Adverse effects of Anticancer Drugs

Question 1

Adverse effects are common to many

antineoplastic agents are

Answer 1

These include nausea and
vomiting, myelosuppression, mucositis, alopecia,
infertility, and carcinogenesis.

Question 2

Why antineoplastic agents cause these specific side effects?

Answer 2

Because many antineoplastic drugs affect DNA
synthesis, all rapidly proliferating cells are more
sensitive to the toxic effects of chemotherapy.

Question 3

What are such tissue sites where

drug effects are usually manifested?

Answer 3

Normal tissues such as the bone marrow, intestinal

mucosa, and hair follicles

Question 4

What is the most common dose-limiting

side effect of cytotoxic agents.

Answer 4

Myelosuppression ( Myeolsuppression plus fever is bad)

Question 5

Whats a desired therapeutic effect in

leukemia patients during induction chemotherapy.

Answer 5

Myelotoxicity

Question 6

If the patient has a low baseline WBC or platelet count, has diminished bone marrow reserve, has impaired drug-elimination capabilities, or is to receive a combination of several drugs that cause myelosuppression.

Answer 6

Empiric dosage reductions may be made for the first
chemotherapy treatment

• an alternative to dose reductions.

Question 7

What is the most common hematologic complication of

cancer chemotherapy?

Answer 7

anemia

Question 8

What drug is more commonly associated with
anemia than many other chemotherapeutic
agents.

Answer 8

Carboplatin

Question 9

Multiple conditions are known to cause anemia in

cancer patients, like

Answer 9

Chronic gastrointestinal, blood loss, nutrient deficiency (e.g., iron and folate), chemotherapy and radiation therapy, bone marrow invasion by the tumor, hemolysis,
renal dysfunction, and anemia of chronic disease.

Question 10

treatment of chemotherapy related anemia is:

Answer 10

Red blood cell transfusions,recombinant human erythropoietic products— epoetin alfa and darbepoetin alfa

Question 11

What’s Neutropenia?

Answer 11

When the ANC falls below 500/mm3, infection

risk increases.

Question 12

Neutropenia treatment

Answer 12

Initiation of empiric antibiotics.

Question 13

The antibiotics are chosen based on

Answer 13

reliable coverage of the most likely organisms, antibiotic sensitivities at the institution, the patient’s signs and symptoms (if present), side effect profiles,
and cost.
(5)

Question 14

The CSFs role

Answer 14

have the ability to enhance the production and
also the function of their target cells.
So, reduce the incidence, magnitude, and duration of
neutropenia

Question 15

CSFs types

Answer 15

Two agents, G-CSF (granulocyte colony-stimulating factor) and GM-CSF (granulocyte-macrophage colony-stimulating factor)

Question 16

The most common toxicity of the CSFs is

Answer 16

bone pain (20% to
25% of patients), which can be treated with
acetaminophen.
S/E: increase in lactate
dehydrogenase, alkaline phosphatase, and uric acid levels.

Question 17

Thrombocytopenia remain the

mainstay of management

Answer 17

platelet transfusions

Question 18

platelet transfusions are

reserved for patients with-

Answer 18

a platelet count of
<10,000 cells/mm3 unless they are actively
bleeding, must undergo a surgical procedure, or
have documented infections or fever in which the
threshold is higher.

Question 19

• When used after chemotherapy regimens

associated with a high risk of thrombocytopenia, what drug was used?

Answer 19

Oprelvekin

Question 20

oprelvekin is associated with some

significant adverse effects -

Answer 20

mostly related to fluid
retention (e.g., edema, dilutional anemia,
dyspnea, and pleural effusions).

Question 21

What’s a common site

of chemotherapy-induced toxicity

Answer 21

The gastrointestinal mucosa is composed of
epithelial cells with a high mitotic index and
rapid turnover rate,

Question 22

Agents most commonly associated with mucositis

include

Answer 22

5-FU, doxorubicin, and methotrexate.

