chemo Flashcards by Shea Green

Chemotherapy ADE include

hypersensitivity 
n/v
mucositis
alopecia
neuropathy
cutaneous reactions 
extravasation 
thrombosis 
MC: Myelosuppression! lowest blood cell count usually 10-14days after admin of chemo, and recovery w/in 3-4 wks
-anemia a few months after 1st dose 
-neutropenia, then thrombocytopenia

How well did you know this?

Not at all

Perfectly

What are the 5 phases of chemo induced nausea/vomiting

Acute: w/in 1-2 hrs of chemo. Tx with Ondansetron
Delayed: >24 hours after admin. Tx w/ Aprepitant, fosaprepitant, or rolapitant
Anticipatory: prior to admin in those who had significant n/v with chemo before. Tx w/ prophylactic benzos (diazepam, lorazepam) the night before admin
Breakthrough: occurs despite prophylaxis. Tx with prochlorperazine or phenothiazine around the clock
Refractory: poor response to all antiemetics. Tx w/ glucocorticoids (DXM)

How well did you know this?

Not at all

Perfectly

Where can mucositis occur

Gi mucosa

Inflammation as ulcers, local infection, can’t eat drink or swallow, systemic microbial invasion

How well did you know this?

Not at all

Perfectly

Mucositis is MC associated with

5-FU 
Doxorubicin 
Methotrexate 
Multikinase inhibitors (nibs) 
mTOR inhibitors (rolimus)

How well did you know this?

Not at all

Perfectly

Patients at high risk for mucositis are

Poor dentitions
those on high dose chemo
those on radiation involving oropharynx
-prevent mucositis with good oral hygiene! go to the dentist before chemo Tx, rinse mouth w/ backing soda and salt water frequently between courses of chemo

How well did you know this?

Not at all

Perfectly

What analgesics can be used to Tx mucositis

Mouthwash!
viscous lidocaine*
diphenhydramine liquid
Dyclonine sucrets*

How well did you know this?

Not at all

Perfectly

How can you manage local infection 2/2 mucositis

Candida: Clotrimazole troches or nystatin oral suspension for thrush. Oral fluconazole or IV antifungals for more severe
Reactivation of HSV: Acyclovir

How well did you know this?

Not at all

Perfectly

What is Palifermin

Keratinocyte Growth Factor that binds to KGF receptor resulting in proliferation, differentiation, and migration of epithelial cells on tongue, buccal, esophagus, and salivary glands

How well did you know this?

Not at all

Perfectly

Palifermin is approved for

high dose chemoradiotherapy prior to stem cell transplant

How well did you know this?

Not at all

Perfectly

ADE of Palifermin are

*Increased amylase and lipase

change in taste, mouth or tongue discoloration

How well did you know this?

Not at all

Perfectly

How do you treat mucositis that manifests as diarrhea and abdominal pain

IVF, electrolyte supplement
Lomotil or Loperamide (non-infectious antispasmodics)
Octreotide: somatostatin analog, esp for severe diarrhea

How well did you know this?

Not at all

Perfectly

What cutaneous reactions are associated with chemo

localized rash
photosensitivity
skin hyperpigmentation
nal changes 
hand-foot syndrome/acral erythema (diffuse edema &amp; erythema on palms and soles) 
-generally reversible and self limited

How well did you know this?

Not at all

Perfectly

Cutaneous reactions are associated with

Cytarabine
5-FU
Bleomycin

How well did you know this?

Not at all

Perfectly

How do you treat cutaneous reactions

Emollients if w/ dry skin
topical/systemic abx if rash gets infected
steroids to prevent itching and inflammation
Acral erythema: PO B6 (pyridoxine) QD, cold packs to extremities during chemo admin

How well did you know this?

Not at all

Perfectly

What is hand foot skin reaction

Associated with multikinase inhibitors, FU, capecitabine, and liposomal doxorubicin
Localizes to areas of pressure/friction (hands, feet)
Can prevent w/ daily moisturizer
Can treat with urea cream, topical steroids, and pain meds (gabapentin, NSAIDs)

How well did you know this?

Not at all

Perfectly

What is alopecia

Most distressing but usually temporary hair loss
W>M
All body, not just scalp.
MC associated with Taxane and Docetaxel

How well did you know this?

Not at all

Perfectly

How do you treat alopecia

Cool caps to decrease blood flow to the scalp

How well did you know this?

Not at all

Perfectly

What is extravasation

When chemo gets out of the blood and into surrounding structures (ex. IV line was not patent)
Causes prolonged pain, tissue sloughing, infection, and loss of mobility

How well did you know this?

Not at all

Perfectly

What causes extravasation

Vesiacants: agents that cause severe tissue damage if they escape the vasculature 
Antracyclines 
Actinomycin D
Vinca alkaloids 
Mitomycin C
Nitrogen mustard 
Takanes (Taxol*)

How well did you know this?

Not at all

Perfectly

How do you treat extravasation

Study These Flashcards

Apply ice packs to affected area EXCEPT:
Vinca alkaloids better managed by applying heat*
Sodium thiosulfate to neutralize nitrogen mustard
Hyaluronidase to improve outcome after vinca alkaloids, etoposide, and taxanes
Topical dimethyl sulfoxide for anthracycline and mitomycin C
Dexrazone IV (totect) for anthracycline!

