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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 (cyclophosphomide, ifosfomide, melphalan, lomustine, carmustine, estramustine)
procarbazine

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21
Q

what is acute n+v symptoms

A

occur within 24h treatment

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22
Q

what is delayed n+v

A

first occuring more than 24h after treatment

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23
Q

what is anticipatory n+v

A

occuring prior to subsequent doses

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24
Q

which forms of n+v are more difficult to control

A

delayed & anticipatory

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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

“Mildly Funky Elephants Munch Veggies Always”

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).

“Moderately Tall Doctors Make Cool Moves”

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.

Highly Committed Dr’s Care

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

52
Q

You are reviewing Ms. Blue Berry in clinic today. She has recently started azathioprine to treat generalized myasthenia gravis as advised by her consultant. She mentions that she has read the patient information leaflet and noted that this medication interacts with one of her blood pressure medications, ramipril. You acknowledge this interaction and plan to consult the British National Formulary (BNF) for confirmation. What is a likely consequence of the interaction between azathioprine and ramipril?

A

The interaction between azathioprine and ACE inhibitors like ramipril can increase the risk of adverse effects related to blood cell production causing leukopenia and anaemia.

53
Q

Mrs. Benita Adryl has been diagnosed with severe atopic eczema and has tried various treatments without success. The GP has arranged a specialist appointment for immunosuppressant treatment. She also mentions that she is trying to conceive with her partner and asks if this might affect her ability to get pregnant. What is the use of mycophenolate in CBP?

A

The MHRA advises that women of childbearing potential should use at least one effective method of contraception before and during treatment with mycophenolate, and for 6 weeks after discontinuation. It is preferable to use two methods of contraception. Male patients or their female partners should use effective contraception during treatment and for 90 days after discontinuation.

54
Q

If concomitant allopurinol and azathioprine, how much do you need to reduce azathioprine dose by

A

reduce azathioprine TO 25%

55
Q

You are attending a CPD sessions at the local Primary Care Network (PCN), which aim to enhance pharmacist involvement in medication management for patients with multiple sclerosis. What criteria indicate an active state of the disease?
- Worsening spasticity needing at least 2 courses of baclofen
- Two or more courses of methylprednisolone in the last 2 years
- Two or more relapses in the past 2 years despite treatment with interferon beta
- Two or more episodes of mood alterations requiring amitriptyline
- Two or more relapses in the past year despite treatment with interferon beta

A

C – An active state of multiple sclerosis is typically characterized by ongoing disease activity despite treatment. This is commonly measured by the frequency of relapses. Two or more relapses in the past two years despite treatment with interferon beta indicates an active state of the disease, as it reflects recent disease activity despite the use of disease-modifying therapy.

56
Q

Extravasation management

A
  1. Stop infusion immediately. Do not remove cannula.
  2. Try to aspirate through the cannula in order to remove as much of the drug as possible - this is more possible if it presents with raised bleb/blister at injection site and is surrounded by hardened tissue; and is often unsuccessful if the tissue if soft or soggy
  3. Medications: CC (HC, dex) can be used to reduce inflammation either injected near the site or given IV elsewhere. Antihistamines and analgesics as needed.
  4. Specialist advice - two treatment options
    - localise and neutralise for vesicant drugs: antidote & cold compress
    - spread and dilute for other drugs: inject saline into area, warm compress, elevate limb, sometimes administer hyaluronidase
57
Q

what is licensed for anthracycline induced extravasaition

A

Dexrazoxane is licensed for the treatment of anthracycline-induced extravasation.

antidote

58
Q

Should you administer hyaluronidase following extravasation of vesicant drugs?

A

Hyaluronidase should not be administered following extravasation of vesicant drugs (unless it is either specifically indicated or used in the saline flush-out technique).

59
Q

Precautions need to be taken to avoid extravasation - ideally, drugs that are likely to cause extravasation e.g. anthracyclines should be given:

A

Through a central line
Patients receiving repeated doses of hazardous drugs peripherally should have the cannula resited at regular intervals.

Placing a glyceryl trinitrate patch distal to the cannula may improve the patency of the vessel in patients with small veins or in those whose veins are prone to collapse.

Patients should be asked to report any pain or burning at the site of injection immediately.

60
Q

Patient has just had an infusion of chemotherapy agent. They say that the area is painful and burning.

A) re assure them that this is normal due to the effects of chemotherapy agents and provide analgesics
B) give them IM adrenaline, this is anaphylaxis
C) this is a sign of extravasation injury - manage as that

A

Answer C

extravasation (the leakage of the chemotherapy drug into surrounding tissue) should be suspected, especially with vesicant drugs (which can cause tissue necrosis), which can cause significant tissue damage.

afsha - malignancy & blood and nutrition (27 decks)

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