Cytotoxin Side Effects Flashcards
What are cytotoxic side effects
Extravastion of intravenous drugs
-severe local tissue necrosis due to leakage of the cytotoxins
Oral mucositis
Sore mouth associated with fluorouracil, methotrexate and anthracyclines
- advise to give good oral hygiene and sucking ice chips with fluorouracil
-Treating is less effective than preventing- treat with saline mouthwashes
-If caused by methotrexate use folic acid (levofolinic acid)
Tumour lysis syndrome
-occurs due to rapid destruction of malignant cells
Risk is higher in non Hodgkin lymphoma, burkitts lymphoma, acute lymphoblastic leukaemia and acute myeloid leukaemia
-higher risk in pre existing hyperuricaemia, dehydration and renal impairment
Causes hyper k, ph, and uricaemia as well as HYPO ca renal damage and arrhythmias
Hyperurcicaemia
More present in Hugh grade lymphoma and leukemia
ALLopurinol started 24hrs before treating those tumours- hydrate patient
Alternative febuxostat given 2 days before treatment
What are the other cytotoxic side effects
Bone marrow suppression
- caused by all drugs other than belomycin and vincristine
Occurs 7-10 days after admission
Check blood count before treatment- reduced dose if bone marrow hasn’t recovered
Avoid treatment during acute infection- or seek medical attention if currently taking
Neutopenic fever immediate- broad spectrum antibiotics
Alopecia- common
Thromboembolism- chemo increases risk
Urothelial toxicity
Causes haemorrhaging in urinary tract
Common in cyclophosphamide and ifosfamide
Treated with Mesna
Myelosupression
Can be caused by methotrexate
Use folinic acid to treat toxicity
How does cytotoxic drugs affect the reproductive system
Mostly teratogenic- not to be administered during pregnancy
Exclude pregnancy before cytotoxic treatment with drugs
Advise on contraceptive before therapy begins
Women of childbearing age to use contraception during and after treatment
Alkylating drug or procarbazine
Increased risk of permanent male sterility
Consider sperm storage
Affected women less- may cause onset of premature Menopause
How does cytotoxic drugs cause nausea and vomiting
Symptoms can be acute, delayed or anticipatory
- delayed and anticipatory are more difficult to control than acute
More common in women patients that are <50, anxiety and repeated exposure
Mild: methotrexate, fluorouracil, etoposide and vinca alkaloids
Moderate: taxanses, low cyclophosphamide doses, high methotrexate doses, etoposide and mitoxantrone
High: cicplatin, decarbazine and high cyclophosphamide doses
How do you prevent nausea and vomiting of cytotoxic drugs
Prevention of ACUTE symptoms (within 24 hrs of treatment)
-low risk patients : dexamethasone or lorazepam
High risk patients: ondansetron, dexamethasone +aprepitant
Prevention of DELAYED symptoms (after 24 hrs of treatment)
Moderately emetogenic drugs: dexamethasone + ondansetron
Highly emetogenic drugs : dexamethasone +aprepitant
Prevention of anticipatory symptoms (occurs before treatment
Lorazepam
Summary of alkylating agents
Cyclophosphamide, ifosfamide and melphalan
-urothelial toxicity
Increased risk if permanent male sterility
Summary of anthracyclines
Daunorubicin, doxorubicin, epirubicin and idarubicin
-Rubi red colour urine
- formulation isn’t interchangeable (conventional, liposomal, pegylated liposomal)
Cardiac side effects
Liposomal- reduced cardiotoxicity but causes painful macular skin eruptions
-prevent skin eruptions by cooling hands and feet. And by avoiding wearing gloves and socks
Summary of antimetabolites
Methotrexate, mercaptopurine, cytarabine and fluorouracil
- mucositis and myelosupression
Summary of cytoxic antibiotics
Bleomycin and mitomycin
Progressive pulmonary fibrosis
Pulmonary toxicity
Summary of taxanes
Cabazitaxel, docetaxel and paclitaxel
Hypersensitivity reactions- premeditate with corticosteroids and antihistamines
Monitor cardiac output
Monitor for signs and symptoms of sepsis and pneumonitis
Summary of vinca alkaloids
Vinblastine vincristine and vindesine
IV administration ONLY -intrathecal= fatal
Bronchospams
Neurotoxicity- neuropathy, motor weakness and myalgia
