Exam 2 - Supportive Care in Oncology Flashcards
List the classes of chemotherapy-induced nausea and vomiting (CINV)? (5)
acute, delayed, breakthrough, anticipatory, refractory
Describe the pathophysiology of CINV?
mediated by serotonin (5-HT3), substance P/neurokinin-1 (NK-1), and dopamine receptors
List patient risk factors for CINV?
age <50 years, emesis during pregnancy, female sex, anxiety/high pretreatment expectations of nausea, little to no previous alcohol use, history of CINV/prone to motion sickness
What is treatment for emesis prevention in high emetic risk with parenteral agents?
day 1 = olanzapine, dexamethasone, NK1 RA, 5-HT3 RA; day 2-4 olanzapine, dexamethasone, aprepitant (PO on days 2-3 if used PO day 1)
What is treatment for emesis prevention in moderate emetic risk with parental agents?
day 1 = dexamethasone, 5-HT3 RA; days 2-3 dexamethasone OR 5-HT3 RA
What is treatment for emesis prevention in low emetic risk with parenteral agents? (4)
dexamethasone OR metoclopramide OR prochlorperazine OR 5-HT3 RA
What is treatment for emesis prevention in minimal emetic risk with parenteral agents?
no routine prophylaxis
What is treatment for emesis prevention in moderate to high emetic risk with oral agents?
5-HT3 RA
What is treatment for emesis prevention in minimal to low emetic risk with oral agents?
as needed (PRN)
What are treatments for breakthrough emesis?
olanzapine, lorazepam, dronabinol, 5-HT3 RA, prochlorperazine, dexamethasone, metoclopramide, scopolamine
What are treatments for anticipatory emesis treatment?
guided imagery, relaxation, hypnosis, cognitive distraction, yoga, biofeedback, progressive muscle relaxation
What are AEs of dexamethasone?
insomnia (administer in morning), dyspepsia, hyperglycemia, hypertension
What are the first generation 5-HT3 RAs? Second?
ondansetron, granisetron; palonosetron
What are AEs of 5-HT3 RAs?
headache, constipation, QTc prolongation
What are AEs of NK1 RAs?
headache, GI , fatigue, hiccups, CYP interactions (decrease dexamethasone dose)
What are the AEs of olanzapine?
sedation, hyperglycemia, fatigue, QTc prolongation
What are AEs of phenothiazines? (2)
drowsiness, constipation
What are AEs of benzamines? (4)
drowsiness, diarrhea, QTc prolongation, tardive dyskinesia
What drug often causes cancer treatment-induced diarrhea (CTID)?
irinotecan
What is first-line treatment for CTID?
loperamide, diphenoxylate-atropine
What are treatments for refractory CTID?
octreotide, tincture of opium, probiotics, rule out C. diff
Define mucositis?
erythematous ulcerative lesions of the mucosa observed in patients treated with chemotherapy and can occur ANYWHERE IN GI TRACT
Define stomatitis?
inflammation limited to the oral cavity
Explain the five-stage model of oral mucositis?
initiation, primary damage response, signal amplification, ulceration, healing
List risk factors of chemotherapy-induced mucositis?
smoking, poor oral hygiene, oral lesions at baseline, female sex, pretreatment nutritional status, chemotherapy (melphalan, cisplatin + radiation, high-dose MTX, doxorubicin, busulfan, 5-FU)
What are treatment options for management of chemotherapy-induced mucositis?
oral decontamination with mouthwash (dexamethasone for Everolimus-induced), pain control (2% viscous lidocaine), artificial saliva products or chewing gum, liquid/soft diets/TPN, fluconazole for oral candidiasis
List patient risk factors for febrile neutropenia?
prior chemo/radiation, bone marrow involvement, recent surgery/open wounds, liver/renal dysfunction, >65 years receiving full chemo doses
Who should be given G-CSFs for febrile neutropenia primary prevention?
those with a risk >20% (high)
What are treatments for febrile neutropenia primary prevention?
filgrastim, pegfilgrastim, eflapegrastim-xnst or efbemalengrastim alfa-vuxw
What is the difference between filgrastim and its analogues used for febrile neutropenia primary prevention?
filgrastim is given daily until ANC recovery and the others are single dose, and filgrastim should be continued for neutropenia that develops
What is the recommendation for secondary prevention of febrile neutropenia?
if no prior G-CSF give, if Hx of G-CSF consider chemo dose reduction or treatment change
What are treatments for cancer pain?
non-opioids, opioids both +/- adjuvants
Describe cancer treatment immune-related AEs?
skin and GI show up first but skin and endocrine take longest to resolve
What are treatments for cancer treatment immune-related AEs?
systemic corticosteroids
