Cytotoxic Safety & Therapeutic Issues Flashcards
what are reasons why you may not want to administer chemotherapy (5)
- signs of infection
- vomiting or diarrhea
- anorexia, inappetance
- PUPD
- concurrent medications
what should you do before deciding if it is safe to administer chemo (2)
- physical exam
- routine blood tests (renal, liver and hematology)
what is myelosuppression
bone marrow suppression
what is the order of cells that are susceptible to myelosuppression
- neutropenia (shortest half life)
- thrombocytopenia
- anemia
how is myelosuppression prevented
check hematology prior to chemo
reduce/delay chemotherapy
what is the number of neutrophils that would be considered too low
>2.5 x 10^9/L
describe what actions would be taken in mild, moderate and severe neutropenia during chemo treatment
how is chemotherapy drugs dosed
according to body surface area
what is the formula for chemotherapy drug dosing
BSA = K x BWt (grams)^2/3/10^4
K = 10.1 dogs
K = 10.0 cats
calculate the dose of vincristine to administer to a 30kg dog
vincristine = 0.7mg/m^2
m^2 = 0.965m^2
vincristine = 0.7mg/m^2
= 0.7 x 0.965 = 0.68mg
concentration is 1mg/ml so dose to give is 0.68ml
calculate the dose of cyclophosphamide to give to a 20kg dog
tablets = 50mg/m^2
m^2 = 0.74m^2
cyclophosphamide tabelts = 50mg/m^2
= 50 x 0.74 = 37mg
tablets available as 50mg = dilemma do not split cytotoxic drugs
how do you solve dosing dilemmas (can’t spit tablets)
- increase dosing interval
- get drugs reformulated to match exact dose
who should never handle cytotoxic drugs
- under 18y
- pregnant or breastfeeding women
- immunocompromised people
what are the risks when handling cytotoxic drugs (6)
- absorption via skin or mucus membranes
- aerosol formation when removing liquid chemotherapy
- inhalation
- self-inoculation when administering injectable agents
- handling of waste
- patient excreta
how do you minimze exposure to cytotoxic drugs
- don’t eat, drink, store food, smoke or apply makeup in areas where cytotoxic drugs are stored, prepared or administered
- use visual warnings (signs, hazard tape)
- use of best practice when handling drugs & waste
- wear PPE
describe how you would safely administer cytotoxic drugs generally (8)
- avoid aerolization
- wear PPE
- place IV catheters
- locked syringes
- closed systems
- restraint of patients
- disposal by incineration
- excretion of drugs
what PPE should you wear
- gloves: double gloves, latex free, powder free
- gown: chemoprotective, disposable, back closure, cuffs
- eye shield
- face mask/respirator
what is the gold standard injectable drug prepareation
laminar flow biological safety cabinet
what are other ways for injectable drug preparation (2)
- closed/needle-free admin systems (ICU medical, phaseal)
- well ventilated area with careful prep (chemo spikes, ventilating needles)
describe the process of preparing injectables (4)
- spike vial with needle while vial is upright
- invert bottle, wrap swab around and withdraw liquid
- re-invert vial to an upright position
- wrap swab around while withdrawing needle to collect any aerosols
why use a catheter when administering cytotoxic drugs
- ensures accurate dosage
- less likely to slip and mis inject
- allows thorough flushing with saline
- allows to keep system closed when using a T-connector
describe the steps to an IV bolus administration (4)
- check patency of catheter by flushing with 0.9% NaCl
- carefully insert needle through the injection port
- cover with a swab and inject the drug. wrap swab around needle when removing to collect any droplets
- flush through with copious amounts of 0.9% NaCl before removing catheter
how are SC/IM injections done
use leur lock syringes
when inserting the needle place an alcohol soaked swab over the site
swab the area when removing the needle
how are oral tablets administered
- wear gloves
- never split tablets
- never crush tablets or open capsules
- give in a small amount of food to allow easier admin
- if dispensing to clients use warning tape dn supply gloves
how are spills managed
a cytotoxic spill kit should be availble
alert staff
wear protective clothing
absorbent towels
polythene bags
wash surfaces with copious water
what are chemotherapy excretion times
metabolized by liver and excreted in urine, feces and saliva
different drugs over different time
what are general side effects caused by chemotherapy drugs
- perivascular reacitno
- myelosuppression
- GI upset
- hypersensitivity
- alopecia (rare)
- delayed effects (infertility, new tumour induction)
how do you treat extravasation
- stop treatment
- stuck back as much as possible
- cold compress (hot for vinca alkaloids)
- talk to owners
- standard wound management
- surgical debridement, skin grafts
- dilute with saline, other drugs?
what is the after care of animals recieving chemo in the practice
- wear PPE
- warning sign on kennel door
- all excreta and soiled kennel liners disposed of as cytotoxic waste
- use alginate laudry bags
- dont use hose to clean kennels
- place warning on lab forms
what is the after care of patients at home
- provide clients with info sheet
- minimize contact with young children, pregnant women, immunosuppressed people
- wear gloves when cleaning excreta
- dicsourage pet sleeping in owners beds – wash pet bed 1x/week
- observe good hygiene – wash food/water bowls, wash hands after petting
