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PH3101 > Chemotherapy in the clinical setting (DONE) > Flashcards

Chemotherapy in the clinical setting (DONE) Flashcards

1
Q

The cell cycle

A 
This is the process by which cells reproduce and develop
Consists of 5 phases:
Resting phase (G1)
Preparation
DNA synthesis (S)
Resting state (G2)
Division (M)
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2
Q

How can chemotherapy be delivered?

A

Oral, IV, SC, IM, intrathecal, intra-vitreal, intravesical, topical, intraperitoneal, intrapleural

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3
Q

Cell cycle specific chemotherapy agents

A

As all cells are not in cycle at the same time they are best given by repeated dosing or by continuous infusion
Examples: anti-metabolites, vinca alkaloids, topoisomerase inhibitors, taxanes

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4
Q

Cell cycle non specific chemotherapy agents

A

Cytotoxic agents that are effective throughout all phases of the cell cycle
They directly affect the DNA molecule
Show no specificity to dividing cells- thought to be more toxic that cell cycle specific
Tend be given as bolus doses
Examples: alkylating agents, antitumour antibiotics, platinum compounds

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5
Q

Advantages of combination therapy

A

Choose drugs with different side effects for maximum effect with minimum toxicity
Broader range of coverage for resistant cells
Less development of new resistant cell lines
Synergistic effects

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6
Q

CMF (breast cancer)

A

Cyclophosphamide
Methotrexate
Fluorouracil

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7
Q

R-CHOP (non-Hodgkins lymphomas)

A 
Rituximab
Cyclophosphamide
Doxoxrubicin
Vincristine
Prednisolone
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8
Q

R-CVP (B-cell lymphoma)

A

Rituximab
Cyclophosphamide
Vincristine
Prednisolone

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9
Q

Preventing adverse effects

A

Appropriate doses
Doses related to weight/surface areas
Appropriate combinations of drugs
Recovery time between cycles

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10
Q

Adverse effects

A 
Infection, bleeding, anaemia
Nausea and vomiting
Mucositis
Alopecia
Infertility
Secondary malignancy
Extravasation
Tumour lysis
Drug-specific
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11
Q

Infection in bone marrow

A

White blood cells destroyed
Severity and duration of myelosuppression is drug dependent
Can predict when patient is most susceptible to infection

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12
Q

Nadir

A

Lowest absolute neutrophil count after chemotherapy

Usually 10-14 days

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13
Q

Risk of infection

A

Neutrophils <1.0 associated with significant morbidity and mortality from infection
Prolonged neutropenia increases risk
At risk from bacteria, virus and fungi

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14
Q

Minimising the risk of infection

A

Good hygiene
Prophylactic anti-infectives e.g. ciprofloxacin
Haematopoietic growth factors e.g. G-CSF
Monitor own temperature at home and act on high readings
Aseptic technique when handling IV catheter siites
Lifestyle advice

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15
Q

Mouth hygiene

A

Brush teeth regularly
Soft toothbrush
Antiseptic mouthwash

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16
Q

Haematopoietic growth factors

A

Limit severity and duration of neutropenia
Reduce risk of infection and avoid treatment delays
Support neutrophils, allow higher doses
Do not prevent neutropenia after chemotherapy
No evidence of improved overall survival
E.g. filgrastim, lenograstim

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17
Q

Bone marrow/stem cell transplant

A

Destruction of the bone marrow restricts doses of chemotherapy that can be used
Bone marrow contains stem cells
Stem cells can also be found in the peripheral blood after chemotherapy or G-CSF
Can give high doses of chemotherapy, then transplant stem cells into patient
Used as a treatment for haematological malignancies such as myeloma, leukaemia and lymphoma

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18
Q

Treatment of infection

A

Treat any fever with broad spectrum antibiotics
Cytotoxic drugs compromise ability of patient to fight infection
Reduce by using prophylactic antibiotics whilst patient is neutropenic and giving lifestyle advice

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19
Q

How to treat infection

A

Immediate broad spectrum IV antibiotics e.g. tazocin and gentamicin
Review daily, responding to positive isolates and clinical signs
Consider unusual infections
Refer any patient feeling unwell during nadir period
Consider interactions of OTC meds with chemotherapy

20
Q

Thrombocytopenia

A

Less common than neutropenia
May occur 7-14 days after chemotherapy
Causes bleeding
Management: avoid IM injections, women receive norethisterone, platelet transfusion, tranexamic acid

21
Q

Anaemia

A

Rare effect due to long life span of circulating RBCs (120 days)
Management: blood transfusion

22
Q

Marrow recovery

A

FBC must be checked before each cycle

Dose reduction or treatment delay if marrow recovery has not occurred

23
Q

Nausea and vomiting

A

Common
Profound effect on QoL
Many recent advance in control of N and V
Anticipatory emesis is now less common due to better symptom control
Delayed emesis remains a problem

