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Oncology Flashcards

1
Q

Acute onset emesis

A

occurs 0-24 hours after chemotherapy. usually resolves in 24 hours. intensity peaks at 5-6 hours

serotonin antagonists, steroids, NK1 antagonists help

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2
Q

Delayed onset emesis

A

Occurs more than 24 hours after chemo

Most common with cisplatin, may occur wth carboplatin or doxorubicin

Schedule antiemetics for DNV

NK1 receptor antagonists help

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3
Q

Mildly emetogenic radiation

A

head/neck or extremities

no prophylaxis needed

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4
Q

Moderately emetogenic radiation

A

upper abdomen or pelvis or craniospinal

Prophylactic antiemetics recommended

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5
Q

Highly emetogenic radiation

A

total body, total nodal, upper-half body

prophylactic antiemetics recommended

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6
Q

duration of antiemetics for highly emetogenic chemo

A

3 days

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7
Q

duration of antiemetics for moderately emetogenic chemo

A

2 days

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8
Q

Recommended antiemetic regimen for highly emetogenic chemo

A

Day 1:
NK1 receptor antagonist
Serotonin receptor antagonist
Dexamethasone
OR
Olanzapine + palonosetron + dex

Consider adding lorazepam, olanzapine, H2RA/PPI

Day 2-4:
Dexamethasone
If aprepitant PO used on day 1, continue schedule
If olanzapine used on day 1, continue schedule

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9
Q

Recommended antiemetic regimen for moderately emetogenic chemo

A

Day 1:
Serotonin receptor antagonist
Dexamethasone
+/-
NK1 antagonist, lorazepam, H2RA/PPI

OR

olanzapine + palonosetron + dex +/- lorazepam, H2Ra/PPI

Day 2-4:
Serotonin antagonist or dex monotherapy or olanzapine if used on day 1

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10
Q

Mild emetogenic chemo regimen

A

single agent

Phenothiazine, butyrophenone (haldol, droperidol), steroids for schedule or PRN
olanzapine for breakthrough

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11
Q

H2RA or PPI role in antiemetic regimen

A

prevent dyspepsia, which may mimic nausea

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12
Q

High emetic chemo IV agents

A

> 90% frequency of emesis

AC (doxorubicin, cyclophosphamide) or separate agents
Carboplatin, Cisplatin
Carmustine
Dacarbazine
Epirubicin
Fam-trastuzumab
Ifosfamide
Mechlorethamine
Melphalan
Sacitizumab
Streptozocin

Use NK1 receptor anagonist, serotonin receptor antagonist, dexamethasone, and olanzapine as prn

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13
Q

Some moderate emetogenic IV chemo

A

31-90% frequency of emesis

Bendamustine
Daunorubicin
Cytarabine/daunorubicin
Ifosfamide
Irinotecan
MTX
oxaliplatin

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14
Q

Emetogenic prophylaxis required for these oral anticancer agents

A

Azacitidine
Busulfan
Ceritinib
Cyclophosphamide
Fedratinib
Lomustine
Midostaurin
Mitotane
Mobocertinib
Selinexor
Tomozolomide

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15
Q

Is there a preferred serotonin receptor antagonist for emesis prevention

A

no, all equal, choose per contract

Dolasetron, granisetron, ondansetron, palonosetron

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16
Q

Serotonin receptor antagonist dosage forms

A

Oral tab:
Ondansetron (+ ODT)
Granisetron
Dolasetron
Palonosetron + netupitant

Parenteral:
Ondansetron
Granisetron
Palonosetron

Patch:
Granisetron

SC:
Granisetron

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17
Q

Can NK1 receptor antagonists be used alone?

A

NO – must be used with serotonin receptor antagonist and steroid.

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18
Q

NK1 receptor antagonists drug interactions

A

oral contraceptives: use another form of birth control

warfarin: significantly decrease INR. recheck INR in 7-10 days.

R-CHOP: may increase neuropathy due to aprepitant’s CYP3A4 inhibition

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19
Q

Low emetogenic chemo antiemetic regimen

A

dexamethasone
OR
Metoclopramide
OR
Prochlorperazine
OR
serotonin receptor antagonist, PO

