Test Bank for Fundamentals of Chemotherapy Immunotherapy Administration - Hematologic Cancer Questio

Fundamentals of Chemotherapy Immunotherapy Administration

Oncology

2024

1. Hematologic cancer (blood cancer) - Ans -cancer that begins in bone marrow or immune system cells.

-Ex: leukemia, lymphoma, multiple myeloma Leukemia - Ans cancer starts in blood-forming tissues like bone marrow causes lots of abnormal blood cells to be produced and enter bloodstream

2. Lymphoma - Ans -cancer that begins in immune system (WBC=lymphocytes) -hodgkin and non-hodgkins -B lymphocytes (B cells) - make antibodies (bacteria and viruses, most common lymphoma -T lymphocytes (T cells) - boost/slow immune, destroy germs and abnormal cells

3. Hodgkin lymphoma - Ans Reed-Sternberg cell (cancer cells in classic) -typically starts in B cells 4. Non-Hodgkin's Lymphoma - Ans -large, diverse group of cancers in immune system cells -indolent (slow growing) or aggressive (fast) 5. Myeloma - Ans Cancer in plasma cells (WBC that produce antibodies) 6. Chemotherapy - Ans All antineoplastic agents used to treat cancer, given through oral and parenteral routes or other routes as specified in the standard, not including hormonal therapies.

7. Who can order chemotherapy? - Ans Written and signed by licensed independent practitioners (MD/DO, PA, Oncology NP) 8. Can you use verbal orders for chemotherapy? - Ans NO! Only when holding/stopping admin.

9. Who can mix Chemotherapy? - Ans Pharmacist, Pharmacy tech, MD/DO, qualified RN 10. Who can administer chemotherapy? - Ans Registered Nurses with specialized education, prep and training. See specific state laws and statutes 11. How often is chemo competency reassessed> - Ans Annual continuing ed and competency assessment is recommended 12. What is the dose verification process? - Ans -confirm plan with patient -two practitioners verify: drug name, dose, volume, rate, route, expiration date, appearance -document verification in chart

13. What PPE is required for IV Chemotherapy? - Ans -Gloves: two pairs, HD tested -Gown: disposable, back closed, long sleeved -Respirator: NIOSH approved -Eye & Face: face shield/mask 14. Neoadjuvant therapy (tumor burden) - Ans Chemo BEFORE primary treatment (common in breast and colon) 15. Adjuvant therapy - Ans Chemo AFTER primary treatment (common in solid tumor) 16. Bone Marrow - Ans soft, sponge-like tissue in center of most bones, produce WBC, RBC, and platelets.

17. Myelosuppression - Ans bone marrow activity is decreased, causing less RBC, WBC and Platelets.

18. Myeloablation - Ans severe myelosuppression 19. Induction phase - Ans initial phase, typically in hospital, intended myelosuppression 20. Consolidation phase (intensification/postremission therapy) - Ans after successful induction, kills cancer cells left in body (ex radiation, stem cell transplant) 21. Synergy - Ans when one chemo drug helps another work better at the same time 22. Complete response - Ans no identifiable cancer present for at least one month or longer 23. Partial response - Ans Measurable tumor reduced by 50% for at least one month with no new tumors 24. Stable disease - Ans Tumor size reduced by less than 50% or less than 25% increase in growth 25. Progressive disease - Ans tumor growth more than 25% or new cancer 26. What are the phases of the cell cycle? - Ans -G1 phase -S phase -G2 phase -M phase 27. What happens in G1 phase? - Ans The cell increases in size and prepares to replicate its DNA. 28. What do chemo drugs do to target S phase? - Ans Prevent cell from making DNA and/or RNA (replicating) (ex: antifolates (methotrexate), antipyrimidines (5-fu), antipurines (hydroxyurea)) 29. What do chemo drugs do to target G2 phase? - Ans Cells prepare to divide, chemo drugs stop development of elements needed for cell division (ex: topoisomerase I and II inhibitors, bleomycin) 30. What do chemo drugs do to target M phase? - Ans Cells divide, drugs prevent cell division, including metaphase arrest or microtubular disorganization 31. (ex: plant alkaloids and taxanes) 32. What are some examples of cell cycle non-specific drugs? - Ans Active throughout the cell cycle: -alkylating agents -anthracycline antibiotics -nitrosureas -miscellaneous 33. What are alkylating agents? - Ans -cell cycle nonspecific -damage DNA to prevent cancer cells from reproducing -create breaks in DNA 34. Cyclophosphamide? - Ans -alkylating agent -treats: leukemia, lymphoma, breast/ovarian CA, myeloma, neuroblastoma, mycosis fungoides, retinoblastoma.

