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PRE-REG-Thuri > CANCER + IMMUNE SYSTEM: CHEMOTHERAPY + SEs + DRUGS > Flashcards

CANCER + IMMUNE SYSTEM: CHEMOTHERAPY + SEs + DRUGS Flashcards

1
Q

What is cancer?

A

Uncontrolled division of abnormal cells

Killed by cytotoxic drugs

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2
Q

What are 3 aims of cytotoxic drugs?

A

Curative

Prolong life

Palliate symptoms

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3
Q

What is neoadjuvant therapy?

A

Drugs given first to shrink tumour before other methods used.

e.g. chemo first, then surgery.

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4
Q

What types of tumours are best resolved using neoadjuvant therapy?

A

Local therapy- primary tumours
less destructive

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5
Q

What types of tumours are best resolved using adjuvant therapy?

A

high risk metastatic disease

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6
Q

What are 5 rules regarding handling chemotherapy?

A

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

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7
Q

What are 4 safe system requirements?

A

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.

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8
Q

What is 1 important safety information regarding administering ORAL cytotoxics + what 2 steps can be done to reduce errors?

A

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.

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9
Q

What are 4 points to remember when dispensing oral cytotoxics?

A

Confirm dose

NO repeat prescriptions

Patient must have written information

Pharmacists + dispensing staff must have access to cancer pharmacist.

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10
Q

Can cytotoxic prescriptions be repeated?

A

NO- except in instruction of specialist

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11
Q

Where are cytotoxic side effects recorded?

A

Common Toxicity Criteria for Adverse Events (CTCAE)

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12
Q

What are 10 SEs of cytotoxics? (B-AUTOPEN)

A

Bone marrow suppression

Alopecia

Urothelial toxicity, hyperuricaemia

Tumour lysis syndrome, thromboembolism

Oral mucositis

Pregnancy + fertility

Extravasation

N + V

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13
Q

What is alopecia?

A

Reversible hair loss

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14
Q

What 3 cancer drugs are most likely to cause oral mucositis? (FAM)

A

fluorouracil, anthracyclines, methotrexate

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15
Q

What 2 cancer drugs/ classes can cause infertility?

A

Alkylating drugs

Procarbazine

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15
Q

What are 2 cancer drugs that do NOT cause bone marrow suppression?

A

Vincristine

Bleomycin

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16
Q

What patient counselling to prevent bone marrow suppression?

A

Report signs of infection or blood disorder

e.g. fever, sore throat, mouth ulcer, bleeding, bruising.

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17
Q

What is a contraindication of chemo drugs?

A

Infections - avoid live vaccines

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18
Q

What to avoid having when taking cytotoxic drugs?

A

Live vaccines

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19
Q

What is 2 treatment drugs for fever in neutropenic patients?

A

Broad spx abx + filgrastim

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20
Q

What is 2 treatment options for fever in symptomatic iron deficiency anaemia?

A

RBC transfusion OR erythropoietin

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21
Q

What 3 cancer drugs is bone marrow suppression delayed in?

A

carmustine, lomustine, + melphalan.

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22
Q

What should be checked to prevent bone marrow suppression?

A

Peripheral blood counts must be checked BEFORE each treatment.

Doses should be reduced if low bone marrow count.

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23
Q

In some patients how can neutropenia be reduced?

A

Using recombinant human granulocyte-colony stimulating factors (G-CSF)

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24
Q

What are 4 counselling points to prevent patient from getting oral mucositis?

A

Rinse mouth

saline mouthwash

Soft tooth brush

Suck ice cube

Overall good oral hygiene

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25
Q

What is the best way to fix oral mucositis?

A

Prevention better than cure

self limiting

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26
Q

What is given with methotrexate in overdose + methotrexate-induced mucositis/myelosuppression?

A

Folinic acid - quicker

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27
Q

What does NOT counteract antibacterial activity of folate antagonists?

A

Folinic acid

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28
Q

What 2 drugs are used together in metastatic colorectal cancer to improve response rate?

A

Fluorouracil + folinic acid

29
Q

What is Extravasation?

A

severe local tissue necrosis if leakage to extravasation parts of vein due to IV drugs not being properly administered.

30
Q

What should be given within 24 hours if patient has Hyperuricaemia due to cytotoxic drugs?

