symptom and side effect management

Question 1

what are 3 risk factors for nonmedical opioid use?

Answer 1

personal or FH of drug or alcohol abuse, personal or FH of mental health disorder, (anxiety, depression, history of abuse, history of PTSD)

Question 2

reaction type which is uncommon, unpredictable, and unrelated to a drug’s mechanism of action

Answer 2

idiosyncratic reaction

Question 3

infusion reaction mediated by IgE and requires previous exposure

Answer 3

allergic reaction

Question 4

resembles a type I interaction with mast cell degranulation

Answer 4

pseudo-allergic or anaphlactoid reaction

Question 5

reaction characterized by fever, nausea, headache, tachycardia, hypotension, rash, and shortness of breath

Answer 5

cytokine release syndrome

Question 6

this type of hypersensitivity reaction occurs in seconds to minutes

Answer 6

Gell and Coombs type I, IgE mediated reactions

Question 7

this type of hypersensitivity reaction occurs in minutes to hours

Answer 7

Gell and Coombs type II, antibody mediated cytotoxic reaction

Question 8

this type of hypersensitivity reaction occurs in several hours

Answer 8

Gell and Coombs type III, immune complex mediated reaction

Question 9

this type of hypersensitivity reaction occurs in hours to days

Answer 9

Gell and Coombs type IV, delayed t-cell mediated responses

Question 10

carboplatin and oxiloplatin generally cause what G&C type reaction

Answer 10

type I, IgE mediated reaction

Question 11

which drugs produce reactions that aren’t a true type I hypersensitivity, but are indistinguishable and may be a result of direct effects on immune cells

Answer 11

paclitaxel and docetaxel

Question 12

what excipiant used in what drug has been shown to induce histamine release and hypotension?

Answer 12

cremaphor, paclitaxel. Albumin bound paclitaxel doesn’t contain cremaphor

Question 13

what type of reaction doesn’t require prior exposure and is more likely to occur at the first exposure?

Answer 13

infusion related reaction

Question 14

what anti-CD20 monoclonal antibody causes infusion reaction in up to 80% of patients

Answer 14

rituximab

Question 15

what percent of patients have an infusion reaction after the 4th infusion of rituximab

Answer 15

30%

Question 16

true or false- premedication reduces the risk of anaphylaxis

Answer 16

false- it does reduce the risk of infusion related reactions, however

Question 17

fever, headache, tachycardia, headache, and rash are symptoms of what type of hypersensitivity reaction?

Answer 17

cytokine release syndrome

Question 18

common terminology criteria for adverse effects should not be used for cytokine release syndrome if it is the result of

Answer 18

CAR T-cell therapy

Question 19

how to manage grade III or below CRS?

Answer 19

short term cessation of the infusion, antipyretics, histamine blockers, and corticosteroids

Question 20

what grade CRS reaction should prompt permanent discontinuation of the inciting drug? What are features of this grade of reaction?

Answer 20

grade IV, life threatening consequences with urgent intervention required

Question 21

what is the overall incidence rate of hypersensitivity reactions to chemotherapy?

Answer 21

5%

Question 22

In infusion reactions, what percent of patients experience a mucocutaneous symptom like pruritis/itching, rash/desquamation, or urticaria

Answer 22

90%

Question 23

In infusion reactions, what percent of patients experience a respiratory symptom like dyspnea, broncospasm, and wheezing?

Answer 23

40%

Question 24

In infusion reactions, acute laryngo-pharyngeal dysesthesia (a cold related sensation of dyspnea, difficulty of swallowing or talking, and odd sensations in the tongue or pharynx) occurs with what drug?

Answer 24

oxaliplatin

Question 25

In infusion reactions, what percent of patients experience a circulatory symptom of hypo/hypertension

Answer 25

30-35%

Question 26

In infusion reactions, what GI symptoms can present?

Answer 26

N/V, cramping, diarrhea

Question 27

fever, hypotension responding to fluids, and hypoxia responding to <40% O2 is what CTCAE grade of CRS?

