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Hem/Onc Module > EXAM ONE > Flashcards

EXAM ONE Flashcards

1
Q

What are the two essential features of stem cells?

A
  1. Capacity to differentiate into different cell types needed to produce mature blood and immune cells
  2. Capacity for self renewal ensures stem cell population is maintained over time
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2
Q

Granulocytes are also known as what?

A

Neutrophils
Segs + Bands

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3
Q

White Blood Cells WBCs have two different phases of development, what are they

A
  1. Lymphoid Cell Line
  2. Myeloid Cell Line
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4
Q

What are the cell types in the Myeloid Cell Line?

A
  1. Granulocytes
  2. Basophils
  3. Monocytes
  4. Eosinophils
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5
Q

What cells are the first line defense mechanism in Oncology?

A

Granulocytes

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6
Q

Define Neutropenia

A

Neutrophil Count <1500 cells/mm

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7
Q

Accurate assessment of absolute value for Neutropenia is calculated how?

A

Absolute Neutrophil Count (ANC) /Absolute Granulocyte Count (AGC)

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8
Q

When should chemotherapy be held with concerns of Neutropenia?

A

Neutrophil Count <1000

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9
Q

Define Neutrophilia

A

Increased Neutrophil Count, further workup needed to determine cause

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10
Q

What are the possible causes of Neutrophilia?

A
  1. Infection
  2. Corticosteroids
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11
Q

Define Myeloproliferative Disorders

A

Increase in the number of granulocytes or lymphs, characterized by mutations in bone marrow stem cells

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12
Q

What are the considerations when calculating an ANC/AGC?

A
  1. Must have CBC with differential
  2. What is the total WBC value?
  3. In differential, what percentage of those WBCs are the neutrophils/granulocytes?
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13
Q

What is the normal value for Platelets?

A

140,000-440,000 uL

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14
Q

What is Thrombocytopenia?

A

Decreased platelet count <140,000

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15
Q

List the drugs that can cause Thrombocytopenia and their mechanism

A
  1. Chemotherapy: decrease in platelet PRODUCTION
  2. Heparin/Penicillin: increase in platelet DESTRUCTION
  3. NSAIDs/ASA: decrease in platelet aggregation FUNCTION
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16
Q

What is Thrombocytosis?

A

Disorder in which the body produces to many platelets

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17
Q

What 3 qualities MUST be true to proceed with chemotherapy treatment? ALL 3 must be true.

A
  1. ANC > 1000 or 1500
  2. Hgb >8
  3. Platelets >100,000
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18
Q

What are Oncogenes?

A

Gas Pedal

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19
Q

What are Tumor Suppressor Genes?

A

Brakes

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20
Q

List the Steps in Hallmarks of Cancer Cells

A
  1. Sustained growth factor signaling
  2. Cell survival/resisting death
  3. Overcoming growth inhibition
  4. Angiogenesis
  5. Endless replication
  6. Invasion/Metastasis
  7. Immune System
  8. Altered Metabolism
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21
Q

What are the Growth Factor Receptors?

A
  1. Receptor Tyrosine Kinase RTKs
  2. HER2/neu: EGFR-2
  3. EGFR-1
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22
Q

Mutations of with Growth Factor Receptor leads to constant activation?

A

Receptor Tyrosine Kinase RTK

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23
Q

What drugs specifically target HER2/neu-EGFR-2, found in breast cancer?

A
  1. Trastuzumab
  2. Lapatinib
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24
Q

What drugs specifically target EGFR-1 found in lung, GI, and stromal cancers?

A
  1. Erlotinib
  2. Lapatinib
  3. Cetuximab
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25
Q

Mutations in what Growth Factor Receptors can cause what?

A

Render drugs useless in treatment

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26
Q

What are the Growth Signals?

A
  1. VEGFR-2: endothelial cells
  2. PDGFRB: smooth muscle cells
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27
Q

Downstream Signaling Pathways include what?