+/- lorazepam, H2RA/PPI

Continue on days 2-4

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20
Q

Moderate-high emetogenic PO chemo regimen

A

Serotonin receptor antagonist (PO) +/- lorazepam, H2RA/PPI

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21
Q

Minimal to low emetogenic PO chemo regimen

A

Metoclopramide or prochlorperazine or serotonin antagonist

prn only

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22
Q

When to modify pain regimen

A

More than 2 prn doses needed in2 4 hour period

Maximize dose/schedule of current pain med first before adding another

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23
Q

Mild pain 1-3 first step

A

nonopioid - NSAID, aspirin, APAP

Can consider show titration of short acting opioids

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24
Q

moderate pain 4-7 persistent first step

A

weak opioid: hydrocodone or codeine

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25
Severe persistent pain 8-10
Strong opioids: morphine, hydromorphone, oxycodone Once stable on short acting, change to extended release at 50-100% of usual daily requirement
26
FDA definition of tolerance to opioids
fentanyl 25 mcg/hr morphine 60mg/day oxycodone 30mg/day hydromorphone 8mg/day for 1 week or longer
27
Metastatic bone pain nonopioid analgesic
NSAID
28
Opioids compared to morphine
Some may have different potency, duration, oral effectiveness, adverse event profiles none is clinically superior to morphine.
29
fentanyl patch in cachectic pt
may not have enough subcutaneous fat for depot to form which results in inadequate pain relief
30
Bisphosphonates in cancer
recommended IV if breast cancer w/ bone mets (every 3-4 weeks) recommended IV if lytic bone destruction with multiple myeloma (q3-4 weeks) recommended in solid tumor mets (q4-12 w) caution osteonecrosis of jaw
31
Denosumab in cancer
RANKL inhibitor that promotes bone removal recommended q4w if bone mets from multiple myeloma
32
Nadir
lowest WBC will fall after chemo usually occurs 10-14 days after chemo and recover by 3-4 weeks after chemo Exceptions: mitomycin, decitabine, azacitidine, bleomyicn, vincristine, nitrosureas = nadirts 28-42 days
33
ANC calculation
ANC = WBC * % granulocytes or neutrophils (segmented + band)
34
General blood counts required for receive chemo
WBC >3000 ANC >1000 Plt >100,000
35
Chemo regimen to avoid CSFs in
ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) in Hodgkin lymphoma due to rare infections and increased bleomycin induced pulm toxicity
36
Febrile neutropenia definition
single oral temperature >101F or more OR 100.4F for >1 hour Neutropenia = ANC< 500 Cultures and signs/symptoms of infection are generally negative, besides fever.
37
Most common source of infection in febrile neutropenia
endogenous flora = gram negative or gram positive More prolonged the neutropenia and more prolonged administration of antibiotics = greater risk for fungal
38
Empiric therapy for febrile neutropenia
broad spectrum monotherapy with antipseudomonal B lactam reassess at 3-5 days
39
When to add vanco for febrile neutropenia
sepsis pneumonia (xray confirmed) positive blood culture for GPC catheter related infection SSTI colonization of MRSA, VRE, or penicillin resistant strep Severe mucositis
40
When to add antifungal to febrile neutropenia
persistent or recurring fever after 4-7 days of ABX and length of neutropenia expected to be more than 7 days
41
Prophylactic antibiotics for febrile neutropenia
FQ or Bactrim consider if going to be profoundly neutropenic for >7 days
42
Pegfilgrastim
Longest acting CSF - only one dose needed cannot give chemo for 10-14 days after
43
CSF for chemo & radiation?
not recommended due to potential for worse myelopsuppression
44
CSF during febrile neutropenia
only should be given in risk factors for complications -- pneumonia, expected neutropenia >10 days, invasive fungal, anc<100
45
When to dose reduce chemo instead of CSF
After an episode of neutropenia & chemo is palliative, not curative.
46
GSF in secondary prophylaxis
CSF administration when previous chemo has been delayed or dose reduced due to prolonged neutropenia
47
GSF in primary prophylaxis
recommended if chemo regimen associated with 20% or greater risk of febrile neutropenia
48
lab values increased in microcytic anemia
TIBC and RBC distribution width
49
microcytic anemia treatment
iron replacement
50
macrocytic anemia cause
folate and b12 deficiency
51
B12 deficiency lab values that are increased
increase in MCV, MCH, methylmalonic acid, homocysteine
52
folate deficiency lab values that are increased
increase in MCV and MCH, b12 normal
53
folate and b12 deficiency treatment
replacement b12 can be PO or IM weekly x1 month, then monthly folate = 1mg folate daily x4 months. must take if pregnant to prevent neural tube defects
54
epoetin and darbepoetin role in chemo associated anemia
-to be given in CHEMO associated anemia only, not cancer-associated anemia -only to be used in noncurative setting
55
Dexrazoxane
Chemoprotectant for anthracyclines (daunorubicin, doxorubicin, idarubicin, epirubicin) and anthracenedione (mitoxantrone) Acts as iron chelator to reduce free radical damage and associated cardiomyopathy consider when >=300mg/m2 of doxorubicin given Also used for anthracycline extravasation
56
Amifostine
chemoprotectant that prevents nephrotoxicity from cisplatin and xerostomia in head/neck cancer high risk for N/V and hypotension - not often used.
57
Mesna
chemoprotectant to prevent hemorrhagic cystitis from cyclophosphamide and ifosfamide ALWAYS used with ifosfamide Start before or with chemo agent and continue after the end of chemo agent
58
Leucovorin
chemoprotectant for methotrexate MTX toxic reactions: mucous membrane toxicity, renal/hepatic toxicity, CNS, myelosuppression Used with fluorouracil in colorectal cancer to improve activity (not as rescue)
59
Glucarpidase
chemoprotectact used for toxic methotrexate concentrations in patients with delayed MTX clearance d/t renal dysfunction Continue leucovorin until MTX concentration is below leucovorin treatment threshold for 3 days. ADMINISER LEUCOVORIN >2 HOURS BEFORE OR AFTER DOSE OF GLUCARPIDASE. GLUCARPIDASE CAN DECREASE LEUCOVORIN CONCENTRATIONS
60
Trilaciclib
chemoprotectant used to decrease myelosuppression from platinum/etoposide regiments OR topotecan-regimens for small cel lung cancer
61
Severe hypercalcemia treatment
corrected ca >14 or symptomatic NS 3-6L in 24 hours Loop diuretics to prevent fluid overload Bisphosphonates - but onset is 3-4 days Calcitonin (rapid onset but short lived) DO NOT give thiazides
62
Tumor Lysis Syndrome
Hyperuricemia, hyperkalemia, hyperphosphatemia, secondary hypocalcemia NS + allopurinol
63
Vesicant antineoplastics
Doxorubicin Daunorubicin Epirubicin Mechloethamine Mitomycin Trabectedin Vincristine Vinblastine Vinorelbine Streptozocin *why we give doxorubicin as injection other than infusion
64
Anthracycline extravasation management
Cold therapy Topical dimethyl sulfoxie (but not that established) Dexrazoxane
65
Vinca alkaloid extravasation management
Heat therapy Hyaluronidase
66
Mechlorethamine extravasation management
sodium thiosulfate
67

BCPS (40 decks)

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