Chemotherapy Biotherapy Certification Q AND 100% VERIFIED A

Resources nccn.org cancer.org LESSON 1: Cell cycle g1- increase in size s- dna replicated g2- cell enlarge and ready to divide m phase- 2 hours 00:45 01:22 mitosis 4 stages, prophase, metapha ...

Resources nccn.org cancer.org LESSON 1: Cell cycle g1- increase in size s- dna replicated g2- cell enlarge and ready to divide m phase- 2 hours 00:45 01:22 mitosis 4 stages, prophase, metaphase, anaphase, telophase -chemo targets certain points in the process apoptosis programmed cell death hematopoiesis formation of blood cells & how cells differentiate -myeloid: pre cells mature into RBCs, platelets and WBCs -lymphoid: pre cells- mature into WBCS Principles of Biotherapy: p51-95 immunology -defense against foreign organisms, homeostasis (destroy aged cells), surveillance immune responses innate: primary line of defense, non specific, no memory adaptive: secondary line of defence with specific memry cytokines -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 vaccines for cancer prevention -hep B prevents hepatitis and hepatocellular carcinoma -hpv vaccine filgrastim aka neupogen SC or IV to derease infection in patients with neutropenic fever associated with myelosuppressive anticancer treatments for nonmyeloid malignancies tbo-filgramstim/ pegfilgrastim reduce duration of neutroenia in patients with non myeloid malignancies palifermin IV to dec incidence of oral mucositis in patients with hem malignanies before BMT 00:02 01:22 sargramostim aka leukine - patients with AML following chemo to shorten neutrophil recovery and reduce incidence of infection IFN gamma reduce frequency and severity o infections related to granulomatous disease aldeleukin treat renal cell carcinoma and metastatic melanoma oprevelkin prevent severe thrombocytopenia and refuce need for platelet transfusions in patients with nonmyeloid malig plerixafor with filgrastim to mobilize hematopoeitc stem cells for collection from peripheral blood of patients sipuleucel castrate resistant prostate cancer rituximab 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 immune system 1st line: skin , ucous membrane, gut flora second line: phagocytes: 3rd line antibodies, t and b cells malignant tumor (cancer) cell strcuture different from parent tissue, cell division uncontrolled, loosely adherent, invade neighboring tissue, establish blood vessels Approaches to treatment cure: prolonged absence of disease control: no further growth and palliation : comfort neoadjuvant therapy in the first step to shrink a tumor before the main treatment) surgery is given -chemo, radiation, hormone therapy adjuvant therapy given afer primary treatment to lower risk of cancer coming back -chemo, radiation, hormone, targeted and biologic therapy myeloblation 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 nonmyeloblative not as intense, chemo doses are not as intense LESSON 2: Alkylating Agents -cytoxan -ifosframide -bendamustine platinum based chemo 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 -carboplatin- risk with age >65, harder on kidney function. over shorter period of time, nausea within first 24 hours. neuro tox cyclophasmide 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 iphosphamide neuro changes can occur- personality changes can occur, neuro checks before central line only -need a bladder protective agent 100% of the time nitrosureas cross blood brain barrier - can treat brain tumors. alkylating agents -pulmonary monitoring Lesson 3: Antimetabolites -azacitidine -capacitabine -fluorouracil -cytarabine -decitabine -methotrexate inhibit DNA and RNA synthesis - can cause myelosuppression, GI toxicities, phospotsensitiivty, hand foot syndrome, vigorous I V hydration to prevent tumor lysis 5 fluorouracil (5 FU) -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 methotrexate 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 azacitidine for treatment of myelodysplastic syndrome: group of cancers in which immature blood cells do not mature (SOB and fatigue are markers) Lesson 4 A cautionary tale about routes 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 intrathecal chemo ONLY methotrexate and cytarabine can be given IT -IT hydrocorisone given at same time to reduce inflammation vincristine dilute in 20mL minibag and infuse over short time- IVP not reommended vinblastine -dilute in 25-50 ns Lesson 5 Antitumor Antibiotics -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 nonanthracycline: actinomycin, mitomycin, bleomycin doxorubicin vesicant extravasation possible- must eval cardiac funciton, ongoing cardiac monitoring, hypersensitivity risk -nausea/ vomiting, mucositis, diarrhea, myelosupression, hepatic impairment, secondary cancer -cardiac: SOB< skipped beats, weight gain -myelosuppress: oral temp daily, report >100.5 GI: nausea vomiting diarrhea, inspect mucosa neuro: numbness/ tingling, burning GU: change in color of urine dexrazoxane cardiac protectant given before bleomycin antitumor antibiotic - lifetime dose warning -can cause hypersensitivity, skin reaction -report SOB< skin issues, protect from sun