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Chemotherapy > Exam 3 randoms > Flashcards

Exam 3 randoms Flashcards

1
Q

Biological response modulators

A

Cytokines: IL-2, Interferon alfa-2b

BCG

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2
Q

Aldesleukin

IL-2

A

Promotes prolif, diff, and recruit of T and B cells, NK cells, thymocytes
Used in metastatic melanoma and renal cell carc
AE: many, Capillary release syn
Absolutely no steorids.

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3
Q

IL-2 management of AEs

A

Cardiac: EKG, want electrolytes K>4, mag>2.
Oatmeal bath, lotions
N/V/D
Hold antiHTN except for beta blockers, give APAP or indometh for fever
Clindamycin prphy
Random crying: haloperidol or lorazepam
SOB: give oxygen
Increased SCr: fluids, start dopamine drip after 1.5 L

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4
Q

Interferon

A

Interferes with cell growth, diff, expression
PEG has much longer half life
Absolutely no steroids
Cause major depression and fatigue

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5
Q

Oncolytic Virus therapy

A

Nonvirulent herpes virus targets cancer cells and kill them

Talmigene laherparepvec

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6
Q

Talmigene laherparepvec

A

Reccurent melanoma, injected into lesions
Do NOT give acyclovir or other antivirals
Don’t touch site, dressing, body fluids for 1 week. Wear gloves if have to. Dispose of all used dressing and cleaning materials in sealed plastic bag before throwing away

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7
Q

Cancer vaccines

A

Sipuleucel-T

Own blood cells are taken out, incubated with PAP/GMCSF and reinjected into body to induce T-cell immunity

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8
Q

Sipuleucel-T

A

For metastatic castration resistant prostate cancer
DO NOT FILTER
Premeds with APAP and benedryl
Mild to moderate AEs

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9
Q

T cell therapies

A 
CAR T cells
Target CD19 (in A.L.L)
Do NOT give growth factor
Do NOT give steroids
Cause cytokine release syndrome
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10
Q

FDA approved CAR T cell drugs

A

Tisagenlecleucel for A.L.L.

Axicabtagene ciloleucel for Large B Cell Lymphoma

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11
Q

Cytokine release syndrome

A 
Premeds: APAP and Diphenhydramine
Antibx at prodrome
1st line: O2, fluids, vasopressors, antipyretics
2nd line: Tocilizumab (IL-6 antagonist)
3rd line: rule out sepsis and adrenal insuff, maybe try steroids here
4th line: Tocilizumab
5th line: Siltuximab
6th line: cyclophos, ATG, alemtuzumab
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12
Q

Checkpoint inhibitors

A 
Inhibit CTLA4 (Ipi), PD1 (Nivo or Pembro), or PDL1
Can un-mask cancer cells and let them be recognized by T-cells
"release the breaks"
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13
Q

Pseudoprogession

A

initial growth in tumor size after initiation of checkpoint inhibitors

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14
Q

Side effects of checkpoint inh

A 
Many organ systems
Ipi has more AEs but Pembro and Nivo have more thyroid, fatigue, and arthralgia
ok to use: STEROIDS
Dermatitis
Enterocolitis
Hepatitis (must rule out others first)
Hypophysitis--Ipi, fatigue and headache, need MRI
Hypothyroidism-Pembro and Nivo
Adrenal insuff
Pneumonitis-can happen with all of these
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15
Q

Adrenal insuffieciency

A

Primary: gluco and mineralcorticoid, test both cortisol and ACTH. Tx with Hydrocortione po
Secondary: glucocorticoid only, don’t test ACTH. Tx with Fludrocortisone po
Life threatening, hypotension
CONSULT endocrinology

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16
Q

If steroids aren’t working in checkpoint inh side effects

A

Infliximab (not ok in hep)

po Budesonide for enterocolitis

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17
Q

When to permanently D/C immunotherpay

A 
SJS, epidermal necrolysis
Lifethreatening bowel perforation
High AST or ALT or Tbili
Life threatening hypophysitis or thyroid
Pneumonitis requiring oxygen or adrenal insuff requiring hosp
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18
Q

Risk factors for cancer

A

Genetics
AGE
family history

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19
Q

Current breast cancer screening

A

Self breast exam: Optional
Clinical breast exam: part of periodic health exam
Mammogram: 40+ yearly
MRI: for BRCA mutation

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20
Q

Who is high risk, screening wise

A 
BRCA mutation or relative with one
Pedigree suggesting genetic predisp
Lifetime risk>20%
Radiation to chest between 10-30 years old
Lobular carcinoma in situ
Gail model of 1.7% in 35+ y/o
Prior history of breast cancer
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21
Q

Mammography benefits

A

prevent metastasis

best benefit >50 y/o, decrease in mortality

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22
Q

Breast cancer prevention

A

Mastectomies decrease risk by 90%
Hystorectomy decrease by 50%
SERM therapy-raloxifen or tamoxifen
Aromatase inh-Exemestane (not FDA ap)

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23
Q

SERM risks

who gets it?

A 
endometrial cancer, women over 50
Thromboembolism
CV events (MI, stroke, TIA)
Cataracts
Hot flashes
Vag discharge

Increased risk, >35 y/o, premen=tamox, post men=tamox/ralox/exemestane

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24
Q

Gail model

A

5 year risk of invasive BrCanc

Determines if benefit outweigh risk of taking tamox

25
Q

Lung cancer screening

A

CT scans annually for high risk patients

Not xray

26
Q

Who are high risk lung cancer?

