-
3 common causes of mucositis
- 5-FU
- MTX
- Stem cell transplant conditioning
-
Given for hematopoietic stem cell tranplants to reduce oral mucositis
Do not give 24 hours before or after chemo
Palifermin
-
Typicall caused by readiation therapy for head and neck cancers or from anit cholinergics
-
tx for xerostima
- oral rinses
- saliva subs
- pilocarpine -- stimulates slivary secretion if residual salivar function
- amifostine: give prior to radiation (slow IVP over 3 minutes, 15-30 minutes pre radiation) as a protecive agent
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Causes of constipation
- Radiation
- Neurologic Damage
- Vinca alkaloids
- Thalidomide
- Decreased Mobility
- other drugs
-
Causes of diarrhea (6)
- 1. 5 FU with or without leucovorin
- 2. Irinotecan
- 3. MTX
- 4. Cytarabine
- 5. GVHD -- diarrhea may be the first sign
- 6. Radiation therapy
-
4 basic tx methods for diarrhea
- Kapectate or metamucil
- Opiod agents
- Somatostatin analogue -- octreotide
- Immunosuppresion for GVHD
-
Dose for loperamide
2 mg after each lose stool or 4 mg load then 2 mg q4 (Max 16mg/day)
-
dose for diphenoxylate
2.5 mg/atropine .025: 1-2 tablets q6 or after each lose stool
-
tx for irinotecan induced diarrhea
acute: facial flushing, abd cramps, nasal congestion, or diaphoresis -- IV atropine 0.5 mg
delayed onset: loperamide 4 mg then 2 mg q2 hour until symptom free for 12 hours (4mg q4 hours)
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Thrombocytopenic precautions
- nothing per rectum
- no IM injections
- no platelet inhibiting agents
-
Platelet transfusion guidelines for patients with cancer
- for leukemia: if less than 10,000 platelets/mcl
- for solid tumors: if less than 20,000
- others: < 10,000
-
___________is approved for prevention of severe thrombocytopenia in patients undergoing chemo for non myeloid malignancies. May cause ______ ______, peripheral _________, and ______ ___ _______
- Oprelvekin
- fluid retention
- peripheral edema
- SOB
-
4 groups of potential vesicants
- Daunorubicin, doxorubicin, idarubicin
- Mechlorethamine
- Plicamycin
- Vinblastine, vincristine
-
Antidote for vincristine, vinblastine, vinorelbine, etoposide, and teniposide
- hyalurinidase
- warm compress
-
Antidote for mechlorethamine
- DMSO (dimethylsulfoxide)
- Sodium thiosulfate
-
Antidote for doxorubicin, daunorubicin, and idarubicin
- Topical DMSO
- Cold compress
-
-
-
Causes of Hand foot syndrome, toxic erythema, palmar plantar erythrodysesthesia ro toxic erythema of palms and soles
- fluorouracil -- prolonged infusions
- anthracyclins -- more common with liposomal doxarubicin
- capcitabine -- 60%
- sorafenib and sunitinib
-
tx of hand foot syndrom
- see oncologist
- decrease dose
-
Tx of acneform rash from EGFR inhibitors
- thick alcohol free emollient cream -- lubriderm
- sun protection all the time
the rash is actually a sign of response
-
Tx of rash
Mild: none or topical hydrocortisone or clindamycin
Moderate: hydrocortisone or clindamycin or pimecrolimus PLUS doxycycline or minocycline
Severe: moderate tx PLUS MDP
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What should you never give radiation with?
- MTX
- Doxorubicin or any anthracycline
- Bleomycin
-
What can you give radiation with?
