered.

A. Anticipate a referral for the patient to cardiology

What type of analgesia is used to access an implanted port for vesicant administration? A. Subcutaneous lidocaine B. Intradermal bacteriostatic saline C. Intradermal lidocaine D. Topical short acting anesthesic*

D. Topical short acting anesthesic*

A patient receiving an infusion of mitomycin reports slight discomfort above the peripheral IV site. What is an appropriate action for the nurse to take? A. Restart the IV below the previous site. B. Wrap the arm in a warm blanket C. Reduce the infusion rate and monitor the site. D. Stop the infusion and aspirate for a blood return.*

D. Stop the infusion and aspirate for a blood return.*

A patient's IV infiltrates. The nurse restarts the IV in: A. A site proximal to the previous site. B. A lower extremity. C. The ventral surface of the wrist. D. The antecubital fossa.*

D. The antecubital fossa.*

According to the ASCO/ONS Chemotherapy Administration safety standards, which one of the following elements is included on the label of a chemotherapy medication? A. Time the agent should be administered B. Expiration time of the medication C. Method for calculating the dose* D Appearance of the medication

B. Expiration time of the medication

Cell division occurs in which phase of the cell cycle A. Synthesis B. Gap C. Mitosis* D. Domancy

C. Mitosis*

What is the goal of adrenolytic therapy? A. Suppression of gonadotropin-releasing hormone B. Suppression of testicular and adrenal steroidogenesis* C. Suppression of the hypothalamic pituitary axis D. Suppression of thyroid stimulating hormone

B. Suppression of testicular and adrenal steroidogenesis*

Which of the following best describes the approval process of biosimilar products? A. Follow an abbreviated licensure pathway B. Do not need FDA approval C. Must complete phase II clinical trials* D. Can be prescribed for any purpose

A. Follow an abbreviated licensure pathway

Key teaching points to promote comfort in the first 24 hours after receiving bleomycin administration include: A. Minimizing exposure to cold environment B. Taking acetaminophen every six hours PRN* C. Applying high-flow oxygen for tachypnea D. Showering immediately after the drug infuses

B. Taking acetaminophen every six hours PRN*

The primary goal of myeloablative therapy is to A. destroy the white blood cells B. reduce tumor burden* C. increase red cell function D. obliterate bone marrow

D. obliterate bone marrow

Patient who are prescribed everolimus need dose adjustments when taking: A. proton pump inhibitors B. CYP3A4 inhibitors C. Angio-converting enzyme inhibitors D. Protein kinase inhibitors

B. CYP3A4 inhibitors

Vincristine has a maximum dose limit because it: A. reduces potential neurologic toxicities B. decreases the incidence of extravasation C. prevents severe constipation D. diminishes the severity of hepatotoxicity

A. reduces potential neurologic toxicities*

Contact inhibition is a property of A. Enzymes B. malignant cells* C. cytotoxic therapy D. normal cells

D. normal cells

The concept of providing truthful information to patients and families is referred to as: A. Veracity B. nonmaleficence C. Advocacy D. Fidelity

A. Veracity

The nurse knows that dose reduced regimens are A. Palliative in nature B. Avoided in young adults C. Used with renal compromise D. Less emetogenic

C. Used with renal compromise

While receiving treatment orders, the nurse notes there are no treatment parameters listed for administering or withholding treatment. The nurse should: A. withhold the treatment plan until the next treatment day B. contact the pharmacy to release the treatment plan C. contact the provider to clarify the treatment parameters D. proceed with the treatments plan and contact the provider

C. contact the provider to clarify the treatment parameters

A patient diagnosed with metastatic cancer of an unknown primary has cancer cells that are: A. Organized with smooth edges B. Adherent with contact inhibition C. Encapsulated* D. Undifferentiated

D. Undifferentiated

In the home setting, bedpans, urinals, and commodes used by a patient who recently received hazardous medications are rinsed with warm water after each use and washed with A. antimicrobial wipes at least twice a day B. a dilute bleach solution daily C. soap and water daily* D. Alcohol wipes at least twice a day

C. soap and water daily

How do selective estrogen receptor modulators differ from selective estrogen receptor down- regulators? A. Both block estrogen receptors B. SERMs are not indicated for ER-positive breast cancers. C. SERMs can activate or block estrogen* D. SERMs can only be administered to a premenopausal woman.

