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.
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