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Anesthesia Pharm > Chemo drugs > Flashcards

Chemo drugs Flashcards

1
Q

Common Adverse effects: chemotherapeutic

most common side effects?

What is the risk of toxicity?

A
  • 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
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2
Q

What is neoadjuvant therapy?

Why is it given?

A

given before surgery to shrink the tumor.

facilitate surgery by decreasing tumor burden and possibly decrease the survival of tumor cells released during surgery

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3
Q

When is adjuvant therapy given?

Why is it given?

A
  • Adjuvant therapy is given after the surgery
  • reduces residual tumor burden
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4
Q

Pallative Therapy

A

unrelated to surgery

not surgical candidates

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5
Q

SIDE EFFECTS OF ALKYLATING AGENTS

What’s the BIG ONE?

whats unique?

A

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

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6
Q

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?

A

exposure to Alkylating Agents

CYCLOPHOSPHAMIDE AND IFOSFAMIDE

SE: Hemorrhagic Cystitis

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7
Q

You are in a case and you see that your patient has a history of chemotherapy what SE of alkylating agents can impact oxygenation?

A

ALKYLATING AGENTS

PNEUMONITIS AND PULMONARY FIBROSIS

–> will change the delivery of O2

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8
Q

A patient that was receiving an alkylating agent for chemotherapy received succinylcholine what should you watch out for?

A

SE: ALKYLATING AGENTS

Inhibition of plasma cholinesterases activity

  • Possible prolonged effects of succinylcholine
  • may be present for 2-3 weeks after treatment
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9
Q

What are the side effects of alkylating agents

A

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

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10
Q

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?

A

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
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11
Q

SE: CYCLOPHOSPHOMIDE

A

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

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12
Q

ALKYLATING AGENT

SE

MELPHALAN

A

ALKYLATING AGENT

Similar to cyclophosphamide

MELPHALAN

PULMONARY FIBROSIS

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13
Q

ALKYLATING AGENT

CHLORAMBUCIL

A

ALKYLATING AGENT

CHLORAMBUCIL

PULMONARY FIBROSIS

HEPATOTOXICITY

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14
Q

ALKYLATING AGENT

SE

BUSULFAN

A

HYPERURICEMIA

AKI

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15
Q

ALKYLATING AGENT

PLATINUM BASED (CISPLATIN, OXALIPLATIN, CARBOPLATIN)

what should come to mind right away?

what should you be cautious of intraop?

A

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

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16
Q

ANTIMETABOLITE: METHOTREXATE

A

Bone marrow suppression –> PARTICULARLY PROBLEMATIC

Ulcerative stomatitis

Diarrhea

Intestinal perforation - unique

NONCARDIOGENIC PULMONARY EDEMA

RENAL INJURY very common!!

Hepatic iNJURY

17
Q

ANTIMETABOLITE: FLUOROUCIL

A

MYOCARDIAL ISCHEMIA - be careful with those who ALSO had CAD

may lead to myocardial infarction up to 1 week after treatment

18
Q

ANTIMETABOLITE: CYTARABINE

A

HEPATIC DYSFUNCTION

CEREBELLAR TOXICITY

19
Q

ANTIMETABOLITE: MERCAPTOPURINE

A
  • JAUNDICE
  • HEPATIC NECROSIS
  • HYPERURICEMIA - allopurinol may help
20
Q

ANTITUMOR ANTIBODIES: ANTHRACYCLINES

sample and SE

A

DAUNORUBICIN, DAXORUBICIN, IDARUBICIN**

CARDIAC TOXICITY

  • Cardiomyopathy - dobutamine, milrinone may be refractory to inotropes
  • Arrhythmias
  • Hypotension
  • Decreased contractility
21
Q

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?

A

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.
22
Q

ANTITUMOR ANTIBIOTIC: BLEOMYCIN

A

Hyperthermia, hypotension, hypoventilation

PULMONARY TOXICITY!

GET FULL PULMONARY FUNCTION TEST

23
Q

Examples of Topoisomerase inhibitors and their side effects

A

Topoisomerase I inhibitor: Ironotecan, Topotecan

Severe Diarrhea - electrolyte imbalance, hypovolemia

Topoisomerase II inhibitor: Etoposide–> systemic hypotension

Hepatitis

24
Q

How will you oxygenate a patient that has received Bleomycin?

What can be exacerbated?

A
25
Q

VINKA ALKALOIDS

A

SIADH

URINARY RETENTION –> maybe masked

AUTONOMIC NEUROPATHY –> Laryngeal nerve paralysis with hoarseness, weakness of extraocular muscles

26
Q

Your patient has been receiving vinca alkaloids. What should you consider when giving neuraxial anesthesia?

A

Minimize risk for worsening neuropathy

  • The concentration of local anesthetics should be reduced
  • Use nerve localization that decreases chances of intraneuron injection
27
Q

TUBULIN BINDING DRUGS: VINCA ALKALOIDS

SE FOR

VINBLASTINE

VINORELBINE

A

VINBLASTINE - TRANSIENT MENTAL DEPRESSION

VINORELBINE - CHEST PAIN, BRONCHOSPASM, DYSPNEA, PULMONARY INFILTRATES

28
Q

TUBULIN BINDING DRUGS: TAXANES

A

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
29
Q

SE of Signal Transduction modifiers

Antiestrogens

A

DVT

HYPERCALCEMIA

30
Q

SE of Signal Transduction modifiers

ANTIADROGENS

A

Hypercalcemia

Skeletal muscle weakness

methemoglobinemia (flutamide)

31
Q

SIDE EFFECTS OF CHEMOTHERAPY AND CONSIDERATIONS FOR ANESTHESIA

A
32
Q

SIDE EFFECTS OF CHEMOTHERAPY AND CONSIDERATIONS FOR ANESTHESIA

PULMONARY

A
  • Presence of reduced function or pulmonary fibrosis may lead to postoperative respiratory failure or prolonged intubation
  • Optimize oxygenation
  • Management of fluidbalance
33
Q

SIDE EFFECTS OF CHEMOTHERAPY AND CONSIDERATIONS FOR ANESTHESIA

RENAL

A

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
34
Q

SE CONSIDERATIONS IN ANESTHESIA

HEPATIC

A

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

35
Q

SE CONSIDERATIONS IN ANESTHESIA

NEUROLOGIC

A

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

Anesthesia Pharm (25 decks)

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