How do you prevent extravasation

Study These Flashcards

good admin technique
Use large veins in forearms
give slowly through running IV line
Pref. thru central venous cath

When is myelosuppression MC seen

Study These Flashcards

when chemo is given at the same time as radiation to chest or pelvic region

What cells are affected in chemo related myelosuppression

Study These Flashcards

WBC (esp PMN): most significantly affected, rapid proliferation, short lifespan (6-12 hrs)
PLT: much less than PMN. 5-10 day lifespan
RBC: affected least. 120 day lifespan

When is myelosuppression good

Study These Flashcards

Myelotoxicity is a desired therapeutic effect in patients with AML during induction therapy

What is the MC hematologic complication of chemotherapy

Anemia | Depends on type and duration of therapy, type and stage of malignancy

What conditions are known to cause anemia in cancer patients

``` chemo and radiation chronic GI blood loss nutrient deficiency (Fe, folate) bone marrow invasion by tumor hemolysis renal dysfunction anemia of chronic disease ```

How do you treat anemia in a cancer patient

RBC transfusion | Recombinant human erythropoietic products (epoetin alfa, darbapoetin alfa)

Before initiating recombinant human erythropoietin, you must

eval underlying condition and initiate specific therapy; Iron deficiency? give Iron B12 or folate supplementation Chronic bleeding? determine site

How do you treat with human recombinant erythropoietin

Start Sx pts when Hgb <10 Target Hgb is 10-12 Indication of response: Hgb increase by 1g, ferritin decline or reticulocyte increase s/p 2-4 wks Reassess Hgb after 4-6 weeks (sr erythropoietin levels dont really help)

Mild ADE of recombinant human EPO (epogen) include

``` pain at injection site rash flu-like Sx seizures HTN ```

Severe ADE of recombinant human EPO are

decreased survival (advanced breast, head and neck, lymphoma, and non-small cell lung cancer) thrombosis pure red cell aplasia

What is neutropenia

ANC falls <500 risk of infection is directly proportional to duration of neutropenia S/Sx of are absent (no WBC respond) so rely on fever as indication of infection! start abx asap

What percent dose should you receive based on granulocyte count

>2000: 100% of dose 1000-2000: 5-% of dose <1000: 0%

What agents are used as colony stimulating factors in neutropenia

G-CSF (granulocyte): Filgrastim, Pegfilgrastim GM-CSF (granulocyte/macrophage): Sargramostim. promotes proliferation of neutrophils, eosinophils, macrophages, monocytes. stimulate megakaryocytes, but no effect on PLT

Giving CSF allow

admin of subsequent chemotherapy courses on schedule= enhanced dose intensity Not consistently translated into improved tumor response or survival

When can you use CSF

primary prophylaxis: prevent neutropenia in 1st chemo cycle | Secondary: prevent recurrent neutropenia in those who had neutropenia previously w/ chemo

What are ADE of CSF

Bone pain (give APAP) Increased LDH, alk phos, uric acid, and liver transaminases pleural and pericardial effusions w/ high doses; also capillary leak syndrome and thrombus formation low grade fever, myalgias, arthralgias, lethargy, mild HA mild erythema at subQ injection sites generalized maculopapular rash -Occur bc of drug's ability to bind neutrophils to endothelial cells, and activate monocytes and macrophages= release cytokines IL1 and TNF

When do you dose CSF

24-72 hours after chemo Stop the day before chemo Pegfilgrastim is long lasting G-CSF and should be stopped w/in 14 days of next chemo dose

How do you treat thrombocytopenia

Platelet transfusion! | reserved for PLT <10, active bleeding, or pending surgery

Who experiences significant thrombocytopenia w/ prior cycle of chemo Oprelvekin

Those with secondary non-myeloid malignancies

What is Oprelvekin (IL-11) associated with

``` Fluid retention (edema, dilutional anemia, dyspnea, pleural effusions) Cardiotoxicity (tachy, AFib, Aflutter, HF) ```

What is the most significant factor in the future of thrombocytopenia Tx

Megakaryocyte stimulating factor

What neuropathy is associated with chemo

sensory, motor, autonomic, or combination Mild: paresthesias of fingers and toes Constipation -MC with Vinca alkaloids and taxane drugs

Cardiotoxicity is associated with

Anthracyclines (Doxorubicin, Daunomycin, Idarubicin, Epirubicin) -MUGA screen scan show you LVEF. If >50%, give antracyclines

What is Cisplatin associated with

nephrotoxicity and neurotoxicity peripheral neuropathy, painful paresthesias Ototoxicity +/- deafness

How do you treat nephro/neurotoxicity associated w/ Cisplatin

vigorous hydration prior, during, and after admin monitor renal fxn and lytes for low mag, K, and Na Give amifostin IV over 15 min prior to cisplatin for protection

What can be used instead of cisplatin

Second gen platinum analog, Carbaplatin! | Non-nephrotoxic but still myelosuppresive

Common Bleomycin toxicities are

Edema of IP joints Hardening of palmar and plantar skin Anaphylaxis, serum sickness like reaction Serious or fatal pulmonary fibrotic rxn, esp in elderly

With bleomycin, monitor for

non-productive cough, dyspnea, and pulmonary infiltrates | If present, dc drug, start high dose corticosteroids, and start empiric abd pending cultures

chemo Flashcards

(49 cards)