-IV, oral, peritoneal -important to hydrate, prevent hemorrhagic cystitis

35. Cisplatin? - Ans -alkylating agent -treats: bladder, testes, ovaries, endometrial, lung, squamous cell of head/neck -IV, peritoneal -high N/V -no aluminum PIV -hearing loss and peripheral neuropathy with long term use

36. Carboplatin? - Ans -alkylating agent -treats: ovarian and off-label use -IV only -dose calculated using calvert formula -no aluminum PIV

37. Oxaliplatin - Ans -alyklating agent -with 5-fluorouracil/leucovorin -Adjuvant treatment: colorectal, testicular, esophageal, pancreatic, gastric, hepatobillary, ovarian, lymphoma -IV only -premed with anti-emetic and dexamethasone

38. Antimetabolites - Ans -stops cells from using folic acid to make DNA (S phase) -Kills cancer cells -cause myelosuppression, N/V, mucositis, GI toxicity

39. Methotrexate - Ans -Antimetabolites -treats: leukemia, lung, breast, head/neck, lymphoma, mycosis fungoides, choriocarcinoma, osteogenic sarcoma -OFF-LABEL: bladder CA, immunosuppression, psoriasis, RA, post-hematopoietic stem cell transplant IV, IM, intrathecal, arterial -monitor renal function 40. Leucovorin calcium - Ans -chemoprotective and chemosensitizing agent -form of folic acid -drug used to lessen toxic effects of methotrexate which blocks action of folic acid.

41. 5-fluorouracil - Ans -Antimetabolites -treat: colon, rectal, breast, stomach, pancreatic, actinic keratosis -IV, TOPICAL

-can use with leucovorin to enhance drug activity -assess oral before/after infusion

42. Antitumor antibiotics - Ans -blocks cell growth by interfering with DNA -nonspecific effect on cell life cycle 43. Doxorubicin - Ans -antitumor antibiotic -treats: solid tumor, hematologic malignancies (breast, prostate, ovarian, lymphomas) -IV push, slow or continuous -urine turns red/orange -vesicant, monitor cardiac function 44. Nitrosoureas - Ans can cross the blood-brain barrier -inhibit DNA/RNA synthesis -interfere with enzymes to copy/repair DNA -long nadir (4-6 weeks) 45. Carmustine - Ans -nitrosourea -treats: brain, lymphoma, myeloma, melanoma, sarcoma, breast, colon, rectal, liver, stomach -IV, arterial, topical, intratumoral -can cause renal toxicity/failure

46. Camptothecins - Ans -topoisomerase I inhibitor -drug blocks enzyme that helps unwind strands in cell reproduction 47. Irinotecan - Ans -Camptothecin Topoisomerase I inhibitor -treats: colorectal, esophageal, gastric, glioblastoma, lung, pancreatic -IV only -severe diarrhea, fluid repletion 48. Plant alkaloids - Ans Work in late G2 and S phases; interfere with topoisomerase II enzyme 49. Paclitaxel - Ans -plant alkaloid -common in combo with cisplatin -treats: ovarian, breast, lung CA no surgery, AIDS related kaposi sarcoma -admin IV only in filter -anaphylaxis, pre-medicate w/pepcid, benadryl, dex 50. Etoposide - Ans -Plant alkaloids -treats: testicular and small cell Lung, off-labels too -IV only, (30-60 min) -can cause anaphylaxis and hypotension 51. Vincristine - Ans -plant alkaloid -treat: lymphoma, leukemia, neuroblastoma, rhabdomyosarcoma -vesicant -IV push or rapid infusion (15 min) -FATAL IF INTRATHECALLY -may develop ileus

