Chemotherapy Flashcards
What are the aims of cancer treatment?
Curative
Prolong life
Palliate symptoms
What is neoadjuvant therapy?
Initial therapy aimed at shrinking primary tumour
What is adjuvant therapy?
Definitive treatment of primary disease when there is a high risk of metastatic disease
What are the guidelines for handling cytotoxic drugs?
Trained personnel Designated pharmacy area Protective clothing Cover eyes First aid Pregnant staff should avoid Procedures for spillages and safe waste disposal Monitor exposure
What is the NPSA alert for oral cytotoxic?
Incorrect dosing of oral cytotoxics - standards for prescribing and using parenteral cytotoxics should also be the same for oral cytotoxics
Do non-specialists have access to treatment plan?
Yes
Protocols include guidance on monitoring and treatment of toxicity
How do you dispense cytotoxics?
Confirm dose
Prescriptions should not be repeated
Patient must have written information
Pharmacists need access to treatment plan
What are the cytotoxic side effects?
Extravasation of IV drugs Thromboembolism Hyperuricaemia Alopecia Nausea and vomiting Bone marrow suppression Urothelial toxicity Oral mucositis Pregnancy and reproductive function
Are cytotoxic drugs teratogenic?
Mostly, yes
Need to exclude pregnancy before treatment and offer contraceptive advice
What are the important counselling points for alkylating drugs and procarbazine?
Permanent male sterility
Sperm storage
Women are less affected but may cause early menopause
What is tumour lysis syndrome?
Caused by rapid destruction of malignant cells
What are the clinical features of tumour lysis syndrome?
Hyper K+
Hyper urea
Hyper PO4
Hypo ca2+
Who are the at risk patients of tumour lysis syndrome?
Renal impairment
Dehydration
Hyperuricaemia
Which cytotoxic drugs cause thromboembolism?
Tamoxifen
Thalidomide
Linadamide
Malignant disease is a risk factor for VTE
How do you prevent oral mucositis?
Rinse mouth
Soft toothbrush
Saline mouthwash
Folinic acid in methotrexate induced adverse effects
Why cytot drugs cause oral mucositis?
Anthracyclines
Antimetabolites - fluorouracil, methotrexate, capecitabine
What is urothelial toxicity?
Haemorrhagic cystitis
What is used to treat urothelial toxicity?
Mesna
What causes urothelial toxicity?
Cyclophosphamide
Which cytotoxics do not cause bone marrow suppression?
Vincristine
Bleomycin
What are the contraindications in bone marrow suppression?
Infections
Avoid live vaccines
What is the treatment of bone marrow suppression?
Withdraw or reduce dose until bone marrow recovers
How do you treat fever with neutropenia?
Broad spectrum antibiotic
Filgrastrim
Avoid paracetamol as delays starting antibiotic
How do you treat symptomatic iron deficiency anaemia?
Erythropoietin
Red blood cell transfusions
When is hyperuricaemia normally present in malignant disease?
High grade lymphoma and leukaemia
Worsened by chemotherapy and associated with renal failure
How do you treat hyperuricaemia?
Allopurinol 24 hours before treating tumours
Febuxostat 2 days before if allopurinol contraindicated
Rasburicase if associated with blood cancer
Which are the mildly emetogenic cytotoxics?
Methotrexate
Vinca alkaloids
Fluorouracil
What are the moderately emetogenic cytotoxics?
Taxanes
Doxorubicin
Cyclophosphamide
High dose MTX
What are the highly emetogenic cytotoxics?
Cisplatin
High dose cyclophosphamide
What is the treatment for anticipatory nausea and vomiting associated with cytotoxic treatment?
Lorazepam
What is the treatment for acute (< 24 hours after treatment) nausea and vomiting associated with cytotoxics?
Low risk of emesis- dexamethasone or lorazepam
High risk of emesis - 5HT3 antagonist, aprepitant + dexamethasone
What is the treatment for delayed nausea and vomiting associated with cytotoxic treatment?
Moderately emetogenic drugs - dexamethasone + 5HT3 antagonist
Highly emetogenic drugs - dexamethasone + aprepitant
What is extravasation of IV drugs?
Severe local tissue necrosis if they leak from the veins into the surrounding subcutaneous or subdermal tissue
Can lead to amputation
What cytotoxics cause extravasation?
Vinca alkaloids
Anthracyclines
What are the cytotoxic antibiotics?
Radiomimetics
Avoid concomitant radiotherapy due to toxicity
What are the anthracyclines?
Doxorubicin - reduce dose if high bilirubin
Epirubicin
Idarubicin
Daunorubicin
What are the side effects of anthracyclines?
Cardiotoxicity- dose related, higher risk if given with herceptin
Red urine
What formulation of doxorubicin reduces incidence of cardiotoxicity and extravasation?
Liposomal formulations
What are the side effects of liposomal doxorubicin?
Hand and foot syndrome - macular, red skin eruptions
To prevent cool the hands and feet
What is the treatment for anthracycline induced side effects?
Dexrazoxane
What are the antineoblastic antibodies?
Bleomycin
What are the side effects of bleomycin?
Pulmonary fibrosis
Respiratory failure in anaesthesia
Hypersensitivity
Dermatological toxicity
What are the vinca alkaloids?
Vincristine Vinblastine Vindesine Vinflunine Vinorelbine
What is the route of administration of vinca alkaloids?
IV only
Intrathecal causes fatal neurotoxicity
What is the NPSA alert for vinca alkaloids?
Adult and teenagers unit receive doses in 50ml mini bag
Children’s unit receive doses by syringe
What are the side effects of the vinca alkaloids?
CNS toxicity (peripheral/autonomic neuropathy)
What are the antimetabolites?
Methotrexate
Capecitabine
Fluorouracil
What are the side effects of the antimetabolites?
Oral mucositis
Myelosuppression
Why is folinic acid used with methotrexate?
Speeds up recovery in methotrexate side effects and overdose
What are the alkylating drugs?
Cyclophosphamide Carmustine Lomustine Mephalan Chlorambucil Ifosfamide
What are the side effects of the alkylating drugs?
Permanent male sterility
Non-lymphocytic leukaemia
What are the aromatase inhibitors?
Anastrazole
Letrozole
Can the aromatase inhibitors be used in premenopausal women?
No, they are anti oestrogens
What are the taxanes?
Paclitaxel
What are the side effects of paclitaxel?
Cardiac disease
Pneumonitis
Sepsis
