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CDM 4 Exam 3 > Lecture 6 - Cancer 2 > Flashcards

Lecture 6 - Cancer 2 Flashcards

1
Q

Risk factors for CINV

A

Chemotherapy = each drug has different risk
Age (younger)
Gender (females)
Alcohol use (inc use = less CINV)
Prior emetic experiences
Motion sickness/morning sickness

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2
Q

Highly Emetogenic Chemotherapy Drugs IV (> 90%)

A

AC- an anthraycline + cyclophosphamide
Cisplatin
Doxorubicing > 60mg/m2

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3
Q

Moderately Emetogenic Chemotherapy drugs IV (30-90%)

A

Azacytidine
Dual liposomal cytarabine + Daunorubicin
Irinotecan
oxaliplatin
Fam-trastuzumab deruxtecan-nxki

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4
Q

Low Emetogenic Chemotherapy drugs IV (10-30%)

A

5-Fluorouracil
Gemcitabine
Paclitaxel
Brentuxumab vedotin
Docetaxel

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5
Q

Minimal Emetic Potential Chemotherapy drugs IV (< 10%)

A

Bevacizumab
Bortezomib
Daratumumab
Nivolumab
Pembrolizumab
Rituximab

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6
Q

Moderate- high risk PO Chemo drugs (> 30%)

A

olaparib
Imatinib > 400mg/day
Temozolamide > 75mg/m2/day

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7
Q

Acute CINV

A

occurs < 24hrs after chemo
5HT3 antagonists = best option

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8
Q

Delayed CINV

A

occurs > 24hrs of receiving chemo
NK-1 inhibitors = best option

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9
Q

Anticipatory CINV

A

occurs as part of reflex response, triggered
Benzo = best option

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10
Q

Breakthrough CINV

A

occurs despite prophylaxis measures
Dopamine antagonists = best option

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11
Q

Ondansetron info

A

Serotonin Antagonist
Oral n IV
Most common

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12
Q

Granisetron info

A

Serotonin Antagonist
Less QTc risk than others
Oral/IV/SubQ/Transdermal

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13
Q

Palonosetreon info

A

Serotonin Antagonist
IV/Oral
Long acting, 30-40 T1/2,
Used delayed CINV

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14
Q

Palonosetreon info

A

Serotonin Antagonist
IV/Oral
Long acting, 30-40 T1/2,
Used delayed CINV

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15
Q

Clinical Pearls 5HT3 Antagonists

A

1st gen equally effective at recommended doses
Plateau effect
Activity improved by co-admin w/ corticosteroid
PO = IV efficacy
Single dose = equiv to multiple
More effective for N than V

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16
Q

Adverse effects n warnings 5HT3 Antagonists

A

Headache
ECG changes
QTc prolong
constipation

usually with repetitive dosing, not one time doses

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17
Q

Dose limit on IV ondansetron?

A

16mg due to QTc

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18
Q

Aprepitant info

A

NK1 inhibitor
Capsules n suspension n injectable emulsion

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19
Q

Fosaprepitant info

A

NK1 inhibitor
single dose vials

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20
Q

Rolapitant info

A

NK1 inhibitor
tablets & injectable emulsion
given once every 2 weeks
Not a 3A4 inhibitor

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21
Q

Netupitant/palonosetron info

A

NK1 inhibitor
capsules w/ dexamethasone (have to reduce dose)

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22
Q

Fosnetupitant/palonosetron info

A

NK1 inhibitor.
IV injection w/ dexamethasone (have to reduce dose)

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23
Q

NK1 inhibitor clinical pearls

A

most common SE = HA

enhances activity of 5HT3 antagonists and corticosteroids

24
Q

Role in therapy of NK1 inhibitors

A

dont treat CINV, but meant to prevent

25
Q

Dexamethasone info

A

8-16mg/day generally

AE: Insomnia, Hyperglycemia, GI, Hiccups (switch to methylprednisolone)

26
Q

Olanzapine for CINV?

A

does work, recommend to dose in bedtime and careful due to side effects

27
Q

Benzos are used commonly for….

A

anticipatory CINV

28
Q

Antiemetic therapy counseling

A

Keep quiet, calm surroundings
Eat small, frequent meals, foods that are easy on stomach
choose emetic agent due to chemotherapy
usually day 1 is worst day
start before chemo, admin on regular schedule n keep breakthrough agents available

29
Q

pts on High Emetic risk (>90%) schedule anti-emetics

A

Day 1 = acute
Day 2-4 = delayed

30
Q

pts on Mod emetic risk (30-90%) schedule anti-emetics

A

Day 1 = acute
Day 2-3 = Delayed

31
Q

pts on Low emetic risk (10-30%) schedule anti-emetics

A

Day 1 = acute

32
Q

regardless of standard scheduled prophylaxis used, all patients should….

