Clinical Oncology - supportive care

Question 1

What are the levels of emetogenic potential and their frequency?

Answer 1

Level 5 - >90% frequency
Level 3 & 4 - >30-90%
Level 2 - 10-30% frequency
Level 1 - <10%

Question 2

What two medication classes are always in a treatment regimen for nausea and vomiting?

Answer 2

5-HT3 antagonist
Steroid (dexamethasone)

Question 3

What medications can be added onto any nausea/vomiting treatment regimen as needed?

Answer 3

-lorazepam 0.5-2 mg po/IV
-PPI or H2RA

Question 4

What medications are best for delayed nausea and vomiting?

Answer 4

NK-1 antagonist, Olanzapine, dexamethasone

Question 5

What are the NK-1 antagonist/ Substance P medications?

Answer 5

Aprepitant, fosaprepitant, rolaprepitant, fosnetupitant, netupitant
-Hiccups, drug interactions

Question 6

What are the 5-HT3 antagonists?

Answer 6

Ondansetron, Granisetron, Dolasetron, Palonosetron
-Headache, constipation, QTc prolongation (not as usual doses)

Question 7

What is the criteria for febrile neutropenia?

Answer 7

ANC < 0.5 x 10^3/ uL or 500 uL AND fever above 100.4 F for at least an hour

Question 8

What are the criteria for using Colony stimulating factors?

Answer 8

> 20% chance of febrile neutropenia or if previous neutropenia complication
treatment: Filgrastim or pegfilgrastim

Question 9

What is the difference between trastuzumab and antracycline induced cardiotoxicity?

Answer 9

(Type II) Trastuzumab is due to EGFR factors, not dose-related, reversible, can restart once ejection fraction improves
(Type I) Anthracyclines is due to cumulative dose, irreversible, leads to CHF