Lecture 5

Question 1

Why are we talking about AINV?

Answer 1

difficulat , stress, panic, loss of adherene and dehydration, fatigue, anorexia

Question 2

What is the MOA behind AINV ?

Answer 2

GI are irritated and send message to the vagal afferent

activated CTZ outside of the BBB

Question 3

What is the main NT for AINV ?

Answer 3

serotonin and dopamine

Question 4

What are the diff types if AINV ?

Answer 4

acute, delayed, breakthrough, anticipatory, refractory

Question 5

Which combo of antineoplstic agents that is HEC ?

Answer 5

anthracyclines (rubicin) + cyclophosphamide

Question 6

Name a HEC IV anticancer drugs ?

Answer 6

anthracyclines (rubicin) + cyclophosphamide, cisplatin, dacarbazine

Question 7

Name a MEC IV anticancer drugs ?

Answer 7

oxaliplatin, carboplatin, individual anthracycline, cyclophosphamide

Question 8

What is a LEC IV anticancer drugs ?

Answer 8

Taxanes, 5FU, etoposide

Question 9

Name a HEC oral drug ?

Answer 9

procarbazine

Question 10

name MEC oral drug?

Answer 10

cyclophosphamide, crizotinib

Question 11

name is LEC oral drug ?

Answer 11

MTX

Question 12

What are the risks factors of more AINV ?

Answer 12

women, morning sickness, motion sickness, previous history, pediatrics

Question 13

What are the factors for low AINV ?

Answer 13

alcoholism, elder >50yo

Question 14

What are the prophylaxis tx for acute/delayed AINV ?

Answer 14

5HT3 antagonist –> ondansetron
NK1 antagonist –> aprepitant
Dexamethasone
Olanzapine

Question 15

What is the MAX dose of olanzapine for AINV ?

Answer 15

10mg / day
** careful with Breakthrough dosing

Question 16

NK1 works best with _____ for AINV ?

Answer 16

5HT3 or dexa

Question 17

What is NEPA?

Answer 17

netupitant ( NK1i) + palonesetron (5HT3i)

Question 18

What are the SE of palonosetron

Answer 18

QTc and constipation

Question 19

What are the SE of olanzapine ?

Answer 19

EPS , orthostatic hypotension

Question 20

What are the SE of aprepitant ?

Answer 20

well tolerated, headacheW

Question 21

What are the SE of dexamethasone ?

Answer 21

Sleep, hunger, mood changes, dyspepsia, hyperglycemia

Question 22

how many drugs do you need for HEC IV AINV ?

Answer 22

3 to 4 drugs

Question 23

If a pt is taking carboplatin or oxaplatin , what is the AINV tx ?

Answer 23

2 drugs + NK1 inhibitor

Question 24

What is the regimen for ORAL HEC ?

Answer 24

5HT3 + dexa ( depends on 5Ht3 dose)

Question 25

What are the caution with prochlorperazine ?

Answer 25

fall risk with olanzapine and anticholinergics CNS depressant, reduce seizures --> with olanzapine

Question 26

What is the DDI with metoclopramide ?

Answer 26

risk of EPS with olanzapine, procholorperazine

Question 27

What are the NON-PHARM for AINV ?

Answer 27

eat smaller and more frequent drink 30 minutes before food, avoid triggers

Question 28

What is the pharm for anticipatory ?

Answer 28

anxiolytic --> lorazeapam

Question 29

What is the pharm for refractory ?

Answer 29

escalate the prophylaxis cannibinoids haloperidol Scopolamine H2 antagonist --> if GERD related

Question 30

When could you consider cannibinoids ?

Answer 30

Breakthrough, refractory

Question 31

What are the consideration for cannibinoids for AINV ?

Answer 31

fall risk avoid smoking --> risk of infection stimulates appetite euphoria, dizziness, hypotension, tachycardia

Question 32

How long should a pt be on ondansetron for AINV and why ?

Answer 32

1-3 days due to QTc prolongation

Question 33

Which of the 5HT3 has the lowest QTc risk ?

Answer 33

palonosetron

Question 34

What is the worry behind aprepitant PK/PD?

Answer 34

reduce the efficacy of oral contraceptive 3A4 ( inducer or inhibitor) 2C9 inducer reduce dose with dexa

Question 35

Which med has a reduced dose when with dexa ?

Answer 35

aprepitant

Question 36

What are the key AE stages for anticancer drugs ?

