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IPT: Hem/Onc/Transplant > Block 2 > Flashcards

Block 2 Flashcards

1
Q

Most common cancer in children are…

A 
1 = leukemia
2 = brain tumor

It is also the number 1 cause of death in children

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2
Q

What are the alkylating agents?

A

Cyclophosphamide/Ifosphamide

Cis/carbo/oxaliplatin

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3
Q

What are the antimicrotubules?

A

Vinblastine
Vincristine
Vinorelbine

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4
Q

What are the antimetabolites?

A

Methotrexate
Mercaptopurine
5-FU
Cytarabine

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5
Q

What are the topoisomerase inhibitors?

A

Irinetecan

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6
Q

What are the antracyclines?

A

Doxorubicin

Mitoxantrone

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7
Q

Alkylating agent MOA?

A

Attaches alkyl group to DNA

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8
Q

Alkylating metabolism info?

A

They are prodrugs

EX: cyclophosphamide has active metabolites and inactive ones (acrolein)

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9
Q

Cyclophosphamide DLT?

A

Myelosuppression

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10
Q

Ifosfamide DLT?

A

Hemorrhagic cystitis

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11
Q

Supportive care for Cyclophosphamide?

A

Colony Stimulating Factor

Hydration

Mesna

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12
Q

Supportive care for Ifosfamide?

A

Methylene Blue

Hydration

Mesna

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13
Q

What causes the hemorrhagic cystitis?

A

Acrolein cause its renally eliminated

Binds to bladder wall

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14
Q

Of the platinum rx, which one is the most emetogenic?

A

Cisplatin

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15
Q

Cisplatin AE?

A

Emetogenic

Nephrotoxicity (Fanconi’s wasting syndrome)

Ototoxicity

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16
Q

Platinum agent supportive care?

A

Antiemetics

Amifostine

Hydration

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17
Q

Which platinum agent has anaphylaxis issues?

A

Carboplatin

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18
Q

Oxaliplatin toxicities?

A

Peripheral neuropathy

Acute - exacerbated by cold

Chronic - interferes w/ daily activities

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19
Q

Oxaliplatin supportive care?

A

Avoid anything cold (warm clothing, warm room, no ice, etc)

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20
Q

How should you NEVER give antimicrobule agents?

A

Intrathecally, 100% fatal

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21
Q

Which vinca antimicrotubule agent does NOT cause N/V?

A

Vincristine

The other 2 do

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22
Q

Which vinca antimicrotubule agent does NOT cause myelosuppression?

A

Vincristine

The other 2 do

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23
Q

Paclitaxel toxicities?

A

Hypersensitivity

Peripheral Neuropathies

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24
Q

Paclitaxel supportive care?

A

Decadron
Benadryl
Famotidine

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25
Q

Pemetrexed (antifolate) AE?

A

Bone marrow suppression + Rash

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26
Q

Methotrexate toxicities?

A

Nephrotoxicity, hepatotoxicity, bone marrow suppression

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27
Q

Methotrexate supportive care?

A

Hydration, Leucovorin, alkalinization

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28
Q

What are the purine analogs and their AE?

A

Mercaptopurine

Hepatotoxicity

Lower dose if taken w/ allopurinol

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29
Q

Purine analog supportive care?

A

Antiemetic if needed

Dose adjustment for neutropenia

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30
Q

What are the pyrimidine analogs and their AE?

A

5-FU

Bolus - leukopenia, thrombo, anemia

Continuous infusion - hand/foot syndrome, diarrhea, mucositis, photosensitivity

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31
Q

5-FU CI?

A

Active infection

MI within last 6 months

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32
Q

What does leucovorin do w/ 5-FU?

A

Primes the drug and causes more cytotoxicity

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33
Q

Cytarabine toxicity?

A

Chemical conjunctivitis, fever

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34
Q

Cytarabine supportive care?

A

Decadron for 48hrs post completion of last dose

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35
Q

Irinotecan Pharmacogenomics?

A

UGT1A1 metabolism, but has polymorphisms. Decrease dose by 75%

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36
Q

Supportive care of anthracyclines?

A

Monitor cardiac function

Dexrazoxane

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37
Q

Etoposide toxicity?

A

Hypotension

Anaphylaxis (if you use polysorbate kind, the phosphate one doesnt have most AE)

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38
Q

Bleomycin AE?

A

Pulmonary fibrosis

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39
Q

Asparaginase info?

A

Deplees asparagine (which is essential for malignant leukemia cells)

Causes hyperglycemia, hypoalbuminemia, coagulopathies, pancreatitis, NO N/V!

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40
Q

How many people are anemic worldwide? USA? Most common cause?

