Cumulative Final-Oncology (Weddle) Flashcards
Anticipatory N/V
Learned response conditioned by severity and duration of previous emetic reactions from prior chemo cycles
**May be provoked by sight, smell, sound
Acute N/V
Within 24H of chemo
Delayed N/V
> 24H after chemo
Breakthrough N/V
N/V that occurs even if on scheduled anti-emetics prior to chemo
Refractory N/V
N/V that persists despite appropriate anti-emetics
Enterochromaffin cells lining the GI tract contain large stores of ______
Serotonin; released in mass quantities + triggers N/V
Neurotransmitters implicated in CINV
Dopamine, Histamine, Acetylcholine, serotonin, substance P
Adding level ___ or ____ agents increases the emetogenicity of the combination regimen by 1 level per agent
3 or 4
Risk factors for CINV
-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
Oral therapy is (>, =, <) IV therapy
=
Which classes will we always have for emetogenicity?
5HT3 antagonist and dexamethasone (steroid)
RF for mucositis
-Pre-existing oral lesions
-Poor dental hygiene
-Ill-fitting dentures
-Combined modality tx (chemo + radiation)
Prevention + tx of mucositis
-Avoid rough food, spices, salt, and acidic fruit
-Eat soft foods/liquid, soft cheeses, and eggs
-Avoid smoking and alcohol (+ alcohol-based mouthwash)
General mouthcare strategies for mucositis
-Baking soda rinses
-Soft-bristle toothbrush
-Saliva substitute
Pain management options for mucositis
-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)
Only thing to help mucositis is ____
WBC count increasing
Low WBC count is _____
neutropenia
Low platelet count is ____
thrombocytopenia
Low RBC count is ____
anemia
Nadir definition
Absolute lowest WBC count during a cycle of chemo
ANC=_____x_____
WBC x % granulocytes
Typical guidelines to safely administer chemotherapy
WBC > 3000 OR ANC > 1500 AND platelet > 100000
Febrile neutropenia definition
Neutropenia + fever (>101) –> must get to hospital and tx with antibiotics
Use primary prophylaxis for neutropenia if we know:
the pt’s chemo regimen is expected to cause >20% incidence of febrile neutropenia
Use secondary prophylaxis for neutropenia is we know:
Pt experienced neutropenic complication from previous cycle of chemo
Agents for neutropenia
Filgrastim and Pegfilgrastim
Filgrastim frequency
1 injection every day
Pegfilgrastim frequency
***NON-LINEAR PK
On-Pro or 1 time injection 1 time after chemo
Who decides which biosimilar to use for neutropenia?
The insurance company
ADR of filgrastim
-Flu-like sx
-Bone and joint pain
-DVT
Tx for thrombocytopenia
Platelets (only give if <10,000 or symptomatic)
Significance of anemia in cancer
FATIGUE; pts report it is more troubling than N/V/pain
Chemo-induced anemia is defined as _______
Hgb <11 or >2 g/dL drop
Tx for anemia
-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
ESAs are not recommended for patients that…
-Are receiving myelosuppressive chemo for CURING disease
-In pts with cancer NOT receiving chemo
-In pts receiving non-myelosuppressive chemo
Do not use ESA to correct Hgb > ____
12 g/dL
Difference between epoetin and darbepoetin
Darbepoetin has a prolonged half-life
Prior to ESA, must get baseline _____ test
iron
Importance of oral iron + food
Iron absorption will be decreased if food is eaten 2h before or 1 hour after iron ingestion