Chemotherapy - side effects Flashcards
Which side effect of chemotherapy is a health professional likely to be most concerned about?
Myelosuppression
Which 2 side effects of chemotherapy is a patient likely to be most concerned about?
Nausea and vomiting and hair loss
Which two drugs dont cause myelosupression?
vincristine, bleomycin
What are the predisposing factors to infection?
¥ Neutropenia
¥ Loss of cell-mediated and humoral immunity (knocking out b and t cells – reduces ability to fight infections). Rituximab affects B cells and chemo drug like Fludarabine affects T cells.
¥ Mucosal damage – need to take sure patients are optimising their mouth care regimens so make sure using mouthwashes and soft toothbrushes – if you have mucositis then it’s a portal for infection with low blood count then can cause life threatening infection.
How can you manage neutropenia?
Primary prophylaxis
- G-CSF – drug. Mobilising and prevent neutropenia. Stimulates neutrophil production and this will be given as primary prophylaxis – 5 or 7 days of G-CSF after chemo cycle to reduce risk of neutropenia.
Secondary prophylaxis
- may have had a complication (been admitted to hospital with infection after first cycle of chemo), then future cycle add G-CSF to prescription to prevent risk of further complications with further cycles. If patient have neutropenia can give G-CSF as an inpatient to boost their cell count.
- Prophylactic antibiotics or antifungals
- May have to delay or dose reduce chemotherapy – e.g. patient with low neutrophils (0.6 e.g.) need to go home and come back in a weeks time and then can give chemo at that point.
- If patient presents with neutropenia and fever (medical emergency) – needs prompt treatment with broad spectrum antibiotics
What is a patient group direction
PGD – patient group direction – give drug without a prescription (accessing drug immediately). Nurses will be allowed to start on IV antibiotics 0 borad spectrum antibiotics (meropenem or tazasin e.g.)
What drug would you give for someone that is has neutropenia and fever with a low risk?
oral antibiotics or IV antibotics for a few days with a step down approach
What drug would you give for someone that is has neutropenia and fever with a high risk?
more than one drug – e.g. using vancomycin with broad spectrum like meropenem or penicilin
What are the effects of cytotoxic drugs on GI tract?
- Nausea and vomiting
- Oral mucositis
- Diarrhoea
How can nausea and vomittiing be subdivided?
- Acute (first 24 hours)
- Delayed (24 hours onwards)
- Anticipatory – often the hardest to manage – when patient sees building and starts to fell sick or sight of nurse is enough for them to be sick.
What are the classes of anti-emetics?
- Dopamine antagonists e.g. haliperiodol, metoclopramide domperidone
- 5-HT3 antagonists e.g. Ondansetron, granestron, palemysetron
- Antihistamines e.g. cyclizine
- NK1 antagonists e.g. aprepritant
- Anticholinergics e.g. Hyoscine hydrobromide and hyoscine butlybromide (less used)
- Corticosteroids e.g. Dexamethasone
- Miscellaneous e.g. Cannabinoids CBD - E.g. nabilone (not really effective)
What are high High emetogenic risk (>90%) drugs?
- Any SCT schedule, cisplatin (leads to serious nausea and vomiting) based chemo – need antiemetics
What are Moderate emetogenic risk (30-90%) drugs?
CHOP, DA, FLAG
What are minimal emetogenic risk (<10%) drugs?
Fludarabine, vincristine, bleomycin
What risk factors are associated with people who are more prone to nausea and vomitting?
- Young age
- Female more likely to feel sick than males
- History of motion sickness
- History of morning sickness
- Adjuvant treatment
- Alcohol may have a protective effect (heavy drinker less likely to be sick)
What are the symptoms of oral mucositis?
- Symptoms include pain, dry mouth, altered taste, ulceration (can lead to secondary infection).
What are common chemo drugs that can cause mucositis?
5-FU, methotrexate, anthracyclines, cytarabine
What are the preventataive measures for oral mucositis?
- Good oral hygiene including use of mouthwashes after brushing teeth
- Sucking ice cubes? – causes vasoconstriction so lessens the effect of chemotherapy (harder for chemo to get to the lining of the mucosa) – i.e. mephan
How can you treat oral mucositis?
- Mouthwashes (usually with anaesthetic – e.g. Difflam)
- Topical steroids
- Sucralfate (currently difficult to get hold of) – used to treat stomach ulcers - protects mouth
- Antacid and oxetacaine (Mucaine®)
- Lignocaine gel – local anaesthetic
- A number of newer treatments are not classed as drugs but as medical devices
- Episil®, Gelclair® (most widely prescribed), Mucodis® - products that line the lining of the mouth – protect and allow healing – no actual active ingredient
Diarrhoea is a common side effect of which 2 chemo drugs?
- Most often seen with 5-FU and irinotecan. Also occurs with majority of nibs
Managed with loperamide (may need to exceed usual max dose (so double the dose)), codeine and even octreotide if very severe
Which chemo drugs can cause alopecia?
Anthracyclines - (Ifosfamide/Cyclophosphamide)
Taxanes - Bleomycin Etoposide
Scalp cooling
What is Plantar palmar erythrodysesthesia (PPE) (hand-foot syndrome) a common side effect of which drugs?
Commonly seen with 5-FU / capecitabine and with some of the nibs e.g. sunitinib, sorafenib, dabrafenib
What are the symptoms of Plantar palmar erythrodysesthesia (PPE)?
- Can result in tenderness, redness, tingling and peeling of the skin on the palms and soles. Patients may even have difficulty walking
How can you manage Plantar palmar erythrodysesthesia (PPE)?
- dose interruption and reduction
- chiropody
- urea based emollients
- cushioned footwear
- avoid long exposure to hot water
- oral analgesia
- pyridoxine (vitamin B6) – normally a high dose of 50mg TDS
