Cancer - Side effects Flashcards
Side effects (all)
- Extravasion of IV drugs
- Thromboembolism
- Hyperuricaemia
- Alopecia
- N + V
- Bone marrow suppression
- Urothelial toxicity
- Oral mucositis
- Pregnancy + reproductive function
Pregnancy + reproductive function
Teratogenic
- Exclude pregnancy prior to treatment
- Offer contraceptive advice to men + women
Alkylating drugs + procarbazine
- Permanent male sterility.
- Counsel patient on sperm storage
- Women are less affected; early menopause may occur
Tumour lysis syndrome
- Caused by rapid destruction of malignant cells.
- Malignant cells rapidly breakdown and release their contents into cell.
Causes:
- Hyperkalaemia
- Hyper urea
- Hyperphosphatemia
- Hypocalcaemia
Tumour lysis syndrome - at risk syndrome
- Renal impairment
- Dehydration
- Hyperuricaemia
Thromboembolism
- Malignant disease = risk factor for VTE
- Cytotoxic drugs also increase this risk (tamoxifen, thalidomide/linadamide)
Oral mucositis - drugs
Anthracyclines
Antimetabolites (methotrexate, fluorouracil, capecitabine)
Oral mucositis - prevention
Good oral hygiene
- Rinse mouth frequently
- Soft toothbrush
- Suck on ice cues
- Saline mouthwash
- Folinic acid in MTX induced adverse effects
Urothelial toxicity
Adverse effects on the epithelial lining of the urinary tract.
Urothelial toxicity = haemorrhagic cystitis
Treatment = MENSA
Urothelial toxicity - drugs
Cyclophosphamide
Bone marrow suppression
FBC before treatment
Fever with neutropenia
- Filgrastrim
- Broad spectrum Abx
- Avoid paracetamol (delays starting antibiotic)
Symptomatic iron-deficiency anaemia
- Erythpoietin OR
- Red blood cell transfusions
Bone marrow suppression - Contraindications
Avoid live vaccines
Bone marrow suppression - drugs
All EXCEPT vincristine + bleomycin
Hyperuricaemia
- Present in high-grade lymphoma + leukaemia
- Worsened by chemotherapy
- Associated with renal failure
Hyperuricaemia - treatment
Allopurinol
- 24 hours before treating such tumours.
- Reduce dose of concomitant azathioprine/mercaptopurine
Febuxostat
- 2 days before if allopurinol C/I
Rasburicase
- For hyperuricaemia associated with blood cancer
N + V (anticipatory)
Lorazepam
N + V (acute symptoms <24 hours after chemo)
Low risk of emesis = dexamethasone or lorazepam
High risk of emesis = 5-HT3 antagonists (aprepitant + dexamethasone)
N + V (delayed symptoms >24 hours after chemo)
Moderately emetogenic = dexamethasone + 5-HT3 antagonist
Highly emetogenic = Dexamethasone + aprepitant
Mild emetogenics
- MTX
- Fluorouracil
- Vinca alkaloids
Moderate emetogenics
- Taxanes
- Doxorubicin
- Cyclophosphamide
- High dose MTX
High emetogenics
- Cisplatin
- High dose cyclophosphamide
Alopecia
Reversible hair loss
Cold caps
Extravasion
Severe local tissue necrosis if they leak from veins into surrounding S/C or subdermal tissue.
Severe cases = amputation
Drugs that cause = anthracyclines +vinca alkaloids
