RT Book, Section
A1 Hale, Kaye E.
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Kress, John P.
SR Print(0)
ID 1107723110
T1 Toxicities of Chemotherapy
T2 Principles of Critical Care, 4e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071738811
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1107723110
RD 2024/04/19
AB Most  antineoplastic  agents  have  toxic  side  effects.New  antineoplastic  agents  are  frequently  being  developed  and  not  all  side  effects  are  known.Diagnosis  or  organ  dysfunction  due  to  drug  toxicity  is  largely  a  diagnosis  of  exclusion.Maintaining  a  level  of  clinical  suspicion  is  key  to  detection  of  drug  toxicity.Therapy  for  drug-induced  toxicity  is  largely  supportive.Myelosuppression  is  a  common  toxic  side  effect  from  high-dose  combination  chemotherapy  regimens  used  in  leukemia  and  bone  marrow  transplant  patients.Pulmonary  toxicity  may  manifest  as  ARDS  especially  in  patients  undergoing  treatment  for  hematologic  malignancies  (eg,  cytarabine  or  gemcitabine)  and  pulmonary  fibrosis  (eg,  bleomycin).Cardiotoxic  side  effects  of  anthracyclines  such  as  doxorubicin  can  lead  to  refractory  heart  failure  if  not  identified  and  managed  early,  while  treatment  with  5-FU  may  precipitate  symptoms  of  acute  MI  due  to  vasospasm  in  patients  with  underlying  risk  factors  for  heart  disease.Mucositis  of  the  oropharynx  and  GI  tract  is  painful  and  can  lead  to  dehydration  and  malnutrition.  Severe  cases  of  oral  mucositis  may  require  intubation  for  airway  protection.Intractable  nausea,  vomiting,  and  diarrhea  can  lead  to  dehydration,  hypovolemia,  and  electrolyte  disturbances.Nephrotoxicity  is  a  dose-limiting  side  effect  of  cisplatin  and  causes  renal  salt  wasting  syndrome.During  treatment  with  methotrexate,  special  attention  must  be  paid  to  urinary  pH  to  avoid  precipitation  in  the  renal  tubules  resulting  in  ATN  and  renal  obstruction.Both  peripheral  and  central  nervous  system  toxicities,  including  posterior  reversible  encephalopathy  syndrome  (PRES),  are  reported  after  high-dose  chemotherapy.The  spectrum  of  severity  of  hypersensitivity  reactions  ranges  from  flushing  and  rash  to  anaphylactic  shock.  Common  causes  of  these  reactions  include  paclitaxel,  platinum  compounds,  and  monoclonal  antibodies.Venous  thromboembolic  disease  is  a  well-known  complication  of  tamoxifen.Thrombotic  thrombocytopenic  purpura  (TTP)  or  thrombotic  microangiopathy  has  been  associated  with  mitomycin,  cisplatin,  and  gemcitabine.