B33 CAN Clinical & Professional Flashcards by Paul Anyasodo

How do we dose chemotherapy?

Fixed Dose
BSA
Weight based dosing
AUC
Dose Banding

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BSA

Body surface area, based on Weight and Height

Correlation between BSA and renal function

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BSA disadvantages

effect of renal impairment
BSA is estimated
Rounding of the BSA calculation and Dose calcualation

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Causes of variation in dose

Pharmacogenetics, Vial contents , Weight Height BSA, Syringe accuracy,
Residual volumes during administartion

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AUC

Area under curve, Need GFR

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Calculating GFR

Use ideal body weight -100 in men -105 in woman

Adjusted body weight

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Fixed doses

Ease of dose preparation
Reduced cost
Lower risk of dosing errors

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Dose banding - Benefits

Fewer dose calculation errors
Quicker Dispensing
Reduced patient waiting times

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Dose banding - disadvantages

Admistered dose may vary from BSA calculated dose

Banded doses may be more expensive

Repeptive strain disorder from repeat syringe usage

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Therapeutic monitoring - Benefits

Cytotoxic drugs fufil requirements for TDM

Help track patient adherence to treatment

Allows individual dose optimisation

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TDM - Disadvantages

Tumour heterogeneity
Drugs have overlapping therapuetic & toxic effects

Practical & economical consideratiosn

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High dose MTX is the only cytotoxic drug on TDM, what can be used to ‘rescue’…?

Folinic acid ‘rescure’ commenced 24 hours after MTX to block unwanted side effects

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Cycle interval

Chemotherapy scheduling gbased of effects of cytotoxic drug on normal tissue

2-3 week cylce as normal cells recover in 3 weeks

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Dose adjustments - Renal function

Calculate for nephrotoxicity

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Staging

Staging the disease (after Diagnosis) allows for baseline for monitoring and prognostic information
Stage 0-4
4( metastised)

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tnm STAGING

Primary tumour = T
REgional lymphnodes = N
m = metastasis

Grade

Grade is the macroscopic assesment of the degree of cellular differentiation
(cancer cells being poorly differentiated grade 3)

Dose adjustments Cardiotoxicity

Two classes of Cardiotoxings

1) Irreversible
2) Reversible

Irreversible caused by anthracyclines (dox)

Reversible caused by Mabs (trastuzumab)

Complications of Cancer

SVCO (Superior vena cava obstruction)
- Narrowing of the SVC

Caused by carcinoma

SVCO : S & S

Oedema in the neck
SOB
Dilation of superior neck skin veins
Headache
Cough coarse voice

SVCO: treatment

Corticosteroids + Defentive treatment: RT or Chemo

Spinal Cord Compression (SCC) : Occurs in…? , Sympotms…?

Occurs when bone metasates
Motor weakness
Sensory Loss
Pain at level of compression

SCC Treatment

Corticosteroids and RT

SCC prognosis

Ability to walk / move at time of diagnosis and treatment begininning

Pharmacist role in SCC

Prompt diagnoisis and delivery of Corticosteroids and Refferal Speak about DVT/PE prophylaxis Laxatives Analgesis

Chemotherapy induced N&V

- impact on QoL

Types of CINV

Acute Breakthrough Refractory Anticapatory N&V PROPHYLAXIS better than treatment

CINV consequences

Delayed therapy (omitted doses) Dehydration Electrolyte imbalance Patient stopping therapy

CINV treatment & MOA

Neurokinin 1 Receptor antagonists NK1RA - & Inhibts the action of Substrate P in both CNS & PNS

Neutropenic sepsis

Infection due to having no neutrophils

Neutropenic sepsis: T and pharmacist role

T: Gentamicin PR: Full Blood count, peniclin allergy

Classification

Non-vesicant (5FU) Irritant -> Pain and phelbitis (cisplatin) Vesicant - Severe tissue damage and necrosis (anthrycyline antibioitcs e.g doxorubicn)

Different sources of funding for cancer drugs

1) Funded by NHS via NICE approval 2) Cancer drug fund (NICE not approved yet) 3) Clinical trail (pharmecutical company funded) (If works legally obliged to continue, gives drug comp. data, cheap) 4) Compassionate use scheme (pharmaceutical company funded) (doctor asks for drug) 5) Privately funded (insurance of induvidual)

Incremental Cost equation

C1 - C0 =

Incremental benefit equation

Qaly1-Qaly0

Incremental Cost Effectiveness Ratio (ICER):

(c1-co) / (Qaly 1 - Qaly 0)

Technology acceptable if ICER < ..... per QALY Gained

Accepted if

EOL acceptable if ICER

EOL acceptable if