Pharm RED

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Author:
cassiedh
ID:
81658
Filename:
Pharm RED
Updated:
2011-05-01 14:28:05
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ch22
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Description:
cancer chemotherapy
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  1. what is it called when a cell dies as normal part of life and not occur in malignancy?
    apoptosis
  2. _____ is associated with aplification of oncogens
    malignancy
  3. malignancy is associated with _______ of ______
    amplification of oncogenes
  4. what does the cell cycle phase-specific chemotherapeutic agents kill?
    cells progressing through active phases of reproductive cell cycle
  5. t/f in malignant cells apoptosis occurs
    false, no cell death-malignant cells continue to grow
  6. what drug inhibits proliferation of breast cancer cells?
    trastuzumab (Herceptin)
  7. what is an example of a monoclonal antibody therapy?
    trastuzumab (Herceptin)
  8. what are the ADE of chemothereapy agents? 4
    • suppression of bone marrow
    • gastrointestinal disturbances
    • cutaneous manifestations
    • oral manifestations
  9. what happens with chemotherapy agents for suppression of bone marrow?
    increased susceptibility to infection
  10. what gasterointestinal disturbances are ADE with chemotherapy agents
    nausea
  11. what are the cutaneous manifestations of chemo agent?
    alopecia (NOT AFFECT dental tx)
  12. what are the oral manifestations of chemo agents?
    mucositis
  13. what is the term used to describe physiologic programmed cell death?
    apoptosis
  14. what is the most common oral complication with chemo?
    mucositis
  15. what are the four major concerns with mucositis?
    • painful
    • systemic infection
    • erythema
    • ulceration
  16. what is the most feared complication of chemo?
    fungal infection
  17. what is an oral manifestation that is most frequently cuased by DAN viruses?
    Herpes simplex VIRUS infections
  18. what oral manifestation of chemo may reduce platelet formation, inducing thrombocytopenia
    hemorrhage
  19. what oral manifestation contributets to pt discomfort and risk of infection and can contribute to oral candidiasis and opportunistic bacterial phatogens?
    xerostomia
  20. what are the oral manifestations of chemo? 6
    • hemorrhage
    • xerostomia
    • neurologic compolications of pain and neruopathy
    • fungal infections
    • HSV
    • mucositis
  21. what are the neurologic complications of pain and neuropathy? 3
    nucositis, zerostomia and infection
  22. what results in osteonecrosis of jaw, severe oral complications, reduced ability to receive adequate doses of chemotherapy?
    poor oral health
  23. what must be done BEFORE chemotherapy?
    thorough oral exam with clinical and radographic eval
  24. Before chemo a dental exam should be done with _____ and _____ care
    surgical and restorative care
  25. what DH tx should be done before chemo?
    periodontal exam and tx, with oral instructions
  26. during therapy all surgical procedures and hygiene appointment treated _____ days before ____
    • 10 days
    • neutrophenia
  27. what helps to reduce symptoms of mucositis?
    topical agents-viscous lidocaine, diphenhydramine syrup, Aluminum hydroxide (milk of manesia, Mylanta)
  28. what drug is contraindicated with mucositis
    COX 1 inhibitors
  29. what are the most appropriated drugs for mucositis?
    ACETAMINOPHEN and opioid receptor agonists in combination
  30. what saline solution is neutral and least damaging mouth wash to tell pt to use for mucositis?
    1/2 teaspoon salt in 8 oz water
  31. carefully remove dental plaque with soft bristle brush, avoid products irritating to soft tissues, clean teeth every ____ hours, _____ from wearing removable prostheses, eat _____ ____ diet
    • 4 hours
    • REFRAIN
    • soft bland diet
  32. how often sould oral cleansing be preformed?
    every 2-4 hours
  33. what antimicrobial agent should be used with a pt on chemo therapy?
    nonalcohol chlorhexidine .12%
  34. what is the most frequently recommeded agent for fungal infection?
    fluconazole
  35. what drug is no longer recommeded in myelosuppression?
    nystatin
  36. what is the drug of choice in the management of oropharyngela candidiasis ossociated with chemotherapy
    fluconazole
  37. what is the platelet count that toothbrush may be too traumatic?
