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IMMUNE SYSTEM ANG MALIGNANT DISEASE > CYTOTOXIC DRUGS - general > Flashcards

CYTOTOXIC DRUGS - general Flashcards

1
Q

The chemotherapy of cancer should be limited to specialists in oncology

A
  • reconstituted by trained personnel
  • reconstituted in designated pharmacy areas
  • wear protective clothing
  • use eye protection
  • avoided by pregnant staff
  • use local procedures for spillage, safe disposal, include syringes, containers and absorbent material
  • monitor staff exposure to cytotoxins
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2
Q

What is “Neoadjuvant” and “Adjuvant” therapy?

A

“Neoadjuvant therapy”
- initial therapy that shrinks down the tumour
- This is so that later local therapy is more effective and less destructive (to the normal tissue)
- “Adjuvant therapy”
- surgery, chemotherapy, and radiotherapy that is given to prevent the cancer returning

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3
Q

Drug classes

A

alkylating agents
anthracyclines
antimetabolites
cytotoxic abx
platinum compounds
taxanes
vinca alkaloids

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4
Q

Alkylating Agents:

A
  • Cyclophosphamide
  • Ifosfamide
  • Melphalan
  • Bendamustine
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5
Q

Anthracyclines

A
  • Daunorubicin
  • Doxorubicin
  • Epirubicin
  • Idarubicin
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6
Q

Antimetabolites:

A
  • Cytarabine
  • Fluorouracil
  • Methotrexate
  • Mercaptopurine
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7
Q

Cytotoxic Antibiotics

A
  • Bleomycin
  • Mitomycin
  • Platinum Compounds: Carboplatin Cisplatin Oxaliplatin.
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8
Q

Taxanes

A
  • Cabazitaxel
  • Docetaxel
  • Paclitaxel
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9
Q

Vinca Alkaloids

A
  • Vinblastine
  • Vincristine
  • Vindesine
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10
Q

Cytotoxin side effects

A
  1. Extravasation of Intravenous Drugs
  2. Oral Mucositis
  3. Tumor lysis syndrome
  4. Hyperuricaemia
  5. Bone marrow suppression
  6. Alopecia: common
  7. Thromboembolism
  8. Urothelial toxicity
  9. Myelosuppression
  10. N+V
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11
Q

Extravasation of Intravenous Drugs

A

Severe local tissue necrosis due to leakage of the cytotoxin

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12
Q

Oral Mucositis

A
  • Very sore mouth
  • More with Fluorouracil, Methotrexate and Anthracyclines (e.g. doxorubicin)
  • Advise good oral hygiene, and sucking ice chips with fluorouracil
  • Ice chips, antiseptic and anti-inflammatory mouthwash, ionic solutions and oral gels may help
  • If caused by methotrexate: use folinic acid (levofolinic acid)
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13
Q

What drugs cause sore mouth as a side effect?

A

Fluorouracil, Methotrexate and Anthracyclines

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14
Q

Tumour Lysis Syndrome

A
  • Occurs due to rapid destruction of malignant cells
  • Higher risk in pre-existing hyperuricaemia, dehydration and renal impairment
  • Causes HYPER K, Ph, Ca and uricaemia → renal damage and arrhythmias
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15
Q

Which cancers have higher risk of tumour lysis syndrome?

A
  • non-Hodgkin’s lymphoma
  • Burkitt’s lymphoma
  • acute lymphoblastic leukaemia
  • acute myeloid leukaemia
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16
Q

Hyperuricaemia

A

elevated serum uric acid level

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17
Q

Which cancers are hyperuricaemia more present in?

