Cancer Toxicities Flashcards
1
Q
metabolic causes of N/V
A
hyperglycemia
hypercalcemia
hypoadernalism
uremia
hyponatremia
2
Q
anticipatory
A
learned response from previous emetic reactions
provoked by sight, sound, or smell
3
Q
acute N/V
A
within 24 hours of chemo
4
Q
delayed N/V
A
after 24 hours
substance P and NK1 binding
5
Q
breakthrough N/V
A
N/V despite being treated with anti-emetics before
6
Q
refractory N/V
A
N/V that persists despite anti-emetics
failed other therapies
7
Q
patho of N/V
A
GI tract is disrupted by chemo
enterochomaffin cells release large stores of serotonin
chemoreceptor trigger zone stimulates vomiting center
8
Q
input to vomiting center from what sources
A
higher cortical centers
pharynx
GI tract
9
Q
wretching is what
A
labored movement before vomiting
10
Q
neurotransmitters involved in N/V
A
dopamine, histamine, acetylcholine, serotonin, substance P
11
Q
chemo induced N/V most common drug
A
cisplatin
12
Q
highly emetogenic percentage and level
A
> 90% level 5
13
Q
moderately emetogenic percentages and level
A
> 30-90% level 3-4
14
Q
low emetic risk percentage and level
A
10-30% level 2
15
Q
minimal emetic risk percentage
A
<10% level 1
16
Q
level 1 and 2 effect on emetogenicity
A
do not effect when combined
17
Q
when combining with a level 3/4 agent how much do we increase emetogenicity
A
1 level per drug added
18
Q
N/V prophylaxis required when
A
moderate-high emetic risk agents
>30%
19
Q
CINV risk factors
A
women
younger
hx motion sick, morning sick, CINV
anxious
20
Q
what is protective of CINV
A
chronic alcohol use
21
Q
highly emetogenic classes that need to be given CINV
A
5HT3 antagonist
steroid
22
Q
options for highly emetogenic regimen
A
4 - NK-1 antagonist, steroid, 5HT3, antipsych
3- dexamethasone, palonosetron, olanzapin
3 - NK-1 antagonist, steroid, 5-HT3 antag
23
Q
options for moderately emetogenic regimen
A
3- dexamethasone, palonosetron, olanzapin
3 - NK-1 antagonist, steroid, 5-HT3 antag
2 - steroid and 5HT3 antagonist
24
Q
low emetogenic regimen and drugs
A
pick a drug
5HT3 antagonists
dexamethasone
metoclopramide
prochorperazine
25
what can be added to CINV regimens if needed for toxicities
H2RA/PPI
benzo (lorazepam)
26
agents that could be used for breakthrough nausea and vomiting
lorazepam
dronabinol
nabilone
5HT3s
dexamethasone
scopalamine
haloperidol
metoclopramide
prochlorperazine
promethazine
olanzapine
27
drug of choice in elderly pateints
prochlorperazine
28
delayed N/V treatments
NK-1 antagonists
dexamethasone
olanzapine
29
anticipatory N/V treatments
behavioral - hypnosis, music, yoga
accupuncture
LORAZEPAM
30
drug of choice for anticipatory N/V
benzos (lorazepam)
31
drug of choice initially for oral agents with high-moderate risk
5-HT3 antagonists
32
radiation in head /neck /GI N/V treatment
5-HT3 antagonists
33
drug of choice for radioactive treatments (Leutitium)
5-HT3s or NK-1s
34
which drug would be poor option in radiopharmaceuticals
steroids
35
side effects of 5HT3 antagonists?
headache
constipation
EKG changes
36
if 5HT has headache can we switch within the class?