52. Hydroxyurea - Ans -antimetabolite/miscellaneous -treats: leukemia, melanoma, inoperable ovarian, with radiation for head/neck, prophylaxis of sickle-cell -ORAL ONLY -consider risks with gout 53. Hormone therapy - Ans -treatment that adds, blocks, removes hormones -hormones can cause cancers (ovarian, prostate) -surgery may remove gland that produces hormone -synthetic hormones may block natural hormones 54. Prostate cancer (hormone therapy) - Ans -androgen (testosterone) cause prostate cell growth -androgen suppression decreases testosterone -castration resistant (less effective over time) 55. Breast cancer (hormone therapy) - Ans -hormone receptor-positive (HR+) - most common -goal: decrease estrogens/progestins -treatment depends on (pre/post menopause) 56. Hormone receptor positive - Ans -cells with proteins that bind to specific hormones -need estrogen or progesterone to grow -can affect treatment 57. Tamoxifen - Ans -estrogen receptor antagonist & receptor modulator -HR+ breast CA -binds to estrogen receptors, alters estrogen genes -ORAL ONLY -can increase ovulation (birth control) 58. Leuprolide - Ans -breast and prostate CA -block LHRH from hypothalamus, block hormone from anterior pituitary gland -Breast=IM q4w ---- Prostate=SC or IM q4-24w -only FDA approved for prostate 59. Targeted therapy - Ans -identify/attack specific cancer cells, less harm to normal -block action or deliver toxic substances to cancer cell -fewer side effects to other treatments 60. Small molecule inhibitors - Ans -tyrosine kinase inhibitors (TKIs) -Mammalian target of rapamycin (mTOR) inhibitors 61. Tyrosine kinase inhibitors (TKIs) - Ans TK = direct cell growth, signaling and division -inhibiting them stops cancer cell growth -drug-drug interaction - TKIs metabolized by CYP 62. Imatinib - Ans -TKI -leukemia -ORAL ONLY -monitor GI upset, and weight gain 63. Lapatinib - Ans -targeted therapy -breast CA -ORAL ONLY -decreased LVEF, no grapefruit juice

64. T-Cell (T lymphocyte) - Ans -type of WBC -part of immune system from stem cells in bone marrow -protect body from infection, fight CA 65. B-Cell (B lymphocyte) - Ans -type of WBC that make antibodies -part of immune system from stem cells in bone marrow 66. Natural killer cell - Ans -immune cell with granules (contain enzymes that kill tumor cells or cells with virus) -type of WBC 67. Immunotherapy as Cancer therapy - Ans -stimulate/suppress immune system to fight Cancer, diseases and infection -some target specific immune cells -some affect entire immune system 68. immune checkpoint inhibitor - Ans -drug that blocks some proteins in immune system -when blocked, Tcells can kill caner cells better -CTLA-4, PD-1, PD-L 1 69. Immune-related adverse events (irAEs) - Ans -inflammation in one or more organ systems -Grade 1 = continue therapy -Grade 2 = hold inhibitor until grade 1 or lower -Grade 3 = hold inhibitors, high dose corticosteroid over 6 weeks -Grade 4 = permanent discontinuation 70. Ipilumumab - Ans -melanoma -checkpoint inhibitor CTLA-4 -IV only -derm, liver, GI toxicities 71. Nivolumab - Ans -melanoma, lung CA, renal, Hodgkin, head/neck, urothlial -checkpoint inhibitor: PD-1 -IV ONLY -liver, kidney toxicities, colitis, electrolytes 72. Cytokines - Ans -proteins made by immune and non-immune cells -can be made in lab -some stimulate immune system, some slow it down 73. Interferons - Ans -natural substance made by WBC to fight diseases -can be made in lab -help keel cancer cells from growing, kills cancer cells -SI and fatigue 74. Interleukin (IL) - Ans -proteins made by WBC and other cells -regulate immune response -lab made: boost immune system in CA treatment 75. Immunomodulators - Ans -multiple myeloma -change the body's immune system -agents activate/suppress function 76. Monoclonal antibodies - Ans -lab made antibodies -mimic antibodies in immune system Murine - made from mice

