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Cancer > Side Effects of Chemotherapy > Flashcards

Side Effects of Chemotherapy Flashcards

1
Q

Name 3 side effects of chemotherapy

A
  • Nausea and vomiting
  • Mucositis (throat and mouth sores)
  • Hypersensitivity
  • Hair loss
  • Rash
  • Fatigue
  • Diarrhoea
  • Myelosuppression
  • Extravasation
  • Constipation
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2
Q

List the common GI side effects

A
  • Changes in the taste of foods
  • Mucositis
  • Changes in eating habits
  • Nausea and vomiting
  • Diarrhoea
  • Constipation
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3
Q

Risk factors

A
  • Female
  • Non-smoker
  • Opioids in surgery
  • Age
  • Type of surgery
  • Drugs
  • Hypotension
  • Hypoxaemia
  • Obesity
  • Migraine
  • Anaesthesia
  • Previous n+v in pregnancy
  • Eating too early post op or delay in gastric emptying
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4
Q

Name 3 complications of CINV

A
  • Dehydration
  • Nutritional deficiency
  • Electrolyte disturbances
  • Aspiration pneumonia
  • Oesophageal tears
  • Chemotherapy dose delays, reductions, discontinuations of treatment
  • Quality of life
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5
Q

What is Acute CINV

A

Within 24 hours (Drugs: Metoclopramide, Domperide, 5HT3)

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6
Q

What is Delayed CINV

A

More than 24 hours after chemotherapy (Drugs: Dexamethasone, NK1)

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7
Q

What is breakthrough CINV

A

CINV despite prophylaxis (Drugs: 5HT3, NK1)

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8
Q

What is Anticipatory CINV

A

Prior to administration of chemotherapy (Drugs: Lorazepam)

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9
Q

What is Refractory CINV

A

CINV despite appropriate measure (Drugs: Levomepromazine, NK1, Nabilone)

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10
Q

What is Mucositis

A

Sore or ulcerated mouth or throat

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11
Q

What is the cause of mucositis?

A

Mucositis is caused as mucosal cells of the mouth and GI tract are sensitive to chemotherapy. The cells regenerate after 7-14 days

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12
Q

Side effects of Mucositis

A
  • Dry mouth due to ulcers
  • Causes discomfort and pain
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13
Q

How to prevent Mucositis?

A

By good oral hygiene
- Regular brushing (soft-brush)
- Avoid flossing and electric toothbrushes
- Rinse mouth regularly (salt water)
- Avoid commercial products that contain alcohol
- Delay dental procedures if possible
- Avoid spicy/acidic foods

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14
Q

How to treat Mucositis pain?

A
  • Local anaesthetic mouthwashes or lozenges
  • ‘Gentle’ mouthwashes
  • Analgesics (paracetamol)
  • Ice
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15
Q

How to treat Mucositis infection?

A
  • Treat by clinical characteristics or cultures
  • Fungal :- Systemic fluconazole or nystatin mouthwash
  • Viral:- Aciclovir
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16
Q

What are the highest risk agents of chemotherapy induced diarrhoea and which cancer is it used to treat?

A
  • 5-fluorouracil
  • Capecitabine
  • Irinotecan

These drugs are used to treat colorectal and breast cancer

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17
Q

List 3 non-pharmacological interventions for chemotherapy induced diarrhoea

A
  • Oral hydration (8-10 glasses clear liquids/day)
  • Dietary modifications
  • Small frequent meals
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18
Q

List 3 pharmacological interventions for chemotherapy induced diarrhoea

A
  • Loperamide (first-line treatment)
  • Oral antibiotics if > 24 degrees (prophylaxis)
  • Severe cases: hospitalisation, IV fluids and electrolytes and stool cultures
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19
Q

What is Irinotecan Chemotherapy?

A

Treatment of metastatic colorectal cancer

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20
Q

Irinotecan Chemotherapy can cause what type of diarrhoeas?

A

It can cause early (or acute- immediately after drug administration) or late (or delayed - occurs after 24 hours) onset diarrhoea

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21
Q

How to treat delayed diarrhoea?

