ONCOLOGY - common adverse effects of anticancer therapy Flashcards

EXAM 2 content

1
Q

what can happen in bone marrow suppression aka myelosuppression?

A

suppressing neutrophils, platelets, & erythrocytes –>
- neutropenia –> risk for infection
- thrombocytopenia –> risk for bleeding
- anemia –> fatigue

pancytopenia = all three are low

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2
Q

how can we treat neutropenia?

A

FILGRASTIM: colony stimulating factors

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3
Q

how can we treat thrombocytopenia?

A
  • avoid drugs that promote bleeding: aspirin & anticoagulants
  • platelet transfusion
  • NEUMEGA: stimulates platelet production
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4
Q

how can we treat anemia?

A
  • PRBC transfusion
  • erythropoietin (EPOETIN ALFA or DARBEPOETIN ALFA)
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5
Q

with anticancer therapies, we see problems with the GI tract, what are they?

A
  • stomatitis: inflammation of oral mucosa, can be so severe that chemotherapy needs to be stopped
  • diarrhea: bc of thinning of lining
  • n/v: from radiation or chemotherapy esp if in the brain
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6
Q

how do we treat stomatitis?

A
  • oral hygiene & bland diet
  • if Candida albicans –> topical antifungal drugs (NYSTATIN)
  • managed with mouthwash w topical anesthetic (LIDOCAINE) + antihistamine (DIPHENHYDRAMINE)
  • if severe –> systemic opioids
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7
Q

how do we treat diarrhea?

A
  • rule out C diff
  • treat with oral LOPERAMIDE: nonabsorbable opioid that slows gut motility by activating local opioid receptors
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8
Q

how do we treat n/v?

A
  • premedication with antiemetics + more than 1 type of antiemetics
  • ONDANSETRON: serotonin antagonist
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9
Q

why is alopecia so common when it comes to chemotherapy?

A

due to hair follicles being a place in body with a lot of proliferation (chemotherapy kills normal cells with lots of proliferation)

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10
Q

how can we prevent alopecia? when does it grow again when therapy is done?

A

cooling scalp –> vasoconstriction –> reduce drug delivery to follicles –> BUT uncomfortable + increase risk of cancer recurrence bc drug is reduced in that area
- regeneration of hair starts 1-2 months AFTER last course of treatment

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11
Q

why would men & women consider banking their sperm & eggs before cancer treatments?

A

reproductive toxicity
- fetal malformation
- risk highest during first trimester
- risk lowers after 18 weeks of gestation
- irreversible sterility in males
- affects ovaries –> amenorrhea, menopausal symptoms, & atrophy of vag epithelium

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12
Q

what is hyperuricemia? why would this occur during cancer treatments? which cancers does this usually happen to? what organ can it damage & why?

A

excessive level of uric acid in blood
- uric acid – formed by BREAKDOWN of DNA, after cell death
- common for treatment for leukemias & lymphomas
- can damage kidneys: deposition of uric acid crystals in renal tubules

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13
Q

how do we treat & prevent hyperuricemia?

A
  • hydration: prevents uric acid in renal tubules
  • ALLOPURINOL: inhibits xanthine oxidase (enzyme that converts nucleic acids to uric acid)
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14
Q

what is extravasation injury? what should you do if this happens? how do we prevent? how to treat?

A

when IV medication goes into nearby tissues –> tissue damage –> tissue necrosis
- STOP INFUSION RIGHT AWAY
- prevent: assessing site prior to administering
- treat: cooling ice pack, dry heat, antidotes
- don’t remove catheter right away, might want to attempt to aspirate medication from IV site

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15
Q

how can carcinogenesis result from cancer therapy? which drug class increases this risk? what are the different types of drug specific toxicities?

A

ANOTHER cancer – results from drug induced damage to DNA
- alkylating agents increase risk
- DAUNORUBICIN = heart
- CISPLATIN = kidneys
- VINCRISTINE = peripheral nerves

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16
Q

what does HSCT stand for?

A

Hematopoietic stem cell transplant?

17
Q

how does HSCT work? when will someone need this? what cancers usually does this?

A

when the pt’s cancer does NOT respond to standard doses, chemo, or radiation – leukemia & lymphoma cancers
- person receives health stem cells to REPLACE their own that have been destroyed BY radiation / chemo

18
Q

what are the different types of donors of HSCT?

A
  • autologous: pt’s OWN stem cells that were collected before cancer treatment
  • allogeneic: stem cells from a related/unrelated donor
  • syngeneic: stems cells donated by identical twin
19
Q

what risks come with HSCT? how do we prevent these risks?

A
  • RISK OF INFECTION –> prophylactic, antibx, antifungal, antiviral

from allogeneic transplant –> GRAFT vs HOST disease
- when donor’s T cells sees recipients blood as FOREIGN –> attacks organs in pt (skin, liver, GI tract) –> treated with immunosuppressants