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ONS/ONCC Chemotherapy Immunotherapy Certificate Exam
135 Questions with Verified Answers
Lesson 1: Foundations to Set the Stage - CORRECT ANSWER Focusing on Cellular Structure and Function - CORRECT ANSWER The Normal Cell Cycle - CORRECT ANSWER -The cell cycle refers to the ordered seres of processes of DNA replication and mitosis, or cell division -Cell nucleus regulates these processes by gathering and processing complexes molecular information Interphase and Mitotic Phase - CORRECT ANSWER Cell division produces two identical cells through these two major phases During interphase: - CORRECT ANSWER Cell grows and DNA is replicated through the following three steps: 1: First growth phase (G1 or first gap) 2: Synthesis phase (S phase) 3:Mitotic Phse (M phase) First Growth Phase (G1 or first gap) - CORRECT ANSWER -cells increase in size -reproduce RNA -"quality assurance" test that the cell will be ready to synthesis DNA -Length of time is variable, can be from hours to days Synthesis Phase (S phase) - CORRECT ANSWER -DNA replicates -Results in the formation of identical pairs of DNA (chromatids)
-which are attached a t the centromere -lasts 2-10 hours Mitotic Phase (M phase) - CORRECT ANSWER -Replicated chromosomes are aligned, separated, and move into 2 new, identical daughter cells -takes about 30-60 minutes Major points of cell regulation are entry and exit from - CORRECT ANSWER -G checkpoint -S Phase -G2 checkpoint -M phase Restriction Point - CORRECT ANSWER -The transition from the resting phase into an actively dividing phase (G0-G1) is a point where cellular transformation can occur -During this time, cells pass through a transition phase known as a restriction point -Extracellular growth factors trigger reentry into G1, and GF are required to send the cells past the restriction point, or the point of no return G0 Phase (resting phase) - CORRECT ANSWER -After mitosis, cells may enter back into the G1 phase or go into a resting phase, known as G -Most cells in the human body reside in G -Exceptions to this are those that are (Resting in G0 phase) - CORRECT ANSWER - Exceptions to this are those that are metabollically active, such as -granulocytes
Inhibitory proteins - CORRECT ANSWER -prevent progression of the cycle when DNA damage is detected -An example of an inhibitory protein is p53 (AKA TP53) DNA Damage Checkpoints - CORRECT ANSWER -If DNA damage is present, cells are programmed to stop dividing or undergo apoptosis (programmed cell death) -The retinoblastoma protein (Rb), p53, and p21 are some of the most well- understood inhibitory proteins (IP) Inhibitory proteins p53 - CORRECT ANSWER -Levels of this IP regulate several important target genes -Will increase when DNA damage is present -Protects against inappropriate signal proliferation -sometimes called the "suicide gene" M Phase Checkpoints - CORRECT ANSWER When the cells prepare to divide, the chromosomes line up in the mitotic spindle. If the chromosomes are not properly aligned, division is not allowed to continue Immunity - CORRECT ANSWER Cells of the Immune System - CORRECT ANSWER Pluripotent Stem Cell - CORRECT ANSWER -The cells of the immune system are created in the bome marrow from what is know as a ___ -A stem cell that can differentiate into any cell type except for extraembryotic tissue, does not yet have a function Myeolid Precursor Cells - CORRECT ANSWER Mature into:
-RBCS
-Plts -WBCs (Granulocytes) Lymphoid Precursor Cells - CORRECT ANSWER Mature into: -Specialized WBCs called lymphocytes (Agranulocytes) Lines of Defense: The Immune System's Response to Attack - CORRECT ANSWER Consists of 2 types of immunity: 1: Innate 2: Adaptive Innate Immunity - CORRECT ANSWER -First line of defense against a pathogen -Does not retain memory of the entity -Involves the following: (skin, mucous membranes, and normal flora of the skin and gut) (Cellular components such as phagocytes, natural killer cells, granulocytes, and macrophages)
- Phagocytes
- Natural Killer Cells
- Granulocytes
- Macrophages - CORRECT ANSWER 1.Cells that engulf and destroy invader