Answer 36

Stage 1 - mild and no need of intervention Stage 4 - life threatning and urgent intervention Grade 5 - Death !

Question 37

Why shouldn't pts use petroleum based lipbalm for dry and cracked lips ?

Answer 37

does not promote healing

Question 38

What are the cause of mucositis ?

Answer 38

chemo radiotherapy m Hematopoietic Sten cells transplantation

Question 39

What are the risks factors of mucositis?

Answer 39

Dry mouth --> use artificial salivary replacement oral health --> denture, bad oral hyginene and peridontal disease Dehydration, alcohol, smoking )2 therapy

Question 40

Why is mucositis such a big deal ?

Answer 40

affects the tx regiment , infection and painful

Question 41

What is the diff in CTCAE stage 2-3 for mucositis ?

Answer 41

Stage 3 - interfers in the oral intake

Question 42

How can we prevent mucositis ?

Answer 42

Good oral hygiene ( soft toothbrush, foss, chlorhexidine) NS saline , club soda, sodium bicarbonate *had head, neck radiation --> high fluoride content Cyrotherapy

Question 43

You would not recommed cryotherapy for pts on _____ ?

Answer 43

Oxaliplatin

Question 44

What should a patient avoid to prevent mucositis ?

Answer 44

alcohol , acidic, extremely hot/cold, poor fitted dentures, caffeine, tobacco

Question 45

What is the Tx for Grade 1-2 mucositis ?

Answer 45

prevention regular rinses pain contol ( analegics topica or oral) monitor for infection/ bleeding

Question 46

What are the tx for grade 2-3 mucositis ?

Answer 46

oral sponge to clean mouth Pink Ladies Akabutus outhwash

Question 47

What is inside Dr. akabutus mouthwash ?

Answer 47

Compounded: nystatin, lidocaine, sodium, hydrocortisone, glycerin

Question 48

Why are ppl not to sure of the efficacy of Dr. Akabutus mouthwash ?

Answer 48

efficacy not better than NS expensive shorten the healing time CS can cause thrusg

Question 49

IF a mouthwash contains opioids orl idocaine mouthwash, pt should____ ?

Answer 49

Always SPIT never swallow (high levels of morphine) Be careful to not bite the tongue on lidocaine

Question 50

What are the additional Tx for severe mucositis ( 3-4) ?

Answer 50

local pain control ( topical opioid mouthwash with Lidocaine, tetracaine) Pain control (opioids) Dexamethasone Doxepin

Question 51

What is a examples of drugs that can cause PPE, hand/Foot syndrome (classical, others) ?

Answer 51

Classic : capecitabine 5FU Taxane Sorafenib Cytarabine

Question 52

What are the risks factors for PPE/ hand and foot syndrome ?

Answer 52

>65 yo female friction ( labour, exercise) heat excessive alcohol use

Question 53

Prevention for hand/foot syndrome ?

Answer 53

Skin care and hygiene avoid heat, friction wear good shoes and not barefoot avoid chemical care, harsh activities

Question 54

What is the main ingredient for gentle creams for PPE ?

Answer 54

emollients

Question 55

What is the first symptoms of PPE ?

Answer 55

tingle and numbness others : peeling, redness, blister, edema, bleeding

Question 56

How do we manage PPE ?

Answer 56

pain :analgesics, topial CS, cool packs ( ** avoid with oxaliplain) Emolients wound care

Question 57

Which drugs commonly cause alopecia ?

Answer 57

cyclophosphamide, anthracyclines, taxanes, etoposide

Question 58

Which chemotherapy agents are commonly associated with hypersensitivity and infusion reactions?

Answer 58

Common agents include taxanes (paclitaxel, docetaxel), platinums (cisplatin, carboplatin, oxaliplatin), bleomycin, and monoclonal antibodies like rituximab.

Question 59

Which cancer-related medications commonly cause constipation?

Answer 59

Common medications associated with constipation include vinca alkaloids (vincristine, vinblastine), 5-HT3 antagonists (ondansetron, granisetron), and opioids.

Question 60

What causes chemotherapy-induced alopecia?

Answer 60

Common agents include cyclophosphamide, anthracyclines, taxanes (paclitaxel, docetaxel), and etoposide.

Question 61

What are the symptoms of hypersensitivity and infusion reactions?

Answer 61

Symptoms can be local (e.g., rash, urticaria, phlebitis) or systemic (e.g., dyspnea, bronchospasm, chest discomfort, fever, hypotension, tachycardia, angioedema).