A
  1. MAPK (Ras/Raf)
  2. Akt
    downstream of growth factor receptors, leading to signaling in the absence of growth factor
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28
Q

Alternative Signaling Pathways include what?

A
  1. STAT3
  2. IGFR
  3. c-Met
    when EGFR and others are blocked, these pathways are unregulated to compensate
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29
Q

Sustained Growth Factor Signaling (HM1) includes growth factor receptors, growth signals, and pathways. What does Cell Survival HM2 include?

A
  1. Cell Membrane Changes
  2. Resistance to Apoptosis
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30
Q

Cell Membrane Changes Blebs include what?

A
  1. Degradation of proteins, nucleic acids, and lipids
  2. Cell lysis
  3. Release of cell components to be used by other cells
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31
Q

Resistance to Apoptosis can be targeted by Conventional Cytotoxic Anticancer Agents, list the main drug that acts by triggering apoptosis.

A

Cisplatin

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32
Q

Resistance to Apoptosis can be targeted by Anti-Apoptotic Protein IAP Inhibitors, blocking an anti-apoptosis protein which promotes apoptosis in return, list the drug that acts by this mechanism.

A

Venetoclax

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33
Q

In HM3: Overcoming Growth Inhibition, what is the main mutated/inactivated gene in 50% of cancers?

A

Tumor Suppressor Gene P53: transcription factor

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34
Q

What types of anticancer drugs can impact the mutation of P53 that affects cell cycle arrest, DNA repair, and apoptotic cell death?

A
  1. Conventional Cytotoxic Anticancer Agents
  2. CDK Inhibitors (Cell Cycle Blockers)
  3. P53
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35
Q

HM4: Limitless Replication Potential is concerned with Telomeres and specifically what?

A

Telomerase: enzyme that adds onto ends of chromosomes — differentiation

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36
Q

A cancer cells becomes UNdifferentiated as it goes through the carcinogenesis pathway, what are elements of UNdifferentiated cells?

A
  1. Fast growth
  2. Non-Uniform morphology
  3. Unstable genotype
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37
Q

What is a Differentiation Agent that can help trigger a cell to go from an UNdifferentiated state to a Differentiated (normal cell) state?

A

Vitamin A Derivatives (degibs)

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38
Q

HM5: Sustained Angiogenesis is concerned with tumor growth, therefore, Tumors grow SLOWEST when they are what?

A
  1. Little: lack a blood supply
  2. Large: outgrow their blood supply
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39
Q

HM5 suggests that to treat tumors you need to target both what?

A
  1. Blood Vessels with anti-angiogenic agents
  2. Cancer Cells with cytotoxic/RTKs
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40
Q

Some Cytotoxic Anticancer Drugs have Anti-Angiogenic Activity at lower doses, list those agents.

A
  1. Gemcitabine
  2. Vinblastine
  3. Docetaxel
  4. Paclitaxel
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41
Q

List the first Anti-VEGF Drug that can be used in HM5?

A

Bevacizumab

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42
Q

VEGF Kinase Inhibitors on Endothelial Cells and PDGF Kinase Inhibitors on Smooth Muscle Cells target vessels, list two agents.

A
  1. Sunitinib
  2. Sorafenib
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43
Q

HM6: Invasion and Metastasis, what class can be used to treat by using the immune system to kill metastases?

A
  1. CTLA-4 Inhibitors
  2. PD-1 Inhibitors
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44
Q

HM7: Immune System, what two immune cells are critical to carcinogenesis and act as immune checkpoint proteins that reduce the immunogenicity of tumors?

A
  1. CTLA-4
  2. PD-1
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45
Q

What are the two considerations in HM8: Altered Metabolism?

A
  1. Warburg Effect
  2. Metformin
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46
Q

What is the Warburg Effect?

A

Cancer cells use glucose breakdown (glycolysis) to produce energy instead of using the mitochondria

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47
Q

What is the role of Metformin in Altered Metabolism of Cancer?

