Cytotoxic

Question 1

Which mediations are used to in N&V ?

Answer 1

• 5-TH3 antagonist
• Substance P antagonist (acts on vomiting centre and CTZ)
• dexomethasone
• dopamine antagonist

Question 2

High emetogenic risk (90%) meds?

Answer 2

• carmustine
• carboplatin (> AMU)
• cisplatin
• cyclophosphamide (>1500)
• busulfan - oral

Question 3

Moderate Emetogenic Risk (30-90%) meds?

Answer 3

• carboplatin (<AUC)
• cyclophophamide ( <1500)
• cyclophophamide - oral
• imatinib oral
• datinomycin
• methotrexate

Question 4

Low emtogentic risk (10-30%) meds?

Answer 4

• docetaxel
• methotrexate
• axitinib - oral

Question 5

How to manage high risk emetogenic - acute and delayed ?

Answer 5

Acute
• 5-HT3 antagonist +
• substance P antagonist +
• dethomethasone

Delayed
• continue dethomethasone - omit if corticosteroids are being used

Question 6

How to manage mod risk emetogenic - acute and delayed

Answer 6

Acute
• 5-HT3 +
• dexomethasone

Delayed
• 5-HT3 OR Dexomesthasone

Question 7

How to manage low risk emetogenic - acute and delayed

Answer 7

Acute
• dopamine antagonist OR
• domperidone

Delayed
• antiemetics are not required

Question 8

What is breakthrough Emesis?

Answer 8

When patient experience N/V after after antiemetic prophylaxis treatment

Question 9

How to treat breakthrough Emesis?

Answer 9

• lorazepam
• 5-HT3 antagonist
• dexamethasone
• dopamine antagonist
- prochloperazine
- domperidone

Question 10

Anticipatory Emesis treatment

Answer 10

BZD
• lorazepam
• can also help relieve anxiety
• give orally

Question 11

Radiation infused nausea & vomiting?

Answer 11

• GI tract is most sensitive to radiation
• uncontrolled can lead to delay or refusal of treatment.

Question 12

Assessments for patient with N+V?

Answer 12

• intensity, duration and frequency of vomiting
• dehydration?
• nutritional status
• serum electrolyte imbalance

Question 13

RINV - risk factors?

Answer 13

• area of treatment
• size of treatment area
• dose of radiation

Question 14

How to manage high risk RINV?

Answer 14

5-HT3 antagonist + dexomethasone

Question 15

How to manage medium risk of RINV ?

Answer 15

5-HT3 antagonist + optional - dexomethasone

Question 16

How to manage low risk of RINV ?

Answer 16

5-HT3 antagonist

Question 17

How to manage minimal RINV?

Answer 17

Rescue therapy with either:
• 5-HT3 antagonist
• dexomethasone
• dopamine antagonist

Question 18

How to minimise symptoms of nausea?

Answer 18

• eat small frequent meals
• avoid strong smelling foods
• eat warm/cold foods
• eat ginger contain foods
• avoid drink before a meal

Question 19

Which part of the body does Mucosistis affect ?

Answer 19

Oral mucosa and GI tract

• all cytotoxic drugs can cause this*

Question 20

Signs and symptoms of mucosistis?

Answer 20

• oral bleeding
• change in taste and saliva
• burning sensation in mouth
• discomfort in swallowing

Question 21

Treatment of mucositis

Answer 21

• alcohol free mouth wash (benzylamine)
• soft foods. Avoid citrus
• analgesics
• lip moisturiser

Question 22

What are the common side effects/conditions of chemotherapy?

Answer 22

• n+v
• infertility
• alopeica
• diarrhoea
• hand food syndrome
• tumour lysis syndrome
• mylosupression

Question 23

Diarrhoea

Answer 23

Agents which can cause this:
• irinotecan, fluorourcil

• oral rehydration
• loperamide

Question 24

Alopecia

Answer 24

Agents which can cause this:
• taxens
• anthracyclines

Management:
• minoxidil
• sun protection
• wigs, hats

Do not do scalp cooling

Question 25

Mylosupression - anemia/thrombopenia/neutropenia

Answer 25

Anemia • low rbc • low heamoblogin • low O2 supply to tissue • management - blood transfusion Thrombopenia • low platelets • higher bruising • management- platelet transfusion Neuropenia • low level of neutrophils - risks of infections • management - antibiotics • infection prevention

Question 26

Advise for infection prevention?

Answer 26

• hand hygiene • avoid sexual intercourse when severe • wash hands before touching food • avoid large crowds • clean and cook food throughly

Question 27

Tumour Lysis Syndrome?

Answer 27

? Due to break down products of malignant cells Effects: hyperkalaemia, hyperurincaemia, sezuires, renal failure Management • hydration • maintenance of urine acid output • allopurinol • rasburicase (allows Uric acid to become more soluble to be excreted)

Question 28

Infertility

Answer 28

Men: • poor sperm production & motility Women: • poor egg quality Management • sperm banking • egg preservation * barrier method during intercourse*

Question 29

Hand-food syndrome

Answer 29

S/S: redness and swelling of palms and soles Management: emollient urea 10% cream