CANCER + IMMUNE SYSTEM: CHEMOTHERAPY + SEs + DRUGS Flashcards
What is cancer?
Uncontrolled division of abnormal cells
Killed by cytotoxic drugs
What are 3 aims of cytotoxic drugs?
Curative
Prolong life
Palliate symptoms
What is neoadjuvant therapy?
Drugs given first to shrink tumour before other methods used.
e.g. chemo first, then surgery.
What types of tumours are best resolved using neoadjuvant therapy?
Local therapy- primary tumours
less destructive
What types of tumours are best resolved using adjuvant therapy?
high risk metastatic disease
What are 5 rules regarding handling chemotherapy?
Pregnant staff should avoid handling.
Wear protective gear- protect eyes
Monitor staff exposure
Reconstitution should be carried out in designated pharmacy areas.
Spills + waste disposure procedures in place
What are 4 safe system requirements?
Cytotoxic drugs for cancer = Given as part of a wider pathway of care coordinated by a MDT.
Cytotoxic drugs should be prescribed, dispensed, and administered only in the context of a written protocol or treatment plan
Injectable cytotoxic drugs should ONLY be dispensed if they are prepared for administration
Oral cytotoxic Meds - dispensed with clear directions.
What is 1 important safety information regarding administering ORAL cytotoxics + what 2 steps can be done to reduce errors?
Risk of incorrect dosing of oral cytotoxic drugs
Non-specialists who prescribe or administer should use written protocols/ treatment plan
When dispensing, confirm dose, NO repeat prescriptions, patient must have written information, pharmacists + dispensing staff must have access to cancer pharmacist.
What are 4 points to remember when dispensing oral cytotoxics?
Confirm dose
NO repeat prescriptions
Patient must have written information
Pharmacists + dispensing staff must have access to cancer pharmacist.
Can cytotoxic prescriptions be repeated?
NO- except in instruction of specialist
Where are cytotoxic side effects recorded?
Common Toxicity Criteria for Adverse Events (CTCAE)
What are 10 SEs of cytotoxics? (B-AUTOPEN)
Bone marrow suppression
Alopecia
Urothelial toxicity, hyperuricaemia
Tumour lysis syndrome, thromboembolism
Oral mucositis
Pregnancy + fertility
Extravasation
N + V
What is alopecia?
Reversible hair loss
What 3 cancer drugs are most likely to cause oral mucositis? (FAM)
fluorouracil, anthracyclines, methotrexate
What 2 cancer drugs/ classes can cause infertility?
Alkylating drugs
Procarbazine
What are 2 cancer drugs that do NOT cause bone marrow suppression?
Vincristine
Bleomycin
What patient counselling to prevent bone marrow suppression?
Report signs of infection or blood disorder
e.g. fever, sore throat, mouth ulcer, bleeding, bruising.
What is a contraindication of chemo drugs?
Infections - avoid live vaccines
What to avoid having when taking cytotoxic drugs?
Live vaccines
What is 2 treatment drugs for fever in neutropenic patients?
Broad spx abx + filgrastim
What is 2 treatment options for fever in symptomatic iron deficiency anaemia?
RBC transfusion OR erythropoietin
What 3 cancer drugs is bone marrow suppression delayed in?
carmustine, lomustine, + melphalan.
What should be checked to prevent bone marrow suppression?
Peripheral blood counts must be checked BEFORE each treatment.
Doses should be reduced if low bone marrow count.
In some patients how can neutropenia be reduced?
Using recombinant human granulocyte-colony stimulating factors (G-CSF)
What are 4 counselling points to prevent patient from getting oral mucositis?
Rinse mouth
saline mouthwash
Soft tooth brush
Suck ice cube
Overall good oral hygiene
What is the best way to fix oral mucositis?
Prevention better than cure
self limiting
What is given with methotrexate in overdose + methotrexate-induced mucositis/myelosuppression?
Folinic acid - quicker
What does NOT counteract antibacterial activity of folate antagonists?