    <20,000/mm3
  38. what should you do when the platelet count is <20,000/mm3 instead of toothbrushing?
    swab areas with SPONGE soeaked in NON-ALCOHOL clorhexidine
  39. what should be avoided with xerostomia?
    fruit juices and hard or spicy foods
  40. what should you recommend for a pt with xerostomia
    • sip water, rinse mouth frequently, chew xylitol containing gum
    • rinse serveral times/daily with mild saline solution
  41. what is the treatment (drug) for xerostomia?
    pilocarpine (Salagen)-must have residual salivary gland function
  42. what is the first part of the dental examine for pain and neuropathy?
    rule out/eliminate infectious source of pain
  43. what can be given to pt with pain and neuropathy who is clenching and bruxing
    bite guard
  44. what drug is used to treat pt with mild to moderate pain and neuropathy?
    nonopioid analgesic (acetaminophen)
  45. what drugs are used to treat moderate to severe pain with a pt that has pain and neuropathy?
    nonopioid in combination with codeine, oxycodone, hydrocondone and dihydrocodeine
  46. antibiotic prophylaxis should be considered to prevent infection in patients whose neutrophil count is less than?
    2,000/mm3
  47. t/f malignant cells proliferate in isolation
    FALSE! the DO NOT!
  48. what are the three mechanism of action of cytotoxic agents?
    • inhibit DNA synthesis and integrity
    • damage DNA
    • inhibit microtubule funciton
  49. what two ways do cytotoxic agetns work?
    • cell-cycle phase specific
    • cell-cycle phase nonspecific
  50. what is chemotherapy designed to initiate?
    apoptosis (physiologic cell death)
  51. what are three commonly anticancer agents?
    • methotrexate
    • 5-fluorouracil (5-FU)
    • doxorubicin
  52. what is a synthetic compound incorporated into DNA
    antimetabolites
  53. what are the DNA damaging agents?
    • alkylating agents-chlorambucil, cyclophosphamide, estramustine, mechlorethamine, melphalan, carmustine, altretamine, losmustine, busulfan
    • platinum compounds-carboplatin, cisplatin, oxyliplatin
    • bleomycin
  54. what interferes with cell functions of survival (hormonal anticancer drugs)?
    additive or ablative
  55. t/f alopecia affects dental tx
    false! it does NOT
  56. what is the process of interfering with cellular function causing death?
    ablative
  57. what are any family of genes that normally encode proteins involved in cell growth?
    oncogenes
  58. what is the ability of a cell to move from the original tissue to distatn sites not normally containing cells of tha ttype
    metastasize
  59. what drugs are associated with mucostis? 3
    • fluorouracil
    • interferon
    • methotrexate
  60. when does mucositis deveolop following chemo?
    5-10 days
  61. when does mucositis resolve post chemo?
    2-3 weeks
  62. what is essential for phagocytosis of bacteria?
    neutrophils
  63. t/f teeth nonrestorable or with severe perio involvement should be removed before chemo tx
    true
  64. what is cx with mucositis?
    cox-1 inhibitors
  65. what is the best choice for mucositis?
    APA and opoid receptor agonist combo
  66. how often should you use salt and water mixture?
    2-3x/day 5-6 days-helps kill bacteria
  67. ____ is no longer recommended in mylosuppression
    nystatin
  68. what is the drug of choice for resistant cases ofHSV or VZV
    forscarnet
  69. what drus are used for milder immunosuppression viral infections? 3
    • oral acyclovir
    • valacyclovir
    • famciclovir
  70. what is preemptive or treatment for CMV (viral infection)
    ganciclovir or foscarnet
  71. what is an acceptable saliva substitute that replicates the feel of saliva?
    linseed oil (numoisen)
  72. what is the oral doseform availabe for xerostomia tx for a pt with sjogrens
    cevimeline (Evoxac)

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