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CDM 4 Exam 3 > Lecture 6 - Cancer 2 > Flashcards

Lecture 6 - Cancer 2 Flashcards

1
Q

Risk factors for CINV

A

Chemotherapy = each drug has different risk
Age (younger)
Gender (females)
Alcohol use (inc use = less CINV)
Prior emetic experiences
Motion sickness/morning sickness

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2
Q

Highly Emetogenic Chemotherapy Drugs IV (> 90%)

A

AC- an anthraycline + cyclophosphamide
Cisplatin
Doxorubicing > 60mg/m2

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3
Q

Moderately Emetogenic Chemotherapy drugs IV (30-90%)

A

Azacytidine
Dual liposomal cytarabine + Daunorubicin
Irinotecan
oxaliplatin
Fam-trastuzumab deruxtecan-nxki

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4
Q

Low Emetogenic Chemotherapy drugs IV (10-30%)

A

5-Fluorouracil
Gemcitabine
Paclitaxel
Brentuxumab vedotin
Docetaxel

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5
Q

Minimal Emetic Potential Chemotherapy drugs IV (< 10%)

A

Bevacizumab
Bortezomib
Daratumumab
Nivolumab
Pembrolizumab
Rituximab

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6
Q

Moderate- high risk PO Chemo drugs (> 30%)

A

olaparib
Imatinib > 400mg/day
Temozolamide > 75mg/m2/day

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7
Q

Acute CINV

A

occurs < 24hrs after chemo
5HT3 antagonists = best option

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8
Q

Delayed CINV

A

occurs > 24hrs of receiving chemo
NK-1 inhibitors = best option

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9
Q

Anticipatory CINV

A

occurs as part of reflex response, triggered
Benzo = best option

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10
Q

Breakthrough CINV

A

occurs despite prophylaxis measures
Dopamine antagonists = best option

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11
Q

Ondansetron info

A

Serotonin Antagonist
Oral n IV
Most common

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12
Q

Granisetron info

A

Serotonin Antagonist
Less QTc risk than others
Oral/IV/SubQ/Transdermal

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13
Q

Palonosetreon info

A

Serotonin Antagonist
IV/Oral
Long acting, 30-40 T1/2,
Used delayed CINV

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14
Q

Palonosetreon info

A

Serotonin Antagonist
IV/Oral
Long acting, 30-40 T1/2,
Used delayed CINV

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15
Q

Clinical Pearls 5HT3 Antagonists

A

1st gen equally effective at recommended doses
Plateau effect
Activity improved by co-admin w/ corticosteroid
PO = IV efficacy
Single dose = equiv to multiple
More effective for N than V

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16
Q

Adverse effects n warnings 5HT3 Antagonists

A

Headache
ECG changes
QTc prolong
constipation

usually with repetitive dosing, not one time doses

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17
Q

Dose limit on IV ondansetron?

A

16mg due to QTc

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18
Q

Aprepitant info

A

NK1 inhibitor
Capsules n suspension n injectable emulsion

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19
Q

Fosaprepitant info

A

NK1 inhibitor
single dose vials

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20
Q

Rolapitant info

A

NK1 inhibitor
tablets & injectable emulsion
given once every 2 weeks
Not a 3A4 inhibitor

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21
Q

Netupitant/palonosetron info

A

NK1 inhibitor
capsules w/ dexamethasone (have to reduce dose)

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22
Q

Fosnetupitant/palonosetron info

A

NK1 inhibitor.
IV injection w/ dexamethasone (have to reduce dose)

