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Therapeutics Fall Semester P3 > Cumulative Final-Oncology (Weddle) > Flashcards

Cumulative Final-Oncology (Weddle) Flashcards

1
Q

Anticipatory N/V

A

Learned response conditioned by severity and duration of previous emetic reactions from prior chemo cycles
**May be provoked by sight, smell, sound

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2
Q

Acute N/V

A

Within 24H of chemo

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3
Q

Delayed N/V

A

> 24H after chemo

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4
Q

Breakthrough N/V

A

N/V that occurs even if on scheduled anti-emetics prior to chemo

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5
Q

Refractory N/V

A

N/V that persists despite appropriate anti-emetics

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6
Q

Enterochromaffin cells lining the GI tract contain large stores of ______

A

Serotonin; released in mass quantities + triggers N/V

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7
Q

Neurotransmitters implicated in CINV

A

Dopamine, Histamine, Acetylcholine, serotonin, substance P

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8
Q

Adding level ___ or ____ agents increases the emetogenicity of the combination regimen by 1 level per agent

A

3 or 4

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9
Q

Risk factors for CINV

A

-Women>men
-Young>old
-Prior hx of motion sickness
-Previous hx of morning sickness
-Anxiety/high pre-treatment anticipation of nausea
-Chronic ethanol may be protective

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10
Q

Oral therapy is (>, =, <) IV therapy

A

=

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11
Q

Which classes will we always have for emetogenicity?

A

5HT3 antagonist and dexamethasone (steroid)

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12
Q

RF for mucositis

A

-Pre-existing oral lesions
-Poor dental hygiene
-Ill-fitting dentures
-Combined modality tx (chemo + radiation)

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13
Q

Prevention + tx of mucositis

A

-Avoid rough food, spices, salt, and acidic fruit
-Eat soft foods/liquid, soft cheeses, and eggs
-Avoid smoking and alcohol (+ alcohol-based mouthwash)

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14
Q

General mouthcare strategies for mucositis

A

-Baking soda rinses
-Soft-bristle toothbrush
-Saliva substitute

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15
Q

Pain management options for mucositis

A

-Topical anesthetic: Lidocaine, diphenhydramine, antacids, mary’s magic mouthwash
-Oral cryotherapy (ice chips)
-Sucralfate (not commonly used)
-Opioids ATC if mod-sev mucositis
-PCA pump is common (if this severe, change chemo for next round)

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16
Q

Only thing to help mucositis is ____

A

WBC count increasing

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17
Q

Low WBC count is _____

A

neutropenia

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18
Q

Low platelet count is ____

A

thrombocytopenia

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19
Q

Low RBC count is ____

A

anemia

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20
Q

Nadir definition

A

Absolute lowest WBC count during a cycle of chemo

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21
Q

ANC=_____x_____

A

WBC x % granulocytes

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22
Q

Typical guidelines to safely administer chemotherapy

A

WBC > 3000 OR ANC > 1500 AND platelet > 100000

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23
Q

Febrile neutropenia definition

A

Neutropenia + fever (>101) –> must get to hospital and tx with antibiotics

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24
Q

Use primary prophylaxis for neutropenia if we know:

A

the pt’s chemo regimen is expected to cause >20% incidence of febrile neutropenia

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25
Q

Use secondary prophylaxis for neutropenia is we know:

A

Pt experienced neutropenic complication from previous cycle of chemo

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26
Q

Agents for neutropenia

A

Filgrastim and Pegfilgrastim

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27
Q

Filgrastim frequency

A

1 injection every day

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28
Q

Pegfilgrastim frequency

A

***NON-LINEAR PK
On-Pro or 1 time injection 1 time after chemo

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29
Q

Who decides which biosimilar to use for neutropenia?

