Exam 1 Flashcards
What is Mosteller Method of dose calculation?
- BSA = ROOT{ [Height(in) *Weight (lb)]/3131}
- BSA = ROOT{ [Height(cm)*Weight(kg)]/3600}
What is Calvert Equation?
Carboplatin dose calculation
- Dose (mg) = Target AUC*(GFR+25)
High emetogenic parenteral chemotherapeutic agents
- AC regimen = anthracycline + cyclophosphamide
- Cisplatin
- Sacituzumab govitecan-hziy
CINV: 5-HT3RA indication, SEs, agents
- Acute & breakthrough
- Constipation, QTc prolongation, serotonin syndrome
- Ondasetron, Granisetron, Palonosetron (only acute, bradycardia, lowest QTc)
- Dolasetron
CINV: NK1RA indication, agents
- Acute & delayed
- Fosaprepitant, aprepitant
CINV: Corticosteroids indication, SEs, agents
- Acute & delayed
- Insomnia, dyspepsia
- Dexamethasone
CINV: Dopamine RA indication, SEs, agents
- Breakthrough/refractory prevention & tx (Olanzapine also acute & delayed)
- Extrapyramidal symptoms (EPS)
- Metoclopramide, Olanzapine, Prochlorperazine, Promethazine (IV not rec)
CINV: Benzodiazepines indication, agent
- Anticipatory
- Lorazepam (BW: respiratory depression w/ opioid)
CINV: Antihistamines use, SE, agents
- Breakthrough
- Anticholinergic effects
- Hydroxyzine, Scopolamine
CINV: Cannabinoids indication, SEs, agents
- Refractory
- A lot
- Dronabinol, Nabilone
CINV: high emetic risk prevention
- Day 1, Day 2-4
Day 1
1. Olanzapine 5-10 mg once
2. NK1 RA
3. 5-HT3 RA
4. Dexamethasone 12 mg IV/PO once
Day 2-4
1. Olanzapine 5-10 mg once
2. Aprepitant 80 mg PO daily on days 2-3 if used
3. Dexamethasone 8 mg IV/PO daily on days 2,3,4
CINV: management of breakthrough
Add one agent from a different drug class than current scheduled preventative regimen
Olanzapine 5-10 mg daily (preferred)
CINV: prevention of anticipatory CINV
Only Lorazepam
Chemo Related Fatigue (CRF): nonpharmacologic therapy
- Cognitive behavioral therapy
- Supportive expressive
- Psycho-educational
Counseling, music therapy, stress reduction therapy, journal writing, meditation
CRF: pharmacologic therapy
- Recommended vs not recommended
- Methylphenidate: AEs insomnia, weight loss, decreased appetite
- Antidepressants not recommended
- Corticosteroids (dexamethasone, methylprednisolone) not routinely recommended
Anemia is low
RBC
Thrombocytopenia is low
Platelets
Leukopenia is low
WBC
What relative time points do we see anemia, neutropenia, thrombocytopenia?
- Neutropenia
- Thrombocytopenia
- Anemia
CRF: Anemia treatment
RBC transfusion in symptomatic or any pt with Hgb <7
CRF: ESAs treatment
Reseserved for palliative
Causes of constipation
Vincristine, opioids, 5HT3RA SE, changes in routine/diet
Gold standard for constipation tx
Laxative
Types of laxatives
Bulk-forming (slow onset, for maintenance), osmotic, emollient (stool softeners), lubricant (short onset, C/I in elderly), stimulant (short onset, stimulate GI peristalsis)
Causes of diarrhea
- Irinotecan, immunotherapy, HER2i (neratinib), Sacituzsumab govitecan
- Mucositis/GI inflammation
- C. diff
- Change in diet/nutrition
Pharmacologic therapy for diarrhea
- Loperamide
- Octreotide if refractory to loperamide
Irinotecan induced diarrhea early onset: cause & tx
- Increased cholinergic transmission due to blockage of ACh
- Atropine
Irinotecan induced diarrhea late onset: cause & tx
- Mucosal damage from SN-38
- Loperamide 4 mg initially, then 2 mg after every loose stool
Immunotherapy induced diarrhea mild tx
- Consider holding immunotherapy
- Loperamide for 2-3 days
- If persistent check lactoferrin/calprotectin
(+: treat as moderate vs -: add mesalamine &/or cholestyramine)
Immunotherapy induced diarrhea moderate tx
- Hold immunotherapy until resolution of symptoms
- Pathologically confirmed microscopic colitis; oral budesonide
- Not confirmed; oral prednisone or methylprednisolone
- If no response, add infliximab or vedolizumab
Immunotherapy induced diarrhea severe tx
- IV methylprednisolone
- If no response, add infliximab or vedolizumab
- G3: permanently d/c anti-CTLA-4 and resume anti-PD 1/L1 after resolution
- G4: permanently d/c any immunotherapy