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NAPLEX Prep > Oncology I: Overview and Side Effect Management > Flashcards

Oncology I: Overview and Side Effect Management Flashcards

1
Q

neoadjuvant vs adjuvant

A

neoadjuvant is prior to chemo and adjuvant is after chemo

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2
Q

cancer warning signs

A

CAUTION
Change in bowel/bladder habits
A sore that wont heal
Unusual bleeding or discharge
Thickening or lump
Indigestion or difficulty swallowing
Obvious changes in wart or mole
Nagging cough or hoarseness

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3
Q

Breast Cancer Screening

A

40-44 annual mamo optional
45-54 annual mamo
>/=55 annual or q2yr mamo

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4
Q

cervical cancer screening

A

female 25-65 yo
papsmear q3yr
HPV test q5yr

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5
Q

At what age should patient receive colonoscopy

A

45 years old and every 10 years thereafter

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6
Q

What smoking frequency requires chest CT

A

20+ pack year history

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7
Q

max lifetime dose of doxorubicin
why?

A

450-550mg/m2
cardiotoxicity

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8
Q

max lifetime dose of vincristine
why?

A

2mg/single dose
peripheral neuropathy

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9
Q

max lifetime dose of bleomycin
why?

A

400 units
pulmonary toxicity

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10
Q

max lifetime dose of cisplatin
why?

A

100mg/m2 per cycle
nephrotoxicity
ototoxicity

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11
Q

methotrexate common toxicity

A

mucositis

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12
Q

nitrosureas common toxicity
drugs in class

A

lomustine
carmustine

neurotoxcity

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13
Q

common toxicity of vinca alkaloids and taxanes
drugs

A

vincristine
vinblastine
vinelorbine

paclitaxel
docetaxel

peripheral neuropathy

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14
Q

doxorubicin-induced cardiotoxicity prophylaxis treatment

A

dexrazoxane

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15
Q

cisplatin-induced neurotoxicity prophylaxis treatment

A

amifostine and water

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16
Q

5-FU-induced overdose treatment

A

uridine triacetate

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17
Q

cyclophosphamide or ifosfamide-induced hemorrhagic cystitis prophylaxis

A

mesna and hydration

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18
Q

irinotecan acute vs delayed diarrhea treatment

A

acute - loperamide
delayed - atropine

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19
Q

treatment for MTX toxicity prevention vs methotrexate antidote

A

prevention= leucovirin
antidote = glucarpidase

20
Q

nadir

definition
when occurs
when recovers
consequence

A

lowest point in platelet or WBC lab value

occurs at 7-14 days post chemo
recovers 3-4 weeks post treatment

increased risk of infection

21
Q

At what platelet value do you transfuse platelets

22
Q

neutropenia vs severe neutropenia vs profound neutropenia

A

WBC 500-1000 ntp
100-500 severe
<100 profound

23
Q

treatment of neutropenia

A

G-CSF
- filgrastim (Neupogen) 5mcg/kg/day until ANC >2,000

Pegylated G-CSF
- Pegfilgrastim (Neulasta) 6mg SC x1/cycle (>14 days apart)