A. Both block estrogen receptors

An important teaching point for a patient receiving Vincristine is to: A. Use gentle perineal irrigation B. Monitor temperature daily* C. Take stool softeners daily. D. maintain a high bulk diet

C. Take stool softeners daily.

Which of the following medications are recommended for a patient receiving a chemotherapy agent with moderate emetogenic risk? A corticosteroid and a: A. Neurokinin -1 antagonist B. Histamine H2 antagonist C. Dopamine receptor antagonist D. Serotonin receptor antagonist*

D. Serotonin receptor antagonist*

Which of the following is a potential side effect of methotrexate? A. Chronic kidney disease B. Joint contractures C. Sexual dysfunction* D. Hemorrhagic cystitis

A. Chronic kidney disease

What is a mechanism of action of monoclonal antibodies? A. Introduce the immune system to fragments of weakened or dead bacteria B. Target tumor specific antigens on the surface of some cancer cells*

C. Provide an activation signal that allows for continued cell growth D. Accelerate and fully engage immune cells to create a robust immune response.

B. Target tumor specific antigens on the surface of some cancer cells*

A patient reports pain unrelieved by oxycodone. The initial for the nurse is to: A. Request an order for additional medication B. Consult with palliative care services C. Report it to the prescribing physician D. Assess the discomfort in 30 minutes

C. Report it to the prescribing physician

A patient is scheduled to receive melphalan 140 mg/m2. The patient's measurements are as follows: height 173 cm and weight 85 kg. Using the Mosteller formula, what is the dose to be administered? A. 257 mg B. 283 mg C. 295 mg D. 280 mg

B. 283 mg

Which of the following is an example of a passive immunotherapy agent? A. Trastuzumab* B. Sipuleucel-T C. Melphalan D. Cladribine

A. Trastuzumab

Which of the following is a characteristic of a cancer cell. A. Restricted movement B. Orderly arrangement C. Uncontrolled division D. Sustained apoptosis

C. Uncontrolled division

What is the common term for cytokine release syndrome? A. Angiogenic event B. Cell signaling C. Infusion reaction D. Cell apoptosis

C. Infusion reaction

Which statement made by a patient ordered high dose melphalan shows an understanding of the provided teaching?

A. "I should avoid sun exposure." B. "I know that this medication causes constipation." C. "I should empty my bladder frequently." D. I should suck on ice during administration."*

D. I should suck on ice during administration."*

Which of the following hormonal agents is classified as an aromatase inhibitor? A. Flutamide B. Leuprolide C. Tamoxifen D. Exemestane*

D. Exemestane*

A patient scheduled for a second dose of flourouracil reports reddening of the skin on the arms, face and neck after gardening. The nurses best response is to: A. Encourage the use of sunscreen when outside B. Withhold the chemotherapy and call the oncologist* C. Instruct on taking cool showers and baths D. Reassure that these symptoms are expected

A. Encourage the use of sunscreen when outside

A patient who completed a third cycle of trastuzumab, doxorubicin, cyclophosphamide, and paclitaxel reports numbness and tingling of hands and feet. Which medication is most likely the cause of this side effect? A. Cyclophosphamide B. Trastuzumab C. Paclitaxel* D. Doxorubicin

C. Paclitaxel*

To help prevent dose-limiting myelosuppression, give paclitaxel before: A. Antitumor antibodies B. Antimetabolites C. Alkylating agents* D. Vinca Alkaloids

C. Alkylating agents*

Which of the following medications is a non-anthracycline antitumor antibiotic? A. Daunorubicin B. Idarubicin C. Mitomycin-C D. Epirubicin

C. Mitomycin-C

A patient with acute myeloid leukemia begins induction therapy that consists of daily daunorubicin for three days and continuous cytarabine for seven days. On day two, midostaurin is prescribed. What likely precipitated this new order? A. A final cytology report was positive for FLT3 mutation* B. The patient has developed a secondary malignancy. C. The patient missed the second dose of daunorubicin. D. The blast percentage remains high on a peripheral smear.