Folinic acid
What 2 drugs are used together in metastatic colorectal cancer to improve response rate?
Fluorouracil + folinic acid
What is Extravasation?
severe local tissue necrosis if leakage to extravasation parts of vein due to IV drugs not being properly administered.
What should be given within 24 hours if patient has Hyperuricaemia due to cytotoxic drugs?
Allopurinol- give before treating tumours
What 2 drugs should be reduced if giving allopurinol too?
mercaptopurine or azathioprine
What is licensed for hyperuricaemia in patients with haematological malignancy?
Rasburicase
What 3 cytotoxic drugs have a high risk of N + V?
Cisplatin
Dacarbazine
High dose cyclophosphamide
What 4 cytotoxic drugs have a low risk of N + V?
Mtx
Vinca alkaloids
FU
etoposide
What 5 cytotoxic drugs have a moderate risk of N + V?
High dose MTX
taxanes
doxorubicin
cyclophosphamide
mitoxantrone
What is treatment for anticipatory N +V?
Lorazepam
What is given for acute N+V if low risk?
Dex
OR
Lorazepam
What is given for acute N+V if high risk?
5 HT3 antagonist + aprepitant + dex
What is given in delayed N + V if patient moderately emetogenic?
dex + 5ht3 antagonists
What is given in delayed N + V if patient highly emetogenic?
Dex + aprepitant or rolapitant + metoclopramide
What can cytotoxic drugs increase risk of?
VTE
What 2 cytotoxics are known to increase vte?
Tamoxifen
thalidomide/ linadamide
What does tamoxifen cause?
Endo cancer
What is patient counselling for vte Prevention while on cytotoxic?
Report SOB, chest pain, swelling in calf of one leg
What is given for haemorrhage cystitis?
MESNA
What 2 cytotoxics can cayse urothelial toxicity?
Cyclophosphamide
ifosfamide
What is tumour lysis syndrome?
Rapid destruction of cancer cells
What cancer are patients more at risk of developing TLS?
Lymphoma or leukemias
What are the 6 clinical features of tumour lysis?
Increased potassium, urea, phosphate + calcium
Arrhythmias + renal failure
When is febuxostat given?
2 days before chemotherapy.
What 2 cytotoxic drugs are known for extravasation injury?
Vinca alkaloids
Anthracyclines
List 2 topoisomerase 1 inhibitors?
Irinotecan
Topotecan
What is mesna used for?
Haemorrhagic cystitis
What class is cyclophosphamide?
Alkylating agent
What drug class CANNOT be given with concurrent radiotherapy?
anthracyclines
What is ifosfomide + how is it given?
Alkylating agent
IV
What route are Vinca alkaloids never given?
Intrathecal = BAD
How are Vinca alkaloid child unit doses given?
Doses received by syringe
How are Vinca alkaloid adult unit doses given?
receive doses in 50ml mini infusion bag.
What are 2 main SEs of vinca alkaloids?
Neurotoxicity
Severe bronchospasm
What cytotoxic drug class is a radiomimetic?
Anthracycline
Mimics radiation so cannot be given together.
What are 3 main SEs of anthracyclines?
Cardiotoxicity
Extravasation injury
Red urine
What is an antidote of anthracyclines?
Dexrazoxane
How is the liposomal anthracycline better?
Less risk of cardiotoxicity + extravasation injury
What is Hand + foot syndrome or PPE?
Skin reaction affecting the palms of your hands & soles of feet.
Common SE of some chemos.
How to reduce risk of Hand + foot syndrome?
Cool hands + feet.
Avoid socks + gloves for 4-7 days.
What is given for symptom relief of extravasation?
Antihistamines and analgesics may be required.
What is 1st step of extravasation management?
Infusion should be stopped ASAP but the cannula should NOT be removed until after an attempt has been made to aspirate the area (through the cannula) to remove as much of the drug as possible.
What does paclitexel at risk of ? (3)
hypersensitivity - give antihistamine/steroid
sepsis
pneumonaitis