yes, switch agents within class
37
max dose of 5HT3 antagonists
16 mg
38
corticosteroids side effects
hyperglycemia
increased appetite
insomnia
39
substance P / NK1 antags side effects
hiccups
40
dopamine antagonists side effects (chlorpromazine, haloperidol, metoclopramide
EPS symptoms
41
metoclopramide side effect
diahrhea
42
what are the dopamine antagonists
chlorpromazine
haloperidol
metoclopramide
43
olanzapine side effect
sedation
44
phenothiazine / promethazine side effect
sedation
45
dronabinol side effects
hallucinations
increased appetite
46
scopalamine side effect
cant see cant pee cant spit cant shit
47
what population would scopalamine be good for
younger
48
which drugs is EPS a risk
metoclopramide
prochlorperazine
promethazine
49
when to begin anti emesis therap
5-30 mins before
administer around the clock
50
when does mucositis occur
5 to 7 days after chemo start
WBCs start to drop
51
mucositis occurs where
in the mouth
could affect whole GI tract though
52
which drugs cause mucositis
5-FU
doxorubicin, other anthracyclines
53
mucositis is more common with what type of IV infusion
continuous
54
risk factors for mucositis
chemo and radiation combo
pre existing lesions
poor dental hygiene / dentures
55
diet reccomendations with mucositis
no spice, rough foods, salt, acid
eat bland and soft foods
avoid smoking and alcohol
56
pre treatment prevention of mucositis
dental screening
baking soda rinse
soft bristle tooth brusht
57
treatment of mucositis pain: topical anesthetic
topical anesthetic
lidocaine, diphenhydramine
Marys Magic
swish and spit
58
treatment of mucositis pain
use ice chips 30 mins before
sucralfate - some pts get nausaus
opioid
59
PCA used for what
moderate to severe mucositis
60
best thing for mucositis
WBCs going back up
pain meds
61
what is decreased white blood cells called
neutropenia
62
normal range WBCs
4.8-10.8
63
what is decreased platelets called
thrombocytopenia
64
platelet normal range
140-440
65
platelet deficiency causes risk of what
bleeding
66
neutropenia causes what
risk of life threatening infection
67
red blood cell deficiency is waht
anemia
68
anemia symptoms
hypoxia, fatigue
69
RBC normal range
4.6-6.2
70
what is nadir
lowest value of blood counts during cycle of chemo
71
to give chemo we need to have what counts
WBC > 3 x 10^3
OR
ANC >1.5 x 10^3 AND platelet >= 100
72
ANC equation
WBC x % granulocytes
73
severe neutropenia level
<0.5 x 10^3
74
febrile neutropenia is what
ANC < 0.5 x 10^3 and 101 temp
OR
100.4 temp for at least an hour
75
is febrile neutropenia bad
yes pts should go to hospital and get antibiotics
76
what is primary prophylaxis of neutropenic fever
>20% chance it will cause neutropenic fever
(there are certain regimens in guidelines)
77
what is secondary prophylaxis of neutropenic fever
they had neutropenia complications with past chemo
78
what are the two CSF drugs?
filgrastim
pegfilgrastim
79
difference in filgrastim and pegfilgrastim
PEG longer 1/2 life, once subq
filgrastim once daily
80
first CSF biosimilar
filgrastim-sndz
81
is tbo-filgrastim a biosimilar?
no
82
which drug has a continuous injector on body
pegfilgrastin
83
when after chemo do we give filgrastim
3-4 days after chemo
84
when after chemo do we give pegfilgrastim
24 hours after chemo
85
adverse effects of CSFs
bone aches, flu like sx, DVT
86
what drug may help with side effects from CSFs
loratadine
87
when are platelets given?
sometimes if < 10 x 10^3
prior to surgery
active bleeding
88
anemia causes
decreased RBCs
decreased erythopoetin
decreased B12 and folic acid
89
anemia symptoms
fatigue
poor performance status
90
when should pt be worked up for anemia
HgB <11
>2 drop from baseline
91
when is pt symotomatic from anemia
fatigued, hard time getting around
92
blackbox warning of ESAs
increase risk of death and shorten survival time
93
who should not get ESAs
not on chemo
curative intent
not on myelosupressive chemo
94
who should get ESAs
if cancer with CKD
palliative chemo
95
best treatment for anemia
red blood cell transfusion
96
what does erythropoetin do
stimulates RBC production
97
goal for erythropoetin therapy
lowest Hgb level
98
when to reduce erythropoetin dose
if >1 increase in 2 week period
99
difference in darbopoetin
given every 2-3 weeks, long 1/2 life
100
what should we have as baseline done before ESA therapy
iron study
101
what to do if pt has low iron
supplement with oral iron (can be hard)
