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PHRM 864 > Cancer Toxicities > Flashcards

Cancer Toxicities Flashcards

1
Q

metabolic causes of N/V

A

hyperglycemia
hypercalcemia
hypoadernalism
uremia
hyponatremia

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2
Q

anticipatory

A

learned response from previous emetic reactions
provoked by sight, sound, or smell

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3
Q

acute N/V

A

within 24 hours of chemo

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4
Q

delayed N/V

A

after 24 hours
substance P and NK1 binding

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5
Q

breakthrough N/V

A

N/V despite being treated with anti-emetics before

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6
Q

refractory N/V

A

N/V that persists despite anti-emetics
failed other therapies

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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

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8
Q

input to vomiting center from what sources

A

higher cortical centers
pharynx
GI tract

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9
Q

wretching is what

A

labored movement before vomiting

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10
Q

neurotransmitters involved in N/V

A

dopamine, histamine, acetylcholine, serotonin, substance P

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11
Q

chemo induced N/V most common drug

A

cisplatin

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12
Q

highly emetogenic percentage and level

A

> 90% level 5

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13
Q

moderately emetogenic percentages and level

A

> 30-90% level 3-4

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14
Q

low emetic risk percentage and level

A

10-30% level 2

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15
Q

minimal emetic risk percentage

A

<10% level 1

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16
Q

level 1 and 2 effect on emetogenicity

A

do not effect when combined

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17
Q

when combining with a level 3/4 agent how much do we increase emetogenicity

A

1 level per drug added

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18
Q

N/V prophylaxis required when

A

moderate-high emetic risk agents
>30%

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19
Q

CINV risk factors

A

women
younger
hx motion sick, morning sick, CINV
anxious

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20
Q

what is protective of CINV

A

chronic alcohol use

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21
Q

highly emetogenic classes that need to be given CINV

A

5HT3 antagonist
steroid

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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

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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

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24
Q

low emetogenic regimen and drugs

A

pick a drug
5HT3 antagonists
dexamethasone
metoclopramide
prochorperazine

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25
Q

what can be added to CINV regimens if needed for toxicities

A

H2RA/PPI
benzo (lorazepam)

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26
Q

agents that could be used for breakthrough nausea and vomiting

A

lorazepam
dronabinol
nabilone
5HT3s
dexamethasone
scopalamine
haloperidol
metoclopramide
prochlorperazine
promethazine
olanzapine

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27
Q

drug of choice in elderly pateints

A

prochlorperazine

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28
Q

delayed N/V treatments

A

NK-1 antagonists
dexamethasone
olanzapine

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29
Q

anticipatory N/V treatments

A

behavioral - hypnosis, music, yoga
accupuncture
LORAZEPAM

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30
Q

drug of choice for anticipatory N/V

A

benzos (lorazepam)

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31
Q

drug of choice initially for oral agents with high-moderate risk

A

5-HT3 antagonists

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32
Q

radiation in head /neck /GI N/V treatment

A

5-HT3 antagonists

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33
Q

drug of choice for radioactive treatments (Leutitium)

A

5-HT3s or NK-1s

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34
Q

which drug would be poor option in radiopharmaceuticals

A

steroids

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35
Q

side effects of 5HT3 antagonists?

A

headache
constipation
EKG changes

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36
Q

if 5HT has headache can we switch within the class?

A

yes, switch agents within class

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37
Q

max dose of 5HT3 antagonists

A

16 mg

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38
Q

corticosteroids side effects

A

hyperglycemia
increased appetite
insomnia

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39
Q

substance P / NK1 antags side effects

A

hiccups

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40
Q

dopamine antagonists side effects (chlorpromazine, haloperidol, metoclopramide

A

EPS symptoms

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41
Q

metoclopramide side effect

A

diahrhea

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42
Q

what are the dopamine antagonists

A

chlorpromazine
haloperidol
metoclopramide

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43
Q

olanzapine side effect

A

sedation

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44
Q

phenothiazine / promethazine side effect

A

sedation

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45
Q

dronabinol side effects

A

hallucinations
increased appetite

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46
Q

scopalamine side effect

A

cant see cant pee cant spit cant shit

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47
Q

what population would scopalamine be good for

A

younger

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48
Q

which drugs is EPS a risk

A

metoclopramide
prochlorperazine
promethazine

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49
Q

when to begin anti emesis therap

A

5-30 mins before
administer around the clock

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50
Q

when does mucositis occur

A

5 to 7 days after chemo start
WBCs start to drop

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51
Q

mucositis occurs where

A

in the mouth
could affect whole GI tract though

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52
Q

which drugs cause mucositis

A

5-FU
doxorubicin, other anthracyclines

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53
Q

mucositis is more common with what type of IV infusion

A

continuous

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54
Q

risk factors for mucositis

A

chemo and radiation combo
pre existing lesions
poor dental hygiene / dentures

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55
Q

diet reccomendations with mucositis

A

no spice, rough foods, salt, acid
eat bland and soft foods
avoid smoking and alcohol

