Chemo drugs Flashcards
Common Adverse effects: chemotherapeutic
most common side effects?
What is the risk of toxicity?
- Myelosuppression (thrombocytopenia, anemia, leukopenia) –> usually dose-limiting factor and most common side effect that leads to temporary or permanent discontinuation of therapy
- Nausea/ vomiting
- Diarrhea
- Mucosal ulceration
- Dermatitis
- Alopecia
- Electrolyte disturbances
- Infection
- Organ dysfunction (cardiac, hepatic, renal dysfunction)
- most drugs carry narrow therapeutic indexes – risk for toxicity HIGH
What is neoadjuvant therapy?
Why is it given?
given before surgery to shrink the tumor.
facilitate surgery by decreasing tumor burden and possibly decrease the survival of tumor cells released during surgery
When is adjuvant therapy given?
Why is it given?
- Adjuvant therapy is given after the surgery
- reduces residual tumor burden
Pallative Therapy
unrelated to surgery
not surgical candidates
SIDE EFFECTS OF ALKYLATING AGENTS
What’s the BIG ONE?
whats unique?
Bone marrow suppression (dose limiting factor)
- Lymphacytopenia present within 24 hours
- Variable changes of platelet and erythrocyte counts
- Hemolytic anemia –> COMMON ESP. in the OR with transfusions
Gonodal Dysfunction
Hemorrhagic cystitis -> UNIQUE –> CYCLOPHOSPHAMIDE AND IFOSFAMIDE- HEMATURIA
Alopecia
Skin pigmentation
You are in a case and you see that your patient has a history of chemotherapy which medication warrants an extra investigation if you were to do a urologic procedure?
exposure to Alkylating Agents
CYCLOPHOSPHAMIDE AND IFOSFAMIDE
SE: Hemorrhagic Cystitis
You are in a case and you see that your patient has a history of chemotherapy what SE of alkylating agents can impact oxygenation?
ALKYLATING AGENTS
PNEUMONITIS AND PULMONARY FIBROSIS
–> will change the delivery of O2
A patient that was receiving an alkylating agent for chemotherapy received succinylcholine what should you watch out for?
SE: ALKYLATING AGENTS
Inhibition of plasma cholinesterases activity
- Possible prolonged effects of succinylcholine
- may be present for 2-3 weeks after treatment
What are the side effects of alkylating agents
Bone marrow suppression - general
Gonodal dysfunction
Hemorrhagic cystitis
Alopecia
Skin pigmentation
N/V
Skeletal Muscle weakness/seizures
Pneumonitis and pulmonary fibrosis
Inhibition of plasma cholinesterases activity
Nephropathy - maybe prevented with adequate hydration
A patient has received CYCLOPHOSPHOMIDE. What would you watch out for?
The same patient is scheduled to have a CABG what would you ask for and why?
Cyclophosphamide can cause Fibrosing pneumonitis it may occur from months to years.
Ask for the last dose of CYCLOPHOSPHOMIDE
- may cause PERICARDITIS, PERICARDIAL EFFUSION
- may progress to tamponade
- Hemorrhagic myocarditis (may develop greater or equal to 2 weeks post last dose)
- may impact inotrope or decreases in cardiac output or may make you trigger TTE or TEE FASTER
SE: CYCLOPHOSPHOMIDE
Fibrosing Pneumonitis
Pericarditis, pericardial effusion
Hemorrhagic Cystitis
SIADH – UNIQUE SIDE EFFECT MAY GET HYPONATREMIA
Inhibits PLASMA CHOLINESTERASE
Thrombocytopenia
Hypersensitivity Reactions
Alopecia
N/V
Mucosal Ulcerations
Skin pigmentation
Hepatotoxicity
ALKYLATING AGENT
SE
MELPHALAN
ALKYLATING AGENT
Similar to cyclophosphamide
MELPHALAN
PULMONARY FIBROSIS
ALKYLATING AGENT
CHLORAMBUCIL
ALKYLATING AGENT
CHLORAMBUCIL
PULMONARY FIBROSIS
HEPATOTOXICITY
ALKYLATING AGENT
SE
BUSULFAN
HYPERURICEMIA
AKI
ALKYLATING AGENT
PLATINUM BASED (CISPLATIN, OXALIPLATIN, CARBOPLATIN)
what should come to mind right away?
what should you be cautious of intraop?
RENAL INJURY
may start 3-5 days after start of tx
BE CAREFUL WITH FLUID MANAGEMENT
HYPOMAGNESEMIA
CORRECT ELECTROLYTES TO AVOID DYSRHYTMMIAS
ototoxicity – unique
PERIPHERAL NEUROPATHY –> be careful since we are monitoring local anesthetic administration
SEIZURES - unique
ANTIMETABOLITE: METHOTREXATE
Bone marrow suppression –> PARTICULARLY PROBLEMATIC
Ulcerative stomatitis
Diarrhea
Intestinal perforation - unique
NONCARDIOGENIC PULMONARY EDEMA
RENAL INJURY very common!!
