Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OCN Review > Treatment > Flashcards

Treatment Flashcards

1
Q

What is the treatment of choice for stage I and most stage II NSCLC?

A

Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Whipple

A

Pancreaticoduodenectomy
Removal of distal portion of stomach, 1st & 2nd portions of duodenum, head of pancreas, CBD, and gall bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are common chemos for endometrial cancer?

A

Paclitaxel, doxorubicin, cisplatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is treatment for low grade nonseminoma or high grade testicular cancer?

A

BEP
bleomycin, etoposide, cisplatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is treatment for low grade seminoma testicular cancer?

A

Surveillance or radiation or Adjuvant Carboplatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the treatment for stage I bladder cancer?

A

Transurethral resection of bladder with fulguration + intravesical chemo (gemcitabine or mitomycin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the treatment for stage II & III bladder cancer?

A

Neoadjuvant cisplatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the treatment for stage I prostate cancer?

A

Watchful waiting, possible prostatectomy or cryotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the initial treatment for malignant melanoma?

A

Complete excision with disease free margins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Standard treatment for most early stage head and neck cancers

A

Surgical resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is 1st treatment for neurologic system cancers?

A

Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is treatment for CLL?

A

Watchful waiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the treatment for AML?

A

Induction: cytarabine and anthracycline
Consolidation: daunorubicin or idarubicin and etoposide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the treatment for CML?

A

Imatinib, dasatinib or nilotinib, allogenic bone marrow transplant or stem cell transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the treatment for ALL?

A

Induction and CNS prophylaxis: Imatinib, cyclophosphamide, vincristine, doxorubicin, dex alternated with high dose MTX and cytarabine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is 1st line treatment for Hodgkin’s lymphoma?

A

ABVD: adriamycin/doxorubicin, bleomycin, vincristine, dacarbazine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What risks arise after mantle radiation in teens and young adults?

A

Increase risk of breast cancer and cardiac toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What targeted therapy is used to treat Non-Hodgkin’s lymphoma?

A

Rituximab and obinutuzimab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the treatment for Ewing sarcoma?

A

Systemic chemo + RT(if unresectable), surgery (is resectable) or both
Doxorubicin, ifosfamide, etoposide, cyclophosphamide, vincristine

Stem cell transplant is high risk for relapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can help avoid amputation in soft tissue sarcoma?

A

Pre and post-op radiation decreases the risk of local recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is treatment for Kaposi sarcoma?

A

Antiretroviral therapy (ART)

If advanced or not responding, chemo or RT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the potential side effects of radiation?

A

Nausea, appetite changes, diarrhea, fatigue, leukopenia, thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the most appropriate vascular access device for an AML for pt going through induction therapy?

A

Port

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Minimize radiation exposure

A

Type of radiation source
As Low As Reasonably Achievable
Lead shielding (or plexiglass for beta particles)
Time exposed
Distance from radiation source: double the distance between you and source

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are signs of phlebitis?

A

Pain, erythema, steak formation, palpable cord, edsma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are signs of infiltration?

A

Leaking at site, cool skin, tightness, edema, decreased infusion rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are signs of extravasation?

A

Difficulty infusing, leaking around site, redness, edema, pain, burning, lack of blood return

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What type of central line is good for ambulatory or outpatient therapy as opposed to intensive inpatient therapy?

A

PICC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which is associated with a higher incidence of thrombosis in patients with hematologist malignancies? Port or PICC

A

PICC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

About what % of cancer patients will receive radiation?

A

1/2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How does radiation therapy work?

A

Kills cells by destroying their DNA either directly or creating charged particles (free radicals) within the cells that can damage the DNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What type of radiation is the most common?

A

External beam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is stereotactic radiosurgery?

A

A single large dose of radiation to a tumor

—>Brain tumors that can’t be treated with surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is used with stereotactic body RT?

A

Special equipment to position patient
CANNOT be used on the brain
Emerging areas: lung, liver, bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Which cancers are a brachytherapy common treatment for?

A

Prostate, uterus, cervix, breast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Why is radiation done before surgery?

A

=neoadjuvant
Improves cure rate or makes surgery easier (esophageal, rectal, lung)

37
Q

What does radioembolization do?

A

Used microspheres filled with radioactive isotopes to block a tumor’s blood supply and starve it

38
Q

What type of cancer is radioactive iodine used for?

A

Thyroid cancer

39
Q

What is system radiation?

A

Pt swallows or receives injection of radioactive substance bound to a mab - this helps the substance locate tumor cells

40
Q

What are early side effects of radiation therapy?

A

Aka acute
Occur during treatment, most disappear after treatment
-caused by damage to rapidly dividing normal cells in the area being treated
-skin irritation, salivary glands, hair loss, urinated or bowel problems

41
Q

What are chronic side effects of radiation therapy?

