Chemotherapy /certified fixed orthodontic courses by Indian dental academy

  • 577 views
Uploaded on



The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
No Downloads

Views

Total Views
577
On Slideshare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
0
Comments
0
Likes
1

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Chemotherapy www.indiandentalacademy.com
  • 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 3. Overview Purpose of chemotherapy Types of chemotherapy Toxicity associated with chemotherapy Side effect management www.indiandentalacademy.com
  • 4. Chemotherapy Treatment of: cancer autoimmune disorders Goal: cure, control or palliation of disease Cancer cell growth & division Action is most pronounced in rapidly growing and dividing cells www.indiandentalacademy.com
  • 5. Types of chemotherapy Cell cycle dependent Cell cycle phase specific Cell cycle independent Cell cycle phase non-specific www.indiandentalacademy.com
  • 6. Classes of antineoplastic drugs Alkylating agents Interact directly with cellular DNA Antimetabolites Resemble cellular metabolites (folic acid, purine, pyrimidine) Interfere with DNA precursors & cellular metabolism Antitumor antibiotics Derived from soil fungus, some antiinfective activity Interfere with DNA activity Mitotic Inhibitors Derived from plant extracts Interfere with formation of mitotic spindle, arresting mitosis www.indiandentalacademy.com
  • 7. Classes of antineoplastic drugs Miscellaneous Hormones and hormone antagonists Angiogenesis inhibitors Destroy capillary network to tumor causing tumor shrinkage www.indiandentalacademy.com
  • 8. Normal cells most susceptible to chemotherapy Bone marrow GI tract Hair follicles Many adverse effects seen in these systems www.indiandentalacademy.com
  • 9. Factors influencing response of cancer to chemotherapy Size of tumor Resistance Intrinsic no prior exposure Acquired after start of therapy Temporary Permanent www.indiandentalacademy.com
  • 10. Chemotherapy cycles Cycle a drug protocol, given over a period of time (usually 3-6 weeks) chemotherapy prescribed as a certain number of cycles evaluation of effectiveness reevaluation and planning of further treatment www.indiandentalacademy.com
  • 11. Chemotherapy dosing Based on body size in m2 using nomogram Goal: maximal dose, minimal interval www.indiandentalacademy.com
  • 12. Chemotherapy regimens www.indiandentalacademy.com
  • 13. Biologic Response Modifiers Interferons Interleukins Colony Stimulating Factors www.indiandentalacademy.com
  • 14. Routes of administration Oral IV Site-specific intrathecal: cerebrospinal fluid intraventricular: ventricle of brain, Ommaya reservoir intraperitoneal www.indiandentalacademy.com
  • 15. Intravenous access devices Peripheral IV Nontunneled central venous catheter PICC: peripherally inserted central catheter Tunneled central venous catheter Hickman, Groshong Implantable port Port-a-cath www.indiandentalacademy.com
  • 16. Hickman catheter www.indiandentalacademy.com
  • 17. Portacath www.indiandentalacademy.com
  • 18. Accessed Portacath www.indiandentalacademy.com
  • 19. Extravasation of infusions www.indiandentalacademy.com
  • 20. Handling of chemotherapy Potential carcinogenic & teratogenic effects Chemotherapy precautions Disposal of waste Body fluids www.indiandentalacademy.com
  • 21. Adverse effects of chemotherapy Alopecia: hair loss Myelosuppression: bone marrow suppression anemia: decreased red blood cells fatigue, dyspnea thrombocytopenia: decreased platelets risk for bleeding neutropenia: decreased white blood cells risk for infection www.indiandentalacademy.com
  • 22. Adverse effects of chemotherapy GI effects: Stomatitis: ulcerated or painful oral mucous membranes Anorexia, nausea & vomiting www.indiandentalacademy.com
  • 23. Toxicities of chemotherapy Ototoxicity: hearing loss monitor hearing Nephrotoxicity: kidney dysfunction monitor I&O, weight, fluid status, creatinine, BUN, electrolytes Hepatotoxicity: liver dysfunction monitor for jaundice, liver function tests Neurotoxicity: nerve damage monitor for CNS problems, neuropathies www.indiandentalacademy.com
