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ONS/ONCC CHEMOTHERAPY
IMMUNOTHERAPY CERTIFICATE| Q&A
Lesson 1: Foundations to Set the Stage - ANSWER- Focusing on Cellular Structure and Function - ANSWER- The Normal Cell Cycle - ANSWER--The cell cycle refers to the ordered seres of processes of DNA replication and mitosis, or cell division -Cell nucleus regulates these processes by gathering and processing complexes molecular information Interphase and Mitotic Phase - ANSWER-Cell division produces two identical cells through these two major phases During interphase: - ANSWER-Cell grows and DNA is replicated through the following three steps: 1: First growth phase (G1 or first gap) 2: Synthesis phase (S phase) 3:Mitotic Phse (M phase) First Growth Phase (G1 or first gap) - ANSWER--cells increase in size -reproduce RNA -"quality assurance" test that the cell will be ready to synthesis DNA -Length of time is variable, can be from hours to days Synthesis Phase (S phase) - ANSWER--DNA replicates -Results in the formation of identical pairs of DNA (chromatids) -which are attached a t the centromere -lasts 2-10 hours
Mitotic Phase (M phase) - ANSWER--Replicated chromosomes are aligned, separated, and move into 2 new, identical daughter cells -takes about 30-60 minutes Major points of cell regulation are entry and exit from - ANSWER--G1 checkpoint -S Phase -G2 checkpoint -M phase Restriction Point - ANSWER--The transition from the resting phase into an actively dividing phase (G0-G1) is a point where cellular transformation can occur -During this time, cells pass through a transition phase known as a restriction point -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 G0 Phase (resting phase) - ANSWER--After mitosis, cells may enter back into the G phase or go into a resting phase, known as G -Most cells in the human body reside in G -Exceptions to this are those that are (Resting in G0 phase) - ANSWER--Exceptions to this are those that are metabollically active, such as -granulocytes -and the epithelium of the GI tract Cell Cycling Time - ANSWER-Amount of time from mitosis to mitosis Cell cycle video and image - ANSWER-http://highered.mheducation.com/sites/0072495855/student_view0/ chapter2/animation__how_the_cell_cycle_works.html Check points in the Cell Cycle: Keeping it All Under Control - ANSWER--The cell cycle is carefully controlled through a series of checkpoints
M Phase Checkpoints - ANSWER-When the cells prepare to divide, the chromosomes line up in the mitotic spindle. If the chromosomes are not properly aligned, division is not allowed to continue Immunity - ANSWER- Cells of the Immune System - ANSWER- Pluripotent Stem Cell - ANSWER--The cells of the immune system are created in the bome marrow from what is know as a ___ -A stem cell that can differentiate into any cell type except for extraembryotic tissue, does not yet have a function Myeolid Precursor Cells - ANSWER-Mature into: -RBCS -Plts -WBCs (Granulocytes) Lymphoid Precursor Cells - ANSWER-Mature into: -Specialized WBCs called lymphocytes (Agranulocytes) Lines of Defense: The Immune System's Response to Attack - ANSWER-Consists of 2 types of immunity: 1: Innate 2: Adaptive Innate Immunity - ANSWER--First line of defense against a pathogen -Does not retain memory of the entity -Involves the following: (skin, mucous membranes, and normal flora of the skin and gut) (Cellular components such as phagocytes, natural killer cells, granulocytes, and macrophages)
- Phagocytes
- Natural Killer Cells
- Granulocytes
- Macrophages - ANSWER-1.Cells that engulf and destroy invader
- Cells that sense receptors on self and non-self to determine if they should kill or not
- Type of WBC that have granules (Neutrophils Eosinophils - parasites Basophils - release histamine to stimulate immune response)
- Large phagocytic cells stimulated by infection Adaptive Immunity - ANSWER--Stimulated if innate immunity is insufficient -leads to immune system memory -Humoral immunity -Cell-mediated immunity -Regulatory T-cells Humoral Immunity - ANSWER--B-Cells -Memory B-Cells -Plasma act to produce immunoglobulins (Igs) or antibodies B-Cell - ANSWER--each one is programmed to make one specific antibody -Can recognize antigens whether they are freely circulating in the blood or attached to surface of a microbe -When dividing, can become plasma cells which will then begin secreting antibodies that are unique to that antigen Plasma Cells - ANSWER--some plasma cells will undergo apoptosis -Some will go to the BM where they will continue to secrete antibodies sometimes for years Cell-Mediated Immunity - ANSWER-Depends upon cytotoxic T cells and helper T cells and their cyokinds -more effective against antigens within cells Regulatory T-cells AKA suppressor T-Cells - ANSWER-regulate the immune response to prevent autoimmune reactions and limit inflammatory responses T-Cell - ANSWER--Can only recognize antigens when they are presented to them by "presenting cells"
