Cytotoxic drug side effect Flashcards
Pregnancy + fertility
Most cytotoxic drugs are teratogenic
- Exclude pregnancy + effective contraception
Infertility
- Alkylating drugs and procarbazine carry a risk of permanent male sterility
- Counsel: sperm storage
Bone marrow suppression
except vincristine + bleomycin
- Counsel: report signs of infection or blood disorder
- CI: infections, avoid live vaccines
Bone marrow suppression: treatment
Fever in neutropenic patient:
- Broad spec abx
- Filgrastim
Symptomatic iron deficiency anaemia:
- RBC transfusion OR
- Erythpoietin
Oral mucositis
Most seen in anthracyclines (doxorubicin) + antimetabolites (methotrexate)
Counsel: Good oral health
- Rinse mouth
- Saline mouthwash
- Soft toothbrush
- Suck ice cube
Oral mucositis: treatment
Methotrexate induced oral mucositis: folinic acid
Nausea + vomiting: mild
- MTX
- Vinca alkaloids
- Fluorouracil
- Etoposide
Nausea + vomiting: moderate
- High dose methotrexate
- Taxanes
- Doxorubicin
- Cyclophosphamide
- Mitoxantrone
Nausea + vomiting: high
- Cisplatin
- Dacarbazine
- High dose cyclophosphamide
Nausea + vomiting: treatment
Anticipatory: lorazepam (amnesia, sedative, anxiolytic effects)
Acute <24H:
- Low risk: dexamethasone OR lorazepam
- High risk: 5HT3 antagonist + aprepitant + dexamethasone
Delayed >24H:
- Moderate emetogenic: dexamethasone + 5HT3 antagonist
- High emetogenic: 5HT3 antagonist + aprepitant OR rolapitant + metoclopramide
VTE
high risk: tamoxifen (also causes endometrial cancer), thalidomide, linadamide, pomalidomide
Counsel: report signs of VTE (sudden breathlessness, chest pain, swelling in calf of 1 leg)
Urothelial toxicity
high risk: cyclophosphamide + ifosfamide
Urothelial toxicity: treatment
Hemorrhagic cystitis (blood in urine): MESNA
Tumour lysis syndrome
rapid destruction of cancer cells
High risk: lymphoma or leukaemia
- Clinical features: INC K, urea, phosphate, calcium, arrhythmias + renal failure
Hyperuricemia
- present in high grade lymphoma + leukaemia
- worsened by chemo
Hyperuricemia: treatment
- Allopurinol: 24H before chemo
- Febuxostat: 2 days before chemo
- Rasburicase: haematological cancer
Extravasation injury
High risk: vinca alkaloids + anthracyclines