Question 23

the most effective means of preventing

mucositis is

Answer 23

through good oral hygiene( Chlorhexidine)

Question 24

In patients undergoing radiation therapy to the
head and neck region, chlorhexidine rinses have
detrimental effects on the oral mucosa. Why?

Answer 24

Radiotherapy to the head and neck region causes xerostomia and salivary gland dysfunction which dramatically increases the risk of dental caries and its sequelae.

Question 25

Severe cases of mucositis may lead to dehydration and

require

Answer 25

intravenous hydration and pain medications

including patient-controlled analgesia pumps

Question 26

In the lower portion of the GI tract, this damage is

usually manifested as

Answer 26

diarrhea (mild to life-threatening

in nature) and abdominal pain.

Question 27

For diarrhea

Answer 27

Support with intravenous fluids and electrolyte
supplementation
treated with antispasmodics such as
Lomotil or loperamide
And Octreotide

Question 28

Cutaneous reactions to chemotherapy are generally

reversible and selflimiting

Answer 28

TRUE

Question 29

Cutaneous Reactions

Answer 29

localized rash, photosensitivity,
skin hyperpigmentation, nail changes, and hand–foot
syndrome, but can be associated with severe
hypersensitivity reactions.

Question 30

Common agents known to cause rash in patients include

Answer 30

cytarabine, 5-FU, and bleomycin.

Question 31

Dry skin ttt

Answer 31

emollients help if patients
complain of dry skin, topical and systemic antibiotics may
help if the rash becomes infected, and steroids may help
prevent itching and inflammation.

Question 32

Alopecia from chemotherapy is

Answer 32

usually temporary, and the

degree of hair loss varies widely. Loss of hair is not limited tothe scalp; any area of the body may be affected.

Question 33

What drug causes part of their chemotherapy

regimen are especially prone to total-body alopecia.

Answer 33

taxane

Question 34

methods of preventing

alopecia-

Answer 34

Cryotherapy (local application of ice) and scalp tourniquets

Question 35

What are vesicants-

Answer 35

Vesicants are antineoplastic agents that may cause severe tissue damage if they escape from the vasculature

Question 36

Vesicants like

Answer 36

anthracyclines!!!, actinomycin D, the

vinca alkaloids, mitomycin C, nitrogen mustard, and the taxanes.

Question 37

The tissue damage may result in

Answer 37

prolonged pain, tissue sloughing, infection, and loss of mobility.

Question 38

The most important method of prevention is

Answer 38

good
administration technique, but extravasations may
occur despite good administration technique.

Question 39

The vein selected for administration should be on the

Answer 39

distal portion of the arm.

Question 40

The large veins of the forearm are desirable because

Answer 40

if a drug does extravasate, there is adequate soft-tissue coverage to protect crucial structures like nerves and tendons, and joint function is not put at risk.

Question 41

The person administering the vesicant should verify

Answer 41

needle stability and adequate blood return after each 1

to 2 mL of drug is injected.

Question 42

Infertility and secondary cancers have emerged as

important late effects.

Answer 42

true

Question 43

In men, antitumor drugs produce

Answer 43

severe oligospermia or azoospermia as well as infertility.

Question 44

In women, toxic effects on the ovaries result

clinically in

Answer 44

amenorrhea, vaginal epithelial
atrophy, and menopausal symptoms. These
effects are related to dose and age.

Question 45

• Secondary cancers induced by

Answer 45

chemotherapy and

radiation

Question 46

What are the most common

secondary cancers.

Answer 46

AML

or myelodysplastic syndromes

Question 47

The antineoplastic agents primarily associated

with secondary cancers are

Answer 47

the alkylating agents.
And Etoposide, teniposide, radionucleotides, and the
anthracyclines

Question 48

Solid tumors as secondary malignancies occur
more commonly after treatment with radiation
than with chemotherapy.

Answer 48

TRUE