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After chemotherapy treatment, the chemotherapy drug usually remains in the body for either 3 days or 7 days, depending upon the properties of the drug. The drug is excreted in the urine, stool, vomit, semen, and vaginal secretions during this time. You must take the following precautions until _______________________(Your nurse will write in the date).

If urine, stool, or vomit come in contact with your hands or other body parts, wash the area immediately with soap and water. If caretakers have contact with your body wastes, they should wear latex gloves.

Toilet

Flush the toilet immediately. If you have young children or pets in the home that may have contact with the toilet, flush the toilet twice.

Bedpan, urinal, or emesis (vomit) basin

The caretaker should wear latex gloves when handling the container. After each use, empty and rinse the container well with water. At least once a day, put on latex gloves and wash the item with soap and water. Discard the gloves after each use, and then wash your hands with soap and water.

Diapers

If you need them, wear disposable diapers and/or use disposable bed pads. Caretakers should wear latex gloves when changing diapers or pads. For sanitary reasons andcontainment of odor, it is recommended that you "double bag" the waste by placing the soiled diapers or pads in a tied plastic bag or zip-lock bag, and then place this bag in a tied plastic trash bag. Discard the bag in the trash.

Linens and clothing

Wash linens that are soiled with urine, stool, or emesis as soon as possible. If you cannot wash them immediately, place them in a plastic bag and discard the bag in the trash after the linens are washed. The linens should be washed separately from your other linen, but it is not necessary to change your type of laundry powder or usual way of washing. Soiled linens should be washed a second time. They may be washed with other linens for the second washing. Unsoiled linens can be washed in the usual manner.

Ostomy care

Caretakers should wear latex gloves when emptying or changing the appliance. For sanitary reasons, soiled supplies are discarded by "double bagging." Place the waste first into a plastic tied bag or zip-lock bag, and then put this bag into another plastic bag and discard it in the trash.

Pregnant women

Pregnant women helping patients should avoid coming in contact with the patients' urine, stool, vomit, or semen during treat¬ment and for the first 3 or 7 days after each chemotherapy treatment.

Sexual intercourse

The use of condoms is recommended for 3 or 7 days after therapy to protect your partner from exposure to chemotherapy drugs in your body fluids.

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Chemotherapy Waste | UPMC Hillman Cancer Center

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After chemotherapy treatment, the chemotherapy drug usually remains in the body for either 3 days or 7 days, depending upon the properties of the drug. The drug is excreted in the urine, stool, vomit, semen, and vaginal secretions during this time. You must take the following precautions until _______________________(Your nurse will write in the date).

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A 41-year-old patient-care assistant working on an oncology floor developed an itchy rash approximately 30 minutes after emptying a commode of urine into a toilet [Kusnetz and Condon 2003]. She denied any direct contact with the urine, wore a protective gown and nitrile gloves, and followed hospital policy for the disposal of materials contaminated with antineoplastic drugs. The rash subsided after 1 to 2 days. Three weeks later, she had a similar reaction approximately 1 hour after performing the same procedure for another patient. Upon investigation, it was found that both hospital patients had recently been treated with vincristine and doxorubicin. The patientcare assistant had no other signs or symptoms and reported no changes in lifestyle and no history of allergies or recent infections. After treatment with diphenhydramine (intramuscular) and oral corticosteroids, her symptoms disappeared. Although the cause could not be definitely confirmed, both vincristine and doxorubicin have been associated with allergic reactions when given to patients. The aerosolization of the drug present in the urine may have provided enough exposure for symptoms to develop.

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[1]  Karch, A. M. (2017). Focus on nursing pharmacology. Philadelphia: Wolters Kluwer.

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[2] Karch, A. M. (2017). Focus on nursing pharmacology. Philadelphia: Wolters Kluwer.

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[3]  M. (2016, March 09). Cancer Drugs - Learn with Visual Mnemonics! Retrieved from https://www.youtube.com/watch?v=fIXBa2rExQI
[4]  Tamoxifen: Uses, Side Effects, and More. (n.d.). Retrieved from https://www.breastcancer.org/treatment/hormonal/serms/tamoxifen
[5]  Lopes, J. M. (2018, April 13). Lung Cancer Patients' Survival Is Better with Keytruda Than Chemo, Trial Shows. Retrieved from https://immuno-oncologynews.com/2018/04/13/keytruda-increases-lung-cancer-patients-survival-better-than-chemo/
[6]  Chemotherapy Safety | Chemotherapy. (n.d.). Retrieved August 28, 2018, from https://www.cancercouncil.com.au/cancer-information/cancer-treatment/chemotherapy/safety-precautions/
[7]  Karch, A. M. (2017). Focus on nursing pharmacology. Philadelphia: Wolters Kluwer.

