Cancer Answers 2007


1a. Describe the typical medicines that a cancer patient may be discharged with for supportive care relating to the myelosuppressive effects of their anti-cancer therapy.
- metoclopramide (nausea and vomiting)
- tropisetron (nausea and vomiting)
- norfloxacin (decreases bacterial load in the GIT - prevent infection)
- itraconazole syrup (antifungal)
- nystatin mouthwash (antifungal)
- famciclovir (herpes prophylaxis)
- pantoprazole (stomach irritation prevention)

1b. Using patient specific language, explain the consequences of not adhering to a medication regimen including the drugs described in question 1a.
not adhering to the medication regimen would lead to high risk of developing an infection as your body is currently low on the immune cells (granulocytes) required to fight infection

2. What risks are associated with chronic chemotherapy induced nausea and vomiting and why?
Major concern for cancer patients (infection, mucositis, aspiration pneumonia)
Complications
- dehydration, electrolyte imbalances, GI tearing, aspiration pneumonia, impaired nutrition, inability to continue chemo

3. What medicines are typically used for the treatment of acute chemotherapy induced nausea and vomiting?
acute nausea and vomiting
prophylaxis (before starting chemo)
- 5-HT3 antagonists (e.g. tropisetron, ondansetron)
- steroid (premedicate with dexamethasone - crosses BBB)
breakthrough
- DA antagonist (metoclopramide, prochlorperazine, lorazepam)

delayed nausea and vomiting
begins 1 or 2 days after chemo (high dose IV chemo) - may last several days
aprepitant
- oral neurokinin-1 receptor antagonist
- indicated for prevention (with other agents) of acute and delayed nausea and vomiting associated with highly emetogenic chemotherapy

4. What is G-CSF and when is it used?
G-CSF = granulocyte colony stimulating factors
used in chemotherapy induced neutropenia, where granulocytes are produced less than RBCs (increased risk of all types of infection)

filgrastim, pegfilgrastim, lenograstim
- stimulate production and differentiation of neutrophils from blood precursor cells
- protocol (if chemo highly likely to suppress bone marrow, give as prophylaxis) or prn use (SC - scheduled/prn)
bone pain common adverse effect (paracetamol prn)

5. Why is it important to assess a patient’s full medication history before commencing a course of anti-cancer therapy or supportive care therapy?