Chimeric - part mouse/part human Humanized - mice antibodies attach human antibodies Human - fully human antibodies 77. Rituximab - Ans -M antibodies (nAbs) -mixed mice/human -treat: non-hodgkkins, CLL, RA, granulomatosis, polyangiitis -IV only -premed w/ tylenol, benadryl, -hold HTN meds for previous 12 hrs

78. Trastuzumab - Ans - breast and gastric CA -mAb - HUMANIZED -IV only -no previous cardiac condition, not pregnant

79. Angiogenesis - Ans -blood vessel formation -tumor angiogenesis - new blood vessels tumors need to grow -release of chemicals by tumor and by host cells 80. Antiangiogenic Agents - Ans -keep new blood vessels from forming -prevent growth of new blood vessels tumors need to grow 81. Bevacizumab - Ans -colon, lung, glioblastoma, renal, off label -mAb- humanized -IV (do not push), intravitreal (unlabled) -can cause GI perf, protenuria, fistula, hemorrhage -do not give 28 days before surgery 82. Intraperitoneal - Ans -chemo into abdominal cavity -pt changes positions to distribute chemo 83. Intravesicular - Ans chemo delivered directly into bladder avoiding systemic chemo effects -through cath 84. Intrapleural - Ans throacotomy tube into pleural lining -treats some lung CA that produce malignant pleural effusions 85. Intrathecal/Intraventricular - Ans directly into the cerebrospinal fluid -prevents/treats CA cells that cant be reached systemically b/c blood brain barrier 86. Flare reaction - Ans localized allergic reaction along a vein caused by irritating drugs 87. Infiltration - Ans leaving of IV meds into the surrounding tissue 88. Extravasation - Ans Leaking of IV vesicant meds into SC or subdermal tissues

89. Cytokine release syndrome (CRS) - Ans systemic-inflammatory reaction occurring after the administration of agents that target the immune system and can be life threatening -interferons, ILs, mAbs, Car-t -30min-2hrs after -- up to 7 days

90. Hematologic cancer (blood cancer) - Ans-cancer that begins in bone marrow or immune system cells.

-Ex: leukemia, lymphoma, multiple myeloma 91. Leukemia - Anscancer starts in blood-forming tissues like bone marrow -causes lots of abnormal blood cells to be produced and enter bloodstream 92. Lymphoma - Ans-cancer that begins in immune system (WBC=lymphocytes) -hodgkin and non-hodgkins -B lymphocytes (B cells) - make antibodies (bacteria and viruses, most common lymphoma -T lymphocytes (T cells) - boost/slow immune, destroy germs and abnormal cells 93. Hodgkin lymphoma - AnsReed-Sternberg cell (cancer cells in classic) -typically starts in B cells

94. Non-Hodgkin's Lymphoma - Ans-large, diverse group of cancers in immune system cells -indolent (slow growing) or aggressive (fast) 95. Myeloma - AnsCancer in plasma cells (WBC that produce antibodies) 96. Chemotherapy - AnsAll antineoplastic agents used to treat cancer, given through oral and parenteral routes or other routes as specified in the standard, not including hormonal therapies.

97. Who can order chemotherapy? - AnsWritten and signed by licensed independent practitioners (MD/DO, PA, Oncology NP) 98. Can you use verbal orders for chemotherapy? - AnsNO! Only when holding/stopping admin.

99. Who can mix Chemotherapy? - AnsPharmacist, Pharmacy tech, MD/DO, qualified RN 100.

Who can administer chemotherapy? - AnsRegistered Nurses with specialized education, prep and training. See specific state laws and statutes 101.

How often is chemo competency reassessed> - AnsAnnual continuing ed and competency assessment is recommended 102.

What is the dose verification process? - Ans-confirm plan with patient 103.

-two practitioners verify: drug name, dose, volume, rate, route, expiration date, appearance -document verification in chart 104.

What PPE is required for IV Chemotherapy? - Ans-Gloves: two pairs, HD tested -Gown: disposable, back closed, long sleeved -Respirator: NIOSH approved -Eye & Face: face shield/mask

105.