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[8] Karch, A. M. (2017). Focus on nursing pharmacology. Philadelphia: Wolters Kluwer.

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[9] Philippidis, A. (2018, January 15). Top 10 Best-Selling Cancer Drugs, Q1–Q3 2017 | The Lists. Retrieved from https://www.genengnews.com/the-lists/top-10-best-selling-cancer-drugs-q1-q3-2017/77901033
[10] Chemotherapy Waste. (n.d.). Retrieved from http://hillman.upmc.com/patients/community-support/education/miscellaneous/chemotherapy-waste

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Should the oncology patient in the above case study, take an anti-inflammatory like aspirin or Tylonel for pain associated with the treatment of chemotherapy while taking vincristine?

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Antineoplastic Agents - drugs used in cancer chemotherapy
What is chemotherapy? - most people think of fighting cancer, however only one branch of chemotherapy actually involves drugs that destroy human cells.
What is cancer? - starts with one abnormal cell that divides and passes on the abnormalities to it's daughter cells and continues to grow.  The antineoplastic agents target the abnormal cells, however normal cells are also affected.

Antioplastic agents-  there are various types of these agents, which we will discuss today.  These specific drugs fight neoplasms (or cancers).  The unfortunate part of these drugs is they also effect normal healthy cells which can lead to debilitating side effects and a even further weakened immune system. They can have toxic effects on sperm and ova leading to decreased fertility and can be dangerous to a developing fetus.
These drugs tend to attack any rapidly growing cells, for example, hair follicles leading to hair loss in patients, GI tract leading to nausea and vomiting (which is also caused from cell death circulating in the bloodstream)
Much research is being done to create cancer fighting therapy that attacks enzymes that effect only the damaged cells...one of them we will discuss today is imantinib, which is in the category of the protein kinase inhibitor.

In some cases, when the cancer is too big to be destroyed, the agents are used for palliative care to shrink the tumor and to alleviated some signs and symptoms of the cancer (decrease pain and increase functionality for the patient)

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Cancer Drugs - Learn with Visual Mnemonics!

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[9] - Top 10 Best-Selling Cancer Drugs, Q1–Q3 2017

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[9] - Top 10 Best-Selling Cancer Drugs, Q1–Q3 2017

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Top 10 Best-Selling Cancer Drugs, Q1-Q3 2017 | The Lists | GEN

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The combined sales of all 10 drugs on GEN's list from January through September of last year was $39.632 billion, up 15.2% from $34.407 billion in Q1-Q3 2016.

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The nurse is teaching a client about taking aspirin.  Which of the following points are important for the nurse to include in patient teaching?
A.  advising the client to avoid alcohol while taking aspirin.
B.  instructing the client to take aspirin before meals on an empty stomach
C.  instructing the client to inform the dentist of aspirin dosage before any dental work
D.  instructing the client to inform the surgeon of aspirin dosage before any surgery
E.  suggesting that aspirin may be given to children for fly symptoms

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Anti-inflammatory, Antiarthritis, and Related Agents
What is Inflammatory Response? - designed to protect the body from injury and pathogens.  It can be chronic -fever, aches, pains and lethargy are all caused by inflammation.

Anti-Inflammatory Drugs - Several types of drugs are used as anti-inflammatory agents. We will only be discussing drugs that have a direct effect on the inflammatory response: salicylates - aspirin; nonsteroidal anti-inflammatory drugs (NSAID's) - ibuprofen; related agents - acetaminophen; and anti arthritis drugs.
Because these drugs are OTC abuse and over dosing are a concern.
Salicylates - (aspirin in the case of our presentation) are antipyretic (anti fever), and analgesic (pain blocking) non prescription and not toxic line of drugs.
NSAID"s - (ibuprofen) have anti inflammatory, analgesic effects without the adverse effects of corticosteroids
Related Drugs - (acetaminophen) have antipyretic effects but not as strong anti inflammatory effects as salicylates or NSAID's.
Anti arthritis - 2 types: gold compounds that is used in specific patients with rheumatoid arthritis who don't respond to the usual anti inflammatory therapies. For those who do respond well to anti inflammatory therapies there specific drugs used to block inflammation and tissue damage often found with rheumatoid arthritis.