A

Worldwide - 25% of population

3.5 million Americans have it

Iron deficiency accounts for 50%

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41
Q

What is considered anemic in men and women?

A

Men <13

Women <12

42
Q

What deficiencies cause macrocytic anemia?

A

Folic acid and/or Vit. B12

43
Q

What deficiencies cause microcytic anemia?

A

Iron

44
Q

What deficiencies cause pernicious anemia?

A

Lack of Intrinsic factors

Decreased absorption of Vit. B12

45
Q

How do polyphenols, calcium, and gastrectomy/achlorhydria affect iron?

A

Polyphenols - bind iron an decreases nonheme iron absorption w/ tea/coffee

Calcium - inhibits absorption of both heme/nonheme iron

Gastrectomy - decreases iron absorption

46
Q

Which Rx decrease iron absorption?

A

Al, Mg, Ca containing antacids

Tetracycline + doxycycline

H2 + PPIs

Cholestyramine

47
Q

Which drugs are affected by iron?

A

Levo + Methyldopa

Levothyroxine

Penicillamine

FQ

Mycophenolate

48
Q

How do we mitigate AE or iron therapy?

A

Give w/ meals

Give smaller doses of iron

H2a or PPIs (impairs iron absorption though)

49
Q

How long is oral IDA treatment?

A

3-6 months after resolution of anemia

50
Q

Which iron products are packaged differently?

A

Anything with >30mg of elemental iron are required to be packaged as individual dosage units

51
Q

How do you calculate the total dose needed for iron deficiency anemia?

A

0.0442(14.8-observed hemoglobin) * IBW + (0.26*IBW)

Use ABW if < than IBW

52
Q

What dietary sources inhibit iron absorption

A

Coffee, Tea

Calcium

Zinc

53
Q

MMA elevation and macrocytic anemia, what does it tell you?

A

Specific for Vit. B12 only

54
Q

Homocysteine and macrocytic anemia, what does it tell you?

A

Elevated in folic acid deficiency + low levels of Vit. B12

55
Q

Vit. B12 supplementation AE?

A

Hyperuricemia

Hypokalemia

56
Q

Which drug interacts w/ folic acid?

A

Phenytoin, decreases levels by 15-50%

57
Q

What is the most common cause of megaloblastic anemia?

A

Pregnancy

58
Q 
Iron
Transferrin
Transferrin Sat.
Ferritin
Soluble Transferrin Receptor

Anemia of Inflammation vs Iron deficiency

A

Iron deficiency = everything is low except transferrin and soluble transferrin receptor

Anemia of Inflammation = only ferritin can be increased, the rest are low or normal

59
Q

What is hematocrit?

A

Actual volume of RBC in a volume of whole blood

Typically 3x the Hb value

60
Q

What is mean cell volume?

A

Average volume of RBC

61
Q

Which anemia can reduce mean cell hemoglobin?

A

Iron deficiency

62
Q

TLS affects 4 main pathways, what are they?

A

Lactic acid -> acidosis -> renal failure

Hyperphosphatemia and hypocalcemia -> renal failure

Purine -> hyperuricemia -> renal failure

Hyperkalemia -> heart issues

63
Q

Lab TLS values required?

A

2+ lab changes of the following 3 days prior or 7 days after therapy:

Uric acid >8
Potassium >6
Phosphorous >4.5
Calcium<7

64
Q

Clinical TLS values required?

A

Presence of lab TLS + one of the following:

SCr x1.5 upper limit
Arrhythmia
Seizure
Sudden Death

65
Q

Which lab values are measured in TLS?

A 
CMP
LDH
UA
Mag
Phos

Confirmed TLS = q4-6 hrs

Low risk = daily

66
Q

How do you treat TLS?

A

IV fluids (24-48 hrs before chemo)

Loop diuretics ONLY if refractory to IV hydration

67
Q

What is leukostasis?

A

Extremely elevated WBC count and symptoms of decreased tissue perfusion

68
Q

Main pathophysiology of leukostasis and clinical manifestations?

A

Increased blood viscosity

Local hypoxemia

Blast migration to surround tissues

Fever, pulmonary issues, neurological and visual changes

69
Q

What are the main things used for leukostasis?

A

Hydroxyurea

Induction chemo

Leukapheresis

Supportive care

70
Q

Mild, Moderate, Severe hypercalcemia?

A

First calculate correct calcium

Mild ≤11.9 - no treatment required, just take some fluids, minimize RF

Severe ≥14 - requires aggressive fluid therapy, bisphosphonates, calcitonin

Anything between, no treatment unless symptoms occur

71
Q

What are the first line therapies for hypercalcemia?

