Pharm II (chemo 1e)

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Pharm II (chemo 1e)
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2011-01-09 08:36:22
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Pharm II chemo 1e
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Pharm II (chemo 1e)
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  1. Acute toxicity -alopecia

    to prevent?
    most commonly seen with anthracyclines, taxanes and some alkylating agents

    occurs 3 weeks after first cycle

    - avoid concurrent toxins - vary drugs
  2. Acute toxicity – nausea and vomiting

    Prevention?
    worse in young than elderly

    • most commonly seen with platinum, anthracyclines, IV nitrogen mustard derived alkylators
    • main cause of prematurely discontinuing chemo

    • •Prevention:
    • 1. light meals
    • 2. amnesics
    • 3. multiple drugs
  3. What are some ways to prevent N/V?
    1. HT-3 inhibitors eg. Ondansetron

    2. anti-histaminics eg.prochlorperazine

    3. anti- dopamines eg. Metoclopromide

    4. minor tranquilizers eg. Lorazepam

    5. steroids eg. Dexamethasone

    6. THC
  4. Acute toxicity - myelosuppression
    • most important side effect because it is the biggest cause of treatment related deaths.
    • - white count decreases by 7-10 days
    • - red cells decrease by approximately 1 % per day

    associated with severe mucositis--> infection

    Report Fever and Chills ASAP!!!! (chance of neutrppenia and sepsis). If it persists think Fungal infection.
  5. What are some components of CSF support?
    • 1. granulocyte colony stimulating factor
    • 2. erythropoietin
    • 3. megakaryocyte growth factor
  6. Acute toxicity - mucositis
    -most commonly seen with antimetabolites, occurs at time of nadir ( lowest) blood counts.

    -painful leading to dysphagia and diarrhea resulting in electrolyte disturbance and malnutrition

    -associated with yeast infection
  7. Acute toxicity – skin changes
    extravasation is biggest concern particularly with IV alkylators, naturally occurring products

    • antimetabolites -->discoloration
    • nail changes--> taxanes
    • “hand-foot” syndrome --> infusional chemo and capecitabine

    acneiform rashes--> EGFR inhibitors and steroids (may be a good sign)
  8. Neurologic toxicity
    • Most commonly seen with:
    • - vinca alkaloids
    • - taxanes
    • - platinum

    Sensory may recover, Motor will not
  9. Cardiac toxicity
    • Most Commonly seen with:
    • - anthracyclines
    • free-radical mediated
    • prevented with cardioprotective agent
    • eg. dexrazoxane

    • - 5-FU ( and capecitabine)
    • - high dose cyclophosphamide
  10. Nephrotoxicity
    • Most commonly seen with:
    • - cis-platinum
    • Proximal tubular toxin
    • Prevent with hydration, amifostine
    • - mitomycin-c
    • can cause TTP with renal failure
    • free radical mediated
    • - cyclophosphamide (or ifosfamide)
    • acrolein mediated hemorhagic cystitis
    • may be prevented with MESNA
  11. Pulmonary toxicity
    • Most commonly seen wth:
    • - Bleomycin
    • free radical intermediate that interacts with heme asociated iron in pulmonary interstitium
    • - Gemcitabine
    • - Busulfan
  12. Hematologic toxicity

    How does this present?
    • Most commonly seen with:
    • - all alkylators
    • - anthracyclines
    • Presentation:
    • - myelodysplasia
    • - myelofibrosis
    • - leukemia
    • - (TTP)
  13. What are some Long term Toxicities of Chemotheropy
    • 1. CNS----“chemo brain” Memory loss
    • 2. FATIGUE
    • 3. CHRONIC PAIN
    • 4.hallmarks of AGING---osteoporosis, loss of muscle mass with decrease grip strength and gait speed.
    • 5. SECONDARY MALIGNANCIES
    • -leukemia, Lymphoma, lung cancer, bladder cancer
  14. Considerations during Pregnancy
    ALL agents carry increased risk of adverse outcomes in 1st trimester. (Methotrexate used to induce abortion)

    Patients in 2nd and 3rd trimesters can be treated with most regimens except ANTIMETABOLITES
  15. Considerations of Thromboembolic disease in chemo
    • Cancer is thrombogenic
    • Certain anti-hormonal agents are also thrombogenic especially tamoxifen
  16. Considering the Sexual dysfunctions of Chemo

    Seen with what drugs?
    Cancer has negative impact on libido, also causes N/V/D and fatigue

    • Most commonly seen with anti-hormonal agents
    • - LHRH agonists
    • - androgen and estrogen receptor blockade
    • - estrogen synthesis inhibitors
  17. Changes in bone health with Chemo

    What drugs cause Osteoporosis?
    What cause Arthralgias?
    • 1. corticosteroids
    • 2. aromatase inhibitors (decrease circulating
    • estrogen)
    • 3. LHRH agonists (decrease circulating androgens and estrogen)
    • 4. most chemo agents to certain degree
    • ____________________________
    • 1. Aromatase inhibitors
    • 2. Adjuvant chemo
  18. Gonadal dysfunction of Chemotheropy

    What cause Cessation of ovulation and azoospermia?
    Cessation of ovulation and azoospermia, often seen with alkylators and topoisomerase inhibitors
  19. What are some drugs to avoid during Chemo?
    • 1. anti-inflamatories
    • -Cause mucosal disruption and bleeding risk
    • 2. anti-infectives
    • - increased risk of fungal infections
    • 3. anti-gout medication
    • - may inhibit pro-drug activation (Allopurinol and 5-FU)
    • - may increase drug effect (Colchicine and vincas)
    • (Allopurinol and 6-MP)

    • 4. diuretics
    • - increase risk of renal dysfunction
    • 5. anti-convulsants
    • -increase metabolism and thus decrease efficacy
    • 6. anti-coagulants
    • -leading to increased bleeding

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