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Barriers to successful treatment
- Toxicity to normal cells
- Low host defense
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Barriers to successful tx
Solid tumors respond poorly - tumors can spread or aggravation can encourage growth
Drug resistance - random DNA mutation, P-gycoprotein can pump out drugs
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Strategies for successful treatment
Intermittent therapy - taking breaks, normal cells heal faster
Combination therapy
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Cancer Treatment Toxicities
Bone marrow suppression
GI tract
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If a pt is experiencing CIN/V, give them what?
Zofran
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Other toxicites from cancer treatment
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Classes of cancer drugs
- Cytotoxic
- Hormonal
- Targeted drugs
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Action of Alkylating agents/Platinum compounds
Forms abnormal cross links between DNA strands
Drug resistance is common
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Anti-metabolite action
Disrupt metabolic processes (imposter)
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What are three classes of anti-metabolites?
- Folic acid analogue
- Pyrimidine analogue
- Purine analogue
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Leucovorin rescue
Methotrexate inhibits folic acid metabolism
Leucovorin allows for normal cells to get folic acid, but not the cancer cells
Timing is important
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Anti-tumor antibiotics
Used only to treat cancer
Administerd IV - cause GI toxicity
Cause bone marrow suppression
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Anti-tumor antibiotic effect on the heart
Cardiotoxic - can cause a delayed MI
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Mitotic inhibitors side effects
Peripheral neuropathy
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Topoisomerase Inhibitors
Disrupt cell division in the S process
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Drugs for tx of prostate cancer
- Leuprolide (Lupron) - GnRH agonist
- Flutamide (Eulixen) - Androgen Receptor Blocker
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Lupron action
Increases release of GnRH in order to down regulate the number of testes receptors
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Androgen receptor blocker
Flutamide (Eulixen)
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Flutamide (Eulixen) action
Blocks receptors depriving the cells of all androgen needed for growth
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SERMs
Block estrogen receptors, which the tumor needs to grow in breast cancer
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Adverse effects of SERMs
- Thromboembolism
- Endometriosis
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SERM drugs
- Tamoxifen (Nolvodex)
- Raloxifine (Evista)
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Aromatase inhibitors are SERMs that will block _________ estrogen, but not ___________
breast tumor
ovarian
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Aromatase inhibitors are used for what?
post-menopausal breast cancer
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Adverse effect of Aromatase inhibitors
Estrogen depletion increases the risk of osteoporosis
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Epogen or Procrit are both hematopoetic growth factor drugs used for what?
Correcting anemia when H/H has fallen below 35%
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Why is Fe, Folic acid and B12 given with Epogen/Procrit?
Because these are things that are needed to make blood
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What hematopoetic drug is given to correct WBC count?
Filgrastim/Neupogen
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Thrombopoetic growth factor
- For people who are anemic from chemo
- For platelet count
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