Day 1- Chemotherapy Side Effects and Lymphoma. Flashcards
What are the big chemoreceptors involved in Nausea and Vomiting?
What Serotonin antagonist has decent potency and duration of effect?
What Serotonin antagonist has best potency and duration of effect?
Serotonin and Dopamine.
Palonoestron.
Sustol–> SQ injection of granisetron(only once every 7 days), Sancuso–> Patch that must apply 24-48 hours prior to chemotherapy and can remain on for up to 7 days.
Do we need to add additional steroids for CINV to chemotherapy already containing a steroid?
What are the NK-1 antagonists?
How does a patient use aprepitant? Fosaprepitant?
NO.
Ends in “epitant”. Useful for delayed N/V(also used for acute). Well tolerated.
Given PO for 3 days. Fosa is given IV on day of initial chemo. Dose reduce if someone is using Dexamethasone.
Does Rolapitant have a long half life?
What should you use in anticipatory N/V?
When are dopamine antagonists given?
Yes. Do not use in soybean allergy and infusion reactions.
Benzodiazepines.
PRN agents for breakthrough N/V.
When are antihistamines given?
When are cannabinoids given?
Is alcohol/cigarette previous use protective?
When patient has dizzy induced N/V.
Used for low to moderate emetogenic regimens with unsatisfactory results from other agents.
YES.
What is minimal cut off? Low? Moderate? High?
How do you treat minimal risk acute CINV?
How do you treat low risk acute CINV?
<10%. 10-30%. 30-90%. >90%.
No prophylaxis recommended.
Choose either Single dose of ondansetron 8-16 mg or dexamethasone 8 mg.
How do you treat moderate risk acute CINV?
How do you treat high risk acute CINV?
How to treat delayed CINV?
Palonosetron IV or Granisetron SQ on day 1 PLUS dexamethasone on days 1-3.
NK1 antagonist plus 5-HT3 antagonist day 1 plus dexamethasone days 1-3.
NK1 antagonists,Steroid dose longer than normal, high dose metoclopramide.
How do you treat breakthrough CINV?
What is a normal serum calcium level?
What is mild, moderate, severe calcium?
Re evaluate–> Add medication from a separate class to the current regimen on a prn basis.
- 5-10.8 mg/dL.
- 8-12. 12-14. >14.
What is the corrected calcium equation?
What 3 mechanisms caused hypercalcemia of malignancy?
What is the presentation of the calcemia of malignancy?
Serum Calcium + (0.8 x (4-albumin)).
PTHrP related(80%), Osteolytic, Increased in Vitamin D.
Bones, Stones, Moans, Groans.
How do you treat calcemia of malignancy?
Can you use loop diuretics?
Can you use bisphosphonates?
STOP CALCIUM ADDING DRUGS 1ST!!. Give fluid resuscitation.
Yes but not great, ensure patient is at least euvolemic, avoid thiazides.
YES! Pamidronate and Zolendronic Acid(preferred). Onset is 2-4 days, lasts 3-4 weeks. Zolendronic acid is more potent, shorter infusion time. Watch for osteonecrosis of the jaw and renally adjust.
Can you use denosumab to treat calcium stuff?
Can you use Calcitonin to treat calcium stuff?
When can you use glucocorticoids in calcium stuff?
Yes. Similar to bisphosphanates.
Yes. Can not use alone. Rapid 4-6 hour onset and lasts for 48 hours. Do NOT use nasal formulation.
Used in tumors that cause Vitamin D increase.
How to treat severe calcium levels(>14)?
How do you treat tumor lysis syndrome?
What is the most dangerous component of tumor lysis syndrome?
Fluid resuscitation, bisphosphonate + calcitonin.
PREVENTION. Allopurinol, Rasburicase, Fluids.
Hyperkalemia due to sudden cardiac death.
What is the treatment of spinal cord compression?
What is the definitions of neutropenia?
What is the ANC calculation?
Dexamethasone.
ANC <500 or ANC <1000 with expected drop to below 500 within 48 hours.
WBCx(Segs+Bans).
How do you determine if a patient is high or low risk?
What is Low risk outpatient treatment?
What is empiric therapy for inpatients?
MASCC > or equal to 21 is a low risk, lower than 21 is a high risk.
Oral Ciprofloxacin and Augmentin. Other regimens are Cipro and Clinda if penicillin allergy present. Don’t use fluoroquinolones if patient has received fluroquinolone prophylaxis.
If organism not know, give an anti pseudomonas agent. Cefepime, Piperactillin/tazobactam, meropenem, Imipenem/Cilastatin. DO NOT USE ERDAPENEM.
When does a patient need Vancomycin?
What do you give if Vancomycin is needed?
How do you treat early stage favorable lymphoma?
Mucositis, hemodynamic instability, sepsis, evidence of pneumonia, blood culture for gram positive, catheter/skin/soft tissue infection. Recommend discontinuing after 48 hours if no sign of gram positive.
Vanco + monotherapy group +/- Aminoglycoside or Ciprofloxacin.
2-4.
How do you treat1B/2B?
How do you treat 3-4?
What is the chemotherapy treatment for hodgkins?
4-6 cycles.
6-8 cycles.
ABVD. Salvage therpay is Brentuximab
