CYTOTOXIC DRUGS

Question 1

CYTOTOXIC DRUGS:
What are they for?

Answer 1

Cancer, immune mediated diseases
damage normal tissue

Question 2

CYTOTOXIC DRUGS;

what should be avoided concurrently?

Answer 2

Radiotherapy as it causes toxicity and they are radiomemtics

Question 3

CYTOTOXIC DRUGS:
How is their use optimised?

What is a down side of this

Answer 3

Used as combination regimens to reduce risk of cancer resistance

Thus can be more toxic

Question 4

CYTOTOXIC DRUGS SIDE EFFECTS:
What are SEVEN important side effects

Answer 4

Oral mucositis
N+V
Bone marrow suppression
alopecia
tumour lysis syndrome
hyperurucaemia
VTE

Question 5

CYTOTOXIC DRUGS SIDE EFFECTS:
How is oral mucositis managed?

Answer 5

good oral hygiene
suck on ice during chemotherapy

Question 6

CYTOTOXIC DRUGS SIDE EFFECTS:
How is nausea and vomiting managed?

Answer 6

Lorazepam
Ondansetron
Aprepitant
Dexamethasone

to prevent delayed;
metoclopramide

anticipatory;
lorazepam

Question 7

CYTOTOXIC DRUGS SIDE EFFECTS:
How is bone marrow suppression managed?

Answer 7

Peripheral blood counts should be taken before each treatment and the dose reduced if not fully recovered from the previous dose.

If fever presents in a neutropenic patient, they should be treated immediately with broad spectrum antibiotics-

Filgratism-
Avoid paracetamol

in selected patient’s granulocyte stimulants can be used to reduce the severity and duration of neutropenia.

symptomatic iron-deficiency anaemia-
erythropoietin or RBC transfusion

Question 8

CYTOTOXIC DRUGS SIDE EFFECTS:

What are contraindications of bone marrow suppression?

Answer 8

infections
avoid live vaccines

Question 9

CYTOTOXIC DRUGS SIDE EFFECTS:

what cytotoxic drugs DO NOT cause bone marrow toxicity?

Answer 9

bleomycin
vincristine

Question 10

CYTOTOXIC DRUGS SIDE EFFECTS:

How is alopecia treated?

Answer 10

Unpreventable but reversible
cold cap therapy

Question 11

CYTOTOXIC DRUGS SIDE EFFECTS:

What is tumour lysis syndrome and what are symptoms?

Answer 11

occurs due to rapid destruction of malignant cells ( due to drug or spontaneously)

hyperkalaemia, hyperuricaemia and hyperphosphataemia with hypocalcaemia. Renal damage and arthritis can follow.

Question 12

CYTOTOXIC DRUGS SIDE EFFECTS:

What is treatment and prevention hyperuricaemia?

Answer 12

Allopurinol should be started 24 hours before treating such tumours and patients should be adequately hydrated

febuxostat; started 2 days before

Question 13

CYTOTOXIC DRUGS SIDE EFFECTS:

what safety systems need to be in place for cytotoxic medicines?

Answer 13

Cytotoxic drugs for the treatment of cancer should be given as part of a treatment plan co-ordinated by a multidisciplinary team.

Should be prescribed, dispensed and administered in accordance of a treatment plan

Injectable cytotoxic drugs should only be dispensed if they are prepared for administration

Oral cytotoxic medicines should be dispensed with clear directions for use.

Question 14

VINCA ALKALOIDS:
what are examples vinca alkaloids?

Answer 14

vinblastine, vincristine, vindesine, vinorelbine

Question 15

VINCA ALKALOIDS:

what are vincalakaloids used to treat?

Answer 15

breast cancer, leukaemia, lymphomas, and some solid tumours, other cancers

Question 16

VINCA ALKALOIDS:

What is route of administration of vinca-alkaloids?

Answer 16

IV ONLY!
intrathecal can lead to fatal neurotoxicity

Question 17

VINCA ALKALOIDS:
What are side effects?

Answer 17

CNS toxicity

Question 18

ANTHRACYCLINES:

what is doxorubicin and what is it used for?

Answer 18

anthacycline

and is used for acute leukaemias, Hodgkin’s and non-Hodgkin’s lymphomas, paediatric malignancies, and some solid tumours including breast cancer

Question 19

ANTHRACYCLINES:

What are examples?

Answer 19

epirubicin
idarubicin
daunorubucin
doxorubicin- excreted in bile- reduce dose if high bilirubin

Question 20

ANTHRACYCLINES:
What are side effects?

Answer 20

Cardiotoxicity ( dose- related; higher risk if given with Herceptin)
red urine

Question 21

ANTHRACYCLINES:
What can reduce the incidence of cardiotoxocity and extravasation?

Answer 21

Liposomal formulation of doxorubicin

however can cause
hand and foot syndrome;
macular, red skin eruptions
prevention; cool hands and feed and avoid socks and gloves 4-7 days post treatment.

Question 22

ANTHRACYCLINES:
What is treatment for anthracycline-induced side effects, extravasation and over dose?

Answer 22

dexrazoxane

Question 23

ALKYLATING;

what are alkylating drugs? what are examples?

Answer 23

chemotherapy drugs; They act by damaging DNA, thus interfering with cell replication.

cyclophosphamide
ifosfamide
Cisplatin

Question 24

CYTOTOXIC SIDE EFFECTS:

What cytotoxic drugs are mild emetogenics?

Answer 24

methotrexate
fluorauracil
vinca alkaloids

Question 25

CYTOTOXIC SIDE EFFECTS:

What cytotoxic medications are moderate emetogenics?

Answer 25

Taxans
doxorubicin
cyclophosphamide
high dose mtx

Question 26

CYTOTOXIC SIDE EFFECTS:

What cytotoxic medications are high emetogenics?

Answer 26

Cisplatin
high dose cyclophosphamide

Question 27

CYTOTOXIC SIDE EFFECTS:

What is treatment of acute (<24hrs post chemo) symptoms of N+V?

Answer 27

Low risk emesis- dexamethasone or lorazepam

high risk- 5HT3 antagonist, aprepitant + dexamthasone

Question 28

N+ V
What is treatment of delayed symptoms (> 24hrs post chemo) ?

Answer 28

moderate emetogenic drugs-
dexamethasone + 5HT3 Antagonist

High emetogenic drugs-
dexamethasone + aprepitant

Question 29

ALKYLATING DRUGS;

What are risks of alkylating drugs?

Answer 29

Permanent male sterility
counsel patients on sperm storage

women are less affected; early may menopause occur

Question 30

TAXANES:
What are examples?

Answer 30

Paclitaxel

Question 31

TAXANES:

what are side effects?

Answer 31

cardiac disease
pneumonitis
sepsis