A. A final cytology report was positive for FLT3 mutation*

A monoclonal antibody that targets angiogenesis is ordered for a patient with lung cancer. The patient is most likely being treated with: A. Vandetanib B. Bevacizumab* C. Cetuximab D. pazopanib

B. Bevacizumab

Which agent potentiates cardiotoxicity when administered with trastuzumab? A. Daunorubicin* B. Gemcitabine C. Carmustine D. Bleomycin

A. Daunorubicin

Fulvestrant dosing includes A. a 20 mg tablet once per day B. two intramuscular injections every four weeks.* C. A subcutaneous injection every four weeks. D. a 400 mg tablet three times a day

B. two intramuscular injections every four weeks.*

Which statement best describes the mechanism of action of targeted anticancer therapy? A. Block cancer cell proliferation causing cytotoxicity of cancer cells.* B. Act on rapidly dividing cells, which causes an increase in cell death. C. Interfere with specific pathways on or within the cancer cell. D. Selectively target DNA and cell division mechanisms.

C. Interfere with specific pathways on or within the cancer cell.

Signs and symptoms of venous irritation can include A. Ulceration B. Coolness at the site

C. Swelling D. Darkening of the vein

C. Swelling

Hematologic cancer (blood cancer)

-cancer that begins in bone marrow or immune system cells. -Ex: leukemia, lymphoma, multiple myeloma

Leukemia

cancer starts in blood-forming tissues like bone marrow -causes lots of abnormal blood cells to be produced and enter bloodstream

Lymphoma

-cancer that begins in immune system (WBC=lymphocytes) -hodgkin and non-hodgkins -B lymphocytes (B cells) - make antibodies (bacteria and viruses, most common lymphoma -T lymphocytes (T cells) - boost/slow immune, destroy germs and abnormal cells

Hodgkin lymphoma

Reed-Sternberg cell (cancer cells in classic) -typically starts in B cells

Non-Hodgkin's Lymphoma

-large, diverse group of cancers in immune system cells -indolent (slow growing) or aggressive (fast)

Myeloma

Cancer in plasma cells (WBC that produce antibodies)

Chemotherapy

All antineoplastic agents used to treat cancer, given through oral and parenteral routes or other routes as specified in the standard, not including hormonal therapies.

Who can order chemotherapy?

Written and signed by licensed independent practitioners (MD/DO, PA, Oncology NP)

Can you use verbal orders for chemotherapy?

NO! Only when holding/stopping admin.

Who can mix Chemotherapy?

Pharmacist, Pharmacy tech, MD/DO, qualified RN

Who can administer chemotherapy?

Registered Nurses with specialized education, prep and training. See specific state laws and statutes

How often is chemo competency reassessed>

Annual continuing ed and competency assessment is recommended

What is the dose verification process?

-confirm plan with patient -two practitioners verify: drug name, dose, volume, rate, route, expiration date, appearance -document verification in chart

What PPE is required for IV Chemotherapy?

-Gloves: two pairs, HD tested -Gown: disposable, back closed, long sleeved -Respirator: NIOSH approved -Eye & Face: face shield/mask

Neoadjuvant therapy (tumor burden)fcon

Chemo BEFORE primary treatment (common in breast and colon)

Adjuvant therapy

Chemo AFTER primary treatment (common in solid tumor)

conditioning or preparative therapy

administration of chemo sometimes with total body irradiation to eliminate residual disease or ablate marrow space prior to stem cell transplantation

myeloblative therapy

obliteration of bone marrow with chemo administered in high doses in preparation for stem cell transplant

• lethal levels - does not allow for spontaneous stem cell regrowth - must be followed by transplant to prevent death

Non-myeloablative therapy

reduced intensity conditioning with lower doses of chemo not lethal to bone marrow reliant on graft vs tumor effect use of nonmyeloblative therapy has expanded transplant options and expanded eligibility - older pts and those with comorbidities

Bone Marrow

soft, sponge-like tissue in center of most bones, produce WBC, RBC, and platelets.

Myelosuppression

bone marrow activity is decreased, causing less RBC, WBC and Platelets.

