E2 unique things to look out for ig Flashcards
enterochromaffin
cells in lining of GI tract with lots of serotonin
substance P
one of two important neurotransmitters for CINV
metoclopramide or prochlorperazine
low emetogenic regimen choices
haloperidol
breakthrough option
cannibinoids
breakthrough option
acupuncture
prevention of anticipatory
5Ht3 antag common toxicities (3)
headache, ekg changes, constipation
hiccups
common tox of substance P antag
topical anesthetics
relief for mucositis
sucralfate
pain management mucositis
< 0.5 x 103/µL
WBC value for neutropenia
< 100 x 103/µL
platelet value for thrombocytopenia
nadir
lowest absolute neutrophil count during a cycle of chemo
WBC > 3 x103/µL OR
Absolute neutrophil count (ANC) of > 1.5 x103/µL AND
Platelet count > 100 x103/µL
guidelines to administer chemo safely
ANC < 0.5 x 103/µL and a single oral temperature > 101F
febrile neutropenia
when give CSF
chemo regimens with >20% incidence of febrile neutropenia or 10-20% for neutropenic fever. pretty sure this is just dose dense AC
CSF with non-linear shit
pegfilgrastim
20-kD and N-terminus
pegfilgrastim
Tbo-Filgrastim
not a biosimilar
start at least 24 hours after chemo
pegfilgrastim
flu-like sxs, bone and joint pain, DVT
adverse effects of CSF
loratidine
treatment of bone or joint pain from CSF
splenic enlargement
rare adverse effect with long terme CSF use
connect renal dysfunction and anemia
decreased erythropoietin production causes it
Hgb ≤ 11 g/dL or ≥ 2 g/dL
patients under this criteria should have a work-up before chemo for anemia
CKD and perisurgery
esa’s increase risk of these
peripheral neuropathies
taxanes, vinka, platinums
morphine
metabolized in liver
renal excretion
hydromorphone
renally excreted
caution in liver dysfxn
oxycodone
cyp2d6
caution in liver dysfxn
no iV form
fentanyl
safe in liver and renal
head/neck/esophageal
opioid with rems
fent
true morphine allergy
methadone
neuropathic pain opioid
methadone
excreted urine and feces
methadone
opioid with qtc risk
methadone
low dose nalaxone
respiratory depression
hot flashes
endometrial cancer
DVT
toxicities of tamoxifen
ovarian suppression
required for use of aromatase inhibitors in pre meno women
toxicities aromatase inhibitors
osteoporosis
hot flashes
muscle aches
dose dense treatment follow up
36 months
trastuzumab duration of therapy
1 year
ado-trastuzumab
residual breast cancer
keynote
triple negative
pembrolizumab in breast cancer
triple negative
positive score >10
fam-trastuzumab deruxtecan
HER2 low
CDK4/6 inhibitors
in hormonal therapy metastatic breast cancer
monitoring parameter all CDK4/6
complete blood count
Ribociclib
qtc prolongation
also cdk
cdk4/6 all cause
diarrhea
tamoxifen
raloxifene
exemestane
prevention breast cancdr
gleason score
scale 2-10
prostate cancer
psa >10ng/ml
highly sus for cancer
external beam or brachytherapy
radiation therapy in localized prostate cancer
ADT (prostate)
LHRH agonist +/- anti-androgene or orchiectomy
goal for inducing castrate levels of testosterone
<50 after 1 month of therapy
LHRH agonists irreversible or reversible
reversible
acute LHRH toxicity
tumor flare
long term LHRH agonists toxicities
increase fat
increase insulin
increase cholesterol
oral LHRH agonist
Relugolix
Relugolix
oral LHRH
less cardiovascular events
anti androgens (drugs)
- lutamides
abiraterone
side effect of all anti-androgens
diarrhea
2 orchiectomy toxicities
impotence
hot flashes
men with biochemical failure only
able to consider intermittent ADT
abiraterone
not used in M0
decrease warfarin conc
avoid cyp2c8
caution in pts with seizure history
enzalutamide
non-steroidal
qt prolongation
thyroid dysfunction
cyp shit
apalutamide
less adverse effects than other androgen receptor antagonists
darolutamide
high volume m1HSPC
multiple organ systems
abiraterone + prednisone
added to regimen for m1HSPC
CYP17
abiraterone
must give with predisone
abiraterone
cyp3a4
take on empty stomach
abiraterone
first line chemo drug m1HSPC
docetaxel
cabazitaxel
2nd line m1CRPC
mdr proteins
cabazitaxel
radium 223
prostate cancer
