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PHRM 864 > E2 Supp Care I > Flashcards

E2 Supp Care I Flashcards

1
Q

what are the 5 types of N/V?

A

Anticipatory
Acute
Delayed
Breakthrough
Refractory

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2
Q

Type of N/V that is considered a “learned response” and has had hypnosis be successful (lol)

A

Anticipatory

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3
Q

Type of N/V that usually occurs within 24 hours of receiving chemo

A

acute

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4
Q

type of N/V occuring >24 hours after chemo

A

delayed

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5
Q

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

A

Breakthrough

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6
Q

Type of N/V that persists after failing other therapies

A

refractory

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7
Q

what does the chemo trigger zone (CTC) stimulate?

A

the vomiting center (located in nucleus tractus solitarii)

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8
Q

Nausea -> followed by _________ -> finally emesis

A

wretching

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9
Q

what is wretching

A

labored movement of abdominal and thoracic muscles before puking

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10
Q

5 neurotransmitters implicated in CINV

A

dopamine
histamine
ach
serotonin
substance p
she said the last two were the important ones for us tho

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11
Q

T or F
Level 1 and 2 agents do not contribute to the emetogenicity of the regimen

A

True

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12
Q

T or F:
younger patients are a bigger risk factor for CINV than old asses

A

true somehow

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13
Q

what can be protective for CINV?

A

chronic ethanol loll

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14
Q

what is prophylaxis for acute N/V based on?

A

emetogenic potential of chemotherapy

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15
Q

How many different drug classes do we use when pt is classified as highly emetogenic (regimen A). what are they?

A
  1. NK-1 antagonist
    Steroid
    5-HT3 antagonist
    Atypical Antipsychotics
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16
Q

what do the NK-1 antagonists end with?

A

-repitant

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17
Q

what is the steroid used for emetogenic pts

A

dexamethasone

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18
Q

what 2 classes do we ALWAYS use in emetogenic regimens? (unsure if this is specifically highly or not at the time of making this card)

A

5-HT3 antag and steroid

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19
Q

what do the 5-HT3 antags end with>

A

-setron

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20
Q

what atypical antipsychotic do we use for emetogenic shit

A

olanzapine

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21
Q

what random ass drug can be added on to highly emetogenic regimen B and C?

A

lorazepam

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22
Q

what is the moderately emetogenic regimen A? (classes)

A

steroid and 5-HT3 antag

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23
Q

what is the moderately emetogenic regimen B? (classes)

A

5-HT3 antag and a steroid

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24
Q

what is the moderately emetogenic regimen C? (classes)

A

NK-1 antag
steroid
5-HT3 antag

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25
Q

T or F
Low emetogenic regimens require choosing both drug class options

A

false, only one needed between steroid and 5-HT3 antag

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26
Q

name some of the classes included in breakthrough N/V regimen (theres a lot)

A

dopamine receptor antag
phenothiazines
antipsychotic
benzo
cannabinoid
serotonin agonist
steroids
anticholinergics

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27
Q

delayed N/V typically involves use of one of the following:
________
________
________

A

dexamethasone
NK-1 antag
Olanzapine

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28
Q

4 actions for anticipatory NV

A

prevention
behavioral
acupuncture
lorazepam

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29
Q

prevention guidelines for high to moderate emetogenic risk with oral chemo

A

5-Ht3 antag before chemo and continue daily

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30
Q

prevention guidelines for low to minimal emetogenic risk with oral chemo (3)

A

metoclopramide
prochlorperazine
5-HT3 antag

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31
Q

prevention guidelines for radiation induced emesis

A

5-HT3 antag po with or without dexa

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32
Q

are the common toxicities across classes that important for us to know?