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56
Q

pre treatment prevention of mucositis

A

dental screening
baking soda rinse
soft bristle tooth brusht

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57
Q

treatment of mucositis pain: topical anesthetic

A

topical anesthetic
lidocaine, diphenhydramine
Marys Magic
swish and spit

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58
Q

treatment of mucositis pain

A

use ice chips 30 mins before
sucralfate - some pts get nausaus
opioid

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59
Q

PCA used for what

A

moderate to severe mucositis

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60
Q

best thing for mucositis

A

WBCs going back up
pain meds

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61
Q

what is decreased white blood cells called

A

neutropenia

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62
Q

normal range WBCs

A

4.8-10.8

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63
Q

what is decreased platelets called

A

thrombocytopenia

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64
Q

platelet normal range

A

140-440

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65
Q

platelet deficiency causes risk of what

A

bleeding

66
Q

neutropenia causes what

A

risk of life threatening infection

67
Q

red blood cell deficiency is waht

A

anemia

68
Q

anemia symptoms

A

hypoxia, fatigue

69
Q

RBC normal range

A

4.6-6.2

70
Q

what is nadir

A

lowest value of blood counts during cycle of chemo

71
Q

to give chemo we need to have what counts

A

WBC > 3 x 10^3
OR
ANC >1.5 x 10^3 AND platelet >= 100

72
Q

ANC equation

A

WBC x % granulocytes

73
Q

severe neutropenia level

A

<0.5 x 10^3

74
Q

febrile neutropenia is what

A

ANC < 0.5 x 10^3 and 101 temp
OR
100.4 temp for at least an hour

75
Q

is febrile neutropenia bad

A

yes pts should go to hospital and get antibiotics

76
Q

what is primary prophylaxis of neutropenic fever

A

> 20% chance it will cause neutropenic fever
(there are certain regimens in guidelines)

77
Q

what is secondary prophylaxis of neutropenic fever

A

they had neutropenia complications with past chemo

78
Q

what are the two CSF drugs?

A

filgrastim
pegfilgrastim

79
Q

difference in filgrastim and pegfilgrastim

A

PEG longer 1/2 life, once subq
filgrastim once daily

80
Q

first CSF biosimilar

A

filgrastim-sndz

81
Q

is tbo-filgrastim a biosimilar?

A

no

82
Q

which drug has a continuous injector on body

A

pegfilgrastin

83
Q

when after chemo do we give filgrastim

A

3-4 days after chemo

84
Q

when after chemo do we give pegfilgrastim

A

24 hours after chemo

85
Q

adverse effects of CSFs

A

bone aches, flu like sx, DVT

86
Q

what drug may help with side effects from CSFs

A

loratadine

87
Q

when are platelets given?

A

sometimes if < 10 x 10^3
prior to surgery
active bleeding

88
Q

anemia causes

A

decreased RBCs
decreased erythopoetin
decreased B12 and folic acid

89
Q

anemia symptoms

A

fatigue
poor performance status

90
Q

when should pt be worked up for anemia

A

HgB <11
>2 drop from baseline

91
Q

when is pt symotomatic from anemia

A

fatigued, hard time getting around

92
Q

blackbox warning of ESAs

A

increase risk of death and shorten survival time

93
Q

who should not get ESAs

A

not on chemo
curative intent
not on myelosupressive chemo

94
Q

who should get ESAs

A

if cancer with CKD
palliative chemo

95
Q

best treatment for anemia

A

red blood cell transfusion

96
Q

what does erythropoetin do

A

stimulates RBC production

97
Q

goal for erythropoetin therapy

A

lowest Hgb level

98
Q

when to reduce erythropoetin dose

A

if >1 increase in 2 week period

99
Q

difference in darbopoetin

A

given every 2-3 weeks, long 1/2 life

100
Q

what should we have as baseline done before ESA therapy

A

iron study

101
Q

what to do if pt has low iron

A

supplement with oral iron (can be hard)

102
Q

what drugs cause myalgias

A

taxanes
aromatase inhibitors

103
Q

treatment for myalgias

A

NSAIDs
opioids

104
Q

drug causing hemmoragic cystitis

A

cyclophosphamide

105
Q

hemorrhagic cystitis treatment

A

hydration
mesna

106
Q

heart failure drugs that cause

A

rubicins (anthracyyclines)
cyclophosphamide
trastuzumab

107
Q

drugs causing peripheral neuropathy

A

taxanes
vinca alkaloids
platinums

108
Q

drug causing pulmonary toxicities

A

bleomycin

109
Q

what binds acrolein

A

mesna

110
Q

mesna is taken to decrease what

A

risk of hemorrhagic cystitis

111
Q

how does cardiac toxicity happen from anthracyclines

A

iron dependent free radicals
lower level of enzymes capable of detoxing the free radicals

