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NAPLEx > oncology I > Flashcards

oncology I Flashcards

1
Q

breast cancer screening

A

40-44 annual optional
45-54 begin yearly mammograms
>=55 years mammograms every 2 years or continue yearly

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2
Q

cervical

A

21-29 pap smear every 3 years
30-65 pap smear +HPV DNA test every 5 years

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3
Q

colon

A

> = 45 stool-based tests- if positive, follow-up w/ colonoscopy, every 3 years
colonoscopy every 10 years

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4
Q

dosing considerations for select highly drugs
Bleomycin

A

Lifetime cumulative dose: 400 units
reason: pulmonary toxicity

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5
Q

dosing considerations for select highly drugs
Doxorubicin

A

lifetime cumulative dose: 450-550 mg/m^2
reason: cardiotoxicity

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6
Q

Cisplatin

A

dose per cycle not to exceed 100mg/m^2
reason: nephrotoxicity

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7
Q

Vincristine

A

single dose “capped” at 2mg
reason: neuropathy

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8
Q

all pt prego and breastfeeding

A

all pt regardless of gender must avoid conceiving during tx

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9
Q

N- nitrosoureas

A

Lomustine, carmustine
neurotoxicity

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10
Q

C- Platinum-based

A

Cisplatin, Carboplatin
nephrotoxic/ototoxic

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10
Q

M- methotrexate

A

mucositis

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11
Q

B- Bleomycin, Busulfan, Carmustine, Lomustine

A

Pulmonary Fibrosis

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12
Q

D- Doxorubicin & other anthracyclines

A

cardiotoxic

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13
Q

AI- Immunotherapy

A

targeting CTLA-4 or PDL-1: ipilimumab, atezolizumab, durvalumab, nivolumab, pembrolizumab
autoimmune syndromes (widespread effects)

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14
Q

IP- ifosfamide & cyclophosphamide

A

Hemorrhagic cystitis

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15
Q

VT- vinca alkaloids and taxanes

A

vinca alkaloids (vincristine, vinblastine & vinorelbine) and Taxanes (paclitaxel, docetaxel)
peripheral neuropathy

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16
Q

BMS- bone marrow suppression

A

common toxicity of many chemotherapy agents including: alkylators, anthracyclines, platinum-based compounds (cisplatin), taxanes, topoisomerase I and II inhibitors, antimetabolites and vinca alkaloids (vinblastine and vinorelbine)

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17
Q

chemotherapy adjunctive tx
cisplatin

A

amifostine (ethyol) and hydration
prophylaxis to prevent nephrotoxicity

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18
Q

chemotherapy adjunctive tx
doxorubicin

A

dexrazoxane (totect)
prophylaxis to prevent cardiomayopathy

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19
Q

chemotherapy adjunctive tx
fluorouracil

A

leucovorin or levoleucovorin
given w/ fluorouracil to enhance efficacy (as a cofactor)

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20
Q

chemotherapy adjunctive tx
fluorouracil or capecitabine

A

uridine triacetate
antidote: use within 96 hrs for an over dose or to tx severe, life-threatening or early-onset of tox

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21
Q

ifosfamide

A

Mesna (Mesnex) and hydration
prophylaxis to prevent hemorrhagic cystitis

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22
Q

irinotecan

A

atropine- prevent or treat acute diarrhea
loperamide- treat delayed diarrhea

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23
Q

methotrexate

A

leucovorin or levoleucovorin- given prophylactically after high-dose methotrexate to decrease myelosuppression and mucositis

glucarpidase- an antidote to decrease excessive methotrexate levels due to acute renal failure

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24
Q

myelosuppression- three major groups

A

red blood cells
platelets
white blood cells

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25
Q

myelosuppression
red blood cells

A
  • decrease in RBC- anemia (decrease in Hgb/Hct)
  • symptoms: weakness/fatigue
  • can resolve on its own or with an RBC transfusion

Drug tx:
- erythropoiesis-stimulating agents (ESA)
—> epoetin alfa (epogen, procrit)
—> darbepoetin alfa (Aranesp)

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26
Q

myelosuppression
platelets

A
  • decrease platelets- causing thrombocytopenia
  • symptom: bleeding
  • platelet transfusion, if platelets are very low (<10,000 cells/mm^3)
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27
Q

myelosuppression
white blood cells

A
  • decrease WBC- means leukopenia (decreased immune response)
  • symptoms: fever/infection

drug tx:
- colony-stimulating factors (CSF)
—> filgrastim (Neupogen)
—> pegfilgrastim (Neulasta)

