Chemotherapy Complications

Question 1

what is typhilitis?

Answer 1

it’s neutropenic enterocolitis a life threatening infection in patients who have leukemia who become neutropenic after chemotherapy.

Question 2

What is neutropenic entercolitis?

Answer 2

life threatening infection in patients who have neutropenia post chemotherapy. There’s intestinal mucosal injury and body is unable to fight microorganism invasion into the gut lining.

Question 3

When does neutropenic enterocolitis happen?

Answer 3

This starts 10-14 days post chemotherapy

Question 4

Presentation of typhilitis or neutropenic enterocolitis?

Answer 4

fever after chemotherapy, right lower quadrant abd pain, nausea w/ or without vomiting, and watery or bloody diarrhea.

Question 5

How to diagnosis typhilitis or neutropenic enterocolitis?

Answer 5

Abd CT scan showing fluid filled and distended cecum with thickened wall, intramural air or edema and mucosal thrumbprinting.

Question 6

What test should you always order when trying to evaluate pt who may have neutropenic enterocolitis?

Answer 6

check C diff, and also empirically treat for C diff until infection is ruled out

Question 7

What are the initial antibiotics to start in someone with suspected neutropenic enterocolitis?

Answer 7

cefepime or ceftazidime + metronidazole W/ PO vancomycin if waiting to rule out C diff.

Question 8

if patient has prolonged fever >72hrs and neutropenic enterocolitis, what med do you start?

Answer 8

antifungal therapy

Question 9

When to get surgery involved for treatment of neutropenic enterocolitis?

Answer 9

complicated typhilitis or uncomplicated patients who clinically deteriorate.

Question 10

Do we ever do colonoscopy in neutropenic or thrombocytopenic pts?

Answer 10

no because can perforation with air insufflation. If there’s suspicion of pseudomembranous colitis and negative stool studies can get a sigmoidoscopy to confirm diagnosis.

Question 11

anthracycline (doxorubicin) can cause what in 5-10 years after treatment?

Answer 11

can see anthracycline induced leukemia in about 10-20% of cases and see a MDS phase.

Question 12

What is the prognosis for chemotherapy related leukemia?

Answer 12

they respond poorly to current treatments with chemotherapy or allogenic hematopoietic stem cell transplants

Question 13

what chemo drugs cause pulmonary fibrosis

Answer 13

bleomycin (also can cause organizing pneumonia and hypersensitivity pneumonitis) small molecule tyrosine kinase inhibitors

Question 14

what chemo drugs cause cardiomyopathy?

Answer 14

anthracyclines (doxorubicin) and trastuzumab can cause arrhthymias, heart block, pericarditis and heart failure. RF for this is cumulative dose, hx of chest irradiation, pre existing cardiovascular disease and bone marrow transplant

Question 15

what does methotrexate cause as a side effect?

Answer 15

liver toxicity (hepatic fibrosis)

hypersensitivity pneumonitis

nephrotoxicity (high doses) causes folic deficiency too

so must be on folic acid replacement.

Question 16

what is a side effect of cisplatin?

Answer 16

nephrotoxicity,

ototoxcity

peripheral neuropathy

Question 17

what are the side effects of cyclophosphamide?

Answer 17

hemorrhagic cystitis

bladder cancer

gonadal toxicity

Question 18

side effect of 5 FU (5 fluorouracil)?

Answer 18

severe diarrhea

Question 19

Side effect of EGFR inhibitors (erlotinib and cetuximab)?

Answer 19

skin rash

Question 20

intracranial radiation and chemotherapy as a child for ALL can predispose a patient to developing

Answer 20

brain tumor and hematological malignancies (AML). most common brain tumor is meningioma and glioma. meningeal cells are most susceptible to cranial radiation

Question 21

when do people present with post radiation brain cancer?

Answer 21

latency period of 20 years. see meningiomas are slow growing with symptoms resulting from compression of underlying brain parenchyma high grade gliomas (glioblastoma multiforme) are highly aggressive and often associated with extensive vasogenic edema.

Question 22

side effect of bevacizumab

Answer 22

HTN,

bleeding thrombosis

Question 23

radiation side effect

Answer 23

CAD, thyroid cancer, lymphoma

Question 24

bleomycin side effect

Answer 24

lung toxicity and pulmonary fibrosis

Question 25

vincristine side effect

Answer 25

peripheral neuropathy

Question 26

cyclophosphamide

Answer 26

hemorrhagic cystitis

Question 27

doxorubicin side effect

Answer 27

cardiac toxicity - cardiomyopathy

Question 28

trastuzumab side effect

Answer 28

cardiac toxicity - cardiomyopathy

Question 29

anastrazole side effect

Answer 29

osteopenia

Question 30

rituximab side effect

Answer 30

reactivation of TB

Question 31

EGFR inhibitor side effects cetuximab or gefitinib, erlotinib, lapatinib

Answer 31

can develop into rashes can have erythematous papules and plaques with edema erythema and dysesthesia and the lesions crust over and develop residual skin dryness and telangiectasis.

Question 32

Chemotherapy side effects on chemo man

Answer 32

Bevacizumab- Hypertension, AKI via TMA

Paclitaxel- Interstitial lung disease, bradycardia/heart block

Question 33

how to follow people who are on trastuzumab and doxorubicin?

Answer 33

Trastuzumab - causes LV systolic dysfunction

Doxorubicin -

acute: heart block, arrhythmias, CHF, myocarditis

chronic: dilated cardiomyopathy

Need baseline EKG and echo

echo q3months during treatment

cardiology consult if loss of 10% in LVEF with CHF symptoms.

Question 34

gemcitabine

Answer 34

anal pruritis,

HUS

flu

rash

Question 35

paclitaxel side effects

Answer 35

neuropathy

bradycardia

Question 36

tamoxifene causes

Answer 36

hot flashes

thromboemboli

endometrial cancer

Question 37

hydroxyurea

Answer 37

decreased WBC

myelosuppression

Question 38

cisplatin side effects

Answer 38

nephrotoxicity

ototoxicity

neuropathy

Question 39

etoposide toxicity

Answer 39

myelosuppression

hypotension

weakness

alopecia