Pharmaceuticals and Contraindications

Question 1

benefits of chemoradiation

Answer 1

radiosensitiser - enhances DNA damage

radiation enhancer - enhances radiation effect

chemotherapeutic agents + XRT - does needs to be adjusted with concurrent XRT => acceptable toxicities

increase cancer cure

replace the need for surgery (or delay it)

allows organ preservation

Question 2

common complications of chemo-radiation

Answer 2

• nausea and vomiting
• mucositis/stomatitis

Question 3

what is mucositis/stomatitis

Answer 3

inflammation and damage of the mucous membranes lining the mouth and other parts of the GI tract

Question 4

radiation induced mucositis

Answer 4

more severe and of longer duration when compared to chemo-induced mucositis

• appears after -2weeks of radiation
• peaks by the end of RT => may persist for up to 8 weeks

Question 5

chemo induced mucositis

Answer 5

typically occurs 2-3 weeks from the commencement of chemotherapy

Question 6

mucositis/stomatitis - issues to consider

Answer 6

• symptom control => patient comfort and nutritional intake
• affects ability to eat and drink
  
  • fluid balance and nutritional status may be compromised ==> interruption of tx, hospitalisation

Question 7

mucositis/stomatitis - high risks

Answer 7

-poor oral hygiene
- dry mouth
- gum disease
- smoking
- alcohol consumption

Question 8

mucositis/stomatitis - symptoms

Answer 8

• mild soreness to severe (requiring hospitalisation due to risk of bleeding and infection)

Question 9

what is cystitis

Answer 9

inflammation of the bladder and urethra

Question 10

cystitis - symptoms

Answer 10

• blood in urine
• urgency of urination
• painful urination
• abdominal pain

Question 11

what drugs can help manage mucositis?

Answer 11

• oralube (saliva sub)
• sodium bicarbonate mouthwash
• xylocain (topical anesthetic)
• oromorph (systemic pain relief)

Question 12

What are some side effects of morphine?

Answer 12

• N/V
• Constipation
• Respiratory distress
• Dependance/addiction

Question 13

what drugs help candidiasis?

Answer 13

• Nystatin
• Miconzole oral gel

Question 14

drugs to help manage oesophagitis

Answer 14

Antacids - Gaviscon (neutralise HCL)
Proton pump inhibitors - nexium (reduce acid secretion), pantoprazole

Question 15

Define diarrhoea

Answer 15

Decreased consistency of bowel motions, or ostomy output due to treatment

Question 16

What are the consequences of diarrhoea?

Answer 16

Malnutrition
Weight loss
Electrolyte imbalance
Renal Insufficiency
Hospital administration

Question 17

drugs to help manage diarrhoea

Answer 17

gastrostop - loperamide
lomotil
gastrolyte (oral rehydration)

Question 18

medication to help manage cystitis

Answer 18

ural - urinary alkalinizer
paracetamol
ibuprofen

Question 19

List factors relating to radiation dermatitis

Answer 19

• Obesity
• Older age
• Gender (female)
• Chronic sun exposure
• Smoking
• Breast reconstruction
• Connective tissue disorder

Question 20

What agents can cause drug-induced radiation recall?

Answer 20

An acute inflammatory reaction confined to an area of previous radiation exposure triggered by chemotherapeutic agents.
- Taxanes
- Antibiotics
- Anthracyclines

Question 21

dermatitis meds

Answer 21

hydrocortisone cream

Question 22

How often should patients take Ondansetron?

Answer 22

Maximum 32mg/24 hours

Question 23

How often should patients take dexamethasone?

Answer 23

4mg daily

Question 24

How often should patients take oramorph?

Answer 24

1.5 ml daily / twice daily

Question 25

How often should patients take xylocaine?

Answer 25

15 ml before meals

Question 26

How often should patients use sodium bicarbonate mouthwash?

Answer 26

As required or 4 x daily

Question 27

How often should patients take Nystatin?

Answer 27

1ml held in mouth

Question 28

How often should patients take Gaviscon?

