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PHARM 444 : Neurology/Oncology > Lecture 5 > Flashcards

Lecture 5 Flashcards

AINV

1
Q

Why are we talking about AINV?

A

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

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2
Q

What is the MOA behind AINV ?

A

GI are irritated and send message to the vagal afferent

activated CTZ outside of the BBB

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3
Q

What is the main NT for AINV ?

A

serotonin and dopamine

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4
Q

What are the diff types if AINV ?

A

acute, delayed, breakthrough, anticipatory, refractory

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5
Q

Which combo of antineoplstic agents that is HEC ?

A

anthracyclines (rubicin) + cyclophosphamide

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6
Q

Name a HEC IV anticancer drugs ?

A

anthracyclines (rubicin) + cyclophosphamide, cisplatin, dacarbazine

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7
Q

Name a MEC IV anticancer drugs ?

A

oxaliplatin, carboplatin, individual anthracycline, cyclophosphamide

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8
Q

What is a LEC IV anticancer drugs ?

A

Taxanes, 5FU, etoposide

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9
Q

Name a HEC oral drug ?

A

procarbazine

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10
Q

name MEC oral drug?

A

cyclophosphamide, crizotinib

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11
Q

name is LEC oral drug ?

A

MTX

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12
Q

What are the risks factors of more AINV ?

A

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

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13
Q

What are the factors for low AINV ?

A

alcoholism, elder >50yo

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14
Q

What are the prophylaxis tx for acute/delayed AINV ?

A

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

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15
Q

What is the MAX dose of olanzapine for AINV ?

A

10mg / day
** careful with Breakthrough dosing

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16
Q

NK1 works best with _____ for AINV ?

A

5HT3 or dexa

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17
Q

What is NEPA?

A

netupitant ( NK1i) + palonesetron (5HT3i)

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18
Q

What are the SE of palonosetron

A

QTc and constipation

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19
Q

What are the SE of olanzapine ?

A

EPS , orthostatic hypotension

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20
Q

What are the SE of aprepitant ?

A

well tolerated, headacheW

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21
Q

What are the SE of dexamethasone ?

A

Sleep, hunger, mood changes, dyspepsia, hyperglycemia

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22
Q

how many drugs do you need for HEC IV AINV ?

A

3 to 4 drugs

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23
Q

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

A

2 drugs + NK1 inhibitor

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24
Q

What is the regimen for ORAL HEC ?

A

5HT3 + dexa ( depends on 5Ht3 dose)

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25
Q

What are the caution with prochlorperazine ?

A

fall risk with olanzapine and anticholinergics

CNS depressant, reduce seizures –> with olanzapine

26
Q

What is the DDI with metoclopramide ?

A

risk of EPS with olanzapine, procholorperazine

27
Q

What are the NON-PHARM for AINV ?

A

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

28
Q

What is the pharm for anticipatory ?

A

anxiolytic –> lorazeapam

29
Q

What is the pharm for refractory ?

A

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

30
Q

When could you consider cannibinoids ?

A

Breakthrough, refractory

31
Q

What are the consideration for cannibinoids for AINV ?

A

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

32
Q

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

A

1-3 days due to QTc prolongation

33
Q

Which of the 5HT3 has the lowest QTc risk ?

A

palonosetron

34
Q

What is the worry behind aprepitant PK/PD?

A

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

35
Q

Which med has a reduced dose when with dexa ?

A

aprepitant

36
Q

What are the key AE stages for anticancer drugs ?

A

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

37
Q

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

A

does not promote healing

38
Q

What are the cause of mucositis ?

A

chemo
radiotherapy m
Hematopoietic Sten cells transplantation

39
Q

What are the risks factors of mucositis?

A

Dry mouth –> use artificial salivary replacement

oral health –> denture, bad oral hyginene and peridontal disease

Dehydration, alcohol, smoking
)2 therapy

40
Q

Why is mucositis such a big deal ?

A

affects the tx regiment , infection and painful

41
Q

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

A

Stage 3 - interfers in the oral intake

42
Q

How can we prevent mucositis ?

A

Good oral hygiene ( soft toothbrush, foss, chlorhexidine)

NS saline , club soda, sodium bicarbonate

*had head, neck radiation –> high fluoride content

Cyrotherapy

43
Q

You would not recommed cryotherapy for pts on _____ ?

A

Oxaliplatin

44
Q

What should a patient avoid to prevent mucositis ?

A

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

45
Q

What is the Tx for Grade 1-2 mucositis ?

A

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

46
Q

What are the tx for grade 2-3 mucositis ?

A

oral sponge to clean mouth
Pink Ladies
Akabutus outhwash

47
Q

What is inside Dr. akabutus mouthwash ?

A

Compounded: nystatin, lidocaine, sodium, hydrocortisone, glycerin

48
Q

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

A

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

49
Q

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

A

Always SPIT never swallow
(high levels of morphine)

Be careful to not bite the tongue on lidocaine

50
Q

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

A

local pain control ( topical opioid mouthwash with Lidocaine, tetracaine)

Pain control (opioids)

Dexamethasone

Doxepin

51
Q

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

A

Classic : capecitabine
5FU
Taxane
Sorafenib
Cytarabine

52
Q

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

A

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

53
Q

Prevention for hand/foot syndrome ?

A

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

54
Q

What is the main ingredient for gentle creams for PPE ?

A

emollients

55
Q

What is the first symptoms of PPE ?

A

tingle and numbness

others : peeling, redness, blister, edema, bleeding

56
Q

How do we manage PPE ?

A

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

Emolients

wound care

57
Q

Which drugs commonly cause alopecia ?

A

cyclophosphamide, anthracyclines, taxanes, etoposide

58
Q

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

A

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

59
Q

Which cancer-related medications commonly cause constipation?

A

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

60
Q

What causes chemotherapy-induced alopecia?

A

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

61
Q

What are the symptoms of hypersensitivity and infusion reactions?

A

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

PHARM 444 : Neurology/Oncology (10 decks)

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