Drug specific side effects of chemotherapy Flashcards

1
Q

Platinums

A
  • Very emetogenic
  • Ototoxic
  • Nephrotoxic
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2
Q

Platinums - management

A
  • IV fluids before and after administration.
  • Urine output > 100 ml/hour
  • GFR tests
  • Audiology tests
  • Strong anti-emetics, e.g. NK-1 inhibitor such as aprepitant.
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3
Q

Aprepitant

A
  • Only licensed to be used in conjunction with dexamethasone and a 5-HT3 antagonist.
  • Dexamethasone doses reduced due to synergistic effect.
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4
Q

Methotrexate

A
  • Nephrotoxic
  • Mucositis
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5
Q

Methotrexate - management (nephrotoxicity)

A
  • Urine output must be >100 mL/hour.
  • Bicarbonate
  • Acetazolamide
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6
Q

Bicarbonate + Acetazolamide

A
  • Promote excretion
  • Increase urine pH from 6-7
  • Methotrexate and its metabolites are poorly soluble at acidic pH.
  • Increase in urine pH = increased solubility (by 5-8 fold).
  • Reduces intratubular crystal formation (precipitation)
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7
Q

Methotrexate - management (mucositis)

A
  • Mouthwash
  • Analesia
  • Folinic acid
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8
Q

5-fluorouracil (5-FU/CAPECITABINE)

A
  • Anti-metabolites
  • Capecitabine = pro-drug of 5FU
  • Inhibit pyrimidine synthesis
  • Diarrhoea
  • Palmar-Plantar Erythema (PPE) with capecitabine
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9
Q

5-fluorouracil (5-FU/CAPECITABINE) - monitoring

A
  • Dihydropyrimidine dehydrogenase (DPD) deficiency testing
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10
Q

(5-FU/CAPECITABINE) - managament (PPE)

A

Pyridoxine

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11
Q

Vinca alkaloids

A
  • Inhibit spindle formation
  • Little myelosuppression
  • Neurotoxic+++
  • Constipation often an issue
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12
Q

Nitrogen mustards

A
  • Cyclophosphamide and isosfamide.
  • Both – haemmorrhagic cystitis.
    • Mesna
  • Ifosfamide – encephalopathy.
    • Methylene blue
  • Confusion, drowsiness.
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13
Q

Docetaxel

A
  • Neutropenia
  • Can progress to neutropenic sepsis, defined as:
    • neutrophil count </=0.5 × 109/L
      and:
    • a temperature higher than 38oC or
    • other signs or symptoms consistent with clinically significant sepsis, e.g. hypotension
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14
Q

Docetaxel - management

A
  • GCSF prophylaxis
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15
Q

ANTHRACYCLINES

A
  • Doxorubicin, epirubicin, idarubicin, daunorubicin and mitoxantrone.
  • Cardiotoxic (type 1 - results from cumulative administered dose and is irreversible)
  • Doxorubicin – 450mg/m2
  • Epirubicin – 900mg/m2
  • Central lines reduce cardiotoxicity
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16
Q

Trastuzumab

A
  • Selectively targets HER2
  • HER2 present in myocardium - cardiotoxic.
  • Type 2 cardiotoxicity - reversible.