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afsha - malignancy & blood and nutrition > cytotoxic drug SE > Flashcards

cytotoxic drug SE Flashcards

1
Q

sore mouth is common complication of cancer chemo, most often associated with the following 3

A

MTX
FU
anthracyclines (e.g. doxorubicin, daunorubicin, epirubicin)

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2
Q

is sore mouth a common complication of anthracyclines (-rubicin)

A

yes

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3
Q

for this drug, sucking ice chips during short infusions is helpful in preventing sore mouth

A

FU

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4
Q

Good oral hygiene is probably beneficial against developing sore mouth. Give some examples of this

A

rinsing mouth freq
effective brushing of teeth 2-3x day with soft brush

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5
Q

You should recommend patients who have sore mouth from cancer chemo drugs to use antiseptic or anti inflammatory mouthwashes.

A

False . Can use saline mouthwash but no good evidence to support use of antiseptic or anti inflammatory mouth washes

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6
Q

True or false - mucositis often always can lead to blood borne infection

A

False. Mucositis is generally self limiting but with poor oral hygiene it can be a focus for blood borne infection

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7
Q

hyperuricaemia may be present in high grade …. & ….

A

lymphoma and leukaemia

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8
Q

hyperuricaemia may be present in high grade lymphoma and leukaemia. it can be markedly worsened by chemotherapy and is associated with acute renal failure. therefore, start the FOLLOWING 24 hours before treating such tumours and ensure adequate hydration

A

allopurinol

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9
Q

hyperuricaemia may be present in high grade lymphoma and leukaemia. it can be markedly worsened by chemotherapy and is associated with acute renal failure. therefore, start the allopurinol 24 hours before treating such tumours and ensure adequate hydration.

What is an alternative and when should this be started?

A

Febuxostat
start 2 days before cytotoxic therapy is initiated

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10
Q

if allopurinol is given concomitantly (e.g. to prevent worsening of hyperuricaemia), the dose of the following two drugs needs to be reduced

A

mercaptopurine
azathioprine

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11
Q

What is rasburicase used for

A

licensed for hyperuricaemia in pt with haemotological malignancy

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12
Q

how does rasburicase work (licensed for hyperuricaemia for pt with haemological malignancy)

+ when may it be of particular value

A

recombinant urtate oxidase

it rapidly reduces plasma uric acid conc and may be of particular value in preventing complications following treatment of leukaemias or bulky lymphomas (because hyperuricaemia may be present in high grade lymphoma and leukaemia)

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13
Q

True or false - all cytotoxic drugs cause bone marrow suppression

A

false.

vincristine and bleomycin do not

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14
Q

All cytotoxic drug, except the following 2, cause bone marrow suppression

A

vincristine
bleomycin

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15
Q

how many days after administration does bone marrow suppression commonly occur?

and in which drugs is it delayed for?

A

7-10 days after administration

camustine, lomustine melphalan

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16
Q

true or false - fever in a neutropenic pt required immediate BS-abx

A

true

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17
Q

how would you usually treat symptomatic anaemia?

A

RBC transfusions

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18
Q

in selected patients, you can use the following to reduce the duration and severity of neutropenia

A

recombinant human granulocyte colony stimulating factors

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19
Q

most cytotoxics are teratogenic and should not be given during pregnancy, esp during which trimester?

A

1st

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20
Q

regimens that do not contain the following 2 drugs may have less effect on fertility, however those that DO contain them carry the risk of causing permanent male sterility (no effect on potency)

A

alkylating drugs
procarbazine

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21
Q

what is acute n+v symptoms

A

occur within 24h treatment

22
Q

what is delayed n+v

A

first occuring more than 24h after treatment

23
Q

what is anticipatory n+v

A

occuring prior to subsequent doses

24
Q

which forms of n+v are more difficult to control

A

delayed & anticipatory

25
Q

RF for cytotoxic drug induced n+v

A
  • females
  • under 50
  • anxious pt
  • experience motion sickness
  • repeated exposure to the cytotoxic drug
26
Q

True or false - susceptibility to drug induced n+v decreases with repeated exposure to the cytotoxic drug

A

FALSE
susceptibility INCREASES

27
Q

true or false - patients under 50 more likely to experience drug induced n+v with cytotoxics

A

true

28
Q

The following cytotoxics are classed as mildly emetogenic treatment (5)

A
  • FU
  • Etoposide
  • MTX (less than 100 mg/m2, low dose in children)
  • Vinca alkaloids (e.g. vinblastine, vincristine, etc)
  • Abdominal radiotherapy
29
Q

When is MTX considered mildly emetogenic

A

dose less than 100 mg/m2, low dose in children

30
Q

Vinca alkaloids e.g. vinblastine are how emetogenic?

