Adverse effects of Anticancer Drugs Flashcards
Adverse effects are common to many
antineoplastic agents are
These include nausea and
vomiting, myelosuppression, mucositis, alopecia,
infertility, and carcinogenesis.
Why antineoplastic agents cause these specific side effects?
Because many antineoplastic drugs affect DNA
synthesis, all rapidly proliferating cells are more
sensitive to the toxic effects of chemotherapy.
What are such tissue sites where
drug effects are usually manifested?
Normal tissues such as the bone marrow, intestinal
mucosa, and hair follicles
What is the most common dose-limiting
side effect of cytotoxic agents.
Myelosuppression ( Myeolsuppression plus fever is bad)
Whats a desired therapeutic effect in
leukemia patients during induction chemotherapy.
Myelotoxicity
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.
Empiric dosage reductions may be made for the first
chemotherapy treatment
- an alternative to dose reductions.
What is the most common hematologic complication of
cancer chemotherapy?
anemia
What drug is more commonly associated with
anemia than many other chemotherapeutic
agents.
Carboplatin
Multiple conditions are known to cause anemia in
cancer patients, like
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.
treatment of chemotherapy related anemia is:
Red blood cell transfusions,recombinant human erythropoietic products— epoetin alfa and darbepoetin alfa
What’s Neutropenia?
When the ANC falls below 500/mm3, infection
risk increases.
Neutropenia treatment
Initiation of empiric antibiotics.
The antibiotics are chosen based on
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)
The CSFs role
have the ability to enhance the production and
also the function of their target cells.
So, reduce the incidence, magnitude, and duration of
neutropenia
CSFs types
Two agents, G-CSF (granulocyte colony-stimulating factor) and GM-CSF (granulocyte-macrophage colony-stimulating factor)
The most common toxicity of the CSFs is
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.
Thrombocytopenia remain the
mainstay of management
platelet transfusions
platelet transfusions are
reserved for patients with-
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.
• When used after chemotherapy regimens
associated with a high risk of thrombocytopenia, what drug was used?
Oprelvekin
oprelvekin is associated with some
significant adverse effects -
mostly related to fluid
retention (e.g., edema, dilutional anemia,
dyspnea, and pleural effusions).
What’s a common site
of chemotherapy-induced toxicity
The gastrointestinal mucosa is composed of
epithelial cells with a high mitotic index and
rapid turnover rate,
Agents most commonly associated with mucositis
include
5-FU, doxorubicin, and methotrexate.
the most effective means of preventing
mucositis is
through good oral hygiene( Chlorhexidine)
In patients undergoing radiation therapy to the
head and neck region, chlorhexidine rinses have
detrimental effects on the oral mucosa. Why?
Radiotherapy to the head and neck region causes xerostomia and salivary gland dysfunction which dramatically increases the risk of dental caries and its sequelae.
Severe cases of mucositis may lead to dehydration and
require
intravenous hydration and pain medications
including patient-controlled analgesia pumps
In the lower portion of the GI tract, this damage is
usually manifested as
diarrhea (mild to life-threatening
in nature) and abdominal pain.
For diarrhea
Support with intravenous fluids and electrolyte supplementation treated with antispasmodics such as Lomotil or loperamide And Octreotide
Cutaneous reactions to chemotherapy are generally
reversible and selflimiting
TRUE
Cutaneous Reactions
localized rash, photosensitivity,
skin hyperpigmentation, nail changes, and hand–foot
syndrome, but can be associated with severe
hypersensitivity reactions.
Common agents known to cause rash in patients include
cytarabine, 5-FU, and bleomycin.
Dry skin ttt
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.
Alopecia from chemotherapy is
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.
What drug causes part of their chemotherapy
regimen are especially prone to total-body alopecia.
taxane
methods of preventing
alopecia-
Cryotherapy (local application of ice) and scalp tourniquets
What are vesicants-
Vesicants are antineoplastic agents that may cause severe tissue damage if they escape from the vasculature
Vesicants like
anthracyclines!!!, actinomycin D, the
vinca alkaloids, mitomycin C, nitrogen mustard, and the taxanes.
The tissue damage may result in
prolonged pain, tissue sloughing, infection, and loss of mobility.
The most important method of prevention is
good
administration technique, but extravasations may
occur despite good administration technique.
The vein selected for administration should be on the
distal portion of the arm.
The large veins of the forearm are desirable because
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.
The person administering the vesicant should verify
needle stability and adequate blood return after each 1
to 2 mL of drug is injected.
Infertility and secondary cancers have emerged as
important late effects.
true
In men, antitumor drugs produce
severe oligospermia or azoospermia as well as infertility.
In women, toxic effects on the ovaries result
clinically in
amenorrhea, vaginal epithelial
atrophy, and menopausal symptoms. These
effects are related to dose and age.
• Secondary cancers induced by
chemotherapy and
radiation
What are the most common
secondary cancers.
AML
or myelodysplastic syndromes
The antineoplastic agents primarily associated
with secondary cancers are
the alkylating agents.
And Etoposide, teniposide, radionucleotides, and the
anthracyclines
Solid tumors as secondary malignancies occur
more commonly after treatment with radiation
than with chemotherapy.
TRUE
