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Carcinoma (Rx (Meds (anti neoplastic agent (antimetabolites (Fluorouracil…

- - - - Alkylating agents
        
        v,i, Cisplatin
      - antimetabolites
        
        Fluorouracil (5-FU) nv
        
        Methotrexate (MTX) nv
      - Antibiotics to inhibit DNA synthesis
        
        Doxorubicin (Adriamycin) nv
        
        Bleomycin (Blenoxane) nv
      - Mitotic inhibitor
        
        Vincristine (Oncovin) v
      - Hormone topoisomerase inhibitor
        
        Damage to DNA double strand synthesis
        
        Iriontecan (Campto, CPT11) nv 1st line tfor metastatic colon / rectal carcinomas
      - Plantinum coordination complex
        
        cross link to inhibit DNA replication
        
        Oxaliplatin (Eloxatin) v
      - attac the fast dividing cells
    - - interferon
    - - revent antineoplastic therapy toxicitiy & MTX atagonist antidoe
      - folinic acid (FA, Leucovorin)
    - - Dexamethasone (decadron)
      - tamoxifen
    - - monocolonal antibody to angiogenic factor
      - VEGF inhibitor
        
        Bevacizumab (Avastin)
      - EGfr inhibitor
        
        Cetuximab (Erbitux, C225)
  - - - GI
        
        N&V D&C
        
        anticipatory
        
        due to stress
        
        acute
        
        CNS affected by chemo
        
        Delayed-onset 24 hrs post
        
        toxicity to GI
        
        Chronic
        
        Constipation, dehydration & opiod use
        
        give 5HT-3 emend & zofran
        
        altered taste, dysphagia, anorexia
        
        weight loss
        
        catabolism cause muscle wastage
        
        Cachexia
        
        profound weight loss
        
        care
        
        Diet modification
        
        mouth care prn
        
        check for dehydration & e- balance
        
        Weight loss,
        
        strict I/O and
        
        topical antibiotic
        
        nystatin
      - bone marrow depression
        
        opportunistic infection
        
        fever
        
        oral mucositis & stomatisis
        
        candida
        
        Bleeding
        
        Petechaie, gum bleeding
        
        anaemia
        
        pallor , fatigue, SOB
        
        do CBC
        
        RBC : anemia
        
        WBC: neutropenia
        
        Platelet: Thrombocytopneia
      - Alopecia with eye brows and eyelashes
        
        wear wig, scarf
        
        mild shampoo
        
        growth when chemo discountined
      - Drug extravasation
      - anti neoplastic agent attack the fast dividing cells
      - reproduction
        
        increase chance of genetic disease
        
        sperm / ova bank
      - tumor lysis syndrome
        
        fatal etabolic emergency
        
        usually D2-3 treatment
        
        massive tumor lysis
        
        e+ imblance & nucleic acid
        
        cause renal failure
    - - pain
      - fatigue
      - cardiotoxicity
      - pulmonary toxicity
      - hepato
      - neuro
      - anaphylatic shock
      - nephron
  - - - types
        
        external beam radiation
        
        IGRT Image guided radiotherapy
        
        IMRT intensity modulated radiation therapy
        
        internal therapy
        
        brachotherapy - radiation implants
        
        systemic
        
        PO/IV intracavity
        
        radiosensitizer
        
        cisplatin
        
        radioprotector
        
        radioimmunotherapy
        
        radiolabeled antibody with isotope attach to cancer cells only
      - adverse effect, similar to chemo
        
        attack fast dividing cells
- - - - no invade & metastasize
  - - - large nuclei
      - actively dividing
      - anaplastic
      - no capusle
        
        invade & metastasize
    - - epidermal growth factor receptor EGFR
        
        EGFR still can't stop signalling in KRAS
        
        cetuximab (Erbitux) won't effective in such case
        
        transmit signal to let cancer reproduce and metastasize