A

please someone let me know

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33
Q

T or F:
emetogenicity is additive

A

true, adding two agents can make it worse

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34
Q

when are anti-emetics most effective? (not a time)

A

when given for prophylaxis

35
Q

T or F
GI mucosa is comprised of epithelial cells and has a slow turnover rate

A

false, rapid turnover rate

36
Q

4 things that can be used as pain management for chemo induced mucositis

A

topical anesthetics
oral cryotherapy
sucralfate
opioids

37
Q

what weird thing can you do before receiving 5-FU to decrease mucositis incidence and severity

A

ice chips 30 min before

38
Q

what is the most common dose-limiting toxicity of chemo?

A

neutropenia

39
Q

what is the nadir?

A

(absolute neutrophil count or ANC) is the lowest value the blood counts fall to during a cycle of chemo

40
Q

someone tell me what to know from slide 54

A

please

41
Q

what kind of neutropenia is this?
ANC < 0.5 x 103/µL

A

severe

42
Q

what kind of neutropenia is this?
ANC < 0.5 x 103/µL and a single oral temperature > 101F (> 38.3C) or > 100.4F (> 38.0C) for at
least an hour

A

febrile

43
Q

If the patient is to receive a chemotherapy regimen that is expected to cause > 20% incidence of febrile neutropenia
A. Primary prophylaxis
B. Secondary prophylaxis

A

A. primary

44
Q

The patient experienced a neutropenic complication from a previous cycle of chemotherapy and now you want to prevent that again
A. Primary prophylaxis
B. Secondary prophylaxis

A

B. secondary

45
Q

4 things colony stimulating factors decrease for prophylactic use

A
  • incidence of febrile neutropenia
  • length of hospitalization
  • confirmed infections
  • duration of antibiotics
46
Q

what are the 3 CSF agents we have on the slides?

A

Filgrastim G-CSF
Pegfilgrastim
Sargramostim GM-CSF

47
Q

Has non-linear PK and clearance
A. Filgrastim G-CSF
B. Pegfilgrastim
C. Sargramostim GM-CSF

A

B

48
Q

Drop in WBC and neutrophil count after discontinuation
A. Filgrastim G-CSF
B. Pegfilgrastim
C. Sargramostim GM-CSF

A

A and C

49
Q

Not considered a biosimilar
A. Tbo-Filgrastim (Granix)
B. Filgrastim-sndz (Zarxio)
C. Filgrastim-aafi (Nivestym)
D. Filgrastim-ayow (Releuko)

A

A

50
Q

how long after completion of chemo do you start Filgrastim?

A

3-4 days and continue until post-nadir ANC is normal

51
Q

how long after chemo do you start pegfilgrastim? also a unique thing too

A

at least 24 hours after chemo and give up to 3-4 days after.

at least 14 days should elapse between dose and the next cycle of chemo

52
Q

3 adverse effects with. filgrastim

A

flu like sxs
bone + joint pain
DVT

53
Q

what can the adverse effect of bone+musculoskeletal pain from CSF be attributed to?

A

rapid proliferation of bone marrow myeloid cells

54
Q

what are 3 agents we can use for bone/musculoskeletal pain from CSFs

A

acetaminophen
non opioids
loratidine? weird and niche

55
Q

what organ is affected in a rare adverse effect from CSF?

A

spleen

56
Q

Usually defined as a platelet count
< 100 x 10^3/µL

A

thrombocytopenia

57
Q

ASCO guideline recommends a threshold for platelet transfusion of 10 x 103/µL

A

thrombocytopenia

think of the number 10 i guess

58
Q

4 general causes of anemia

A

decreased RBC prod
decreased erythropoietin prod
decreased b12, iron, folic
blood loss

59
Q

Chemotherapy Induced Anemia:
Patients with a Hgb ≤ __ g/dL or ≥ __ g/dL drop
from baseline should undergo a work-up

A

11, 2

60
Q

what is ESA?