A

Hydration + Bisphosphonates = number 1

Calcitonin

Loop diuretics

72
Q

Which drugs may worsen hypercalcemia?

A

Calcium

Vit. D

Thiazide diuretics

Lithium

73
Q

What important to keep in mind when dosing bisphosphonates for hypercalcemia?

A

Duration is 2-4 weeks long, so do NOT repeat dose within 7 days

74
Q

When and why should you redose bisphosphonates for hypercalcemia?

A

Redose it on day 7 if calcium remains high

75
Q

Which oncologic emergency can allopurinol/rasburicase be used in?

A

TLS

76
Q

RF for oral mucositis?

A

Poor oral health

Chemos such as 5-FU, methotrexate, etoposide, cytarabine, doxorubicin, melphalan

“…nibs”

Head/neck cancer, HSCT, radiation

77
Q

What are some ways to prevent mucositis?

A

Frequent rinsing (w/o alcohol in it) = saline, bicarb solution, or water

78
Q

How does oral cryotherapy, calcium phosphate rinse, and benzydamine mouthwash help prevent mucositis?

A

Oral cryotherapy (ice chips) - local vasoconstriction which causes less drug delivery to mouth

Calcium Phosphate - helps HSCT pts

Benzydamine - for head/neck cancer patients

79
Q

What is the only FDA approved Rx for prevention of chemo-induced mucositis?

A

Palifermin

80
Q

General strategy treatment plan for mucositis?

A
  1. Bland rinses
  2. Topical anesthetics (lidocaine, morphine, doxepin, magic mouthwash)
  3. Systemic analgesics w/ opioids
81
Q

What are the neurotransmitters found in the GI tract + CNS that are involved in N/V?

A

Serotonin

Neurokinin

Dopamine

82
Q

RF for CINV?

A

Younger people

Women>Men

Drink less alcohol

Combo Rx + IV>PO

83
Q

Emetic potential of IV Rx?

A

> 90% = high

30-90 = moderate

10-30 = low

<10 = minimal

84
Q

Emetic potential of PO Rx?

A

≥30 = moderate/high

85
Q

Where and what kind of serotonin receptor is blocked for CINV?

A

5-HT3

Brain + GI tract

86
Q

Ondansetron
Dolasetron
Palonosetron
Granisetron

Which one is used for prevention only?

A

Dolansetron

87
Q

Ondansetron
Dolasetron
Palonosetron
Granisetron

Which one has QT prolongation issues?

A

Ondansetron if single IV dose >16mg

88
Q

What are the NK1 receptor antagonists?

A

Aprepitant, Fosaprepitant (Emend)

Rolapitant

89
Q

Which NK1 receptor antagonists has interaction issues?

A

Aprepitant + Fosaprepitant w/ decadron

90
Q

Which products block both NK1 and 5-HT3?

A

Netupitant (PO) + Fosnetupitant (IV)

Both have palonosetron w/ them

91
Q

Besides NK1 + 5-HT3, what other products can be used for CINV?

A

Steroids

Olanzapine

Ativan

Cannabinoids

Dopamine antagonists (prochlorperazine, promethazine)

92
Q

Olanzapine issues?

A

Sedation (use 5mg instead of 10)

Wt gain

QTc issues

93
Q

Ativan issues?

A

Little anti-emetic activity, but used as adjunct

Causes hypotension and perceptual disturbances

94
Q

Cannabinoid issues?

A

Marinol has highly variable oral absorption (targets CB1)

Increases appetite

Orthostatic hypotension, s

NOT used for 1st line treat due to AE

95
Q

Which dopamine antagonist may cause tissue injury if administered parenterally?

A

Promethazine

96
Q

Prochlorperazine vs Promethazine, which one is more sedating?

A

Promethazine, blocks more histamine

97
Q

Haldol
Metoclopramide
Scopolamine

Which one blocks dopamine receptors only?

A

Haldol

98
Q

Haldol
Metoclopramide
Scopolamine

Which one blocks ACh only?

A

Scopolamine

99
Q

Haldol
Metoclopramide
Scopolamine

Which one blocks DA + peripheral serotonin at high doses?

A

Metoclopramide

100
Q

What drug can be used for anticipatory emesis?

A

Lorazepam 0.5-2mg PO

But you can do behavioral therapy

101
Q

Which iron rx requires a test dose?

A

Iron dextran; 25mg

102
Q

What are the 3 oral iron supplements? Doses?

A

Ferrous fumarate (106mg Fe) 1tab BID

Ferrous gluconate (38mg Fe) Up to 3tab BID-TID

Ferrous sulfate (65mg Fe) 1tab TID

IPT: Hem/Onc/Transplant (7 decks)

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