side effects of chemotherapeutic drugs


SIDE EFFECTS OF CHEMOTHERAPEUTIC DRUGS


The side effects of chemotherapeutic agents are immense. The synthetic and more modern drugs are however reduced the severity since they are associated with fewer side effects.
Alongside newer treatments of cancer are also other co-administered therapy that help to reduce severity, like 5-hydroxytryptamine(5HT3) antagonists.  
Despite these advances, side effects are still an issue to be battled with by both the patient and the health care team. Major side effects are listed below


i)                    nausea and vomiting

it was managed by metoclopramide and domperidone initially but more recent platinum drugs such as ondansetron yield better results and are drugs of choice.

ii)                  Hair loss

This side effect is associated with the MOA of chemotherapy that inhibits manufacture of new cells. It can only be avoided in situations where alternative drugs can be given. The effect can be partially reduced by scalp cooling.

iii)                 Bone marrow suppression

Most cytotoxic drugs suppress the production of hemoglobin, white blood cells, and platelets. Because of this, severely myelosuppressive chemotherapy is only given when there is treatment with curative intend. Anemia and thrombocytopenia are managed by transfusion of the affected blood product.
White blood cell transfusions have not been successful therefore neutropenic patients are managed by early introduction of iv antibiotics. Its normally done by combining a 3rd generation cephalosporine and an aminoglycoside or a penicillin and therapy reviewed regularly to assess effectiveness.


iv)                 Cardiotoxicity

It’s a rare side effect associated with doxorubicin. It is dose related and is prevented by ensuring the total dose is within the right range.  Signs of impending cardiotoxicity include
o   Shortness of breath.
o   Chest Pain.
o   Heart palpitations.
o   Fluid retention in the legs.
o   Distention of the stomach.
o   Dizziness.

v)                  Neurotoxicity

This are effects on the nervous system and may include
o   Paralysis or weakness in the limbs.
o   Altered sensation, tingling and numbness in the limbs.
o   Headache.
o   Vision loss.
o   Loss of memory and cognitive function.
o   Uncontrollable obsessive and/or compulsive behavior.
o   Behavioral problems.
o   Sexual dysfunction.


vi)                 Nephrotoxicity

Most cytotoxic drugs cause renal damage if dose is not well kept in range. This effect is also prevented by ensuring adequate diuresis throughout the whole period of treatment.

See (General principles of care in oncology)


vii)               Sterility

Some cytotoxic drugs cause sterility due to their mechanism of action that limits reproduction of rapidly dividing cells that may include germ cells of the reproductive system. Alkylating agents may cause an irreversible sterility in males, and thus storage of sperm is important when giving therapy with curative intent.

viii)             Secondary malignancies

Anticancer drugs have mutagenic potential and the development of secondary malignancies, especially acute leukemia may result, though uncommonly.  Alkylating agents are the most causative agent for secondary malignancies.



cytotoxic drugs, leukemia


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