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Summer 1 > chemo > Flashcards

chemo Flashcards

1
Q

Chemotherapy ADE include

A 
hypersensitivity 
n/v
mucositis
alopecia
neuropathy
cutaneous reactions 
extravasation 
thrombosis 
MC: Myelosuppression! lowest blood cell count usually 10-14days after admin of chemo, and recovery w/in 3-4 wks
-anemia a few months after 1st dose 
-neutropenia, then thrombocytopenia
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2
Q

What are the 5 phases of chemo induced nausea/vomiting

A

Acute: w/in 1-2 hrs of chemo. Tx with Ondansetron
Delayed: >24 hours after admin. Tx w/ Aprepitant, fosaprepitant, or rolapitant
Anticipatory: prior to admin in those who had significant n/v with chemo before. Tx w/ prophylactic benzos (diazepam, lorazepam) the night before admin
Breakthrough: occurs despite prophylaxis. Tx with prochlorperazine or phenothiazine around the clock
Refractory: poor response to all antiemetics. Tx w/ glucocorticoids (DXM)

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3
Q

Where can mucositis occur

A

Gi mucosa

Inflammation as ulcers, local infection, can’t eat drink or swallow, systemic microbial invasion

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4
Q

Mucositis is MC associated with

A 
5-FU 
Doxorubicin 
Methotrexate 
Multikinase inhibitors (nibs) 
mTOR inhibitors (rolimus)
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5
Q

Patients at high risk for mucositis are

A

Poor dentitions
those on high dose chemo
those on radiation involving oropharynx
-prevent mucositis with good oral hygiene! go to the dentist before chemo Tx, rinse mouth w/ backing soda and salt water frequently between courses of chemo

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6
Q

What analgesics can be used to Tx mucositis

A

Mouthwash!
viscous lidocaine*
diphenhydramine liquid
Dyclonine sucrets*

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7
Q

How can you manage local infection 2/2 mucositis

A

Candida: Clotrimazole troches or nystatin oral suspension for thrush. Oral fluconazole or IV antifungals for more severe
Reactivation of HSV: Acyclovir

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8
Q

What is Palifermin

A

Keratinocyte Growth Factor that binds to KGF receptor resulting in proliferation, differentiation, and migration of epithelial cells on tongue, buccal, esophagus, and salivary glands

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9
Q

Palifermin is approved for

A

high dose chemoradiotherapy prior to stem cell transplant

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10
Q

ADE of Palifermin are

A

*Increased amylase and lipase

change in taste, mouth or tongue discoloration

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11
Q

How do you treat mucositis that manifests as diarrhea and abdominal pain

A

IVF, electrolyte supplement
Lomotil or Loperamide (non-infectious antispasmodics)
Octreotide: somatostatin analog, esp for severe diarrhea

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12
Q

What cutaneous reactions are associated with chemo

A 
localized rash
photosensitivity
skin hyperpigmentation
nal changes 
hand-foot syndrome/acral erythema (diffuse edema & erythema on palms and soles) 
-generally reversible and self limited
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13
Q

Cutaneous reactions are associated with

A

Cytarabine
5-FU
Bleomycin

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14
Q

How do you treat cutaneous reactions

A

Emollients if w/ dry skin
topical/systemic abx if rash gets infected
steroids to prevent itching and inflammation
Acral erythema: PO B6 (pyridoxine) QD, cold packs to extremities during chemo admin

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15
Q

What is hand foot skin reaction

A

Associated with multikinase inhibitors, FU, capecitabine, and liposomal doxorubicin
Localizes to areas of pressure/friction (hands, feet)
Can prevent w/ daily moisturizer
Can treat with urea cream, topical steroids, and pain meds (gabapentin, NSAIDs)

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16
Q

What is alopecia

A

Most distressing but usually temporary hair loss
W>M
All body, not just scalp.
MC associated with Taxane and Docetaxel

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17
Q

How do you treat alopecia

A

Cool caps to decrease blood flow to the scalp

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18
Q

What is extravasation

A

When chemo gets out of the blood and into surrounding structures (ex. IV line was not patent)
Causes prolonged pain, tissue sloughing, infection, and loss of mobility

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19
Q

What causes extravasation

A 
Vesiacants: agents that cause severe tissue damage if they escape the vasculature 
Antracyclines 
Actinomycin D
Vinca alkaloids 
Mitomycin C
Nitrogen mustard 
Takanes (Taxol*)
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20
Q

How do you treat extravasation

A

Apply ice packs to affected area EXCEPT:
Vinca alkaloids better managed by applying heat*
Sodium thiosulfate to neutralize nitrogen mustard
Hyaluronidase to improve outcome after vinca alkaloids, etoposide, and taxanes
Topical dimethyl sulfoxide for anthracycline and mitomycin C
Dexrazone IV (totect) for anthracycline!

