Chapter 61: Oncology I: Overview and Side Effect Management Flashcards
1
Q
What is an adjuvant
A
Treatment given AFTER the primary therapy (usually surgery) or CONCURRENT with other therapy (usually radiation) to eradicate residual disease and decrease recurrence
2
Q
A tumor that is not cancerous is also called
A
benign
3
Q
What is used to make a definitive diagnosis of cancer
A
Biopsy
4
Q
What is a neoadjuvant
A
Treatment given BEFORE the primary therapy to shrink the size of the tumor and make surgery more effective
5
Q
Cancer that has returned after a period during which it could not be detected is called
A
recurrence
6
Q
The disappearance of the signs and symptoms of cancer, but not necessarily the presence of the disease is called
A
Remission
7
Q
How is cancer staged
A
T - size and extent
N - spread to lymph nodes
M - whether the cancer has metastasized
8
Q
Cancer that cannot be cured and leads to death is called
A
Terminal or end-stage
9
Q
What are the warning signs that warrant referral to a physician (if suspected cancer)
A
CAUTION: Change in bowel or bladder habits A sore throat that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty swallowing Obvious change in wart or mole Nagging cough or hoarseness
10
Q
____ is recommended for prevention of colorectal cancer and CVD in patients who are 50-59 years old, have ASCVD risk ≥ 10%, have ≥ 10-year life expectancy and are at low risk of bleeding
A
Low-dose ASA
11
Q
To reduce risk of developing skin cancer, you should use a broad-spectrum sunscreen with an SPF of at least ____ and reapply every __ hours
A
15-30
2 hours
12
Q
Mammograms should begin ____ in women age 45-54
A
Yearly
13
Q
Mammograms should be done ____ at age 55
A
every 2 years or yearly
14
Q
Women age 21-29 should have a PAP smear every ___
A
3 years
15
Q
At what age should women have a pap smear and HPV DNA test?
How often?
A
age 30-65
every 5 years
16
Q
Men and women over ____ years should have stool-based tests done (i.e., fecal occult blood test, stool DNA test) and colonoscopy every ____ or flexible sigmoidoscopy every ___
A
45 years
10 years
5 years
17
Q
Men and women age 55-74 should complete an annual ____ if all of the following:
- In good health
- Have ____
- Still smoking or quit smoking within the past 15 years
A
annual CT scan of the chest
at least a 30-pack year smoking hx
18
Q
If a patient ops to be tested for prostate, it involves:
what age?
A
PSA test (blood test) \+/- digital rectal exam
for ≥ 50
19
Q
Max dose for bleomycin and reason
A
Lifetime cumulative dose: 400 units
Pulmonary toxicity
(Lungs have 4 lobes – 400)
20
Q
Max dose for doxorubicin and reason
A
Lifetime cumulative dose: 450-550 mg/m2
Cardiotoxicity
21
Q
Max dose for Cisplatin and reason
A
Dose per cycle not to exceed 100 mg/m2
Nephrotoxicity
22
Q
Max dose for Vincristine and reason
A
Single dose “capped” at 2 mg
Neurotoxicity
23
Q
Almost all classic chemo drugs can cause myelpsuppression EXCEPT:
A
asparginase, bleomycin, vincristine
24
Q
How to manage neutropenia in myelosuppression:
A
CSFs
25
How to manage anemia in myelosuppression:
RBC transfusions and (in palliation only) ESAs
26
How to manage thrombocytopenia in myelosuppression:
platelet transfusions
27
Which chemo drugs commonly cause nausea/vomiting
Cisplatin, cyclophosphamide, ifosfamide
28
Management of N/V with chemotherapy
NK1-RA
5HT3-RA
dexamethasone
IV/PO fluid hydration
29
Which chemo drugs commonly cause mucositis
Fluorouracil, MTX
30
Management of mucositis with chemotherapy
Symptomatic treatment: mucosal coating agents, topical local anesthetics, antifungals, antivirals
31
Which chemo drugs commonly cause diarrhea
Irinotecan, capecitabine, FU, MTX
32
Management of diarrhea with chemotherapy
IV/PO fluid hydration, antimotility meds (e.g., loperamide)
Irinotecan: atropine for early-onset diarrhea
(loperamide for delayed diarrhea)
33
Which chemo drug commonly causes constipation
Vincristine
34
Management of constipation with chemotherapy
Stimulant laxatives, Miralax
35
Management of xerostomia with radiation
artificial saliva substitutes, pilocarpine
36
Which chemo drug class commonly causes cardiomyopathy
Anthracyclines
37
Which chemo drugs commonly cause QT prolongation
Arsenic trioxide, many TKIs
38
What can be given prophylactically in select patients receiving doxorubicin
dexrazoxane (Zinecard) to prevent cardiomyopathy
39
Which chemo drugs can cause pulmonary fibrosis
Bleomycin, busulfan, carmustine, lomustine
40
Which chemo drugs can cause pneumonitis
Immune therapy MABs targeting PD-1 and CTLA-4
41
Management of pulmonary toxicity/ pneumonitis
stop drug
Steroids for immune therapy agents
