Lecture 5 Flashcards
AINV
Why are we talking about AINV?
difficulat , stress, panic, loss of adherene and dehydration, fatigue, anorexia
What is the MOA behind AINV ?
GI are irritated and send message to the vagal afferent
activated CTZ outside of the BBB
What is the main NT for AINV ?
serotonin and dopamine
What are the diff types if AINV ?
acute, delayed, breakthrough, anticipatory, refractory
Which combo of antineoplstic agents that is HEC ?
anthracyclines (rubicin) + cyclophosphamide
Name a HEC IV anticancer drugs ?
anthracyclines (rubicin) + cyclophosphamide, cisplatin, dacarbazine
Name a MEC IV anticancer drugs ?
oxaliplatin, carboplatin, individual anthracycline, cyclophosphamide
What is a LEC IV anticancer drugs ?
Taxanes, 5FU, etoposide
Name a HEC oral drug ?
procarbazine
name MEC oral drug?
cyclophosphamide, crizotinib
name is LEC oral drug ?
MTX
What are the risks factors of more AINV ?
women, morning sickness, motion sickness, previous history, pediatrics
What are the factors for low AINV ?
alcoholism, elder >50yo
What are the prophylaxis tx for acute/delayed AINV ?
5HT3 antagonist –> ondansetron
NK1 antagonist –> aprepitant
Dexamethasone
Olanzapine
What is the MAX dose of olanzapine for AINV ?
10mg / day
** careful with Breakthrough dosing
NK1 works best with _____ for AINV ?
5HT3 or dexa
What is NEPA?
netupitant ( NK1i) + palonesetron (5HT3i)
What are the SE of palonosetron
QTc and constipation
What are the SE of olanzapine ?
EPS , orthostatic hypotension
What are the SE of aprepitant ?
well tolerated, headacheW
What are the SE of dexamethasone ?
Sleep, hunger, mood changes, dyspepsia, hyperglycemia
how many drugs do you need for HEC IV AINV ?
3 to 4 drugs
If a pt is taking carboplatin or oxaplatin , what is the AINV tx ?
2 drugs + NK1 inhibitor
What is the regimen for ORAL HEC ?
5HT3 + dexa ( depends on 5Ht3 dose)
What are the caution with prochlorperazine ?
fall risk with olanzapine and anticholinergics
CNS depressant, reduce seizures –> with olanzapine
What is the DDI with metoclopramide ?
risk of EPS with olanzapine, procholorperazine
What are the NON-PHARM for AINV ?
eat smaller and more frequent
drink 30 minutes before food, avoid triggers
What is the pharm for anticipatory ?
anxiolytic –> lorazeapam
What is the pharm for refractory ?
escalate the prophylaxis
cannibinoids
haloperidol
Scopolamine
H2 antagonist –> if GERD related
When could you consider cannibinoids ?
Breakthrough, refractory
What are the consideration for cannibinoids for AINV ?
fall risk
avoid smoking –> risk of infection
stimulates appetite
euphoria, dizziness, hypotension, tachycardia
How long should a pt be on ondansetron for AINV and why ?
1-3 days due to QTc prolongation
Which of the 5HT3 has the lowest QTc risk ?
palonosetron
What is the worry behind aprepitant PK/PD?
reduce the efficacy of oral contraceptive
3A4 ( inducer or inhibitor)
2C9 inducer
reduce dose with dexa
Which med has a reduced dose when with dexa ?
aprepitant
What are the key AE stages for anticancer drugs ?
Stage 1 - mild and no need of intervention
Stage 4 - life threatning and urgent intervention
Grade 5 - Death !
Why shouldn’t pts use petroleum based lipbalm for dry and cracked lips ?
does not promote healing
What are the cause of mucositis ?
chemo
radiotherapy m
Hematopoietic Sten cells transplantation
What are the risks factors of mucositis?
Dry mouth –> use artificial salivary replacement
oral health –> denture, bad oral hyginene and peridontal disease
Dehydration, alcohol, smoking
)2 therapy
Why is mucositis such a big deal ?
affects the tx regiment , infection and painful
What is the diff in CTCAE stage 2-3 for mucositis ?
Stage 3 - interfers in the oral intake
How can we prevent mucositis ?
Good oral hygiene ( soft toothbrush, foss, chlorhexidine)
NS saline , club soda, sodium bicarbonate
*had head, neck radiation –> high fluoride content
Cyrotherapy
You would not recommed cryotherapy for pts on _____ ?
Oxaliplatin
What should a patient avoid to prevent mucositis ?
alcohol , acidic, extremely hot/cold, poor fitted dentures, caffeine, tobacco
What is the Tx for Grade 1-2 mucositis ?
prevention
regular rinses
pain contol ( analegics topica or oral)
monitor for infection/ bleeding
What are the tx for grade 2-3 mucositis ?
oral sponge to clean mouth
Pink Ladies
Akabutus outhwash
What is inside Dr. akabutus mouthwash ?
Compounded: nystatin, lidocaine, sodium, hydrocortisone, glycerin
Why are ppl not to sure of the efficacy of Dr. Akabutus mouthwash ?
efficacy not better than NS
expensive
shorten the healing time
CS can cause thrusg
IF a mouthwash contains opioids orl idocaine mouthwash, pt should____ ?
Always SPIT never swallow
(high levels of morphine)
Be careful to not bite the tongue on lidocaine
What are the additional Tx for severe mucositis ( 3-4) ?
local pain control ( topical opioid mouthwash with Lidocaine, tetracaine)
Pain control (opioids)
Dexamethasone
Doxepin
What is a examples of drugs that can cause PPE, hand/Foot syndrome (classical, others) ?
Classic : capecitabine
5FU
Taxane
Sorafenib
Cytarabine
What are the risks factors for PPE/ hand and foot syndrome ?
> 65 yo
female
friction ( labour, exercise)
heat
excessive alcohol use
Prevention for hand/foot syndrome ?
Skin care and hygiene
avoid heat, friction
wear good shoes and not barefoot
avoid chemical care, harsh activities
What is the main ingredient for gentle creams for PPE ?
emollients
What is the first symptoms of PPE ?
tingle and numbness
others : peeling, redness, blister, edema, bleeding
How do we manage PPE ?
pain :analgesics, topial CS, cool packs ( ** avoid with oxaliplain)
Emolients
wound care
Which drugs commonly cause alopecia ?
cyclophosphamide, anthracyclines, taxanes, etoposide
Which chemotherapy agents are commonly associated with hypersensitivity and infusion reactions?
Common agents include taxanes (paclitaxel, docetaxel), platinums (cisplatin, carboplatin, oxaliplatin), bleomycin, and monoclonal antibodies like rituximab.
Which cancer-related medications commonly cause constipation?
Common medications associated with constipation include vinca alkaloids (vincristine, vinblastine), 5-HT3 antagonists (ondansetron, granisetron), and opioids.
What causes chemotherapy-induced alopecia?
Common agents include cyclophosphamide, anthracyclines, taxanes (paclitaxel, docetaxel), and etoposide.
What are the symptoms of hypersensitivity and infusion reactions?
Symptoms can be local (e.g., rash, urticaria, phlebitis) or systemic (e.g., dyspnea, bronchospasm, chest discomfort, fever, hypotension, tachycardia, angioedema).
