I+M disease cytotoxics

Question 1

CYTOTOXIC DRUGS

guidelines for DRUG HANDLING?

Answer 1

Reconstituted by trained personnel
Reconstituted in designated pharmacy areas
Protective clothing
Eye protection
X Pregnant staff
Use local procedures-> spillages/safe disposal/syringes/containers/absorbent material
Monitor staff exposure

Question 2

give examples of ALKYLATING AGENTS?

Answer 2

cyclosphosphamide/ifosofamide/melphalan

Question 3

give examples of ANTHRACYCLINES?

Answer 3

daunorubicin/doxorubicin/epirubicin/idarubicin

Question 4

give examples of ANTIMETABOLITES?

Answer 4

cytarabine/fluorouracil/methotrexate/mercaptopurine

Question 5

give examples of CYTOTOXIC ANTIBIOTICS?

Answer 5

bleomycin/mitomycin

Question 6

give examples of PLATINUM COMPOUNDS?

Answer 6

carboplatin/cisplatin/oxaliplatin

Question 7

give eg of TAXANES?

Answer 7

cabazitaxel/docetaxel/paclitaxel

Question 8

give eg of VINCA ALKALOIDS?

Answer 8

vinblastine/vincristine/vindesine

Question 9

EXTRAVASTAION OF IV drugs?

Answer 9

A number of cytotoxic drugs will cause severe local tissue necrosis if leakage into the extravascular compartment occurs. To reduce the risk of extravasation injury it is recommended that cytotoxic drugs are administered by appropriately trained staff.

Question 10

CYTOTOXIC SIDE-EFFECTS

ORAL MUCOSITIS
(Sore mouth) associated w which ones?

Answer 10

Fluorouracil/Methotrexate/Anthracyclines

Question 11

CYTOTOXIC SIDE-EFFECTS

ORAL MUCOSITIS
Advice?
Preventing>Treating, treat with what?

Answer 11

Good oral hygiene, suck ice chips w/ fluorouracil

tx:
Saline mouthwash

Question 12

CYTOTOXIC SIDE-EFFECTS

ORAL MUCOSITIS tx
If caused by methotrexate?
Methotrexate rescue therapy/OD?

Answer 12

Folinic acid
Methotrexate rescue therapy/OD? Levofolinic acid, also given w/ fluorouracil for colorectal cancer

Question 13

CYTOTOXIC- TUMOUR LYSIS SYNDROME

Why does it occur?
Higher risk in…?

Answer 13

Due to rapid destruction of malignant cells

Higher risk in…?
Non-Hodgkin’s/Burkitt lymphoma/ALL/AML &
Pre-existing hyperuricaemia/Dehydration/Renal Impairment

Question 14

CYTOTOXIC SIDE-EFFECTS

TUMOUR LSYIS SYNDROME CAUSES..?

Answer 14

HYPER kalaemia/uricaemia/phosphataemia
HYPO calcaemia (P&C linked)
ALL can lead to renal damage/arrhythmias :(

Question 15

TUMOUR LYSIS SYNDROME- HYPERURICAEMIA

More present in..? LL

Answer 15

High-grade Lymphoma/Leukaemia

Question 16

TUMOUR LYSIS SYNDROME- HYPERURICAEMIA

What drug+advice 24hrs pre-treatment? aLL
Alternative?

Answer 16

Allopurinol+adequate hydration
Alternative? Febuxostat 2 days pre-treatment

…
dose of mercaptopurine or azathioprine should be reduced if allopurinol needs to be given concomitantly.

Question 17

X, a recombinant urate oxidase, is licensed for hyperuricaemia in patients with haematological malignancy. It rapidly reduces plasma-uric acid concentration and may be of particular value in preventing complications following treatment of leukaemias or bulky lymphomas.

Answer 17

rasburicase

Question 18

CYTOTOXIC SIDE-EFFECTS

BONE-MARROW SUPPRESSION
Caused by all of them EXCEPT..?

Answer 18

Vincristine/Bleomycin

Question 19

CYTOTOXIC SIDE-EFFECTS

BONE-MARROW SUPPRESSION
When does it occur?

Answer 19

7-10 days after administration
…
but is delayed for certain drugs, such as carmustine, lomustine, and melphalan

Question 20

CYTOTOXIC SIDE-EFFECTS

BONE-MARROW SUPPRESSION
What counts do you check pre-treatment? Reduce?

Answer 20

Check blood count, reduce dose if bone marrow not recovered

Question 21

CYTOTOXIC SIDE-EFFECTS

BONE-MARROW SUPPRESSION

AVOID treatment during..?

Answer 21

Acute infection/seek help asap!

Question 22

CYTOTOXIC SIDE-EFFECTS

BONE-MARROW SUPPRESSION

Neutropenic fever immediate treatment?

