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HDT 3.2 > Cancer Side Effects > Flashcards

Cancer Side Effects Flashcards

1
Q

Which side effect of chemotherapy is a health professional likely to be most concerned about?

A

myelosuppression

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2
Q

Which side effects of chemotherapy are a patient likely to be most concerned about?

A

nausea
vomiting
hair loss

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3
Q

how is haematological toxicity caused ?

A

killed stem cells in the bone marrow affected the most by chemo and myelosuppression

downstream effect of…
thrombocytopenia
anemia
neutropenia

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4
Q

what is the most risky haematological toxicity?

A

neutropenia = risk of life

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5
Q

what are predisposing factors of developing neutropenia?

A
  • mucosal damage =increase opportunity pathogens
  • depth/duration of neutropenia
  • loss of cell mediated and humoural immunity
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6
Q

why is depth/duration of neutropenia important?

A

larger the time under RBC count = larger time for risk of infection = larger risk

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7
Q

how is neutropenia managed/treated?

A
  1. G-CSF - stimulates stem cell proliferation
  2. prophylactic antibiotics/anti-fungals
  3. delayed/reduced dose chemo
  4. PT with neutropenia and fever = broad spectrum antibiotic
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8
Q

what would you do if your chemo pt has neutropenia and fever?

A

prompt broad spectrum antibiotic treatment

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9
Q

how is GI toxicity caused ?

A

GI tract worn away by the passage of food and require food replacement

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10
Q

what GI effects occur from cytotoxic drugs?

A

nausea n vomiting
diarrhoea
oral mucositis

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11
Q

how can nausea and vomiting be characterised?

A

acute - first 24hrs
delayed - after 24hrs
anticipatory - e.g. arrival to chemotherapy

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12
Q

how is nausea and vomiting managed?

A

5-HT3 receptor antagonists and NK1 antagonists - antiemtics

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13
Q

what are the classes of anti-emetics? and name examples

A
  1. dopamine antagonists - metoclopramide/domperidone
  2. 5-HT3 antagonists - ondansetron
  3. antihistamine - cyclizine
  4. NK1 antagonists - aprepitant
  5. anticholinergics - hyoscine hydrobromide
  6. corticosteroids - dexamethasone
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14
Q

what are the risk factors for nausea/vomiting?

A

young age
female
history of motion sickness
history of morning sickness
adjuvant therapy

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15
Q

how are chemo treatment scaled when it comes to nausea/vomiting?

A
  1. high emetogenic risk (>90%)- cisplatin based chemo/SCT
  2. moderate emetogenic risk (30-90%) - DA/FLAG
  3. low emetogenic risk (10-30%) - bortezomib
  4. minimal emetogenic risk (<10%) - bleomycin/vincristine
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16
Q

what treatment plans for low emetogenic risk ?

A

metoclopramide PRN (po/iV) prechemo and TTO

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17
Q

what treatment plans for moderate emetogenic risk ?

A

metoclopramide (po/IV) + dexamethasone 8mg pre-chemo then metoclopramide 10mg TDS 3/7 and dexamethasone 2mg TDS 3/7 TTO

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18
Q

what treatment plans for high emetogenic risk ?

A
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19
Q

what are the symptoms of oral mucositis?

A

pain
dry mouth
altered taste
ulcerations

leads to infections

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20
Q

what drugs are responsible for oral mucositis?

A

5-FU
MTX
anthracyclines
cytarabrine

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21
Q

how can oral mucositis be prevented?

A

good oral hygiene - using mouthwashes

22
Q

how can oral mucositis be treated?

A
  1. antiseptic mouthwashes
  2. topical steroids
  3. sucralfate - for ulcers
  4. antacid and oxetacaine - local anaesthetic
  5. lidocaine gel - local anaesthetic
23
Q

what drugs are responsible for diarrhoea?

A

5-FU
irinotecan
majority of nibs

24
Q

how is diarrhoea treated?

A

loperamide 2 tabs every 2 hrs - max dose
codeine n octreotide if very severe

25
Q

what drugs are responsible for skin toxicities?

A

anthracyclines
bleomycin
etoposide

26
Q

what skin toxicities are people mainly concerned about?

A

alopecia but hair will regrow

27
Q

what can treat alopecia?

A

scalp cooling is used to cause vasoconstriction of blood vessels to the area = less chemotherapeutic effect = less hair damage

28
Q

name skin toxicities

A

alopecia
hand and foot syndrome/PPE

29
Q

how is hand and foot syndrome/PPE treated?

A

dose interruption/reduction
chiropody
cushioned footwear
urea based emollients
decrease exposure to warm water
oral analgesia
pyridone -vit b

30
Q

what drugs cause hand and foot syndrome/PPE?

A

5-DU
capecitabine
some nibs

31
Q

what are symptoms of hand and foot syndrome/PPE?

A

tenderness
redness
tingling
peeling of the skin on the palms and soles
difficulty walking

32
Q

what is tumour lysis syndrome?

A

chemo = large number of cells killed = release of urate from nucleic acid breakdown = urate deposit in kidneys = renal failure

33
Q

how is tumour lysis syndrome prevented?

A

hydration and allopurinol/fexobustat

34
Q

how does allopurinol prevent tumour lysis syndrome?

A

prevents formation of uric acid

35
Q

how is tumour lysis syndrome treated?

A

rasburicase
allopurinol doesn’t work on already formed uric acid deposits

36
Q

what drugs causes reproductive toxicities?

A

alkylating agents

37
Q

what is offered to those at risk of reproductive toxicities?

A

young males - sperm banking prior to chemo
females - IVF/egg freezing/ ovarian tissue freezing

38
Q

what does chemo do to women reproductive system?

A

amenorrhoea
menopausal symptoms

39
Q

what drugs cause pulmonary toxicities?

A

bleomycin - fibrosis n chronic pneumonia
dose dependent

40
Q

what drugs cause nephrotoxicity?

A

cisplatin
ifosfamide
MTX

41
Q

what can nephrotoxicity cause?

A

renal failure
electrolyte disturbances

42
Q

what must you do if you suspect nephrotoxicity?

A

dose reduction
good hydration

high dose MTX= alkalise urine to prevent

43
Q

how do you alkalise urine?

A

sodium bic. and saline administration

44
Q

why would you alkalise urine ?

A

when acidic urine build up causing nephrotoxicity due to high dose MTX forming MTX crystallisation

45
Q

what drugs cause neurotoxicity?

A

cisplatin
oxaliplatin
vinca alkaloids - Vincristine
bortezomib
thalidomide

46
Q

what can neurotoxicity cause?

A
  1. peripheral neuropathy - pins n needles
  2. autonomic neuropathy - constipation
47
Q

what drugs cause cardiotoxicity?

A

anthracyclines - doxorubicin
5-FU
cyclophosphamide

48
Q

what can cardiotoxicity cause?

A

arrhythmias = heart failure

49
Q

describe the side effects of checkpoint inhibitors?

A

auto-immune effects on the immune system
appears within first weeks/months of treatment
potentially life threatening
affect the skin/GI tract

50
Q

how are checkpoint inhibitor side effects managed?

A

corticosteroids

HDT 3.2 (17 decks)

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