| DNE lifetime cumulative dose of 400 units for bleomycin
42
Which chemo drugs can cause hepatotoxicity
Antiandrogens (bicalutamide, flutamide, nilutamide)
43
Management of hepatotoxicity
Steroids for immunotherapy agents
44
Which chemo drugs can cause nephrotoxicity
Cisplatin, MTX
45
What drug can be given prophylactically with cisplatin to reduce the risk of nephrotoxicity
Amifostine (Ethyol)
Ensure adequate hydration
| DNE max cycle dose of 100 for cisplatin
46
Which chemo drugs can cause hemorrhagic cystitis
Ifosfamide (all doses), cyclophosphamide (higher doses)
47
What drug is always given prophylactically with ifosfamide (and sometimes with cyclophosphamide) to reduce risk of hemorrhagic cystitis
Mesna (Mesnex)
ensure adequate hydration
48
Which chemo drug classes can cause peripheral neuropathy
```
Vinca alkaloids (vincristine, vinblastine, vinorelbine)
Platinums (cisplatin, oxaliplatin)
Taxanes (paclitaxed, docetaxel, cabazitaxel)
```
49
Management of neuropathy with vincristine and oxaliplatin
symptomatic treatment
vincristine: limit dose to 2mg/dose
oxaliplatin: avoid cold temperatures and avoid cold beverages (cold-mediated neuropathy)
50
Which chemo drugs have clotting risk
Aromatase inhibitors (i.e., anastrazole, letrozole), SERMs (e.g., tamoxifen, raloxifene)
51
What adjunctive treatment can be given with fluorouracil to enhance efficacy
Leucovorin
52
What adjunctive treatment can be given with fluorouracil or capecitabine as an antidote within 96 hours for an OD or to treat severe, life-threatening or early-onset toxicity
Uridine triacetate (Vistogard)
53
What adjunctive treatment can be given with MTX prophylactically after MTX to decrease myelosuppression and mucositis in high-dose therapy
Leucovorin or levoleucovorin (Fusilev)
54
What adjunctive treatment can be given with MTX as an antidote to decrease excessive MTX levels d/t acute renal failure
Glucarpidase (Voraxaze)
55
what is nadir?
lowest point that WBCs and platelets reach after chemo
56
When does nadir occur
7-14 days after chemo
57
WBCs and platelets generally recover ____ post treatment
3-4 weeks
58
All drugs used for myelosuppression (e.g., EPO, filgrastim) are kept ____ and are given by ____
refrigerated
SC injection
59
What ANC is considered neutropenia
< 1000 cells/mm3
60
What ANC is considered severe neutropenia
| profound neutropenia?
< 500 cells/mm3
| <100
61
What are G-CSFs used for
To prevent neutropenia
by stimulating production of WBCs
62
Filgrastin brand name
Neupogen
63
Pegfilgrastim brand name
Neulasta
64
How often is filgrastim dosed
daily
65
How often is pegfilgrastim dosed
1 syringe once per chemo cycle
66
Side effects of filgrastim & pegfilgrastim
Bone pain
67
SE of sargramostim
fever, bone pain, arthralgias, myalgias, rash
68
While using filgrastim or pegfilgrastim, patients should report any signs of ______
Enlarged spleen (pain in the left upper abdomen)
69
Which drug has to be documented when it was given since it should have at least 12 days from dose to the next cycle of chemo: filgrastim or pegfilgrastim
Pegfilgrastim
70
T/F: empiric antibiotics are started immediately if a fever occurs after chemo
True
71
Neutropenia diagnosis requirements
Oral temp > 38.3C (101F) x 1 reading
and ANC < 500 cells/mm3
72
Which bacteria have the highest risk for causing sepsis
Gram-negative
73
The initial empiric abx for neutropenia must provide adequate ____ coverage, including _____
Gram-negative
Pseudomonas aeruginosa
74
Treatment of neutropenia, low risk patients
(expected ANC < 500 for ≤ 7 days, no comorbidities)
ORAL
cipro/levo + augmentin
| clindamycin can replace augmentin in pcn allergy
75
Treatment of neutropenia, high risk patients
(expected ANC < 500 for > 7 days, comorbidities present, renal or hepatic impairment)
INTRAVENOUS anti-pseudomonal beta-lactam
76
ESAs should only be initiated when Hgb is
< 10 g/dL
77
ESA's risk in cancer
can shorten survival and increase tumor progression - ONLY for palliation
78
What needs to be assessed when using ESAs since they will not work well to correct anemia if these levels are inadequate
Serum ferritin, transferrin saturation (TSAT) and total iron-binding capacity (TIBC)
79
When are platelet transfusions indicated
When platelet count is < 10,000 cells/mm3
| or < 30K with bleeding present
80
What patient factors increase the risk of N/V
```
female
age < 50
anxiety, depression
dehydration
history of motion sickness
history of N/V with prior regimens
```
81
For CINV, when should antiemetics be administered
30 min prior to chemo and provide take-home antiemetic therapy
82
What is the onset of acute, delayed, and anticipatory CINV
acute - within 24 hrs after chemo