Myeloablation

severe myelosuppression

Induction phase

initial phase, typically in hospital, intended myelosuppression

Consolidation phase (intensification/postremission therapy)

after successful induction, kills cancer cells left in body (ex radiation, stem cell transplant)

Synergy

when one chemo drug helps another work better at the same time

chemoprevention

the use of drugs or other agents to inhibit or prevent disease i.e., use of tamoxifen in women with high risk of breast cancer

graft vs tumor effect

the donor cell response against the malignancy; a desirable response

immunosuppression

administration of antineoplastic agents at doses sufficient to blunt an immune response, i.e., methotrexate given after transplantation to prevent graft vs host disease

average white blood cell nadir

10-14 days

dose density

drug dose per unit of time higher density reduces the amount of time between rounds which may reduce the chance of tumor regrowth

dose intensity

the amount of chemotherapy administered to a patient over a specific unit of time

Complete response

no identifiable cancer present for at least one month or longer

Partial response

Measurable tumor reduced by 50% for at least one month with no new tumors

Stable disease

Tumor size reduced by less than 50% or less than 25% increase in growth

Progressive disease

tumor growth more than 25% or new cancer

What are the phases of the cell cycle?

-G1 phase -S phase -G2 phase -M phase

What happens in G1 phase?

The cell increases in size and prepares to replicate its DNA.

What happens in the S phase?

DNA replication

What happens in g2 phase

the cell produces organelles and materials for division

What happens in the M phase

cell division

What do chemo drugs do to target S phase?

Prevent cell from making DNA and/or RNA (replicating) (ex: antifolates (methotrexate), antipyrimidines (5-fu), antipurines (hydroxyurea))

What do chemo drugs do to target G2 phase?

Cells prepare to divide, chemo drugs stop development of elements needed for cell division (ex: topoisomerase I and II inhibitors, bleomycin)

What do chemo drugs do to target M phase?

Cells divide, drugs prevent cell division, including metaphase arrest or microtubular disorganization (ex: plant alkaloids and taxanes)

What are some examples of cell cycle non-specific drugs?

Active throughout the cell cycle: -alkylating agents -anthracycline antibiotics

-nitrosureas -miscellaneous

What are alkylating agents?

-cell cycle nonspecific -damage DNA to prevent cancer cells from reproducing -create breaks in DNA

Cyclophosphamide?

-alkylating agent -treats: leukemia, lymphoma, breast/ovarian CA, myeloma, neuroblastoma, mycosis fungoides, retinoblastoma. -IV, oral, peritoneal -important to hydrate, prevent hemorrhagic cystitis

Cisplatin?

-alkylating agent -treats: bladder, testes, ovaries, endometrial, lung, squamous cell of head/neck -IV, peritoneal -high N/V -no aluminum PIV -hearing loss and peripheral neuropathy with long term use

Carboplatin

-alkylating agent -treats: ovarian and off-label use -IV only -dose calculated using calvert formula

• premedicate with serotonin antagonist and dex -no aluminum PIV

Oxaliplatin

-alyklating agent -with 5-fluorouracil/leucovorin -Adjuvant treatment: colorectal, testicular, esophageal, pancreatic, gastric, hepatobillary, ovarian, lymphoma -IV only

• pulmonary fibrosis acutely
• hepatotoxicity and neuropathy - 2 types reversible and more prolonged severe with long term use -premed with 5HT3 blocker and dexamethasone

Antimetabolites

-works in S phase - do not allow cell to leave s phase -interferes with enzymes needed for DNA synthesis -Kills cancer cells -cause myelosuppression, N/V, mucositis, GI toxicity

Methotrexate

-Antimetabolites -treats: leukemia, lung, breast, head/neck, lymphoma, mycosis fungoides, choriocarcinoma, osteogenic sarcoma -OFF-LABEL: bladder CA, immunosuppression, psoriasis, RA, post-hematopoietic stem cell transplant

• IV, IM, intrathecal, arterial -monitor renal function

Leucovorin calcium

-chemoprotective and chemosensitizing agent -form of folic acid -drug used to lessen toxic effects of methotrexate which blocks action of folic acid.

