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Doxorubicin chemo preparation

Doxorubicin MOA

Doxorubicin inhibits DNA and RNA synthesis by intercalation between DNA base pairs by inhibition of topoisomerase II and by steric obstruction. Doxorubicin intercalates at points of local uncoiling of the double helix. Although the exact mechanism is unclear, it appears that direct binding to DNA (intercalation) and inhibition of DNA repair (topoisomerase II inhibition) result in blockade of DNA and RNA synthesis and fragmentation of DNA. Doxorubicin is also a powerful iron chelator; the iron-doxorubicin complex can bind DNA and cell membranes and produce free radicals that immediately cleave the DNA and cell membranes.

Questions:

For those who prepare chemotherapy, we always need detailed guidelines for the preparation of Doxorubicin, and all the chemo handling and preparing precautions.

Does your preparation depend on the route of administration?

Do we use the beads in all preparations, or only for the chemoembolization? 

Do we only need a chemo vertical laminar flow hoods, or the equipment we use should ensure closed system?

Answers:

Doxorubicin is like any other hazardous drug that requires to be prepared under certain conditions stated in USP 800. You may refer to the latest version online. It should answer all your question regarding the precautions you must follow. Closed system devices are not enough by itself to prepare biohazard meds including chemotherapy without a primary engineering control device.

Doxorubicin is mixed with beads for particular procedure called chemoembolization in hepatocellular carcinoma and its given as intra-arterial injection by a trained provider (usually radiologist). But it is never mixed with beads for other routes.

Doxorubicin is given intravenously as a push, intermittent infusion, or continue infusion. This is usually decided by the treatment protocol you would use. For example, in AC protocol (doxorubicin and cyclophosphamide) for breast carcinoma, doxorubicin is given as IV push over 10-12 minutes. While in a more complicated protocol such as R-EPOCH, it is combined with other chemotherapy drugs and is infused as a continuous infusion over 24 hours for multiple days.

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Chemotherapy Compatibility Chart

Next update will be adding a new page under projects; that will be including a compatibility chart for chemotherapy preparations versus different intravenous fluids.

It should look like the image below...

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DOXOrubicin Chemoembolization in CathLab

Restricting tumor blood flow, where small particles loaded with chemotherapy agent are injected through a catheter directly into the artery supplying the tumor.

Procedure performed under local anesthesia with conscious sedation, meaning full awareness of the patient of the surrounding and the healthcare staff around him/her.

PDF source.

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