A

Metformin can induce AMP Kinase which decreases cancer cell use

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48
Q

Alkylating Agents are Traditional Cytotoxic Agents, what is their MOA?

A
  1. Bind covalently to the DNA molecule
  2. Inhibit DNA Synthesis (S Phase)
  3. Attack ANY diving cell
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49
Q

How do Alkylating Agents bind to the DNA molecule?

A

Electrophile reacts with basic groups aka DNA and bind to stop cell growth

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50
Q

What was the first Alkylating Agent?

A

Mechlortheramine

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51
Q

What are the Nitrogen Mustard Alkylating Agents?

A
  1. Cyclophosphamide
  2. Ifosfamide
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52
Q

What are important Alkylating Agents? CCOT?

A

C: Cisplatin
C: Carboplatin
O: Oxaliplatin
T: Temozolomide

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53
Q

Anti-Tumor Antibodies are Traditional drugs, what is their MOA?

A
  1. Act by alkylation or intercalation
  2. BOTH = inhibition of DNA Synthesis
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54
Q

Anthracyclines are a class of Anti-Tumor Agents, they block Topoisomerase II, list the agents in this class.

A
  1. Doxorubicin
  2. Daunorubicin
  3. Epirubicin
  4. Idarubicin
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55
Q

How do Anthracyclines (anti-tumor) agents work specifically?

A

Intercalators

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56
Q

Bleomycin is an MISC Anti-Tumor Agent, what is its MOA?

A

DNA Strand Breaks
Bleo = Blow Apart

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57
Q

Antimetabolite Agents are used to decrease DNA Synthesis, what is its MOA?

A
  1. Block the biosynthesis or use of normal cellular metabolites
  2. Remove critical proteins in DNA Replication, being false substrates for DNA synthetic enzymes
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58
Q

Antimetabolites target specific DNA replication proteins, list the agents that are Pyrimidine Analogues that mimic pyrimidines to stop DNA synthesis.

A
  1. Fluorouracil 5-FU
  2. Gemcitabine
  3. Capecitabine
  4. Azacitidine
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59
Q

Antimetabolites target specific DNA replication proteins, list the agents that are Purine Analogues that mimic purines to stop DNA synthesis.

A
  1. 6-Mercaptopurine
  2. Vidarabine
  3. Vladribine
  4. Fludarabine
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60
Q

What Plant Alkaloid Agents have an MOA of: Arrest cell division by preventing the formation of the mitotic spindle? VIN = Anti-Mitotic

A

VINCAS
1. Vincristine
2. Vinblastine
3. Vinorelbine

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61
Q

What Plant Alkaloid Agents have an MOA of: Inhibit Topoisomerase II –> DNA during synthesis?

A

Epipodophyllotoxin
1. Etoposide

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62
Q

What Plant Alkaloid Agents have an MOA of: Inhibit Topoisomerase I - an enzyme responsible for the unwinding DNA synthesis?

A

Campothecins TECANS
1. Irinotecan
2. Topotecan

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63
Q

What Plant Alkaloid Agents have an MOA of: Stabilize Mircotubules –> block cell division in M Phase?

A

TAXENES
1. Paclitaxel
2. Docetaxel

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64
Q

What Plant Alkaloid Agents have an MOA of: Microtubule Stabilization?

A

Ixabepilone

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65
Q

What Plant Alkaloid Agents have an MOA of: Antimicrotubule Agent, binds to and blocks PLUS ends of microtubules?

A

Eribulin

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66
Q

Anti-Hormone class Anti-Androgen has what MOA?

A

Inhibit and/or degrade the androgen receptor

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67
Q

List the Anti-Androgen Agents

A
  1. Bicalutamide
  2. Flutamide
  3. Nilutamide
  4. Apalutamide
  5. Enzalutamide
  6. Abiraterone
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68
Q

Anti-Hormone class Anti-Estrogens has what MOA?

A

Inhibit and/or degrade the estrogen receptor

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69
Q

List the Anti-Estrogens Agents

A
  1. Tamoxifen
  2. Fulvestrant
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70
Q

Anti-Hormone class Aromatase Inhibitors has what MOA?

