Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ND Ontario Prescribing Exam > Cancer Chemotherapy Toxicity > Flashcards

Cancer Chemotherapy Toxicity Flashcards

1
Q

Types of Chemotherapy-induced nausea and vomiting (CINV)

A

acute, delayed, and anticipatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What’s considered acute Chemotherapy-induced nausea and vomiting (CINV)

A

N + V that starts a few hours after chemo and usually does not persist beyond 24 hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Incidence of acute CINV

A

over 90% of patients receiving highly emetogenic chemo (cisplatin, cyclophosphamide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Patient-related risk factors for acute CIVN

A
  • younger age
  • female
  • past hx of low alcohol intake
  • poor control of sx in prior cycles
  • hx of motion sickness or nausea in pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Neurotransmitter responsible in acute CIVN

A
  • serotonin (5-HT3 receptors) is most responsible
  • type 2 dopamine (neurokinin-1 receptors)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How chemo and radiation therapy causes acute CINV?

A

Therapy causes enterochromaffin cells lining the GI tract to release serotonin in large amounts, activating 5-HT3 receptors in the GI tract, which stimulate the vomiting centre in the medulla oblongata.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What’s considered delayed Chemotherapy-induced nausea and vomiting (CINV)

A

Begins at least 24 hours after administration of chemo and may last for 6-7 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Most common drugs causing acute CINV

A

Cisplatin and cyclophosphamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What drugs cause delayed CINV?

A

Cisplatin and cyclophosphamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Incidence of delayed CINV

A

as high as 80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Neurotransmitter responsible for delayed CINV

A
  • substance P-dependent mechanisms appear to play a significant role
  • serotonin is less important
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What’s considered anticipatory Chemotherapy-induced nausea and vomiting (CINV)

A

Is a conditioned or learned response to previously poorly managed nausea and vomiting in chemo patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Incidence of anticipatory CINV

A

~25% patients by the 4th course of chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When anticipatory CINV happens?

A

Occurs before, during or immediately after chemo administration but before acute nausea and vomiting would be expected to occur.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Does anticipatory CINV worsens with each cycle of chemo?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How many patients refuse to continue tx because of the intolerance of N+V in anticipatory CINV?

A

up to 30% of patients

17
Q

What are the goals of therapy in CINV?

A
  1. Prevent or minimize acute, delayed and anticipatory N+V to maintain: (a) quality of life, (b) help patient adherence with active tx, and (c) avoid treatment delays.
  2. Decrease incidence and severity of N+V, if it has started, and maintain patient comfort.
  3. Prevent complications.
18
Q

What are some complications of CINV?

A
  1. esophageal tears
  2. dehydration
  3. anorexia
  4. malnutrition
  5. weight loss
  6. pathological bone fractures
  7. metabolic alkalosis
  8. chloride and potassium depletion
19
Q

How to assess CINV?

A
  1. A thorough hx including:
    - onset and duration of sx
    - timing of N and/or retching and/or V
    - description of the vomiting episode
    - medications
  2. Physical examination with particular attention to:
    - orthostatic pressure
    - abdominal pain, distention, constipation, hemorrhage
    - neurologic assessment including cranial nerves, vestibular and pupillary functions, extrapyramidal signs
  3. Lab tests:
    - electrolytes: urea, creatinine, sodium, potassium, chloride, calcium, albumin
    - drug screening: such as digoxin if suspected as a cause of N+V
20
Q

Why would you test for chloride in CINV?

A

to assess hydration status

21
Q

Why would you test for albumin in CINV?

A

to assess for hypercalcemia

22
Q

Other causes for N+V, besides CINV

A
  • fluid/electrolyte abnormalities
  • bowel obstruction
  • CNS or hepatic metastases
  • infections
  • radiation therapy
23
Q

Other drugs, besides chemo, for N+V

A
  • opioids
  • digoxin
  • antibiotics
24
Q

What could increase the risk of N+V when taking an emetogenic drug?

A

< 50 yoa
female gender
motion sickness
nausea in pregnancy
chemotherapy-induced nausea and vomiting (CINV)

25
Q

IV Cancer Tx Agents with high emetogenic potential (>90%)

A
  • carmustine
  • cisplatin
  • cyclophosphamide (>1500mg/m2)
  • dacarbazine
  • mechlorethamine
  • streptozocin
26
Q

IV Cancer Tx Agents with moderate emetogenic potential (30-90%)

A
  • bendamustine
  • carboplatin
  • cyclophosphamide (<1500mg/m2)
  • cytarabine (>1000mg/m2)
  • daunorubicin
  • doxorubicin
  • epirubicin
  • ifosfamide
  • irinotecan
  • methotrexate (dose-dependent)
  • oxaliplatin
  • romidepsin
  • temozolomide
27
Q

IV Cancer Tx Agents with minimal emetogenic potential (<10%)

A
  • bevacizumab
  • bleomycin
  • busulfan
  • cladribine
  • fludarabine
  • obinutuzumab
  • vincristine
  • vindesine
  • vinorelbine
28
Q

Oral Cancer Tx Agents with high emetogenic potential (>90%)

A
  • hexamethylmelamine
  • procarbazine
29
Q

Oral Cancer Tx Agents with moderate emetogenic potential (30-90%)

A
  • bosutinib
  • ceritinib
  • crizotinib
  • cyclophosphamide
  • imatinib
  • temozolomide
30
Q

Oral Cancer Tx Agents with minimal emetogenic potential (<10%)

A
  • busulfan
  • chlorambucil
  • erlotinib
  • gefitinib
  • hydroxyurea
  • L-phenylalanine mustard
  • melphalan
  • methotrexate
  • pomalidomide
  • ruxolitinib
  • 6-thioguanine
  • sorafenib
  • vemurafenib
  • vismodegib
31
Q

CINV Non-pharmacological choices for dietary adjustments

A
  • try small, light meals several times a daily
  • avoid foods high in fat or heavy aroma
  • try dry, starchy foods
  • if unable to tolerate solid foods, try ice chips and small sips of clear liquids
  • avoid food preparation because the smell of food cooking often worsens nausea
32
Q

CINV Non-pharmacological choices for behavioural methods

A
  • relaxation techniques may help decrease physiologic arousal and anxiety
  • individualized exercise programs may help decrease anxiety and depression
  • systematic desensitization may be helpful for anticipatory nausea and vomiting
33
Q

What are other CINV Non-pharmacological choices besides dietary and behavioural?

A
  • keep movement to a minimum; rest in bed or chair to avoid vestibular stimulation
  • acupuncture and acupressure may be effective in alleviating CINV
  • sleep has been shown to protect against CIVN

ND Ontario Prescribing Exam (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions