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Flashcards in chemo Deck (49):
1

Chemotherapy ADE include

hypersensitivity
n/v
mucositis
alopecia
neuropathy
cutaneous reactions
extravasation
thrombosis
MC: Myelosuppression! lowest blood cell count usually 10-14days after admin of chemo, and recovery w/in 3-4 wks
-anemia a few months after 1st dose
-neutropenia, then thrombocytopenia

2

What are the 5 phases of chemo induced nausea/vomiting

Acute: w/in 1-2 hrs of chemo. Tx with Ondansetron
Delayed: >24 hours after admin. Tx w/ Aprepitant, fosaprepitant, or rolapitant
Anticipatory: prior to admin in those who had significant n/v with chemo before. Tx w/ prophylactic benzos (diazepam, lorazepam) the night before admin
Breakthrough: occurs despite prophylaxis. Tx with prochlorperazine or phenothiazine around the clock
Refractory: poor response to all antiemetics. Tx w/ glucocorticoids (DXM)

3

Where can mucositis occur

Gi mucosa
Inflammation as ulcers, local infection, can't eat drink or swallow, systemic microbial invasion

4

Mucositis is MC associated with

5-FU
Doxorubicin
Methotrexate
Multikinase inhibitors (nibs)
mTOR inhibitors (rolimus)

5

Patients at high risk for mucositis are

Poor dentitions
those on high dose chemo
those on radiation involving oropharynx
-prevent mucositis with good oral hygiene! go to the dentist before chemo Tx, rinse mouth w/ backing soda and salt water frequently between courses of chemo

6

What analgesics can be used to Tx mucositis

Mouthwash!
viscous lidocaine*
diphenhydramine liquid
Dyclonine sucrets*

7

How can you manage local infection 2/2 mucositis

Candida: Clotrimazole troches or nystatin oral suspension for thrush. Oral fluconazole or IV antifungals for more severe
Reactivation of HSV: Acyclovir

8

What is Palifermin

Keratinocyte Growth Factor that binds to KGF receptor resulting in proliferation, differentiation, and migration of epithelial cells on tongue, buccal, esophagus, and salivary glands

9

Palifermin is approved for

high dose chemoradiotherapy prior to stem cell transplant

10

ADE of Palifermin are

*Increased amylase and lipase
change in taste, mouth or tongue discoloration

11

How do you treat mucositis that manifests as diarrhea and abdominal pain

IVF, electrolyte supplement
Lomotil or Loperamide (non-infectious antispasmodics)
Octreotide: somatostatin analog, esp for severe diarrhea

12

What cutaneous reactions are associated with chemo

localized rash
photosensitivity
skin hyperpigmentation
nal changes
hand-foot syndrome/acral erythema (diffuse edema & erythema on palms and soles)
-generally reversible and self limited

13

Cutaneous reactions are associated with

Cytarabine
5-FU
Bleomycin

14

How do you treat cutaneous reactions

Emollients if w/ dry skin
topical/systemic abx if rash gets infected
steroids to prevent itching and inflammation
Acral erythema: PO B6 (pyridoxine) QD, cold packs to extremities during chemo admin

15

What is hand foot skin reaction

Associated with multikinase inhibitors, FU, capecitabine, and liposomal doxorubicin
Localizes to areas of pressure/friction (hands, feet)
Can prevent w/ daily moisturizer
Can treat with urea cream, topical steroids, and pain meds (gabapentin, NSAIDs)

16

What is alopecia

Most distressing but usually temporary hair loss
W>M
All body, not just scalp.
MC associated with Taxane and Docetaxel

17

How do you treat alopecia

Cool caps to decrease blood flow to the scalp

18

What is extravasation

When chemo gets out of the blood and into surrounding structures (ex. IV line was not patent)
Causes prolonged pain, tissue sloughing, infection, and loss of mobility

19

What causes extravasation

Vesiacants: agents that cause severe tissue damage if they escape the vasculature
Antracyclines
Actinomycin D
Vinca alkaloids
Mitomycin C
Nitrogen mustard
Takanes (Taxol*)

20

How do you treat extravasation

Apply ice packs to affected area EXCEPT:
Vinca alkaloids better managed by applying heat*
Sodium thiosulfate to neutralize nitrogen mustard
Hyaluronidase to improve outcome after vinca alkaloids, etoposide, and taxanes
Topical dimethyl sulfoxide for anthracycline and mitomycin C
Dexrazone IV (totect) for anthracycline!