  • 24. Toxicities of chemotherapy Pulmonary toxicity: lung damage monitor for dyspnea, pulmonary function tests Cardiotoxicity: heart damage monitor for signs of heart failure, arrhythmias, chest discomfort Gastrointestinal toxicity: monitor for stomatitis, diarrhea, fluid status Gonadal toxicity: offer reproductive options www.indiandentalacademy.com
  • 25. Management of chemotherapy side effects Anticipate adverse effects Prophylactic treatment Monitor for toxic effects Laboratory tests Diagnostic screening tests Importance of patient & family education Multidisciplinary team management www.indiandentalacademy.com
  • 26. Bone marrow suppression Anemia: decreased red blood cells Erythropoietin (EPO): stimulates production of red blood cells in the bone marrow administered SC or IV Side effects: headache, hypertension, arthralgia (bone or joint pain), diarrhea, nausea, fatigue www.indiandentalacademy.com
  • 27. Bone marrow suppression Neutropenia: decreased white blood cells G-CSF (granulocyte-colony-stimulating factor): stimulates production of white blood cells in the bone marrow Administered SC or IV Common side effect: bone pain Do not give < 24 hrs before or after chemotherapy, or within 12 hours of radiation www.indiandentalacademy.com
  • 28. Bone marrow suppression Thrombocytopenia: decreased platelets GM-CSF (granulocyte-magrophage-colonystimulating factor) Stimulates neutrophils and platelets Platelet transfusion to keep platelet count >20,000 www.indiandentalacademy.com
  • 29. Gastrointestinal effects: Stomatitis & Esophagitis May be due to chemotherapy or radiation Pain medications: narcotic analgesics Viscous Lidocaine: topical anesthetic Oral ulcer solutions: I.e. lidocaine + antacid + benadryl elixir Nystatin swish & swallow: used to treat thrush Artificial saliva: salivary gland deactivation Remember: pain with oral medication administration, may need elixirs or IV www.indiandentalacademy.com
  • 30. Gastrointestinal effects: Nausea & Vomiting Acute: first 24 hours Delayed: after 24 hours Anticipatory: stimulated by the experience of chemotherapy Nausea control during first 24 hours prevents delayed response www.indiandentalacademy.com
  • 31. Gastrointestinal effects: Nausea & Vomiting Combinations of chemotherapy drugs can stimulate different nausea pathways Combinations of antiemetics work on different pathways, increasing effectiveness Routine administration: before or during chemotherapy and for 24-48 hours after www.indiandentalacademy.com
  • 32. Types of Antiemetics: Serotonin Antagonists Ondansetron (Zofran): first drug serotonin antagonist, 1992 Granisetron (Kytril): longer acting, more potent Blocks serotonin receptors of chemoreceptor trigger zone and vagal nerve endings Most effective antiemetics, first-line for chemotherapy Side effects: headache, weakness, drowsiness, constipation www.indiandentalacademy.com
  • 33. Types of antiemetics Corticosteriods Inhibit prostaglandin synthesis Decadron (dexamethasone) Solumedrol (methylprednisolone) Side effects: anxiety, euphoria, insomnia, edema www.indiandentalacademy.com
  • 34. Types of antiemetics Anxiolytics Decrease sensitivity of vomiting center Benzodiazepines : lorazepam (Ativan), diazepam (Valium) Useful in anticipatory nausea & vomiting Side effects: sedation, confusion, amnesia www.indiandentalacademy.com
  • 35. Types of antiemetics Phenothiazines: Prochlorperazine (Compazine) Promethazine (Phenergan) Useful in mild to moderate nausea treatment (second-line with chemotherapy) Often used after surgery Side effects: sedation, orthostatic hypotension, extrapyramidal symptoms www.indiandentalacademy.com
  • 36. Antiemetic combinations Decadron (dexamethasone) + Ondansetron + Lorazepam (Ativan) Decadron (dexamethasone) + Kytril (granisetron) www.indiandentalacademy.com
  • 37. www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com