Neoadjuvant therapy (tumor burden) - AnsChemo BEFORE primary treatment (common in breast and colon) 106.

Adjuvant therapy - AnsChemo AFTER primary treatment (common in solid tumor) 107.

Bone Marrow - Anssoft, sponge-like tissue in center of most bones, produce WBC, RBC, and platelets.

108.

Myelosuppression - Ansbone marrow activity is decreased, causing less RBC, WBC and Platelets.

109.

Myeloablation - Anssevere myelosuppression 110.

Induction phase - Ansinitial phase, typically in hospital, intended myelosuppression 111.

Consolidation phase (intensification/postremission therapy) - Ansafter successful induction, kills cancer cells left in body (ex radiation, stem cell transplant) 112.

Synergy - Answhen one chemo drug helps another work better at the same time 113.

Complete response - Ansno identifiable cancer present for at least one month or longer 114.

Partial response - AnsMeasurable tumor reduced by 50% for at least one month with no new tumors 115.

Stable disease - AnsTumor size reduced by less than 50% or less than 25% increase in growth 116.

Progressive disease - Anstumor growth more than 25% or new cancer 117.

What are the phases of the cell cycle? - Ans-G1 phase -S phase -G2 phase -M phase

118.

What happens in G1 phase? - AnsThe cell increases in size and prepares to replicate its DNA. 119.

What do chemo drugs do to target S phase? - AnsPrevent cell from making DNA and/or RNA (replicating) 120. (ex: antifolates (methotrexate), antipyrimidines (5-fu), antipurines (hydroxyurea)) 121.

What do chemo drugs do to target G2 phase? - AnsCells prepare to divide, chemo drugs stop development of elements needed for cell division 122. (ex: topoisomerase I and II inhibitors, bleomycin) 123.

What do chemo drugs do to target M phase? - AnsCells divide, drugs prevent cell division, including metaphase arrest or microtubular disorganization 124. (ex: plant alkaloids and taxanes) 125.

What are some examples of cell cycle non-specific drugs? - AnsActive throughout the cell cycle: -alkylating agents -anthracycline antibiotics -nitrosureas -miscellaneous 126.

What are alkylating agents? - Ans-cell cycle nonspecific -damage DNA to prevent cancer cells from reproducing -create breaks in DNA 127.

Cyclophosphamide? - Ans-alkylating agent 128.

-treats: leukemia, lymphoma, breast/ovarian CA, myeloma, neuroblastoma, mycosis fungoides, retinoblastoma.

129.

-IV, oral, peritoneal 130.

-important to hydrate, prevent hemorrhagic cystitis

131.

Cisplatin? - Ans-alkylating agent -treats: bladder, testes, ovaries, endometrial, lung, squamous cell of head/neck -IV, peritoneal -high N/V -no aluminum PIV -hearing loss and peripheral neuropathy with long term use

132.

Carboplatin? - Ans-alkylating agent -treats: ovarian and off-label use -IV only -dose calculated using calvert formula -no aluminum PIV

133.

Oxaliplatin - Ans-alyklating agent -with 5-fluorouracil/leucovorin -Adjuvant treatment: colorectal, testicular, esophageal, pancreatic, gastric, hepatobillary, ovarian, lymphoma -IV only --premed with anti-emetic and dexamethasone

134.

Antimetabolites - Ans-stops cells from using folic acid to make DNA (S phase) -Kills cancer cells -cause myelosuppression, N/V, mucositis, GI toxicity

135.

Methotrexate - Ans-Antimetabolites -treats: leukemia, lung, breast, head/neck, lymphoma, mycosis fungoides, choriocarcinoma, osteogenic sarcoma -OFF-LABEL: bladder CA, immunosuppression, psoriasis, RA, post-hematopoietic stem cell transplant -IV, IM, intrathecal, arterial -monitor renal function

136.

Leucovorin calcium - Ans-chemoprotective and chemosensitizing agent -form of folic acid -drug used to lessen toxic effects of methotrexate which blocks action of folic acid.

137.

5-fluorouracil - Ans-Antimetabolites -treat: colon, rectal, breast, stomach, pancreatic, actinic keratosis -IV, TOPICAL -can use with leucovorin to enhance drug activity -assess oral before/after infusion 138.