A

Continue for weeks, months, or years after treatment ends
-salivary gland damage can be permanent (amifostine can be given IV as a cytoprotectant if given during head & neck radiation)

42
Q

What are systemic side effects of radiation therapy?

A

Fatigue
Nausea +/- vomiting common when abdomen and brain treated

43
Q

What are late side effects of radiation therapy?

A

Depends on other factors (chemo? Genetics? Smoking?)
Fibrosis of the affected area
Damage to bowels, causing diarrhea and bleeding
Memory loss
Infertility
Rarely, a 2nd cancer (highest in people treated as children or adolescents)

44
Q

What do women who have been treated with radiation to the chest for Hodgkin’s lymphoma have an increased risk for later in life?

A

Breast cancer

45
Q

When does a tandem transplantation occur for a patient with multiple myeloma who did not achieve a very good partial response after 1st transplantation?

A

<= 6 months

46
Q

What cancers are autologous stem cell transplants used to treat?

A

Multiple myeloma, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, neuroblastoma, germ cell tumors

47
Q

What are the risks and benefits of autologous stem cell transplants?

A

No graft vs host disease
No benefit of graft vs tumor effect
Potential for contamination with cancer cells

48
Q

What diseases are allogenic stem cell transplants used to treat?

A

Leukemia, NHL, MDS, aplastic anemia, sickle cell, thalassemia, falcons anemia

49
Q

What are the risks and benefits of allogenic stem cell transplants?

A

Complication of infection or long-term organ damage from treatment regimens
Graft vs host
Length of time to locate compatible donor
Benefits: no malignant cells in graft

50
Q

What is the function of HLAs?

A

They differentiate self from non-self

Located on surface of WBCs

51
Q

What happens in graft vs host disease?

A

T-lymphocytes recognize a non-self major histiocompatibility complex (MCH) and rallies the immune system to destroy it

52
Q

What is a myeloablative regimen?

A

Lethal doses of chemo to eradicate cancer cells and produce severe immunosuppression

53
Q

What is a myeloablative regimen used for?

A

Allogenic and autologous stem cell transplant

It decreases the ability of the host to reject the donor

54
Q

What is a non-myeloablative regimen?

A

Reduced intensity of chemo and total body irradiation

55
Q

What is a non-myeloablative regimen used for?

A

Older patient or those with major comorbidities

56
Q

What is given to diminish the reaction to the preservative DMSO before the infusion of the stem cells?

A

Diuretics, diphenhydramine, acetaminophen, corticosteroids

(+aggressive hydration)

57
Q

What side effects may occur with the infusion of stem cells?

A

Pink-tinged urine due to breakdown of RBCs, garlic smell or taste from DMSO, HTN/hypo, tachycardia, Bradycardia, chest tightness, dyspnea, cough, flushing or hives, fever/chills, nausea, vomiting, diarrhea

Typically all resolve within 24-48hrs

Less common with fresh vs frozen

58
Q

When has engraftment occurred?

A

ANC >500/mm^3 and platelets>20,000/mm^3

Generally 14-21 days

59
Q

How is graft vs host disease diagnosed?

A

Biopsy of affected organs

60
Q

What are risk factors for developing graft vs host disease?

A

Matched unrelated donor and haploidentical transplantation
Older patients
Peripheral stem cell collection

61
Q

What is the treatment for GVHD?

A

Corticosteroids

62
Q

What is considered acute GVHD?

A

During 1st 100 days

63
Q

What 3 organs are affected in acuteGVHD?

A

Skin (rash, pruritis)
GI (N/V/anorexia, large volume diarrhea)
Liver (elevated bilirubin, weight gain)

64
Q

What organs are affected in chronic GVHD?

A

Eyes, mouth, lung, liver, skin, GI, hematologic

65
Q

What is the most common side affect of hematopoietic stem cell transplantation (HSCT)?

A

Neutropenia and the associated infections

Bacteria, gram + and - are most common cause of infection

Common sites: oral mucosa, CVAD

Prophylactic quilonlone recommended if neutropenia expected >=7 days

66
Q

What is Mohs surgery and what is it used for?

A

Microscopically controlled surgery to shave off one very thin layer at a time. Used when extent of cancer not known it when as much healthy tissue as possible need to be saved (e.g. around eye)

67
Q

What are patients going through CAR T cell immunotherapy at high risk for?

A

Cytokine release syndrome
—> extremely high fever, unstable BP, vascular leak, pulmonary edema, coagulopathies or multi organ failure

68
Q

What is the treatment for cytokine release syndrome?

A

High dose steroids or tocilizumab

69
Q

What are the most frequent immune-related adverse events from immunotherapy?

