Flashcards in 5.5 Complications of Chemotherapy Deck (21):
What are the ways Chemo can be given?
Oral, IV, into cavities (intraperitoneal, intrathecal) or into large blood vessels
What are the general acute causes of toxicity from chemo?
Nauseau or vomiting
What are the acute class specific toxicities?
Interstitial pneumonitis: bleomycin
What are the general late causes of toxicity from chemo?
Early menopause/low androgen levels in men: Osteoporosis, increased CV disease, sexual dysfunction
What are the late class specific toxicities
What are the 3 types of chemo induced nausea and vomiting?
Acute emesis (first 24 hours)
Delayed emesis (>24h post chemo)
What are the neurotransmitters involved in chemo induced nausea and vomiting?
Substance P (delayed)
What are the anti nausea drugs given for CINV?
5-HT3 antagonists (ondansatron, palonosetron)
NK-1 receptor antagonists: Aprepitant
What is the mechanism of Aprepitant?
Blocks substance P binding to the NK-1 receptor - improves acute and delayed
What is the treatment for anticipatory emesis?
achieve initial good control
- Benzodiazepines around time of chemo (Lorazepam, alprazolam)
What is the most common oral toxicity from chemo?
What do you need to exclude in moderate-severe mucositis?
What are the gastro toxicities
Clostridium difficile-associated colitis
What are the anti-diarrhoeal agents?
What increases in risk with neutropenic fever?
Invasive fungal infections
Viral infections: HSV, VZV, CMV
What is the definition of neutropenic fever?
Neutrophils 38.3 on one occasion, >38 on two 1 hour apart
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
What is the examination in neutopenic patient?
Signs of infection
Examine skin, mucosa and surgical scars
Abdo exam looking for tenderness
Perianal exam (perianal sepsis)
AVOID DIGITAL RECTAL
Cardiac to exclude murmur
What is the assessment of neutropenic patient that indicates infection?
- They do not have the immune system to mount a normal response
What is the treatment for neutropenic fever?
Antibiotics - Broad spectrum
Empiric considered when there is a known outbreak of a resistant organism
Examine twice daily initially
Modify antibiotics according to culture