Chemo side effects

Question 1

What are the complications of CINV

Answer 1

Dehydration, Nutritional deficiency, Elctrolyte distrubances, Aspiration pneumonia, Oesophageal tears, Chemotherpay dose delays

Question 2

What are the types of CINV?

Answer 2

Actute - within 24 hours (Metoclopramide, Doperidone, 5HT3)
Delayed - More than 24 hours post chemo (Dexamethasone, NK1)
Breakthrough - CINV despite prophylaxis (5HT3, NK1)
Anticipatory - Piror to admin of chemo (Lorazepam)
Refractory - CINV despite appropriate measures (Levomepromazine, NK1, Nabilone)

Question 3

What is mucositis?

Answer 3

Sore / ulcerated mouth, mucosal cells of mouth and GI tract sensitive to chemo, causes discomfort and pain.

Question 4

What is the prevention of Mucositis?

Answer 4

Regular brushing, avoid floss, rinse mouth regularly, avoid commercial products if they contain alcohol.

Question 5

What are the treatments of Mucositis?

Answer 5

Pain - Local anastheic, analgesic, ice
Infections - Funfal ( Systemic fluconazole or nystatin) Viral (Aciclorivr)

Question 6

Who is at risk of Chemo induced Diaeehoea?

Answer 6

5-flouroracil, Capecitabine, Irinotecan.

Question 7

What are the pharmacological intervetions for Chemo induced Diarrhoea?

Answer 7

Lopearmide, Oral antibitoics.
In severe cases - IV fluids and electrolytes

Question 8

What are the causes of chemo constipation?

Answer 8

Chemo - Cisplatin, Vinca alkaloids.
Opoids for pain.

Question 9

What is the prevention of Chemo constipation?

Answer 9

fluids (6-8 glasses)
High fibre foods
Exercise

Question 10

What are the treatment for chemo constipation?

Answer 10

Laxatives
Review of medication

Question 11

What is alopecia?

Answer 11

Hair loss.

Question 12

What is Febrile Neutropenia?

Answer 12

Temp of 38 greater and absolute neutrophil count of <0.5 X 10^9/L

Question 13

Prevention of Febrile neutropenia?

Answer 13

Good hygeine, avoid crowds & sick people, food safety
If myelosuppresive chemo consider - Prophylatic antibiotics , G-CSF prophylaxis, Dose reductions.

Question 14

What dose GCSF stand for?

Answer 14

Granulocyte Colonly Stimulating Factor (GCSF)

Question 15

What does GCSF do?

Answer 15

Sitmulates production of neutrophils

Question 16

What are the risk factors of Neutropenia?

Answer 16

Hypotenisve, COPD, Leukaemia treatment, dehydrates, inpatient.

Question 17

Treatment of Neutropenic Sepsis?

Answer 17

Low risk :
PO antibitocs ( Ciprofloxacin, Co-amoxiclav)
Outpatient treatment
IV stat then PO
High risk:
Urgent empirical IV (Tazocin, ceftazidime, vancomycin/gentamicin)
Admission
Review after 48h - PO

Question 18

What is the dermatological side effects of Capecitabine?

Answer 18

Hand foot syndrome 57%
Palm of hands/feet -> tingling, redness, numbness, pain, swelling.

Question 19

What are the treatments of the Capectiabine dermatological side effects?

Answer 19

Lanolin containg creams.

Question 20

What can EGFR inhibitors cause?

Answer 20

Papulopustular eruption.

Question 21

EGFR inhibitor skin reactioin treatments?

Answer 21

Mild:
Topical antibitic cream (Clindamycin)
Moderate :
Add topical steroid (Hydrocortisone cream)
Oral antibiotics (Doxycycline)
Severe :
Dematology refferal
Dose reduction.
Consider stopping treatment.

Question 22

Immunotherapy Long term side effects?

Answer 22

Cardiac, thromboembolic, secondary cancers, infertility, respiratory.

Question 23

What is Extravasation?

Answer 23

Accidental leakage from a vein into surrounding tissue.
Cause irritation, necrosis.

Question 24

Hypersensitivity reaction Pre medication?

Answer 24

Dexamethasone 20mg PO every 6 hours for 4 doses.
Ranitidine 150mg PO every 8 hours for 3 doses.
Chlorphenamine 4mg PO every 6 hours for 4 doses.