What Are Cytotoxic Drugs?

A class of drugs that can effectively kill immune cells and inhibit their proliferation. It can be caused by skin contact or inhalation, including reproductive system, urinary system, liver and kidney system, and teratogenic effects.

A class of drugs that can effectively kill immune cells and inhibit their proliferation. It can be caused by skin contact or inhalation, including reproductive system, urinary system, liver and kidney system, and teratogenic effects.

That is, alkylating agents (such as cyclophosphamide, nitrogen mustard, etc.). As anti-tumor drugs, their cytotoxicity mainly lies in the alkylation of guanine or adenine in DNA molecules, causing single-strand breaks and cross-linking of double helix strands, thus changing the structure of DNA and damaging its function, hindering RNA synthesis Thereby inhibiting cell mitosis.

Cytotoxic drugs

In addition, alkylating agents are immunosuppressants, inhibiting the activity of antigen-sensitive cells, blocking the appearance of immunoblasts, promoting the breakdown of small lymphocytes, and reducing their number. It is commonly used in the treatment of tumors and refractory nephropathy.

Classification of cytotoxic drugs

Alkaloids: paclitaxel, vinorelbine, docetaxel, hydroxycamptothecin.

Metabolism: gemcitabine, cytarabine, tegafur, methotrexate.

Antibiotics: epirubicin, pirarubicin, idarubicin, mitomycin, mitoxantrone.

Alkylating agents: Ifosfamide, dacarbazine.

Platinum agents: cisplatin, oxaliplatin.

Cytotoxic drugs safety practices

The main adverse reactions of cytotoxic drugs (anti-tumor drugs) are: myelosuppressive reactions, gastrointestinal reactions, neurotoxic reactions, nephrotoxic reactions, cardiotoxic reactions, pulmonary toxic reactions, liver toxic reactions and drug allergic reactions. Easy to cause harm. Through the standardized operation of the intravenous drug allocation center, the harm of cytotoxic drugs to the human body can be reduced, and occupational protection can be done well. Because these drugs are different from other drugs in terms of their own characteristics, human hazards, occupational protection, etc., strict regulations must be made for the configuration and operation of cytotoxic drugs.

1 Cytotoxic drugs 1. Preparation for preparation of cytotoxic drugs

(1) Gloves and uniforms

Use powder-free latex gloves (thickness should be greater than 0.007mm). The thickness of the gloves and the time of contact with the drug determine the permeability of the gloves. The permeability of the gloves will increase with time, usually every 60 minutes or If the gloves are damaged, punctured, or contaminated with drugs, the gloves need to be replaced. If the operator is allergic to latex, he can switch to nitrile gloves or wear double gloves, that is, wear a pair of PVC gloves inside the latex gloves, and he must wash his hands before and after removing the gloves. Uniforms should be made of impervious, non-flocculating material with a completely closed front and cuffs that must be extended. Uniform cuffs can be rolled into gloves, preferably disposable

(2) Respiratory protection device

Class II or class III vertical airflow biological safety cabinets must be used when configuring and mixing cytotoxic drugs. Horizontal airflow biological safety cabinets are not allowed.

(3) Eye and face protection

Eyes and face should be protected to prevent the medicine from splashing out. It should be protected when using aerosols and sprays (such as masks); ordinary glasses cannot provide adequate protection.

(4) Preparation of biological safety cabinet

Place a plastic back mat on the counter surface. The mat must be replaced after the whole day's configuration or when droplets appear on the mat; all the configuration and the medicines and equipment needed for the medication should be prepared before the drug is dispensed. This can reduce the impact on the airflow in the cabinet and reduce the pollution to personnel.

(5) Cleaning of biological safety cabinet

Contaminated items must be placed in leak-proof and puncture-proof containers located in biological safety cabinets; personal protective equipment must be removed and placed in leak-proof and puncture-proof containers located in the preparation area. Operators must not put personal protective equipment Dress out the preparation area.

(6) Equipment preparation

Syringe and dissolution container: prevent the needle plug from being separated from the syringe; the liquid in the syringe must not exceed 3/4 of the length of the syringe to prevent the needle plug from accidentally slipping out of the syringe; the syringe and The needle should be prevented from being squeezed, knocked, slipped, and there is no need to cover the needle when discarding the syringe. It should be immediately thrown into a puncture-proof container for disposal. This can prevent the generation of drug droplets and prevent needle puncture. Dispose of your equipment in a disposable stab-resistant container in a biosafety cabinet. Preparation of personal protective equipment: Personal protective equipment includes uniforms and gloves that meet the requirements; respiratory system, eye and face protective equipment.

2 Cytotoxic drugs 2. Preparation of cytotoxic drugs

(1) Operation of ampoule

Gently tap the ampoule to drop the neck and the top of the drug on its bottom, and rub the neck of the ampoule with alcohol; When opening the ampoule, wrap the ampoule with a sterile gauze; if the ampoule is a dry substance that needs to be redissolved The solvent should be slowly added along the wall of the ampoule to prevent the powder of the drug from scattering; it is best to use a syringe with a filter membrane.

(2) Vial operation

As the air pressure in the glass bottle will increase, care should be taken during operation to avoid aerosols of the drug. When the needle is withdrawn, if the pressure in the bottle is too high, the liquid will overflow.

(3) Bottle opening device

It is best to use a non-stick filter tip; improper use of a bottle opener increases the chance of contamination.

(4) Container with label

All containers containing cytotoxic drugs must be labeled with a declarative language warning, such as: "Warning: chemotherapy drugs, handle with care"; the outer surface of the container should be wiped with fabric to remove possible contamination, The inner surface of the container must be rubbed with alcohol, and the container should preferably be properly sealed.

(5) Precautions during operation

Before putting on gloves, wash your hands immediately after removing the gloves; Gloves and uniforms should be replaced immediately if they are contaminated; The work area should be covered with a plastic back mat; All syringes and needles should be complete Dispose in a leak-proof and puncture-proof container with a clear label; The solution bag of the drug should also be completely disposed in the above-mentioned container.

3 Cytotoxic drugs 3. Relevant regulations and systems for environmental control

Only authorized employees can enter the drug configuration area; The configuration area should avoid frequent logistics and personnel entry and exit to avoid bringing the drugs in the biological safety cabinet into the surrounding environment; The entrance of the drug configuration area should be marked with a conspicuous mark Explain that only authorized personnel can enter; There should be appropriate warning labels in the area where the drug is stored to remind the protective measures to be taken when handling cytotoxic drugs; No eating, drinking, smoking, chewing gum, makeup, etc. are allowed in the area where the drugs are configured And storage of food; treatment procedures for handling drug droplets and accidental contact with the skin or eyes should be posted in the configuration area; there should be a pool in the drug configuration area, preferably with a nozzle to flush the eyes, and some optional preparations including physiological Solutions including saline; The configuration of all dangerous drugs should be performed in class II or class III; Aseptic operation should be observed when configuring cytotoxic drugs.