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IPT: Hem/Onc/Transplant > Block 3 More > Flashcards

Block 3 More Flashcards

1
Q

Ovarian cancer and when it’s discovered, whats the issue?

A

Once it’s found, its usually stage 3/4 so survival rate is kinda doodoo

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2
Q

RF for ovarian cancer?

A

Age ≥70

Menopause

Late pregnancy ≥35yo

2+ more 1st degree relatives w/ this cancer

Breast cancer FH

Estrogen w/o progesterone for ≥10yrs

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3
Q

Poor prognostic factors for ovarian cancer?

A

Clinical stage (most important, usually stage III)

FH

Grade of tumor

BRCA1/2 (higher chance of cancer, but survival is higher, hmmm)

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4
Q

Prevention + screening for ovarian cancer?

A

Prevent via:

oral contraceptives ≥5yrs
Surgery RRSO
Have given birth
Breastfeeding >1yr

Screening: nothing really, but high risk can do surgery RRSO between age 35-40 after child is born

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5
Q

Surgery goals + ovarian cancer?

A

Microscopic = no residual disease

Optimal <1cm

Suboptimal >1cm

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6
Q

Surgery for ovarian cancer, fertility and no fertility requirements?

A

Fertility wanted = 1A or 1C, one ovary is removed, 1B = both ovaries removed

No fertility needed = I - IV; total removal of uterus + ovaries or just both ovaries alone

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7
Q

Generic chemo for ovarian cancer includes..?

A

Taxane + Platinum agent

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8
Q

Carboplatin AE?

A

Hypersensitivity, N/V

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9
Q

Bevacizumab dosing and surgery considerations and AE?

A

1st dose = 90min
2nd = 60
3rd = 30

Hold for 6 weeks from debulking post op

AE = bleed, decreased wound healing, GI issues

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10
Q

Intraperitoneal chemo requirements for ovarian cancer?

A

Stage 3 (<1cm)

Overall, pretty good standing

≤65yrs old

No prior surgery

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11
Q

Intraperitoneal toxicity management?

A

Warm IP to body temp

Hydration

Anti-emetics

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12
Q

Rucaparib
Olaparib
Niraparib

AE?

A

Rucaparib = cholesterol, liver

Olaparib = pneumonitis

Niraparib = HTN, palpitations

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13
Q

RF for cervical cancer?

A

HPV 16 + 18 (most important factor*)

Early sexual h/o (<18)

Multiple partners

Oral contraceptives >5yrs

Smoking

Immunosuppression

≥3 full term pregnancies

Low socioeconomic status

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14
Q

What is the gardasil vaccine?

A

HPV vaccine for ages 9-45 for both men and women

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15
Q

Gardasil scheduling?

A

Age 9-14; 2 dose series at months 0 and 6-12

15-45; 3 dose series at months 0,2,6

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16
Q

What makes up most of the cervical cancer cases (what cell type)?

A

Squamous cell carcinoma

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17
Q

Whats given in cervical cancer w/ radiation?

A

Radiation + cisplatin or carbo or cisplatin + 5-FU

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18
Q

Chemo regimen for advanced/recurrent cervical cancer

A

Cis/carboplatin + paclitaxel + bevacizumab

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19
Q

What drug/classes are used for induction immunosuppression?

A

ATG (rabbit + equine)

Basiliximab

Methylprednisolone

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20
Q

ATG class MOA?

A

Polyclonal AB that deplete T cells

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21
Q

ATG class AE?

A

Cytokine release syndrome; fever, chills, rigors, pulmonary edema, hypotension

^pre-treat with APAP, benadryl, steroids. If rigors keeps existing, use meperidine/cyclobenzaprine

Cytopenia

Infection

PTLD

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22
Q

Basiliximab MOA?

A

Chimeric monoclonal AB that targets CD-25/IL-2. It does NOT deplete T cells, but rather makes them inactive for 4-6 wks

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23
Q

Basiliximab AE?

A

Virtually none, no premedication required

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24
Q

Who needs ATG drug?

A

Young, black, blood group incompatibility issues, DGF/DSA or PRA>20%, cold ischemia time >24hrs, and those who need to avoid steroids

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25
Q

What drugs are used for maintenance immunosuppression?

A

Calcineurin inhibitors (cyclosporine, tacrolimus)

Anti Proliferatives (Aza, MMF, MPS, mTORi)

Steroids

Co-stimulation inhibitor (belatacept)

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26
Q

How is cyclosporine monitored via peak/trough?

A

Use 2 hr peak and 12 hr trough; C2 is better for cyclosporine due to differences in formulations

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27
Q

Cyclosporine AE?

A

Gingival hyperplasia, HTN, hyperlipidemia, kidney damage, hirsutism

28
Q

What kind of substrate is cyclosporine?

A

P-gp + CYP3A4

Inducers ~ carbamazepine, rifampin, phenobarbital, phenytoin, st. johns wart = so less cyclosporine levels

29
Q

What should be avoided when taking cyclosporine?

A

NSAIDs, aminoglycosides, amphoteracin

30
Q

Tacrolimus vs Cyclosporine monitoring peak/trough differences?

A

Tacrolimus correlates well with the 12hr trough

31
Q

Tacrolimus AE?