A

Aromatase: rate-limiting step in estrogen synthesis

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71
Q

List the Aromatase Inhibitors Agents

A
  1. Anastrozole
  2. Letrozole
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72
Q

The “CICIB” ending means what?

A

CDK Inhibitor

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73
Q

The “PARIB” ending means what?

A

PARIB Inhibitor

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74
Q

What is the MOA of Arsenic Trioxide?

A

Induces apoptosis through reactive oxygen species

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75
Q

What is the MOA of Pegaspargase/Calasparra-Pegol?

A

Removes vital amino acid asparagine critical to growth of some tumor cells

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76
Q

What is the MOA of Bacillus Calmette Guerin BCG for bladder cancer?

A

Vaccine against bovine bacteria that non-specifically enhances system to remove tumor cells

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77
Q

New Agents Palbociclib, Abemacicib, and Ribociclib act how?

A

CDK4/6 Inhibitors: arrest cells in G1/S Phase, mimics normal CDK inhibitors

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78
Q

New Agents Olaparib, Rucaparib, Niraparib, and Talazoparib act how?

A

PARP Inhibitors: break DNA strands

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79
Q

What is Aldesleukin?

A

T-Cell Growth Factor, stimulate formation of TReg, T-Effector, and T-Memory cells

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80
Q

What is the MOA of Interferon Alpha 2A?

A
  1. Increase phagocytic activity of macrophages
  2. Increase cytotoxicity of lymphocytes for target
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81
Q

Differentiation Agents Vitamin A Derivatives have what MOA?

A
  1. Analogues of Vitamin A, bind to Ra/RXR/RAR transcription factor
  2. Induce tumor cell differentiation to become more mature, less malignant cells
82
Q

List the Vitamin A Derivatives

A
  1. Tretinoin
  2. Bexarotene
83
Q

Differentiating Agents DEGIBs have what MOA?

A
  1. Sonic Hedgehog
  2. Inhibitors of SMO1
84
Q

List the DEGIB Agents

A
  1. Vismodegib
  2. Sonidegib
  3. Glasdegib
85
Q

List the 2 Proteasome Inhibitors and their specific targets

A
  1. Bortezomib: 26S proteasome
  2. Carfilzomib and Ixazomib: 20S proteasome
86
Q

What is the MOA of Selinexor?

A
  1. Blocks Exportin-1, which transports proteins
  2. Decrease oncogene levels in cytoplasm
  3. Apoptosis induction
87
Q

What is the MOA of Venetoclax?

A
  1. Blocks Bcl-2, anti-apoptotic protein
  2. Apoptosis induction
88
Q

What is the MOA of Tratuzumab IV?

A

Antibody that blocks EGF binding to HER2/NEU

89
Q

What is the MOA of Pertuzumab IV?

A

Antibody that blocks HER2/NEU dimerization with itself and other like receptors

90
Q

What is the MOA of Lapatinib and Tucatinib PO?

A

Small molecule that blocks HER2/NEU kinase activity
PROTOTYPICAL

91
Q

List the EGFR-1 Tyrosine Kinase Inhibitor drugs

A
  1. Erlotinib
  2. Afatinib
92
Q

Afatinib is an EGFR-1 Tyrosine Kinase Inhibitor, what is its MOA?

A

IRREVERSIBLE EGFR inhibitor, can be used in some resistant tumors

93
Q

What is the MOA of CetuXIMAB?

A
  1. Anti-EGFR-1 Monoclonal Antibodies
  2. Prevent EGF ligand from binding to receptor
  3. K-Ras is downstream of EGFR in MAP kinase pathway
94
Q

Cetuximab only works on what kind of tumors?

A

Wild-Type K-Ras Tumors

95
Q

What is the MOA of ImaTINIB?

A
  1. Inhibit BCR-abl kinase
  2. Decrease cell growth
  3. Inhibit at the ATP binding site of kinase
96
Q

What is the MOA of CrizoTINIB?

