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Pharmacology for FRCR CO1 > 2.2 Toxicity of systemic therapies > Flashcards

2.2 Toxicity of systemic therapies Flashcards

1
Q

What is the dose limiting toxicity (DLT)?

A

Occurence of a grade 3 toxicity during the first cycle

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2
Q

What drugs cause cardiotoxicity?

A
  • Doxorubicin
  • Herceptin
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3
Q

What drugs cause nephrotoxicity?

A

Carboplatin
Cisplatin

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4
Q

What drugs cause ototoxicity?

A
  • Carboplatin
  • Cisplatin
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5
Q

What drug causes hepatotoxicity?

A
  • Lomustine
  • Oxaliplatin
  • Irinotecan
  • Methotrexate
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6
Q

What chemotherapy can cause haemorrhagic cystitis?

A

Cyclophosphamide

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7
Q

What chemotherapy can cause intestinal ileus?

A

Vincristine

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8
Q

What chemotherapies commonly cause hypersensitivity?

A
  • Docetaxel
  • Paclitaxel
  • L-asparaginase
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9
Q

What chemotherapy causes fluid retention?

A

Docetaxel

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10
Q

What chemotherapy causes PPE?

A

Cape

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11
Q

What chemotherapies cause peripheral neuropathy?

A
  • Vincristine
  • Platinums
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12
Q

What chemotherapies cause pulmonary fibrosis?

A
  • Bleomycin
  • Busulfan
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13
Q

What are the 8 (A->H) types of toxicity?

A
  1. Type A (Augmented) - dose related
  2. Type B (Bizarre) - idiosyncratic
  3. Type C (Continuing) - persist for a long time
  4. Type D (Delayed) - apparent a while after drug used
  5. Type E (End of use) - toxicity caused by withdrawal e.g. benzos or opiates
  6. Type F (Failure)
  7. Type G (Genetic/genomic)
  8. Type H (Hypersensitivity)
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14
Q

What are type A toxicities?

A

Dose dependent
Predictable
Exaggeration of medicine’s normal effect at normal doses e.g. hypotension with high ACEi dose

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15
Q

What are Type B toxicities?

A

Reactions not pharmacologically predictable

e.g. anaphylaxis with penicillins

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16
Q

What is an example of a Type C toxicity?

A

Osteonecrosis of the Jaw in bisphosphonates

17
Q

What is the definition of an acute toxicity?

A

Within 14 days

e.g. nephrotoxicity, peripheral neuropathy, ototoxicity with cisplatin

18
Q

What is a long term toxicity, and what letter type comes under this?

A

Type C(ontinuous) and Type D(elayed)

e.g. with cisplatin neuropahty and ototoxicity can persist
Infertility, secondary malignancy

19
Q

What is extravasation?

A

Leakage of fluid from the bein into surrounding tissue

Cytotoxic drugs cause particularly severe extravasation

20
Q

What are the risk factors for extravasation?

A
  1. Vascular - small, fragile, hard veins, ACF cannulation, multiple sites
  2. Clotting issue
  3. Lymph node removal
  4. Reduced sensation e.g. peripheral neuropathy, DMM2
  5. Obesity
  6. Elderly
  7. High flow pressure
21
Q

What are the signs and symptoms of extravasation?

A
  1. Pain
  2. Change in sensation
  3. Increased infusion resistence
  4. awelling
  5. Erythema
  6. Venous discolouration
  7. Inflammation
  8. Blistering
  9. Induring (thinkening and hardening of skin)
22
Q

What are the two ways to manage extravasation of cytotoxins?

A

‘Localise and neutralise’

‘Disperseand dilute’

23
Q

Which chemotherapies require ‘localise and neutralise’?

A

Anthracyclines
Mitomycin C

24
Q

What are the steps involved in ‘Localise and Neutralise’?

A
  • Cold pack to vasoconstrict
  • Antidote for vesicants - dexrazoxane (Savene)
  • Hydrocortisone 1% cream
  • Move and elevate limb for 48 hours
  • Analgesia
25
Q

When should Savene (derazoxane) be used?

A

Extravasation >3ml peripherally
Any extravasation centrally

Within 6 hours

OD for 3 days - infuse over 1-2 hours

26
Q

When should Savene (dexrozoxane) not be used?

A
  1. With Dimethylsufoxide (DMSO) or steroids
  2. Hepatic or renal impairment
  3. With live vaccines
  4. With phenytoin
27
Q

What are the risks of Savene (dexrazoxane)?

A
  1. Cytotoxic - Nadir 11-12 days
  2. Electrolyte imbalances (Na and K)
28
Q

What are the steps in ‘Disperse and Dilute’?

A
  1. Inject hyaluronidase (1500 IU in 1ml water)
  2. Warm compress
  3. Hycrocortisone cream
  4. Analgesia
29
Q

Extravasation of which chemos should be managed by’disperse and dilute’?

A

Vinca alkaloids
Taxanes

30
Q

Which chemos are DNA Binding vesicants?

A

CINS

  • Daunorubicin
  • Doxorubicin
  • Epirubicin
  • Mytomicin
31
Q

What are the non-DNA binding vesicants?

A

Taxels - Pacli, Doce
Ines -Vincristine, Vinorelbine

32
Q

What are the irritants?

A
  • Etoposide
  • 5FU
  • Irinotecan
  • Topotecan
  • All the platins
  • Ifosfamide
33
Q

What are the neutral extravasators?

A
  • Bev
  • Bleomcin
  • Cetuximab
  • Cyclophosphamide
  • Gemcitabine
  • Methotrexate
  • Pemetrexed
  • Rituximab

Pharmacology for FRCR CO1 (7 decks)

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