- Cells that sense receptors on self and non-self to determine if they should kill or not
- Type of WBC that have granules (Neutrophils Eosinophils - parasites Basophils - release histamine to stimulate immune response)
- Large phagocytic cells stimulated by infection
T-Cell - CORRECT ANSWER -Can only recognize antigens when they are presented to them by "presenting cells" -Recognize phagocytized fragments of an antigen that are put on the surface of antigen-presenting cells Helper T-Cells (CD4+) - CORRECT ANSWER -help other T-Cells by secreting chemicals -Help B Cells to respond -rapidly divide, in an effort to stay ahead of the antigen dividsion -some will turn into effector cells, which secrete different kinds of cytokines -respond similarly to B-Cells Cytotoxic T-Cells (CD8+) - CORRECT ANSWER -Directly kill cells for which they are activated to kill -rapidly divide, become mature cells, and start killing antigens Cytokines - CORRECT ANSWER -Secreted by lymphocytes -Tasked with eliminating the antigen -Multifunctional subsances having proinflammatory, anti-inflammatory, and regulatory functions in the immune system Cytokines Include.. - CORRECT ANSWER -Interferons (IFNs) -Tumor necrosis factors -Transforming GFs -Interleukins (IL -1, -2, -3, -4, -6, -8, -10, and -15)
-These cytokines regulate antibody production and the functions of B and T cells as well as interact with antigen-presenting cells and NKCs Benign Tumors - CORRECT ANSWER -encapsulated and grow in an orderly manner with smooth edges -Do not invade neighboring tissue -DO not metastasize to distant sites -the cells well differentiated in that they look like the parent cell Characteristics of Cancer Cells - CORRECT ANSWER -Malignant tumors are not encapsulated -Cell structure is different from parent tissue (no as well differentiated) -Cell division is uncontrolled -Cells are loosely adherent without contact inhibition -Cells are able to invade neighboring tissue -Cells can migrate and metastasize to distant sites -Can stimulate the development of new blood vessels to supply the tumor (angiogenesis) Proto-oncogene - CORRECT ANSWER -regulate normal cell growth and division -large family of genes that code for proteins and enzymes that turn on the cell cyle Oncogene - CORRECT ANSWER when mistakes in copies of DNA can occur, if a mutation occurs next to a proto-oncogene, it can "turn on" and become a ______
- These receptors ae called receptor tyrosine kinases
- To send the message through the membrane, the receptor often has to join with another recetor to become active and t autophophorylate
- This is called dimerization and can be the following: Dimerization - CORRECT ANSWER 1. Homodimerization: binding with the same type of receptor, such as an epidermal GF receptor (EGFR) 1 receptor with another EGFR
- Heterodimerization: binding with a different kind of receptor, such as EGFR binding with EGFR Protein tyrosine kinases phosphorylates - CORRECT ANSWER -turned on by giving up a phosphate molecule -the message is now send via a "bucket bridage", or passing the message from one molecule to other signaling molecules until the message gets first into the cell nucleus -where it is transcribed Pathways - CORRECT ANSWER many pathways and crossalks signaling btw and among the different pathways, and they all have the power to control cell behavior in one way or another mitogen-activating protein kinase (Raf-1/MAPK) pathway - CORRECT ANSWER - shown to decrease the benefits of some cancer drugs -decrease disease-free survival time in some pts mammalian target of rapamycin (mTOR) survival pathway - CORRECT ANSWER - play a role in resistance to some chemotherapy agents in certain pts by keeping cells that have been exposed to chemotherapy from undergoing apoptosis -role in angiogenesis