A
  1. Inhibitor of ALK Kinase
97
Q

What is the MOA of IbruTINIB?

A
  1. Inhibitors of Bruton’s Tyrosine Kinase, found in liquid tumors
  2. Lead to apoptotic cell death
  3. Cytotoxic
98
Q

What does the “TINIB” ending mean?

A

Kinase Inhibitor

99
Q

Sotorasib and Asagrasib are Downstream Kinase Inhibitors, what is its target? ‘ras’

A

Mutant K-RAS G12C

100
Q

Vemurafenib and Dabrafenib are Downstream Kinase Inhibitors, what is its target? ‘raf’

A

B-Raf

101
Q

Trametinib, Cobimetinib, and Binimetinib are Downstream Kinase Inhibitors, what is its target? ‘met’

A

MEK 1/2

102
Q

Idelisib, Copanlisib, Pelisib, and Umbrolisib are Downstream Kinase Inhibitors, what is its target? ‘lisib’

A

PI-3 Kinase

103
Q

Everolimus and Temsirolimus are Downstream Kinase Inhibitors, what is its target? ‘limus’

A

mTOR

104
Q

What is the order of Downstream Signaling Kinases?

A
  1. Ras – Raf – MEK — MAPK
  2. Ras – Raf – Akt
  3. PI-3 Kinase – PDK1 – Akt
  4. mTOR – Akt
105
Q

True or False, you cannot give a downstream drug for an upstream mutation?

A

True

106
Q

What is the MOA of Midostaurin?

A

Small molecule inhibitor of multiple signaling kinases

107
Q

What is the MOA of BevaciZUMAB?

A
  1. Monoclonal antibodies against VEGF
  2. Prevents VEGF from binding to VEGFR
108
Q

What is the MOA of PomalidOMIDE and LenalidOMIDE?

A
  1. Block VEGF and bFGF
  2. Induce apoptosis
  3. Anti-Inflammatory Anti-TNF activity
  4. CI in Pregnancy
109
Q

What is the MOA of SoraENIB and SuniTINIB?

A
  1. Block VEGF2 on endothelial cells (blood vessels)
  2. Block PDGFR on smooth muscle cells surrounding blood vessels
    aka do BOTH
110
Q

List the VEGFR2/PDGFRbeta targeted anti-angiogenic agents?

A
  1. Sorafenib
  2. Sunitinib
111
Q

Ipilmumab is an Immune Checkpoint Inhibitor, what is its MOA?

A
  1. Antibody inhibitor of CTLA-4
  2. Blocks CTLA-4 sustains cytotoxic T cell killing of cancer cells
112
Q

What is the MOA of PD-1/PD-1L Inhibitors?

A
  1. Act at the level of the tumor cells/periphery
  2. Trigger the immune system to kill tumor cells
113
Q

Pembrolizumab and Nivolumab are PD-1/PD-1L Inhibitors, what is their specific target?

A

PD-1 Receptor

114
Q

Rituximab and Obinutuzumab are Targeted Antibodies, what is their target and use?

A

Target: CD20
Use: B cell tumors and multiple myeloma

115
Q

Blinatumomab and Tebentafusp are Targeted Antibody, what is their MOA?

A
  1. Bispecific T cell Engagers BiTES
  2. Link CD19 and Mutant HLA with CD3 of T cell
116
Q

Denileukin DiftiTox Antibody Conjugte has what Missile and Warhead?

A

Missile: Interleukin 2: targets drug to T cells
Warhead: Diphtheria Toxin: kills cells

117
Q

Inotuzumab Ozogamicin Antibody Conjugate has what Missile and Warhead?

A

Missile: CD22 Antibody: expressed on tumors
Warhead: Ozogamicin: cytotoxic small molecule

118
Q

T-VEC is an Oncolytic Virus, what is its MOA?