A

Age 55-74 and
>30 pack year smoking (1 pack yr=ppd*yrs smoking)
Current smokers or quit w/in past 15 yrs
Smoking cessation is only effective prevention

27
Q

Colorectal canc screening

A 
Fecal occult blood test (need to avoid NSAIDS, vitamin c, and iron 3 days before)
Fecal immunochemical test
Stool DNA
Barium enemas 
Tumor markers (CEA)
Fleg sig
**Colonoscopy**
28
Q

Colorectal Prevention

A

Diet (high fiber 39 g, Low fat, fruits and veg high in antiox, ca2+ rich, VitD)
Smoking cess
Low dose ASA in 50-59 y/o to decrease COX2-med free rad formation

29
Q

Prostate Cancer Screening

A

Digital rectal exam
PSA (total, velocity, free <15%
Followup with transrectal ultrasound

30
Q

Prostate canc prevention

A

5alpha reductase inh (finasteride) cause a higher grade diagnosis if get cancer
Selenium and Vit E not effective

31
Q

Cervical cancer screening

A

Pap test (mostly liquid)
HPV DNA for high risk strains
21-65 every 3 years

32
Q

Cervical cancer prevention

A

less sex partners, delay onset of sex
Gardasil 9 vaccine for all 9-26
Strain 16 and 18 are most harmful

33
Q

Melanoma screening

A

ABCDE
Asymmetry, border, color, diameter, evolving
Monthly self inspection data insufficient

34
Q

Melanoma prevention

A

minimize UV exposure

strongest rays are 10-4 sun protection and sunscreen

35
Q

Sunscreen

A

UVB>uva
SPF regards UvB
At least SPF 30 q2h

36
Q

Hazardous meds

A 
must be one or more:
carcinogenicity
teratogenicity
reproductive tox
organ tox at low doses
genotoxicity
structure that resembles a hazardous drug
NIOSH writes list
37
Q

NIOSH list tables

A

Table 1: antineoplastics
Table 2: Non-antineoplastics that are hazardous
Table 3: Non-antineoplastics that have reproductive effects

38
Q

USP 800 shipping

A

hazardous drugs needs to be in impervious plastic to keep separate from other drugs
Need to be unpacked in negative pressure
Unpack using PPE
Gloves when transporting to storage or work areas

39
Q

Storing hazardous drugs

A

Table 3 drugs ok with other inventory
Table 1 need to be in neg pressure room
Need a separate refrigerator

40
Q

Compounding chemo

A

Table 1 needs double PPE, in a BSC with air quality 5+
Need separate mortars, etc
Prime tubing in hood
Dispose in yellow bin

41
Q

Closed sys trans devices

A

need for administering but not required from compounding

42
Q

Hazardous handling at home

A

Separate from other family members meds
wash hands before and after, use gloves, plastic medicine cups, no pill boxes
Cut pills in a plastic bag
Discard into plastic bag.
flush toilets twice with lid down 48 hrs after chemo

43
Q

Vincristine

A

BE CAREFUL
do not admin intrathecally
always but in a bag
two nurse review

44
Q

TKI adverse events

A 
Myelosup
Cardiotox
Diarrhea/constipation
Edema
Dermatologic tox
Naus/vom
Hepatotox
QT prolongation
45
Q

TKI EGFR acneiform rash

A

Severity of rash correlates to response of therapy
Papules erupt 2 weeks
On face, scalp, upper chest, back
Treat with hydrocortisone, clinda/doxy

46
Q

TKI VEGFR Hand foot reaction

A

Localized hyperkeratosis and painful plaques, 3-4 weeks after
Avoid hot water and stress on hands/foot
Treat with hydrocortisone, urea ointments, top antibiotics
Exfoliate
Analgesics

47
Q

Aromatase inh and SERM side effects

A 
Hot flashes
Mood changes
Osteoporosis (Arom)
Arthalgia
Uterine/endo cancer
HTN
naus/vom
48
Q

Antiandrogen side effects

A 
Hot flashes
Sex dysfx
Gynecomastia
Increased chol and TGs
Osteoporosis
49
Q

Hot flash management

A

Dress in layers
non2D6 SSRI/SNRI or gabapentin
Exercise
NO hormone replacement

50
Q

Arthrlagia management

A

Exercise, acupuncture
NSAIDs
Vitamin D if low
Switch to diff SERM or arom inh

51
Q

Antimetabolite side effects

A

Myelosupr
Immune supr
Rash, hand-foot syndrome, pigment changes
Diarrhea

52
Q

Antimetabolite diarrhea management

A

Loperamide
Fluids
Small meals with BRAT diet
infection signs/symp?

53
Q

Antimetabolite hand-foot syndrome

A

Urea products
avoid stress to feet and palms
NSAIDS/APAP
avoid hot/cold

54
Q

Alkylating agents side effects

A 
Myelosupr
2ndary malignancies
N/V
Infertility 
Mucositis
Pigment and rash
Seizures
55
Q

Immune modulator side effects

A 
BBW teratogenic
BBW VTE (use warf LMWH or ASA)
myelosupr
Neuropathy
Constipation diarrhea
Fatigue
56
Q

Proteosome inh

side effects

A

Neuropathy (gaba, venla)

N/V/D/const

57
Q

Retinoid side effects

A

Differentiation syndrome

Rash/skin changes

58
Q

TKIs and acid sup

A

Avoid PPIs, H2RAs, antacids
OK to give antacid 2 hours before or after dose
OK to use H2RAs 2 hrs after dose once daily

59
Q

Procarbazine and food

A

Serotonin syndrome or hypertensive crisis may happen if ingestion of tyramine, phenylalanine, or caffeine
Alcohol can cause disulfiram-like rxn

Chemotherapy (20 decks)

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