Pharmaceuticals and Contraindications Flashcards
benefits of chemoradiation
radiosensitiser - enhances DNA damage
radiation enhancer - enhances radiation effect
chemotherapeutic agents + XRT - does needs to be adjusted with concurrent XRT => acceptable toxicities
increase cancer cure
replace the need for surgery (or delay it)
allows organ preservation
common complications of chemo-radiation
- nausea and vomiting
- mucositis/stomatitis
what is mucositis/stomatitis
inflammation and damage of the mucous membranes lining the mouth and other parts of the GI tract
radiation induced mucositis
more severe and of longer duration when compared to chemo-induced mucositis
- appears after -2weeks of radiation
- peaks by the end of RT => may persist for up to 8 weeks
chemo induced mucositis
typically occurs 2-3 weeks from the commencement of chemotherapy
mucositis/stomatitis - issues to consider
- symptom control => patient comfort and nutritional intake
- affects ability to eat and drink
- fluid balance and nutritional status may be compromised ==> interruption of tx, hospitalisation
mucositis/stomatitis - high risks
-poor oral hygiene
- dry mouth
- gum disease
- smoking
- alcohol consumption
mucositis/stomatitis - symptoms
- mild soreness to severe (requiring hospitalisation due to risk of bleeding and infection)
what is cystitis
inflammation of the bladder and urethra
cystitis - symptoms
- blood in urine
- urgency of urination
- painful urination
- abdominal pain
what drugs can help manage mucositis?
- oralube (saliva sub)
- sodium bicarbonate mouthwash
- xylocain (topical anesthetic)
- oromorph (systemic pain relief)
What are some side effects of morphine?
- N/V
- Constipation
- Respiratory distress
- Dependance/addiction
what drugs help candidiasis?
- Nystatin
- Miconzole oral gel
drugs to help manage oesophagitis
Antacids - Gaviscon (neutralise HCL)
Proton pump inhibitors - nexium (reduce acid secretion), pantoprazole
Define diarrhoea
Decreased consistency of bowel motions, or ostomy output due to treatment
What are the consequences of diarrhoea?
Malnutrition
Weight loss
Electrolyte imbalance
Renal Insufficiency
Hospital administration
drugs to help manage diarrhoea
gastrostop - loperamide
lomotil
gastrolyte (oral rehydration)
medication to help manage cystitis
ural - urinary alkalinizer
paracetamol
ibuprofen
List factors relating to radiation dermatitis
- Obesity
- Older age
- Gender (female)
- Chronic sun exposure
- Smoking
- Breast reconstruction
- Connective tissue disorder
What agents can cause drug-induced radiation recall?
An acute inflammatory reaction confined to an area of previous radiation exposure triggered by chemotherapeutic agents.
- Taxanes
- Antibiotics
- Anthracyclines
dermatitis meds
hydrocortisone cream
How often should patients take Ondansetron?
Maximum 32mg/24 hours
How often should patients take dexamethasone?
4mg daily
How often should patients take oramorph?
1.5 ml daily / twice daily
How often should patients take xylocaine?
15 ml before meals
How often should patients use sodium bicarbonate mouthwash?
As required or 4 x daily
How often should patients take Nystatin?
1ml held in mouth
How often should patients take Gaviscon?
1 hour after eating
How often should patients take PPIs?
1 x daily
How often should patients take nexium?
40mg 2 x daily
List some chemotherapy specific side effects
- affects healthy cells such as blood cells causing anemia and infection
- hair loss
-mucositis - constipation
- N&V
Why are patients undergoing brain radiotherapy usually prescribed Dexamethasone?
Management of oedema and inter-cranial pressure
drugs used for nausea and vomiting + contraindications
- 5HT3 antagonist
- ondansetron, granisetron
- constipation, headache, migraine, QT prolongation (heart condition)
- corticosteroids
- dexamethasone
- infection, oedema, hypertension, hyperglycaemia, delay wound healing, weight gain
-dopamine receptor antagonist
- metoclopramide, prochloriperazine
- tremor, slurred speach, akathisia, dystonia
management of mild to moderate oral mucositis
pain control
- suck on ice cubes
- use pain medications as advised by your doctor
dietary modification
- eat moist or soft foods
- avoid foods that require a lot of chewing
- avoid acidic, spicy, salty and hot foods
oral care
- rinse mouth 5-6 times each day
- brush teeth with soft tooth brush
candidiasis (anti-fungal infection) medications
- nystatin oral drops
- 1mL qid to be held in mouth as long as possible
- amphotericin B lozenges
- 1 lozenge qid for 1-2 weeks
- miconazole 2% oral gel
- half a measuring spoon (2.5ml) qid
- fluconazole - dosing varies
- topical anesthetics
- 15mL before meals
- careful with hot beverages
- cost
- systemic pain relief
- different strengths
- side effects
- nausea and vomiting, drowsiness, constipation, respiratory depression, dependence
drugs for oesophagitis
- antacids
- neuralise HCL secreted by gastric parietal cells
- tablets should be chewed
- constipation => containing Al and Ca
- diarrhoea => containing Mg
- monitor Ca, Al and/or Mg concentration => accumulation and toxicity in renally impaired patients
- H2 antagonists
- proton pump inhibitors
what is diarrhoea + leads to…
decreased consistency of bowel motions, or ostomy output due to treatment =/- abdominal pain and/or cramping (may also contain blood or mucus)
may lead to malnutrition, weight loss, electrolyte imbalance, renal insufficiency and hospital admission
management for diarrhoea
- oral rehydration (8 to 10 large glasses of clear liquids - water, sports drinks, clear juices or broth)
- antisecretory agents
- activate opioid receptors in the gut wall, decreasing bowel motility and increasing fluid absorption
- loperamide (non-analgesic opioid)
- dephenoxylate and atropine (opiate analogue)
- lactobacillus
- containing probiotics may be useful in preventing chemo and/or radiation therapy induced
management (medications) of cystitis
- ural
- ibuprofen
- paracetamol
ural medication
- to treat burning and painful symptoms
- 1-2 sachets dissolved in cold water qid
- may alter therapeutic effects of medication
ibuprofen for cystitis
analgesics, anti-pyretic and anti-inflammatory
paracetamol for cystitis
negligible anti-inflammatory effects
drugs for mucositis
- topical anaesthetics
- 15ml before meals
- careful with hot beverages
- cost
- systemic pain relief
- different strengths
- side effects; nausea and vomiting, drowsiness, constipation, respiratory depression, dependence
- saliva substitute
- for dry mouth, salivary gland hypofunction
- for topical use (spray)
- artificial lemon flavour
- sodium bicarbonate mouth wash
- increase salivary pH => improves symptoms of dry mouth
- cheap and effective
Antacids contraindications
Constipation -> if containing al and Ca
Diarrhoea -> if containing Mg
Monitor Ca, Al and Mg concentration -> accumulation and toxicity in renally impaired patients
