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PM4B > Complications of chemotherapy > Flashcards

Complications of chemotherapy Flashcards

1
Q

What are the classic side effects of chemotherapy?

A
  1. Nausea
  2. Vomiting
  3. Fatigue
  4. Hair loss
  5. Diarrhoea and mucositis
  6. Infection and drop in white cell count
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2
Q

What is conventional chemotherapy?

A

An umbrella term for chemotherapy that consists of

  1. Traditional (older) chemotherapy drugs
  2. Lack of target specificity to cancer cells
  3. Targeting rapidly dividing cells
  4. With classic chemotherapy side effects
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3
Q

Why do chemotherapy side effects occur?

A
  1. Conventional chemotherapy targets rapidly dividing cells which lead to the destruction of hair follicles, stem cells and mucosal cells
  2. Leads to non specific toxicity through killing of normal body cells
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4
Q

Define acute vomiting

A

Expected vomiting after the first 24 hours after chemotherapy administration

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5
Q

Define delayed vomiting

A

Occurs more than 24 hours after chemotherapy administration and up to 6-7 days after chemo

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6
Q

Define anticipatory vomiting

A

Occurs prior to beginning of a new cycle of chemotherapy as it expected from anxiety or previous cycle response- most common after 3-4 cycles of chemo

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7
Q

Define breakthrough vomiting

A

Development of symptoms despite anti-emetic therapy that require treatment with additional pharmacological agent

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8
Q

Define refractory vomiting

A

Patients who have failed on both standard and rescue medication

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9
Q

What are the different grades of nausea?

A

Grade 1- Loss of appetite without alteration of eating habits

Grade 2- Oral intake decreased without significant weight loss, dehydration, malnutrition, IV fluids indicated for less than 24 hours

Grade 3- Inadequate oral caloric or fluid intake; IV fluids, tube feeding or TPN indicated for more than or equal to 24 hours

Grade 4- Life threatening consequences

Grade 5- DEATH

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10
Q

What are the different grades of vomiting

A

Grade 1- 1 episode in 24 hours

Grade 2- 2-5 in 24 hours; IV fluids indicated at less than 24 hours

Grade 3- More than or equal to 6 episodes in 24 hours; IV fluids or TPN indicated at more than or equal to 24 hours

Grade 4- Life threatening consequences

Grade 5- DEATH

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11
Q

What grade is cisplatin for nausea and vomiting

A

GRADE 3- all cause high rates for nausea and vomiting

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12
Q

Give examples of anti-emetics and the receptor site and action they have

A
  1. Metoclopramide- D2 antagonist, 5-HT3 antagonist, 5HT4 agonist
  2. Domperidone- D2 antagonist
  3. Hyoscine hydrobromide- Muscarinic antagonist
  4. Ondansertron- 5HT3 antagonist
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13
Q

What regimen in the lungs and GI has the highest rates for emetogenicity (sick)?

A

Lung:
Cis/pemetrexed: High
Cisplatin/Vinorelbine: High

Upper GI:
Cis/5FU: High
ECF: High
Gem/cis: High

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14
Q

Describe a typical anti-emetic regime used?

A
  1. Given pre and post chemotherapy
  2. Dexamethasone in low doses of 2mg or 4mg BD usually max 3 days pre and post chemo
  3. 5-HT3 antagonist like ondansetron or granisetron for 1-3 days as very constipating for pre and post chemo
  4. Dopamine antagonist given with 5-HT3 and dexamethasone post chemo such as domperidone or metoclopramide max 5 days PRN
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15
Q

How do you treat diarrhoea in cancer patients

A

Loperamide: can be taken at 2 hourly

Irinotecan: used in colorectal cancer treatments-

Atropine 300mg sc pre-irinotecan to minimuse cholinergic side effects like diarrhoea

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16
Q

How do you treat mucositis in patients?

A
  1. Early treatment to avoid issues with eating and drinking
  2. Mouthwashes with Difflam and chlorhexidine
  3. Good oral hygiene is necessary and soft toothbrush
17
Q

How do you treat hair loss?

