Cyto

Question 1

Preventing acute Nausea and vomiting

Answer 1

Pre-treatment with lorazepam/ dexamethasone can be used for patients with a low emesis risk.

A 5HT3 antagonist such as ondanesteron can be given orally for patients with higher risk, sometimes paired with dexamethasone

Question 2

Preventing delayed symptoms

Answer 2

Moderately emetogenic chemotherapy delayed
symptoms can use dexamethasone as well as a 5HT3-
receptor antagonist. Highly emetogenic chemotherapy
can use a combination of aprepitant and
dexamethasone can work. Metoclopramide
hydrochloride and rolapitant are licensed for delayed
nausea and vomiting caused by chemotherapy.

Question 3

preventing anticipatory symptoms

Answer 3

Lorazepam can be used for its anxiolytic, sedative and amnesiac effect

Question 4

Oral mucositis

Answer 4

Chemo often causes sore mouth especially with MTX, anthracyclines or flurouracil. Rinse the mouth often, brush the teeth several times a day, good oral hygiene and sucking on ice chips

Question 5

Tumour lysis syndrome

Answer 5

• Can occur secondary to treatment related or spontaneous rapid malignant cell destruction
  Most at risk: high white blood counts/ solid tumours / leukaemia

Question 6

Predisposing factors of tumour lysis syndrome

Answer 6

Dehydration, renal impairment and hyperuricemia

Question 7

Tumour lysis syndrome complications

Answer 7

Hyperphosphataemia, hyperuicemia and hyperkalemia are features and can lead to arrthymias and renal damage

Question 8

Hyperuricaemia in cyto

Answer 8

• Associated with acute renal failure
• Start allopurinol 24 hours before treating the tumour and ensure hydration
• Reduce the azathioprine or mercaptopurine dose
• Febuxostat can be used starting 2 days before cytotoxic therapy

Question 9

Which two cytotoxic drugs do NOT cause bone marrow suppression

Answer 9

Bleomycin and vincristine

Question 10

Cytotoxic drugs on pregnancy and reproduction

Answer 10

.Although women aren
’t as affected, their reproductive
lifespan can be shortened with the onset of early
menopause. No foetal abnormality or abortion increase
has been recorded in women still fertile following
cytotoxic chemotherapy.

Question 11

Handling cytotoxic

Answer 11

Guidelines for handling cytotoxic drugs
Monitor staff exposure to cytotoxic drugs
Only trained personnel should reconstitute these
drugs
Pregnant personnel should avoid exposure, while
those of childbearing age must be informed of
potential reproductive hazards
Carry out reconstitution in designated areas of
pharmacy
Wear protective clothing including gowns, masks
and gloves
Protect the eyes and have first aid nearby.
Deal with spillages as well as safe waste material
disposal for containers, absorbent material and
syringes using local procedures