module 11 oncology supportive care

Question 1

CINV

Answer 1

Easier to prevent than treat
treatment chose by:
- emetogenic potential of chemo regimen
- risk of delayed N/V

Question 2

minimal emetogenic risk

Answer 2

no prophylaxis necessary

Question 3

low emetogenic risk

Answer 3

dexamethasone
or
1st gen 5HT3 antagonist

Question 4

moderate emetogenic risk

Answer 4

dexamethasone + 5TH3 antagonist

- if pt developes severe emesis after pervious cycle add NK1 antagonist

Question 5

severe emetogenic risk

Answer 5

NK1 antagonist + 5HT3 antagonist + dexamethasone

Question 6

Rx for anticipatory NV

Answer 6

benzodiapepines

Question 7

colony stimulating factors

Answer 7

cytotoxic chemo -> bone marrow suppression -> dec. WBC (particularly neutrophils)
Granulocyte-colony stimulating factors: help to prevent and/or treat neutropenia

Question 8

anticoagulation

Answer 8

cancer produces hypercoagulabe state in pt

- LMWH is gold standard

Question 9

hypercalcemia tx

Answer 9

1. hydration
2. IV bisphosphonates or denosumab
3. calcitonin
4. dialysis

Question 10

calcitonin

Answer 10

IV: works quickly to lower Ca levels

- tachyphylaxis after about 8 doses: tolerance

Question 11

Bisphosphonates and denosumab

Answer 11

effecting at lowering Ca levels

- takes several days to see an effect

Question 12

tumor lysis syndrome

Answer 12

certain tumors have high tumor burden
- chemo kills the cells, spilling contents into blood stream: 
-- uric acid
-- phosphorus
-- potassium 
Accumulation: 
- arrhythmia
- organ failure, renal

Question 13

tumor lysis syndrome tx

Answer 13

easier to prevent than tx

1. hyperhydration
   - u/o of 100-200 ml/hr
2. lower uric acid levels
   - allopurinol
   - rasburicase

Question 14

G-CSF med

Answer 14

filgrastim

pegfilgrastim

Question 15

GM-CSF med

Answer 15

sargramostim

Question 16

filgrastim/pegfilgrastem effector cell

Answer 16

neutrophil

Question 17

filgrastim AE

Answer 17

bone pain

Question 18

filgrastim EDU

Answer 18

begin 1-3 days after chemo

Question 19

pegfilgrastim EDU

Answer 19

self mediated clearance via neutrophils
once per cycle dosing
administer 1-3 days after chemo

Question 20

sargramostim effector cell

Answer 20

neutrophil
eosinophil
macrophage

Question 21

sargramostim AE

Answer 21

first dose: 
- hypoTN
- flushing
low-grade fever
bone pain
injection site skin reaction

Question 22

sargramostim use

Answer 22

after induction of chemo in older patients with AML

Question 23

sargramostim EDU

Answer 23

limited exerience

lack of FDA approval for febrile neutropenia