A

More present in high-grade Lymphoma and Leukaemia

18
Q

Hyperuricaemia - treatment

A
  • ALLopurinol started 24hrs before treating those tumours: hydrate patient
  • Alterative: Febuxostat given 2 days before treatment
19
Q

Bone-Marrow Suppression

A
  • Caused by all drugs other than Vincristine and Bleomycin
  • Occurs 7-10 days after administration
  • Check blood count before treatments - reduce dose if bone marrow hasn’t recovered
  • Avoid treatment during acute infection - or seek medical attention if currently taking
  • Neutropenic fever Immediate → broad-spectrum antibiotics
20
Q

Which drugs do NOT cause bone marrow suppression

A

Vincristine and Bleomycin

21
Q

Alopecia

A
  • Reversible hair loss is a common complication
  • Varies between drugs and patients
  • No pharmacological therapy is currently available to prevent this from happening
22
Q

Urothelial Toxicity

A
  • Causes haemorrhage in urinary tract
  • Common in cyclophosphamide and ifosfamide
  • Treated with Mesna
23
Q

Myelosuppression

A
  • Can be caused by methotrexate
  • Use folinic acid to treat toxicity
24
Q

Pregnancy and cytotoxic drugs

A
  • Mostly teratogenic - not to be administered during pregnancy
  • Exclude pregnancy before
  • Advise on contraceptive before therapy begins
  • Women of childbearing age to use contraception during and after treatment
25
Q

Alkylating drug or procarbazine - effect on reproductive system

A
  • Increased risk of permanent male sterility
  • Consider sperm storage
  • Affects women less - may cause onset of a premature menopause
26
Q

Which drugs can cause increase risk of permanent male sterility

A

Alkylating drug or procarbazine

27
Q

Symptoms of nausea and vomiting can be

A

acute
delayed
anticipatory
Delayed + anticipatory more difficult to control than acute

28
Q

Nausea and vomiting - more common in

A

More common in women, patients <50, anxiety and repeated exposure

29
Q

Mild risk of N+V

A

Mild: Fluorouracil, etoposide, methotrexate, vinca alkaloids

30
Q

Moderate risk of N+V

A
  • Taxanes
  • doxorubicin
  • Low cyclophosphamide doses
  • mitoxantrone
  • high methotrexate doses
31
Q

High risk of N+V

A
  • Cisplatin
  • dacarbazine
  • high cyclophosphamide doses
32
Q

N+V - prevention of acute symptoms (within 24 hours of treatment)

A

Low risk patients: Dexamethasone or lorazepam
High risk patients: Ondansetron + dexamethasone + aprepitant

33
Q

Prevention of delayed symptoms (after 24 hours of treatment)

A

Moderately emetogenic drugs: Dexamethasone + ondansetron
Highly emetogenic drugs: Dexamethasone + aprepitant

34
Q

Prevention of anticipatory symptoms (occurs before treatment)

A

Lorazepam

35
Q

Use of folinic acid

A
  • They are used to counteract the folate-antagonist action of Methotrexate
  • This speeds recovery from
    Methotrexate-induced mucositis or myelosuppression
36
Q

Alkylating agents - side effects

A

Cyclophosphamide Ifosfamide Melphalan
* Urothelial toxicity
* Increased risk of permanent male sterility

37
Q

Anthracyclines - side effects

A

Daunorubicin Doxorubicin Epirubicin Idarubicin
* “Rubi-red urine”
* Formulations not interchangeable (conventional, liposomal, pegylated liposomal)
Cardiotoxic side-effects
Liposomal → reduced cardiotoxicity but causes painful macular skin eruptions
* Prevent skin eruptions by cooling hands / feet and by avoiding gloves / socks

38
Q

Antimetabolites - side effects

A

Cytarabine Fluorouracil Methotrexate Mercaptopurine
* Mucositis and myelosuppression

AMENDMENTS
31/03/2024 - Tumour Lysis Syndrome should read:

39
Q

Cytotoxic Antibiotics - side effects

A

Bleomycin Mitomycin
* Progressive pulmonary fibrosis
*Pulmonary toxicity

40
Q

Taxanes - side effects

A

Cabazitaxel Docetaxel Paclitaxel
* Hypersensitivity reactions → premedicate with corticosteroids and antihistamines
* Monitor cardiac output
Monitor for signs and symptoms of pneumonitis and sepsis

41
Q

Vinca Alkaloids - side effects

A

Vinblastine Vincristine Vindesine
* INTRAVENOUS ADMINISTRATION ONLY - INTRATHECAL = FATAL
*Bronchospasm
*Neurotoxicity - neuropathy, motor weakness, myalgia

IMMUNE SYSTEM ANG MALIGNANT DISEASE (5 decks)

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