Ex2 Chemo

Question 1

Dose limiting factor of chemotherapy

Answer 1

Myelosuppression

Question 2

Most common side effect that leads to temporary or permanent d/c of therapy

Answer 2

Myelosuppression

Question 3

Most chemotherapeutic drugs carry _________, so risk of toxicity is ______

Answer 3

Narrow therapeutic index

High risk of toxicity

Question 4

Given before surgery to facilitate surgery by decreasing tumor burden, possibly decrease survival of tumor cells released during surgery

Answer 4

Neoadjuvent Therapy

Question 5

Given after surgery to reduce residual tumor burden

Answer 5

Adjuvant therapy

Question 6

Therapy is unrelated to surgery, solely for decreasing symptoms

Answer 6

Palliative therapy

Question 7

Unique Side Effect of Alkylating Agents

Answer 7

Bone marrow suppression 
Hemorrhagic cystitis 
Pneumonitis, PF
Inhibition of Plasma Cholinesterase Activity
Nephropathy

Question 8

Dose Limiting Factor of alkylating agents

Answer 8

Bone Marrow Suppression

Question 9

Cyclophosphamide - unique side effects

Answer 9

Pericarditis
Hemorrhagic Cystitis
Inhibits plasma cholinesterase activity - prolongs SUX

Question 10

Unique Side Effects of Melphalan

Answer 10

Pericarditis
Hemorrhagic Cystitis

Inhibits plasma cholinesterase activity - prolongs SUX

Question 11

Unique Side Effects of Busulfan

Answer 11

Pulmonary Fibrosis

Question 12

Unique Side Effects of “platins”

Answer 12

Renal Injury
Hypomagnesemia
Ototoxicity
Peripheral Neuropathy

Question 13

Dose Limiting Side Effect of platins

Answer 13

Renal Injury

Question 14

Platinum Based Alkylating Agents

Answer 14

Cisplatin
Oxaliplatin
Carboplatin

Question 15

Unique Side Effects of Methotrexate (Antimetabolite Agents)

Answer 15

Intestinal perforation
Noncardiogenic pulmonary edema
Encephalopathic Syndrome

Question 16

Unique side effects of Fluorouracil (antimetabolite agent)

Answer 16

Myocardial ischemia

MI ( up to 1 week after tx )

Question 17

Unique side effects of Cytarabine (antimetabolite agents)

Answer 17

Cerebellar toxicity, ataxia

Question 18

Unique side effects of Mercaptopurine (antimetabolite agent)

Answer 18

Hepatic Necrosis

Question 19

Anti tumor antbx

Answer 19

End in “mycin” or “rubicin”

Question 20

Unique side effect of Daunorubicin, Doxorubicin, Idarubicin

Answer 20

Cardiac Toxicity

Red Urine

Question 21

Cardiac Toxicity can result in which chemotherapeutic agents?

Answer 21

Daunorubicin, Doxorubicin, Idarubicin

Question 22

When does cardiomyopathy occur after anthracyclines??

Answer 22

Within 1 week of initiation

Question 23

Characteristics of Cardiomyopathy from Anthracyclines

Answer 23

Often irreversible
Peaks at 1-3 months
Dose dependent (higher dose = higher risk)
Increased risk with previous CVS injury, hypotension, radiation, previous tx w/ cyclophosphamide

Question 24

Anthracyclines effect on anesthesia

Answer 24

Even with normal return of CVS fxn, myocardial depressant effect can be amplified

Question 25

Types of cardiomyopathy in antitumor antibodies: anthracyclines

Answer 25

Acute cardiomyopathy

Severe, acute cardiomyopathy

Question 26

Acute cardiomyopathy occurs in _____ amount of patients

Answer 26

10%

Question 27

Characteristics of Acute Cardiomyopathy

Answer 27

Benign changes on ECG
Cardiac conduction abnormalities, left axis deviation
Occur at all dose levels
Resolve 1-2 months post tx

Question 28

Characteristics of severe acute cardiomyopathy

Answer 28

Dry, nonproductive cough

Rapidly progressive HF - unresponsive to inotropes/mechanical ventricular assistance

Question 29

Severe acute myopathy is _______ in 60% of patients in _______ (time)

Answer 29

Fatal

Within 3 weeks

Question 30

Unique adverse effect of Bleomycin

Answer 30

Pulmonary toxicity

Specifically Interstitial Fibrosis

Question 31

Risk factors for pulmonary Toxicity of Bleomycin

Answer 31

dose dependent
Drug use, age, prior chest radiation, O2 therapy, combo chemo, prior pulmonary dx, cigarettes, excessive intraop IV fluids/transfusions

Question 32

Effects of PF from Bleomycin on lung function

Answer 32

Alveolar-arterial gradient for oxygen increased

Pulmonary diffusion capacity decreased

Question 33

Anesthesia relevance for IPF from Bleomycin

Answer 33

Keep inhaled oxygen therapy LOW <30%

SpO2 >90%

Question 34

Unique effects of vinca alkaloids (tubulin binding)

Answer 34

Neurologic - neuropathy; loss of Achilles’ tendon reflex, paresthesia, weakness/atrophy of extremities
Autonomic Neuropathy — shock type picture

Question 35

Dose limiting effect of vinca alkaloids (Tubulin binding)

Answer 35

Neuropathy

Question 36

Unique Effect of Tubulin Binding Drugs: Taxanes

Answer 36

Cardiac effects - dysrhythmias, myocardial ischemia, asymptomatic bradycardia

Question 37

Effects on patients undergoing chemo during anesthesia

Answer 37

Lower N/V
Enhanced Cardiosuppressive Effects
NMBA - neuropathies may effect monitoring
Avoid Rx that increase seizure potential
Renal — ISO/DES preferred (Sevo = Compound A)
Hepatic - Vecuronium/Rocuronium may need adjusted dose d/t hepatic metabolism
Oral - Intubation difficulty d/t ulcers/inflammation
Increased SSI risk

Question 38

Alkylating agents that cause pulmonary fibrosis

Answer 38

Melphalan
Chlorambucil 
Busulfan
Mitomycin 
Cyclophosphamide

Question 39

Vinca alkaloids

Answer 39

Vinblastine
Vincristine
Vinorelbine

Question 40

Taxanes

Answer 40

Docetaxel, Palitaxel

Question 41

Chemo targets cells during which stage

Answer 41

M/S Phase