5-fluorouracil

-Antimetabolites -treat: colon, rectal, breast, stomach, pancreatic carcinoma, actinic keratosis -IV, TOPICAL -can use with leucovorin to enhance drug activity -mucositis, angina, EEG changes, hypotension, hand foot syndrome -assess oral before/after infusion

Antitumor antibiotics

-blocks cell growth by interfering with DNA -nonspecific effect on cell life cycle

• cardiac toxicity and myelosuppression

Doxorubicin

-antitumor antibiotic -treats: solid tumor, hematologic malignancies (breast, prostate, ovarian, lymphomas) -IV push, slow or continuous -urine turns red/orange -vesicant, monitor cardiac function - acute CHF with reduced LVEF

Nitrosoureas

can cross the blood-brain barrier -inhibit DNA/RNA synthesis -interfere with enzymes to copy/repair DNA

-long nadir (4-6 weeks) -n/v, mucositis, pulmonary fibrosis, secondary malignancy with long term use

Carmustine

-treats: brain, lymphoma, myeloma, melanoma, sarcoma, breast, colon, rectal, liver, stomach -IV, arterial, topical, intratumoral -can cause renal toxicity/failure -pulmonary toxicity - PFT baseline and reg intervals

Camptothecins

-topoisomerase I inhibitor -drug blocks enzyme that helps unwind strands in cell reproduction -causes breakage of DNA strands

Irinotecan

-Camptothecin Topoisomerase I inhibitor -treats: colorectal, esophageal, gastric, glioblastoma, lung, pancreatic -IV only -severe diarrhea, fluid repletion

Plant alkaloids

Work in late G2 and S phases; interfere with topoisomerase II enzyme

Paclitaxel

-plant alkaloid -common in combo with cisplatin -treats: ovarian, breast, lung CA no surgery, AIDS related kaposi sarcoma -admin IV only in filter -anaphylaxis, pre-medicate w/pepcid, benadryl, dex

Etoposide

-Plant alkaloids -treats: testicular and small cell Lung, off-labels too -IV only, (30-60 min) -can cause anaphylaxis and hypotension

Vincristine

-plant alkaloid -treat: lymphoma, leukemia, neuroblastoma, rhabdomyosarcoma -vesicant -IV push or rapid infusion (15 min) -FATAL IF INTRATHECALLY -may develop ileus

Hydroxyurea

-antimetabolite/miscellaneous -treats: leukemia, melanoma, inoperable ovarian, with radiation for head/neck, prophylaxis of sickle-cell -ORAL ONLY -consider risks with gout

Hormone therapy

-treatment that adds, blocks, removes hormones -hormones can cause cancers (ovarian, prostate) -surgery may remove gland that produces hormone -synthetic hormones may block natural hormones

Prostate cancer (hormone therapy)

-androgen (testosterone) cause prostate cell growth -androgen suppression decreases testosterone -castration resistant (less effective over time)

Breast cancer (hormone therapy)

-hormone receptor-positive (HR+) - most common -goal: decrease estrogens/progestins -treatment depends on (pre/post menopause)

Hormone receptor positive

-cells with proteins that bind to specific hormones -need estrogen or progesterone to grow -can affect treatment

Tamoxifen

-estrogen receptor antagonist & receptor modulator -HR+ breast CA -binds to estrogen receptors, alters estrogen genes -ORAL ONLY -can increase ovulation (birth control)

Leuprolide

-breast and prostate CA -block LHRH from hypothalamus, block hormone from anterior pituitary gland -Breast=IM q4w ---- Prostate=SC or IM q4-24w -only FDA approved for prostate

Targeted therapy

-identify/attack specific cancer cells, less harm to normal -block action or deliver toxic substances to cancer cell -fewer side effects to other treatments

Small molecule inhibitors

-tyrosine kinase inhibitors (TKIs) -Mammalian target of rapamycin (mTOR) inhibitors

Tyrosine kinase inhibitors (TKIs)

TK = direct cell growth, signaling and division -inhibiting them stops cancer cell growth -drug-drug interaction - TKIs metabolized by CYP

Imatinib

-TKI -leukemia -ORAL ONLY -monitor GI upset, and weight gain

Lapatinib

-targeted therapy -breast CA -ORAL ONLY -decreased LVEF, no grapefruit juice

T-Cell (T lymphocyte)

-type of WBC -part of immune system from stem cells in bone marrow -protect body from infection, fight CA

B-Cell (B lymphocyte)

-type of WBC that make antibodies -part of immune system from stem cells in bone marrow

Natural killer cell

-immune cell with granules (contain enzymes that kill tumor cells or cells with virus) -type of WBC