delayed - > 24 hours after chemo
anticipatory - before chemo
83
Drug therapy for acute CINV
5HT3-RA
84
Drug therapy for delayed CINV
NK1-RA, corticosteroids, palonosetron, olanzapine
85
Drug therapy for anticipatory CINV
BZDs; start evening prior to chemo
86
Which drug has the highest emetic risk
Cisplatin
87
Antiemetic regimen for high-emetic risk chemo
3 or 4 drugs:
- NK1RA + 5HT3RA + Olanzapine + Dexamethasone (preferred)
- Olanzapine + Palonosetron + Dexa
- NK1RA + 5HT3RA + Dexa
88
What meds can be used for breakthrough CINV
5HT3-RA, dopamine RA, cannabinoids, olanzapine
89
Common SE of 5HT3-RAs
migraine-like headaches and constipation
| minimal sedation
90
dopamine receptor antagonists common SE
sedation
(prochlorperazine, promethazine, metoclopramide)
91
management of extrapyramidal symptoms like acute dystonic reactions should be managed with
anticholinergics (benztropine, diphenhydramine)
92
Droperidol has restricted use due to
QT prolongation
93
Cannabinoids like dronabinol and nabilone can be used as second-line agents and are synthetic analogs of
delta-9-THC
94
Aprepitant brand name
(PO) Emend
95
Fosaprepitant brand name
(IV) Emend
96
What formulation does fosaprepitant come in
Injection
97
Aprepitant/Fosaprepitant/netupitant are CYP3A4 inhibitors; dose of ____ should be decreased
Dexamethasone
98
Ondansetron brand name
Zofran, Zuplenz film
99
Granisetron brand name
Sancuso
100
Palonosetron brand name
Aloxi
101
5HT3-RA should not be used with ____ d/t severe ____ and loss of consciousness
apomorphine
hypotension
102
5HT3-RA warnings
risk of serotonin syndrome when used in combination with other serotonergic agents
103
Short-term SE of dexamethasone
increased appetite/weight gain, fluid retention, insomnia
| Higher doses increase BP and blood glucose
104
Prochlorperazine brand name
Compazine
105
Promethazine brand name
Phenergan
106
Metoclopramide brand name
Reglan
107
Olanzapine brand name
Zyprexa
108
Promethazine should not be used in children < ___ years of age d/t risk of ____ depression
2 years
respiratory
109
Promethazine given IV route can cause
Serious tissue injury if extravasation occurs
| deep IM preferred
110
Boxed warning for metoclopramide
tardive dyskinesia that can be irreversible
111
Side effects of dopamine receptor antagonists
Sedation, lethargy, acute EPS, can decrease seizure threshold
112
Dronabinol brand name
Marinol
113
Dronabinol must be
refrigerated
114
Nabilone brand name
Cesamet
115
Side effects of cannabinoids
Somnolence, euphoria, increased appetite
116
What is the max dose of loperamide when treating chemo induced diarrhea
16 mg/day
117
What is the classic med that blocks acute diarrhea
Atropine
118
What is the classic med used for xerostomia (dry mouth)
Pilocarpine
119
What drugs are used to treat Candida infection with oral mucositis
Nystatin oral suspension or clotrimazole troches
120
Which drugs can cause hand-foot syndrome, or PPE
Capecitabine and FU
121
How can you treat hand-foot syndrome
Cooling with cold compresses
Emollients to retain moisture
Steroids and pain meds to lessen inflammation and pain
122
What medications are used to treat hyperuricemia in tumor lysis syndrome
Allopurinol and rasburicase
123
Treatment for mild hypercalcemia of malignancy
hydration and loop diuretics
IV bisphosphonates
124
Treatment for mod-severe hypercalcemia of malignancy
- IV hydration with NS
- Calcitonin is sometimes used initially for up to 48 hrs
- IV bisphosphonate (e.g., pamidronate, zoledronic acid)
- denosumab - can build bone density and reduce fraction
125
Calcitonin brand name
Miacalcin
126
Zoledronic acid brand name for hypercalcemia of malignancy
| brand name for osteoporosis
Zometa
| Reclast
127
Denosumab brand name for hypercalcemia of malignancy
| brand name for osteoporosis
Xgeva
| Prolia
128
Denosumab MOA
Monoclonal antibody that block the interaction between RANKL and RANK
129
To prevent immunologic reactions, most monoclonal antibodies require the following premeds:
APAP and diphenhydramine
130
Major chemo vesicants include
anthracyclines and vinca alkaloids
131
If extravasation occurs, what can be done
apply cold compresses (except with vinca alkaloids and etoposide, use warm compresses)
Antidotes:
- Anthracyclines: dexrazoxane (Totect) or dimethyl sulfoxide
- Vinca alkaloids and etoposide: hyaluronidase
132
Drugs that can be given intrathecally include:
and must be ______
Cytarabine, MTX, hydrocortisone and thiotepa
Preservative-free
133
Which chemo drug can be fatal if given intrathecally
Vincristine
| Do not dispense in a syringe
134
When chemo is being planned, vaccination should precede chemo by ≥ ____
2 weeks