A

The insurance company

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30
Q

ADR of filgrastim

A

-Flu-like sx
-Bone and joint pain
-DVT

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31
Q

Tx for thrombocytopenia

A

Platelets (only give if <10,000 or symptomatic)

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32
Q

Significance of anemia in cancer

A

FATIGUE; pts report it is more troubling than N/V/pain

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33
Q

Chemo-induced anemia is defined as _______

A

Hgb <11 or >2 g/dL drop

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34
Q

Tx for anemia

A

-If pt is symptomatic (hard time getting around)
>Transfuse as indicated
>Consider ESA (risk: shortened overall survival and/or increased risk of tumor progression)
>Perform iron studies

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35
Q

ESAs are not recommended for patients that…

A

-Are receiving myelosuppressive chemo for CURING disease
-In pts with cancer NOT receiving chemo
-In pts receiving non-myelosuppressive chemo

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36
Q

Do not use ESA to correct Hgb > ____

A

12 g/dL

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37
Q

Difference between epoetin and darbepoetin

A

Darbepoetin has a prolonged half-life

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38
Q

Prior to ESA, must get baseline _____ test

A

iron

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39
Q

Importance of oral iron + food

A

Iron absorption will be decreased if food is eaten 2h before or 1 hour after iron ingestion

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40
Q

How to tx myalgia/arthraligia

A

NSAID or opioid

41
Q

How to tx hemorrhagic cystitis

A

Hydration + Mesna

42
Q

How to tx HF from doxorubicin

A

Dexrazoxane

43
Q

How to tx peripheral neuropathy

A

Change infusion rate
Adjunctive pain med (gabapentin/amitriptyline)

44
Q

How to tx pulmonary toxicity from bleomycin

A

CCS

45
Q

Problem with type 1 chronic cardiac dysfunction: doxorubicin

A

Related to cumulative dose of anthracycline
-Once EF drops, it is irreversible
-Take off anthracycline + never put back on

46
Q

Type 2 chemo cardiac dysfunction: trastuzumab

A

-Not related to cumulative dose
-It is reversible
-Take pt off until EF comes back up, then they can start trastuzumab again

47
Q

Do not use ____ with trastuzumab

A

anthracycline bc increases risk for cardiac toxicity

48
Q

Give ____ for anemia if extremely debilitated or severe SOB

A

Blood transfusion

49
Q

Onset for ESA is ____

A

Weeks

50
Q

Assessment of pain

A

O: Onset
P: provokes (makes it worse)
Q: quality (what does it feel like)
R: radiate
S: severity
T: time (when did the pain start)
U: understanding (how much we can improve)

51
Q

What should you ask pts BEFORE starting opioids?

A

Are you having regular BM?

52
Q

Tier 1 pain meds

A

Non-opioids (pain 1-3)
-Acetaminophen (Tylenol)
-Ibuprofen
-ASA

53
Q

Tier 2 pain meds

A

Combo products/mild opioids (pain 4-6)
-Norco
-Hydrocodone/ibuprofen
-Tramadol
-Percocet
-Oxycodone/ASA
-Oxycodone/ibuprofen
-Codeine/APAP

54
Q

Tier 3 pain meds

A

Opioids (pain 7-10)
-Morphine
-Hydromorphone
-Fentanyl
-Oxycodone
-Methadone

55
Q

Does tier 2 medications have max doses?

A

YES

56
Q

Does tier 3 medications have max doses?

A

NO

57
Q

____is metabolized in the LIVER and has active metabolites excreted RENALLY

A

Morphine
**Must have liver and renal function

58
Q

Use hydromorphone with caution in ____ dysfunction

A

Liver

59
Q

Oxycodone is metabolized by ____. Use with caution in ____ dysfunction. Which dosage form is not available?

A

CYP2D6
Liver
IV

60
Q

If pt has liver or renal dysfunction, it is safe to use ____

A

Fentanyl

61
Q

Important info about fentanyl

A

-Do not start opioid naive pt on this
-Risk for addiction and abuse
-REMS protocol
-Respiratory depression may occur
-Temp-dependent increase in release

62
Q

If really high dose opioid and no relief, switch to ____

A

Methadone; helpful for neuropathic pain

63
Q

Do not give methadone to a patient with ____

A

Poor mental status

64
Q

Get baseline ____ prior to methadone initiation

A

EKG

65
Q

When switching between opioid agents, may reduce dose by ____% due to cross tolerance

A

25%

66
Q

Pruritis (itching) most often seen with ___ administration

A

Morphine

67
Q

Patients do not develop tolerance to _____

A

Constipation

68
Q

If pt on opioids and develops respiratory depression, what is the next step?