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23
Q

NK1 inhibitor clinical pearls

A

most common SE = HA

enhances activity of 5HT3 antagonists and corticosteroids

24
Q

Role in therapy of NK1 inhibitors

A

dont treat CINV, but meant to prevent

25
Dexamethasone info
8-16mg/day generally AE: Insomnia, Hyperglycemia, GI, Hiccups (switch to methylprednisolone)
26
Olanzapine for CINV?
does work, recommend to dose in bedtime and careful due to side effects
27
Benzos are used commonly for....
anticipatory CINV
28
Antiemetic therapy counseling
Keep quiet, calm surroundings Eat small, frequent meals, foods that are easy on stomach choose emetic agent due to chemotherapy usually day 1 is worst day start before chemo, admin on regular schedule n keep breakthrough agents available
29
pts on High Emetic risk (>90%) schedule anti-emetics
Day 1 = acute Day 2-4 = delayed
30
pts on Mod emetic risk (30-90%) schedule anti-emetics
Day 1 = acute Day 2-3 = Delayed
31
pts on Low emetic risk (10-30%) schedule anti-emetics
Day 1 = acute
32
regardless of standard scheduled prophylaxis used, all patients should....
get 1 take-home anti-emetic for breakthrough symptoms
33
Clinical Pearls of Corticosteroids
Dexamethasone used across all regimens n guidelines Caution pts underline DM, olanzapine as alternative if pt suffer delayed CINV longer than day 4, consider prolong dex by few days
34
Antiemetic rec for oral chemo High-moderate emetic risk
use oral drugs such as...Dolasetron, Granisetron, Ondansetron
35
Antiemetic rec for oral chemo Low-miniaml emetic risk
PRN only recommended
36
Severe neutropenia defined as...
ANC < 500 or with predicted decline to < 500 over next 48hrs
37
Febrile neutropenia defined as....
ANC < 500 or with predicted decline to < 500 over next 48hrs + single oral temp > 38.3C or >38C for 1hr
38
General principles to safely admin chemotherapy (WBC/Platelets)
WBC > 3000 OR ANC > 1500 Platelets > or = 100,000
39
Filgrastin info
5mcg/kg/day subQ or short IV infusion 15-30min or by continuous IV
40
Pegfilgrastin info
6mg SubQ once per cycle, start atleast 24hrs after chemo should be atleast 12hrs btwn med and next cycle if chem on days 1 n 15, give peg after each dose if cant return to clinic next day, Neulasta Onpro
41
which neutropenia pts can get primary prophylaxis meds?
>20% risk 10-20% risk = consider n select cases
42
CSF application - Secondary prophylaxis
during pretreatment after previous cycle of chemo caused neutropenic fever
43
CSF application - Afebrile neutropenia
to shorten duration of severe chemotherapy induced neutropenia in pts who have neutropenia without fever
44
CSF admin
admin atleast 24hrs after cytotoxic chemo, dont admin within 24hrs of therapy transient inc in neutrophil count typically 1-2 days after initiation use for up to 2 weeks or >10,000
45
Peg filgrastin admin caveat
dont admin between 14 days before and 24hrs after cytotoxic chemo admin
46
Neulasta Onpro
device attached on chemo day and programed to deliver dose the next day (over 45min ~ 27hrs after chemo dose)
47
Filgrastin n other related stuff ADE
Bone pain = careful with Tylenol to not block fever Allergic reactions Splenic rupture = rare ARDS Pulmonary toxic if using bleomycin-containing regimens
48
Causes of Anemia
Hemorrhage Chemo n Radiation therapy Iron, Folic acid, B12 deficiency Bone marrow involvement Renal dysfunction Anemia of chronic disease
49
Factors influencing incidence of anemia
Type of cancer Stage of disease Duration fo disease Type of therapy Intensity of therapy Prior to therapy
50
Classification of Anemia
Mild < 10 Moderate 8-9.9 severe 6.5-< 8 Life threatening < 6.5
51
Erythropoietin alfa (Poetin) indications
Anemia.... 1. in pts w/ non-myeloid malignancies whose anemia is due to chemo 2. CKD 3. HIV infection pts treated with zidovudine 4. pts scheduled to undergo elective non-cardiac, non-vascular surgery to reduce need for allogeneic transfusions have to have 2 additional months of planned chemo if used myelosuppressive chemo
52
Erythropoietin alfa (Epoetin) dosing
40,000 units/wk SQ or 150 units/kg 3 times per week
53
Darbepoetin alfa info
has ~ 23.6 hr 1/2lfie compared to 8.5 of Epoetin indication: Chronic renal failure, chemo associated anemia in pts w/ non-myeloid malignancies
54
Clinical response to transfusion vs ESA
Transfusion = immediate ESA = Weeks to months ESA beneficial in pts who don't want transfusion, don't have access or RBC supply is limited
55
When to initiate ESA therapy in cancer chemo pts
when Hb < 10 and there is a minimum of 2 additional months of planned chemo admin iron n correct before starting ESA ~ 2 weeks after admin to see inc in Hb

CDM 4 Exam 3 (11 decks)

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