21

How do you prevent extravasation

good admin technique
Use large veins in forearms
give slowly through running IV line
Pref. thru central venous cath

22

When is myelosuppression MC seen

when chemo is given at the same time as radiation to chest or pelvic region

23

What cells are affected in chemo related myelosuppression

WBC (esp PMN): most significantly affected, rapid proliferation, short lifespan (6-12 hrs)
PLT: much less than PMN. 5-10 day lifespan
RBC: affected least. 120 day lifespan

24

When is myelosuppression good

Myelotoxicity is a desired therapeutic effect in patients with AML during induction therapy

25

What is the MC hematologic complication of chemotherapy

Anemia
Depends on type and duration of therapy, type and stage of malignancy

26

What conditions are known to cause anemia in cancer patients

chemo and radiation
chronic GI blood loss
nutrient deficiency (Fe, folate)
bone marrow invasion by tumor
hemolysis
renal dysfunction
anemia of chronic disease

27

How do you treat anemia in a cancer patient

RBC transfusion
Recombinant human erythropoietic products (epoetin alfa, darbapoetin alfa)

28

Before initiating recombinant human erythropoietin, you must

eval underlying condition and initiate specific therapy;
Iron deficiency? give Iron
B12 or folate supplementation
Chronic bleeding? determine site

29

How do you treat with human recombinant erythropoietin

Start Sx pts when Hgb <10
Target Hgb is 10-12
Indication of response: Hgb increase by 1g, ferritin decline or reticulocyte increase s/p 2-4 wks
Reassess Hgb after 4-6 weeks (sr erythropoietin levels dont really help)

30

Mild ADE of recombinant human EPO (epogen) include

pain at injection site
rash
flu-like Sx
seizures
HTN

31

Severe ADE of recombinant human EPO are

decreased survival (advanced breast, head and neck, lymphoma, and non-small cell lung cancer)
thrombosis
pure red cell aplasia

32

What is neutropenia

ANC falls <500
risk of infection is directly proportional to duration of neutropenia
S/Sx of are absent (no WBC respond) so rely on fever as indication of infection! start abx asap

33

What percent dose should you receive based on granulocyte count

>2000: 100% of dose
1000-2000: 5-% of dose
<1000: 0%

34

What agents are used as colony stimulating factors in neutropenia

G-CSF (granulocyte): Filgrastim, Pegfilgrastim
GM-CSF (granulocyte/macrophage): Sargramostim. promotes proliferation of neutrophils, eosinophils, macrophages, monocytes. stimulate megakaryocytes, but no effect on PLT

35

Giving CSF allow

admin of subsequent chemotherapy courses on schedule= enhanced dose intensity
Not consistently translated into improved tumor response or survival

36

When can you use CSF

primary prophylaxis: prevent neutropenia in 1st chemo cycle
Secondary: prevent recurrent neutropenia in those who had neutropenia previously w/ chemo

37

What are ADE of CSF

Bone pain (give APAP)
Increased LDH, alk phos, uric acid, and liver transaminases
pleural and pericardial effusions w/ high doses; also capillary leak syndrome and thrombus formation
low grade fever, myalgias, arthralgias, lethargy, mild HA
mild erythema at subQ injection sites
generalized maculopapular rash
-Occur bc of drug's ability to bind neutrophils to endothelial cells, and activate monocytes and macrophages= release cytokines IL1 and TNF

38

When do you dose CSF

24-72 hours after chemo
Stop the day before chemo
Pegfilgrastim is long lasting G-CSF and should be stopped w/in 14 days of next chemo dose

39

How do you treat thrombocytopenia

Platelet transfusion!
reserved for PLT <10, active bleeding, or pending surgery

40

Who experiences significant thrombocytopenia w/ prior cycle of chemo Oprelvekin

Those with secondary non-myeloid malignancies

41

What is Oprelvekin (IL-11) associated with

Fluid retention (edema, dilutional anemia, dyspnea, pleural effusions)
Cardiotoxicity (tachy, AFib, Aflutter, HF)

42

What is the most significant factor in the future of thrombocytopenia Tx

Megakaryocyte stimulating factor

43

What neuropathy is associated with chemo

sensory, motor, autonomic, or combination
Mild: paresthesias of fingers and toes
Constipation
-MC with Vinca alkaloids and taxane drugs

44

Cardiotoxicity is associated with

Anthracyclines (Doxorubicin, Daunomycin, Idarubicin, Epirubicin)
-MUGA screen scan show you LVEF. If >50%, give antracyclines

45

What is Cisplatin associated with

nephrotoxicity and neurotoxicity
peripheral neuropathy, painful paresthesias
Ototoxicity +/- deafness

46

How do you treat nephro/neurotoxicity associated w/ Cisplatin

vigorous hydration prior, during, and after admin
monitor renal fxn and lytes for low mag, K, and Na
Give amifostin IV over 15 min prior to cisplatin for protection

47

What can be used instead of cisplatin

Second gen platinum analog, Carbaplatin!
Non-nephrotoxic but still myelosuppresive

48

Common Bleomycin toxicities are

Edema of IP joints
Hardening of palmar and plantar skin
Anaphylaxis, serum sickness like reaction
Serious or fatal pulmonary fibrotic rxn, esp in elderly

49

With bleomycin, monitor for

non-productive cough, dyspnea, and pulmonary infiltrates
If present, dc drug, start high dose corticosteroids, and start empiric abd pending cultures