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28
Q

WBC nadir

A

lowest point in WBC which occurs about 7-14 days after chemotherapy

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29
Q

RBC nadir

A

lowest point in RBC
generally after several months of tx, due to the long life-span of RBC (120 days average)

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30
Q

WBCs and platelets generally recover

A

3-4 weeks post tx. the next dose of chemothera[y is given after the WBCs and platelets and return to a safe level

next cycle can be delayed to give more time to recover

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31
Q

neutropenia

A

<1,000 cells/mm^3

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32
Q

severe neutropenia

A

< 500 cells/mm^3

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33
Q

profound neutropenia

A

<100 cells/mm^3

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34
Q

growth colony stimulating factors

A

G-CSF or simply CSFs, stimulate the production of WBC in the bone marrow. they are given prophylactically after chemo to shorten the time the pt is at risk for infection due to neutropenia and to reduce mortality

  • they are used to prevent (or reduce) neutropenia- NOT used for acute tx
35
Q

sargramostim

A

used only for stem cell transplants

35
Q

G-CSF
filgrastim

A

Neupogen
biosimilar: tbo-filgrastim (granix)
daily dosing- tx through post naider

  • colony-stimulating factor
36
Q

pegylated G-CSF
Pegfilgrastim

A

Neulasta
biosimilars: a lot with letters infront of it lol
sc once per chemo cycle
- colony-stimulating factor

37
Q

GM-SCF
sargramostim

A

leukine
limited to use in stem cell transplant
- colony-stimulating factor

38
Q

major SE for colony-stimulating factors?

A

bone pain, fever
sargramostim: fever, arthralgias, myalgias, rash, bone pain

39
Q

pt should report what w/ colony-stimulating factor

A

amu signs of enlarged spleen (pain in left upper abdomen or respiratory distress syndrome)

40
Q

what should you document w/ pegfilgrastim?

A

must document when given, should have at least 12 days before the next chemotherapy cycle

41
Q
  • colony-stimulating factor
    storage
A

store in the refrigerator, and protect vials from light

42
Q

neutropenia diagnosis

A

fever: oral tem >38.3 or >38.0 for >1hr
neutropenia: ANC <500 or expected to drop below <500

43
Q

neutropenia
low-risk tx

A

expected to drop ANC <500 for <=7 days and no cormbidimites

oral anti-pseudomonal antibiotics:
cipro or levo +
augmentin (for gram +) or clinda (if allergy)

44
Q

neutropenia
high-risk tx

A

expected ANC <=100 for >7 days and presence of comorbidities (renal or hepatic impairment)

IV anti-pseudomonal beta-lacatams:
cefepime or
ceftazidime or
meropenem or
imipenem/cilastatin or
piperacillin/tazo

45
Q

Hgb normal

A

female: 12-16 g/dL
male: 13.5- 18 g/dL
initiate ESA only wne HgB <10g/dL

46
Q

ESAs for tx anemia

A

can shorten survival and increase tumor progression, NOT recommend in pt w/ curative intent!
epoetin alfa (Epogen, procrit)
epoetin alfa-ebx (retacrit)
longer-acting darbepoetin alfa (Arnesp)

47
Q

w/ ESA make sure:

A

iron levels are adequate. other wise ESA will not work

48
Q

thrombocytopenia

A

can result in spontaneous uncontrolled bleeding
normal range: 150,000-450,000
spontaneous risk for bleed increases when <10,000

49
Q

thrombocytopenia
when to start platelet transfusion

A

<30,000 or active bleeding is present

50
Q

chemotherapy N/V
acute

A
  • within 24hrs after chemo
  • serotonin and substance P
    drug tx:
  • 5HT-3 antagonist
  • NK1 receptor antagonist
  • dexamethasone, olanzapine
51
Q

chemotherapy N/V
delayed

A
  • > 24 hrs after chemo
  • substance P and dopamine
    drug tx:
  • NK1 antagonists
  • corticosteroids
  • palonosetron
  • olanzapine
52
Q

chemotherapy N/V
anticipatory

A
  • before chemo
  • GABA
    drug tx:
  • benzo: start the evening prior to chemo
53
Q

5HT3- receptor antagonists (RA)

A
  • ondasetron
  • granisetron
  • palonsetron
54
Q

NK1- RA

A
  • aprepitant PO
  • fosaprepritant IV
  • rolapitant
55
Q

combo 5HT3- RA and NK1-RA

A
  • netupitant /palonsetron PO (Akynzeo)
  • Fosnetupitant/ palonosetron IV (Akynzeo)
56
Q

other… N/V

A

olanzapine

57
Q

steroid… N/V

A

dexamethasone

58
Q

substance P/NK-1 RA antagonists

A

inhibit the substance P/neurkinin 1 receptor, therefore augmenting the antiemetic activity of 5HT-3 receptors antagonist and corticosteroids to inhibit acute and delayed phases of chemotherapy-induced emesis

