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Pre-reg Exam 2021 > Chemotherapy > Flashcards

Chemotherapy Flashcards

1
Q

What are the aims of cancer treatment?

A

Curative
Prolong life
Palliate symptoms

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2
Q

What is neoadjuvant therapy?

A

Initial therapy aimed at shrinking primary tumour

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3
Q

What is adjuvant therapy?

A

Definitive treatment of primary disease when there is a high risk of metastatic disease

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4
Q

What are the guidelines for handling cytotoxic drugs?

A 
Trained personnel
Designated pharmacy area
Protective clothing
Cover eyes
First aid
Pregnant staff should avoid
Procedures for spillages and safe waste disposal
Monitor exposure
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5
Q

What is the NPSA alert for oral cytotoxic?

A

Incorrect dosing of oral cytotoxics - standards for prescribing and using parenteral cytotoxics should also be the same for oral cytotoxics

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6
Q

Do non-specialists have access to treatment plan?

A

Yes

Protocols include guidance on monitoring and treatment of toxicity

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7
Q

How do you dispense cytotoxics?

A

Confirm dose
Prescriptions should not be repeated
Patient must have written information
Pharmacists need access to treatment plan

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8
Q

What are the cytotoxic side effects?

A 
Extravasation of IV drugs
Thromboembolism 
Hyperuricaemia 
Alopecia 
Nausea and vomiting
Bone marrow suppression 
Urothelial toxicity
Oral mucositis
Pregnancy and reproductive function
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9
Q

Are cytotoxic drugs teratogenic?

A

Mostly, yes

Need to exclude pregnancy before treatment and offer contraceptive advice

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10
Q

What are the important counselling points for alkylating drugs and procarbazine?

A

Permanent male sterility
Sperm storage
Women are less affected but may cause early menopause

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11
Q

What is tumour lysis syndrome?

A

Caused by rapid destruction of malignant cells

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12
Q

What are the clinical features of tumour lysis syndrome?

A

Hyper K+
Hyper urea
Hyper PO4
Hypo ca2+

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13
Q

Who are the at risk patients of tumour lysis syndrome?

A

Renal impairment
Dehydration
Hyperuricaemia

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14
Q

Which cytotoxic drugs cause thromboembolism?

A

Tamoxifen
Thalidomide
Linadamide

Malignant disease is a risk factor for VTE

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15
Q

How do you prevent oral mucositis?

A

Rinse mouth
Soft toothbrush
Saline mouthwash
Folinic acid in methotrexate induced adverse effects

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16
Q

Why cytot drugs cause oral mucositis?

A

Anthracyclines

Antimetabolites - fluorouracil, methotrexate, capecitabine

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17
Q

What is urothelial toxicity?

A

Haemorrhagic cystitis

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18
Q

What is used to treat urothelial toxicity?

A

Mesna

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19
Q

What causes urothelial toxicity?

A

Cyclophosphamide

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20
Q

Which cytotoxics do not cause bone marrow suppression?

A

Vincristine

Bleomycin

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21
Q

What are the contraindications in bone marrow suppression?

A

Infections

Avoid live vaccines

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22
Q

What is the treatment of bone marrow suppression?

A

Withdraw or reduce dose until bone marrow recovers

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23
Q

How do you treat fever with neutropenia?

A

Broad spectrum antibiotic
Filgrastrim

Avoid paracetamol as delays starting antibiotic

24
Q

How do you treat symptomatic iron deficiency anaemia?

A

Erythropoietin

Red blood cell transfusions

25
Q

When is hyperuricaemia normally present in malignant disease?

A

High grade lymphoma and leukaemia

Worsened by chemotherapy and associated with renal failure

26
Q

How do you treat hyperuricaemia?

A

Allopurinol 24 hours before treating tumours

Febuxostat 2 days before if allopurinol contraindicated

Rasburicase if associated with blood cancer

27
Q

Which are the mildly emetogenic cytotoxics?

A

Methotrexate
Vinca alkaloids
Fluorouracil

28
Q

What are the moderately emetogenic cytotoxics?

A

Taxanes
Doxorubicin
Cyclophosphamide
High dose MTX

29
Q

What are the highly emetogenic cytotoxics?

A

Cisplatin

High dose cyclophosphamide

30
Q

What is the treatment for anticipatory nausea and vomiting associated with cytotoxic treatment?

A

Lorazepam

31
Q

What is the treatment for acute (< 24 hours after treatment) nausea and vomiting associated with cytotoxics?

A

Low risk of emesis- dexamethasone or lorazepam

High risk of emesis - 5HT3 antagonist, aprepitant + dexamethasone

32
Q

What is the treatment for delayed nausea and vomiting associated with cytotoxic treatment?

A

Moderately emetogenic drugs - dexamethasone + 5HT3 antagonist

Highly emetogenic drugs - dexamethasone + aprepitant

33
Q

What is extravasation of IV drugs?

A

Severe local tissue necrosis if they leak from the veins into the surrounding subcutaneous or subdermal tissue

Can lead to amputation

34
Q

What cytotoxics cause extravasation?

A

Vinca alkaloids

Anthracyclines

35
Q

What are the cytotoxic antibiotics?

A

Radiomimetics

Avoid concomitant radiotherapy due to toxicity

36
Q

What are the anthracyclines?

A

Doxorubicin - reduce dose if high bilirubin
Epirubicin
Idarubicin
Daunorubicin

37
Q

What are the side effects of anthracyclines?

A

Cardiotoxicity- dose related, higher risk if given with herceptin

Red urine

38
Q

What formulation of doxorubicin reduces incidence of cardiotoxicity and extravasation?

A

Liposomal formulations

39
Q

What are the side effects of liposomal doxorubicin?

A

Hand and foot syndrome - macular, red skin eruptions

To prevent cool the hands and feet

40
Q

What is the treatment for anthracycline induced side effects?

A

Dexrazoxane

41
Q

What are the antineoblastic antibodies?

A

Bleomycin

42
Q

What are the side effects of bleomycin?

A

Pulmonary fibrosis
Respiratory failure in anaesthesia
Hypersensitivity
Dermatological toxicity

43
Q

What are the vinca alkaloids?

A 
Vincristine
Vinblastine
Vindesine 
Vinflunine
Vinorelbine
44
Q

What is the route of administration of vinca alkaloids?

A

IV only

Intrathecal causes fatal neurotoxicity

45
Q

What is the NPSA alert for vinca alkaloids?

A

Adult and teenagers unit receive doses in 50ml mini bag

Children’s unit receive doses by syringe

46
Q

What are the side effects of the vinca alkaloids?

A

CNS toxicity (peripheral/autonomic neuropathy)

47
Q

What are the antimetabolites?

A

Methotrexate
Capecitabine
Fluorouracil

48
Q

What are the side effects of the antimetabolites?

A

Oral mucositis

Myelosuppression

49
Q

Why is folinic acid used with methotrexate?

A

Speeds up recovery in methotrexate side effects and overdose

50
Q

What are the alkylating drugs?

A 
Cyclophosphamide 
Carmustine
Lomustine
Mephalan 
Chlorambucil
Ifosfamide
51
Q

What are the side effects of the alkylating drugs?

A

Permanent male sterility

Non-lymphocytic leukaemia

52
Q

What are the aromatase inhibitors?

A

Anastrazole

Letrozole

53
Q

Can the aromatase inhibitors be used in premenopausal women?

A

No, they are anti oestrogens

54
Q

What are the taxanes?

A

Paclitaxel

55
Q

What are the side effects of paclitaxel?

A

Cardiac disease
Pneumonitis
Sepsis

Pre-reg Exam 2021 (79 decks)

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