Chemotherapy Flashcards
What are the main considerations for keeping people safe?
Designated area, limited access and no throughway Keep cytotoxic drugs stored separately Trained and knowledgeable staff only No eating/ drinking/ cosmetics Minimise exposure
How do you dose chemo agents?
Dosing
• mg/m2 if over 10 kg
• Often mg/kg if under 10 kg
How do you prepare to give chemo?
• Work in a calm environment, sedate the patient if
necessary
• Indwelling intravenous catheter
• Perfectly placed at first attempt
• Flush catheter to check patency with saline, continue
to check catheter placement throughout
• Check dose of drug is correct!
• Inject via a luer lock bung / screw infusion set / closed system
• Do not obscure catheter and vein during administration
How do deal with the possibility of extravasion?
• Warn clients of risks and worse case scenario outcomes.
• Consider sedation of all patients having vesicant drugs particularly infusions.
• Always use an IV catheter placed perfectly at the first
attempt.
• Check catheter patency, postioning regularly and closely supervisor patients being treated.
• Recorded which veins have been used.
• Know how to deal with the consequences of
extravasations and seek advice
How do you give IV boluses?
Drugs given as boluses • Vincristine • Vinblastine • Cyclophosphamide • Actinomycin-D • Methotrexate Proceedure • Place catheter • Check patency and flush • Administer drug whilst checking patency • Flush (do not draw back) • Remove catheter • Place bandage over site
How do you give infusions?
Sedate patient if necessary.
Place catheter
Check patency and flush
Administer drug by slow infusion
A. 15 - 20 mins for epirubicin and doxorubicin
B. 5 – 10 mins for carboplatin, mitoxantrone
Monitor patient and catheter the whole time.
Flush line and catheter (do not draw back)
Remove catheter
Place bandage over site
How do you give tabletted meds?
•Tabletted drugs include: Chlorambucil Cyclophosphamide Melphalan Lomustine •Proceedure Prepare drugs on an absorbent pad Never crush or break (compound if necessary) Wear waterproof gloves e.g. Nitrile or vinyl Wash after treatment
How do you deal with waste disposal?
1.Special bins for all equipment used to administer cytotoxics.
2.Waste from patients needs to be doubled bagged and marked as contaminated.
3.Waste needs to be kept in a dedicated area for cytotoxic waste
•Arrangement for appropriate disposal
How frequent are s/e from chemotherapy
Around 30 % have some degree of side effect at some stage during treatment
Only 5 % hospitalised
Mortality rate less than 1 %
How long are patients sick for if they do get sick?
GI side effects usually seen in the first 4 days and resolve in the same time period
Bone marrow suppression usually from 7 days and resolved by 10 days
The rest of the time patients are well
Which breeds are well known to be more sensitive to anthracyclines & vinca alkaloids
Various collies
Poss westies
Australian Shepherds
Long haired whippets
If there is a hepatopathy, which drugs need to have their dose re-considered?
anthracyclines
Cyclophosphamide
vinca alkaloids
If there is renal disease, which drugs need to have their dose re-considered?
Cyclophosphamide
Methotrexate
Carboplatin
What are the most common general chemo s/e?
- Bone marrow suppression
- Gastrointestinal
- Alopecia
How does bone marrow suppression d/t chemotherapy present?
• Can see low:
1. Platelet counts (thrombocytopaenia)
2. Neutrophil (neutropenia)
3. None – regenerative anaemia
• Counts are usually lowest after 7 days (Nadir)
• Usually return to normal 3 – 4 days after this
• Some drugs can cause prolonged or permanent
problems
Which drugs are the most myelosuppressive
Anthracyclines Cyclophosphamide Lomustine Carboplatin l-asparaginase and vincristine together
Which drugs are moderately myelosuppressive?
Cytosine Arabinoside
Methotrexate
Melphalan
Vinblastine
Which drugs are mildly myelosuppressive?
Vincristine
Chlorambucil
What should you do if a patient in neutropaenic
Counts above 1 x 109/l
• Patients are unlikely to be at an increased risk of sepsis
Monitor patient closely
Patients which are well with counts below 1 x 10 /l 9
• Patients at an increased risk of sepsis
Manage as outpatient
Keep away from potentially infectious animals
Owner to check temperature twice daily
Anaerobe sparing antibiotics
Patients which are sick with counts below 1 x 109/l
• Patient may be septic
Admit, barrier nurse
IV fluids
CBC and biochemistry to assess patient status
Broad spectrum antibiotics
If there is no rapid improvement look for focus of infection
How does alopecia occur in chemo?
Rare to see a significant change
May see it in constantly growing hair breeds
May lose guard hairs and whiskers