A

Derm and GI

70
Q

How many patient going through HSCT experience mucositis?

A

70%

71
Q

What late effects can patients have from HSCT?

A

Secondary malignancy: AML, MDS, post-transp lymphoproliferative disorders, solid tumors (the radiation may cause melanoma, oral cavity, bone, thyroid, breast)

Ocular conditions, bone density concerns, pulmonary infections

72
Q

What is hepatic sinusoidal obstructive syndrome (HSOS)?

A

Result of TBI + conditioning regimens that contain melphalan, busulfan, cyclophosphamide

Injury to the endothelial tissue results in coagulation and thrombosis within the hepatic sinusoids and venules

During 1st 4 weeks post-transplant

73
Q

About 1/3 of patients going through HSCT will require what?

A

Dialysis

74
Q

What does persistent thrombocytopenia indicate following HSCT?

A

If after 3 months, Poor prognosis

75
Q

When is a blood transfusion indicated?

A

If stable, Hgb between 7&8
If hx CV disease and exhibiting symptoms with Hgb 8

76
Q

What are the ONS recommendations for patients at high risk (<= 20% chance) of developing neutropenia?

A

CSFs
Influenza vaccine
Pneumococcal vaccine
Antifungals, antibacterial prophylaxis

LIKELY to be effective
Private room
HEPA filters/masks
No fresh fruit, veg, fresh or dried flowers
Clean O2 humidifiers and nebs
Automatic ice machines
No animal feces, saliva, urine, litter boxes, cages
Promptly treat animal or insect bites or scratches
No reptiles
Awareness of any construction debris/aerosolization

77
Q

What causes thrombocytopenia?

A

BM infiltrates by primary or metastatic malignancy
DIC or TTP
Splenomegaly
May occur 8-14days after chemo
Meds: NSAIDs, aspirin, thiazide diuretics, tricyclic antidepressant, some abx (pipercillin, ampicillin), heparin

78
Q

When is a platelet transfusion indicated?

A

<10k for patients with acute leukemia, transplant patients and those with solid tumors
<20k if undergoing minor procedure

79
Q

What are dose limiting toxicities?

A

Mucositis, peripheral neuropathy

80
Q

5 phases of mucositis

A

I. Initiation (DNA damage, appears normal)
II. Primary damage response (transcription factor nuclear factor-KB is activated, causes cell death, pt may not feel damage)
III. Signal amplification (cytokines amplify injury, tissue altered but may appear normal)
IV. Ulceration (fibrous exudate thinly covers which can fill with bacteria - pain, dysphasia, decreased intake, difficulty talking, increased risk of bleeding)
V. Healing (once chemo and/or radiation d/c)

81
Q

Who is more at risk of delayed (at least 24hrs after treatment) CINV?

A

Women and patient with previous CINV (cisplatin, carbo, cyclophosphamide, anthracyclines)

82
Q

What are risk factors for CINV?

A

Younger age <50, low chronic alcohol intake, tumor burden, pancreatitis, hepatic mets

83
Q

What are S&S of cachexia?

A

Amenorrhea, polyuria, cold intolerance, poor skin turgor/dry skin, cardiac arrhythmias, loss of muscle mass

Decreased Na, K, albumin, glucose, folate
Increased BUN/Cr ratio

84
Q

What is recommended to manage anorexia?

A

Corticosteroids and progestins

85
Q

What are risk factors for cardiopulmonary toxicities?

A

> 65yo, hx of cardiac or pulmonary, cigarettes, hepatic or renal dysfunction, combination therapy, mediastinal radiation, volume of heart irradiated >30Gy (NH and Hodgkin, left sided breast cancer have large treatment fields that include the heart), daily radiation dose fraction >2Gy/day, cumulative doses of chemo (esp anthracyclines), longer duration of survival

86
Q

What are S&S of chemo induced pneumonitis?

A

Dyspnea, tachypnea, dry cough, anxiety, hypoxenia, hemoptysis, pleuritic pain, use of accessory muscles to breath

Ground glass infiltrates, ABGs, PFTs

Bleomycin

87
Q

What is the treatment for pneumonitis?

A

Cough suppressants, antipyretics, glucocorticoid therapy, cautious use of O2, establish fluid homeostasis, bronchodilators, elevate HOB

88
Q

What are risk factors for developing peripheral neuropathy?

A

Age>60, precious neurologic damage from RT to spine, preexisting peripheral neuropathy, concurrent use of neurotoxic agents, hx of cum dose of some neurotoxic agents (cisplatin, vincristine, taxanes), concurrent use of diuretics, excessive alcohol use, metabolic imbalances, HIV, paraneoplastic syndrome, diabetes, certain chemo, RT

OCN Review (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions