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L - light
A - accumulating
S - stimulating
E - emission
R – radiation
Café- au-lait – called giraffe spots or "coast of Maine spots
Prostate cancer
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4. ENGRAFTMENT – period where transfused stem cells are working , good compltibility
Treatment: - Cortecosteroids
MANIFESTATIONS:
1. Non-infectious fever
2. Skin rashes
3. Wt. gain
4. Diarrhea
5. Pulmonary infiltrates
COMPLICATIONS:
1. Failure to engraft
2. Graft versus host dse. in allogenic transplants
3. Veno- occlusive Disease/ Hepatic Sinusoidal Obstructive Syndrome
Cell Cycle-Specific
o S- phase: anti-metabolites
o M- phase: Vinca / plant alkaloids
Cell Cycle-Nonspecific
Others (will vary): too complex to categorize
ONCOLOGY 3
EXAMPLES:
Targets nucleus
o Gifitinib
o Imatinib
o Nilotinib
o Erlontinib
Targets centrioles
o Docetaxel
o Paclitaxel
Targets ribosomes?
o Cladribine
o Hydroxyurea
o Dacarbazine
o Irinotecan
o Procarbazine
SETTINGS
o Hospital
o Outpatient (enter or department)
o Clinic
o Home Care
ONCOLOGY 3
ROUTE
o Topical
o Oral
o IV
o Arterial
o Muscular
o Subcutaneous
o Intracavitary
o Intrathecal- subarachnoid or subdural space, spinal cord
DOSAGE
o Total Body Surface Area, (lawas=dosage)
o Previous responses to chemotherapy or radiation therapy
o Function of major organs
Note:
Oncology: stop the infusion but you don’t have to terminate
Neutralizing agent: prevent tissue death
Mitotane- design for adenocarcinoma
Containdications:
Warfarin
Phenytoin
Spironolactone
NEUTRALIZING SOLUTIONS EXTRAVASATED TISSUES: (to delay necrotic effect)
Sodium thiosulfate
ONCOLOGY 3
Hyaluronidase
Sodium Bicarbonate
Note:
Right atrial silastic catheter/ Venous access device
HYPERSENSITIVITY REACTIONS:
Desensitization procedures
Reduced dosages
Slower infusion rates
PRE-MEDICATION REGIMENS:
TOXICITY:
ONCOLOGY 3
CNS
Stomatitis/Mucositis
Dermatological reactions
Renal Damage
Bone Marrow Depression
Liver Damage
GI effects
Teratogenecity/infertility
GASTROINTESTINAL SYSTEM
Serotonin Blockers
o Ondansetron (Zofran)
o Granisetron (Kytril)
o Dolasetron (Anzenet)
o Palonesetron (Aloxi)
TOXICITY:
- Gastro intestinal system
Meds: decreases n/v
o Dopaminergic blockers
Metoclopramide (Regun)
o Neurokinin 1 Receptor Antagonist
Aprepitant ( Emend)
o Others:
Corticosteroids, Phenothiazines, Histamines, Sedatives
- Non-pharmachologic approach
Relaxation technique
Imagery
Acupressure
- Diet
Small frequent meals
Bland foods
Comfort foods
HEMATOPOIETIC SYSTEM
- Myelosuppression (may occur 7-14 dys after admission)
Leukopenia ( decrease WBC’s)
Neutropenia (decrease granulocytes)
Anemia ( decrease RBC’s)
Thrombocytopenia (decrease platelets)
Increase risk of infection and bleeding
- Nadir Counts
Febrile neutropenia ( < 1,500/mm3)
- Colony Factors
Granulocytes Colony-Stimulating Factor (G-CSF)
Granulocytes Macrophage Colony Stimulating Factor (GM-CSF)
NOTES: G-CSF and GM-CSF stimulate RBC’s production
G-CSF and GM-CSF – slowly administer
RENAL SYSTEM
Factors
o Direct affect during excretion
o Accumulation of end products after cell lysis
Monitor
o BUN
o Serum Creatinine
o Creatinine Clearance
o Serum Electrolyte Levels
Note: creatinine is the by-product of muscle
Interventions:
o Adequate hydration
o Diuresis
o Alkalinization of urine
o Allopurinol – hyperurecemia
o Amifostine – minimizes renal toxicity
Hemorrhagic cystitis
o d/t cyclophosphamide and ifosfamide therapy
o hematuria: microscopic to frank bleeding
o symptoms: ranging from transient irritative irritation dysuria, suprapubic pain , to life threatening
hemorrhage.
Management:
Aggressive IV hydration
Frequent voiding
Diuresis
MESNA (MESNEX)
CYTOPROTECTANT
Prevent bleeding
ONCOLOGY 3