A
  • Regular loperamide (4mg then 2mg every 2 hours until diarrhoea free for 12 hours)
  • Ciprofloxacin 250mg bd for 7/7 if lasts >24 hours
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22
Q

Irinotecan can inhibit the enzyme Acetylcholinersterase causing Anti Cholinergic Syndrome. What is Anti Cholinergic Syndrome?

A

Is a state of confusion with characteristic features related to dysfunction of the autonomic parasympathetic (cholinergic) nervous system.

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23
Q

What are the symptoms of Anti Cholinergic Syndrome?

A
  • Increased sweating
  • Increased saliva
  • Stomach cramps
  • Diarrhoea
  • Restlessness
  • Visual hallucinations
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24
Q

How can Anti Cholinergic Syndrome be treated/reversed?

A

Subcutaneous atropine (300mcg) or as prophylaxis

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25
Q

What 4 factors cause Chemotherapy Induced Constipation

A
  • Chemotherapy
  • Supportive care
  • Inactivity
  • Dietary changes
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26
Q

What can cause Chemotherapy Induced Constipation

A
  • Drugs: Cisplatin and Vinca Alkaloids (Vincristine)
  • Neurotoxicity
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27
Q

What factors of supportive care causes constipation?

A
  • Opioids given for pain
  • Ondansetron used for nausea and vomiting
28
Q

How to prevent Chemotherapy Induced Constipation

A
  • Fluids (6-8 glasses water per day)
  • High fibre food, fruit and vegetables
  • Exercise
29
Q

How to treat Chemotherapy Induced Constipation

A
  • Laxatives
  • Review chemo medication
30
Q

What is ‘Alopecia’ in simple terms?

A

Hair loss

31
Q

Why does Alopecia occur?

A

Cells that promote hair growth are fast growing cells and they are affected by chemotherapy. Chemo drugs attack other rapidly growing cells in your body — including those in your hair roots.

32
Q

Alopecia in cancer patients is permanent. True or false?

A

False

33
Q

What is Myelosuppression?

A

It is a condition in which bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets.

34
Q

What is Anemia?

A

A condition in which the body does not have enough healthy red blood cells and the main symptom of Anemia is feeling tired (Fatigue)

35
Q

What is Neutropenia

A

A condition where you have a low number of white blood cells called neutrophils in your blood. Neutropenia increases risk of infection.

36
Q

What is Thrombocytopenia

A

A condition in which you have a low blood platelet count. Symptoms of Thrombocytopenia includes being easily bruised and may bleed longer than usual.

37
Q

What is Febrile Neutropenia

A

A condition marked by fever and a lower-than-normal number of neutrophils in the blood - Patient with neutropenia. High risk due to myelosupressive chemotherapy.

38
Q

Febrile Neutropenia requires urgent treatment with…

A

Empirical antibiotics

39
Q

Temperature and Absolute Neutrophil Count for a patient with Neutropenia

A
  • Temperature of >38 degrees
  • Absolute Neutrophil count <0.5x10^9/L
40
Q

How to prevent Febrile Neutropenia in general

A
  • Good hygiene (Hand washing!)
  • Avoid crowds and ‘sick people’
  • Food safety
41
Q

How to prevent Febrile Neutropenia whilst on Myelosuppresive Chemotherapy

A

Consider:
- Prophylactic antibiotics
- G-CSF prophylaxis (Granulocyte Colony Stimulating Factor)
- Dose reductions

42
Q

What is Granulocyte Colony Stimulating Factor (GCSF)

A
  • It stimulates the production of neutrophils
  • Daily subcutaneous injection given for 5-7 days following myelosupressive chemotherapy (figrastim, lenograstim)
43
Q

Indications for Granulocyte Colony Stimulating Factor (GCSF)

A
  • Chemotherapy with >20% risk of Febrile Neutropenia
  • Continuing chemotherapy following episode of Febrile Neutropenia
44
Q

Patients are at higher risk of complications of Febrile Neutropenia if:

A
  • Severe symptoms
  • Hypotensive
  • Chronic Obstructive Pulmonary Disease symptoms
  • Leukaemia treatment
  • Dehydrated
  • > 60 years
  • Inpatient
45
Q