A

erythropoietic stimulating agents

61
Q

T or F:
ESAs increase risk of death, MI, stroke, VTE, make cancer worse, cause CKD, and something about perisurgery

A

true lol

62
Q

ESAs are not recommended:
- In patients receiving ___________ ____________with curative intent
- In patients with cancer not receiving __________
- In patients receiving non-myelosuppressive chemo

A
  • myelosuppressive chemotherapy
  • chemotherapy
63
Q

epoetin alfa:
_________ which stimulates RBC production

A

glycoprotein

64
Q

Epoetin alfa:
stimulates _______ and ________ of committed erythroid progenitors in the bone marrow

A

division
differentiation

65
Q

Epoetin:
Produced in the _______

A

kidney

66
Q

Epoetin alfa:
________ production regulated by level of tissue oxygenation

A

endogenous

67
Q

Darbepoetin:
stimulates erythropoiesis by binding to the ______ receptor like erythropoietin

A

epoetin

68
Q

Darbepoetin:
Biochemically distinct from epoetin alfa by the addition of a _______ _______ -> prolonged half life (2 - 3 x longer than epoetin)

A

sialic acid

69
Q

Darbepoetin:
indications ->
- anemia in patients with _________ ____________ where anemia is caused by chem o

A

non-myeloid malignancies

70
Q

All oncology patients who are prescribed ESA therapy should have baseline _________ _________ performed

A

iron studies

71
Q

Chemo toxicities:
tx for myalgias/arthralgias (2)

A

Nsaids
pt may need opioids

72
Q

Chemo toxicities:
tx of hemorrhagic cystitis (2)

A

hydration
mesna

73
Q

Chemo toxicities:
tx of heart failure (3) (1 is a med other 2 are not)

A

monitor cumulative dose
assess for risk factors
dexrazoxane

74
Q

Chemo toxicities:
tx of Peripheral neuropathy (2) (1 med 1 not)

A

Change infusion rates (paclitaxel specific)
Adjunct pain meds (gabapentin/amitryptiline)

75
Q

Chemo toxicities:
tx of pulmonary toxicity
(1)

A

corticosteroids (no good tx once it happens really)

76
Q

Type I Chemotherapy Related Cardiac Dysfunction:
Occurs immediately after a single dose or course of therapy with an anthracycline

A. Acute
B. Chronic
C. Delayed

A

A

77
Q

Type I Chemotherapy Related Cardiac Dysfunction:
Uncommon and transient

A. Acute
B. Chronic
C. Delayed

A

A

78
Q

Type I Chemotherapy Related Cardiac Dysfunction:
May involve abnormal ECG findings, including QT-interval prolongation, ST-T wave changes, and arrhythmias

A. Acute
B. Chronic
C. Delayed

A

A

79
Q

Type I Chemotherapy Related Cardiac Dysfunction:
Onset usually within a year of receiving anthracycline therapy

A. Acute
B. Chronic
C. Delayed

A

B

80
Q

Type I Chemotherapy Related Cardiac Dysfunction:
- Rapid onset and progression
- Common and life threatening

A. Acute
B. Chronic
C. Delayed

A

B

81
Q

Type I Chemotherapy Related Cardiac Dysfunction:
Symptoms include tachycardia, tachypnea, exercise intolerance, pulmonary and venous congestion, ventricular dilatation, poor perfusion, and pleural effusion
A. Acute
B. Chronic
C. Delayed

A

B

82
Q

Type I Chemotherapy Related Cardiac Dysfunction:
Manifests as ventricular dysfunction, CHF, conduction disturbances, and arrhythmias

A. Acute
B. Chronic
C. Delayed

A

C

83
Q

Type I Chemotherapy Related Cardiac Dysfunction:
Occurs more often in childhood / adolescence cancer survivors who received anthracyclines

A. Acute
B. Chronic
C. Delayed

A

C

84
Q

Type II Chemotherapy Related Cardiac Dysfunction:
appears to be largely reversible and short-lived

A

trastuzumab

PHRM 864 (22 decks)

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