5 FU
-
May cause radiation recall rxns
XRT in the past then capecitebine + taxol
-
Causes phototoxic rxns
MTX + 5FU + EGFR
-
Pretx of asparaginase
- tylenol and benadryl
- can happen after 24 hours
- if symptoms go straight to the ER
-
tx of bleomycin hypersensitivity
- rare
- pretx with tylenol and benadryl
- take temp q4 hours and call if >101
-
tx of anthracycline hypersensitivity
- mostly just local rxns
- verify if allergic or extravasation
-
tx of monoclonal antibody hypersensitivity
- pretx with benadryl and tylenol
- never infuse less than 30 minutes
- if reaction: stop infusion, continue with pretx and slower infusion
-
tx of hypersensitivity with docetaxel
- pretx with tylenol, dexamethasone, benadryl
- continue pretx until 3-4 days post infusion
-
Causes of cardio myopathy (5)
- anthracyclines
- mitoxantrone
- high dose cyclophosphamide and ifosfamide
- interferon alfa and interleukin
- trastuzumab
-
Causes of arrhythmias (5)
- anthracyclines
- mitoxantrone
- high dose cyclophosphamide
- taxanes (paclitaxel)
- interleukin 2
-
Causes of Ischemia (4)
- 5 FU
- Interleukin 2
- Vinca alkaloids
- Bleomycin, cisplatin, mitomycin c
-
What are two parameters to monitor with anthracyclines?
- total dose of doxorubicin should not exceed 450 mg/m2
- EF < 45% then stop med
-
Get a _____ _____ if base line LVEF is < 50%. You can also get an endometrial ______. Cardiac toxicity is a function of _______ drug level, so you could change form a _____ dose to a _____ hour ________. Selection of ________ anthracyclines may be beneficial
- Muga scan
- biopsy
- peak
- bolus
- 96 hour infusion
- lipsomal
-
_________, as cardio protective agent is recommended. Dose with doxorubicin is ______. Give as IV drop ____-_____minutes before doxo or epirubicin. Doxorubicin must be administered within ____ ______ of _________ infusion
- dexrazoxane
- 10:1
- 15-30
- 30 minutes
- dexrazoxane
-
toxicity is much greater when combined wtih cyclophosphamide
trastuzumab
-
tx for tumor lysis syndrome
- IV hydration - at least 100mg/hr
- urinary alkalinization
- allopurinol
- hemodialysis for those with progressive renal dysfunction
-
4 agents that cause nephrotoxicity
- Cisplatin
- MTX
- Ifosfamide adn cyclophosphamide
- Carboplatin
-
Prevention of nephrotoxicity with cisplatin
- hydration
- saline, manitol, maybe loop
- amifostine
- premeds: hydration, antiemetic, histamine antagonist, dexamethasone
- iv sodium thiosulfate: for excessively high doses
-
nephrotoxicity for MTX
- monitor for increases greater than 5
- hydration and alkalinization of urine
-
Ifosfamide and cyclo nephrotoxicity tx
- min 2 qts of water/ day
- watch out for hemmorrhagic cyctitis
- give mesna with ifosfamide (usually at 60-100% of ifosfamide dose)
- short infusion of ifosfamide: 20% of ifosfamide dose of mesna at 0, 4, and 8 hours
-
nephrotoxicity of carboplatin
- uses AUC
- typciall 6 but can range from 5-7
-
common drugs with hepatotoxicity (6)
- asparaginase
- carmustine
- cytarabine
- mercaptopurine
- streptozocin
- high dose etoposide
- avoid agents if bili is > 5
-
4 drugs with pulmonary toxicity
- bleomycin
- busulfan: high mortality -- especially look for cough
- carmustine
- mitomycin
-
Cause meningeal irritation
- intrathecal MTX
- cytarabine
- thiotepa
-
peripheral neuropathies
- vinca alkaloids
- cisplatin
- carboplatin
- etoposide
- paclitaxel
- may treat with gabapentin
-
cerebellar dysfunction
- fluorouracil
- high dose cytarabine
- asparaginase
-
combination of toxicities
- procarbazine: effects of MAOI
- fludarabine
-
What should you do if neurotoxicity with ifosfamide?
- confusion may progress to encephalopathy and death
- and confusion: bring to ER and give mesna
-
Possible tx of neurotoxicity
- gabapentin for most symptoms
- amifostine -- may decrease the toxicity of cisplatins and taxols
- vitamin E -- may effective but harmful
-
drugs that cause male infertility
- alkylating agents
- antimetabolites -- very few affects
- cisplatin based
-
Female infertility
- alkylating agents
- adjuvant chemo
- MOPP chemo
-
When are secondary malignancies more common?
1-17% more common when radiation and alkylating agents are used
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