Treatment for low risk Neutropenic Sepsis

A
  • PO (oral) antibiotics (e.g. Ciprofloxacin and Co-amoxiclav)
  • Outpatient treatment / short admission
  • IV stat the PO
46
Q

Treatment for high risk Neutropenic Sepsis

A
  • Urgent empirical IV (e.g. Tazocin, Ceftazidime, ? Vancomycin/Gentamicin, ? Antifungal
  • Admission
  • Review after 48 hours - PO
47
Q

What advice would you give a patient experiencing Fatigue (tiredness) from chemotherapy

A
  • Move around and exercise whenever you can
  • Limit activities
  • Eat healthy
  • Drink plenty of fluid
  • Performance status score (Patients ability to perform ADLs)
48
Q

What is a dermatological side effect of Capecitabine?

A

Hand-foot syndrome (57%) (palmar-plantar erythema) - Tingling, redness, numbness, pain and swelling of palms of hands/soles of feet. (Grade 1,2 and 3)

49
Q

How to prevent hand-foot syndrome?

A
  • Avoid tight fitting shoes
  • Rubbing
  • Hot water
  • Moisturisers
50
Q

How to treat hand-foot syndrome?

A

Use creams containing lanolin

51
Q

What are EGFR inhibitors?

A

A substance that blocks the activity of a protein called epidermal growth factor receptor (EGFR). EGFR is found on the surface of some normal cells and is involved in cell growth. It may also be found at high levels on some types of cancer cells, which causes these cells to grow and divide.

  • They can cause severe papulopustular eruptions (rash)
52
Q

Name 2 EGFR Inhibitors

A
  • Cetuximab
  • Erlotinib
53
Q

What is Cetuximab and what is it used to treat?

A
  • Cetuximab is an antibody to EGFR
  • It is used to treat Colorectal, Head and Neck cancer
54
Q

What is Erlotinib and what is it used to treat?

A
  • Erlotinib is a EGFR specific tyrosine kinase inhibitor
  • It is used to treat lung cancer
55
Q

How to treat MILD EGFR inhibitor skin reactions?

A
  • Use of topical antibiotic cream/lotion (Clindamycin)
56
Q

How to treat MODERATE EGFR inhibitor skin reaction?

A
  • Use of topical steroid (e.g. Hydrocortisone cream)
  • Use of Oral antibiotics (e.g. Doxycycline)
57
Q

How to treat SEVERE EGFR inhibitor skin reaction?

A
  • Dematology referral
  • Dose reduction
  • Consider stopping treatment if all else fails
58
Q

What are some side effects of Immunotherapy

A
  • Colitis
  • Pneumonitis
  • Hepatitis
  • Endocrinopathies
  • Rash
  • Immunotherapy don’t work for all patients - All or nothing
59
Q

What are some LONG TERM side effects of Chemotherapy

A
  • Cardiac/Heart problems
  • Thromboembolic (blood clots)
  • Secondary Cancers
  • Infertility
  • Respiratory problems
60
Q

What does the term ‘Extravasation’ mean?

A

Accidental leakage from a vein into surrounding tissues.

61
Q

What 3 things can cause Extravasation?

A
  • Irritants –> Inflammation and Pain
  • Vesicants = Necrosis (death of body tissue) –> Pain, blistering and inflammation
    -Non-vesicants
62
Q

What does Grade 1 Hypersensitivity Reaction indicate?

A

Transient flushing or rash, drug fever <38 degrees

63
Q

What does Grade 2 Hypersensitivity Reaction indicate?

A

Rash, flushing, urticaria, dyspnoea, drug fever > 38 degrees

64
Q

What does Grade 3 Hypersensitivity Reaction indicate?

A

Symptomatic brochospasm with or without urticaria, oedema, angioedema, hypotension

65
Q

What does Grade 4 Hypersensitivity Reaction indicate?

A

Anaphylaxis

66
Q

What does Grade 5 Hypersensitivity Reaction indicate?

A

Death

67
Q

What are 3 pre-medications that can be prescribed for Hypersensitivity reaction from Chemotherapy

A
  • Dexamethasone
  • Ranitidine
  • Chlorphenamine

Cancer (9 decks)

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