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444-Oncology and Neurology > Prevention and Management of Antineoplastic AEs > Flashcards

Prevention and Management of Antineoplastic AEs Flashcards

1
Q

what does the CTCAE stand for

A

common terminology criteria for AEs

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2
Q

Asymptomatic or mild sx
Clinical or diagnostic observations only
Interventions not needed

A

grade 1

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3
Q

Minimal sx
Local or noninvasive intervention indicated

A

grade 2

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4
Q

Severe or medically significant but not immediately life threatening
Hospitalization or prolongation of hospitalization indicated

A

grade 3

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5
Q

Life threatening consequences
Urgent intervention indicated

A

grade 4

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6
Q

death grade

A

5

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7
Q

mouth related AEs to chemo

A

cracked, dry lips
dry mouth
mucositis
taste changes
cavities
thick saliva

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8
Q

define oral mucositis

A

acute inflammation and or ulceration of the oral or oropharyngeal mucosal membranes
can cause pain/ discomfort and interfere with eating, swallowing, and speech

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9
Q

causes of oral mucositis

A

radiation of head, neck, salivary glands, total body
chemo continuous or at high doses
hematopoietic stem cell transplant (HSCT)

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10
Q

RF for oral mucositis

A

xerostomia
poor oral health
dehydration
alcohol/ tobacco use
O2 therapy

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11
Q

prevention for oral mucositis

A

good oral hygrine
alcohol free chlorhexidine rinses
bland mouth rinses after meals
cryotherapy

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12
Q

what should be used as an extra precaution against oral mucositis if there is head/neck radiation treatment

A

high fluoride toothpaste or fluoride trays

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13
Q

when should cryo not be used as a precaution against oral mucositis?

A

if using oxaliplatin

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14
Q

how to do cryo for oral mucositis prevention

A

hold ice chips, popsicles, or cold water in mouth 5 min prior, during, and 30 min after infusion (do not use with oxiplatin)

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15
Q

what should be avoided in oral mucositis

A

Commercial mouthwashes with alcohol, hard/ acidic/ spicy/ salty foods, poorly fitting dentures (may need to refit after weight loss), caffeine, alcohol, tobacco

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16
Q

Moderate pain, not interfering with oral intake, modified diet indicated grade for oral mucositis

A

grade 2

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17
Q

oral mucositis that is interfering with eating is classified as

A

grade 3

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18
Q

treatment for grade 1-2 oral mucositis includes (4 things)

A

bland rinses
benzdyamine HCL rinses
pain control with systemic or topical analgesics
sips of water

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19
Q

treatment for grade 2-3 oral mucositis

A

switch from toothbrush to oral sponge
pink ladies
akabutu’s mouthwash

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20
Q

what is pink ladies for oral mucositis

A

lidocaine + aluminium hydroxide + magnesium hydroxide

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21
Q

caution with pink ladies

A

fatal arrhythmias from systemic eff of lidocaine

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22
Q

why is akabutu’s mouthwash sus

A

thrush (d/t corticosteroid)
resistance due to subtherapeutic lvl of nystatins
may not be better than saline for healing time
expensive

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23
Q

what is akabutu’s mouthwash

A

nystatin, lido, NaCl, hydrocortisone, glycerin

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24
Q

how to use akabutu’s mouthwash

A

swish 15-20mL F1min, spit, q4-6hrs PRN

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25
Q

what to use for grade 3-4 oral mucositis

A

topical opioid mouthwash (morphine)
lidocaine viscous 2%
tetracaine 0.5% lollipops
systemic pain control- maybe opioids

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26
Q

which of the following mouthwashes can you swallow?
1. lidocaine viscous 2%
2. morphine mouthwash
3. tetracaine mouthwash
4. akabutu’s mouthwash
5. pink ladies

A

lidocaine viscous for pharyngeal mucositis

27
Q

tx for grade 4 oral mucosotis

A

hospitalization + pt controlled analgesia of iV opioids

28
Q

____ can be given for oral mucositis for those on everolimus

A

dexamethasone 0.5mg/5mL

29
Q

what is doxepin 0.5% mouthwash used for?