Antitumor antibiotics - Ans-blocks cell growth by interfering with DNA -nonspecific effect on cell life cycle 139.

Doxorubicin - Ans-antitumor antibiotic -treats: solid tumor, hematologic malignancies (breast, prostate, ovarian, lymphomas) -IV push, slow or continuous -urine turns red/orange -vesicant, monitor cardiac function

140.

Nitrosoureas - Anscan cross the blood-brain barrier -inhibit DNA/RNA synthesis -interfere with enzymes to copy/repair DNA -long nadir (4-6 weeks)

141.

Carmustine - Ans-nitrosourea -treats: brain, lymphoma, myeloma, melanoma, sarcoma, breast, colon, rectal, liver, stomach -IV, arterial, topical, intratumoral -can cause renal toxicity/failure

142.

Camptothecins - Ans-topoisomerase I inhibitor -drug blocks enzyme that helps unwind strands in cell reproduction

143.

Irinotecan - Ans-Camptothecin Topoisomerase I inhibitor -treats: colorectal, esophageal, gastric, glioblastoma, lung, pancreatic -IV only -severe diarrhea, fluid repletion 144.

Plant alkaloids - AnsWork in late G2 and S phases; interfere with topoisomerase II enzyme 145.

Paclitaxel - Ans-plant alkaloid -common in combo with cisplatin -treats: ovarian, breast, lung CA no surgery, AIDS related kaposi sarcoma -admin IV only in filter -anaphylaxis, pre-medicate w/pepcid, benadryl, dex 146.

Etoposide - Ans-Plant alkaloids -treats: testicular and small cell Lung, off-labels too -IV only, (30-60 min)-can cause anaphylaxis and hypotension

147.

Vincristine - Ans-plant alkaloid -treat: lymphoma, leukemia, neuroblastoma, rhabdomyosarcoma -vesicant -IV push or rapid infusion (15 min) -FATAL IF INTRATHECALLY -may develop ileus 148.

Hydroxyurea - Ans-antimetabolite/miscellaneous -treats: leukemia, melanoma, inoperable ovarian, with radiation for head/neck, prophylaxis of sickle-cell -ORAL ONLY -consider risks with gout

149.

Hormone therapy - Ans-treatment that adds, blocks, removes hormones -hormones can cause cancers (ovarian, prostate) -surgery may remove gland that produces hormone -synthetic hormones may block natural hormones

150.

Prostate cancer (hormone therapy) - Ans-androgen (testosterone) cause prostate cell growth -androgen suppression decreases testosterone -castration resistant (less effective over time) 151.

Breast cancer (hormone therapy) - Ans-hormone receptor-positive (HR+) - most common -goal: decrease estrogens/progestins -treatment depends on (pre/post menopause) 152.

Hormone receptor positive - Ans-cells with proteins that bind to specific hormones -need estrogen or progesterone to grow 153.

-can affect treatment

154.

Tamoxifen - Ans-estrogen receptor antagonist & receptor modulator -HR+ breast CA -binds to estrogen receptors, alters estrogen genes -ORAL ONLY -can increase ovulation (birth control)

155.

Leuprolide - Ans-breast and prostate CA -block LHRH from hypothalamus, block hormone from anterior pituitary gland -Breast=IM q4w ---- Prostate=SC or IM q4-24w -only FDA approved for prostate

156.

Targeted therapy - Ans-identify/attack specific cancer cells, less harm to normal -block action or deliver toxic substances to cancer cell -fewer side effects to other treatments 157.

Small molecule inhibitors - Ans-tyrosine kinase inhibitors (TKIs) -Mammalian target of rapamycin (mTOR) inhibitors 158.

Tyrosine kinase inhibitors (TKIs) - AnsTK = direct cell growth, signaling and division -inhibiting them stops cancer cell growth -drug-drug interaction - TKIs metabolized by CYP 159.

Imatinib - Ans-TKI -leukemia -ORAL ONLY -monitor GI upset, and weight gain 160.

Lapatinib - Ans-targeted therapy -breast CA -ORAL ONLY -decreased LVEF, no grapefruit juice 161.

