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NR 292 - Pharm chapters summary.
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NR 292 - PHARM CHAPTERSSUMMARY
Exam 1: chapters 1-thru 7 and 38, 39, 40, 42
Exam 2: chapters: 45, 46, 10, 11, 12, 13,14,15,16,17,26
Chapter 45: Antineoplastic drugs part 1; This chapter discusses the cell cycle–specific
drugs.
Analogue: A chemical compound with a structure similar to that of another compound but differing
from it with respect to some component
Carcinomas: Malignant epithelial neoplasms that tend to invade surrounding tissue and metastasize to
distant regions of the body.
Cell cycle–nonspecific: Denoting antineoplastic drugs that are cytotoxic in any phase of the cellular
growth cycle.
Cell cycle–specific: Denoting antineoplastic drugs that are cytotoxic during a specific phase of the
cellular growth cycle.
Dose-limiting adverse effects: Adverse effects that prevent an antineoplastic drug from being given in
higher dosages, often restricting the effectiveness of the drug.
Extravasation: The leakage of any intravenously or intraarterially administered medication into the
tissue space surrounding the vein or artery; can cause serious tissue injury.
Paraneoplastic syndromes: Symptom complexes arising in patients with cancer that cannot be
explained by local or distant spread of their tumors
Sarcomas Malignant: neoplasms of the connective tissues arising in bone, fibrous, fatty, muscular,
synovial, vascular, or neural tissue, often first presenting as painless swellings.
Metastasis refers to the spreading of a cancer from the original site of growth (primary lesion) to a new
and remote part of the body (secondary or metastatic lesion).
Cancer patients may also experience various groups of symptoms that cannot be directly attributed
to the spread of a cancerous tumor. Such symptom complexes are referred to as paraneoplastic
syndromes.
Cachexia (general ill health and malnutrition) is the most common such symptom complex.
, The cell growth characteristics of normal and neoplastic cells are similar. Both types of cells pass
through five distinct gap phases:
G0, the resting phase, in which the cell is considered out of the cell cycle; Most normal
human cells exist predominantly in this phase. Cancer cells in this phase are not susceptible
to the toxic effects of cell cycle–specific drugs.
G1, the first gap phase; Enzymes necessary for DNA synthesis are produced.
S, the synthesis phase; DNA synthesis takes place, from DNA strand separation to
replication of each strand to create duplicate DNA molecules
G2, the second gap phase; RNA and specialized proteins are made.
M, the mitosis phase: Divided into four subphases: prophase, metaphase, anaphase, and
telophase; cell divides (reproduces) into two daughter cells.
, The percentage of cells undergoing mitosis at any given time is called the growth fraction of the
tumor.
The actual number of cells that are in the M phase of the cell cycle is called the mitotic
index. Chemotherapy is most effective when used in a rapidly dividing or highly proliferative
tumor.
Hematopoietic stem cells are cells in the bone marrow that have the capacity for self-renewal
and repopulation of the different types of blood and bone marrow cells.
The more technical term for cancer is malignant neoplasm. Drugs used to treat cancer are
therefore known as antineoplastic drugs but are also called cancer drugs, anticancer drugs, and,
most commonly, cytotoxic chemotherapy or just chemotherapy. The nomenclature (naming
system) of cancer drugs can be somewhat more complex and confusing than that for other drug
classes. Cancer treatment is an intensively researched area in health care with many active
research protocols. Multiple names are often used for the same drug, depending on its stage of
development.
Antineoplastic drugs that are cytotoxic (cell killing) in any phase of the cycle are called cell cycle–
nonspecific drugs.
Those drugs that are cytotoxic during a specific cell cycle phase are called cell cycle–
specific drugs.
, There are used to treat a variety of solid or circulating tumors
Antimetabolites
Mitotic inhibitors
Alkaloid topoisomerase II inhibitors
Topoisomerase I inhibitors
Antineoplastic enzymes
Myelosuppression, also known as bone marrow suppression or bone marrow depression, is
another unwanted adverse effect of certain antineoplastics. It commonly results from drug- or
radiation-induced destruction of rapidly dividing cells in the bone marrow, primarily the cellular
precursors of WBCs, red blood cells (RBCs), and platelets.
Myelosuppression, in turn, leads to leukopenia, anemia, and thrombocytopenia. The cancer
patient is often at greater risk for infection because of leukopenia (reduced WBC count)
secondary to chemotherapy. Patients often need antibiotics intravenously (IV), either to prevent
or to treat bacterial infections. Such patients are referred to as being neutropenic. Drug-induced
anemia (reduced RBC count) often leads to hypoxia and fatigue, whereas thrombocytopenia
(reduced platelet count) makes the patient more susceptible to bleeding. The lowest level of
WBCs in the blood following chemotherapy (or radiation) treatment is called the nadir.
The nadir normally occurs roughly 10 to 28 days after dosing, depending on the particular drug
or combination of drugs that is used. Anticipation of this nadir based on known cancer drug data
can be used to guide the timing of prophylactic (preventive) administration of antibiotics and
blood stimulants known as hematopoietic growth factors
Common relative contraindications for cancer drugs include very low WBC count. ongoing
infectious process, severe compromise in nutritional and hydration status, reduced kidney or
liver function, or a decline in organ function in any system that may be further affected by the
toxic effect of the drug being administered.
Reduction in fertility is a major concern in postpubertal patients. Cancer also complicates 1 in
1000 pregnancies. All chemotherapy drugs are classified as pregnancy category D. The choice to
use chemotherapy in a pregnant woman is based on risk versus benefit. Both radiation and
chemotherapy treatments can cause significant permanent fetal harm or death. The greatest
risk is during the first trimester. Chemotherapy treatment during the second or third trimester is
more likely to improve maternal outcome without significant fetal risk.
Chemotherapy special considerations
Toxicities
Contraindications
Pregnancy
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