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PHM703 Heme/Onc 1 > Supportive Care > Flashcards

Supportive Care Flashcards

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1
Q

chemo induced nausea and vomiting (CINV)

A

-increases morbidity
-negatively effects patients quality of life
-non-adherence to chemo and/or dose reductions
-decline in behavioral and mental status

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2
Q

acute CINV

A

occurring within the first 24 hours after initiation of chemo

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3
Q

delayed CINV

A

occurring from 24 hours to several days (2-5) after chemo

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4
Q

breakthrough CINV

A

occurring despite appropriate prophylactic treatment

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5
Q

anticipatory CINV

A

occurring before a treatment as a conditioned response to the occurrence of CINV in previous cycles

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6
Q

refractory CINV

A

recurring in subsequent cycles of therapy, excluding anticipatory CINV

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7
Q

general principles of emesis control

A

-prevention is key!
-for chemo regimens with multiple agents, prophylaxis should be based on agent with highest emetic risk

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8
Q

risk factors for CINV

A

emesis during pregnancy, age <50, female, anxiety/high pretreatment expectations of nausea, little or no previous alcohol use, history of CINV, prone to motion sickness

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9
Q

emesis prevention- high emetic risk parenteral agents: day 1

A

olanzapine, dexamethasone, NK1 RA, 5-HT3 RA

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10
Q

emesis prevention- high emetic risk parenteral agents: days 2-4

A

olanzapine, dexamethasone, aprepitant

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11
Q

emesis prevention- moderate emetic risk parenteral agents: day 1

A

dexamethasone, 5-HT3 RA

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12
Q

emesis prevention- moderate emetic risk parenteral agents: day 2-3

A

dexamethasone or 5-HT3 RA

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13
Q

emesis prevention- low emetic risk parenteral agents

A

dexamethasone or metoclopramide or prochlorperazine or 5-HT3 RA

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14
Q

emesis prevention- oral agents

A

5-HT3 RA

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15
Q

breakthrough emesis treatment

A

-add one agent from a different class to current regimen
-consider atc admin over prn
-consider antacid is pt has dyspepsia

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16
Q

breakthrough emesis drug options

A

olanzapine, lorazepam, dronabinol, 5-HT3 RA, prochlorperazine, dexamethasone, metoclopramide, scopolamine

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17
Q

anticipatory emesis treatment

A

-prevention is key!
-avoid strong smells
-lorazepam is useful in anxiety-related
-acupuncture
-behavioral therapy

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18
Q

anticipatory emesis behavioral therapy options

A

guided imagery, relaxation, hypnosis, cognitive distraction, yoga, biofeedback, progressive muscle relaxation

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19
Q

dexamethasone AE

A

insomnia (take in morning), dyspepsia (take w food), hyperglycemia, hypertension

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20
Q

5-HT3 RA agents

A

-ondansetron, granisetron: preventing acute CINV
-palonosetron: preventing acute and delayed CINV

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21
Q

5-HT3 RA AE

A

headache, constipation, QTc prolongation

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22
Q

NK1 agents

A

aprepitant, fosaprepitant, rolapitant, fosnetupitant/polansetron, netupitant/polasetron