T-Cell (T lymphocyte) - Ans-type of WBC -part of immune system from stem cells in bone marrow -protect body from infection, fight CA 162.

B-Cell (B lymphocyte) - Ans-type of WBC that make antibodies -part of immune system from stem cells in bone marrow 163.

Natural killer cell - Ans-immune cell with granules (contain enzymes that kill tumor cells or cells with virus) -type of WBC 164.

Immunotherapy as Cancer therapy - Ans-stimulate/suppress immune system to fight Cancer, diseases and infection -some target specific immune cells -some affect entire immune system 165. immune checkpoint inhibitor - Ans-drug that blocks some proteins in immune system -when blocked, Tcells can kill caner cells better -CTLA-4, PD-1, PD-L 1 166.

Immune-related adverse events (irAEs) - Ans-inflammation in one or more organ systems -Grade 1 = continue therapy -Grade 2 = hold inhibitor until grade 1 or lower -Grade 3 = hold inhibitors, high dose corticosteroid over 6 weeks -Grade 4 = permanent discontinuation

167.

Ipilumumab - Ans-melanoma -checkpoint inhibitor CTLA-4 -IV only -derm, liver, GI toxicities

168.

Nivolumab - Ans-melanoma, lung CA, renal, Hodgkin, head/neck, urothlial -checkpoint inhibitor: PD-1 -IV ONLY -liver, kidney toxicities, colitis, electrolytes 169.

Cytokines - Ans-proteins made by immune and non-immune cells -can be made in lab -some stimulate immune system, some slow it down

170.

Interferons - Ans-natural substance made by WBC to fight diseases -can be made in lab -help keel cancer cells from growing, kills cancer cells -SI and fatigue 171.

Interleukin (IL) - Ans-proteins made by WBC and other cells -regulate immune response -lab made: boost immune system in CA treatment

172.

Immunomodulators - Ans-multiple myeloma -change the body's immune system -agents activate/suppress function 173.

Monoclonal antibodies - Ans-lab made antibodies -mimic antibodies in immune system -Murine - made from mice -Chimeric - part mouse/part human -Humanized - mice antibodies attach human antibodies -Human - fully human antibodies 174.

Rituximab - Ans-M antibodies (nAbs) -mixed mice/human -treat: non-hodgkkins, CLL, RA, granulomatosis, polyangiitis -IV only -premed w/ tylenol, benadryl, -hold HTN meds for previous 12 hrs 175.

Trastuzumab - Ans- breast and gastric CA -mAb - HUMANIZED -IV only -no previous cardiac condition, not pregnant 176.

Angiogenesis - Ans-blood vessel formation -tumor angiogenesis - new blood vessels tumors need to grow -release of chemicals by tumor and by host cells

177.

Antiangiogenic Agents - Ans-keep new blood vessels from forming -prevent growth of new blood vessels tumors need to grow

178.

Bevacizumab - Ans-colon, lung, glioblastoma, renal, off label -mAb- humanized -IV (do not push), intravitreal (unlabled) -can cause GI perf, protenuria, fistula, hemorrhage -do not give 28 days before surgery 179.

Intraperitoneal - Ans-chemo into abdominal cavity -pt changes positions to distribute chemo 180.

Intravesicular - Anschemo delivered directly into bladder avoiding systemic chemo effects -through cath 181.

Intrapleural - Ansthroacotomy tube into pleural lining -treats some lung CA that produce malignant pleural effusions 182.

Intrathecal/Intraventricular - Ansdirectly into the cerebrospinal fluid -prevents/treats CA cells that cant be reached systemically b/c blood brain barrier 183.

Flare reaction - Anslocalized allergic reaction along a vein caused by irritating drugs 184.

Infiltration - Ansleaving of IV meds into the surrounding tissue 185.

Extravasation - AnsLeaking of IV vesicant meds into SC or subdermal tissues 186.

Cytokine release syndrome (CRS) - Anssystemic-inflammatory reaction occurring after the administration of agents that target the immune system and can be life threatening -interferons, ILs, mAbs, Car-t -30min-2hrs after -- up to 7 days