Chemotherapy Complications Flashcards
(39 cards)
what is typhilitis?
it’s neutropenic enterocolitis a life threatening infection in patients who have leukemia who become neutropenic after chemotherapy.
What is neutropenic entercolitis?
life threatening infection in patients who have neutropenia post chemotherapy. There’s intestinal mucosal injury and body is unable to fight microorganism invasion into the gut lining.
When does neutropenic enterocolitis happen?
This starts 10-14 days post chemotherapy
Presentation of typhilitis or neutropenic enterocolitis?
fever after chemotherapy, right lower quadrant abd pain, nausea w/ or without vomiting, and watery or bloody diarrhea.
How to diagnosis typhilitis or neutropenic enterocolitis?
Abd CT scan showing fluid filled and distended cecum with thickened wall, intramural air or edema and mucosal thrumbprinting.
What test should you always order when trying to evaluate pt who may have neutropenic enterocolitis?
check C diff, and also empirically treat for C diff until infection is ruled out
What are the initial antibiotics to start in someone with suspected neutropenic enterocolitis?
cefepime or ceftazidime + metronidazole W/ PO vancomycin if waiting to rule out C diff.
if patient has prolonged fever >72hrs and neutropenic enterocolitis, what med do you start?
antifungal therapy
When to get surgery involved for treatment of neutropenic enterocolitis?
complicated typhilitis or uncomplicated patients who clinically deteriorate.
Do we ever do colonoscopy in neutropenic or thrombocytopenic pts?
no because can perforation with air insufflation. If there’s suspicion of pseudomembranous colitis and negative stool studies can get a sigmoidoscopy to confirm diagnosis.
anthracycline (doxorubicin) can cause what in 5-10 years after treatment?
can see anthracycline induced leukemia in about 10-20% of cases and see a MDS phase.
What is the prognosis for chemotherapy related leukemia?
they respond poorly to current treatments with chemotherapy or allogenic hematopoietic stem cell transplants
what chemo drugs cause pulmonary fibrosis
bleomycin (also can cause organizing pneumonia and hypersensitivity pneumonitis) small molecule tyrosine kinase inhibitors
what chemo drugs cause cardiomyopathy?
anthracyclines (doxorubicin) and trastuzumab can cause arrhthymias, heart block, pericarditis and heart failure. RF for this is cumulative dose, hx of chest irradiation, pre existing cardiovascular disease and bone marrow transplant
what does methotrexate cause as a side effect?
liver toxicity (hepatic fibrosis)
hypersensitivity pneumonitis
nephrotoxicity (high doses) causes folic deficiency too
so must be on folic acid replacement.
what is a side effect of cisplatin?
nephrotoxicity,
ototoxcity
peripheral neuropathy
what are the side effects of cyclophosphamide?
hemorrhagic cystitis
bladder cancer
gonadal toxicity
side effect of 5 FU (5 fluorouracil)?
severe diarrhea
Side effect of EGFR inhibitors (erlotinib and cetuximab)?
skin rash
intracranial radiation and chemotherapy as a child for ALL can predispose a patient to developing
brain tumor and hematological malignancies (AML). most common brain tumor is meningioma and glioma. meningeal cells are most susceptible to cranial radiation
when do people present with post radiation brain cancer?
latency period of 20 years. see meningiomas are slow growing with symptoms resulting from compression of underlying brain parenchyma high grade gliomas (glioblastoma multiforme) are highly aggressive and often associated with extensive vasogenic edema.
side effect of bevacizumab
HTN,
bleeding thrombosis
radiation side effect
CAD, thyroid cancer, lymphoma
bleomycin side effect
lung toxicity and pulmonary fibrosis
