Ex2 Chemo Flashcards
Dose limiting factor of chemotherapy
Myelosuppression
Most common side effect that leads to temporary or permanent d/c of therapy
Myelosuppression
Most chemotherapeutic drugs carry _________, so risk of toxicity is ______
Narrow therapeutic index
High risk of toxicity
Given before surgery to facilitate surgery by decreasing tumor burden, possibly decrease survival of tumor cells released during surgery
Neoadjuvent Therapy
Given after surgery to reduce residual tumor burden
Adjuvant therapy
Therapy is unrelated to surgery, solely for decreasing symptoms
Palliative therapy
Unique Side Effect of Alkylating Agents
Bone marrow suppression Hemorrhagic cystitis Pneumonitis, PF Inhibition of Plasma Cholinesterase Activity Nephropathy
Dose Limiting Factor of alkylating agents
Bone Marrow Suppression
Cyclophosphamide - unique side effects
Pericarditis
Hemorrhagic Cystitis
Inhibits plasma cholinesterase activity - prolongs SUX
Unique Side Effects of Melphalan
Pericarditis
Hemorrhagic Cystitis
Inhibits plasma cholinesterase activity - prolongs SUX
Unique Side Effects of Busulfan
Pulmonary Fibrosis
Unique Side Effects of “platins”
Renal Injury
Hypomagnesemia
Ototoxicity
Peripheral Neuropathy
Dose Limiting Side Effect of platins
Renal Injury
Platinum Based Alkylating Agents
Cisplatin
Oxaliplatin
Carboplatin
Unique Side Effects of Methotrexate (Antimetabolite Agents)
Intestinal perforation
Noncardiogenic pulmonary edema
Encephalopathic Syndrome
Unique side effects of Fluorouracil (antimetabolite agent)
Myocardial ischemia
MI ( up to 1 week after tx )
Unique side effects of Cytarabine (antimetabolite agents)
Cerebellar toxicity, ataxia
Unique side effects of Mercaptopurine (antimetabolite agent)
Hepatic Necrosis
Anti tumor antbx
End in “mycin” or “rubicin”
Unique side effect of Daunorubicin, Doxorubicin, Idarubicin
Cardiac Toxicity
Red Urine
Cardiac Toxicity can result in which chemotherapeutic agents?
Daunorubicin, Doxorubicin, Idarubicin
When does cardiomyopathy occur after anthracyclines??
Within 1 week of initiation
Characteristics of Cardiomyopathy from Anthracyclines
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
Anthracyclines effect on anesthesia
Even with normal return of CVS fxn, myocardial depressant effect can be amplified
Types of cardiomyopathy in antitumor antibodies: anthracyclines
Acute cardiomyopathy
Severe, acute cardiomyopathy
Acute cardiomyopathy occurs in _____ amount of patients
10%
Characteristics of Acute Cardiomyopathy
Benign changes on ECG
Cardiac conduction abnormalities, left axis deviation
Occur at all dose levels
Resolve 1-2 months post tx
Characteristics of severe acute cardiomyopathy
Dry, nonproductive cough
Rapidly progressive HF - unresponsive to inotropes/mechanical ventricular assistance
Severe acute myopathy is _______ in 60% of patients in _______ (time)
Fatal
Within 3 weeks
Unique adverse effect of Bleomycin
Pulmonary toxicity
Specifically Interstitial Fibrosis
Risk factors for pulmonary Toxicity of Bleomycin
dose dependent
Drug use, age, prior chest radiation, O2 therapy, combo chemo, prior pulmonary dx, cigarettes, excessive intraop IV fluids/transfusions
Effects of PF from Bleomycin on lung function
Alveolar-arterial gradient for oxygen increased
Pulmonary diffusion capacity decreased
Anesthesia relevance for IPF from Bleomycin
Keep inhaled oxygen therapy LOW <30%
SpO2 >90%
Unique effects of vinca alkaloids (tubulin binding)
Neurologic - neuropathy; loss of Achilles’ tendon reflex, paresthesia, weakness/atrophy of extremities
Autonomic Neuropathy — shock type picture
Dose limiting effect of vinca alkaloids (Tubulin binding)
Neuropathy
Unique Effect of Tubulin Binding Drugs: Taxanes
Cardiac effects - dysrhythmias, myocardial ischemia, asymptomatic bradycardia
Effects on patients undergoing chemo during anesthesia
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
Alkylating agents that cause pulmonary fibrosis
Melphalan Chlorambucil Busulfan Mitomycin Cyclophosphamide
Vinca alkaloids
Vinblastine
Vincristine
Vinorelbine
Taxanes
Docetaxel, Palitaxel
Chemo targets cells during which stage
M/S Phase