A

get 1 take-home anti-emetic for breakthrough symptoms

33
Q

Clinical Pearls of Corticosteroids

A

Dexamethasone used across all regimens n guidelines
Caution pts underline DM, olanzapine as alternative
if pt suffer delayed CINV longer than day 4, consider prolong dex by few days

34
Q

Antiemetic rec for oral chemo High-moderate emetic risk

A

use oral drugs such as…Dolasetron, Granisetron, Ondansetron

35
Q

Antiemetic rec for oral chemo Low-miniaml emetic risk

A

PRN only recommended

36
Q

Severe neutropenia defined as…

A

ANC < 500 or with predicted decline to < 500 over next 48hrs

37
Q

Febrile neutropenia defined as….

A

ANC < 500 or with predicted decline to < 500 over next 48hrs
+
single oral temp > 38.3C or >38C for 1hr

38
Q

General principles to safely admin chemotherapy (WBC/Platelets)

A

WBC > 3000 OR ANC > 1500
Platelets > or = 100,000

39
Q

Filgrastin info

A

5mcg/kg/day subQ or short IV infusion 15-30min or by continuous IV

40
Q

Pegfilgrastin info

A

6mg SubQ once per cycle, start atleast 24hrs after chemo
should be atleast 12hrs btwn med and next cycle
if chem on days 1 n 15, give peg after each dose
if cant return to clinic next day, Neulasta Onpro

41
Q

which neutropenia pts can get primary prophylaxis meds?

A

> 20% risk
10-20% risk = consider n select cases

42
Q

CSF application - Secondary prophylaxis

A

during pretreatment after previous cycle of chemo caused neutropenic fever

43
Q

CSF application - Afebrile neutropenia

A

to shorten duration of severe chemotherapy induced neutropenia in pts who have neutropenia without fever

44
Q

CSF admin

A

admin atleast 24hrs after cytotoxic chemo, dont admin within 24hrs of therapy

transient inc in neutrophil count typically 1-2 days after initiation

use for up to 2 weeks or >10,000

45
Q

Peg filgrastin admin caveat

A

dont admin between 14 days before and 24hrs after cytotoxic chemo admin

46
Q

Neulasta Onpro

A

device attached on chemo day and programed to deliver dose the next day (over 45min ~ 27hrs after chemo dose)

47
Q

Filgrastin n other related stuff ADE

A

Bone pain = careful with Tylenol to not block fever
Allergic reactions
Splenic rupture = rare
ARDS
Pulmonary toxic if using bleomycin-containing regimens

48
Q

Causes of Anemia

A

Hemorrhage
Chemo n Radiation therapy
Iron, Folic acid, B12 deficiency
Bone marrow involvement
Renal dysfunction
Anemia of chronic disease

49
Q

Factors influencing incidence of anemia

A

Type of cancer
Stage of disease
Duration fo disease
Type of therapy
Intensity of therapy
Prior to therapy

50
Q

Classification of Anemia

A

Mild < 10
Moderate 8-9.9
severe 6.5-< 8
Life threatening < 6.5

51
Q

Erythropoietin alfa (Poetin) indications

A

Anemia….
1. in pts w/ non-myeloid malignancies whose anemia is due to chemo
2. CKD
3. HIV infection pts treated with zidovudine
4. pts scheduled to undergo elective non-cardiac, non-vascular surgery to reduce need for allogeneic transfusions

have to have 2 additional months of planned chemo if used myelosuppressive chemo

52
Q

Erythropoietin alfa (Epoetin) dosing

A

40,000 units/wk SQ or 150 units/kg 3 times per week

53
Q

Darbepoetin alfa info

A

has ~ 23.6 hr 1/2lfie compared to 8.5 of Epoetin

indication: Chronic renal failure, chemo associated anemia in pts w/ non-myeloid malignancies

54
Q

Clinical response to transfusion vs ESA

A

Transfusion = immediate
ESA = Weeks to months

ESA beneficial in pts who don’t want transfusion, don’t have access or RBC supply is limited

55
Q

When to initiate ESA therapy in cancer chemo pts

A

when Hb < 10 and there is a minimum of 2 additional months of planned chemo

admin iron n correct before starting ESA
~ 2 weeks after admin to see inc in Hb

CDM 4 Exam 3 (11 decks)

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