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https://www.breastcancer.org/treatment/hormonal/serms/tamoxifen

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Non-small cell lung cancer (NSCLC) patients with PD-L1 protein in their tumors lived significantly longer when treated with the immunotherapy Keytruda (pembrolizumab) than standard platinum-based chemotherapy, a Phase 3 clinical trial shows.

"Keytruda has now shown a significant survival benefit compared with chemotherapy for patients with locally advanced or metastatic nonsquamous or squamous NSCLC" whose tumors have PD-L1, Roger M. Perlmutter, the president of Merck Research Laboratories, said in a press release.

"Keytruda is a foundational treatment for NSCLC, and has consistently demonstrated a survival benefit as monotherapy [a stand-alone therapy], or in combination with chemotherapy, in the treatment of metastatic lung cancer," he said. "We sincerely thank the patients and clinical [trial] investigators for their participation in this important study."

The global KEYNOTE-042 trial ( NCT02220894) compared Keytruda and standard chemo as a stand-alone, first-line therapy for 1,274 patients with locally advanced or metastatic NSCLC.

Patients were randomly assigned to either a 200-mg dose of Keytruda every three weeks or one of two chemotherapy regimens over a maximum of six cycles. The chemo regimen for patients with squamous (epidermoid) NSCLC was carboplatin plus Taxol (paclitaxel). For nonsquamous NSCLC patients, it was carboplatin plus Alimta (pemetrexed), with an option of adding Alimta.

An independent review board's analysis showed that Keytruda met the trial's main objective of increasing patients' overall survival more than chemo. Its safety profile matched that seen in previous studies of patients with advanced NSCLC.

Researchers will now assess the progression-free survival of Keytruda patients - the length of time it takes for their cancer to worsen. A secondary goal of the trial was to see if Keytruda improved progression-free survival better than chemotherapy.

Merck plans to present the KEYNOTE-042 results at a medical conference and submit them to regulatory authorities worldwide.

"Improvement in overall survival is the ultimate objective in the treatment of advanced lung cancer," said Tony Mok, MD, a professor of clinical oncology at the Chinese University of Hong Kong.

"KEYNOTE-042 is the first randomized Phase 3 study of a single-agent immunotherapy using overall survival as the primary endpoint that has demonstrated significant benefit as a first-line therapy in NSCLC patients who tested positive for PD-L1," Mok added.

Keytruda is an anti-PD-1 antibody that prevents the PD-1 protein in immune T-cells from binding to PD-L1. Cancer cells use the binding to avoid an immune attack. By preventing this interaction, Keytruda boosts T-cells' ability to detect and fight tumor cells.

Merck's clinical trial program for Keytruda is the largest in immuno-oncology, with more than 700 studies in multiple cancers. In lung cancer, the company is evaluating Keytruda both as a stand-alone therapy and in combination with other treatments across multiple stages of the disease NSCLC is the most frequent type of lung cancer, accounting for about 85 percent of cases.

Keytruda is approved in the U.S. and the European Union to treat diverse types of advanced cancers. These include metastatic NSCLC, Hodgkin's lymphoma, colorectal cancer, melanoma, head and neck squamous cell carcinoma, gastric or gastroesophageal junction adenocarcinoma, and locally advanced or metastatic urothelial carcinoma.

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Lung Cancer Patients' Survival Is Better with Keytruda Than Chemo, Trial Shows

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Non-small cell lung cancer (NSCLC) patients with PD-L1 protein in their tumors lived significantly longer when treated with the immunotherapy Keytruda (pembrolizumab) than standard platinum-based chemotherapy, a Phase 3 clinical trial shows. "Keytruda has now shown a significant survival benefit compared with chemotherapy for patients with locally advanced or metastatic nonsquamous or squamous NSCLC" whose tumors have PD-L1, Roger M.

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A nurse is providing instructions to a client receiving an antineoplastic medication.  When implementing the plan, the nurse should tell the client to:
A. Drink beverages containing alcohol in moderate amount during the evening.
B. Eat high fiber rich foods.
C. Take aspirin as needed for headaches
D. Consult with health care providers before receiving immunizations.