A

Allopurinol- give before treating tumours

31
Q

What 2 drugs should be reduced if giving allopurinol too?

A

mercaptopurine or azathioprine

32
Q

What is licensed for hyperuricaemia in patients with haematological malignancy?

A

Rasburicase

33
Q

What 3 cytotoxic drugs have a high risk of N + V?

A

Cisplatin

Dacarbazine

High dose cyclophosphamide

34
Q

What 4 cytotoxic drugs have a low risk of N + V?

A

Mtx

Vinca alkaloids

FU

etoposide

35
Q

What 5 cytotoxic drugs have a moderate risk of N + V?

A

High dose MTX

taxanes

doxorubicin

cyclophosphamide

mitoxantrone

36
Q

What is treatment for anticipatory N +V?

A

Lorazepam

37
Q

What is given for acute N+V if low risk?

A

Dex

OR

Lorazepam

38
Q

What is given for acute N+V if high risk?

A

5 HT3 antagonist + aprepitant + dex

39
Q

What is given in delayed N + V if patient moderately emetogenic?

A

dex + 5ht3 antagonists

40
Q

What is given in delayed N + V if patient highly emetogenic?

A

Dex + aprepitant or rolapitant + metoclopramide

41
Q

What can cytotoxic drugs increase risk of?

A

VTE

42
Q

What 2 cytotoxics are known to increase vte?

A

Tamoxifen

thalidomide/ linadamide

43
Q

What does tamoxifen cause?

A

Endo cancer

44
Q

What is patient counselling for vte Prevention while on cytotoxic?

A

Report SOB, chest pain, swelling in calf of one leg

45
Q

What is given for haemorrhage cystitis?

A

MESNA

46
Q

What 2 cytotoxics can cayse urothelial toxicity?

A

Cyclophosphamide

ifosfamide

47
Q

What is tumour lysis syndrome?

A

Rapid destruction of cancer cells

48
Q

What cancer are patients more at risk of developing TLS?

A

Lymphoma or leukemias

49
Q

What are the 6 clinical features of tumour lysis?

A

Increased potassium, urea, phosphate + calcium

Arrhythmias + renal failure

50
Q

When is febuxostat given?

A

2 days before chemotherapy.

51
Q

What 2 cytotoxic drugs are known for extravasation injury?

A

Vinca alkaloids

Anthracyclines

52
Q

List 2 topoisomerase 1 inhibitors?

A

Irinotecan

Topotecan

53
Q

What is mesna used for?

A

Haemorrhagic cystitis

54
Q

What class is cyclophosphamide?

A

Alkylating agent

55
Q

What drug class CANNOT be given with concurrent radiotherapy?

A

anthracyclines

56
Q

What is ifosfomide + how is it given?

A

Alkylating agent

IV

57
Q

What route are Vinca alkaloids never given?

A

Intrathecal = BAD

58
Q

How are Vinca alkaloid child unit doses given?

A

Doses received by syringe

59
Q

How are Vinca alkaloid adult unit doses given?

A

receive doses in 50ml mini infusion bag.

60
Q

What are 2 main SEs of vinca alkaloids?

A

Neurotoxicity

Severe bronchospasm

61
Q

What cytotoxic drug class is a radiomimetic?

A

Anthracycline

Mimics radiation so cannot be given together.

62
Q

What are 3 main SEs of anthracyclines?

A

Cardiotoxicity

Extravasation injury

Red urine

63
Q

What is an antidote of anthracyclines?

A

Dexrazoxane

64
Q

How is the liposomal anthracycline better?

A

Less risk of cardiotoxicity + extravasation injury

65
Q

What is Hand + foot syndrome or PPE?

A

Skin reaction affecting the palms of your hands & soles of feet.

Common SE of some chemos.

66
Q

How to reduce risk of Hand + foot syndrome?

A

Cool hands + feet.

Avoid socks + gloves for 4-7 days.

67
Q

What is given for symptom relief of extravasation?

A

Antihistamines and analgesics may be required.

68
Q

What is 1st step of extravasation management?

A

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.

69
Q

What does paclitexel at risk of ? (3)

A

hypersensitivity - give antihistamine/steroid

sepsis

pneumonaitis

PRE-REG-Thuri (44 decks)

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