CRPC with bone metasteses
pembrolizumab in prostate cancer
expressing dMMR or MSI-H
DRE and TRUS
screening prostate
annual prostate screen
psa >2.5
every 2 years screen prostate
psa <2.5
finasteride
prostate cancer prevention
increases gleason score
finasteride
FAP HNPCC
haha
hereditary syndrome risk factor for colorectal
jaundice
hepatomegaly
weight loss
presentation of colorectal
dMMR or MSI-H tumor colorectal
decreased benefit from 5-FU in stage II
can benefit from 5-FU in stage III
surgery alone is definitive therapy
stage I and II colorectal
when chemo will not work in stage II colorectal
MSI-H or dMMR
paresthesia
neutropenia
GI
toxicities oxaliplatin
requires port
folfox
KRAS mutation colorectal
lack of response to anti-EGFR mabs
(dont use cetuximab and panitumumab)
KRAS and BRAF
predictive biomarkers for colorectal
KRAS WT metastatic colorec tal
use cetuximab or panitumumab
dMMR/MSI-H in colorectal
pembro OR
use Nivolumab + ipilimumab
bevacizumab in colorectal
its VEGF (falls under no targetable mutations)
metastatic in combo with FOLFIRI or FOLFOX
FOBT and FIT
primarily detect colon cancer
detects hemoglobin
fecal immunochemical test (FIT)
1st degree relative with colon cancer
screen at 40 or 10 years younger than youngest age of diagnosis in family
thymidylate synthase
DPD
5-FU
early and late onset diarrhea
irinotecan
give atropine
with irinotecan for early onset diarrhea
SN-38
UGT1a1
irinotecan
cold intolerance
oxaliplatin
cross-links DNA, inhibiting dna replication
oxaliplatin
hand-foot syndrome and diarrhea
capecitabine
binds to extracellular domain of EGFR
Cetuxima b
only used in KRAS WT pts colorectal
cetuximab + panitumumab
acneform rash
hypomagnesemia
cetuximab and panitumumab
premedicate with H1 antagonist
cetuximab
recombinant igG2 mab
panitumumab
bleeding and hypertension
bevacizumab + many black box warnings
metabolic derangements
from death of malignant cells
tumor lysis syndrome
urine output 80-100 ml/hr
hydration for TLS
urate oxidase and allantoin
hyperuricemia -> TLS
causes direct tubular injury
hyperuricemia from tls
pt cant take allopurinol what do you give
rasburicase
rasburicase Ci
pregnant or breastfeed
electrolyte changes TLS
everything hyper except hypocalcemia
MSCC diagnosis
MRI
immediately start what if sus of MSCC
steroids
Kyphoplasty
balloon in spine
bone cement injected into fractured bone
vertbroplasty
bisphosphonates in MSCC
offered in pts w/ vertebral involvement to reduce fracture or collapse
SVC
superior vena cava syndrome
major blood vessel from head to neck and arms to heart and lungs and whatever
extrinsic compression
svs syndromee
adjunctive therapies svc syndrome
elevation of head
steroids
diuretics
malignant pleural effusion common in
lung
breast
lymphoma
CXR (chest x-ray)
diagnosis of MPE
thoracentesis
needle aspiration of fluid from pleural effusion
thoracentesis vs pleurodesis
thora -> <1-3 months to live
pleuro -> >1-3 months
pleurodesis drugs and administration of said drugs
talc
doxycycline
bleomycin
intrathecal (gross)
lynch II syndrome
risk factor ovarian
ascites
presenting symptom ovarian
debulking
ovarian cancer surgerey
optimally debulked
<1 cm of disease
sub-optimally debulked
> 1 cm disease
AUC x (GFR+25)
carboplatin dosing * absolutely on exam
anaphylaxis
itching
rash
chest tightness
type I hypersens
erythema, induration
type IV hypersens
MHC and APC
t cells recognize antigens
something about type IV hypersens
pretty common drug for hypersens reaction
paclitaxel
mostly type I
cremophor EL
paclitaxel diluent -> hypersens
facial flushing
back pain
chest or throat tightness
taxane infusion reactions
premedicate paclitaxel with
dexamethasone
benadryl
famotidine
cutaneous sxs
vomiting
htn
carboplatin hypersens symptoms
parp inhibitors use
ovarian cancer
platinum sensitive
ovarian cancer
treat with initial regimen again
platinum resistant
salvage regimen
platinum progressive
ovarian cancer
no response or progression
effective screening tool ovarian cancer
none you fool
oral contraceptives
ovarian cancer prevention
NSCLC histology
