Clinical Questions Flashcards
Carcinoma
Cancer starting in the skin or lining of the organs
Leukemia
Cancer of WBC
Lymphoma
Cancer of lypmphatic system
Multiple Myeloma
Cancer of bone marrow
Sarcoma
Cancer of connective tissue like fat, muscle, blood vessels, and bone (osteosarcoma)
neoadjuvant
treatment given BEFORE the primary therapy
When should you begin annual breast exams for females?
age 45 - 54 years
When should you begin breast exams every 2 years?
age 55 years and up
When should you start pap smear screening for cervival cancer and how often?
21 years - 29 years get it every 3 years
When should you start pap smears + HPV DNA testing and how often?
Age 30 years or older every 5 years
When should you start prostate screening in men?
50 years old or older
use prostate specific antigen blood test (PSA) with a digital rectal exam (optional)
What is the criteria for annual screening for lung cancer?
- in good health
- have at least 30 pack year smoking history
- still smoking OR quit within the last 15 years
start at age 55 years old
When do you start screening for colon cancer?
45 years old or greater
What is the lifetime cumulative dose for doxorubicin? Why?
450 - 550 mg/m2
Cardiotoxicity
What is the lifetime cumulative dose for bleomycin? Why?
400 units
Pulmonary toxicity
What is the max dose per cycle for cisplatin? Why?
100 mg/m2
Nephrotoxicity
What is the max single dose of vincristine? Why?
2 mg
Neuropathy
What could you use with doxorubicin to decrease cardiomyopathy?
Dexrazoxane (Totect)
What could you use with cisplatin to decrease nephrotoxicity?
Amifostine (Ethyol) and HYDRATION
What could you use with methotrexate to decrease myelosuppression and mucositis?
Leucovorin
also Glucarpidase is used for acute renal failure
What could you use with fluorouracil to enhance efficacy?
Leucovorin
What could you use with ifosfamide prevent hemorrhagic cystitis?
Mesna (Mesnex) and HYDRATION
What could you use with irinotecan to decrease diarrhea?
Atropine
When does WBC and platelets usually reach nadir?
7 - 14 days after chemo
How do you calculate ANC?
WBX x (%segs + %bands)/100
When is the ANC neutropenic? severe neutropenic?
< 1000 cells/mm
< 500 cells/mm
When should filgrastim or pegfilgrastim be used for cancer patients?
When patients are at a > 20% chance of developing chemo-induced febrile neutropenia
When should empiric antibiotics be started for febrile neutropenia?
Oral temp 38.8 C or 101 F
OR
ANC < 500 cells/mm
A patient with no comorbidities is receiving chemotherapy for lung cancer. Their temperature today was 38.6 C and ANC count is 453 cells/mm. What would you give (if anything) for febrile neutropenia?
Oral anti-pseudomonal
Cipro + Augmentin
Levo + Clindamycin
Febrile > 38.3 C and ANC count is < 500
An obese patient with history of CVD, T2DM, and HTN is receiving chemotherapy for stomach cancer. Their temperature today was 38.9 C and the ANC was 120 cells/mm. What would you give (if anything) for febrile neutropenia?
IV anti pseudomonal beta lactams
Cefepime
Ceftazidime
Meropenem
Imipenem/Cilastatin
Zosyn
A patient with no comorbidities is receiving chemotherapy for lung cancer. Their temperature today was 36 C and ANC count is 867 cells/mm. What would you give (if anything) for febrile neutropenia?
Patient is afebrile. No empiric antibotics are necessary.
What are the normal levels of Hgb?
Female 12 - 16
Male 13.5 - 18
A 33 yo female patient is being treated for breast cancer for curative intent. She started developing anemia with hgb 7.6. Her iron levels are normal. Would it be appropriate to start epoetin alfa (Epogen) therapy?
NO she is being treated with curative intent = ESAs have a risk of increased tumor progression and shortened survival
A 56 yo male patient is on palliative care chemotherapy for skin cancer. He started developing anemia with hgb 6.4. His iron levels are normal. Would it be appropriate to start darbepoetin alfa (Aranesp) therapy?
Yes, this patient is NOT on curative therapy. It is a non-myeloid malgnancy. His hgb is < 10 g/dL and iron levels are normal.
What labs should you receive before initating any ESA?
Iron labs
Hgb level
What is the appropriate platelet count to initiate platelet transfusion?
< 10,000 cells/mm
A patient has received cisplatin this morning. They call to complain of nausea and vomiting later that day. How would you classify and treat this? When SHOULD you have started therapy?
Acute CINV - HIGH emetic risk
Treat with 5-HT-3 receptor antagonists
NK-1RA
Olanzapine
Dexamethasone
Should have started BEFORE chemo
A patient is receiving moderate-risk chemotherapy regimen for CINV later this week. What therapy regimens are recommended?
2 - 3 drugs
- NK1-RA + 5HT3-RA + dexamethasone
- 5HT3-RA + dexamethasone
- Palonosetron + olazapine + dexamethasone
*** continue for 2 days after chemotherapy
A patient is receiving low-risk chemotherapy regimen for CINV later this week. What therapy regimens are recommended?
- Granisetron or Ondansetron
- Dexamethasone
- Prochlorperazine
- Metoclopramide
***do not use NK-1-RA
A patient is receiving low-risk chemotherapy regimen for CINV later this week. A physician started the patient on aprepitant (Emend) for prophylaxis. Is this monotherapy regimen appropriate?
NO, you should not use NK1-RA drugs for low risk CINV
Which CINV drugs have a increased risk for serotonin syndrome?
5-HT-3 receptor antagonists:
-ondensetron (zofran)
-granisetron (Sancuso)
-Palonosetron (Aloxi)
A cancer patient on chemotherapy and also receiving pilocarpine. How could this be helpful in cancer patients?
Pilocarpine is a muscarinic (cholinergic) drug, so it can help with xerostomia or dry eyes from some chemotherapy medications.
A cancer patient is on irinotecan, capecitabine, Zyprexa, Aloxi, and Decadron. Palmar plantar erthrodysesthesia starts to occur. Which drug most likely to cause this symptom?
capecitabine is most likely to cause hand anf foot syndrome (as well as fluorouracil)
A patient is on IV chemotherapy when extravastation occurs. What are the most common drugs that cause this? Which ones need cold compress vs cold?
Anthracycline = cold
Vinca alkaloid = warm
What are warning signs of melanoma skin cancer?
A - asymmetry
B - Border
C - Color
D- Diameter
E - Evolving
What is a gene mutation that is a higher risk of developing breast cancer?
BRCA1 and 2
What is Klinefelter syndrome?
When a male has one Y chromosome but two or more X chromosomes
^^^^ higher risk of developing breast cancer
A 47 year old pre-menopausal female patient came for her mammogram and found she has breast cancer. Additional testing found ER+/PR+/HER2-. What is the initial treatment option for her?
Tamoxifen
**do not use Aromatase inhibitors!! they do not block ovarian produced estrogen!!! unless used with GnRH agonists
A 53 year old post-menopausal female patient came for her mammogram and found she has breast cancer. Additional testing found ER+/PR+/HER2-. What is the initial treatment option for her?
Aromatase inhibitors
-Anastrozole (Arimidex)
-Lanstrozole
A 46 year old pre-menopausal female patient came for her mammogram and found she has breast cancer. Additional testing found ER-/PR-/HER2+. What is the initial treatment option for her?
Trastuzumab (Herceptin)
A 50 year old male patient goes in for his PSA. The level comes back as 18 ng/mL. What does this indicate? What are his treatment options?
Prostate Cancer > 10 ng/mL
4 - 10 ng/mL is chance of BPH
GnRH antagonist
GnRH agonist (leuprolide or goserelin) + Antiandrogen
How would you calculate BSA to dose a chemotherapy drug?
sqroot_| (height)(weight)/3600