59
Q

aprepitant

A

Emend
- substance P/NK-1 RA antagonists

60
Q

Fosaprepitant

A

Emend
- substance P/NK-1 RA antagonists

61
Q

ondansetron

A

Zofran, Zuplenz film
- 5HT-3 RA

62
Q

granisetron

A

Sancuso
- 5HT-3 RA

63
Q

Palonosetron

A

Aloxil
injection
PO only incombo (Akynzeo)
- 5HT-3 RA

64
Q

warnings w/- 5HT-3 RA

A
  • QT prolongation
  • serotonin syndrome
    contra: w/ apomorphine (apokyn)- due to severe hypotension nad loss of consciousness
65
Q

dexamethasone

A

decadron
contra: in systemic fungal infection…
- corticosteroids

66
Q

dopamine receptor antagonists

A

blocks dopamine in CNs and chemoreceptor trigger zone

67
Q

prochlorperazine

A

compazine
increased mortality in elderly pt w/ dementia-related psychosis
- dopamine receptor antagonists

68
Q

Promethazine

A

Phenergan
do not use in children<2, respiratory depression
do not give via intra-arterial or Sc admin. IV route can cause serious tissue injury if extravasation.
Deep IM injection preferred
- dopamine receptor antagonists

69
Q

metoclopramide

A

Reglan
can cause irreversible TD! Decrease dose w/ renal impairment
- dopamine receptor antagonists

70
Q

Olanzapine

A

zyprexa
second gen psych…
- dopamine receptor antagonists

71
Q

droperidol

A

injection
QT prolongation, and arrhythmias risk
- dopamine receptor antagonists

72
Q

big warning w/ - dopamine receptor antagonists

A

symptoms of Parkinson’s disease can be exacerbated. Avoid use in pt w/ parkinson disease
- EPS( common SE in children- antidote is diphenhydramine and benzo)
- can decrease seizure threshold
- QT prolongation (droperidol highest risk)

73
Q

dronabinol

A

Marinol
refrigerate
- cannabinoids

74
Q

nabilone

A

cesamet
- cannabinoids

75
Q

irinotecan

A

I- RUN- TO- THE- CAN
cause cholinergic excess- acute diarrhea w/ abdominal cramping
atropine: classic anticholinergic- prevent acute diarrhea
pilocarpine: classic anticholinergic used for dry mouth (xerostomia) cause salvation, tears (lacrimation) for dry eyes

76
Q

tumor lysis syndrome can cause

A

hyperkalemia (can cause arrrhthmais)
hypocalcemia (can cause anorexia, nausea, and seizures
hyperuricemia (gout)

77
Q

gout

A

use allopurinol, but remember HLAB testing… if you cant use it, use:
rasburicase- it is expensive, contra: G6PD deficiency

78
Q

Hypercalcemia tx
hydration w/ NS and loop diuretics

A
  • increase real Ca exretion
  • onset min to hrs
  • mild, moderate, severe cases
79
Q

Hypercalcemia tx
calcitonin

A

calcitionin (miacalcin)
- inhibits bone resorption, increases renal Ca recreation
- onset 2-6 hrs
- moderate, severe cases

80
Q

Hypercalcemia tx
IV bisphosphonates

A
  • zoledronic acid (zometa) 4mg IV once, may repeat in 7 days
    DO NOT confuse w/ reclast which is 5mg IV yearly for osteoporosis!
  • inhibits bone resorption by stopping osteoclast function
  • onset 24-72 hrs
  • mild, moderate, severe cases
81
Q

Hypercalcemia tx
denosumab

A

denosumab (Xeva) 120mg SC dosing…
DO NOT confuse w/ prolia which is dosed at 60mg SC every 6 months for osteoporosis!
- monoclonal antibody that blocks the interaction between RANK l and RANK preventing osteoclast formation
- onset 24-72hrs
- moderate, severe cases

82
Q

anthracyclines
extravasated

A

antidote: dexrazoxane (totect) or dimethyl- sulfoxide

83
Q

vinca alkaloids and etoposide
extravasated

A

hyaluronidase

84
Q

vax and chemo

A
  • avoid live vax (immunocompro state)
  • precede chemo >= 2 weeks

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