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Chapter 8 - Immune system and malignant disease > 2. Principles of chemotherapy > Flashcards

2. Principles of chemotherapy Flashcards

1
Q

What is chemotherapy?

A

Cytotoxic drugs that kill cancerous cells (cells that uncontrollably divide and are abnormal) to stop it from spreading

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2
Q

Cytotoxic drug classes

A
  • ANTHRACYCLINES:
  • VINCA ALKALOIDS:
  • ANTIMETABOLITES:
  • ALKYLATING DRUG:
  • PLATINUM/DNA CROSS LINKERS
  • TAXANES
  • OTHER ANTIBIOTICS
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3
Q

Anthracycline cytotoxics

A

ANTHRACYCLINES:
* Doxorubicin
* Daunorubicin

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4
Q

Vinca alkaloids cytotoxics

A

VINCA ALKALOIDS:
* Vinblastine
* Vincristine
[Vin-] (more)

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5
Q

Antimetabolite cytotoxics

A

ANTIMETABOLITES:
* Mercaptopurine
* Methotrexate
* Fluorouracil
* Gemcitabine (more)

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6
Q

Alkylating cytotoxics

A

ALKYLATING DRUG:
* Cyclophosphamide
* Melphalan
* Chlorambucil (more)

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7
Q

Platinum cytotoxics

A

PLATINUM/DNA CROSS LINKERS
* Cisplatin
* Carboplatin

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8
Q

Taxane cytotoxics

A

TAXANES
* Docetaxel
* Paclitaxel

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9
Q

Cytotoxic drug classes (broken down)

A

ANTHRACYCLINES:
* Doxorubicin
* Daunorubicin

VINCA ALKALOIDS:
* Vinblastine
* Vincristine
[Vin-]

ANTIMETABOLITES:
* Mercaptopurine
* Methotrexate
* Fluorouracil
* Gemcitabine (more_

ALKYLATING DRUG:
* Cyclophosphamide
* Melphalan
* Chlorambucil (more)

PLATINUM/DNA CROSS LINKERS
* Cisplatin
* Carboplatin

TAXANES
* Docetaxel
* Paclitaxel

OTHER ANTIBIOTICS
* Bleomycin
* Mitomycin

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10
Q

Types of cytotoxic drugs

A

Neo-adjuvant - initial chemotherapy to shrink primary tumour before radiotherapy/surgery

Adjuvant - used with radiotherapy/surgery

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11
Q

How should chemotherapy be handled?

A
  • Only trained staff in a designated area
  • Must wear protective gear
  • Must have spills and waste disposal procedures
  • Must monitor staff exposure

PREGNANT STAFF MUST AVOID

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12
Q

Ways to reduce risk of incorrect dosing of oral cytotoxic drugs

A

Non-specialists who prescribe or administer chemotherapy MUST have access to written protocols or treatment plan

During dispensing,
* confirm dose
* Patient must have written information

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13
Q

Cytotoxic drug side effects (#10)

A
  • Alopecia
  • Extravasation
  • Oral mucositis
  • Pregnancy and fertility
  • Venous thromboembolism
  • Urothelial toxicity
  • Hyperuricaemia
  • Bone marrow suppression
  • Nausea and vomiting
  • Tumour lysis syndrome

As cytotoxic drugs inadvertently target healthy cells, this results in many side effects

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14
Q

Pregnancy and cytotoxic drugs

what it is, how it should be managed and common causative drugs

A

Most cytotoxic drugs are teratogenic. Patients that are pregnant are seen by specialists.

Pregnancy must be excluded before treatment and effective contraception must be used during and sometime after treatment.

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15
Q

Cytotoxic drugs and fertility

what it is, how it should be managed and common causative drugs

A

Cytotoxic drugs inadvertently target healthy cells such as sex cells (sperm and eggs). This causes infertility.

Alkylating drugs and procarbazine can cause permanent male infertility. Patient should be counselled on storing their sperm.
Can cause early menopause in women

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16
Q

Bone marrow suppression and cytotoxic drugs

what it is, how it should be managed and common causative drugs

A

All cytotoxic drugs cause bone marrow suppression EXCEPT vincristine and bleomycin

Patients must report signs of infection or bleeding disorder (sore throat, mouth ulcers, bruising, bleeding).

