W9 Adverse Drug Reactions (AG) Flashcards
What is the Definition of Chemotherapy?
- “A treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, or infusion, or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy, or biologic therapy.”
Chemotherapy are high risk drugs!
Definition of A Cytotoxic Agent?
A substance that kills cells, including cancer cells. These agents may stop cancer cells from dividing and growing and may cause tumours to shrink in size.”
Types of Ca treatments available? (7)
Hormone therapy
Surgery
Bone marrow transplantation
Chemotherapy
Targeted therapy
Radiation therapy
Immunotherapy
What is the Aim of chemotherapy?
To do maximum damage to cancer cells whilst causing minimum damage to healthy tissue.
Adverse events with of Chemotherapy?
Mouth ulcers, nausea/vomiting
nephrotoxicity, diarrhoea, cystitis, infertility, neurotoxicity, hair loss, lung toxicity, cardiotoxocity, local reaction, skin changes, bone marrow suppression
Common side effects And Actions to take to treat this?
- Neutropenia – delay chemo/ give G-CSF* / dose reduction
- Thrombocytopenia – delay chemo / dose reduction
- Mucositis – depends on severity- gelclair/ raspberry mucilage/caphasol (artificial saliva)
- Diarrhoea – loperamide, codeine
- Alopecia – cold cap/ wigs
- Nausea & vomiting – metoclopramide, ondansetron, aprepitant
- Skin toxicity
- Neuropathy
- Fatigue
*E.g. Filigristin
Less common adverse events
- Ototoxicity
- Hepatic impairment (transient or permanent)
- Electrolyte disturbances
- Ocular toxicity
- Secondary malignancies
Some of these can take months / years to develop
Acute phase reactions
ACUTE adverse events? (4) and drugs that cause this?
- Anaphylaxis (any drug)
- Infusion related / hypersensitivity reactions (carboplatin, paclitaxel)
- Extravasation (cisplatin) -leakage of chemo drug outside of a vein
- Acute cholinergic syndrome (irinotecan)
Hypersensitivity reactions (Need to know)
What are the symptoms?
Immediate Management steps?
*Difficulty breathing
*Noisy breathing
*Swollen tongue, lips and face
*Swelling or tightness in the throat
*Difficulty talking or a hoarse voice
*Wheezing and coughing *Tummy pain and vomiting
*Dizziness
*Collapse
Immediate Management:
- Stop chemotherapy infusion
- Administer hydrocortisone 100mg IV and chlorphenamine 10mg IV
- Obs inc pulse, bp, sats
- ECG and/or cardiac monitor for severe reactions
- Close monitoring and repeat obs until symptoms resolve
Can be a delayed reaction.
Extravasation
What is it?
What are the risk factors?
- Unintentional leakage of fluid from vein into surrounding tissue during administration
- Rare (<5%)
Risk factors:
* Site of venipuncture (blood draw)
(size of vein, fragility, radiotherapy)
* Diabetes / vascular disorders
* Size/ age
* Number of previous administrations
* Vesicant drugs (doxorubicin)
Extravasation: what to do? (7)
1.Stopping the flow of chemotherapy drugs through the IV.
2.As much as possible, removing the spilled drugs from the affected area.
3.Removing the IV.
4.Elevating the affected arm.
5.Applying cream to ease symptoms.
6.Applying cold compresses. Cold compresses help with pain.
7.Applying warm compresses
Acute Cholinergic Syndrome- Irinotecan:
Symptoms?
Treatment?
- Diarrhoea (can be life threatening!)
- Sweating
- Salivation
- Bradycardia
- May start during irinotecan infusion or shortly afterwards
- Inhibition of acetylcholinesterase
- Treatment atropine sulphate S/C (anti-cholinergic)
- Prophylaxis with atropine given with all cycles
.
BLOOD & Chemotherapy
Bone Marrow Toxicity:
- Red blood cells & white blood cells are constantly produced in bone marrow
- They grow rapidly – susceptible to toxic effects of chemotherapy
Life span
▪ RBC 120 days
▪ Neutrophils 6 hours
▪ Platelets 10 days
* Different chemotherapy drugs will produce a “NADIR” (lowest blood counts) at different times post chemo – average 7 – 14 days
Symptoms of bone marrow toxicity:
for RBC, WBC, Platelets?
Red Blood Cells:
- breathlessness
- feeling tired
- dizziness
Platelets:
- bruising easily
- bleeding taking a long time to stop
- blood in urine or faeces
White Blood Cells:
- reduced ability to fight infection
- increased risk of sepsis
Neutropenia & chemotherapy:
Neutropenic sepsis (NS)
What is the neutrophil range to diagnose a patient with NS?
What 2 other symptoms to confirm a diagnosis?
- Diagnose NS in patients having anticancer treatment whose neutrophil count is 0.5 × 10^9 (normal >1.5) neutrophils per litre or lower and who have either:
- A temperature higher than 38°C OR
- other signs or symptoms consistent with clinically significant sepsis.
- Sepsis is a syndrome defined as life-threatening organ dysfunction due to a
dysregulated host response to infection.
=ACUTE MEDICAL EMERGENCY!
What is Febrile Neutropenia? (FN)
Possible complications?
Treatment to prevent this?
- FN is the most common complication of anticancer treatment, and describes the presence of fever in a person with neutropenia.
- Possible complications of NS include organ failure, invasive and atypical infection, coagulopathy, encephalopathy and delirium, psychological sequelae and death.
- FN can be effectively prevented by the use of G-CSFs (filgrastim)
=ACUTE MEDICAL EMERGENCY!
Febrile Neutropenia (FN) – risk factors?
(need to know)
- Older age
- Advanced disease/metastasis
- No abx prophylaxis
- Prior episode of FN
- No use of G-CSFs
- Female
- Asian race
- Anemia (Hb <12 g/dL)
- CVD
- Renal disease
- Abormal liver transaminases
- ECOG score >2
- Patient with comorbidity ( >1)
- Baseline ANC ( <1500 cells/mm3)
- Baseline serum albumin <3.5g/dL
- Poor nutritional status and/or lower weight
- Prior chemo or radiotherapy
- Prior infection
How to prevent neutropenia?
- Use of GCSF (filgrastim)
- S/C admin
- Expensive
- Admin >24 hours post chemo
- Continue until after NADIR
- Continue until neutrophils recovered
- Stop >24 hours before chemo
- G-CSF ADRs: Hypersensitivity, interstitial lung disease, capillary leak syndrome,
glomerulonephritis, splenomegaly, splenic rupture, malignant cell growth, thrombocytopenia, leucocytosis, immunogenicity etc. – Bone pain!
Chemotherapy alert card:
Given to patients- especially so hospital can identify this they are experiencing and ADR such as Febrile neutropenia (FN) OR Neutropenic Sepsis (NS)
What do you do if: “Neutrophils fall and fail to recover to adequate level before the next cycle of chemotherapy?
- Do they have FN?
- Treatment delay until recovery
- Dose reduction (relationship between the severity of neutropenia which
directly influences the incidence of FN and the intensity of Chemo) - Use of GCSF (filgrastim)
- What you do depends on intent and implications of dose reduction
- Neutropenic sepsis – ONCOLOGICAL/ MEDICAL EMERGENCY – Urgent/immediate antibiotics