21
Q

How do you prevent extravasation

A

good admin technique
Use large veins in forearms
give slowly through running IV line
Pref. thru central venous cath

22
Q

When is myelosuppression MC seen

A

when chemo is given at the same time as radiation to chest or pelvic region

23
Q

What cells are affected in chemo related myelosuppression

A

WBC (esp PMN): most significantly affected, rapid proliferation, short lifespan (6-12 hrs)
PLT: much less than PMN. 5-10 day lifespan
RBC: affected least. 120 day lifespan

24
Q

When is myelosuppression good

A

Myelotoxicity is a desired therapeutic effect in patients with AML during induction therapy

25
Q

What is the MC hematologic complication of chemotherapy

A

Anemia

Depends on type and duration of therapy, type and stage of malignancy

26
Q

What conditions are known to cause anemia in cancer patients

A 
chemo and radiation 
chronic GI blood loss 
nutrient deficiency (Fe, folate) 
bone marrow invasion by tumor 
hemolysis 
renal dysfunction 
anemia of chronic disease
27
Q

How do you treat anemia in a cancer patient

A

RBC transfusion

Recombinant human erythropoietic products (epoetin alfa, darbapoetin alfa)

28
Q

Before initiating recombinant human erythropoietin, you must

A

eval underlying condition and initiate specific therapy;
Iron deficiency? give Iron
B12 or folate supplementation
Chronic bleeding? determine site

29
Q

How do you treat with human recombinant erythropoietin

A

Start Sx pts when Hgb <10
Target Hgb is 10-12
Indication of response: Hgb increase by 1g, ferritin decline or reticulocyte increase s/p 2-4 wks
Reassess Hgb after 4-6 weeks (sr erythropoietin levels dont really help)

30
Q

Mild ADE of recombinant human EPO (epogen) include

A 
pain at injection  site 
rash 
flu-like Sx 
seizures 
HTN
31
Q

Severe ADE of recombinant human EPO are

A

decreased survival (advanced breast, head and neck, lymphoma, and non-small cell lung cancer)
thrombosis
pure red cell aplasia

32
Q

What is neutropenia

A

ANC falls <500
risk of infection is directly proportional to duration of neutropenia
S/Sx of are absent (no WBC respond) so rely on fever as indication of infection! start abx asap

33
Q

What percent dose should you receive based on granulocyte count

A

> 2000: 100% of dose
1000-2000: 5-% of dose
<1000: 0%

34
Q

What agents are used as colony stimulating factors in neutropenia

A

G-CSF (granulocyte): Filgrastim, Pegfilgrastim
GM-CSF (granulocyte/macrophage): Sargramostim. promotes proliferation of neutrophils, eosinophils, macrophages, monocytes. stimulate megakaryocytes, but no effect on PLT

35
Q

Giving CSF allow

A

admin of subsequent chemotherapy courses on schedule= enhanced dose intensity
Not consistently translated into improved tumor response or survival

36
Q

When can you use CSF

A

primary prophylaxis: prevent neutropenia in 1st chemo cycle

Secondary: prevent recurrent neutropenia in those who had neutropenia previously w/ chemo

37
Q

What are ADE of CSF

A

Bone pain (give APAP)
Increased LDH, alk phos, uric acid, and liver transaminases
pleural and pericardial effusions w/ high doses; also capillary leak syndrome and thrombus formation
low grade fever, myalgias, arthralgias, lethargy, mild HA
mild erythema at subQ injection sites
generalized maculopapular rash
-Occur bc of drug’s ability to bind neutrophils to endothelial cells, and activate monocytes and macrophages= release cytokines IL1 and TNF

38
Q

When do you dose CSF

A

24-72 hours after chemo
Stop the day before chemo
Pegfilgrastim is long lasting G-CSF and should be stopped w/in 14 days of next chemo dose

39
Q

How do you treat thrombocytopenia

A

Platelet transfusion!

reserved for PLT <10, active bleeding, or pending surgery

40
Q

Who experiences significant thrombocytopenia w/ prior cycle of chemo Oprelvekin

A

Those with secondary non-myeloid malignancies

41
Q

What is Oprelvekin (IL-11) associated with

A 
Fluid retention (edema, dilutional anemia, dyspnea, pleural effusions) 
Cardiotoxicity (tachy, AFib, Aflutter, HF)
42
Q

What is the most significant factor in the future of thrombocytopenia Tx

A

Megakaryocyte stimulating factor

43
Q

What neuropathy is associated with chemo

A

sensory, motor, autonomic, or combination
Mild: paresthesias of fingers and toes
Constipation
-MC with Vinca alkaloids and taxane drugs

44
Q

Cardiotoxicity is associated with

A

Anthracyclines (Doxorubicin, Daunomycin, Idarubicin, Epirubicin)
-MUGA screen scan show you LVEF. If >50%, give antracyclines

45
Q

What is Cisplatin associated with

A

nephrotoxicity and neurotoxicity
peripheral neuropathy, painful paresthesias
Ototoxicity +/- deafness

46
Q

How do you treat nephro/neurotoxicity associated w/ Cisplatin

A

vigorous hydration prior, during, and after admin
monitor renal fxn and lytes for low mag, K, and Na
Give amifostin IV over 15 min prior to cisplatin for protection

47
Q

What can be used instead of cisplatin

A

Second gen platinum analog, Carbaplatin!

Non-nephrotoxic but still myelosuppresive

48
Q

Common Bleomycin toxicities are

A

Edema of IP joints
Hardening of palmar and plantar skin
Anaphylaxis, serum sickness like reaction
Serious or fatal pulmonary fibrotic rxn, esp in elderly

49
Q

With bleomycin, monitor for

A

non-productive cough, dyspnea, and pulmonary infiltrates

If present, dc drug, start high dose corticosteroids, and start empiric abd pending cultures

Summer 1 (16 decks)

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