s/e and monitoring of cytotoxic drugs Flashcards
s/e of IV cyotoxic drugs
extravasation of IV drugs = severe local tissue necrosis due to leakage of cyotoxin
s/e of cytotoxic drugs
- oral mucositis
- tumor lysis syndrome
- hyperuricaemia
- bone marrow suppression
- alopecia (most common)
- thromboembolism (chemo inc risk)
- urothelial toxicity
- myelosuppression
which drugs cause oral mucositis (sore mouth)
- fluorouracil
- methotrexate
- anthracyclines
what helps with sore mouth associated with fluorouracil
- sucking ice chips
- good oral hygiene
is tx or preventing oral mucositis more effective
tx is less effective
tx of oral mucositis
saline mouthwash
tx of oral mycositits if due to methotrexate
folinic acid (levofolinic acid)
how does tumor lysis syndrome occur
due to rapid destruction of malignant cells
what diseases have a higher risk of tumor lysis syndrome
- non-hodgkins lymphoma
- burkitts lymphoma
- acute lymphblastic leukaemia
- acute myeloid leukaemia
- pre-exisiting hyperuricaemia
- renal impairment
- dehydration
what does tumour lysis sydrome cause
HYPER - K, Ph, Ca, uricaemia = leads to renal damage and arrhythmias = leads to renal damage and arrhythmias
which conditions is hyperuricaemia more present
more present in high grade lymphoma and leukaemia
hyperuricaemia s/e of cytotoxic
when is allopurinol started before tx tumors
also alternative to allopurinol
- 24HR before treating tumors also hydrate pt
- alternative = feboxostat given 2DY before tx
which drugs cause bone marrow suppression
caused by all drugs other except vincristine and bleomycin
s/e of cyotoxin s/e
when does bone marrow suppression occur
occurs 7-10DY after admin
s/e of cytoxin
what is checked to prevent / monitor bone marrow supression
check blood count before tx and reduce dose if bone marrow hasn’t recovered
during acute infection is cytotoxin drugs continued?
avoid tx during acute infections or seek medical if currently taking
bone marrow supression - s/e of cytotoxin
tx of neutropenic fever if developed
immediately given broad spectrum antibodies
does chemo increase or decrease risk of thromboembolism
increases
s/e of cytotoxin
what does urothelial toxicity cause in urinary tract
causes haemorrhage in urinary tract
which drugs cause urothelial toxicity
common in cyclophosphamide and ifosfamide
tx of urothelial toxicity
mesna
which drug causes myelosuppression
can be caused by methotrexate
tx of myelosuppression toxicity
folinic acid
Cytotoxin drugs + reproductive systems
- mostly teratotogenic
- exclude pregn before tx
- contraception advise before tx
- women of child-bearing age = contraception before + after tx
alkyating drugs or procarbazine warnings with reproduction
- high risk of permanent male stetility
- consider sperm storage
- affects women less onset of premature menopause
alkylating agents s/e
cyclophosphamide, ifofsamide ,melphalan
-urthoelial toxicity
-high risk of permanent male sterility
colour of urine, formulations, s/e and liposomal
anthracyclines
daunorubicin, doxorubicin, epirubicin, idarubicin
- rubi-red urine
- formulation x interchangable (conventional, liposomal, peggylated liposomal)
- cardiotoxic s/e
- liposomal -=less cardiotoxicity but causes painful mascular skin eruptions, prevent by cooling hands/feet/ avoiding gloves + sicks
antimetabolites s/e
cytarabine, fluorouracil, methotrexate, mercaptopurine
mucositis + myelosupression
cytotoxic antibodies s/e
blemoycin, mitomycin
- progressive pulmonary fibrosis
- pulmonary toxicity
type of reactions and monitoring
taxanes s/e and monitoring
carbazitaxenes, docetaxes, paciltaxes
- hypersensitivity reactions - premediate with corticosteroids + antihistamines
- monitor cardiac output
- monitor for signs and symp of penumonitis + spesis
vinca alkaloids route of admin and s/e
vinblastine, vincristine, videsine
- IV admin only
- AVOID intratheal route it is FATAL
- bronchospasms
- neurotoxicity = neuropathy, motor weakness, myalgia
