Supportive Care I [NEED TO FINISH]

Question 1

What is the pathophysiology of Chemotherapy Induced Nausea/Vomiting?

Answer 1

• Begins in the GI Tract cytotoxic chemotherapy that damages the epithelial cells [Enterochromaffin] releasing LARGE amounts of serotonin

Basically a lot of Serotonin?

Question 2

When the serotonin is released, what gets activated?

Answer 2

• Chemoreceptor Trigger Zone [CTZ] stimulating vomiting center

Question 3

What are some of the complications that can occur with vomiting?

Answer 3

• Dehydration, Electrolyte Abnormaliltes, Fatigue, Depression

Question 4

What are the different types of Nausea/Vomiting?

Answer 4

• Anticipatory, Acute, Delayed, Breakthrough, Refractory

Question 5

What is Anticipatory Nausea/Vomiting?

Answer 5

• Conditioned by previous emetic reactions that are provoked by sight, sound or smell

Question 6

What is Acute Nausea/Vomiting?

Answer 6

• Occurs within 24 hours of Chemotherapy

Question 7

What is Delayed Nausea/Vomiting?

Answer 7

• Occurs > 24 hours of Chemotherapy

Question 8

What is Breakthrough Nausea/Vomiting?

Answer 8

• Occurs even if on anti-emetics

Question 9

What is Refractory Nausea/Vomiting?

Answer 9

• Persists despite anti-emetics [FAILED]

Question 10

What neurotransmitters are affected with CINV?

Answer 10

• Dopamine, Histamine, Acetylcholine, Serotonin, Substance P

Question 11

What is the MOST emetogenic chemotherapy agent?

Answer 11

• Cisplatin

Question 12

What are some of the risk factors for CINV?

Answer 12

• Women > Men
• Young > Old
• Previous Motion or Morning Sickness
• Anxiety

Question 13

What important things to know about the treatment guidelines for CINV?

Answer 13

• Prophylaxis
• 5-HT can be substituted between each-other
• Oral = IV

Question 14

What are the drug regimens used in HIGHLY emetogenic patients?

Answer 14

• A: NK-1 Antagonist, Steroid, 5-HT3 Antagonist, Antipsych
• B: NK-1 Antagonist, Steroid, 5-HT3 Antagonist
• C: Steroid, 5-HT3 Antagonist, Antipsych

Question 15

What are the drugs regimens used in MODERATELY emetogenic patients?

Answer 15

• A: Steroid, 5-HT3 Antagonist
• B: Steroid, 5-HT3 Antagonist, Antipsych
• C: NK-1 Antagonist, Steroid, 5-HT3 Antagonist

Question 16

What are the drug regimens used in LOW emetogenic patients?

Answer 16

• Steroid, 5-HT3 Antagonist [PICK ONE]

Question 17

What are some of the drugs that can be used for Breakthrough Nausea/Vomiting?

Answer 17

• Dopamine Antagonist [Haloperidol, Metoclopramide]
• Phenothiazines [Procholorperazine, Promethazine]
• Antipsych [Olanzapine]
• Benzo [Lorazepam]
• Cannabinoids [Dronabinol, Nabilone]
• Serotonin Antagonist [“-setron”]
• Steroids [Dexamethasone]
• Anticholinergic [Scopolamine]

Question 18

What are some of the drugs that are used for Delayed Nausea/Vomiting?

Answer 18

• Dexathasone OR…
• NK-1 Antagonist OR…
• Olanzapine

Question 19

What are some of the drugs that are used for Anticipatory Nausea/Vomiting?

Answer 19

• PREVENTION
• Behavioral [Relax, Hypnosis, yoga…]
• Lorazepam

Question 20

What are some of the common toxicites for 5-HT3 Antagonist?

Answer 20

• Headache [switch 5-HT3s], QTC prologation, Constipation

Question 21

What are some of the common toxicities for Corticosteroids?

Answer 21

• Insomia, Hyperglycemia

Question 22

What are some of the common toxicities for Substance P Antagonist [“-pitant”]?

Answer 22

• Hiccups, drug interactions [steriods]

Question 23

What are some of the common toxicities for Dopamine antagonist?

Answer 23

• Diarrhea, Sedation

Question 24

What are some of the common toxicities for Olanzapine?

