Prevention and Management of Antineoplastic AEs Flashcards
what does the CTCAE stand for
common terminology criteria for AEs
Asymptomatic or mild sx
Clinical or diagnostic observations only
Interventions not needed
grade 1
Minimal sx
Local or noninvasive intervention indicated
grade 2
Severe or medically significant but not immediately life threatening
Hospitalization or prolongation of hospitalization indicated
grade 3
Life threatening consequences
Urgent intervention indicated
grade 4
death grade
5
mouth related AEs to chemo
cracked, dry lips
dry mouth
mucositis
taste changes
cavities
thick saliva
define oral mucositis
acute inflammation and or ulceration of the oral or oropharyngeal mucosal membranes
can cause pain/ discomfort and interfere with eating, swallowing, and speech
causes of oral mucositis
radiation of head, neck, salivary glands, total body
chemo continuous or at high doses
hematopoietic stem cell transplant (HSCT)
RF for oral mucositis
xerostomia
poor oral health
dehydration
alcohol/ tobacco use
O2 therapy
prevention for oral mucositis
good oral hygrine
alcohol free chlorhexidine rinses
bland mouth rinses after meals
cryotherapy
what should be used as an extra precaution against oral mucositis if there is head/neck radiation treatment
high fluoride toothpaste or fluoride trays
when should cryo not be used as a precaution against oral mucositis?
if using oxaliplatin
how to do cryo for oral mucositis prevention
hold ice chips, popsicles, or cold water in mouth 5 min prior, during, and 30 min after infusion (do not use with oxiplatin)
what should be avoided in oral mucositis
Commercial mouthwashes with alcohol, hard/ acidic/ spicy/ salty foods, poorly fitting dentures (may need to refit after weight loss), caffeine, alcohol, tobacco
Moderate pain, not interfering with oral intake, modified diet indicated grade for oral mucositis
grade 2
oral mucositis that is interfering with eating is classified as
grade 3
treatment for grade 1-2 oral mucositis includes (4 things)
bland rinses
benzdyamine HCL rinses
pain control with systemic or topical analgesics
sips of water
treatment for grade 2-3 oral mucositis
switch from toothbrush to oral sponge
pink ladies
akabutu’s mouthwash
what is pink ladies for oral mucositis
lidocaine + aluminium hydroxide + magnesium hydroxide
caution with pink ladies
fatal arrhythmias from systemic eff of lidocaine
why is akabutu’s mouthwash sus
thrush (d/t corticosteroid)
resistance due to subtherapeutic lvl of nystatins
may not be better than saline for healing time
expensive
what is akabutu’s mouthwash
nystatin, lido, NaCl, hydrocortisone, glycerin
how to use akabutu’s mouthwash
swish 15-20mL F1min, spit, q4-6hrs PRN
what to use for grade 3-4 oral mucositis
topical opioid mouthwash (morphine)
lidocaine viscous 2%
tetracaine 0.5% lollipops
systemic pain control- maybe opioids
which of the following mouthwashes can you swallow?
1. lidocaine viscous 2%
2. morphine mouthwash
3. tetracaine mouthwash
4. akabutu’s mouthwash
5. pink ladies
lidocaine viscous for pharyngeal mucositis
tx for grade 4 oral mucosotis
hospitalization + pt controlled analgesia of iV opioids
____ can be given for oral mucositis for those on everolimus
dexamethasone 0.5mg/5mL
what is doxepin 0.5% mouthwash used for?
oral mucositis
what is hand food syndrome or PPE
redness and pain on palms of hands and feet
RF for PPE
> 65yrs
female
friction
heat
excessive alcohol use
most common culprits of PPE
capecitabine, 5FU, sorafenib, cytarabine, docetaxel and paclitaxel
first sx of PPE
tingling and numbness of soles and palms
PPE prevention
skincare / hygiene
avoid head (including wearing gloves while washing the dishes)
foot care- comfy fitted shoes
hand care- avoid chemicals and stressing actions (clapping)
Minimal skin changes or dermatitis (erythema, edema, or hyperkeratosis without pain)
grade 1
Skin changes (peeling, blisters, bleeding, edema, or hyperkeratosis) with pain, limiting instrumental ADH
grade 2
Severe skin changes (peeling, blisters, bleeding, edema, or hyperkeratosis) with pain, limiting self care ADL
grade 3
PPE treatment
oral analgesics, topical CS, cool packs on palms
emollients
oral dexamethasone
celecoxib
when would you not recommend flossing to a pt with oral mucositis
if it causes pain/ bleed or if platelets <50
chemo induced alopecia usually sets in by
1-3wks
how long after chemo will hair come back?
6-8wks
most common antineoplastics for alopecia
cyclophosphamide
anthracyclines
taxanes
etoposides
what antineoplastics are commonly associated with hypersensitivity rxns
taxanes
platinums
bleomycin
monoclonal abx (rituximan)
when do hypersensitivity/ infusion reactions to antineoplastics usually happen
first few min/hours of first dose but can be up to 48hrs later
how to prevent hypersensitivity reactions to chemo
follow recommendations of spec meds
incorporate 1 or more: systemic CS, HH1 antagonist, H2 antagonist, and an antipyretic
what are some systemic CSs that can be incorporated to prevent hypersens rxns
hydrocortisone
prednisone
dexamethasone
what to do if hypotension is a concern for chemo pt
if they have antihypertensives- ask them to hold for 24hrs pre chemo
what to do if pt has a hypersensitivity rxn to chemo
stop infusion, start supportive care with CS, antihistamines, antipyretics, oxygen
rechallenge if mild-mod reaction
what antineoplastic agents are commonly associated with constipation
vinca alkaoids
5HT3RA
opioids
what should chemo pts do after meals if they’re prone to constipation?
try to poop 30-60min after eating to take advantage of gastrocolic reflex
what should be avoided for constipation if pt is on myelosuppressive chemo?
suppositories, enemas, rectal exams due to lo platelet count or neutropenia
what should be monitored if pt is constipated on chemo
BM frequency, stool appearances, effort to defecate
what are some warnng sgns of bowel obstructon
can’t pass gas
sudden watery darrhea after constpaton
f pt has no BM after ____days they need pharm help
3
what are some symptoms of possible spinal cord compression
sensory loss and motor weakness = refer to ER
Occasional or intermittent sx, occasional use of stool softeners, laxatives, dietary mod, or edema
grade 1
Persistent sx w/ regular laxatives or enemas, limiting instrumental ADLs
grade 2
Constipation with manual evacuation indicated, Limiting self care ADL
grade 3
what types of laxatives should be given to chemo induced constipaiton?
sennosides
PEG is sennosides are too harsh
how to use sennosides for chemo induced constipation
start with regular dosing then progressively increase until normal bowel pattern restored and movements are soft and comfortable to pass
how long does PEG take to work?
2-3d
when can you use rectal products for chemo induced constipation
if pt not at risk of neutropenia or thrombocytopenai
if constipation with pervious chemo sessions, consider ___________
prophylactic PEG3350