Patients on cytotoxics must AVOID live vaccines - CONTRAINDICATED

17
Q

Treatment of fever in neutropenic patients

A

Broad spectrum-antibiotic or filgrastim

18
Q

Treatment of iron-deficiency anaemia

A

Red blood cells transfusion or erythropoietin to stimulate red blood cell production (warning: can cause tumour progression and death)

19
Q

Cytotoxic drugs and oral mucositis

what it is, how it should be managed and common causative drugs

A

Cytotoxic drugs Inadvertently target healthy mucosal cells that line the gastrointestinal tract.
Oral mucositis is a sore and inflammed mouth.
Patients must be advised on good oral hygience: rinse mouth regularly, use saline mouthwash, use soft toothbrush 2-3x daily and suck on ice cubes

Anthracyclines and antimetabolites commonly cause this

20
Q

Treatment for methotrexate-induced oral mucositis and bone marrow suppression

A

Folinic acid

21
Q

Drugs with high emetogenic potential

A
  • Cisplatin
  • Dacarbazine
  • High-dose cyclophosphamide

CDHC

22
Q

Drugs with moderate emetogenic potential

A
  • High-dose methotrexate
  • Taxanaes (paclitaxel)
  • Doxorubicin
  • Cyclophosphamide
  • Mitoxantrone

hMMCDT

23
Q

Drugs with mild emetogenic potential

MEFV

A
  • Methotrexate
  • Vinca alkaloids
  • Fluorouracil
  • Etoposide
24
Q

Types of nausea and vomiting associated with cytotoxic drugs

A
  • Anticipatory, occurs before treatment:
  • Acute <24 hours of chemotherapy administration
  • Delayed >24 hours of chemotherapy administration:
25
Q

Treating nausea and vomiting associated with cytotoxic drugs

A

Anticipatory: Lorazepam (amnesia, sedative, anxiolytic effects)

Acute ** <24hrs of chemotherapy administration:**
* LOW RISK: Dexamethasone or Lorazepam
* HIGH RISK: 5-HT3 antagonist + aprepitant + dexamethasone

Delayed >24 hours of chemotherapy administration:
* MODERATE EMETOGENIC: Dexamethasone + 5-HT3 antagonist
* HIGH EMETOGENIC: Dexamethasone + aprepitant OR rolapitant + metoclopramide

26
Q

Cytotoxic drugs and venous thromboembolism

A

Tamoxifen and thalidomide increase the likelihood of venous thromboembolism

Patients must report signs of: breathlessness, chest pain, swelling in the calf of one leg

27
Q

Cytotoxic drugs and urothelial toxicity

symptoms, cause and treatment

A

Where the urothelial cells that line the urinary tract become inflammed which can lead to haemorrhagic cystitis (when the bladder becomes inflammed and causes urinary symptoms) and blood in urine.

More common with acrylating drugs: cyclophosphamide and ifosfamide.When the drugs are metabolised acroline is produced and is responsible for urothelial toxicity

Treated with MESNA which reacts with the acroline metabolites

28
Q

Cytotoxic drugs and tumour lysis syndrome

A

This is the rapid destruction of cancer cells. More likely to happen in patients with lymphomas and leukemias.
Clinical features:
* High potassium = can cause arrthymias
* High calcium
* High urea = can cause crystals which can enter kidneys and cause damage -> renal failure
Patients at increased risk are patients with existing kidney impairement, dehydration

29
Q

Cytotoxic drugs and hyperuricaemia

A

High-grade lymphomas and leukaemia may contain high calcium. Made worse by chemotherapy and leads to gout

Allopurinol is used to treat hyperuricaemia and must be started 24 hours before chemotherapy

Febuxostat is used to treat hyperuricaemia and must be started 2 days before chemotherapy

Rasburicase is used to treat haemotological cancer

30
Q

Extravasation and cytotoxic drugs

A

When intravenous cytotoxic drugs leak from the veins into surrounding tissue. Musy be quickly dealt with to prevent damage to local tissue. COMPLICATIONS = amputation

Can happen with any drug administered intravenously
Can be particularly irritable with vinca alkaloids and anthracyclines

Make sure to stop the infusion, and do not remove the line. Disconnect the IV tube from the cannula, aspirate any remaining drug from the cannula

31
Q

Vinca alkaloids mechanism of action

A

Bind to tubulin threads to arrest dividing cells in metaphase

32
Q

Vinca alkaloids

route of administration, side effects

A

Route of administration:
- NEVER INTRATHECALLY = FATAL
* - adult/adolescents: doses in 50ml mini infusion bag
* Children: doses by syringe

Side effects:
* neurotoxicity
* Severe bronchospasm

33
Q

Anthracycline Cytotoxic antibiotics

A

Are radiomimetics, so must be avoided with radiotherapy

Anthracycline antibiotics typially end in “-rubicin”, e.g doxorubicin

34
Q

Anthracycline cytotoxic antibiotics

properties and side effects

A
  • Cardiotoxicity
  • Extravasaion injury
  • Colours urine red

Liposomal Dexrazoxane is used to reduce cardiotoxicity and extravasation injury.

Liposomal formulations can cause hand and foot syndrome. Can be prevented by cooling hands and feet, avoiding socks and gloves for 4-7 days after treatment

35
Q

Cytotoxic drug side effects

list them

A
  • Extravasation
  • Hair loss
  • Venous thromboemolism
  • Immunosuppression (bone marrow suppression, neutropenia)
  • Oral mucositis
  • Nausea and vomiting
  • Iron deficiency

Chapter 8 - Immune system and malignant disease (2 decks)

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