Pharmecuticals

Question 1

Benefits of chemo radiation

Answer 1

• Radiosensitiser: enhances DNA damage
  
  • Radiation enhancer: enhances radiation effect
  • Chemotherapeutic agents + XRT: doses need to be adjusted with concurrent XRT -> acceptable toxicities

Increases cancer cure rate
Replaces or delays need for surgery
Allows organ preservation

Question 2

Complications of chemo

Answer 2

Nausea and vomiting
RT vomiting is less severe than chemo

Question 3

Nausea and vomiting medication

Answer 3

injections, wafers (dissolves) helps as people usually can’t swallow things
5HT3 antagonist: ondansetron, granisetron -> constipation, headache/migraine, QT-prolongation

Corticosteroids: Dexamethasone -> infection, oedema, hypertension, hyperglycaemia delay wound healing, weight gain

Dopamine receptor antagonist - metoclopramide, prochlorperazine, tremor, slurred speech, akatisia, dystonia

Question 4

Which mucousitis is more severe

Answer 4

• Radiation induced
  
  • Longer duration and more severe
  • Appears around 2 weeks of radiation and at its worse by the end of RT, may persist for up to 8 weeks
  • Chemotherapy induced ones occur 2-3 weeks from chemo commencement

Question 5

Considerations for mucositis

Answer 5

symptom control, nutritional intake

Question 6

What leads to higher risks of mucositis

Answer 6

poor oral hygiene, gum disease, dry mouth, smoking, alcohol consumption

Question 7

Symptoms of mucositis

Answer 7

mild soreness to severe, risk o bleeding and infection

Question 8

Treatment for mucositis

Answer 8

Requires dietary modifications: soft foods
Candidiasis: anti fungal infection medication, lozenges
Topical anaesthetics
Systemic pain relief such as morphine - drowsiness, constipation, respiratory depression, dependence
Saliva substitute: for dry mouth, gland hypofunction, for topical use (spray), artificial lemon flavour
Sodium bicarbonate mouthwash: increase salivary pH -> improves symptoms of dry mouth, cheap and effective

Question 9

Oesophagitis treatments

Answer 9

Antacids
- Neutralise HCL secreted
H2 antagonists
- In short supply
- Reduce gastric acid secretion - > reduce symptoms of reflux
Proton pump inhibitors
- Can increase risk of osteoporosis
- Stimulated and basal acid secretion

People need a script: depending on the dosage

Question 10

Diarrhoea issues and treatment

Answer 10

• May lead to malnutrition, weight loss, electrolyte imbalance, real insufficiency and hospital admission
  
  • To help with diarrhoea: oral rehydration -> 8-10 large glasses of clear liquids (not just water, sports drinks, clear juices or broth)
  • Infection risk (neutropenia)
  • Use gastro stop or lomotil: antisecretory agents -> activate opioid receptors in the gut wall, decreasing bowel motility and increasing fluid absorption
  • Overusing it can cause constipation
  • Lactobacillus-containing probiotics may be useful in preventing chemo and/or radiation therapy induced

Question 11

Cystitis what is it and symptoms

Answer 11

• Inflammation of the bladder and urthera: common side effect for radiotherapy in pelvic region
  
  • Generally acute onset
  • Self-limiting symptoms <3 months following RT
  • Symptoms include: painful urination, blood in urination, urgency, abdominal pain

Question 12

How can we help with cystitis

Answer 12

ural, ibuprofens, paracetamol
Ural: to treat burning and painful symptoms, 1-2 sachets dissolved in cold water, may alter therapeutic effects of medication

Ibuprofen: analgesic, anti-pyretic and anti-inflammatory
Bleeding risk, readily available, if there is blood in urine and things like that, it may increase risks of bleeding

Paracetamol: negligible anti-inflammatory effects

Question 13

Dermatitis treatments

Answer 13

Redness, swelling, skin peeling off
Use sorbelene creams
- Can occur weeks to months to years after RT, 6-9% of patients impacted
- Diagnosis is based on the appearance within the previous radiation therapy field
- Hydrocortisone cream
- After withdrawal of the drug, the reaction usually resolves within 1-2 weeks
- Aloe Vera gel: it depends on the product and which part of the plant, hence evidence is 50-50. Therefore, not the most reliant. Not a first line
- EGFR inhibitor induced rash -> can cause more rash
- Cannot use steroid creams for too long as it thins out skin

Question 14

Drug induced radiation recall

Answer 14

an acute inflammatory reaction confine to an area of previous radiation exposure that is triggered by chemotherapeutic agents or other drugs

Question 15

Other agents and radiation

Answer 15

• Immunotherapies: RT may cause issues and potentiate the effect of anti-PD-1 immunotherapy in NSCLC
  
  • CDK 4/6 inhibitors: high grade haematological toxicity, neutropenia recurs -> 3rd degree burns
  • Complementary and Alternative medicine (CAM) - anti-oxidants -> stop these a week before radiation, they play a role in managing the free radicals, making radiation less effective

Question 16

How to ensure patient care

Answer 16

Interacting with patient: be professional and empathetic, safe use of medicine
Taking medications as directed, stigma to use medications, did not tell anyone
Consider cultural differences

Question 17

When and where do patients get dermatitis

Answer 17

Common side effects of breast, head and neck and lung cancer

Can occur in anterior of neck, extremities, chest/breast, abdomen, face and scalp

Question 18

What are some patient factors of dermatitis

Answer 18

Obesity, older age, gender (female), chronic sun exposure, smoking, breast implants/reconstruction

Pre-existing disorders: connective tissue disorders, radio sensitivity disorders

Question 19

Antacids contraindications

Answer 19

Constipation -> if containing al and Ca
Diarrhoea -> if containing Mg
Monitor Ca, Al and Mg concentration -> accumulation and toxicity in renally impaired patients

Question 20

H2 antagonists contraindications

Answer 20

Accumulation may occur in renal impairment patients -> may need dose adjustment