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
2
Q
What are the alkylating agents?
A
Cyclophosphamide/Ifosphamide
Cis/carbo/oxaliplatin
3
Q
What are the antimicrotubules?
A
Vinblastine
Vincristine
Vinorelbine
4
Q
What are the antimetabolites?
A
Methotrexate
Mercaptopurine
5-FU
Cytarabine
5
Q
What are the topoisomerase inhibitors?
A
Irinetecan
6
Q
What are the antracyclines?
A
Doxorubicin
Mitoxantrone
7
Q
Alkylating agent MOA?
A
Attaches alkyl group to DNA
8
Q
Alkylating metabolism info?
A
They are prodrugs
EX: cyclophosphamide has active metabolites and inactive ones (acrolein)
9
Q
Cyclophosphamide DLT?
A
Myelosuppression
10
Q
Ifosfamide DLT?
A
Hemorrhagic cystitis
11
Q
Supportive care for Cyclophosphamide?
A
Colony Stimulating Factor
Hydration
Mesna
12
Q
Supportive care for Ifosfamide?
A
Methylene Blue
Hydration
Mesna
13
Q
What causes the hemorrhagic cystitis?
A
Acrolein cause its renally eliminated
Binds to bladder wall
14
Q
Of the platinum rx, which one is the most emetogenic?
A
Cisplatin
15
Q
Cisplatin AE?
A
Emetogenic
Nephrotoxicity (Fanconi’s wasting syndrome)
Ototoxicity
16
Q
Platinum agent supportive care?
A
Antiemetics
Amifostine
Hydration
17
Q
Which platinum agent has anaphylaxis issues?
A
Carboplatin
18
Q
Oxaliplatin toxicities?
A
Peripheral neuropathy
Acute - exacerbated by cold
Chronic - interferes w/ daily activities
19
Q
Oxaliplatin supportive care?
A
Avoid anything cold (warm clothing, warm room, no ice, etc)
20
Q
How should you NEVER give antimicrobule agents?
A
Intrathecally, 100% fatal
21
Q
Which vinca antimicrotubule agent does NOT cause N/V?
A
Vincristine
The other 2 do
22
Q
Which vinca antimicrotubule agent does NOT cause myelosuppression?
A
Vincristine
The other 2 do
23
Q
Paclitaxel toxicities?
A
Hypersensitivity
Peripheral Neuropathies
24
Q
Paclitaxel supportive care?
A
Decadron
Benadryl
Famotidine
25
Pemetrexed (antifolate) AE?
Bone marrow suppression + Rash
26
Methotrexate toxicities?
Nephrotoxicity, hepatotoxicity, bone marrow suppression
27
Methotrexate supportive care?
Hydration, Leucovorin, alkalinization
28
What are the purine analogs and their AE?
Mercaptopurine
Hepatotoxicity
Lower dose if taken w/ allopurinol
29
Purine analog supportive care?
Antiemetic if needed
Dose adjustment for neutropenia
30
What are the pyrimidine analogs and their AE?
5-FU
Bolus - leukopenia, thrombo, anemia
Continuous infusion - hand/foot syndrome, diarrhea, mucositis, photosensitivity
31
5-FU CI?
Active infection
MI within last 6 months
32
What does leucovorin do w/ 5-FU?
Primes the drug and causes more cytotoxicity
33
Cytarabine toxicity?
Chemical conjunctivitis, fever
34
Cytarabine supportive care?
Decadron for 48hrs post completion of last dose
35
Irinotecan Pharmacogenomics?
UGT1A1 metabolism, but has polymorphisms. Decrease dose by 75%
36
Supportive care of anthracyclines?
Monitor cardiac function
Dexrazoxane
37
Etoposide toxicity?
Hypotension
Anaphylaxis (if you use polysorbate kind, the phosphate one doesnt have most AE)
38
Bleomycin AE?
Pulmonary fibrosis
39
Asparaginase info?