Hepatic iNJURY
ANTIMETABOLITE: FLUOROUCIL
MYOCARDIAL ISCHEMIA - be careful with those who ALSO had CAD
may lead to myocardial infarction up to 1 week after treatment
ANTIMETABOLITE: CYTARABINE
HEPATIC DYSFUNCTION
CEREBELLAR TOXICITY
ANTIMETABOLITE: MERCAPTOPURINE
- JAUNDICE
- HEPATIC NECROSIS
- HYPERURICEMIA - allopurinol may help
ANTITUMOR ANTIBODIES: ANTHRACYCLINES
sample and SE
DAUNORUBICIN, DAXORUBICIN, IDARUBICIN**
CARDIAC TOXICITY
- Cardiomyopathy - dobutamine, milrinone may be refractory to inotropes
- Arrhythmias
- Hypotension
- Decreased contractility
After a thorough review of your patient’s history, you found out that your patient had received ANTITUMOR ANTIBODIES: ANTHRACYCLINES a decade ago. What would you be concerned about and how will you proceed?
Cardiomyopathy associated with anthracyclines is often irreversible or lasting years
- can start late but peaks 1 -3 months and presents as biventricular congestive heart failure.
FULL CARDIAC WORK UP
- myocardial depressant effect of anesthetics can be amplified with previous anthracyclines even with normal resting cardiac function up to 2 months after treatment.
ANTITUMOR ANTIBIOTIC: BLEOMYCIN
Hyperthermia, hypotension, hypoventilation
PULMONARY TOXICITY!
GET FULL PULMONARY FUNCTION TEST
Examples of Topoisomerase inhibitors and their side effects
Topoisomerase I inhibitor: Ironotecan, Topotecan
Severe Diarrhea - electrolyte imbalance, hypovolemia
Topoisomerase II inhibitor: Etoposide–> systemic hypotension
Hepatitis
How will you oxygenate a patient that has received Bleomycin?
What can be exacerbated?
VINKA ALKALOIDS
SIADH
URINARY RETENTION –> maybe masked
AUTONOMIC NEUROPATHY –> Laryngeal nerve paralysis with hoarseness, weakness of extraocular muscles
Your patient has been receiving vinca alkaloids. What should you consider when giving neuraxial anesthesia?
Minimize risk for worsening neuropathy
- The concentration of local anesthetics should be reduced
- Use nerve localization that decreases chances of intraneuron injection
TUBULIN BINDING DRUGS: VINCA ALKALOIDS
SE FOR
VINBLASTINE
VINORELBINE
VINBLASTINE - TRANSIENT MENTAL DEPRESSION
VINORELBINE - CHEST PAIN, BRONCHOSPASM, DYSPNEA, PULMONARY INFILTRATES
TUBULIN BINDING DRUGS: TAXANES
CARDIAC EFFECTS ARE A BIG DEAL
VASCULAR PERMEABILITY (more common with DOCETAXEL)
- peripheral edema, pleural effusion, ascites
- Fluid retention may be dose dependent
- modify fluid resuscitation
SE of Signal Transduction modifiers
Antiestrogens
DVT
HYPERCALCEMIA
SE of Signal Transduction modifiers
ANTIADROGENS
Hypercalcemia
Skeletal muscle weakness
methemoglobinemia (flutamide)
SIDE EFFECTS OF CHEMOTHERAPY AND CONSIDERATIONS FOR ANESTHESIA
SIDE EFFECTS OF CHEMOTHERAPY AND CONSIDERATIONS FOR ANESTHESIA
PULMONARY
- Presence of reduced function or pulmonary fibrosis may lead to postoperative respiratory failure or prolonged intubation
- Optimize oxygenation
- Management of fluidbalance
SIDE EFFECTS OF CHEMOTHERAPY AND CONSIDERATIONS FOR ANESTHESIA
RENAL
SIDE EFFECTS OF CHEMOTHERAPY AND CONSIDERATIONS FOR ANESTHESIA
RENAL
- Monitor and replace electrolytes as needed
- Adjust medications that undergo renal metabolism and/or elimination
- Management of acid/base disorders
- Avoid nonsteroidal anti-inflammatory drugs if possible
- Isoflurane and desflurane are volatile agents of choice instead of sevoflurane due to nephrotoxic compound A
SE CONSIDERATIONS IN ANESTHESIA
HEPATIC
Hepatic
• Adjust medications that undergo hepatic metabolism and/or
elimination
• Vecuronium and rocuronium may need to be dosed adjusted
• Avoid drugs that may worsen hepatotoxicity
Isoflurane preferred volatile agent
Halothane can cause hepatoxicity
SE CONSIDERATIONS IN ANESTHESIA
NEUROLOGIC
NEUROLOGIC
- Avoid drugs that increases seizure potential
- Motor and sensory neuropathies may impact monitoring of neuromuscular blockers
- Increased risk for falls with wasting and paresis of muscles
- Palsy of cranial nerves may present similar to cerebral ischemia
- (double vision, disconjugate gaze, hoarseness, facial palsy)
- Residual anesthetic/neuromuscular blockade may be difficult to assess with baseline neuropathy