Answer 22

Broad-spectrum antibiotic

Question 23

CYTOTOXIC SIDE-EFFECTS

Alopecia- common, no pharm tx
Thromboembolism - Chemo increases risk

Question 24

CYTOTOXIC SIDE-EFFECTS

UROTHELIAL TOXICITY
Causes?
Common in?
Treatment?

Answer 24

Causes? Haemorrhage in urinary tract
Common in? ALKYLATING- Cyclophosphamide/Ifosfamide
Treatment? Mesna

Question 25

CYTOTOXIC SIDE-EFFECTS MYELOSUPPRESSION Caused by? Treatment?

Answer 25

Caused by? Methotrexate Treatment? Folinic Acid

Question 26

CYTOTOXIC DRUGS- PREGNANCY/REPRODUCTIVE SYSTEM TECU?

Answer 26

Teratogenic Exclude pregnancy pre-treatment w/ drugs Contraceptive advice pre-therapy Use contraception during+after treatment

Question 27

CYTOTOXIC DRUGS ALKYLATING DRUGS/PROCARBAZINE Increased risk of?

Answer 27

Cyclophosphamide/Ifosfamie/Melphalan Increased risk of? Urothelial toxicity Male sterility Women affected less, may cause onset of premature menopause ??

Question 28

CYTOTOXIC NAUSEA & VOMITING Types of symptoms?

Answer 28

Acute (in first 24hrs) /delayed/anticipatory Delayed/anticipatory the worst

Question 29

CYTOTOXIC CAUSES OF NAUSEA & VOMITING just know a few… MILDly emetogenic?

Answer 29

FLUOROURACIL METHOTREXATE VINCRISTINE ETOPOSIDE

Question 30

CYTOTOXIC CAUSES OF NAUSEA & VOMITING just know a few… MODERATEly emetogenic?

Answer 30

DOXORUBICIN LOW CYCLOPOHSPHAMIDE DOSES HIGH METHOTREXATE DOSES MITOXANTRONE

Question 31

CYTOTOXIC CAUSES OF NAUSEA & VOMITING just know a few… HIGHly emetogenic?

Answer 31

CISPLATIN HIGH DOSES OF CYCLOPHOSPHAMIDE DACARBAZINE

Question 32

CYTOTOXIC NAUSEA AND VOMITING PREVENTION OF ACUTE symptoms (within 24hrs of treatment) LOW-RISK? HIGH-RISK?

Answer 32

LOW-RISK? dexamethasone OR lorazepam HIGH-RISK? 5ht3 receptor antagonist: ondansetron+dexamethasone+aprepitant

Question 33

CYTOTOXIC NAUSEA & VOMITING PREVENTION OF ANTICIPATORY SYMPTOMS (occurs pre-treatment)?

Answer 33

LORAZEPAM

Question 34

ALKYLATING AGENTS- KEY POINTS EXAMPLES? SIDE-EFFECTS?

Answer 34

CYCLOPHOSPHAMIDE/IFOSFAMIDE/MELPHALAN UROTHELIAL TOXICITY RISK OF PERMANENT MALE STERILITY

Question 35

ANTHRACYCLINES- EXAMPLES?

Answer 35

DAUNORUBICIN (RUBY-RED URINE!) DOXORUBICIN EPIRUBICIN IDARUBICIN

Question 36

ANTHRACYCLINES- DOXORUBICIN KEY POINTS?

Answer 36

RUBY-RED URINE FORMULATIONS NOT INTERCHANGEABLE (conventional/liposomal/pegylated liposomal) CARDIOTOXIC SIDE-EFFECTS LIPOSOMAL formulations-> reduced cardiotoxicity but causes painful macular skin eruptions -> Prevents skin eruptions by cooling hands/feet/avoid gloves&socks

Question 37

ANTIMETABOLITES EXAMPLES? SIDE-EFFECTS?

Answer 37

EXAMPLES? CYTARABINE FLUOROURACIL METHOTREXATE MERCAPTOPURINE SIDE-EFFECTS? MUCOSITIS MYELOSUPPRESSION

Question 38

CYTOTOXIC ANTIBIOTICS EXAMPLES? SIDE-EFFECTS?

Answer 38

EXAMPLES? BLEOMYCIN MITOMYCIN SIDE-EFFECTS? PROGRESSIVE PULMONARY FIBROSIS PULMONARY TOXICITY

Question 39

TAXANES- EXAMPLES?

Answer 39

CABAZITAXEL DOCETAXEL PACLITAXEL

Question 40

TAXANES- SIDE-EFFECTS/MONITORING?

Answer 40

HYPERSENTIVITY-> premedicate w/ corticosteroids+antihistamines MONITOR: Cardiac output S+s of pneumonitis+sepsis Contraception during+6 months after

Question 41

VINCA ALKALOIDS EXAMPLES? SIDE-EFFECTS?

Answer 41

VINBLASTINE VINCRISTINE VINDESINE SIDE-EFFECTS? IV ADMINISTRATION ONLY (INTRATHECAL= fatal) BRONCHOSPASM NEUROTOXICITY- neuropathy/motor weakness/myalgia