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B33 CAN > B33 CAN Clinical & Professional > Flashcards

B33 CAN Clinical & Professional Flashcards

1
Q

How do we dose chemotherapy?

A 
Fixed Dose
BSA
Weight based dosing
AUC
Dose Banding
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2
Q

BSA

A

Body surface area, based on Weight and Height

Correlation between BSA and renal function

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3
Q

BSA disadvantages

A

effect of renal impairment
BSA is estimated
Rounding of the BSA calculation and Dose calcualation

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4
Q

Causes of variation in dose

A

Pharmacogenetics, Vial contents , Weight Height BSA, Syringe accuracy,
Residual volumes during administartion

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5
Q

AUC

A

Area under curve, Need GFR

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6
Q

Calculating GFR

A

Use ideal body weight -100 in men -105 in woman

Adjusted body weight

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7
Q

Fixed doses

A

Ease of dose preparation
Reduced cost
Lower risk of dosing errors

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8
Q

Dose banding - Benefits

A

Fewer dose calculation errors
Quicker Dispensing
Reduced patient waiting times

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9
Q

Dose banding - disadvantages

A

Admistered dose may vary from BSA calculated dose

Banded doses may be more expensive

Repeptive strain disorder from repeat syringe usage

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10
Q

Therapeutic monitoring - Benefits

A

Cytotoxic drugs fufil requirements for TDM

Help track patient adherence to treatment

Allows individual dose optimisation

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11
Q

TDM - Disadvantages

A

Tumour heterogeneity
Drugs have overlapping therapuetic & toxic effects

Practical & economical consideratiosn

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12
Q

High dose MTX is the only cytotoxic drug on TDM, what can be used to ‘rescue’…?

A

Folinic acid ‘rescure’ commenced 24 hours after MTX to block unwanted side effects

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13
Q

Cycle interval

A

Chemotherapy scheduling gbased of effects of cytotoxic drug on normal tissue

2-3 week cylce as normal cells recover in 3 weeks

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14
Q

Dose adjustments - Renal function

A

Calculate for nephrotoxicity

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15
Q

Staging

A

Staging the disease (after Diagnosis) allows for baseline for monitoring and prognostic information
Stage 0-4
4( metastised)

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16
Q

tnm STAGING

A

Primary tumour = T
REgional lymphnodes = N
m = metastasis

17
Q

Grade

A

Grade is the macroscopic assesment of the degree of cellular differentiation
(cancer cells being poorly differentiated grade 3)

18
Q

Dose adjustments Cardiotoxicity

A

Two classes of Cardiotoxings

1) Irreversible
2) Reversible

Irreversible caused by anthracyclines (dox)

Reversible caused by Mabs (trastuzumab)

19
Q

Complications of Cancer

A

SVCO (Superior vena cava obstruction)
- Narrowing of the SVC

Caused by carcinoma

20
Q

SVCO : S & S

A 
Oedema in the neck
SOB
Dilation of superior neck skin veins
Headache
Cough coarse voice
21
Q

SVCO: treatment

A

Corticosteroids + Defentive treatment: RT or Chemo

22
Q

Spinal Cord Compression (SCC) : Occurs in…? , Sympotms…?

A

Occurs when bone metasates
Motor weakness
Sensory Loss
Pain at level of compression

23
Q

SCC Treatment

A

Corticosteroids and RT

24
Q

SCC prognosis

A

Ability to walk / move at time of diagnosis and treatment begininning

25
Q

Pharmacist role in SCC

A

Prompt diagnoisis and delivery of Corticosteroids and Refferal

Speak about DVT/PE prophylaxis
Laxatives
Analgesis

26
Q

Chemotherapy induced N&V

A
  • impact on QoL
27
Q

Types of CINV

A

Acute
Breakthrough
Refractory
Anticapatory N&V

PROPHYLAXIS better than treatment

28
Q

CINV consequences

A

Delayed therapy (omitted doses)
Dehydration
Electrolyte imbalance
Patient stopping therapy

29
Q

CINV treatment & MOA

A

Neurokinin 1 Receptor antagonists
NK1RA
- & Inhibts the action of Substrate P in both CNS & PNS

30
Q

Neutropenic sepsis

A

Infection due to having no neutrophils

31
Q

Neutropenic sepsis: T and pharmacist role

A

T: Gentamicin

PR: Full Blood count, peniclin allergy

32
Q

Classification

A

Non-vesicant (5FU)

Irritant -> Pain and phelbitis (cisplatin)

Vesicant - Severe tissue damage and necrosis (anthrycyline antibioitcs e.g doxorubicn)

33
Q

Different sources of funding for cancer drugs

A

1) Funded by NHS via NICE approval
2) Cancer drug fund (NICE not approved yet)
3) Clinical trail (pharmecutical company funded) (If works legally obliged to continue, gives drug comp. data, cheap)
4) Compassionate use scheme (pharmaceutical company funded) (doctor asks for drug)
5) Privately funded (insurance of induvidual)

34
Q

Incremental Cost equation

A

C1 - C0 =

35
Q

Incremental benefit equation

A

Qaly1-Qaly0

36
Q

Incremental Cost Effectiveness Ratio (ICER):

A

(c1-co) / (Qaly 1 - Qaly 0)

37
Q

Technology acceptable if ICER < ….. per QALY Gained

A

Accepted if

38
Q

EOL acceptable if ICER

A

EOL acceptable if

B33 CAN (5 decks)

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