Immunotherapy as Cancer therapy

-stimulate/suppress immune system to fight Cancer, diseases and infection -some target specific immune cells -some affect entire immune system

immune checkpoint inhibitor

-drug that blocks some proteins in immune system -when blocked, Tcells can kill caner cells better -CTLA-4, PD-1, PD-L 1

Immune-related adverse events (irAEs)

-inflammation in one or more organ systems -Grade 1 = continue therapy -Grade 2 = hold inhibitor until grade 1 or lower -Grade 3 = hold inhibitors, high dose corticosteroid over 6 weeks -Grade 4 = permanent discontinuation

Ipilumumab

-melanoma -checkpoint inhibitor CTLA- -IV only -derm, liver, GI toxicities

Nivolumab

-melanoma, lung CA, renal, Hodgkin, head/neck, urothlial -checkpoint inhibitor: PD- -IV ONLY -liver, kidney toxicities, colitis, electrolytes

Cytokines

-proteins made by immune and non-immune cells -can be made in lab -some stimulate immune system, some slow it down

Interferons

-natural substance made by WBC to fight diseases -can be made in lab -help keel cancer cells from growing, kills cancer cells -SI and fatigue

Interleukin (IL)

-proteins made by WBC and other cells -regulate immune response -lab made: boost immune system in CA treatment

Immunomodulators

-multiple myeloma -change the body's immune system -agents activate/suppress function

Monoclonal antibodies

-lab made antibodies -mimic antibodies in immune system

Murine - made from mice Chimeric - part mouse/part human Humanized - mice antibodies attach human antibodies Human - fully human antibodies

Rituximab

-M antibodies (nAbs) -mixed mice/human -treat: non-hodgkkins, CLL, RA, granulomatosis, polyangiitis -IV only -premed w/ tylenol, benadryl, -hold HTN meds for previous 12 hrs

Trastuzumab

• breast and gastric CA -mAb - HUMANIZED -IV only
• no previous cardiac condition, not pregnant

Angiogenesis

-blood vessel formation *tumor angiogenesis - new blood vessels tumors need to grow -release of chemicals by tumor and by host cells

Antiangiogenic Agents

-keep new blood vessels from forming -prevent growth of new blood vessels tumors need to grow

Bevacizumab

-colon, lung, glioblastoma, renal, off label -mAb- humanized -IV (do not push), intravitreal (unlabled) -can cause GI perf, protenuria, fistula, hemorrhage -do not give 28 days before surgery

Intraperitoneal

-chemo into abdominal cavity -pt changes positions to distribute chemo

Intravesicular

chemo delivered directly into bladder avoiding systemic chemo effects -through cath

Intrapleural

throacotomy tube into pleural lining -treats some lung CA that produce malignant pleural effusions

Intrathecal/Intraventricular

directly into the cerebrospinal fluid -prevents/treats CA cells that cant be reached systemically b/c blood brain barrier

Flare reaction

localized allergic reaction along a vein caused by irritating drugs

Infiltration

leaving of IV meds into the surrounding tissue

Extravasation

Leaking of IV vesicant meds into SC or subdermal tissues

Cytokine release syndrome (CRS)

systemic-inflammatory reaction occurring after the administration of agents that target the immune system and can be life threatening -interferons, ILs, mAbs, Car-t -30min-2hrs after -- up to 7 days

What does bone marrow create? - CORRECT ANSWER WBCs, RBCs, platelets

Leukemia - CORRECT ANSWER Starts in blood-forming tissues (the bone marrow)

Causes abnormal blood cells to be produced/enter the bloodstream

Lymphoma - CORRECT ANSWER affects the immune system

types: hodgkins, non-hodgkins

Hodgkin lymphoma - CORRECT ANSWER Reed-Sternberg cells

starts in B cells (type of WBC that creates antibodies)

Non-hodgkins lymphoma - CORRECT ANSWER a large. diverse group of immune system cancers

Myeloma - CORRECT ANSWER cancer in the plasma cells

What do plasma cells do? - CORRECT ANSWER produce antibodies

Neoadjuvant therapy - CORRECT ANSWER chemotherapy before primary treatment

Adjuvant therapy - CORRECT ANSWER chemotherapy after primary treatment

ex: surgery then chemotherapy

Induction - CORRECT ANSWER the initial phase of chemotherapy, typically performed in the hospital

