Parenteral Nutrition in Cancer Chemotherapy

Parenteral Nutrition also known as intravenous feeding is a method of feeding that bypasses the gastrointestinal tract. Fluids are given into a vein to provide most of the nutrients the body needs. The method is used when a person cannot or should not receive feedings or fluids by mouth. Parenteral nutrition delivers nutrients such as sugar, carbohydrates, proteins, lipids, electrolytes, and trace elements to the body. These nutrients are vital in maintaining high energy, hydration, and strength levels. Some people only need to get certain types of nutrients intravenously. This is the example of how TPN given:

CDR –Cytotoxic Drug Reconstitution

Cytotoxic drugs inhibit or prevent the function of cells. Cytotoxic drugs are primarily used to treat cancer, frequently as part of a chemotherapy regime. Recently, their uses have expanded to treat certain skin conditions (e.g., psoriasis), rheumatoid and juvenile rheumatoid arthritis, and steroid-resistant muscle conditions. The most common forms of cytotoxic drugs are known as antineoplastic. The terms ‘antineoplastic’ and ‘cytotoxic’ are often used interchangeably.

Cytotoxic drugs can prevent the rapid growth and division of cancer cells. They can also affect the growth of other quick dividing cells in the body, like hair follicles and the lining of the digestive system. As a result of the treatment, many normal cells are damaged along with the cancer cells.

There are no exposure limits set for cytotoxic drugs. CUPE’s position is that even low-level exposure to cytotoxic drugs should be avoided. The only safe occupational exposure to cytotoxic drugs is no exposure.

TDM-Therapeutic Drug Monitoring

The monitoring of therapeutic drugs involves measuring drug concentrations in plasma, serum or blood. This information is used to individualize dosage so that drug concentrations can be maintained within a target range.

Drug concentration at the site of action cannot be routinely measured, but the desired or adverse effects may correlate better with plasma or blood concentrations than they do with dose. For a few drugs, concentration measurements are a valuable surrogate of drug exposure, particularly if there is no simple or sensitive measure of effect.

When there is a large inter-individual variation between dose and effect, for example when there is large pharmacokinetic variation, individualizing drug dosage is difficult.1 This is particularly relevant for drugs with a narrow target range or concentration-dependent pharmacokinetics. Similarly, variations within an individual can occur over time for a range of reasons with some drugs, and therapeutic drug monitoring could then be useful.

Therapeutic drug monitoring involves not only measuring drug concentrations, but also the clinical interpretation of the result. This requires knowledge of the pharmacokinetics, sampling time, drug history and the patient's clinical condition.