Exam 2 - Supportive Care in Oncology

Question 1

List the classes of chemotherapy-induced nausea and vomiting (CINV)? (5)

Answer 1

acute, delayed, breakthrough, anticipatory, refractory

Question 2

Describe the pathophysiology of CINV?

Answer 2

mediated by serotonin (5-HT3), substance P/neurokinin-1 (NK-1), and dopamine receptors

Question 3

List patient risk factors for CINV?

Answer 3

age <50 years, emesis during pregnancy, female sex, anxiety/high pretreatment expectations of nausea, little to no previous alcohol use, history of CINV/prone to motion sickness

Question 4

What is treatment for emesis prevention in high emetic risk with parenteral agents?

Answer 4

day 1 = olanzapine, dexamethasone, NK1 RA, 5-HT3 RA; day 2-4 olanzapine, dexamethasone, aprepitant (PO on days 2-3 if used PO day 1)

Question 5

What is treatment for emesis prevention in moderate emetic risk with parental agents?

Answer 5

day 1 = dexamethasone, 5-HT3 RA; days 2-3 dexamethasone OR 5-HT3 RA

Question 6

What is treatment for emesis prevention in low emetic risk with parenteral agents? (4)

Answer 6

dexamethasone OR metoclopramide OR prochlorperazine OR 5-HT3 RA

Question 7

What is treatment for emesis prevention in minimal emetic risk with parenteral agents?

Answer 7

no routine prophylaxis

Question 8

What is treatment for emesis prevention in moderate to high emetic risk with oral agents?

Answer 8

5-HT3 RA

Question 9

What is treatment for emesis prevention in minimal to low emetic risk with oral agents?

Answer 9

as needed (PRN)

Question 10

What are treatments for breakthrough emesis?

Answer 10

olanzapine, lorazepam, dronabinol, 5-HT3 RA, prochlorperazine, dexamethasone, metoclopramide, scopolamine

Question 11

What are treatments for anticipatory emesis treatment?

Answer 11

guided imagery, relaxation, hypnosis, cognitive distraction, yoga, biofeedback, progressive muscle relaxation

Question 12

What are AEs of dexamethasone?

Answer 12

insomnia (administer in morning), dyspepsia, hyperglycemia, hypertension

Question 13

What are the first generation 5-HT3 RAs? Second?

Answer 13

ondansetron, granisetron; palonosetron

Question 14

What are AEs of 5-HT3 RAs?

Answer 14

headache, constipation, QTc prolongation

Question 15

What are AEs of NK1 RAs?

Answer 15

headache, GI , fatigue, hiccups, CYP interactions (decrease dexamethasone dose)

Question 16

What are the AEs of olanzapine?

Answer 16

sedation, hyperglycemia, fatigue, QTc prolongation

Question 17

What are AEs of phenothiazines? (2)

Answer 17

drowsiness, constipation

Question 18

What are AEs of benzamines? (4)

Answer 18

drowsiness, diarrhea, QTc prolongation, tardive dyskinesia

Question 19

What drug often causes cancer treatment-induced diarrhea (CTID)?

Answer 19

irinotecan

Question 20

What is first-line treatment for CTID?

Answer 20

loperamide, diphenoxylate-atropine

Question 21

What are treatments for refractory CTID?

Answer 21

octreotide, tincture of opium, probiotics, rule out C. diff

Question 22

Define mucositis?

Answer 22

erythematous ulcerative lesions of the mucosa observed in patients treated with chemotherapy and can occur ANYWHERE IN GI TRACT

Question 23

Define stomatitis?

Answer 23

inflammation limited to the oral cavity

Question 24

Explain the five-stage model of oral mucositis?

Answer 24

initiation, primary damage response, signal amplification, ulceration, healing

Question 25

List risk factors of chemotherapy-induced mucositis?

Answer 25

smoking, poor oral hygiene, oral lesions at baseline, female sex, pretreatment nutritional status, chemotherapy (melphalan, cisplatin + radiation, high-dose MTX, doxorubicin, busulfan, 5-FU)

Question 26

What are treatment options for management of chemotherapy-induced mucositis?

Answer 26

oral decontamination with mouthwash (dexamethasone for Everolimus-induced), pain control (2% viscous lidocaine), artificial saliva products or chewing gum, liquid/soft diets/TPN, fluconazole for oral candidiasis

Question 27

List patient risk factors for febrile neutropenia?

Answer 27

prior chemo/radiation, bone marrow involvement, recent surgery/open wounds, liver/renal dysfunction, >65 years receiving full chemo doses

Question 28

Who should be given G-CSFs for febrile neutropenia primary prevention?

Answer 28

those with a risk >20% (high)

Question 29

What are treatments for febrile neutropenia primary prevention?

Answer 29

filgrastim, pegfilgrastim, eflapegrastim-xnst or efbemalengrastim alfa-vuxw

Question 30

What is the difference between filgrastim and its analogues used for febrile neutropenia primary prevention?

Answer 30

filgrastim is given daily until ANC recovery and the others are single dose, and filgrastim should be continued for neutropenia that develops

Question 31

What is the recommendation for secondary prevention of febrile neutropenia?

Answer 31

if no prior G-CSF give, if Hx of G-CSF consider chemo dose reduction or treatment change

Question 32

What are treatments for cancer pain?

Answer 32

non-opioids, opioids both +/- adjuvants

Question 33

Describe cancer treatment immune-related AEs?

Answer 33

skin and GI show up first but skin and endocrine take longest to resolve

Question 34

What are treatments for cancer treatment immune-related AEs?

Answer 34

systemic corticosteroids