A

Tremors, diabetes, alopecia

32
Q

Azathioprine MOA?

A

Prodrug converted to 6-MP that is a purine (A/G) analog that inhibits both T + B cells

33
Q

Azathioprine AE?

A

Liver issues, consider lowering dose/dc if they have infection

34
Q

Azathioprine DDI?

A

Allopurinol

35
Q

Mycophenolate MOA?

A

Inhibits IMPHD and depletes guanosine stores and also blocks T + B cells

More effective vs Azathioprine

36
Q

Conversion of MMF to MPS?

A

1000mg MMF = 720mg MPS

37
Q

MMF/MPS AE?

A

N/V/D; consider lowering dose/dc if they have infection

MPS has better GI effects

38
Q

MMF/MPI DDI?

A

PPI only affect MMF

39
Q

Sirolimus MOA?

A

mTOR inhibitor

Prevents G1 to S phase of cell cycle

Blocks IL-2 mediated T cell proliferation

40
Q

How is sirolimus monitored via peak/trough?

A

Only checks 24hr trough

12hr trough for everolimus though

41
Q

Sirolimus AE?

A

Hypertriglyceridemia, thrombosis, proteinuria, delayed wound healing

BBW: give med after a month with liver transplant and 3 months for lung transplant due to artery thrombosis

42
Q

Belatacept MOA?

A

Co-stimulates CD28 to CD80/86

43
Q

How to you treat acute (cellular) rejection?

A

Mild/Moderate = methylprednisolone 500mg IV 3-5days + augment therapy

Moderate/Severe = methylprednisolone 500mg IV 3-5days + augment therapy + anti-thymocyte agent

44
Q

What are the sources of stem cells?

A

Peripheral blood stem cells thru leukapheresis

Umbilical cords

Bone marrow from iliac crest

45
Q

G-CSF drugs? MOA?

A

Filgrastim

Makes more neutrophils

46
Q

G-CSF AE? PK?

A

Bone pain

Onset = 1-2 days

47
Q

GM-CSF drugs? MOA?

A

Sargramostim

Makes more neutrophils, eosinophils, monocytes, macrophages

48
Q

GM-CSF AE? PK?

A

Capillary leak syndrome, infusion related issues, SVTs, plus a lot of AE

CI = yeast allergy

Onset = 7-14 days

49
Q

Plerixafor AE? PK? Monitoring?

A

Onset = 6-9hrs

Will cause fetal harm (use back up method for 1wk after)

Must be given w/ or after filgrastim

50
Q

Donors of peripheral blood stem cell, what do they have to do?

A

~5 days prior to donating, they must be on daily mobilizing agents

51
Q

Autologous vs allogeneic

Which one is donor ≠ host?

A

Allogenic

Autologous donor is host

52
Q

Autologous vs allogeneic

Which one REQUIRES MAC?

A

Autologous requires just that one

Allogeneic can use MAC or RIS

53
Q

Autologous vs allogeneic

Which one is cure the final objective?

A

Allogeneic

54
Q

Autologous vs allogeneic

Which one requires immunosuppression?

A

Allogeneic

55
Q

Autologous vs allogeneic

Which one has a lower risk of graft failure?

A

Autologous

56
Q

Purpose of Ursidiol?

A

Prevent SOS (sinusoidal obstructive syndrome)

57
Q

Acute GVHD clinical presentation? Chronic

A

Skin, Liver, GI issue (usually <100 days)

Chronic hits all organs

58
Q

How is chronic GVHD categorized?

A

Mild = 1-2 organs affected insignificantly (except lungs)

Moderate = 1 significant organ affected or 3+ organs not significantly affect or mild lung impairment

Severe = moderate lung impairment or 1 major organ disability

59
Q

What are the high risk patients for infection?

A

Allogeneic

Alemtuzumab users

Acute leukemia

High dose steroids (>20mg prednisone)

Anticipated neutropenia >10days

60
Q

Physiologic response of infection in NON neutropenic pt vs neutropenic pt?

A

NON = chills, fever, increased WBC, microbiology results

Neutropenic = just fever

61
Q

Definition of fever?

A

Oral temp ≥38.3 C or 101 F

≥38 C or 100.4 F for ≥1hr

62
Q

Bugs found in neutropenia?

A

G+ = S. aureus

G- = Pseudo + Entero

63
Q

Low vs High MASCC and whats included in the high category?

A

≥21 = low

<21 = high; duration 7-10 days, allogeneic, alemtuzumab

64
Q

What do give during neutropenic prophylaxis?

Bacterial?
Fungal?
HSV/VSV?

A

Bacterial = FQ

Fungal = Triazole or echinocandin

HSV/VSV = acyclovir or valacyclovir

All duration is during neutropenia

65
Q

Outpatient + oral TREATMENT of neutropenic fever

A

Cipro AND Augmentin

Levo

66
Q

Inpatient + TREATMENT of neutropenic fever? Complications?

A

Cefepime is DOC

Can do ceftazidime, carbapenem, or zosyn

Infected line? Add vanco

Pneumonia during flu season? Add oseltamivir

IPT: Hem/Onc/Transplant (7 decks)

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