Chemotherapy /certified fixed orthodontic courses by Indian dental academy


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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 ,or call

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Chemotherapy /certified fixed orthodontic courses by Indian dental academy

  1. 1. Chemotherapy
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education
  3. 3. Overview Purpose of chemotherapy Types of chemotherapy Toxicity associated with chemotherapy Side effect management
  4. 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
  5. 5. Types of chemotherapy Cell cycle dependent Cell cycle phase specific Cell cycle independent Cell cycle phase non-specific
  6. 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
  7. 7. Classes of antineoplastic drugs Miscellaneous Hormones and hormone antagonists Angiogenesis inhibitors Destroy capillary network to tumor causing tumor shrinkage
  8. 8. Normal cells most susceptible to chemotherapy Bone marrow GI tract Hair follicles Many adverse effects seen in these systems
  9. 9. Factors influencing response of cancer to chemotherapy Size of tumor Resistance Intrinsic no prior exposure Acquired after start of therapy Temporary Permanent
  10. 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
  11. 11. Chemotherapy dosing Based on body size in m2 using nomogram Goal: maximal dose, minimal interval
  12. 12. Chemotherapy regimens
  13. 13. Biologic Response Modifiers Interferons Interleukins Colony Stimulating Factors
  14. 14. Routes of administration Oral IV Site-specific intrathecal: cerebrospinal fluid intraventricular: ventricle of brain, Ommaya reservoir intraperitoneal
  15. 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
  16. 16. Hickman catheter
  17. 17. Portacath
  18. 18. Accessed Portacath
  19. 19. Extravasation of infusions
  20. 20. Handling of chemotherapy Potential carcinogenic & teratogenic effects Chemotherapy precautions Disposal of waste Body fluids
  21. 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
  22. 22. Adverse effects of chemotherapy GI effects: Stomatitis: ulcerated or painful oral mucous membranes Anorexia, nausea & vomiting
  23. 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
  24. 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
  25. 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
  26. 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
  27. 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
  28. 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
  29. 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
  30. 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
  31. 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
  32. 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
  33. 33. Types of antiemetics Corticosteriods Inhibit prostaglandin synthesis Decadron (dexamethasone) Solumedrol (methylprednisolone) Side effects: anxiety, euphoria, insomnia, edema
  34. 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
  35. 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
  36. 36. Antiemetic combinations Decadron (dexamethasone) + Ondansetron + Lorazepam (Ativan) Decadron (dexamethasone) + Kytril (granisetron)
  37. 37. Leader in continuing dental education