Cancer - Side effects

Question 1

Side effects (all)

Answer 1

• Extravasion of IV drugs
• Thromboembolism
• Hyperuricaemia
• Alopecia
• N + V
• Bone marrow suppression
• Urothelial toxicity
• Oral mucositis
• Pregnancy + reproductive function

Question 2

Pregnancy + reproductive function

Answer 2

Teratogenic
- Exclude pregnancy prior to treatment
- Offer contraceptive advice to men + women

Question 3

Alkylating drugs + procarbazine

Answer 3

• Permanent male sterility.
• Counsel patient on sperm storage
• Women are less affected; early menopause may occur

Question 4

Tumour lysis syndrome

Answer 4

• Caused by rapid destruction of malignant cells.
• Malignant cells rapidly breakdown and release their contents into cell.

Causes:
- Hyperkalaemia
- Hyper urea
- Hyperphosphatemia
- Hypocalcaemia

Question 5

Tumour lysis syndrome - at risk syndrome

Answer 5

• Renal impairment
• Dehydration
• Hyperuricaemia

Question 6

Thromboembolism

Answer 6

• Malignant disease = risk factor for VTE
• Cytotoxic drugs also increase this risk (tamoxifen, thalidomide/linadamide)

Question 7

Oral mucositis - drugs

Answer 7

Anthracyclines
Antimetabolites (methotrexate, fluorouracil, capecitabine)

Question 8

Oral mucositis - prevention

Answer 8

Good oral hygiene
- Rinse mouth frequently
- Soft toothbrush
- Suck on ice cues
- Saline mouthwash
- Folinic acid in MTX induced adverse effects

Question 9

Urothelial toxicity

Answer 9

Adverse effects on the epithelial lining of the urinary tract.
Urothelial toxicity = haemorrhagic cystitis
Treatment = MENSA

Question 10

Urothelial toxicity - drugs

Answer 10

Cyclophosphamide

Question 11

Bone marrow suppression

Answer 11

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

Question 12

Bone marrow suppression - Contraindications

Answer 12

Avoid live vaccines

Question 13

Bone marrow suppression - drugs

Answer 13

All EXCEPT vincristine + bleomycin

Question 14

Hyperuricaemia

Answer 14

• Present in high-grade lymphoma + leukaemia
• Worsened by chemotherapy
• Associated with renal failure

Question 15

Hyperuricaemia - treatment

Answer 15

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

Question 16

N + V (anticipatory)

Answer 16

Lorazepam

Question 17

N + V (acute symptoms <24 hours after chemo)

Answer 17

Low risk of emesis = dexamethasone or lorazepam

High risk of emesis = 5-HT3 antagonists (aprepitant + dexamethasone)

Question 18

N + V (delayed symptoms >24 hours after chemo)

Answer 18

Moderately emetogenic = dexamethasone + 5-HT3 antagonist

Highly emetogenic = Dexamethasone + aprepitant

Question 19

Mild emetogenics

Answer 19

• MTX
• Fluorouracil
• Vinca alkaloids

Question 20

Moderate emetogenics

Answer 20

• Taxanes
• Doxorubicin
• Cyclophosphamide
• High dose MTX

Question 21

High emetogenics

Answer 21

• Cisplatin
• High dose cyclophosphamide

Question 22

Alopecia

Answer 22

Reversible hair loss
Cold caps

Question 23

Extravasion

Answer 23

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