Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OU Module Hem/Onc Spring 2019 > Exam 2 Adverse Effects > Flashcards

Exam 2 Adverse Effects Flashcards

1
Q

Most anticancer drugs are known to cause myelosuppression except for which drugs?

A
  • VINCRISTINE
  • BLEOMYCIN
  • corticosteroids
  • interferons
  • L-asparaginase
  • hormones
  • methotrexate w/ leucovorin rescue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are risk factors for myelosuppression?

A
  • Poor marrow reserve (with increasing age)
  • Type of chemotherapy
  • Prior radiation to the pelvis
  • Prior treatment with chemotherapy
  • Concurrent treatment with radiation
  • Impaired drug elimination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which drugs do you renally adjust to decrease myelosuppression?

A
  • cisplatin
  • carboplatin
  • methotrexate
  • topotecan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which drugs do you hepatically adjust to decrease myelosuppression?

A
  • anthracyclines
  • vinca alkaloids
  • taxanes
  • irinotecan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which drugs are so toxic (myelosuppression) that it takes a long time to recover?

A
  • Busulfan

- Carmustine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

define neutropenia

A

Absolute Neutrophil Count (ANC) < 500/mm^3, or an ANC < 1000/mm^3 with expected to drop less than 500/mm3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the number one cause of treatment delays?

A

neutropenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

define neutropenic fever

A

neutropenia + fever of 101 degrees F or higher for more than one hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the ways in which you can prevent neutropenia?

A
  • dose reduction

- CSFs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When would you use a CSF to prevent neutropenia?

A
  • if neutropenia (neutropenic fever) incidence is >= 20%

- (use GM-CSF) prevention of neutropenia in patients > 55 receiving induction therapy for AML

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

G-CSF dosing

A

5-10 mcg/kg/day SQ until ANC > 10,000/mm3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the CSFs?

A
  • Filgrastim: G-CSF
  • Pegfilgrastim: G-CSF long acting
  • Sargramostim: GM-CSF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the administration window for CSFs?

A

> 24 hours but < 72 hours after start of chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the benefit of giving G-CSF?

A

decreases number of febrile days hospital stay and number of antibiotics used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How long does Pegfilgrastim lasts?

A

14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How long do you give Filgrastim for?

A

until post-nadir ANC recovery to normal or near-normal levels (ANC of 10k)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the main adverse effect of CSFs?

A
  • bone pain

- + fever for GM-CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When are you most likely to use growth factors? Cure or palliation?

A

cure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which agents are commonly associated with thrombocytopenia?

A
  • Topotecan
  • Carboplatin
  • Gemcitabine
  • Bortezomib
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When do you treat for thrombocytopenia?

A
  • platelet counts < 10-20,000/mm^3 or < 50,000mm^3 with active bleeding
  • fall / injury precautions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When should you give blood / platelet infusion in thrombocytopenia?

A

when platelet drops below 10k

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What can you do to prevent thrombocytopenia?

A
  • Interleukin-11 (oprelvekin)

- Dose reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Interleukin-11 (oprelvekin) MOA

A

stimulates platelet production through the stimulation of megakaryocytopoiesis and thrombopoiesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Interleukin-11 (oprelvekin) dose

A

50 µg/kg SC once daily 6-24 hours after chemo until post-nadir platelet count is 100k cells/µL or for 21 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which agents are commonly associated with anemia?

A
  • cisplatin
  • carboplatin
  • but can occur with any marrow toxic agent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Treatment / prevention of anemia

A

Transfusion of packed red blood cells (PRBCs) for hemoglobin < 8gm/dL or higher if severely symptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What does EPO do?

A

speeds up process of stem cell differentiating into red blood cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Erythopoietin (Procrit®) dosing

A
  • 100-150 units/kg SQ three times a week or 40,000 units once a week
  • can only increase dose once
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

When should you give Erythopoietin (Procrit®)?

A

give to high risk patients with hemoglobins <10gm/dL prior to chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Darbepoetin alfa dosing

A
  • know 500mcg every 3 weeks

- 1.5 mcg/kg/week to 6 mcg/kg every 3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which drugs are most commonly associated with mucositis?

A
  • 5-Fluorouracil (esp w/ bolus)
  • Methotrexate
  • Doxorubicin
  • Taxanes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

risk factors for mucositis

A
  • Poor oral hygiene/dentures
  • Leukemia / lymphoma
  • Young age
  • Radiation therapy
  • Poor nutritional status
  • High dose therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

prevention of mucositis

A
  • Oral hygiene
  • Pretreatment dental evaluation
  • Oral cryotherapy (ice chips)
  • Leucovorin rescue (for methotrexate)
  • Colony-stimulating factors? (theoretical benefit)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

treatment of mucositis

A
  • analgesics
  • antifungal agents
  • antiviral agents: acyclovir
  • antibiotics: vancomycin
  • growth factor: Palifermin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

risk factors for diarrhea

A
  • elderly

- female

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Which agents are most commonly associated with diarrhea?