A
  1. Triggers release of GM-CDF within tumor which triggers lysis
  2. Triggers an immune antitumor response
  3. Injections into tumor
119
Q

Tisagenlecleucel and Ciloleucel are Gene Therapy, what is its MOA?

A
  1. Adoptive T cell Transfer
  2. CAR-T gene targets CD19 on leukemia cells to trigger T cells to kill them
120
Q

List the Risk Factors for CINV

A
  1. Younger age
  2. Female sex
  3. Previous history of CINV
  4. Little to no previous alcohol use
  5. Prone to motion sickness
  6. History of morning sickness during pregnancy
  7. Anxiety or high pretreatment expectation of nausea
121
Q

What are the 2 main potential causes of CINV?

A
  1. Chemotherapy
  2. Radiation
122
Q

Central Pathway of CINV originates in the brain and has what main NT?

A

Substance P

123
Q

Peripheral Pathway of CINV originates in the GI Tract and has what main NT?

A

serotonin 5HT

124
Q

ACUTE CINV is related to what?

A

Serotonin

125
Q

Delayed CINV is related to what?

A

Substance P

126
Q

What chemotherapeutic agent is known to caused Delayed CINV?

A

Cisplatin

127
Q

Ondansetron is a 5HT3 Receptor Antagonist, used for Acute CINV, what are the warnings?

A
  1. Serotonin Syndrome
  2. OTc Prolongation
128
Q

What is the HEM/MEC Dosing of Ondansetron?

A

16-24 mg PO or 8-16 mg once on day 1

129
Q

What is the Low Emetic Risk Dosing of Ondansetron?

A

8-16 mg PO once on day 1

130
Q

What is the HEM/MEC Dosing of Granisetron?

A
  1. 2mg PO once on day 1
  2. 3.1 mg/24 hr transdermal patch 24-28 hours prior to 1st dose of chemotherapy
131
Q

What is the Low Emetic Risk Dosing of Granisetron?

A

1-2 mg PO once on day 1

132
Q

What is the HEC/MEC Dosing for Palonosetron?

A

0.25 mg IV once on day 1, IV ONLY

133
Q

What generation of 5HT3 Antagonists is better for preventing Delayed CINV?

A

2nd generation (Palonosetron)

134
Q

What is the MOA of Neurokinin I (NK-1) Receptor Antagonists?

A
  1. Prevent acute and delayed by inhibiting the binding of substance P
135
Q

For NK-1 Receptor Antagonists what is it recommended to be used in combination with for HEC/MEC?

A

Dexamethasone +/- Olanzapine

136
Q

What is the dosing for Aprepitant Emend PO?

A

125 mg PO once on day 1

137
Q

What is the dosing for Aprepitant Cinvanti IV?

A

130 mg IV once on day 1

138
Q

Aprepitant increases plasma concentrations of Dexamethasone, what must be done?

A

Decrease dexamethasone dose by 50%

139
Q

What is the dosing for Prochlorperazine, commonly used for breakthrough CINV?

A

10 mg Q6hrs prn

140
Q

What is the dosing for Olanzapine, used for breakthrough and refractory CINV? As effective as NK-1 Antagonists for prevention of CINV

A

5-10 mg PO once on day 1

141
Q

What is the most common side effect of Olanzapine?

A

Sedation

142
Q

What drug has a 12 week limit on its therapeutic use?

A

Metoclopramide

143
Q

What is the dosing for Dexamethasone?

A

12 mg PO or IV once on day 1

144
Q

What is the max dose of Dexamethasone when given with Aprepitant/Dosaprepitant or Netupitant?

A

12 mg

145
Q

What is adjunct therapy or used for prevention of anticipatory N/V?

A

Benzos aka Lorazepam

146
Q

High CINV Drug Regimen Options

A
  1. 4-3-3 drug regimen Day One
  2. 3 options Day Two-Four
147
Q

Moderate CINV Drug Regimen Options

A
  1. 2-2-3 drug regimen Day One
  2. 3 options Day Two-Three
148
Q

Low CINV Drug Regimen Options

A
  1. ONE Drug (dexamethasone)
149
Q

What drugs are used for High Emetic Chemotherapy CINV?