Answer 24

• Sedation

Question 25

What are some of the common toxicities for Phenothiazines?

Answer 25

- Sedation, Tissue Damage [promethazine]

Question 26

What are some of the common toxicities for Cannibaniods?

Answer 26

- Drowsiness, dizziness, hallucination

Question 27

What are some of the common toxicities for Lorazepam?

Answer 27

- Sedation, Hallucination

Question 28

What are some of the common toxicities for Scopolamine?

Answer 28

- Anticholinergic

Question 29

What are some important principles that are related to emetogenicity prevention and management?

Answer 29

- Emetogenicity is additive [Two Mod agents = 1 high agent] - Tailored accordingly - PROPHYLAXIS [5-30 mins before chemo]

Question 30

What is the Pathophysiology for Mucositis?

Answer 30

- GI mucosa that has a rapid turnover rate --> inflammation or ulcerations [top to bottom]

Question 31

What are some of the risk factors for Mucositis?

Answer 31

- **Poor Dental hygiene** - Combo treatments [**Chemo & Rads**]

Question 32

What is Neutropenia?

Answer 32

- Decreased WBC [<500] --> Increases life-threatening infections

Question 33

What is important to know about Neutropenia?

Answer 33

- Myelosuppression is dose limiting [chemo] - Occurs 10-14 days after chemo

Question 34

What is Severe Neutropenia & Febrile Neutropenia?

Answer 34

- Severe: ANC < 500 [increase infection] - Febrile: ANC < 500 + 101 F

Question 35

Within netropenia, what is the main treatment?

Answer 35

- **Colony Stimulating Factors** [**Increases WBC**] - Primary Prophylaxis: receives chemo >20% of febrile netropenia - Secondary Prophylaxis: Netropenic event from previous cycle

Question 36

What are the different Conlony stimulating agents that are used in Netropenia?

Answer 36

- Filgrastim [main] - Pegfilgrastim [pegylated]

Question 37

What are some of the averse effects of Colony stimulating agents?

Answer 37

- $$$ - Flu-like symptoms [because of WBC], bone and joint pain, DTV

Question 38

What is Thrombocytopenia?

Answer 38

- Platelet count of < 100 x 10^3/uL

Question 39

What is the treatment for Thrombocytopenia?

Answer 39

- GIVE PLATELETS

Question 40

What is anemia?

Answer 40

- Decrease in blood cell production - Blood loss

Question 41

What is the main thing to do when a patient has chemotherapy induced anemia?

Answer 41

- Symptomatic? - **Transfuse**, ESAs [not really recommended],**Iron**

Question 42

What are the two main ESAs that are used in Anemia?

Answer 42

- Erythropoietin, Darbepoetin

Question 43

What is important to know about Iron in anemic cancer patients?

Answer 43

- **ALL patients** that have ESA **should have IRON studies**[Serum Ferritin, Iron, Iron Saturation]

Question 44

What is important to know about the iron products in Anemia?

Answer 44

- Iron Dextran: IN infusion - Iron Surcrose: IV injection - Ferric Gluconate: Iv Injection

Question 45

What are some of the classic chemo toxicites? | Pains? Bladder? Cardio? Neruo? Pulmonary?

Answer 45

- **Pains**: -Taxenes & AI [use NSAIDS or Opioids] - **Bladder**: Cyclophosphamide [HYDRATE or Mesna] - **Cardio**: -Rubicins & HER2+ [**Dexrazoxane**] - **Neuro**: -taxanes, vincas, plats [Gabapentin] - **Pulmonary**: Bleomycin [corticosteroids]

Question 46

What is Mesna and what does it help?

Answer 46

- **Decreases the risk of Hermorrahgic Cyctitis** [from cyclophosmide] - BINDS the **acrolin**

Question 47

What causes the cardiotoxicities within cancer?

Answer 47

- Formation of iron-oxygen free radicals [from the "rubicins" making irreversible damages

Question 48

What are the types that are related to chemo induces cardiac dysfunction?

Answer 48

- Type I -- Acute: like heart attack -- Chronic: getting a year of rubicins [DANGER] -- Late-onset: Several years of therapy - Type II - HER2 [Reverisble]