Answer 27

grade 2

Question 28

this hypersenitivity reaction is considered grade 3 when there is bronchospasm or IV intervention indicated

Answer 28

allergic reaction

Question 29

this hypersensitivity reaction is characterized by breathing difficulty, hypotension, urticaria, cyanosis and requires close monitoring for the next 24 hours.

Answer 29

anaphylaxis

Question 30

what drug takes advantage of the fact that acute lymphoblastic leukemia cells and some other suspected tumor cells are unable to synthesize a non-essential amino acid, whereas normal cells are able to make their own; thus leukemic cells require higher amount of this amino acid.

Answer 30

L-asparaginase

Question 31

l-asparaginase, taxanes, platinums, epipodophyllotoxins (etoposide, teniposide), and some monoclonal antibodies (cetuximab, daratumumab, and ofatumumab) have what potential for hypersensitivity reactions?

Answer 31

high potential

Question 32

anthracyclines like doxorubicin, daunorubicin, and even the pegylated liposomal doxorubicin have what potential frequency for hypersensitivity reactions?

Answer 32

occasional potential

Question 33

what potential for hypersensitivity reactions do antibiotics, alkylating agents, antimetabolites, vinca alkaloids, and immunotherapy have?

Answer 33

rare potential

Question 34

how to manage anaphylaxis? If bradycardia? If hypotension? If pt taking beta blockers?

Answer 34

epinephrine, NS, h1/h2 antagonists, if bradycardia: atropine, if hypotension: dopamine or vasopressin, if beta-blocker treatment: glucagon infusion, corticosteroids

Question 35

skin symptoms and signs are present in what percent of anaphylactic episodes?

Answer 35

90%

Question 36

Skin or mucosal symptoms and signs (such as hives, itching, flushing, and angioedema), which are helpful in making the diagnosis, are absent or unrecognized in what percent of episodes of anaphylaxis?

Answer 36

up to 10 percent of all episodes.

Question 37

an acute episode of hypotension and what other symptoms could indicate anaphylaxis?

Answer 37

GI distress, respiratory symptoms, cardiovascular symptoms

Question 38

when considering anaphylaxis, skin or mucosal symptoms and signs (such as hives, itching, flushing, and angioedema), which are helpful in making the diagnosis, are absent or unrecognized in what percent of episodes?

Answer 38

up to 10 percent

Question 39

what is defined as a recurrence of symptoms meeting anaphylaxis diagnostic criteria that develops within 1 to 48 hours following the apparent resolution of the initial anaphylactic episode with no additional exposure to the causative agent.

Answer 39

Biphasic anaphylaxis. Occurs in about 5 percent of cases

Question 40

the preferred route for initial administration of epinephrine for anaphylaxis in most settings and in patients of all ages

Answer 40

IM

Question 41

what drug can be used to manage VOD/SOS if there is pulmonary or renal compromise

Answer 41

defibrotide

Question 42

what potentially fatal liver-related syndrome is signaled by weight gain and early water retention?

Answer 42

veno-occlusive disease/ sinusoidal obstruction syndrome VOD/SOS

Question 43

when treating anaphylaxis, what is the starting dose of epinephrine for adults?

Answer 43

Patients who weigh >50 kg can be given 0.5 mg (0.5 mL of the 1 mg/mL solution)

Question 44

when treating anaphylaxis, IM epinephrine may be repeated at what interval if there is no response or an inadequate response or even sooner if clinically indicated.

Answer 44

5- to 15-minutes

Question 45

Note that for anaphylaxis, the dose is how much less of the IV epinephrine dose used in cardiac arrest (advanced cardiac life support)

Answer 45

1/10th or less

Question 46

if a patient taking beta-blockers appears to be refractory to epinephrine, what can be administered because it has inotropic and chronotropic effects that are not mediated through beta-receptors

Answer 46

glucagon

Question 47

when using opiates for cancer pain, what percentage increase is indicated for mild to moderate pain refractive to the current dose?

Answer 47

25-50% increase

Question 48

when using opiates for cancer pain, what percentage increase is indicated for severe pain refractive to current dose?

Answer 48

50-100% increase

Question 49

when using extended release opiates for cancer pain, what percentage of total daily dose is indicated for breakthrough dosing?

Answer 49

5-20% of total daily dose of ER dosing