24
Q

Adverse effects of G-CSF and pegylated G-CSF

A

bone pain, fever, arthralgias, rash
monitor for s/sx enlarged spleen

25
what is the benefit of pegylated G-CSF
longer half-life
26
febrile neutropenia dx
temp >/=38.3 once or >/= 38 for 1 hour PLUS ANC <500 or <1000 and expected to decrease to <500 in next two days
27
febrile neutropenia treatment
low risk (ANC <100 and no comorbidities) --> po cipro or levofloxacin as anti pseud PLUS amox/clav (clinda if allergy) high risk (ANC <100 with comorbidities, CrCl <30 or LFTs >5x ULN) --> IV antipseud (pip/tazo, cefepime, ceftazidime, meropenem, imepenem/cilastatin)
28
risk factors for chemotherapy induced nausea and vomiting (CINV)
female <50 anxiety, depression dehydration hx of CINV or motion sickness
29
what is the appropriate timing for CINV treatment
initiate antiemetics 30 min prior to chemo
30
5-HT3 receptor antagonists used in CINV
ondansetron palonosetron granisetron dolasetron
31
NK1RAs used in CINV
aprepitant po aprepitant IV fosaprepitant IV rolapitant
32
Akynzeo generic
netupitant/palonosetron PO or fosnetupitant/palonosetron IV
33
which chemo agent has highest emetic risk
cisplatin
34
which antiemetics are used acutely (<24h after chemo)
5HT3 RAs NK1RAs dexamethasone olanzapine
35
which antiemetics are used in delayed CINV (>24h after chemo)
NK1RA corticosteroids olanzapine palonosetron granisetron ER SQ
36
Patient is initiated on low emetic risk chemo. Which agents can be used for CINV ppx? How are these administered?
One of the following as IV 1. dexamethasone 2. metoclopramide 3. prochlorperazine 4. 5HT3 RA PO option = 5HT3RAs LOW RISK = ONE MED
37
Patient is to start a moderate CINV risk chemotherapy. What are CINV ppx options? How are they administered?
NEED >/= 2 AGENTS administered IV * = preferred regimen Day 1 Day 2-3 *dexam dexam or *5HT3RA 5HT3RA olanzapine olanzapine dexam palonosetron NK1RA NK1RA (aprepitant po day 2-3 if po given on day 1) dexam 5HT3RA TIP=if olanzapine is given on day 1, must be given day 2-3
38
Patient is to start a high CINV risk chemotherapy. What are CINV ppx options? How are they administered?
NEED >/= 3 AGENTS administered IV * = preferred regimen Day 1 Day 2-FOUR *dexam dexam *olanzapine olanzapine *NK1RA NK1RA (aprepitant po day 2-4 if po given on day 1) *5HT3RA 5HT3RA olanzapine olanzapine dexam palonosetron NK1RA NK1RA (aprepitant po day 2-3 if po given on day 1) dexam dexam 5HT3RA TIP=if olanzapine is given on day 1, must be given day 2-4
39
prochlorperazine, metoclopramide, promethazine MOA use ADE
DA-R antagonists breakthrough CINV sedation, EPS, acute dystonia
40
chemo induced diarrhea treatment
irinotecan atropine/diphenoxylate
41
oral mucositis common causative chemo agents treatment
5-FU and MTX 2% viscous lidocaine soft toothbrush ice chips (vasoconstrict and prevent chemo delivery to mouth mucosa) can rinse with NaCl or NaHCO3 solutions
42
treatment for patients that develop oral candidiasis from chemo-induced mucositis
nystatin suspension or clotrimazole troches
43
viscous lidocaine 2% for oral mucositis in chemo is contraindicated in what age group
<3 yo
44
hand-foot-mouth disease (plamar-plantar-erythrodysesthesia = PPE) common causative chemo agents treatment options
5-FU, liposomal doxorubicin, TK-i (sorafetinib, sunitinib), cytirabine, capecitabine tx: emollients (aquaphor), topical steroids, pain meds, cool compress avoid abrasive activities and tasks requiring clenching hands
45
tumor lysis syndrome laboratory findings treatment
hyperkalemia hypocalcemia (potassium binds Ca and deposits in kidneys) hyperphosphatemia hyperuricemia (leads to gout) tx = allopurinol 400 to 800 mg/day with IV NS to flush kidneys
46
hypercalcemia of malignancy patho treatment
cancer causes calcium resorption into blood which increases fracture risk and serum Ca treatment: zolendronic acid (bisphosphonate) 4mg IV x1 and IV NS
47
how long before chemotherapy initiation should vaccines be given
at least 2 weeks before

NAPLEX Prep (57 decks)

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