102
what drugs cause myalgias
taxanes
aromatase inhibitors
103
treatment for myalgias
NSAIDs
opioids
104
drug causing hemmoragic cystitis
cyclophosphamide
105
hemorrhagic cystitis treatment
hydration
mesna
106
heart failure drugs that cause
rubicins (anthracyyclines)
cyclophosphamide
trastuzumab
107
drugs causing peripheral neuropathy
taxanes
vinca alkaloids
platinums
108
drug causing pulmonary toxicities
bleomycin
109
what binds acrolein
mesna
110
mesna is taken to decrease what
risk of hemorrhagic cystitis
111
how does cardiac toxicity happen from anthracyclines
iron dependent free radicals
lower level of enzymes capable of detoxing the free radicals
112
acute cardiac tox from anthracyclines looks like what
occurs immediately after they take
not cumulative dose related
ECG findings (like pt having heart attack)
113
what is type 1 cardiac tox
anthracyclines
114
what is chronic cardiac tox type 1
more common
onset within a year
cumulative dose related
tachycardia, exercise intolerant,
Looks like chronic HF
115
what is late onset cardiac dysfunction type 1 and who does it occur in
years after therapy
pediatric population
CHF, arrythmias
116
doxorubicin cumulative dose when risk really goes up
450 mg/m2
7-8 cycles
117
what is type II cardiac dysfunction
HER2 therapies
(trastuzumab)
118
is Type II cardiac tox dose dependent
no not dose dependent
EGFR pathway
119
is Type II cardiac tox reversible or irreversible
reversible
120
is Type I cardiac tox reversible or irreversible
irreversible
121
highest risk of cardiac tox from which two drugs together
trastuzumab and antrhacycline
122
OPQRSTU
onset
provokes
quality
radiate
severity
time
understanding
123
pain scale 1-3 options
non -opioids
acetaminophen
ibuprofen
aspirin
124
pain scale 4-6 options
combo products
hydrocodone/acetaminophen
tramadol
any combo with acet / ibuprofen
125
pain scale 7-10 options
pure opioids
126
morphine caution in which pts
renal failure
127
hydromorphone vs morphine which is more potent
hydrophormone
128
hydromorphone excreted how
renally
129
oxycodone metabolized how
CYP2D6
130
oxycodone has casued what in renal failure pts
sedation and CNS toxicity
131
oxycodone isnt available in what dosage form
IV
132
fentanyl metabolized where
liver
133
which drug safe in renal dysfunction and liver dysfunction
fentanyl
134
what patients could use fentanyl as alternative
refractory N/V
cant take PO
(Patch)
135
Duragesic brand for wht
fentanyl
136
box warnings for fentanyl
risk addiction
respiratory depression
monitor closely
accidental exposure
avoid direct heat sources (after shower)
137
who shouldnt use fentanyl patch
opioid naive
138
who should use methadone
true morphine allergy
opioid induced ADRs
refractory to other opioids
neuropathic pain
long acting at low cost
139
who should avoid methadone
if many drug interactions
risks scyncope or arrythmia
adhernece issues
poor cognition
140
is stomach upset a morphine allergy
not a true allergy
141
is methadone an option for renal failure
yes , no adverse events
142
should we use methadone in liver failure
NO, not advised in liver dysfunction
143
which opioid causes QTC prolongation
methadone
144
when switching agents what can we do
decrease dose by 25%
145
perferred dosage form for opioids
oral
146
which opioid side effect do pts not develop tolerance to?
constipation, alwasy need a regimen
147
what to use for constipation regimen
stimulant laxative +/- stool softner
148
pruritis seen mostly with what drug
morphine
149
myclonic jerking is a sign of what
opioid toxicity
150
what to do if respiratory depression on opioid for chronic pain
give low dose Narcan, dilute with NaCl
151
caution with PCAs in what disease state
sleep apnea
152
PCA to oral how to convert
calculate 24 hour dose
convert to desired agent
reduce 25%
divide into appropriate
use PRN 10-20% of total dose every 3-4 hrsc
153
celiac plexus used in which pts
pancreatic caner pts where other meds arent working
154
intrathecal pump used for who
refractory to other opioids or increased toxicities
155
what doses are used in intrathecal?
lower doses
156
intrathecal meds (7)
morphine
hydromorphone
fentanyl
clonidine
baclofen
ziconotide
bupivacaine
157
radiation used in what
bony and brain metastates
158
what two drug help with bone metastasis
NSAIDs
dexamethasone
159
ECOG scale 0 = what
5 = what
0 = gets around just fine
5 = dead
160
RECIST used for what
scans