Deplees asparagine (which is essential for malignant leukemia cells)
Causes hyperglycemia, hypoalbuminemia, coagulopathies, pancreatitis, NO N/V!
40
How many people are anemic worldwide? USA? Most common cause?
Worldwide - 25% of population
3.5 million Americans have it
Iron deficiency accounts for 50%
41
What is considered anemic in men and women?
Men <13
Women <12
42
What deficiencies cause macrocytic anemia?
Folic acid and/or Vit. B12
43
What deficiencies cause microcytic anemia?
Iron
44
What deficiencies cause pernicious anemia?
Lack of Intrinsic factors
Decreased absorption of Vit. B12
45
How do polyphenols, calcium, and gastrectomy/achlorhydria affect iron?
Polyphenols - bind iron an decreases nonheme iron absorption w/ tea/coffee
Calcium - inhibits absorption of both heme/nonheme iron
Gastrectomy - decreases iron absorption
46
Which Rx decrease iron absorption?
Al, Mg, Ca containing antacids
Tetracycline + doxycycline
H2 + PPIs
Cholestyramine
47
Which drugs are affected by iron?
Levo + Methyldopa
Levothyroxine
Penicillamine
FQ
Mycophenolate
48
How do we mitigate AE or iron therapy?
Give w/ meals
Give smaller doses of iron
H2a or PPIs (impairs iron absorption though)
49
How long is oral IDA treatment?
3-6 months after resolution of anemia
50
Which iron products are packaged differently?
Anything with >30mg of elemental iron are required to be packaged as individual dosage units
51
How do you calculate the total dose needed for iron deficiency anemia?
0.0442(14.8-observed hemoglobin) * IBW + (0.26*IBW)
Use ABW if < than IBW
52
What dietary sources inhibit iron absorption
Coffee, Tea
Calcium
Zinc
53
MMA elevation and macrocytic anemia, what does it tell you?
Specific for Vit. B12 only
54
Homocysteine and macrocytic anemia, what does it tell you?
Elevated in folic acid deficiency + low levels of Vit. B12
55
Vit. B12 supplementation AE?
Hyperuricemia
Hypokalemia
56
Which drug interacts w/ folic acid?
Phenytoin, decreases levels by 15-50%
57
What is the most common cause of megaloblastic anemia?
Pregnancy
58
```
Iron
Transferrin
Transferrin Sat.
Ferritin
Soluble Transferrin Receptor
```
Anemia of Inflammation vs Iron deficiency
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
What is hematocrit?
Actual volume of RBC in a volume of whole blood
Typically 3x the Hb value
60
What is mean cell volume?
Average volume of RBC
61
Which anemia can reduce mean cell hemoglobin?
Iron deficiency
62
TLS affects 4 main pathways, what are they?
Lactic acid -> acidosis -> renal failure
Hyperphosphatemia and hypocalcemia -> renal failure
Purine -> hyperuricemia -> renal failure
Hyperkalemia -> heart issues
63
Lab TLS values required?
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
Clinical TLS values required?
Presence of lab TLS + one of the following:
SCr x1.5 upper limit
Arrhythmia
Seizure
Sudden Death
65
Which lab values are measured in TLS?
```
CMP
LDH
UA
Mag
Phos
```
Confirmed TLS = q4-6 hrs
Low risk = daily
66
How do you treat TLS?
IV fluids (24-48 hrs before chemo)
Loop diuretics ONLY if refractory to IV hydration
67
What is leukostasis?
Extremely elevated WBC count and symptoms of decreased tissue perfusion
68
Main pathophysiology of leukostasis and clinical manifestations?
Increased blood viscosity
Local hypoxemia
Blast migration to surround tissues
Fever, pulmonary issues, neurological and visual changes
69
What are the main things used for leukostasis?
Hydroxyurea
Induction chemo
Leukapheresis
Supportive care
70
Mild, Moderate, Severe hypercalcemia?
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
What are the first line therapies for hypercalcemia?
Hydration + Bisphosphonates = number 1
Calcitonin
Loop diuretics
72
Which drugs may worsen hypercalcemia?
