Chemotherapy I Flashcards
Skipper Hypothesis
The ability of chemotherapy to cure is inversely proportional to the tumor burden
Cytotoxicity
= efficacy of the drug (in killing cancer cells)
Toxicity
= side effects
Partial remission
> 50% reduction in tumor burden
Phase I clinical trials
determine dose and dose limiting toxicity
Phase II clinical trials
Determine Activity
Phase III clinical trials
Determine efficacy
Constitutional toxicities
Nausea, vomiting
Loss of appetitie
Fatigue
Toxicities due to effect on normal dividing cells
Myelosuppression Temporary hair loss Mucositis, sore mouth Diarrhea Sterility Menopause Secondary neoplasms
Organ specific toxicity of anthracyclines (doxorubicin)
Cardiac toxic
Organ specific toxicity of Bleomycin
Pulmonary toxicity
Organ specific toxicity of cis-DDP (cisplatin)
Nephrotoxicity
Absolute neutrophil count
White blood cell count x (%neutrophils + % bands)
Nadir
Lowest neutrophil count
10-14 days after dose
What can you give to prevent neutropenia?
Colony stimulating factors
Filgrastim (G-CSF)
*DO NOT start after already neutropenic
Febrile neutropenia
ANC less than 500, fever greater than 100.5 F
give broad spec Antibiotics
Thrombocytopenia
platelet transfusion if less than 10,000 or low platelet count at any levels and patient is bleeding
Anemia
Blood transfusions
Agents to give for nausea/vomiting
*ONDANSETRON prochlorperazine Selective serotonin antagonists Corticosteroids Lorazepam (anticipatory) Aprepitant
Side effects of anti-emetics
Dexamethason:
Compazine:
Ondansetron:
Dexamethason: elevated sugars
Compazine: Extrapyramidal
Ondansetron: prolonged QT
Stomatitis
Inflammation of mucus membranes of mouth
Give magic mouthwash
+/- nystatin for oral fungal infection
Self-limiting
Vesicants
A substance that causes tissue blistering
Ex. viscristine, vinblastine, doxorubicin, daunorubicin
Portacath