phosphoinositide 3-kinases (PI3K) - CORRECT ANSWER -transduction enzymes that activate Akt, leading to cell survival, increased cell proliferation, and growith Neoadjuvant Treatment - CORRECT ANSWER -treatment given as a first step to shrink a tumor before the main treatment, usually surgery -examples: chemo, radiation therapy, hormone therapy Adjuvant therapy - CORRECT ANSWER -additonal cancer treatment given after the primary treatment to lower the risk that the cancer can recur -Examples: chemo, radiation therapy, hormone therapy, targeted therapy, or biologic therapy Dose density - CORRECT ANSWER -refers to the drug dose per unit of time -reduction of time between treatments to achieve higher concentration than in a standard treatment plan Dose intensity - CORRECT ANSWER -amount of drug delivered over time -smaller doses of chemotherapy given more frequently Relative dose intensity (RDI) - CORRECT ANSWER -calculated by comparing the dose that the pt received to the planned dose of the standard regimen Oral Chemotherapy - CORRECT ANSWER -greater challenge to adherence because the responsibility falls on the pt and caregiver Nonadherence - CORRECT ANSWER -pt takes too few or too many pills Overadherence - CORRECT ANSWER -when a pt believes a dose was missed or that "more is better", too much medication may be taken, leading to increased toxicity Factor affecting adherence - CORRECT ANSWER -provider relationship
-possibility for a hypersensitivity reaction which is rash, urticaria, erythema, pruritis, rarely bronchospasm and hypotensision -notify RN if itching, scratchy throat, difficulty breathing, rash -Blood count, particularly platelets, monitored because thrombocytopenia is a dose-limiting toxicity -Oral dosage: 1-5mg/kg/day Cisplatin (Planitol) - CORRECT ANSWER -Alkylating agent -nephrotoxic (IV hydration 2-3 L per day) -severe N/V -ovarian and testicular Cyclophosphamide (Cytoxin) - CORRECT ANSWER -Alkylating agent) -hemorrhagic cystitis (dysuria, hematuria, hemorrhage) -DC treatment if hemorrhagic cystitis -adequate hydration Oxaliplatin - CORRECT ANSWER -Alkylating agent -irritant and vesicant, extra caution with the IV site -peripheral neuropathy is a dose-limiting side effect (exacerbated by cold temperatures) -avoid cold drinks and foods, wearing gloves and warm shoes -avoid breathing cold air
Intrathecal Chemotherapy - CORRECT ANSWER -injects chemo directly into the subarachnoid space so it reaches the CNS -Often used to treat leukemia and lymphoma that has spread to the CNS since most IV chemo does not cross the blood-brain barrier -only MTX and cytarabine via this route -IT hydrocortisone is often given at the same time to reduce inflammation -MUST be preservative free to avoid CNS irritation Chemotherapy-Induced N/V (CINV) Risk factors - CORRECT ANSWER -younger -have a hx of low or no alcohol consumption -are female -hx of morning sickness -prone to motion sickness -have had chemo previously Types of CINV - CORRECT ANSWER -Acute: occurring within 24 hours -Delayed: from 24 hour - 5 days after -Breakthrough: Occurring despite treatment -Anticipatory: triggered by taste, odor, memories, visions, anxiety r/t chemo -Refractory: occurring despite subsequent cycles when treatment failed in earlier cycles Prevention/Treatment of hand foot syndrome - CORRECT ANSWER -limit exposure of hands and feet to hot water -take cool showers -avoid exposure to sources of heat, such as using saunas or sitting in the sun
Mucositis - CORRECT ANSWER -inflammation of the mucous membrane lining the digestive tract from mouth to anus -affects 40-100% of pts Stomatitis - CORRECT ANSWER -specifically inflammatory conditions of the mouth Xerostomia - CORRECT ANSWER -dryness of the mouth caused by damage to or dysfunction of the salivary glands Hypersensitivity Reaction (HSR) - CORRECT ANSWER -body mounts an immunologic response to a foreign substance or antigen, resulting in local tissue injury IgE-mediated - CORRECT ANSWER -immediate (within 5 minute) HSR, present like classic allergic reactions T-Cell--Mediated - CORRECT ANSWER -Delayed hypersensitivity reactions, can occur any time after the immediate hypersensitivity window, even days or weeks Type 1 HSR early S/SX - CORRECT ANSWER -pruritus -restlessness, agitation, anxiety, feeling of impending doom -fever, flushing, chills -urticaria (hives) -maculopapular rash -edema of hands, face, and feet -N/V -dyspnea, wheezing, bronchospasm -hypotension, cyanosis -circulatory and respiratory collapse Type IV HSR - CORRECT ANSWER -pneumonitis -mucositis -contact dermatitis -granulomas -Graph vs host disease
