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Heme/Onc > GI toxicities > Flashcards

GI toxicities Flashcards

1
Q

What is mucositis?

A

Inflammatory, ulcerative lesions of the oral and/or GI tract

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2
Q

What is the cell turnover for the GI tract?

A

7-10 days

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3
Q

What is the incidence of mucositis in HD chemotherapy and HSCT?

A

100%

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4
Q

What are the sx of mucositis?

A

Pain
Ab bloating
NVD
Constipation

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5
Q

What drugs cause mucositis?

A 
Anthracyclines
Bleomycin
Cyclophosphamide
Taxanes
Vinca alkaloids
5-FU
Capecitabine
Cytarabine
Gemicitabine
Hydroxyurea
MTX
Pemetrexed
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6
Q

What are the consequences of mucositis?

A 
Delayed therapy
Reduction in chemo intensity
Increased hospital stays
Poor nutrition status
Increased risk of infection
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7
Q

What are the WHO grade scale for oral mucositis?

A 
Grade 0: no oral mucositis
Grade 1: Erythema and soreness
Grade 2: Ulcers, able to eat solids
Grade 3: Ulcers, requires liquid diet
Grade 4: Ulcers, unable to eat anything
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8
Q

What is the prevention of cystitis?

A 
Oral hygiene
Oral cryotherapy
Oral zinc supplementation
Treat dental issues
Nutrition and hydration
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9
Q

What is used for sx control of mucositis?

A 
Magic mouthwash
Pain control (opioids/PCA)
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10
Q

What is treatment of mucositis?

A

Palifermin

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11
Q

What is palifermin?

A

Keratinocyte growth factor

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12
Q

How does palifermin work?

A

Promotes epithelial cell proliferation, differentiation and migration

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13
Q

What are AEs of palifermin?

A

Rash
Edema
Taste disturbances
Arthralgias

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14
Q

What is xerostomia?

A

Dry mouth

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15
Q

What is amifostine used for?

A

Xerostomia in radiation of the head and neck

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16
Q

What disease does amifostine reduce?

A

Esophagitis with chemo+radiation for NSCLC

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17
Q

What drugs cause diarrhea?

A 
Irinotecan
5-FU/capecitabine
Cytarabine
MTX
TKI
Anti-EGFR therapy
HD conditioning regimens for SCT
18
Q

What grade is classified as uncomplicated diarrhea?

A

Grades 1-2 w/no added RFs

19
Q

How many stools per day are in grades 1-2?

A

<4-6 per day

20
Q

What grade is classified as complicated diarrhea?

A

Grade 3-4 or Grade 1-2 w/presence of any added RF

21
Q

What are added RFs for diarrhea?

A 
Mod-severe cramping
Sepsis
Grade 2+ N/V
Neutropenia
Decreased performance status
Blood in stool
Fever
Dehydration
22
Q

Where is uncomplicated diarrhea treated?

A

Outpatient

23
Q

What are ways to manage uncomplicated diarrhea?

A 
D/C lactose-containing products and EtOH
Increase fluid intake (8-10 large glasses of clear liquid/day)
Small, frequent meals
BRAT diet
Lactobacillus for prevention
Loperamide
24
Q

If a patient has grade 2 diarrhea after chemo, what do we do?

A

Hold chemo until sx resolve and reduce dose w/next cycle

25
Q

What is the loperamide dose?

A

4mg, then 2mg every 4 hours

26
Q

What is the max daily dose of loperamide?

A

16mg/d (exception: irinotecan)

27
Q

When do we DC loperamide?

A

Diarrhea free for at least 12 hours

Diarrhea persists for more than 48 hours

28
Q

What is a 2nd line anti-diarrheal agent?

A

Octreotide
Diphenoxylate/atropine
Tincture of opium

29
Q

How do we adjust dose of loperamide if diarrhea persists for at least 24 hours?

A

Increase dose to 2mg every 2 hours

30
Q

Where do we treat complicated diarrhea?

A

Hospital admission

31
Q

What are the treatments of complicated diarrhea?

A

IV fluids, electrolyte replacement
Octreotide
Further work-up
ABX

32
Q

How do we work-up complicated diarrhea?

A

CBC
Electrolytes
Stool: blood, C diff, other infections

33
Q

When does early onset diarrhea start with irinotecan administration?

A

During treatment or w/in 2-6 hours after administration

34
Q

What is the mechanism of early onset irinotecan induced diarrhea?

A

Reversible cholinesterase inhibition

35
Q

What are the effects of irinotecan?

A 
Lacrimation
Diaphoresis
Ab cramping
Flushing 
Diarrhea
36
Q

What drug is used to treat irinotecan induced diarrhea?

A

Atropine 0.25-1 mg IV/SC

37
Q

When does late onset diarrhea start with irinotecan administration?

A

1-12 days after administration

38
Q

How long can late onset diarrhea last with irinotecan induced diarrhea?

A

2-5 days; potentially fatal

39
Q

What is the mechanism of late onset irinotecan induced diarrhea?

A

Direct toxicity from irinotecan and SN-38

Genetic polymorphism in UGT1A1 enzyme, responsible for inactivating SN-38 via glucoronidation

40
Q

What is the treatment of late onset irinotecan induced diarrhea?

A

HD loperamide: 4mg, then 2mg every 2 hours

No max dose

Heme/Onc (20 decks)

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