Answer 28

1 hour after eating

Question 29

How often should patients take PPIs?

Answer 29

1 x daily

Question 30

How often should patients take nexium?

Answer 30

40mg 2 x daily

Question 31

List some chemotherapy specific side effects

Answer 31

- affects healthy cells such as blood cells causing anemia and infection - hair loss -mucositis - constipation - N&V

Question 32

Why are patients undergoing brain radiotherapy usually prescribed Dexamethasone?

Answer 32

Management of oedema and inter-cranial pressure

Question 33

drugs used for nausea and vomiting + contraindications

Answer 33

- 5HT3 antagonist - ondansetron, granisetron - constipation, headache, migraine, QT prolongation (heart condition) - corticosteroids - dexamethasone - infection, oedema, hypertension, hyperglycaemia, delay wound healing, weight gain -dopamine receptor antagonist - metoclopramide, prochloriperazine - tremor, slurred speach, akathisia, dystonia

Question 34

management of mild to moderate oral mucositis

Answer 34

pain control - suck on ice cubes - use pain medications as advised by your doctor dietary modification - eat moist or soft foods - avoid foods that require a lot of chewing - avoid acidic, spicy, salty and hot foods oral care - rinse mouth 5-6 times each day - brush teeth with soft tooth brush

Question 35

candidiasis (anti-fungal infection) medications

Answer 35

- nystatin oral drops - 1mL qid to be held in mouth as long as possible - amphotericin B lozenges - 1 lozenge qid for 1-2 weeks - miconazole 2% oral gel - half a measuring spoon (2.5ml) qid - fluconazole - dosing varies - topical anesthetics - 15mL before meals - careful with hot beverages - cost - systemic pain relief - different strengths - side effects - nausea and vomiting, drowsiness, constipation, respiratory depression, dependence

Question 36

drugs for oesophagitis

Answer 36

- antacids - neuralise HCL secreted by gastric parietal cells - tablets should be chewed - constipation => containing Al and Ca - diarrhoea => containing Mg - monitor Ca, Al and/or Mg concentration => accumulation and toxicity in renally impaired patients - H2 antagonists - proton pump inhibitors

Question 37

what is diarrhoea + leads to...

Answer 37

decreased consistency of bowel motions, or ostomy output due to treatment =/- abdominal pain and/or cramping (may also contain blood or mucus) may lead to malnutrition, weight loss, electrolyte imbalance, renal insufficiency and hospital admission

Question 38

management for diarrhoea

Answer 38

- oral rehydration (8 to 10 large glasses of clear liquids - water, sports drinks, clear juices or broth) - antisecretory agents - activate opioid receptors in the gut wall, decreasing bowel motility and increasing fluid absorption - loperamide (non-analgesic opioid) - dephenoxylate and atropine (opiate analogue) - lactobacillus - containing probiotics may be useful in preventing chemo and/or radiation therapy induced

Question 39

management (medications) of cystitis

Answer 39

- ural - ibuprofen - paracetamol

Question 40

ural medication

Answer 40

- to treat burning and painful symptoms - 1-2 sachets dissolved in cold water qid - may alter therapeutic effects of medication

Question 41

ibuprofen for cystitis

Answer 41

analgesics, anti-pyretic and anti-inflammatory

Question 42

paracetamol for cystitis

Answer 42

negligible anti-inflammatory effects

Question 43

drugs for mucositis

Answer 43

- topical anaesthetics - 15ml before meals - careful with hot beverages - cost - systemic pain relief - different strengths - side effects; nausea and vomiting, drowsiness, constipation, respiratory depression, dependence - saliva substitute - for dry mouth, salivary gland hypofunction - for topical use (spray) - artificial lemon flavour - sodium bicarbonate mouth wash - increase salivary pH => improves symptoms of dry mouth - cheap and effective

Question 44

Antacids contraindications

Answer 44

Constipation -> if containing al and Ca Diarrhoea -> if containing Mg Monitor Ca, Al and Mg concentration -> accumulation and toxicity in renally impaired patients