Lesson 7: Cumulative Dose - CORRECT ANSWER Cumulative dose - CORRECT ANSWER total amount of one antineoplastic agent given to the pt, adding up each time that the pt has received it Cumulative lifetime dose - CORRECT ANSWER -"cumulative dose should not exceed..." -total amount of specific antineoplastic agents that can be safely given over the course of a pt's lifetime Extravasation - CORRECT ANSWER -leak of a drug capable of causing tissue damage from the vessel in which it is being administered into the surround tissue Irritant - CORRECT ANSWER -causes inflammation, pain, and burning but rarely causes tissue necrosis Vesicants - CORRECT ANSWER -causes blistering and significant pain and tissue damage and destruction, leading to tissue death Vesicants in PIVs - CORRECT ANSWER -Do not use IV in hand, wrist, AC areas -Do NOT place the IV below a recent ventipuncture site used (<24 hours) -Use a flexible IV catheter When a vesicant extravasation occurs or is suspected, take the following steps: - CORRECT ANSWER 1. Immediately STOP administering the vesicant and IV fluids
- Disconnect the IV tubing from the IV device. Do not remove the IV device or noncoring port needle
- Attempt to aspirate residual vesicant from the IV device or port needling use a small (1-3 mL) syringe
- Remove the peripheral IV device or port needle
-targeted therapy ae chosen and designed to interact with their target on or within the cells, whereas chemo were IDed becaused they kill cells -targeted therapies are often cytostatic (they block tumor cell proliferation) whereas chemo agents are cytotoxic (kill tumor cells) Goals of targeted therapy - CORRECT ANSWER -disease cure when used as primary or adjuvant therapy -improving overall response or increase disease-free survival when used in combination with conventional therapies -controlling or stabilizing disease -maintaining or enhancing quality of life -decreasing the severity of toxicities from other therapies Receptor - CORRECT ANSWER -molecule inside or on the surface of a cell that binds to a specific substance causes a specific effect in that cell Monomer - CORRECT ANSWER molecule that can join with other identical monomers to form a structure called a polymer Ligand - CORRECT ANSWER a substance that forms a complex with another biomolecule to exert a biologic effect Ligand Binding - CORRECT ANSWER process by which the ligand attaches to a specific receptor site and activates that receptor, activating the signaling pathway Dimerization - CORRECT ANSWER two monomers that are side-by-side on the surface of the cell are paired and activated by a ligand, which causes a series of signals Kinase - CORRECT ANSWER type of enzyme that adds chemicals called phosphates to other molecules such as sugars or proteins causing other molecules in the cell to become either active or inactive
phosphorylation - CORRECT ANSWER activation of a chemical process to initiate signaling targeted therapies work by doing the following - CORRECT ANSWER 1. blocking angiogenesis
- blocking signals inside or outside the cell
- delivering toxic substances to the cell
- stimulating the body's immune system BCR/ABL - CORRECT ANSWER -fusion protein tyrosine kinase formed with a gene translocation occurs between gene 9 and 22 -gene abnormality called the Philadelphia chromosome seen in CML and ALL VEGF - CORRECT ANSWER this is the primary angiogenic factor produced by cells mTOR - CORRECT ANSWER -target of rapamycin -a protein that tells cells when to grow, divide, and survive Two ways that angiogenesis inhibitors work - CORRECT ANSWER 1. some intergere with action of VEGF which stimulates n ew blood vessel formation
- others target their molecules that stimulate new blood vessel growth Small Molecule Compound Targeted Therapies - CORRECT ANSWER -end in -ib -targets located inside the cell because these gents are able to enter cells more easily -intracellular -most given orally