A

5HT3 + NK + Dex +/- Olanzapine

150
Q

What drugs are used for Moderate Emetic Chemotherapy CINV?

A

5HT3 + Dex +/- NK or
Palonosetron + Dex + Olanzapine

151
Q

What drugs are used for Low Emetic Chemotherapy CINV?

A

NO NK
ONE Agent: 5HT3, Olanzapine, or Prochlorperazine

152
Q

Serious Illness Definition

A

Health Condition that carries high mortality AND
1. Negatively impacts function OR
2. Excessively strains their caregiver

153
Q

Define Total Pain

A

Suffering that encompasses all of a person’s physical, psychological, social, spiritual, and practical struggles

154
Q

List the 4 different types of pain that occur in cancer patients

A
  1. Pain associated with tumor
  2. Pain associated with treatment
  3. Pain unrelated to either
  4. Acute vs Chronic pain
155
Q

Nocicpeitve Pain has what two categories and how are they described?

A
  1. Somatic: sharp, well localized, throbbing, pressure
  2. Visceral: diffuse, aching, and cramping
156
Q

Define Nociceptive Pain

A

Injury to somatic and visceral structures

157
Q

Define Neuropathic Pain

A

Injury to peripheral or central nervous system
-Burning, sharp, or shooting
-AE of chemotherapy

158
Q

What are the Goals of Pain Management: 5 A’s

A
  1. Analgesia
  2. Activities
  3. Adverse Effects
  4. Aberrant Drug Taking
  5. Affect
159
Q

What are the etiologies of pain?

A
  1. Nociceptive
  2. Neuropathic
  3. Affective
  4. Behavioral/Cognitive
160
Q

What classifies a patient as Opioid Tolerant?

A
  1. At least 25 mcg/hr fentanyl patch
  2. 60 mg morphine daily
  3. 30 mg PO oxycodone daily
    4, 8 mg PO hydromorphone daily
    ALL for a week or longer
161
Q

Mild Pain, Opioid Naive

A

1st non-opioids + adjunct therapy

162
Q

Mild Pain, Opioid Tolerant

A

Non-opioid + adjuvant + re-evaluate opioid

163
Q

Moderate/Severe Pain, Opioid Naive

A

Non-opioid + adjuvant + short acting opioid as needed

164
Q

Moderate/Severe Pain, Opioid Tolerant

A

Non-opioid + adjuvant + short acting opioid + titration + consider long acting

165
Q

What medications can be used for Oral Mucositis?

A
  1. Gabapentin
  2. Local Anesthetics/Oral Care
166
Q

What medications can be used for Bone Pain w/o Oncologic Emergency?

A
  1. NSAIDs
  2. APAP
  3. Steroids
  4. Bisphosphonates
167
Q

What medications can be used for Nerve Pain?

A
  1. SNRIs
  2. Gabapentin
  3. Pregablin
168
Q

NSAIDs and APAP may mask what in Neutropenic Patients?

A

Fevers, could consider Celebrex instead

169
Q

What medication can be used for Chemotherapy Induced Peripheral Neuropathy?

A

Duloxetine 30 mg PO QD x 1 week, then increased to 60 mg PO QD

170
Q

When adding on Maintenance Opioid Therapy, what is the dosing of the long acting formulation?

A

50-100% of total short acting dose
Short acting is now 10-10% of the total dose

171
Q

What are the 4 Reasons for Changing Opioids during Reassessment?