24
Q

Risk factors for N and V

A 
Emetogenic potential of chemotherapy drugs
Previous experience of chemotherapy
Female gender
Under 50 years old
Low alcohol intake
Anxiety
25
Q

Anti-emetic drugs

A

5HT3 antagonists: granisetron, ondansetron, tropisetron
Standard antiemetics: cyclizine, metoclopramide, Domperidone
Aprepitant
Dexamethasone
Lorazepam
Levomepromazine

26
Q

5HT3 antagonists

A 
Block 5HT3 receptors in CTZ
Highly effective
More effective if combined with dexamethasone
Oral or IV
Less effective for delayed N and V
27
Q

Aprepitant

A

Neurokinin 1-receptor antagonist
Licensed to treat N and V caused by chemotherapy
IV form = fosaprepitant

28
Q

Dexamethasone

A

Most effective available agent for delayed emesis

Given in combination with other anti-emetics for regimens of high emetogenicity

29
Q

Lorazepam

A

Useful for anticipatory N and V
Amnesic, sedative and anxiolytic effects
May be given IV or sub-lingually

30
Q

Levomepromazine

A

Phenothiazine derivative
Good for delayed emesis
Can be given as an SC infusion

31
Q

Mucositis

A

Symptoms: ulceration, pain, tingling, dry mouth, loss of taste
May affect whole GIT
Easier systemic access for bacteria and fungi present in the mouth
May develop 3-4 days after chemotherapy

32
Q

Management of mucositis

A

Good oral hygiene
Regular use of antiseptic mouthwash
painkillers- mouthwashes, oral, injection
Calcium folinate with MTX

33
Q

Alopecia

A

Drug dependent e.g. etoposide
Reversible
Scalp cooling techniques- of little benefit
Wigs available on NHS

34
Q

Male infertility

A

Azospermia and infertility common (esp. alkylating drugs e.g. cyclophosphamide)
May be permanent
Sperm banking
Pre-treatment counselling

35
Q

Female infertility

A

Amenorrhoea and sterility can occur
Ovarian function may be restored
Premature menopause
Pre-treatment counselling

36
Q

Secondary malignancy

A

Affects mainly children
Especially with alkylating agents
Most common secondary malignancies are all lymphoma

37
Q

Extravasation

A

Vesicant drug leaks out of vein into surrounding tissue
May require plastic surgery
Should always be treated as an emergency

38
Q

Management of extravasation

A

Avoid by: regular observation, using central lines

Treat by: stopping infusion, drawing back if possible, flushing site and using antidotes

39
Q

Tumour lysis

A

Treatment of bulky, fast growing disease- large amount of waste products
Accumulation causes acute renal failure
Mainly associated with acute leukaemias and high grade lymphoma
Prevent with hydration, allopurinol, rasburicase

40
Q

Renal toxicity

A

Cisplatin, ifosfamide, methotrexate, carboplatin, cyclophosphamide
Prevention: maintain diuresis > 100ml/hour, monitor urea and creatinine

41
Q

Haemorrhagic cystitis

A

Potential side effect of ifosfamide and cyclophosphamide (high dose) drug metabolite scours the bladder epithelium
Management: mesna- reacts with acrolein in the urinary tract to form harmless compound, high fluid intake

42
Q

Electrolyte disturbances

A

Cisplatin: electrolyte leaching occurs- Mg, Zn, Ca and K- manage with IV electrolyte and fluid supplements
High dose 5-FU: hypokalaemia- manage with oral/IV supplements

43
Q

Cardiac toxicity

A

Especially with anthracyclines e.g. doxorubicin, daunorubicin
Causes cardiomyopathy and heart failure
Minimise by setting maximum cumulative dose

44
Q

Neurotoxicity

A

Vinca alkaloids e.g. vincristine can cause nerve damage
Patients report tingling or numbness of fingers/toes, constipation
Use alternative vinca alkaloid, or withhold

45
Q

Hypersensitivity/infusion reactions

A

Occurrence increasing with use of monoclonal antibodies
Regularly seen with taxanes and rituximab
Infusions should be started very slowly
Cover with steroids and antihistamines
Close observation by nurses trained to respond

46
Q

Hand-foot syndrome

A

Occurs during treatment with 5-FU

Treat with pyridoxine and emollients

47
Q

Drugs used specifically to prevent induced side effects

A 
Calcium folinate (folinic acid)
Rescue from methotrexate- speeds recovery from methotrexate induced mucositis and myelosuppression
Given in repeated doses over at least 2 days, start 24 hours after beginning of methotrexate infusion

PH3101 (25 decks)

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