mostly adenocarcinoma
SCLC
rapid proliferation
super common to cause brain metasteses
lung cancer:
highly sensitive to radiation and chemo
SCLC
cisplatin + etoposide
SCLC every time
prophylactic cranial radiation
limited stage SCLC
extensive stage SCLC shit
without radiation
rarely curable
Atezolizumab and Durvalumab seen where
extensive stage SCLC
pemetrexed
see only in NSCLC
pembro in NSCLC
unresectable
PD-L1 >1%
not candidates for surgery
exon 19 or 21
osimertinib
fevers
secondary skin cancers
dabrafenib
visual changes
retinal detachment
fevers
rash
trametinib
sotorasib
KRAS G12C mutation in NSCLC
albumin bound paclitaxel
seen in squamous NSCLC
nivolumab in melanoma
stage 3
pembro with low dose ipilimumab
metastatic 2nd line option in melanoma for those that progressed on prior anti pd-1 therapy
unique tox vemurafenib
development of squamous cell carcinoma
pro of encorafenib and binimetinib
less fevers
CTLA-4
ipilimumab
Reed-sternberg cells
hodgkins
90% are B cell
non-hodgkins
epstein-barr virus
global risk factor for myelomas
Ann arbor staging A and B
A-> asymptomatic
B -> B symptoms
ABVD
HL regimen
doxo, bleo, vinblastine, dacarbazine
relapsed hodgkins
brentuximab
stem cell transplant
malignant B or T lymphocytes and precursors
non hodgkin’s lymphoma
PTHrp
increased parathyroid
part of HCM (calcium and bone shit)
severe HCM main sx
heart shit
corrected calcium
serum calcium + 0.8 (4-serum albumin)
normal calc is 8.5-10
<12
12-14
>14
degrees of hypercalcemia
mild moderate severe
T or F
hydration reduces calcium faster than bisphosphonates
true
calcitonin
used in severe HCM
refractory HCM
denosumab
RANK-L
kappa B
something with bone in cancer patients idk HCM shit
also denosumab has affinity for
men with prostate cancer
women with breast cancer
both risk factors for
fractures
drugs off top of my head that need renally adjusted
bisphosphonates
capecitabine
osteonecrosis of jaw
bisphos and deno
IPI >/= 2
NHL
use Pola-R-CHP instead of RCHOP
HepB anything
rituximab in NHL
entacavir
give to people that get hepB from rituximab in NHL
bendamustine
part of regimen for relapsed DLBCL/Aggressive NHL
with rituximab and polatuzumab
when to use CAR-T
relapsed DLBCL/Aggressive NHL
-leucel
car-t cells in NHL all end with
when to use bites NHL
third line after failing 2 lines of systemic, progressed on car-t or stem cell transplant
IL-6
tocilizumab
bite for NHL
bone marrow biopsy
required for CML diagnosis
allogenic hematopoetic stem cell transplant
only way to cure CML / leukemic clone i cant tell
avoid acid reducers
dasatinib
metabolic syndrome and qtc prolongation
nilotinib
t315 can be used in resistant cml
asciminib
deep molecular response
discontinue TKI
bcr-abl <0.1%
translocation chromosomes 9 and 22
CML
bcr-abl
philly
fludarabine
CLL
del(11q)
add alkylating agent
reflects loss of tp53
Del17p in CLL
Monoclonal B lymphocytes > 5 x 109 /L in peripheral blood
CLL diagnosis
RAI staging
CLL
treatment in CLL
stage III or IV
organ dysfunction
you see any BTK (-brut) what do you think
CLL first line option solo or add chemoimmuno
BLC-2 and BIM and PUMA
venetoclax
CLL
CYP3a4 and PGP
venetoclax drug interactions
venetoclax in CLL
when they have del 17p or p53 mutation
main toxicity with venetoclax*
tumor lysis syndrome
transient increase in absolute lymphocyte count
associated with btk inhibitors
FTL3 mutations
AML
TKIS can target this
induction and consolidation
AML, MM
cytarabine
intensive induction in AML
pyrimidine analog
cytarabine
cerebellar side effects
chemical conjunctivitis
cytarabine
t(15;17)
APL (subset of AML)
crowd out normal cells
ALL and maybe the other too idk
hide in balls and brain
ALL
HyperCVAD
ALL
cyclophosphamide, vincristine, doxorubicin, dexamethasone
hypomethylating agent
azacitidine
cd19 and cd3
blinatumomab
cytokine release syndrome
immune effector cell-associated neurotoxicity syndrome
blinatumomab?
asparaginase
ALL only?
IgG
MM pathology
lenalidomide
dexamethasone
bortezomib
MM 3 drug regimeen
crab
lymphoma lecture
hypercalcemia
renal dysfunction
anemia
bone lesions