A

-Hold opioid
-Give dilute naloxone

69
Q

Use caution giving PCA to pts with _____

A

Sleep apnea

70
Q

Don’t treat _____ with opioids

A

Anxiety/depression

71
Q

____ work well for bony mets (throbbing/achy pain)

A

NSAIDs

72
Q

Hypercalcemia etiology

A

Bony mets stimulate osteoclasts in bone marrow and renal calcium retention

73
Q

Calcium 10-12 mg/dL (mild)

A

Don’t realize anything is going on

74
Q

Calcium 12-14 mg/dL (moderate)

A

Pt begins to get confused

75
Q

Calcium >14 mg/dL (severe)

A

Pt may get seizures/go into a coma

76
Q

Corrected calcium equation

A

Serum Calcium + 0.8 (4-serum albumin)
***Normal calcium: 8.5-10 mg/dL

77
Q

Diagnosing skeletal related events

A

-Symptoms (bony mets or tenderness)
-Scans (radionucleotide bone scan)
-Other scans (CT, MRI, PET)

78
Q

Bony mets can cause a large release of ____ into the bloodstream

A

Calcium

79
Q

If calcium level is mild, what is tx?

A

drink fluid and stay hydrated

80
Q

If calcium level is moderate, what is tx?

A

introduce bisphosphonate (zoledronic acid, pamidronate) + HYDRATION!!!!!!!

81
Q

If calcium level is severe, what is tx?

A

HYDRATION, bisphosphonate, calcitonin (if calcium does not drop after 24H)

82
Q

How to tx refractory HCM

A

Denosumab

83
Q

How to treat chronic HCM

A

Zaledronic acid or pamidronate

84
Q

Why are loop diuretics not used up front?

A

Diuretics not used up front bc already dehydrated; once at baseline, then think about loop diuretics

85
Q

If an IV bisphosphonate is needed for skeletal related events, does it need to be renally dose adjusted?

A

YES!!!!!!!!!!!!!!!!!!

86
Q

If an IV bisphosphonate is needed for hypercalcemia or malignancy, does it need to be renally dose adjusted?

A

NO!!!!!!

87
Q

Why would denosumab be used instead of a bisphosphonate?

A

It does not need to be renally dose adjusted for pts with renal dysfunction and it can be given SQ, whereas bisphosphonates can only be used IV

88
Q

Radioisotopes are delivered ____ to the tumor

A

More specifically

89
Q

SE of radioisotopes

A

Expensive and may cause myelosuppression

90
Q

What supplements should a patient receive if they are taking bisphosphonates?

A

Calcium and Vitamin D

91
Q

Difference between cost/time between zaledronic acid and pamidronate

A

Zoledronic acid: short infusion time (15 min) and ~$70
Pamidronate: longer infusion time (2H) and cheaper

92
Q

Frequency and indication for denosumab

A

Monthly; may suppress residual osteoclast function in pts who poorly respond to bisphosphonates

93
Q

Denosumab considerations

A

-Correct hypocalcemia prior to initiation
-Supplement calcium and vit D daily
-NO RENAL ADJUSTMENTS
-Expensive

94
Q

ADR of HCM therapy

A

Osteonecrosis of the jaw (boney jaw)
-IV»PO
-Oral infection
-Zaledronic > Denosumab >Pamidronate
**Get baseline dental evaluation prior to tx

95
Q

Possible tx options for osteonecrosis of the jaw

A

-Palliative
-Pain control
-Chlorhexidine
-Antibiotics
-Conservative surgery

96
Q

Do not use bisphosphonates if CrCl < ___ ml/min

A

30

97
Q

Other ADR of denosumab&raquo_space; zaledronic acid

A

Hypocalcemia
Bone pain
N/diarrhea
Fatigue

98
Q

What frequency do we normally use HCM agents for?

A

Q3month dosing

Therapeutics Fall Semester P3 (7 decks)

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