Characteristics of Cancer Cells - ANSWER--Malignant tumors are not encapsulated -Cell structure is different from parent tissue (no as well differentiated) -Cell division is uncontrolled -Cells are loosely adherent without contact inhibition -Cells are able to invade neighboring tissue -Cells can migrate and metastasize to distant sites -Can stimulate the development of new blood vessels to supply the tumor (angiogenesis) Proto-oncogene - ANSWER--regulate normal cell growth and division -large family of genes that code for proteins and enzymes that turn on the cell cyle Oncogene - ANSWER-when mistakes in copies of DNA can occur, if a mutation occurs next to a proto-oncogene, it can "turn on" and become a ______ Examples of oncogoenes - ANSWER-1. EGFR or Erb-B1 (codes for an epidermal GF receptor in the receptor-tyrosine kinase family ad is associated with head and neck and colorectal cancers) -EGFR inhibitor therapies are known to cause cutaneous reactions
- Erb-B2 or HER2/neu (codes for an EGFR protein in the tyrosine kinase family and is associated with some breast cancers) Tumor suppressor genes - ANSWER--act like brakes in a car, slowing down or stopping cell growth and division -in the presence of malignancies, they bind to DNA with intention of repairing or activating apoptosis -for it to be turned on it must be expressed or "opened" in the DNA helix so that it can be transcribed or copied p53 - ANSWER--"sucidie gene" -activates apoptosis when the cell is damaged beyond repair or too old to function
-more than 50% of solid tumors, the gene is mutated and unable to perform its normal function Growth Signals - ANSWER--cancer cells are able to find their own growth signals making them self-sufficient Signal transduction - ANSWER--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 Signal transduction steps - ANSWER-1. Messages usually sent from outside the cell where the messenger (ligand) first binds to the cell receptor which extended through the cell membrane
- These receptors ae called receptor tyrosine kinases
- To send the message through the membrane, the receptor often has to join with another recetor to become active and t autophophorylate
- This is called dimerization and can be the following: Dimerization - ANSWER-1. Homodimerization: binding with the same type of receptor, such as an epidermal GF receptor (EGFR) 1 receptor with another EGFR
- Heterodimerization: binding with a different kind of receptor, such as EGFR1 binding with EGFR Protein tyrosine kinases phosphorylates - ANSWER--turned on by giving up a phosphate molecule -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 -where it is transcribed Pathways - ANSWER-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 mitogen-activating protein kinase (Raf-1/MAPK) pathway - ANSWER--shown to decrease the benefits of some cancer drugs -decrease disease-free survival time in some pts
-lifestyle fit -cost -medication knowledge -pill burden -regiment complexity Lesson 2: Alkylating Agents - ANSWER- Alkylating Agents - ANSWER--function by causing a break in the DNA helix strand, causing interference with DNA replication, which results in cell death Alkylating Agent Subgroups - ANSWER--Nitrogen mustards (cyclophosphamide{Cytoxin}, ifosfamide{Ifex}, bendamustine{Treanda}) -Platinum-based (cisplatin{Planitol}, carboplatin{Paraplatin}): do not possess an alkyl group -nitrosoureas Nitrosoureas - ANSWER--subgroup of alkylating agents -able to cross the blood-brain barrier (effective in treating some brain tumors, melanomas, lymphomas) -Carmustine (BiCNU) -Lomustine (CeeNu) -Streptozocin (Zanosar) -pulmonary monitoring recommended Carboplatin (Paraplatin) - ANSWER--Alkylazing agent -possibility for a hypersensitivity reaction which is rash, urticaria, erythema, pruritis, rarely bronchospasm and hypotensision -notify RN if itching, scratchy throat, difficulty breathing, rash -Blood count, particularly platelets, monitored because thrombocytopenia is a dose- limiting toxicity -Oral dosage: 1-5mg/kg/day Cisplatin (Planitol) - ANSWER--Alkylating agent