112
Q

acute cardiac tox from anthracyclines looks like what

A

occurs immediately after they take
not cumulative dose related
ECG findings (like pt having heart attack)

113
Q

what is type 1 cardiac tox

A

anthracyclines

114
Q

what is chronic cardiac tox type 1

A

more common
onset within a year
cumulative dose related
tachycardia, exercise intolerant,
Looks like chronic HF

115
Q

what is late onset cardiac dysfunction type 1 and who does it occur in

A

years after therapy
pediatric population
CHF, arrythmias

116
Q

doxorubicin cumulative dose when risk really goes up

A

450 mg/m2
7-8 cycles

117
Q

what is type II cardiac dysfunction

A

HER2 therapies
(trastuzumab)

118
Q

is Type II cardiac tox dose dependent

A

no not dose dependent
EGFR pathway

119
Q

is Type II cardiac tox reversible or irreversible

A

reversible

120
Q

is Type I cardiac tox reversible or irreversible

A

irreversible

121
Q

highest risk of cardiac tox from which two drugs together

A

trastuzumab and antrhacycline

122
Q

OPQRSTU

A

onset
provokes
quality
radiate
severity
time
understanding

123
Q

pain scale 1-3 options

A

non -opioids
acetaminophen
ibuprofen
aspirin

124
Q

pain scale 4-6 options

A

combo products
hydrocodone/acetaminophen
tramadol
any combo with acet / ibuprofen

125
Q

pain scale 7-10 options

A

pure opioids

126
Q

morphine caution in which pts

A

renal failure

127
Q

hydromorphone vs morphine which is more potent

A

hydrophormone

128
Q

hydromorphone excreted how

A

renally

129
Q

oxycodone metabolized how

A

CYP2D6

130
Q

oxycodone has casued what in renal failure pts

A

sedation and CNS toxicity

131
Q

oxycodone isnt available in what dosage form

A

IV

132
Q

fentanyl metabolized where

A

liver

133
Q

which drug safe in renal dysfunction and liver dysfunction

A

fentanyl

134
Q

what patients could use fentanyl as alternative

A

refractory N/V
cant take PO
(Patch)

135
Q

Duragesic brand for wht

A

fentanyl

136
Q

box warnings for fentanyl

A

risk addiction
respiratory depression
monitor closely
accidental exposure
avoid direct heat sources (after shower)

137
Q

who shouldnt use fentanyl patch

A

opioid naive

138
Q

who should use methadone

A

true morphine allergy
opioid induced ADRs
refractory to other opioids
neuropathic pain
long acting at low cost

139
Q

who should avoid methadone

A

if many drug interactions
risks scyncope or arrythmia
adhernece issues
poor cognition

140
Q

is stomach upset a morphine allergy

A

not a true allergy

141
Q

is methadone an option for renal failure

A

yes , no adverse events

142
Q

should we use methadone in liver failure

A

NO, not advised in liver dysfunction

143
Q

which opioid causes QTC prolongation

A

methadone

144
Q

when switching agents what can we do

A

decrease dose by 25%

145
Q

perferred dosage form for opioids

A

oral

146
Q

which opioid side effect do pts not develop tolerance to?

A

constipation, alwasy need a regimen

147
Q

what to use for constipation regimen

A

stimulant laxative +/- stool softner

148
Q

pruritis seen mostly with what drug

A

morphine

149
Q

myclonic jerking is a sign of what

A

opioid toxicity

150
Q

what to do if respiratory depression on opioid for chronic pain

A

give low dose Narcan, dilute with NaCl

151
Q

caution with PCAs in what disease state

A

sleep apnea

152
Q

PCA to oral how to convert

A

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
Q

celiac plexus used in which pts

A

pancreatic caner pts where other meds arent working

154
Q

intrathecal pump used for who

A

refractory to other opioids or increased toxicities

155
Q

what doses are used in intrathecal?

A

lower doses

156
Q

intrathecal meds (7)

A

morphine
hydromorphone
fentanyl
clonidine
baclofen
ziconotide
bupivacaine

157
Q

radiation used in what

A

bony and brain metastates

158
Q

what two drug help with bone metastasis

A

NSAIDs
dexamethasone

159
Q

ECOG scale 0 = what
5 = what

A

0 = gets around just fine
5 = dead

160
Q

RECIST used for what

A

scans

PHRM 864 (23 decks)

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