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PHAM02 > Wk 10: Adverse effects of cancer treatment > Flashcards

Wk 10: Adverse effects of cancer treatment Flashcards

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1
Q

During pre-assessment, what type of things are included during patient assessment?

A
  • Psychological
  • Fears
  • Social
  • Self care
  • Eating + drinking
  • Pain assessment
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2
Q

What are the common side effects associated w/ chemo?

A
  • Fatigue
  • Myelosuppression
  • Nausea + vom
  • Inc risk of infection
  • Alopecia
  • Diarrhoea/constipation
  • Neuropathy
  • Mucositis
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3
Q

What are the potential factors of cancer related fatigue?

A
  • Anaemia
  • Wasting
  • Tumour burden
  • Sleep disturbances
  • Pain
  • Treatment
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4
Q

What is myelosuppression?

A
  • Red prod of erythrocytes, WBC + platelets
  • Occurs: 7-10 days after treatment
  • 20 days recovery
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5
Q

What are the risks of myelosuppression?

A
  • Low erythrocytes: anaemia - treat w/ blood transfusion
  • Red WBC: neutropenia
  • Red platelets: thrombocytopenia
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6
Q

How is myelosuppression managed?

A
  • Blood counts before treatment + before each cycle of chemo
  • Low: red dose + delay treatment
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7
Q

What is given for the prophylaxis of myelosuppression?

A

High risk of neutropenia:
- Antibiotics
- Antifungal
- Antiviral

Growth factors:
- G-granulocytes (filgrastim)

  • E-granulocytes (erythropoietin)
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8
Q

What is neutropenic sepsis?

A

Neutropenia w/ temp +/- symptoms of infection (medical emergency)

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9
Q

What is given to treat neutropenic sepsis?

A

Broad spectrum antibiotics:
- Tazocin 48hrs
- Meropenem 48hrs
- Ceftazidime 48hrs

  • Anaerobic cover: metronidazole
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10
Q

What causes sickness in the body?

A
  • Chemo activates NT
  • Chemoreceptor trigger zone (brain) + GI tract
  • Vomiting centre in brain = sickness
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11
Q

Which patients are more susceptible to nausea + vomiting?

A
  • Female
  • Under 50
  • Non drinker
  • Anxious
  • Previous motion sickness/morning sickness
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12
Q

What is given for chemo triggering the chemoreceptor trigger zone?

A
  • Dopamine: metoclopramide
  • Serotonin: ondansetron
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13
Q

Whats is given for chemo, radiotherapy + surgery triggering the GI tract?

A
  • Dopamine: metoclopramide
  • Serotonin: ondansetron
  • Cyclizine
  • Hyoscine
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14
Q

What is given for anticipation nausea + vomiting?

A

Benzodiazepines

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15
Q

What are the types of N+V?

A
  • Acute (w/in 24hrs)
  • Delayed
  • Anticipatory (fear/memory)
  • Breakthrough (despite antiemetics)
  • Refractory
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16
Q

What are the counselling points for a patient w/ anorexia + taste disturbances?

A
  • Eat healthily + liquids
  • Maintain healthy weight
  • Make + freeze meals in advance
  • Avoid fad diets
  • Monitor weight
  • Refer to dietetics
  • May need artificial feeding (TPN) or via PEG/JEG
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17
Q

What is mucositis?

A
  • Oral mucosa vulnerable to chemo due to rapid growth + cell turnover rate
  • Inflammation of mouth = ulceration
  • Inc risk of neutropenia
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18
Q

What is the management strategy of mucositis?

A
  • Good mouth care
  • Mouth wash
  • Good nutrition
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19
Q

What is mucositis associated with?

Study These Flashcards
A

Antimetabolites + anthracyclines

20
Q

What is the treatment of established mucositis?

Study These Flashcards
A
  • Topical analgesics/anaesthetics
  • Topical ineffective: Systemic pain control measures
21
Q

What are the counselling points for a patient with constipation?

Study These Flashcards
A
  • Consider normal bowel function
  • Maintain adequate fluid
  • Healthy diet
  • Gentle exercise
22
Q

What is given for constipation?

Study These Flashcards
A
  • Docusate sodium
  • Macrogol
23
Q

What needs to be monitored if a patient has constipation?

Study These Flashcards
A

Bowel obs or spinal cord compression

24
Q

What are the complications of diarrhoea?

Study These Flashcards
A
  • Dehydration
  • Metabolic disturbances
  • Malnutrition
25
What is the counselling points for diarrhoea?
- Maintain fluid - Healthy diet - Loperamide prn - Seek advice if > 48hrs
26
What are the symptoms of diarrhoea associated with irinotecan?
- > 24hrs = cholinergic - Sweating - Hyper salivation - Visual disturbances - Abdominal cramps - Watery eyes - Hypo
27
How do you treat a patient w/ diarrhoea associated with irinotecan?
- REPORT - After 24hrs treat w/ loperamide - Report if lasts > 24hrs despite loperamide
28
What is peripheral neuropathy associated with?
- Chemo - Disease - Complication of surgery/radiotherapy
29
What are important points of peripheral neuropathy?
- Initially mild, gradually worsens - Dose red required - Reversible + irreversible
30
What are the symptoms of peripheral neuropathy?
- Numbness, tingling of hands + feet - Burning of hands + feet - Numbness round mouth - Constipation - Loss of sensation + positional sense - Leg cramps - Difficulty picking things up
31
What are the symptoms of hand-foot syndrome?
Palm + sole: - Redness - Swelling - Burning - Tenderness - Tight skin - Blisters
32
What is hand-foot syndrome caused by?
- Capecitabine - 5-fluouracil - Doxorubicin
33
What are the counselling points for hand-foot syndrome?
- Avoid highly perfumed prods - Moisturise - Avoid sun exposure - Short nails - Report rashes + itchiness
34
What is a preventable measure of alopecia?
Cold cap
35
What is tumour lysis syndrome?
Metabolic disturbances that occurs as result of rapid cell lysis - common w/ leukaemia + lymphoma
36
How does tumour lysis syndrome occur?
- K + phosphate released from dying cells - Nucleic acid breakdown = uric acid - Hypocalcemia = secondary response to hyperphosphatemia + renal failure
37
What is the treatment/prevention for tumour lysis syndrome?
- IV hydration - Manage hyperuricemia (allopurinol) - Start 12hrs prior to treatment
38
What are the longer term effects in terms of infertility + teratogenicity?
- Avoid pregnancy esp 1st trimester - Amenorrhoea - Induce early menopause - Sterility: depression of spermatogenesis (pre-counselling + sperm storage) - LT effects in children
39
Give examples of long term effects
- 2nd cancer - CV/respiratory - Psychological issues
40
What are the side effects of cetuximab?
- Targets EGFR on normal skin cells - Rashes, dry skin + itching
41
What are the side effects of hormone therapy in women?
- Menopausal symptoms - Hair thinning - Osteoporosis - Thrombosis
42
What are the side effects of hormone therapy in men?
- Muscle strength reduction - Erectile dysfunction - Low libido - Hair thinning
43
Which chemotherapy agents have the highest risk of causing cancer induced nausea + vomiting?
- Cisplatin - High dose cyclophosphamide
44
Which chemotherapy agents have the mid risk of causing cancer induced nausea + vomiting?
- Carboplatin - Low dose cyclophos - Doxorubicin
45
Which chemotherapy agents have a low risk of causing cancer induced nausea + vomiting?
- Taxanes - 5-fluorouracil - Methotrexate
46
Which chemotherapy agents have the lowest risk of causing cancer induced nausea + vomiting?
- Vincristine - Bleomycin

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