Breast Cancer

Question 1

associated with poor prognosis

Answer 1

young 
HER2+
ER - 
poorly differentiated
lymph node involvement

Question 2

dose dense regimen

Answer 2

14 days between treatments
requires GCSF, reduced time for body to recovery
increased survival rates??

Question 3

what can prastuzumab be used for

Answer 3

metastatic HER2+

Question 4

when can you start trastuzumba

Answer 4

when taxane is started

not with anthracycline

Question 5

ask patients to refrain from using

Answer 5

herbal and OTC products

Question 6

neutropenia =

Answer 6

<1x10^9 neutrophils/L

Question 7

granulocytopenia =

Answer 7

WBC < 2.5x10^9/L

Question 8

when do you use filgrastam

Answer 8

pts high risk for neutropenia

to increase WBC

Question 9

monitoring for neutropenia and what to do

Answer 9

fever >38 2 times in one hour

go to emerg and get iv antibiotics

Question 10

prevention of neutropenai

Answer 10

get flu shot
wash hands
avoid ppl who are sick

Question 11

is low hemoglobin a reason to delay chemo

Answer 11

no just give blood products

Question 12

thrombocytopenia =

Answer 12

<100x10^9platelets/L

Question 13

is there a treatmetn to increase platelets

Answer 13

no

Question 14

monitoring for thrombocytopenia

Answer 14

easy brusing
cuts that dont heal
nose bleed
blood in urine/stool 
bleeding gums

Question 15

how does ondasetron work

Answer 15

decreases serotonin

since serotonin only high for about 36hr useless after that

Question 16

side effects of ondasetron

Answer 16

headache

constipation

Question 17

dosing of griesetron

Answer 17

1mg pre and then 1mg BID x 4 doses after

for highly emetogenic drugs (epirubicin)

Question 18

dexamethasone side effects

Answer 18

insomnia
mood changes
increase BG

Question 19

dose of dex

Answer 19

give 12mg pre and then 4mg BID days 2 and 3 for NV

give 8mg BID x 3day, at least 3 doses before docetaxel admin for edema

Question 20

doses of aprepitant

Answer 20

125mg pre

80mg post days 2+3

Question 21

metoclopramide dose

Answer 21

10-20mg q4-6hr prn for between cycles

Question 22

metoclopramide side effects

Answer 22

EPS

diarhea

Question 23

lorazepam use

Answer 23

anticipatory nausea

Question 24

stomatitis treatment

Answer 24

rinse with salt water
good dental hygiene
sensodyne

Question 25

infusion related reaction

Answer 25

fever, chills, | will often see in first cycle

Question 26

drugs causing infusion reaction

Answer 26

taxane - pretreat with antihistamine and corticosteroid cisplatin after6wks docetaxel SJS trastuzumab first cycle

Question 27

hand foot syndrome treatment

Answer 27

mouisturizers | prevent damage - gloves

Question 28

drug causing hand foot

Answer 28

5FU

Question 29

how to deal with fatigue

Answer 29

dont overdo it when feeling well rest decreased activity

Question 30

how long does fatigue occur

Answer 30

6-8month after treatment

Question 31

how to manage myalgia

Answer 31

rest acetaminophen codiene

Question 32

how to treat diarrhea

Answer 32

call clinic to determine if electrolytes ok then loperamide | replace fluids

Question 33

how to prevent nail changes

Answer 33

dip in ice water during treatment

Question 34

chance of leukemia

Answer 34

1% developing hematological malignancy wiht anthracycline

Question 35

how to prevent cardiac dysfunction

Answer 35

MUGA scan before anthracycline and trastuzumab then q3month | has to be >50%

Question 36

prevention of extravasation

Answer 36

picc line

Question 37

side effects of anthracycline

Answer 37

``` NV diarrhea mucositis pink/red urine cardiomyopathy vesicant alopecia rare leukemia ```

Question 38

side effects of taxane

Answer 38

``` peripheral neuropathy extensive alopecia HIGH RATE OF NEUTROPENIA fluid retention nail changes, arthralgia paclitaxel hypersensitivity ```

Question 39

trastuzumab side effects

Answer 39

``` hypersensitivity reaction rare cardiotoxicity arthralgia myelosuppression rare well toleracted ```

Question 40

goals

Answer 40

prevent recurrence prevent contralateral breast cancer long term remission

Question 41

things to monitor before chemo

Answer 41

CBC hydration status LVEF baseline and q3mon