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IHO Week 4 (MJ) > APL and Supportive Care > Flashcards

APL and Supportive Care Flashcards

1
Q

How does APL arise

A

from a single translocation

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2
Q

Why is APL an oncologic emergency?

A

Rapidly evolving clotting abnormalities, risk for fatal hemorrhage

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3
Q

RNF4

A

E3 ubiquitin ligase that marks PML for destruction

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4
Q

ATRA

A

all trans retinoic acid

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5
Q

As2O3 mechanism

A

RNF4 marks PML for destruction as sulfur coordinates to As, results in conformational change in PML

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6
Q

In APL what is the relation between PML and RAR-alpha?

A

juxtaposed

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7
Q

What does RAR-alpha do normally?

A

Signal for terminal differentiation for pro-lymphocytes

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8
Q

What happens when PML and RAR-alpha are juxtaposed?

A

Low affinity for RA, less terminal differentiation

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9
Q

What happens when give ATRA?

What happens if you stop ATRA?

A
  • Therapeutically drives RAR-alpha, pro-lymphocyte differentiation - hematologic remission
  • Disease comes back
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10
Q

ASO3 and ATRA together?

A

AsO3 Induces degradation of chimeric protein
(Induces apoptosis)
ATRA addresses maturation block

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11
Q

3 contexts of nausea?

A

Anticipatory
Acute
Delayed (>24 hours)

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12
Q

Differential of nausea (besides emetogenic potential of drugs)

A

Anxiety, GERD, mechanical obstruction, increased intra-abdominal pressure, intraperitoneal blood, increased intracranial pressure, biliary/uretral colic, pregnancy

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13
Q

What is true about pregnancy and young women?

A

They are all pregnant until proven otherwise

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14
Q

Mech of acute nausea?

A

In GI tract, 5HT stimulates vagus nerve

Peripheral Pathway

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15
Q

Mech for treating acute nausea?

A

5HT receptor antagonist

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16
Q

Mech of chronic nausea?

A

chemical trigger in brainstem, NK-receptor

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17
Q

Mech for treating chronic nausea?

A

NK1-receptor antagonists (block substance P)

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18
Q

ABCD of nausea drugs?

A

Ativan (lorazepam)
Benadryl (diphenhydramine)
Compazine (chlorpromazine) or haliperidol or olanzapine
Dexamethasone

19
Q

Cancers known for thrombotic diathesis?

A 
Pancreas
Breast
Prostate
Bladder
Lung 
CNS
20
Q

What correlates with poor survival in cancers?

A

elevated D-dimer
elevated INR
other measures of hypercoagulability

21
Q

Relationship between high BMI and clotting?

A

BMI high results in more estrogen, estrogen goes to liver and makes clots

22
Q

Most active agent to manage DVT in cancer?

A

low molecular weight heparin (LMWH)

23
Q

How long should cancer patients stay on LMWH?

A

at least two weeks, ideally until thrombogenic stimulus is removed.

24
Q

Why metastasis to bone?

A

good ‘soil’ for cancers

25
Q

What two cancers universally affect bone?

A

Breast and Prostate

26
Q

Bone directed treatment extends survival in what three cancers?

A

Myeloma
Breast
Renal
(NOT prostate)

27
Q

Classic anti-resorptive therapy

A

bisphosphonates

28
Q

Most potent anti-resorptive therapy

A

zoledronic acid

29
Q

What cancer drugs make gut sluggish?

A

Vica alkaloids and microtubule poisons

30
Q

Best drugs that cause diarrhea?

A

Irinotecan and 5-FU

31
Q

Why is polyethylene glycol good at treating constipation?

A

gentle, doesn’t cause gas

32
Q

Mineral oil

A

prevents tearing (constipation)

33
Q

Never write a prescription for narcotics…

A

without discussing specific measures for constipation

34
Q

Fiber?

A

Don’t forget to supplement (on both ends of spectrum)

35
Q

First step in treating diarrhea?

A

Electrolyte supplementation

36
Q

What is useful in secondary diarrhea (unresponsive to other treatments?)

A

Somatostatin analogues

37
Q

Tincture of opium

A

Treatment of diarrhea (quite useful)

38
Q

Do not write a prescription to treat diarrhea…

A

without electrolytes

39
Q

Myelosuppression treatment

A

G-CSF available as recombinant peptide

40
Q

G-CSF side effect

A

Low back pain

41
Q

Use of EPO in cancer patients?

A

restricted to transfusion dependent marrow failure

42
Q

Hgb above 10

A

associated with worse outcomes (if previously anemic)

43
Q

FDA drugs approved for chemo induced thrombocytopenia?

A

Eltrombopag

Romiplostim

IHO Week 4 (MJ) (10 decks)

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