6.4 Wk-4 SEs associated with chemo.

Question 1

What are the typical side effects seen with conventional chemotherapy?

Answer 1

• Nausea and vomiting
• Diarrhoea
• Mucositis
• Hair loss
• Fatigue
• Myelosuppression – Anaemia/ Neutropaenia/Thrombocytopaenia
• Tumour Lysis syndrome

Question 2

When does nausea or vomiting occur?

Answer 2

Acute < 24hrs

Delayed >2-7 days
Anticipatory – They had it before so the anticipation it will happen again forces it to happen before the next cycle.

Breakthrough - Despite Tx

Refractory - Fail on standard and rescue medication

Question 3

How is nausea and vomiting graded?

Answer 3

Grade 1 – 5
* Grade 1…1 episode per day
* Grade 3…Hospitalised
* Grade 5…Death

Question 4

What are the non pharmacological interventions which mights be considered to manage nausea and vomiting?

Answer 4

Minimise dehydration & dry mouth
* Small quantities of fluid regularly, building over time as the they recover

Maitain energy levels - To help get through th cycle
* Start diet with perhaps dry rich tea biscuits, toast or similar, before gradually building to a normal healthy diet of fruit, vegetables, carbohydrates and protein.

• Ethnic alternatives may be required depending upon culture
• Consider Ginger in tea or drinks
• Pressure on the acupuncture P6 point in the wrist.
• Provide any education resources available

Signpost to patient groups
* To help them connect with others in the same situation
* Get access to other educational resources

Question 5

What are the pharmacological interventions which might be considered in total?

Answer 5

• Dopamine 2 antagonist - Metoclopromide
• Corticosteriod - Dexamethasone
• Proton pump inhibitor - Lansoprazole
• 5 hydroxytryptamine inhibitors - (5HT3 inhibitor) Ondansetron
• Neurokinen 1 inhibitor - Aprepitant

Question 6

What are the 2 stages at which N&V therapy might be prescribed

Answer 6

Pre Chemo, to reduced immediate symptoms on day 1
During chemo, to reduce symptoms between day 2-7

Question 7

How is the therapeutic approach for treating N&V decided upon…

Answer 7

The therapeutic approach is determined by the risk associated with the chemotherapy regimen to be given e.g.
* Low risk of N&V
* Medium risk of N&V
* High risk of N&V

Question 8

What approach to manage N&V asociated with chemotherapy is adopted pre chemotherapy treatment start?

Answer 8

When using chemo drugs with** low risk **of N&V
* e.g. Flouoruacil

• Use Dopamine 2 antagonist - Metoclopromide

When using chemo drugs with med risk of N&V
* e.g. Any Chemotherapy

• Use Corticosteroid - Dexamethasone &
• A proton pump inhibitor - Lasoprazole &
• 5 hydroxytrypatimine inhibitor (5HT3 inhibitor) Ondansetron

When using chemo drugs with high risk of N&V
* e.g. Cisplatin
* Use Corticosteroid - Dexamethasone &
* A proton pump inhibitor - Lansoprazole &
* 5 hydroxytrypatimine inhibitor (5HT3 inhibitor) Ondansetron

Question 9

What approach to manage N&V asociated with chemotherapy is adopted post chemotherapy treatment start?

Answer 9

When using chemo drugs with** low risk **of N&V e.g. Flouoruacil

• Use Dopamine 2 antagonist - Metoclopromide

When using chemo drugs with med risk of N&V e.g. Any Chemotherapy

• Use Corticosteroid - Dexamethasone &
• A proton pump inhibitor - Lasoprazole &
• 5 hydroxytrypatimine inhibitor (5HT3 inhibitor) *Ondansetron

When using chemo drugs with high risk of N&V
e.g. Cisplatin
* Use Corticosteroid - Dexamethasone &
* A proton pump inhibitor - Lansoprazole &
* 5 hydroxytrypatimine inhibitor (5HT3 inhibitor) *Ondansetron &
* Nurokinin1 inhibitor - Aprepitant

Pre CT is the same as post CT, except, add Neurokinin 1 for high risk

Question 10

What is tumour cell lysis?

Answer 10

If there is a massive release of cancer cell content, this may result in a massive release of uric acid and electrolytes, which could ultimately lead to an AKI.

Tx of choice is Allopuriol which helps to remove the uric acid. (Often used as a Tx for gout)

Question 11

What is a common Tx used for patients suffring from tumour lysis syndrome?

Answer 11

Allopurinol to lower uric acid.

Question 12

What side effects can all chemotherapy drugs cause to a lesser or greater extent?

Answer 12

• Pain
• Nausea and vomiting
• Diarrhoea
• Mucositis
• hair loss
• Fatigue

Question 13

What type of drugs are Anthracylcines?

Answer 13

Topoisomerase II inhibitors

Question 14

What are 3 common anthracyclines/Topoisomerase II inhibitors?

Answer 14

• Doxorubicin
• Epirubicin
• Idarubicin

Question 15

What are the more serious side effects which can occur with Anthracyclines?

Answer 15

Anthracyclines/Topisomerase II inhibitors, can also cause significant side effects
* Type I cumulative dose dependent cardiotoxicity
* Myelosuppression
* Gastrointestinal toxicity.

Close monitoring and supportive care are important aspects of managing patients receiving anthracycline chemotherapy.

Question 16

How might you try and minimise the side effects associated with anthracyclines?

Answer 16

• Central line into a vein, where the blood flow is fast to try and dilute the drug.
• Anthracyclines are vesicants, so do not administer IV into an arm via a venflon!

Question 17

What is a vesicant chemotherapy?

Answer 17

• Powerful chemotherapy
• When administerd IV via a venflon can lead to blistering, tissue necrosis, pain and in the worst case may require amputation.

Question 18

What is a common serious side effect associated with Trastuzumab (Herceptin)?

Answer 18

Trastuzumab is a monoclonal antibody
It targets HER2 receptir in breast cancer
But, there are also HER2 receptors in the myocardium
May cause type II cardiotoxicty which is generally reversible

Question 19

How might you minimise the risk of cardiotoxicity with trastuzumab?

Answer 19

• Assess cardiac function prior to treatment to establish a baseline for th patient
• Carefully consider dosing regimen
• Monitor cardiact function vs baseline
• Consider beta blocker or Ace inhibitor as they are potential cardio protective.