-nephrotoxic (IV hydration 2-3 L per day) -severe N/V -ovarian and testicular Cyclophosphamide (Cytoxin) - ANSWER--Alkylating agent) -hemorrhagic cystitis (dysuria, hematuria, hemorrhage) -DC treatment if hemorrhagic cystitis -adequate hydration Oxaliplatin - ANSWER--Alkylating agent -irritant and vesicant, extra caution with the IV site -peripheral neuropathy is a dose-limiting side effect (exacerbated by cold temperatures) -avoid cold drinks and foods, wearing gloves and warm shoes -avoid breathing cold air Intrathecal Chemotherapy - ANSWER--injects chemo directly into the subarachnoid space so it reaches the CNS -Often used to treat leukemia and lymphoma that has spread to the CNS since most IV chemo does not cross the blood-brain barrier -only MTX and cytarabine via this route -IT hydrocortisone is often given at the same time to reduce inflammation -MUST be preservative free to avoid CNS irritation Chemotherapy-Induced N/V (CINV) Risk factors - ANSWER--younger -have a hx of low or no alcohol consumption -are female -hx of morning sickness -prone to motion sickness -have had chemo previously Types of CINV - ANSWER--Acute: occurring within 24 hours -Delayed: from 24 hour - 5 days after
Neutropenic Fever - ANSWER--temp of 38.3 or greater one time -temp of 38 lasting 1 hour Absolute Neutrophil Count - ANSWER-- (%segs + %bands) x (WBC) / 100 Mucositis - ANSWER--inflammation of the mucous membrane lining the digestive tract from mouth to anus -affects 40-100% of pts Stomatitis - ANSWER--specifically inflammatory conditions of the mouth Xerostomia - ANSWER--dryness of the mouth caused by damage to or dysfunction of the salivary glands Hypersensitivity Reaction (HSR) - ANSWER--body mounts an immunologic response to a foreign substance or antigen, resulting in local tissue injury IgE-mediated - ANSWER--immediate (within 5 minute) HSR, present like classic allergic reactions T-Cell--Mediated - ANSWER--Delayed hypersensitivity reactions, can occur any time after the immediate hypersensitivity window, even days or weeks Type 1 HSR early S/SX - ANSWER--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 Type IV HSR - ANSWER--pneumonitis -mucositis -contact dermatitis -granulomas -Graph vs host disease Lesson 7: Cumulative Dose - ANSWER-
Cumulative dose - ANSWER-total amount of one antineoplastic agent given to the pt, adding up each time that the pt has received it Cumulative lifetime dose - ANSWER--"cumulative dose should not exceed..." -total amount of specific antineoplastic agents that can be safely given over the course of a pt's lifetime Extravasation - ANSWER--leak of a drug capable of causing tissue damage from the vessel in which it is being administered into the surround tissue Irritant - ANSWER--causes inflammation, pain, and burning but rarely causes tissue necrosis Vesicants - ANSWER--causes blistering and significant pain and tissue damage and destruction, leading to tissue death Vesicants in PIVs - ANSWER--Do not use IV in hand, wrist, AC areas -Do NOT place the IV below a recent ventipuncture site used (<24 hours) -Use a flexible IV catheter When a vesicant extravasation occurs or is suspected, take the following steps: - ANSWER-1. Immediately STOP administering the vesicant and IV fluids
- Disconnect the IV tubing from the IV device. Do not remove the IV device or noncoring port needle
- Attempt to aspirate residual vesicant from the IV device or port needling use a small (1-3 mL) syringe
- Remove the peripheral IV device or port needle
- Initiate appropriate management measures Managing Non-DNA Binding Vesicant Extravasation - ANSWER--Vinca Alkaloids (vincristine, vinblastine) -Do not bind to DNA in healthy cells when they extravasate into tissue. Indirect effect on healthy tissue -Treat with heat, elevation, and hyaluronidase local injection (spreads the vesicant through the tissue for faster metabolism of the vesicant agent)
Monomer - ANSWER-molecule that can join with other identical monomers to form a structure called a polymer Ligand - ANSWER-a substance that forms a complex with another biomolecule to exert a biologic effect Ligand Binding - ANSWER-process by which the ligand attaches to a specific receptor site and activates that receptor, activating the signaling pathway Dimerization - ANSWER-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 Kinase - ANSWER-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 phosphorylation - ANSWER-activation of a chemical process to initiate signaling targeted therapies work by doing the following - ANSWER-1. blocking angiogenesis
