Managing Symptoms associated with Chemo

Question 1

Describe CINV

Answer 1

Acute = N/V within 24hrs
Delayed = after 24hrs (2-5 days)
Anticipatory = after 1st cycle = next cycle associates smell/sight with being sick = very hard to treat
Breakthrough = sick despite anti-emetics
Refractory = just can’t control it

Question 2

Which drugs have highest N+V risk?

Answer 2

Platinum drugs

Question 3

What are examples of drugs used for CINV?

Answer 3

Ondansetron + palonosetron (selective 5HT3 receptor antagonists)
Aprepitant (NK1-receptor antagonist)
Dexamethasone ( corticosteroid)
Metoclopramide (D2 antagonist)
Cyclizine (H1 receptor antagonist)

Question 4

How is the central pathway involved in CINV?

Answer 4

Delayed phase
Primarily in the brain

Question 5

How is the peripheral pathway involved in CINV?

Answer 5

Acute phase
Primarily in GI tract

Question 6

What are the adverse effects of ondansetron?

Answer 6

Cardiotoxic
= 16mg infused over at least 15mins

Question 7

Describe antiemetic treatment ladder

Answer 7

1st = NO pre-chemo + metoclopramide to take home
2nd = IV dexamethasone pre-chemo + metoclopramide to take home
3rd = IV ondansetron + dexamethasone pre-chemo, metoclopramide to take home + dexamethasone to take home
4th = as previous step with either aprepitant i addition or palonosetron in place of ondansetron (IV + oral)
5th = as previous step BOTH aprepitant i addition + palonosetron in place of ondansetron (IV + oral)

Question 8

What is mucositis/stomatitis?

Answer 8

Inflammation of tissue lining of oral cavity
= affected = cells divide rapidly
Can be caused by anti-metabolites = methotrexate/gemcitabine
Effects eating + drinking

Question 9

What is the management of mucositis/stomatitis?

Answer 9

Prevention better = good oral hygiene = mouthwash, soft toothbrush
Chlorhexidine mouthwash

Question 10

What is plantar erythrodysesthesia (PPE)?

Answer 10

Effects hands + feet = hand foot syndrome
= dry out skin + peel off - very painful + can affect walking
Common with capecitabine = pro-drug converted to 5FU in vitro

Question 11

How do you treat plantar erythrodysesthesia (PPE)?

Answer 11

Moisturising cream containing urea
eg. Udderly smooth - used on cows udders

Question 12

What can be caused by kinase inhibitors?

Answer 12

Skin issues = acne-like rash = obvious on face = people mention it = have to talk about the cancer
Treat with topic steroids + Abx
Can also make hair go brittle

Question 13

Describe chemo-induced diarrhoea (CID)

Answer 13

Treat with atropine (acute)
After 24hrs = high dose loperamide
Common in irinotecan

Question 14

Describe myelosuppression

Answer 14

ALL chemo can cause this = given in cycles = cells can regenerate = back to normal = next cycle
Have to delay chemo if NOT back to normal
Anaemia = RBC
Neutropenia = WBC
Thrombocytopenia = platelets
Effected because they all divide rapidly
Can present as bruising

Question 15

Describe neutropenic sepsis

Answer 15

Neutropenia with active infection
Considered medical emergency
Neutrophil = <0.5 x10*9
Temp higher than 38
Other signs relevant to sepsis
Treat = empirical beta-lactam Abx in form of piperacillin with tazobactam