A
  1. Lack of therapeutic response
  2. Change in patient status
  3. Development of adverse effects
  4. Other considerations
172
Q

Oral Morphine to Oral Oxycodone

A

Morphine 24 — Oxycodone 20

173
Q

Tramadol in Cancer

A

Binds mu opioid receptors weakly
Prodrug
Not as helpful in cancer pain

174
Q

Morphine in Cancer

A
  1. Gold standard for opioid analgesic for pain and compairson
  2. ITCHING
  3. AVOID in AKI/renal failure
175
Q

Hydrocodone in Cancer

A
  1. Hydrocodone 1:1 equivalent with morphine
  2. APAP limits use
176
Q

Oxycodone in Cancer

A
  1. Interchangeable with morphine in the front line treatment of cancer related pain
  2. Can open capsules
  3. Must be taken with food high fat in order to ensure consistent plasma levels
177
Q

What is the Conversion from OME to Fentanyl?

A

1 mcg/hr:2 total oral morphine equivalents

178
Q

Methadone for Cancer

A
  1. Require 2.4 doses of methadone per day to achieve good pain control
  2. Avoid in liver injury
179
Q

In renal failure, avoid morphine and consider what agents?

A
  1. Methadone
  2. Fentanyl
180
Q

In liver failure, avoid methadone and consider what agents?

A

Hydromorphone

181
Q

What is the tapering approach of opioids?

A

5-20% reduction of total daily dose every 4 wks

182
Q

What are the Stimulant Laxatives?

A
  1. Bisacodyl
  2. Senna
183
Q

What are the Osmotic Laxatives?

A
  1. PEG
  2. Lactulose
  3. Magnesium Citrate
184
Q

In Opioid Induced Constipation, first line agents are what?

A

Laxatives

185
Q

What type of therapy is contraindicated for Neutropenic or Thrombocytopenia patients?

A

Renal Suppositories or Enemas

186
Q

What are the Non-Pharmacologic Management options for Dyspnea?

A
  1. Fan
  2. Reposition
  3. Pulmonary Rehab
  4. Supplemental Oxygen
187
Q

What are the first line agents for Refractory Dyspnea?

A

Opioids

188
Q

For patients experiencing Dyspnea and Related Anxiety what medication can be used?

A

Benzo aka Lorazepam

189
Q

In Excessive Excretions of Dyspnea, what medications can be used?

A
  1. Scopolamine
  2. Atropine
  3. Hyoscyamine
  4. Glycopyrrolate: does not cross BBB
190
Q

What medication is used for early satiety in Anorexia/Cachexia patients?

A

Metoclopramide

191
Q

What medications are an appetite stimulant used in Anorexia/Cachexia patients?

A
  1. Megestrol Acetate: high risk of death
  2. Dexamethasone
  3. Olanzapine: insomnia/anxiety/nausea
  4. Mirtazapine: insomnia
192
Q

What is a non Rx used for fatigue related to cancer?

A

American Ginseng

193
Q

What Pyschostimulants are used for fatigue related to cancer?

A
  1. Methylphenidate
  2. Modafinil
194
Q

What medications can be used for Resless Leg Syndrome

A
  1. Ropinirole
  2. Pramipexole/Pregablin
  3. Carbidopa/Levodopa
195
Q

Shorting Acting Benzo Lorazepam is used for refractory insomnia first line, what is the 2nd line therapy option?

A

Zolpidem

196
Q

Palliative Care Points

A
  1. Begins at time of disease and given alongside treatment
  2. Should be provided fro all patients with chronic and serious illness
  3. Specialist palliative care for complex situations
197
Q

Hospice Care Points

A
  1. Begins after treatment of the disease is stopped
  2. Reserved for patients with lifespan <6 months
  3. Provided by hospice clinicians
198
Q

What are the 3 general Advance Directives?

A
  1. Health Care Agent (POA)
  2. Living Will
  3. POLST: portable document of provider medical orders
199
Q

Signs of Dying

A
  1. 1-3 months prior to death: decreased food intake
  2. 1-3 weeks prior to death: talking with unseen
200
Q

Describe the Death Rattle

A
  1. Terminal respiratory secretions
  2. Mucus and Saliva build up in the patients’ throat
  3. Patient’s can lose ability to clear throat: wet, rattling sound as breath through secretions

Hem/Onc Module (5 decks)

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