A

Prevented with scalp cooling

Very time consuming and not particularly comfortable (brain freeze)

18
Q

How do you measure fatigue and what are the different levels?

A

Performance levels

0= normal activity level, no symptoms

1= normal activity leave, symptomatic

2= Bed less than half the day, assistance with daily activities, symptomatic

3= bed more than half a day, symptomatic

4= Bed written

19
Q

What happens if a patient has anaemia on chemotherapy?

A
  1. May transfuse to increase haemoglobin levels

2. May have to delay next cycle or reduce doses

20
Q

What is thrombocytopenia and neutropenia and what causes and how do you treat them?

A

Thrombocytopenia- bleeding and bruising

Neutropenia- infection prone

Causes: Bone marrow suppression- myelosuppression

Treatment:
FBC taken before each cycle of chemotherapy
Delays/dose reductions if not adequate
Patients counselled to be vigilant and report possible symptoms
Thermometers essential

21
Q

What is tumour lysis syndrome, what can it lead to and how do you treat it

A

Associated with aggressive and large haematological cancers

High cell burden with chemotherapy leads to mass cell lysis

Uric acid and electrolytes released from cells as they breakdown

Leading to deranged U and E and acute kidney injury

Treatment: allopurinol or rasburicase to promote uric acid secretion

22
Q

What is burkitts lymphoma

A

Patient losing up to 10kg in weight with first cycle of chemo due to breakdown of all cells

23
Q

What are the specific side effects of platinum drugs

A
  1. Very emetogenic- high rate of nausea and vomiting
  2. Very ototoxic (hearing) and nephrotoxic (kidney)
  3. Requiring IV fluids before and after administration
24
Q

how do you treat specific platinum side effects

A

Strong anti-emetics like aprepitant (NK1 inhibitor)

Use of IV fluids Mg and K to prevent electrolyte drop and extreme urine output of >100ml per hour to ensure it is excreted quickly

25
Q

How do you treat the side effects of the anti-folate methotrexate

A

IV fluid with bigger doses

urine output of >100ml alongside bicarbonate (increases pH to make more alkali) and acetazolamide to promote excretion

Mucositis- mouthwashes (difflam) and analgesia required

Folinic acid is started 24 hours after methotrexate to help rescue normal cells and prevention of side effects

26
Q

How do you treat the side effects of the anti-metabolite 5-fluorouracil

A

Use of capecitabine which is a pro drug of 5-FU to inhibit pyrimidine synthesis against Palmar-Plantar Erythema (PPE)

Loperamide for diarrhoea

Pyridoxine helps minimise PPE

27
Q

How should vinca alkaloids be given and how do you treat some of the side effects

A

Given in 20mL IV injection and 50mL infusion bags but never intrathecally as it causes death

Treat constipation with laxative

28
Q

How do you treat the side effects of nitrogen mustards and give some examples of nitrogen mustards?

A

Examples: Cyclophosphamide and ifosfamide

Can cause haemorrhagic cystitis which irritates lining of bladder with acrolein- treated with MESNA that binds to this agent in the kidneys

Ifosfamide can cause encephalopathy and methylene blue is used to treat it

29
Q

What are the side effects of Docetaxel

A

Neutropenia= neutrophil count =0.5 × 109/L
GCSF prophylaxis
Progression to neutropenic sepsis

Defined when:
Temperature higher than 38oC
or
other signs or symptoms consistent with clinically significant sepsis, e.g. hypotension

30
Q

What are the side effects of anthracyclins and why do they occur

A
  1. Anthracyclines cause oxidative stress, leading to death of the myocardial cells
  2. Lifetime cumulative doses for all AND across the group
  3. Vesicants- avoid the hand use
  4. Central lines reduce cardiotoxicity
31
Q

What are the side effects of Trastuzumab?

A

Targets HER2 receptor cells present in myocardium

Cardiotoxicity in months and years

PM4B (13 decks)

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