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NAPLEX Prep > Oncology - Supportive Care > Flashcards

Oncology - Supportive Care Flashcards

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1
Q

Chemo that doesn’t cause myelosuppression

A

Blemycin, pegspargase, vincristine

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2
Q

What is nadir

A

Lowest point that WBCs and platelet reach →7-14 days
RBC nadir occur several months

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3
Q

How long is WBC and platelet recover after chemo

A

3-4 weeks

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4
Q

What is neutropenia

A

<1000

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5
Q

What is severe neutropenia

A

<500

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6
Q

Drug that stimulate WBC production

A

Granulocyte Colony Stimulating Factor:
- Filgrstin
- Pegfilgastin

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7
Q

Filgrastim

A

Neupogen

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8
Q

Pegfilgrastin

A

Neulasta, Neulasta Onpro

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9
Q

How often to administer Neupogen

A

QD until post-nadir recovery

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10
Q

How often to adminster Neulasta

A

Once per chemo cycle

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11
Q

ADR of G-CSF

A

Bone pain, splenic rupture (upper abdominal pain)

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12
Q

Storage and admin of G-CSF

A

Store in refrigerator
Adminster no sooner than 24 hrs after chemo

Neulasta Onpro: on-body injector → delvers dose 27 hrs after chemo

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13
Q

Diagnostic criteria for febrile neutropenia

A

PO temp: ≥38.3 (101) x 1 reading
ANC <500

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14
Q

ABX recommend for febrile neutropenia

A

PA coverage:
Low risk (ANC ≤100 for 7 days and no cormorbities) → PO PA ABX → Cipro, Levo, Augmentin (G+) or Clindamycin (G+)

High risk (ANC ≤100 x 7days, comorbitites, Renal and hepatic impairment) → IV PA ABX → Zosyn, Meropenem, imipenem/cilastatin, cefepime, ceftazidime

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15
Q

Tx for thrombocytopenia

A

Platelet transfusion (if plt <10000)

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16
Q

TX of chemo-anemia

A
  1. Resolve on its own
  2. RBC transfusion (symptomatic)
  3. ESA
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17
Q

Indication for ESA

A

Palliative care (non curative cancer):
Hgb <10
Non-myeloid malignancy
Iron replacement if needed

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18
Q

ESA product

A

Epoetin alfa (Epogen, Procrt)
Darbopoeitin alfa (Aranesp)

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19
Q

Acute NV

A

<24 hr after chemo

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20
Q

Delayed NV

A

≥24 hr after chemo

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21
Q

Anticipatory NV

A

Before tx and develops as a condition response

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22
Q

Breakthrough NV

A

Occurs at any time

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23
Q

Chemo that has a higher risk for NV

A

Cisplatin

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24
Q

NK1-RAs

A

Aprepitant
Fosaprepitant
Rolapitant

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25
5-HT3RA
Dolasetron Granisetron Ondansetron Palonostetron
26
DRAs
Olanzapine Haloperidol Metoclopramide Prochlorperizine Promethazine
27
Other antinause
Dronabinol Dexamethasone Lorazepam
28
How to prevent acute NV
Adminster 30 min before chemo
29
Drug indicated for anticipatory NV
Lorazepam
30
Antiemetic regimen for high risk emesis (Cisplatin)
3 or 4 drugs: - Preferred: NK1-RA + 5HT3 RA + olanzapine + dexamethasone - NK1-RA + 5HT3 RA + dexamethasone + Palonesetron + olazapine + dexamethasone
31
Drugs for breakthrough CINV
5-HT3 RA and DRA
32
Aprepitant
Emend
33
Fosaprepitant
Emen
34
MOA of NK1 RA
Inhibit substance P/NK1R → augmenting antiemetic activity of 5-HT3EA and CS
35
MOA of 5-HT3RA
Block serotonin both peripherally on vagal nerve terminals and centrally on chemoreceptor trigger zone
36
Ondansetron
Zofran
37
Granesetron
Sancuso
38
Palonosetron
Aloxi
39
CI of 5-HT3RA
Apomorphine
40
5-HT3RA ADR
Serotonin syndrome QTc prolongation (limit IV zofran for <16 mg) → palonosetron is lowest risk HA, constipation
41
ADR of dexamethasone
HA, increased BP and BG, weight gain, insomnia, fluid retention
42
When to take Ativan
Start the eventing prior to chemo
43
Dexamethasone
Decadron
44
Lorazepam
Ativan
45
Olanzapine
Zyprexa
46
Prochlorperazine
Compro
47
Promethazine
Phenergan
48
Metoclopramide
Reglan
49
Haloperidol
Haldol
50
BBW of promethazien
Avoid in children <2YO → extravasation in intra-arterially, sc, and IV → serious tissue injury
51
ADR of DRA
PD exacerbation Sedation, lethargy, acute EPS (Benadryl and benzotropine), QTc prolongation
52
Dosing adjustment for Metoclopramide
CrCl <60 → reduce by 50%
53
Dronabinal
Marinol (C-III) Syndros (C-II)
54
ADR of dronabinol
Somnolence, euphoria, ↑ appetite
55
MOA of scopolamine
Anticholinergic Q72H behind ear
56
Pregnancy and chemo
Chemo is teratogenic → reliable barrier methods
57
Requirements to compound chemo
USP 800
58
Chemo that is a vesicant → necrosis. How do you mitigate
Antrocycline → cold compress with dexrazoxane or topical DMSO Vinca alkaloids → warm compress and hyaluronidase
59
When to adminster vaccines post chemo
≥2 wks Avoid live vaccines during chemo
60
Premedications for mAbs
APAP (650 mg PO) Diphenhydramine
61
Rituximab
Rituxan
62
Target of Rituxan
CD20
63
ADR of rituxamab
Hepatitis B reactivation → check panel prior
64
Cetuximab
Erbitux
65
66
ADR of Cetuximab
Acneiform rash → correlates with response to therapy Photosensitivity Reduce skin damage by topical steroids and ABX
67
Trastuzumab
Herceptin
68
Target of trastuzumab
HER2 overexpession
69
ADR of trastuzumab
Cardiotoxicity → monitor LVED using echo or MUGA scan Formulations are not interchangeable
70
Target of bevacizamab
VEGF inhibitor → inhibit growth of blood vessels needed for tumor proliferation Works on circulatory system
71
Bevacizamab
Avastin
72
ADR of Bevacizamab
Impaired wound healing (wait 28 days before or after surgery) Thromboembolic events Fatal bleeding GI perforation
73
PD1 inhibitors
Pembrolizumab Nivolumab
74
ADR of PD1 inhibitors
Immune-mediated toxicities
75
CTLA-4 inhibitors
Ipilimumab
76
ADR of Ipimumab
Immune-mediated toxicities
77
Target of Imatinib
BCR-ABL fusion gene
78
ADR of imatinib
Fluid retention QT prolongation Take with food to prevent GI upset
79
Imatinib
Gleevac
80
Target of Dabrafenib
BRAF V600E or V600K mutation
81
Target of Vemurafenib
BRAF V600E or V600K mutation
82
ADR of BRAF inhibitors
New malignancies QT prolongation

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