Chemotherapy Extravasation

Question 3

What does extravasation refer to?

Answer 3

The leakage of chemotherapy drugs into surrounding tissues, causing local tissue damage, necrosis, or ulceration.

Question 4

How are chemotherapy drugs classified based on their DNA-binding properties?

Answer 4

They are classified into DNA-Binding (Vesicants) and Non-DNA-Binding (Irritants or Vesicants).

Question 5

What are DNA-Binding agents also known as?

Answer 5

Vesicants.

Question 6

Name two examples of DNA-Binding chemotherapy agents.

Answer 6

• Anthracyclines (Doxorubicin, Epirubicin, Daunorubicin)
• Alkylating agents (Mustargen, Cisplatin, Carboplatin)

Question 7

What type of tissue damage do DNA-Binding agents cause?

Answer 7

Severe tissue necrosis.

Question 8

What are Non-DNA-Binding agents also known as?

Answer 8

Irritants or Vesicants.

Question 9

Name two examples of Non-DNA-Binding chemotherapy agents.

Answer 9

• Vinca alkaloids (Vincristine, Vinblastine, Vinorelbine)
• Taxanes (Paclitaxel, Docetaxel)

Question 10

What type of injury do Non-DNA-Binding agents cause?

Answer 10

Inflammation, pain, and possible necrosis.

Question 11

What is the first treatment step for extravasation caused by DNA-Binding agents?

Answer 11

Cold compress (vasoconstriction to limit spread).

Question 12

What is the role of topical DMSO in treating extravasation?

Answer 12

Reduces oxidative damage.

Question 13

What is the ONLY FDA-approved antidote for anthracycline extravasation?

Answer 13

Dexrazoxane (Totect®).

Question 14

When should Dexrazoxane be administered for it to be effective?

Answer 14

IV within 6 hours.

Question 15

What is the first treatment step for extravasation caused by Non-DNA-Binding agents?

Answer 15

Heat compress (vasodilation helps disperse drug).

Question 16

What is the role of Hyaluronidase in treating extravasation?

Answer 16

Breaks down hyaluronic acid, helping drug spread and absorb.

Question 18

What does the mnemonic ‘Hot Vinca, Cold Dox’ help remember?

Answer 18

Management of extravasation for Vinca alkaloids and Doxorubicin/Anthracyclines

‘Hot’ refers to Vinca alkaloids which require heat and hyaluronidase, while ‘Cold’ refers to Doxorubicin which requires cold compress and DMSO plus dexrazoxane.

Question 19

What do ‘Hot’ and ‘Cold’ represent in the mnemonic ‘Hot Vinca, Cold Dox’?

Answer 19

‘Hot’ represents Vinca alkaloids and ‘Cold’ represents Doxorubicin/Anthracyclines

‘Hot’ indicates the use of heat and hyaluronidase, while ‘Cold’ indicates the use of cold compress, DMSO, and dexrazoxane.

Question 20

What is the focus of the mnemonic ‘DNA-Binders Love Cold’?

Answer 20

Management of extravasation for DNA-binding drugs

This includes Anthracyclines, Mitomycin, and Alkylators, which require cold compress and DMSO.

Question 21

Which drugs are associated with the mnemonic ‘DNA-Binders Love Cold’?

Answer 21

• Anthracyclines
• Mitomycin
• Alkylators

These drugs are managed with cold compress and DMSO during extravasation.

Question 22

What does the mnemonic ‘Vincas Need Heat & Help (Hyaluronidase)’ signify?

Answer 22

Management of extravasation for Vinca alkaloids

Vinca alkaloids require heat and hyaluronidase for effective management.

Question 23

Which treatment is indicated for Vinca alkaloids according to the mnemonic ‘Vincas Need Heat & Help’?

Answer 23

Heat and Hyaluronidase

This treatment approach is necessary to manage extravasation effectively.

Question 25

What is the first step in managing chemotherapy extravasation?

Answer 25

STOP infusion immediately ## Footnote Leave IV line in place for aspiration/drug-specific treatment.

Question 26

What are DNA-Binding Agents associated with in terms of risk?

Answer 26

Severe necrosis risk ## Footnote Examples include Anthracyclines (Doxorubicin, Epirubicin), Alkylators (Cisplatin, Mustargen), and Mitomycin C.

Question 27

What is the treatment for DNA-Binding Agents extravasation?

Answer 27

COLD compress, Topical DMSO 99%, Dexrazoxane ## Footnote COLD compress for 15–20 min, 4x/day × 24–48h; DMSO applied every 8h × 7d; Dexrazoxane IV within 6h only for anthracyclines.

Question 28

What type of compress should be used for Non-DNA-Binding Agents extravasation?

Answer 28

HEAT compress ## Footnote Apply for 15–20 min, 4x/day × 24–48h to promote vasodilation.

Question 29

Identify two examples of Non-DNA-Binding Agents.

Answer 29

Vinca alkaloids, Taxanes ## Footnote Examples include Vincristine, Vinblastine, and Paclitaxel.

Question 30

What is the role of Hyaluronidase in managing Non-DNA-Binding Agents extravasation?

Answer 30

Enhances drug dispersion ## Footnote Inject subcut around the extravasation site.

Question 31

What should be monitored and documented after chemotherapy extravasation?

Answer 31

Size and symptoms ## Footnote Surgical consult if ulceration/necrosis develops.

Question 32

What mnemonic helps remember the treatments for extravasation?

Answer 32

Hot Vinca, Cold Dox ## Footnote Vincas need heat, Doxorubicin needs cold.

Question 33

Fill in the blank: DNA-Binders get ______ therapy.

Answer 33

cold

Question 34

Fill in the blank: Never use cold for vincas as it ______ vasospasm.

Answer 34

worsens

Question 35

Fill in the blank: Never use heat for anthracyclines as it ______ necrosis.

Answer 35

accelerates

Question 36

What is the treatment approach for extravasation of Anthracyclines?

Answer 36

COLD + DMSO + Dexrazoxane ## Footnote Follow the treatment protocol for DNA-Binding Agents.

Question 37

What is the treatment approach for extravasation of Vinca alkaloids?

Answer 37

HEAT + Hyaluronidase ## Footnote Follow the treatment protocol for Non-DNA-Binding Agents.