principles of chemotherapy Flashcards
what is cancer
uncontrolled division of abnormal cells
tx of cancer
cytotoxic drugs
why are cytotoxic used
curative/ prolong life/ palliate symptom
What 2 ways CT drugs use
1) neoadjuvant (in radiotherapy /surgery)- shrinks primary tumour allow txment to allow local therapy to be less destructive, inc effectiveness
2) adjuvant (before radiotherapy/ surgery) - in initial chemo where high risk of subclinical metastatic disease that can go unnoticed - maximises therapy
are a combination of CT drugs good for chemo
yes they reduce drug resistance but more risk than single drug
how to handle CT drugs
- avoid in pregnant staff
- trained and esignated area to dispense and handle
- monitor exposure
- protective gear
- spills and waste management protocol
CT safe systems
- tx plan
- dispense as administered for injection
dispense clear instructions
MHRA - rules on ct
RISK Incorrect CT drug doses
- non specialist who prescribe and administer - access to written protocols/ tx plan
- dispensing confirm dose and dont repeat prescriptions, patient must have written info so dispense and pharmacist can access hospital cancer pharmacist
Common S/e of CT
1) extravastion, nausea and vomiting, tumour lysis syndrome, oral mucositis ,pregnancy and infertility, urotheilial toxicity , hyperuricaemia , VTE, bone marrow suppression
alopecia s/e
common hair loss (reversible)
CT and preg and fretility
most ct drugs teratogenic, exclude pregnancy (-ve test and contraception) ,
can target rapidly dividing sperm nd egg cells women least effected but can cause early menopause
men counsel on sperm storage
drug cause of teratogenicity
alkylating drugs and procarbazine
what causes bone marrow suppression
every CT but (vincristine or bleomycin)
who to avoid ct in bone marrow suppression
avoid in infection or where live vaccine due to blood dyscrasia (insert symptoms)
tx of neutropenia and infection in bone marrow suppression
filgrastim and high spec antibiotic
tx of symptomatic iron def anaemia with bone marrow suppression
rbc transfuision and eryropoitin
oral mucositis s/e , drug causes and counselling
due to rapidly dividing cell target i.e mucus cells mouth and gut
counsel to use saline mouth wash ,soft toothbrush 2-3x a day, suck ice
drug causes of oral mucositis
anthryacycline (doxorubicin)
and antimetabolite (MTX
tx of Mtx induced mucositis
folinic acid
n/v
diff drug class of cytotoxic has diff emetogenic spectrum
mild emetogenics M V F E
MTX, vinca alkaloid, fluorouracil
, etoposide
moderate emetogenic
high dose MTX , taxanes, doxorubicin, mitoxantrone, cyclophosphamide
high emetogenic (cdc)
cisplatin, high dose cyclophosphonamide, dacarbazine
tx of anticipatory (before tx) n and v + s/e
lorazepam (sedation, anxiolytic, amnesia)
tx acute n/v 24 hrs before chemo
low risk? high risk?
low risk `; dexamethasone or lorazepam
high risk ; dexametasone+ apreprepitant+ 5ht3 antagonist (ondansetron)
delayed > 24hrs before tx
moderate emetogenic: dexametasone+ 5ht3 antag
high emetogenic; dexametasone+ aprepitant or rolepitant +metoclopramide
which type of n/v tx easier to control
acute <24hrs
extravastion what is it
ct leaks from iv and locally irritates skin is corrosive (local severe tissue necrosis)
drugs causes of extravastion
anthracycline and vinca alkaloid
VTE? and drug causes
cancer and ct drugs are risk
counsel on detection - sudden breathless, chest pain, swelling calf of one leg
tamoxifen (breast cancer- also causes endometrial cancer)
thalidomide/ lindomaide
urothelial toxicity s/e and drug causes
urothelial cells inflamed
causes mesna; haemorrhage cystitis
notice haemturia
drug cause; cyclophosphamide and ifosfomide
tumour lysis
rapid destruction of cancer cell common leukaemia or lymphoma
inc k+, urea, calcium phosphate
follow Rf and arrhythmia
hyperuricaemia
high uric cancer - common in leukaemia and lymphoma increase gout
worsens with chemo
prophylaxis chemo
24 hr before
48 hr before
haemotological cancer
24hr before= allopurinol
48 hr before= febuxostat
haematological = rasburicase