A

midly

31
Q

The following (5) are moderately emetogenic

A

the taxanes (e.g. paclitaxel)
doxorubicin hydrochloride
intermediate and low doses of cyclophosphamide mitoxantrone
high doses of methotrexate (0.1– 1.2 g/m2).

32
Q

how emetogenic are high doses (0.1– 1.2 g/m2) of MTX?

A

moderately

33
Q

The following 3 are highly emetogenic

A

cisplatin
dacarbazine
high doses of cyclophosphamide.

34
Q

How emetogenic is cisplatin

A

highly

35
Q

Prevention of acute symptoms for pt at low risk of emesis, what can you use

A

pre treatment with dexamethasone or lorazepam can be used

36
Q

Pre treatment with dexamethasone or lorazepem can be used when?

A

Prevention of acute symptoms for pt at low risk of emesis

37
Q

For patients at high risk of emesis, what can you use as prevention of acute symptoms (pre treatment)

A

5HT3 antagonist (usually PO) + dexamethasone + neurokinin receptor antagonist aprepitant

38
Q

When would you use the following pre treatment for prevention of acute symptoms

5HT3 antagonist (usually PO) + dexamethasone + neurokinin receptor antagonist aprepitant

A

pt at high risk of emesis

39
Q

Prevention of delayed symptoms with moderately emetogenic chemotherapy

A

dexamethasone + 5HT3 receptor antagonist

40
Q

Prevention of delayed symptoms for highly emetogenic chemotherapy

A

dexamethasone + aprepitant

41
Q

Rolapitant and metoclopramide hydrochloride are licensed for ….

A

delayed chemotherapy-induced nausea and vomiting.

42
Q

What is the best way to prevent anticipatory symptoms

A

good symptom control

43
Q

What drug can be used as prevention of anticipatory symptoms and why?

A

Lorazepam can be helpful for its amnesic, sedative, and anxiolytic effects.

Remember - good symptom control is the best way to prevent anticipatory symptoms. Thats why its helpful

44
Q

T or F - chemotherapy increases risk of TE

A

true
Venous thromboembolism can be a complication of cancer itself, but chemotherapy increases the risk.

45
Q

T or F - there are pharmacological methods of preventing alopecia

A

False.
Reversible hair loss is a common complication, although it varies in degree between drugs and individual patients. No pharmacological methods of preventing this are available.

46
Q

What to do if there is fever in a neutropenic patient (neutrophil count less than 1.06×109/litre).

A

Immediate BS-ABx therapy
Appropriate bacteriological investigations should be conducted as soon as possible.

47
Q

When does tumour lysis syndrome occur

A

secondary to spontaneous or treatment-related rapid destruction of malignant cells.

48
Q

Which pt are at risk of tumour lysis syndrome? (hint - types of cancer)

A

non-Hodgkin’s lymphoma (especially if high grade and bulky disease)
Burkitt’s lymphoma
acute lymphoblastic leukaemia and acute myeloid leukaemia (particularly if high white blood cell counts or bulky disease)
occasionally those with solid tumours

49
Q

Name 3 predisposing factors to tumour lysis syndrome

A
  • pre existing hyperuricaemia
  • dehydration
  • RI
50
Q

Features of tumour lysis syndrome
- electrolyte imbalances, and other symptoms/damages

A

Features include hyperkalaemia, hyperuricaemia, and hyperphosphataemia with hypocalcaemia; renal damage and arrhythmias can follow.

51
Q

What needs to be done to reduce the risk of extravasation injury (severe local tissue necrosis if leakage into extravascular compartment occurs)

A

recommended that cytotoxic drugs are administered by appropriately trained staff

afsha - malignancy & blood and nutrition (17 decks)

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