Supportive Care Cancer Final Exam

Question 1

What is the MOA of n/v in chemo

Answer 1

1. chemo induces damage to GI mucosa
2. Lots of serotonin released from GI
3. chemo receptor trigger zone stimulates vomiting center
4. emesis

Question 2

what are risk factors for CINV

Answer 2

women > men
younger > older
hx of motion sickness and or morning sickness
previous CINV
anxiety w/ nausea
chronic ethanol can be protective

Question 3

what are the regimens for highly emetogenic

Answer 3

4 drug or 3 drug regimen

Question 4

what are the regimens for moderately emetogenic

Answer 4

2 drug or 3 drug

Question 5

what are the drug regimens for low emetogenic

Answer 5

1 drug

Question 6

what drugs are in the 4 drug regimen

Answer 6

any NK-1 antagonist
steroid (dex)
5HT3
olanzapine

Question 7

what drugs are in the 3 drug regimen

Answer 7

5HT3
Steroid
NK1 antagonist or olanzapine

Question 8

what drugs are in the 2 drug regimen

Answer 8

steroid
5HT3

Question 9

what drug is in the 1 drug regimen

Answer 9

Dex, metoclopramide, prochlorperazine, or any 5HT3

Question 10

what are NK1 antagonists for CINV

Answer 10

aprepitant
fosaprepitant
rolapitant

Question 11

what is the steroid for CINV

Answer 11

dexamethasone

Question 12

what are the 5HT3 antagonists for CINV

Answer 12

dolasetron
granisetron
ondansetron
palonsetron

Question 13

what other drugs can be added to CINV drug regimens

Answer 13

Lorazepam PRN or H2/PPI

Question 14

what are good add ons for breakthrough NV

Answer 14

haloperidol
metoclopramide
prochlorperazine
promethazine
lorazepam
cannabinoids

Question 15

what drugs should be utilized in delayed NV

Answer 15

steroid, NK1, 5HT3

Question 16

what should be used in anticipatory NV

Answer 16

benzos, behavioral, prevention

Question 17

how to prevent radiation induced emesis

Answer 17

pretreat for each day of radiation 5HT3 +/- dex

Question 18

what are toxicities of 5HT3 drugs

Answer 18

EKG changes
constipation
headache

Question 19

what are risk factors for mucositis

Answer 19

continuous chemo infusions
hx oral lesions
poor dental hygiene
chemo and radiation at the same time

Question 20

how to prevent mucositis

Answer 20

avoid trigger foods
choose soft/simple foods
avoid smoking and alcohol

Question 21

what are the pain management options for mucositis

Answer 21

topical anesthetics (magic mouthwash)
cryotherapy
sucralfacte
po/iv opioids (PCA pump)

Question 22

what is the most common dose limiting toxicity of chemo

Answer 22

bone marrow suppression

Question 23

what is neutropenia

Answer 23

< 0.5 x 10^3 WBC

Question 24

when does neutropenia usually occur

Answer 24

at the nadir
10-14 days after chemo

Question 25

should you administer chemo if a patient is neutropenic?

Answer 25

Depends. Only if curable disease and they can tolerate it

Question 26

when to use primary prophylaxis for neutropenia

Answer 26

-if patient is getting chemo that causes febrile neutropenia -high risk patients (pre-existing neutropenia, extensive prior hemo, irradiation of bones with lots of marrow)

Question 27

when to use secondary prophylaxis for neutropenia

Answer 27

if patient had neutropenic complication from previous chemo cycle

Question 28

what are the CSFs to use for neutropenia

Answer 28

filgrastim pegfilgrastim biosimilars

Question 29

when to give platelets

Answer 29

count is less than 100 x 10^3

Question 30

when to treat anemia in cancer

Answer 30

if hemoglobin is really low (around 7)

Question 31

how to treat anemia in cancer

Answer 31

-transfusions -treat symptoms -iron -esa

Question 32

when are ESAs not recommended

Answer 32

curative cancer pts not getting chemo non-myelosuppressive chemo

Question 33

when to use ESAs

Answer 33

CKD palliative chemo

Question 34

how to dose ESAs

Answer 34

dose to maintain lowest hemoglobin level

Question 35

what chemo causes myalgias/arthralgias

Answer 35

microtubules (taxels) aromatase inhibitors

Question 36

what chemo causes hemorrhagic cystitis

Answer 36

cyclophosphamide

Question 37

what chemo causes heart failure

Answer 37

doxorubicin trastuzumab

Question 38

what chemo causes peripheral neuropathy

Answer 38

taxanes, platinums, vinca alkaloids

Question 39

what chemo causes pulmonary toxicity

Answer 39

bleomycin

Question 40

what are the common opioids for cancer pain

Answer 40

morphine hydromorphone oxycodone fentanyl methadone

Question 41

what opioids should be avoided in liver dysfunction

Answer 41

morphine, hydromorphone, oxycodone

Question 42

when to use methadone

Answer 42

morphine allergy pain refractory long acting, low cost option

Question 43

who should avoid methadone

Answer 43

syncope or arrhythmias

Question 44

what is the preferred route for opioids

Answer 44

oral

Question 45

how to treat opioid induced constipation

Answer 45

stimulant +/- stool softener

Question 46

how to treat opioid induced over sedation

Answer 46

wait for tolerance hold sedatives dose reduce

Question 47

how to treat pruritis with opioids

Answer 47

decrease dose or switch drug add antihistamine if needed

Question 48

how to treat opioid induced respiratory depression

Answer 48

hold opioid give low dose naloxone slowly to bring back

Question 49

what is the equation for corrected calcium

Answer 49

serum calcium + 0.8(4 - serum albumin)

Question 50

what is the normal calcium level

Answer 50

8.5-10

Question 51

what are the degrees of hypercalcemia

Answer 51

< 12 mild 12-14 moderate > 14 severe

Question 52

how to treat mild HCM

Answer 52

hydration d/c meds

Question 53

how to treat moderate HCM

Answer 53

hydrate IV/loops bisphosphonate

Question 54

what drugs can be used in HCM

Answer 54

zoledronic acid pamidronate

Question 55

how to treat severe HCM

Answer 55

hydration/loops bisphosphonates calcitonin

Question 56

how to treat bony mets

Answer 56

radiation chemotherapy IV agents

Question 57

do you renal adjust bisphosphonates for Skeletal Related Events

Answer 57

yes

Question 58

when to use denosumab

Answer 58

bony mets from solid tumors

Question 59

what should be done before starting denosumab

Answer 59

correct calcemia prior to start

Question 60

what are AEs of bone agents

Answer 60

Osteonecrosis of jaw renal dysfunction hypocalcemia bone pain Nausea Diarrhea Fatigue