Calcium
Vit. D
Thiazide diuretics
Lithium
73
What important to keep in mind when dosing bisphosphonates for hypercalcemia?
Duration is 2-4 weeks long, so do NOT repeat dose within 7 days
74
When and why should you redose bisphosphonates for hypercalcemia?
Redose it on day 7 if calcium remains high
75
Which oncologic emergency can allopurinol/rasburicase be used in?
TLS
76
RF for oral mucositis?
Poor oral health
Chemos such as 5-FU, methotrexate, etoposide, cytarabine, doxorubicin, melphalan
"...nibs"
Head/neck cancer, HSCT, radiation
77
What are some ways to prevent mucositis?
Frequent rinsing (w/o alcohol in it) = saline, bicarb solution, or water
78
How does oral cryotherapy, calcium phosphate rinse, and benzydamine mouthwash help prevent mucositis?
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
What is the only FDA approved Rx for prevention of chemo-induced mucositis?
Palifermin
80
General strategy treatment plan for mucositis?
1. Bland rinses
2. Topical anesthetics (lidocaine, morphine, doxepin, magic mouthwash)
3. Systemic analgesics w/ opioids
81
What are the neurotransmitters found in the GI tract + CNS that are involved in N/V?
Serotonin
Neurokinin
Dopamine
82
RF for CINV?
Younger people
Women>Men
Drink less alcohol
Combo Rx + IV>PO
83
Emetic potential of IV Rx?
>90% = high
30-90 = moderate
10-30 = low
<10 = minimal
84
Emetic potential of PO Rx?
≥30 = moderate/high
85
Where and what kind of serotonin receptor is blocked for CINV?
5-HT3
Brain + GI tract
86
Ondansetron
Dolasetron
Palonosetron
Granisetron
Which one is used for prevention only?
Dolansetron
87
Ondansetron
Dolasetron
Palonosetron
Granisetron
Which one has QT prolongation issues?
Ondansetron if single IV dose >16mg
88
What are the NK1 receptor antagonists?
Aprepitant, Fosaprepitant (Emend)
Rolapitant
89
Which NK1 receptor antagonists has interaction issues?
Aprepitant + Fosaprepitant w/ decadron
90
Which products block both NK1 and 5-HT3?
Netupitant (PO) + Fosnetupitant (IV)
Both have palonosetron w/ them
91
Besides NK1 + 5-HT3, what other products can be used for CINV?
Steroids
Olanzapine
Ativan
Cannabinoids
Dopamine antagonists (prochlorperazine, promethazine)
92
Olanzapine issues?
Sedation (use 5mg instead of 10)
Wt gain
QTc issues
93
Ativan issues?
Little anti-emetic activity, but used as adjunct
Causes hypotension and perceptual disturbances
94
Cannabinoid issues?
Marinol has highly variable oral absorption (targets CB1)
Increases appetite
Orthostatic hypotension, s
NOT used for 1st line treat due to AE
95
Which dopamine antagonist may cause tissue injury if administered parenterally?
Promethazine
96
Prochlorperazine vs Promethazine, which one is more sedating?
Promethazine, blocks more histamine
97
Haldol
Metoclopramide
Scopolamine
Which one blocks dopamine receptors only?
Haldol
98
Haldol
Metoclopramide
Scopolamine
Which one blocks ACh only?
Scopolamine
99
Haldol
Metoclopramide
Scopolamine
Which one blocks DA + peripheral serotonin at high doses?
Metoclopramide
100
What drug can be used for anticipatory emesis?
Lorazepam 0.5-2mg PO
But you can do behavioral therapy
101
Which iron rx requires a test dose?
Iron dextran; 25mg
102
What are the 3 oral iron supplements? Doses?
Ferrous fumarate (106mg Fe) 1tab BID
Ferrous gluconate (38mg Fe) Up to 3tab BID-TID
Ferrous sulfate (65mg Fe) 1tab TID
