Cytotoxic agents

• Substances used in the treatment and control of malignant

and other diseases.
• They are designed to destroy/killing rapidly growing cancer
cells
• Most of the injectable cytotoxic agents are powdered
preparations that needs to be reconstituted before use.
– Chemotherapy: the use of any chemical agent to treat or control
a disease. Most often used to describe treatment of malignant
and other diseases with cytotoxic agents
– Antibiotics: obtained from life (naturally) and used against life
(microorganisms)
– Chemotherapeutics: obtained artificially and used against
microorganism
– Mutagenic: capable of causing damage to genes
– Carcinogenic: Capable of causing cancer
– Teratogenic: Capable of causing foetal damages either
physiological or anatomical
• Symbol of cytotoxic materials
 General considerations
• All medical, nursing and pharmacy personnel must
ensure that they are familiar with the proper guidelines
involved in handling transport, preparation,
administration or disposal of waste of any cytotoxic
agent
• All personnel involved in the handling, transport,
preparation or disposal of cytotoxic agent should have
access to health monitoring staff
• The handling, preparation, storage or disposal of
cytotoxic agents are consistently lined with adverse
health risks and these adverse health risks may be
reduced by implementation of suitable safety
precautions
 Role of Pharmacist
• Pharmacist can provide a cytotoxic
reconstitution service
• Due to his background of pharmacy, he is the
one in handling cytotoxic agents
• Should be well trained in aseptic techniques.
• Provide a safe and efficient service for
dispensing of cytotoxic agents
• Safe handling
• As these agents are non selective generally and
destroy some healthy tissue as well, thus
personnel handling the drugs may be at risk if
sensible precautions are not taken.
• Exposure for short time can cause irritation,
dizziness, nausea and allergic reactions.
• Exposure for prolong period of time may have
risks of malignancies, leukaemia's, teratogenesis,
and infertility.
• Exposure can be minimised by following strict
safety procedures.
• Preparation
• All cytotoxic agents should be prepared by oncology pharmacy
• Use separate laminar flow hood. Avoid horizontal LFH.
• Proper ventilation of the area but windows and doors should be
closed.
• Working surface should be non porous and easily cleanable.
• Equipment and cytotoxic drugs should be properly and separately
stored.
• Neutralizing solutions should also be close to hand.
• Preparation and dispensing must be in accordance with the country
rules and regulations
• Proper dressing should be followed.
• Use of solid non porous surface or use of large tray in laminar flow
hood.
• Preparations will be packaged as required for direct administration
to the patient and shall not be further modified
• All cytotoxic agents should be labelled with cytotoxic symbol
• Packaging
• Packaged in sealed, leak proof containers, with outer
bags, heat sealed where possible. The container should
protect the agent from breakage in transport,
• Transport of cytotoxic agents
• Transported in sealed inflexible containers resistant to
breakage. The containers should be labelled with the
sign and should be returned to pharmacy after use
• Storage
• Clearly marked storage areas must be available for all
cytotoxic agents. Safe storage areas must be designed
to minimize the risk of breakage. Cytotoxic agents must
not be stored in food storage and preparation areas
• Spills and Disposal
• Detailed procedures for coping with spills and
waste disposal must be distributed to all staff
handling cytotoxic agents.
• IV admixture sets, syringes, and other
contaminated materials should be placed in
high risk waste containers and labelled as
hazard.
• Control of Substances Hazardous to Health
(COSHH)