- blocking signals inside or outside the cell
- delivering toxic substances to the cell
- stimulating the body's immune system BCR/ABL - ANSWER--fusion protein tyrosine kinase formed with a gene translocation occurs between gene 9 and 22 -gene abnormality called the Philadelphia chromosome seen in CML and ALL VEGF - ANSWER-this is the primary angiogenic factor produced by cells mTOR - ANSWER--target of rapamycin -a protein that tells cells when to grow, divide, and survive Two ways that angiogenesis inhibitors work - ANSWER-1. some intergere with action of VEGF which stimulates n ew blood vessel formation
- others target their molecules that stimulate new blood vessel growth Small Molecule Compound Targeted Therapies - ANSWER--end in -ib
-targets located inside the cell because these gents are able to enter cells more easily -intracellular -most given orally Monoclonal Antibody Targeted Therapy - ANSWER-- end in -mab -relatively large in size and therefore usually cannot enter cells -extracellular or transmembrane -man made version of antibodies that are designed to attack a very specific target on cancer cells -usually from mice Lesson 12: Immunotherapy - ANSWER- Immunotherapy works by - ANSWER--stopping or slowing the growth of cancer cells -stopping cancer from spreading to other parts of the body -helping the immune system recognize cancer cells and increase its effectiveness at eliminating cancer cells Passive Immunotherapy - ANSWER--initate an antitumor effect but do not result in any immunologic memory -require repeated administration to be effective -includes monoclonal antibodies and cytokines Active Immunotherapy - ANSWER--capitalize on the immune system's ability to remember a foreign invade -mount an immune response against the tumor and hopefully remember the cancer cells long after treatment has stopped -includes cancer vaccines Specific Immunotherapy - ANSWER--capitalize on tumor markers to specifically target and kill cancer cells -examples are mAbs and cancer vaccines
-consisting of garments that provide barriers to protect workers from HDs -places the primary responsibility for protection on the worker Donning PPE - ANSWER-1. wash hands
- inspect gloves
- apply first pair of gloves
- put on gown with gloves inside cuff
- second pair of gloves over the cuff
- put on eye and face protection Doffing PPE - ANSWER-1. Remove outer gloves turning them inside out
- remove the gown
- remove the face shield
- properly dispose 5.remove inner gloves
- wash hands True statements related to drug dose calculation and administration - ANSWER--the AUC calculation incorporates renal function as part of the equation -Pts who have had previous radiation therapy or chemo are considered special populations with regard to a potential need for dose modification -The AUC calculation is used for carboplatin dosing -Children may metabolize drugs differently than adults; dose modifications are possible What is a monoclonal antibody, and how is it different from chemo? - ANSWER--mAbs are agents that are derived from human or mouse antibodies or a combination of the two -mAbs search out proteins on the cells surface -mAbs recognize and bind to specific anatigens on the cells surface
-natural killer cells and/or cytotoxic proteins of the immune system recognize and destroy the marked tumor cells -mAbs can also directly induce cell death as well -One of the biggest differences is that mAbs cause harm only to those cells that are marked or binded
Should I avoid my grandchildren and other family members when I am getting treatment? - ANSWER--it is perfectly safe for you to have contact with your loved ones while getting treatment -Hugging, kissing, and spending time together while eating are all safe activities -Safety with bodily fluids is necessary for the first 48 hours after receiving chemo Can I be intimate with my partner during treatment? - ANSWER--you should definiely check with your HCP first to be sure -traces of chemo may be present in vaginal fluid for up to 48 hours after treatment -use of a barrier is recommended for this reason for at least the first 48 hours