A
  • 5-FU
  • Interleukin-2
  • Irinotecan
  • Erlotinib (KNOW THIS)
  • EGFR agents
  • oral VEGF inhibitors
  • ipilimumab (50% chance)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Which agent can cause both early and late diarrhea?

A

Irinotecan

38
Q

How do you treat diarrhea caused by irinotecan?

A
  • Treat early diarrhea with anticholinergics

- Late diarrhea treated with loperamide (4mg stat and then 2mg Q2 hours until diarrhea stops)

39
Q

treatment of diarrhea (no prevention)

A
  • Loperamide
  • Octreotide
  • steroids 1-2mg/kg methylprednison
  • hydration
  • electrolyte supplementation
  • bowel rest
  • nutritional support
40
Q

Grade 2 diarrhea treatment

A

oral diphenoxylate hydrochloride and atropine sulfate four times per day and budesonide 9 mg once per day

41
Q

Grade 3 or 4 diarrhea treatment

A
  • 1–2 mg/kg/day methylprednisolone

- no improvement or relapse: single dose of infliximab 5 mg/kg

42
Q

Which agents are most likely associated with constipation?

A
  • Vinca alkaloids: Vincristine, vinblastine, vinorelbine

- Patients on pain medications

43
Q

prevention of constipation

A
  • Stool softeners

- stimulant / hyperosmotic laxatives

44
Q

treatment of constipation

A
  • Increased laxatives
  • Methylnaltrexone ( esp. if opioid induced) (1 time dose usually effective)
  • Disimpaction
  • enemas
  • NG tube
45
Q

Which agents are most likely to cause renal toxicity?

A
  • Cisplatin - Tubular necrosis and electrolyte wasting
  • High dose methotrexate -Precipitates in renal tubules
  • Ifosfamide, high dose cyclophosphamide
46
Q

Which patients are as risk for developing renal toxicity?

A
  • Pre-existing renal dysfunction
  • Concurrent use of other nephrotoxic drugs (e.g. cisplatin, aminoglycosides, amphotericin, NSAIDs)
  • High dose therapy or increased cumulative dose
47
Q

prevention of nephrotoxicity with cisplatin

A
  • hydrate with 1L of NS + 20mEq K + 8 mEq of Mg over 1-2 hours to obtain a urine flow rate of 100mL/hour
  • then give dieuretics (furosemide)
  • Change to less nephrotoxic analog (carboplatin)
  • Amifostine (Ethyol)
48
Q

treatment of nephrotoxicity with cisplatin

A
  • Hydration, replacement of electrolytes
  • Discontinuation other nephrotoxins
  • Dialysis
49
Q

Amifostine (Ethyol) MOA

A
  • only protects healthy cells
  • gets converted into a compound that goes into cell to protect it
  • give BEFORE cisplatin
50
Q

prevention of nephrotoxicity with methotrexate

A
  • Alkalinization of urine to pH >= 7
  • Sodium bicarbonate beginning 12 hours prior and continuing 24 hours after
  • Dose adjustment for renal insufficiency
51
Q

Which agents are most commonly associated with bladder toxicity?

A
  • Cyclophosphamide

- Ifosfamide

52
Q

MOA of bladder toxicity

A
  • Cyclophosphamide gets broken down into active components phosphoramide mustard and acrolein
  • acrolein is the cytotoxic agent to the bladder
53
Q

prevention of bladder toxicity

A
  • Vigorous hydration

- Administer with mesna (binds to acrolein)

54
Q

treatment of bladder toxicity

A
  • Increased hydration
  • Mesna
  • Bladder irrigation
  • Hyperbaric oxygen, prostaglandin E2, formalin
  • Cystectomy for refractory cases
55
Q

mesna dosing IV

A

20% of ifosfamide dose immediately before and then 20% of dose 4 and 8 hours after IV boluses of ifosfamide

56
Q

mesna dosing PO

A

20% of ifosfamide dose immediately before and then 40% of dose 2 and 6 hours after IV boluses of ifosfamide

57
Q

Which agents are most likely to cause cardiac toxicity?

A
  • Anthracyclines (Doxorubicin, Daunorubicin, Idarubicin)
  • Mitoxantrone
  • Her2-targeted agents
  • VEGF and BCR-ABL inhibitors
58
Q

What are the types of cardiotoxicity that Anthracyclines can cause?