Consolidation - CORRECT ANSWER the second phase of chemotherapy which is used to ensure that induction (phase one) takes effect; reduces the chance of recurrence

ex: radiation, stem cell transplant

Myeloblative therapy - CORRECT ANSWER obliterates the bone marrow with high dose chemo in preparation of a stem cell transplant

death will occur if not followed by stem cell transplant

myelosuppression - CORRECT ANSWER activity of bone marrow is decreased resulting in less RBCs, WBCs, and platelets

Myeloblation - CORRECT ANSWER severe myelosuppression

What does synergy mean? - CORRECT ANSWER when one chemo drug helps another work

Chemoprevention - CORRECT ANSWER the use of chemotherapy to prevent cancer

What is an example of chemoprevention? - CORRECT ANSWER tamoxifen use in women with a high risk of breast cancer

Why would a medication such as methotrexate be administered after a transplant? - CORRECT ANSWER to prevent graft versus host disease

What does complete response mean? - CORRECT ANSWER no identifiable cancer is present for at least one month

What does partial response mean? - CORRECT ANSWER the tumor size is reduced by 50% for at least one month & no new tumors are present

What does stable disease mean? - CORRECT ANSWER the tumor size is reduced by less than 50% or there is less than 25% growth of the tumor

What does progressive disease mean? - CORRECT ANSWER the tumor grows more than 25% or the cancer has metastasized

How do alkylating agents work? - CORRECT ANSWER by damaging DNA to prevent cancer cells from reproducing

What type of chemo drug is cyclophosphamide? - CORRECT ANSWER Alkylating agent

it works by damaging DNA to prevent cancer cells from reproducing

Nursing considerations: cyclophosphamide - CORRECT ANSWER encourage hydration to prevent hemorrhagic cystitis

What type of chemo drug is cisplatin? - CORRECT ANSWER alkylating agent

it works by damaging DNA to prevent cancer cells from reproducing

Nursing considerations: Cisplatin - CORRECT ANSWER - severe nausea and vomiting is common

• promote hydration
• avoid aluminum PIV
• long term use will cause neuropathy and hearing loss

Long term use of cisplatin will cause: - CORRECT ANSWER hearing loss and neuropathy

What type of chemo drug is carboplatin? - CORRECT ANSWER Alkylating agent

it works by damaging DNA to prevent cancer cells from reproducing

Nursing considerations: carboplatin - CORRECT ANSWER - anaphylaxis and embolic events may occur

• calvert formula
• avoid aluminum PIV
• premedicate with dexamethasone and a serotonin antagonist (ex: trazodone)

What drugs do you need to avoid aluminum PIVs? - CORRECT ANSWER carboplatin

cisplatin

(alkylating agents)

What drug utilizes the calvert formula? - CORRECT ANSWER carboplatin

Premedication for carboplatin involves: - CORRECT ANSWER dexamethasone and a serotonin antagonist (ex: trazodone)

oxaliplatin is used in "synergy" with - CORRECT ANSWER 5-fluorouracil and leucovorin

What type of drug is oxaliplatin? - CORRECT ANSWER alkylating agent

it works by damaging DNA to prevent cancer cells from reproducing

Nursing considerations: oxaliplatin - CORRECT ANSWER - used in conjunction with 5- fluorouracil and leucovorin

• may cause acute pulmonary fibrosis
• long term use may cause hepatotoxicity and (reversible) neuropathy
• pre-medicate with dexamethasone and "5HT3 blocker" (zofran)

Long term use of oxaliplatin can cause - CORRECT ANSWER hepatotoxicity

reversible neuropathy

Pre-medcation for oxaliplatin involves: - CORRECT ANSWER 5H3T blocker (zofran)

dexamethasone

How do antimetabolites work? - CORRECT ANSWER by interfering with DNA synthesis

What type of drug is methotrexate? - CORRECT ANSWER antimetabolite

interferes with DNA synthesis

Nursing considerations: methotrexate - CORRECT ANSWER monitor renal function

What type of drug is 5-fluorouracil? - CORRECT ANSWER antimetabolite

interferes with DNA synthesis