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23
Q

rolapitant pearl

A

extended half life, should not be admin in <2wk intervals

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24
Q

olanzapine AE

A

sedation (morning admin), hyperglycemia, fatigue, QTc prolongation

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25
cancer treatment induced diarrhea (CTID)
-can causes dehydration and malnutrition -chemo delays or reductions
26
assessment of CTID
-history -volume and duration of diarrhea -hydration status -fever, dizziness, abd pain, weakness
27
nonpharm management of CTID
-avoidance of foods that would aggravate the diarrhea -aggressive oral/IV hydration and electrolyte replacement
28
pharm management of CTID
1. loperamide 2. diphenoxylate-atropine
29
refractory CTID treatment
-octreotide -tincture of opium -probiotics -rule out c. diff and inf colitis
30
grade 1 CTID management
-loperamide -consider adding bulk-forming agents -diphenoxylate-atropine prn
31
grade 2 CTID management
-initiate/continue loperamide -diphenoxylate-atropine q6h prn -consider hyoscyamine prn -consider atropine prn
32
grade 3-4 CTID management
-initiate/continue loperamide -diphenoxylate-atropine prn -consider hyoscyamine prn -consider atropine prn -consider octreotide q8h inf
33
mucositis complications
decrease oral intake, increase infection risk, pain
34
mucositis vs stomatitis
muco: ulcerative lesions of the mucosa treated with chemo anywhere in the GI tract stoma: mucositis limited to the oral cavity
35
prevention of mucositis
oral hygiene and cryotherapy
36
management of CIM: oral decontamination
-bland or oncology mouthwash -dexamethasone mouthwash for everolimus-induced
37
management of CIM: pain control
-2% viscous lidocaine swish and spit -systemic opioids
38
management of CIM: palliation of dry mouth
artificial saliva products or chewing gum to increase saliva production
39
management of CIM: nutritional support
-liquid or soft diet -TPN
40
management of CIM: oral candidiasis treatment
fluconazole
41
neutropenia definition
neutro: ANC <500 profound neutro: <100 prolonged: >10d
42
neutropenia consequences
-dose reduction or treatment delays -compromise clinical outcomes -longer hospital stays -increase treatment costs -decreased quality of life
43
risk factors for febrile neutropenia
-prior chemo or radiation -persistent neutropenia -bone marrow involvement -recent surgery and/or open wounds -liver/renal dysfunction -age >65
44
primary prevention for high (>20%) risk febrile neutropenia
-regardless of risk factors -G-CSFs recommended
45
primary prevention for intermediate (10-20%) risk febrile neutropenia
->/1 risk factor -consider G-CSFs
46
primary prevention for low (<10%) risk febrile neutropenia
->/ risk factors -G-CSFs may be considered
47
primary prevention of neutropenic fever agents (G-CSF)
filgrastim, pegfilgrastim, eflapegrastin
48
filgrastim
-short acting -start up to 3-4d after completion of chemo -given 5mcg/kg daily until ANC recovery
49
pegfilgrastim
-long acting -admin up to 3-4d after completion of chemo -singe admin ->/12d b/t dose and next round of chemo
50
eflapegrastim
-long acting -adming 24h after completion of chemo -single admin -do not admin 14d before and 24h after chemo
51
did patient receive prophylactic G-CSFs?
-filgrastim > continue -pegfilgrastim or efta > no additional needed -did not receive > assess risk factors
52
possible indications for G-CSF use in established febrile neutropenia
sepsis, age >65, ANC <100, >10d, pneumonia, invasive fungal inf, hospitalization, prior episode
52
secondary prevention for febrile neutropenia
prior use of G-CSFs > chemo dose reduction or change in treatment no prior use > consider use
52
classes of cancer pain (CP)
somatic, visceral, neuropathic
53
somatic CP
-tumor involves bone, muscle, connective tissue -aching, stabbing, throbbing, pressure
54
visceral CP
-tumor involves internal organs, and blood vessels -gnawing, cramping, aching, sharp pain
55
neuropathic CP
-sustained by damage or dysfunction in the nervous system -burning, tingling, shooting, electric/shocking pain
56
management of cancer pain
-non-opioid: acetaminophen, NSAIDs -adjuvant: antidepressants, anticonvulsants, corticosteroids, topical analgesic -opioids
57
mild-moderate immune mediated AE management
-symptomatic management -local therapies preferred if available -consider delaying immunotherapy -corticosteroid may be required
58
severe immune mediated AE management
-hold immunotherapy -corticosteroid therapy required -possible additional immunosuppressant -inpatient management may be necessary
59
corticosteroid management for immune mediated AE
-systemic -prednisone or methylprednisolone -prolonged taper (4-12wks)
60
corticosteroid supportive care
-gastritis: PPI or H2RA -infection: bactrim or fluconazole -osteoporosis: vitamin D

PHM703 Heme/Onc 1 (5 decks)

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