A
  • Acute: Arrhythmias
  • Subacute: Toxic myocarditis, pericarditis
  • Chronic: CHF Late:
  • Ventricular dysfunction
59
Q

Anthracyclines max doses

A
  • Doxorubicin doses > 450-550mg/m^2
  • Daunorubicin doses > 450-550mg/m^2
  • Idarubicin doses > 150mg/m^2
  • Epirubicin doses > 900mg/m^2
60
Q

Risk factors for Anthracycline-related cardiotoxicity

A
  • Bolus infusions (less prolonged infusion)
  • Older age
  • Pre-existing cardiac disease
  • Previous mediastinal irradiation
61
Q

prevention of Anthracycline-related cardiotoxicity

A
  • All patients should have a baseline MUGA done to evaluate potential cardiotoxicity (ejection fraction should be >50%)
  • give as continuous infusion instead of bolus
  • limit total cumulative dose
  • dexrazoxane
62
Q

dexrazoxane MOA

A

Metal chelator that strips doxorubicin from iron complexes, & prevents generation of free oxygen radicals

63
Q

Which drugs cause QT prolongation?

A

BCR-Abl drugs: imatinib, dasatinib, nilotibib

64
Q

Which drugs cause hypertension?

A

VEGF-drugs: sunitinib, sorafenib, bevacizumab

65
Q

Treatment with tyrosine kinase should not be started in which patients?

A

pts who have excessive corrected QT prolongation > 500ms

66
Q

Which drugs are most commonly associated with pulmonary toxicity?

A
  • Bleomycin (4% incidence)
  • All trans-retinoic acid - “Retinoic acid syndrome”
  • EGFR inhibitors
  • mTOR inhibitors
67
Q

Prevention of bleomycin related pulmonary toxicity

A

Limit total cumulative dose to < 400 units total of bleomycin

68
Q

Which agents are most commonly associated with neurotoxicity?

A
  • Vinca alkaloids (especially vincristine)
  • Cisplatin
  • Oxaliplatin
  • Bortezomib
  • Taxanes and Epothilones
  • Ifosfamide
  • Brentuximab vedotin
  • High dose cytarabine
69
Q

prevention of neurotoxicity

A
  • No known method – Amifostine or gabapentin?
  • Avoid cold temperatures for oxaliplatin (exacerbated)
  • Use in appropriate patients
70
Q

treatment of neurotoxicity

A
  • Supportive care: Analgesics for pain

- Amifostine?

71
Q

Which drugs are most commonly associated with alopecia?

A

Anthracyclines and Taxol®, many others as well

72
Q

prevention of alopecia

A

ice caps

73
Q

treatment of alopecia

A

wigs, scarves, hat

74
Q

Which drugs are most commonly associated with photosensitivity?

A
  • 5-FU, MTX

- all-trans retinoic acid

75
Q

prevention of photosensitivity

A

Wear sunscreen SPF > 30, or preferably sun block

76
Q

treatment of photosensitivity

A

Supportive-Topical lotions

77
Q

Which drugs are most commonly associated with acne like rash?

A

EGFR

78
Q

treatment for mild rash

A

topical steroid or cream

AND/OR clindamycin gel

79
Q

treatment for moderate rash

A

topical steroid higher potency or clindamycin gel

AND oral doxy

80
Q

treatment for severe rash

A

topical steroid higher potency or clindamycin gel
AND oral doxy
AND steroid dose pack

81
Q

Which agents are most likely associated with hand-foot syndrome?

A
  • capecitabine
  • infusion 5FU
  • oral tyrosine kinase inhibitors (sunitinib, sorafenib)
82
Q

treatment for hand-foot syndrome

A
  • Dose reduction
  • Avoid tight-fitting shoes; repetitive rubbing or prolonged heat to hands and feet
  • keep areas moist
83
Q

Which agents are vesicants?

A
  • Anthracyclines
  • vinca alkaloids
  • nitrogen mustards (mechlorethamine)
  • mitomycin C
  • dactinomycin
84
Q

prevention of vesicants

A
  • use central venous catheters

- have experienced nurse administer drug

85
Q

treatment of vesicants

A
  • stop infusion
  • withdraw fluid
  • ice packs for all drugs except vinca (use heat for vinca)
86
Q

antidote for nitrogen mustard

A

sodium thiosulfate

87
Q

antidote for vinca

A

hyaluronidase

88
Q

antidote for Anthracyclines

A

DMSO or dexrazoxane

89
Q

Totect (Dexrazoxane) dosing

A
  • Day 1: 1000 mg/m2
  • Day 2: 1000 mg/m2
  • Day 3: 500 mg/m2
  • do not exceed 2000mg at any one time
90
Q

Which agents are most likely associated with hypersensitivity reactions?

A
  • L-asparaginase
  • Paclitaxel
  • Bleomycin (rare)
  • Cisplatin
  • Anthracyclines (hives as local infusion site)
91
Q

prevention of hypersensitivity reactionso

A
  • L-asparaginase: Give 2 unit test dose, avoid IV administration of the drug
  • Paclitaxel: Premedicate with steroids, H1- and H2-blockers
  • Bleomycin: 1 mg (1 unit) test dose
92
Q

treatment of hypersensitivity reactions

A
  • Corticosteroids
  • epinephrine
  • antihistamines (H1 and H2 blockers)

OU Module Hem/Onc Spring 2019 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions