5.5 Complications of Chemotherapy Flashcards Preview

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Flashcards in 5.5 Complications of Chemotherapy Deck (21):
1

What are the ways Chemo can be given?

Oral, IV, into cavities (intraperitoneal, intrathecal) or into large blood vessels

2

What are the general acute causes of toxicity from chemo?

Alopecia/hair loss
Nauseau or vomiting
Oral toxicity
Enterotoxicity
Bone Marrow
Amennorhoea
Teratogenesis
Hypersensitivity reactions
Dermatological reactions
Social toxicity

3

What are the acute class specific toxicities?

Nephrotoxicity: MTX
Neurological complications
Interstitial pneumonitis: bleomycin
Cardiac
Haemorrhage cystitis

4

What are the general late causes of toxicity from chemo?

Infertility
Early menopause/low androgen levels in men: Osteoporosis, increased CV disease, sexual dysfunction
Myelosuppression
Vascular disease
Neuropathy
Renal impairment
Cognitive impairment

5

What are the late class specific toxicities

Second malignancy
Cardiac failure
Pulmonary fibrosis

6

What are the 3 types of chemo induced nausea and vomiting?

Acute emesis (first 24 hours)
Delayed emesis (>24h post chemo)
Anticipatory emesis

7

What are the neurotransmitters involved in chemo induced nausea and vomiting?

Dopamine
Serotonin (acute)
Substance P (delayed)

8

What are the anti nausea drugs given for CINV?

Metoclopamide
Dexamethasone
5-HT3 antagonists (ondansatron, palonosetron)
NK-1 receptor antagonists: Aprepitant

9

What is the mechanism of Aprepitant?

Blocks substance P binding to the NK-1 receptor - improves acute and delayed

10

What is the treatment for anticipatory emesis?

achieve initial good control
- Benzodiazepines around time of chemo (Lorazepam, alprazolam)

11

What is the most common oral toxicity from chemo?

Oral mucositis

12

What do you need to exclude in moderate-severe mucositis?

HSV infection

13

What are the gastro toxicities

Diarrhoea
Constipation
Neutropenic enterocolitis
Clostridium difficile-associated colitis

14

What are the anti-diarrhoeal agents?

Loperamide, diphenoxylate

15

What increases in risk with neutropenic fever?

Bacterial sepsis
Invasive fungal infections
Viral infections: HSV, VZV, CMV

16

What is the definition of neutropenic fever?

Neutrophils 38.3 on one occasion, >38 on two 1 hour apart

17

What is important in the assessment of the neutropenic patient?

Establish a source of the infection: damaged oral or gut mucosa, skin breaks, central venous catheter, community acquire pneumonia
Ask about infectious symptoms (cough, sore throat, diarrhoea, urinary symptoms, rash)
Ask about catheter
Any sick contacts

18

What is the examination in neutopenic patient?

Signs of infection
Examine skin, mucosa and surgical scars
Catheter
Examine chest
Abdo exam looking for tenderness
Perianal exam (perianal sepsis)
AVOID DIGITAL RECTAL
Cardiac to exclude murmur

19

What is the assessment of neutropenic patient that indicates infection?

Temperature
- They do not have the immune system to mount a normal response

20

What is the treatment for neutropenic fever?

Antibiotics - Broad spectrum

Empiric considered when there is a known outbreak of a resistant organism

IV fluid
Oxygen support
Examine twice daily initially
Modify antibiotics according to culture

21

What drug is associated with cardiomyopathy?

Anthracycline - not reversible
Trastuzumab (Herceptin) - reversible