A

oral mucositis

30
Q

what is hand food syndrome or PPE

A

redness and pain on palms of hands and feet

31
Q

RF for PPE

A

> 65yrs
female
friction
heat
excessive alcohol use

32
Q

most common culprits of PPE

A

capecitabine, 5FU, sorafenib, cytarabine, docetaxel and paclitaxel

33
Q

first sx of PPE

A

tingling and numbness of soles and palms

34
Q

PPE prevention

A

skincare / hygiene
avoid head (including wearing gloves while washing the dishes)
foot care- comfy fitted shoes
hand care- avoid chemicals and stressing actions (clapping)

35
Q

Minimal skin changes or dermatitis (erythema, edema, or hyperkeratosis without pain)

A

grade 1

36
Q

Skin changes (peeling, blisters, bleeding, edema, or hyperkeratosis) with pain, limiting instrumental ADH

A

grade 2

37
Q

Severe skin changes (peeling, blisters, bleeding, edema, or hyperkeratosis) with pain, limiting self care ADL

A

grade 3

38
Q

PPE treatment

A

oral analgesics, topical CS, cool packs on palms
emollients
oral dexamethasone
celecoxib

39
Q

when would you not recommend flossing to a pt with oral mucositis

A

if it causes pain/ bleed or if platelets <50

40
Q

chemo induced alopecia usually sets in by

A

1-3wks

41
Q

how long after chemo will hair come back?

A

6-8wks

42
Q

most common antineoplastics for alopecia

A

cyclophosphamide
anthracyclines
taxanes
etoposides

43
Q

what antineoplastics are commonly associated with hypersensitivity rxns

A

taxanes
platinums
bleomycin
monoclonal abx (rituximan)

44
Q

when do hypersensitivity/ infusion reactions to antineoplastics usually happen

A

first few min/hours of first dose but can be up to 48hrs later

45
Q

how to prevent hypersensitivity reactions to chemo

A

follow recommendations of spec meds
incorporate 1 or more: systemic CS, HH1 antagonist, H2 antagonist, and an antipyretic

46
Q

what are some systemic CSs that can be incorporated to prevent hypersens rxns

A

hydrocortisone
prednisone
dexamethasone

47
Q

what to do if hypotension is a concern for chemo pt

A

if they have antihypertensives- ask them to hold for 24hrs pre chemo

48
Q

what to do if pt has a hypersensitivity rxn to chemo

A

stop infusion, start supportive care with CS, antihistamines, antipyretics, oxygen
rechallenge if mild-mod reaction

49
Q

what antineoplastic agents are commonly associated with constipation

A

vinca alkaoids
5HT3RA
opioids

50
Q

what should chemo pts do after meals if they’re prone to constipation?

A

try to poop 30-60min after eating to take advantage of gastrocolic reflex

51
Q

what should be avoided for constipation if pt is on myelosuppressive chemo?

A

suppositories, enemas, rectal exams due to lo platelet count or neutropenia

52
Q

what should be monitored if pt is constipated on chemo

A

BM frequency, stool appearances, effort to defecate

53
Q

what are some warnng sgns of bowel obstructon

A

can’t pass gas
sudden watery darrhea after constpaton

54
Q

f pt has no BM after ____days they need pharm help

A

3

55
Q

what are some symptoms of possible spinal cord compression

A

sensory loss and motor weakness = refer to ER

56
Q

Occasional or intermittent sx, occasional use of stool softeners, laxatives, dietary mod, or edema

A

grade 1

57
Q

Persistent sx w/ regular laxatives or enemas, limiting instrumental ADLs

A

grade 2

58
Q

Constipation with manual evacuation indicated, Limiting self care ADL

A

grade 3

59
Q

what types of laxatives should be given to chemo induced constipaiton?

A

sennosides
PEG is sennosides are too harsh

60
Q

how to use sennosides for chemo induced constipation

A

start with regular dosing then progressively increase until normal bowel pattern restored and movements are soft and comfortable to pass

61
Q

how long does PEG take to work?

A

2-3d

62
Q

when can you use rectal products for chemo induced constipation

A

if pt not at risk of neutropenia or thrombocytopenai

63
Q

if constipation with pervious chemo sessions, consider ___________

A

prophylactic PEG3350

444-Oncology and Neurology (22 decks)

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