Onc Emergencies & Hematology Flashcards
1
Q
what is elevated in tumor lysis syndrome?
A
K, uric acid, phosphate
2
Q
what is low in tumor lysis syndrome
A
calcium
3
Q
which type of malignancy is more commonly associated with tumor lysis syndrome
A
hematologic
4
Q
what is started for high risk tumor lysis syndrome to address uric acid
A
hydration, allopurinol, rasburicase
5
Q
what is started for intermediate risk tumor lysis syndrome to address uric acid
A
hydration, allopurinol +/- rasburicase
6
Q
what is started for low risk tumor lysis syndrometo address uric acid
A
hydration, monitor
7
Q
when is allopurinol started for tumor lysis syndrome?
any dose adjustments
A
24 hours before chemo
NO RENAL ADJUSTMENT
8
Q
caution of raburicase use in what deficiency
A
G6PD
9
Q
which dosing method is better for rasburicase
A
flat dosing more cost effective
10
Q
5 options for hyperkalemia in tumor lysis syndrome
A
loop, calcium chloride/gluconate, R insulin, sodium bicarb, sodium polystyrene
11
Q
3 main methods for hyperphosphatemia treatment
A
hydration, decrease diet intake, phos binders
12
Q
5 phosphate binders
A
calcium acetate, calcium carbonate, aluminum hydroxide, lanthanum, sevelamer
13
Q
when is hypocalcemia treated in tumor lysis syndrome
A
if symptomatic
14
Q
ANC =
A
total WBC x [(% neutrophils + % bands) / 100]
15
Q
when is prophylaxis started for febrile neutropenia
A
consider for int risk
start for high risk
16
Q
bacterial prophylaxis options for feb neutro
A
levofloxacin, cipro, cefpodoxime, pen VK
17
Q
what is used for viral prophylaxis in feb neu?? fungal?
A
acyclovir- viral
azoles
18
Q
oral options for treating infection in feb neutro (4)
A
cipro + amox/clav
levofloxaxin
moxifloxacin
cipro + clindamycin
19
Q
IV options for treatment feb neutro
A
cefepime, pip/tazo, meropenem, imipenem/cilastin, ceftazidime
20
Q
hypercalcemia of malignancy is a corrected Ca level
A
> = 10.5 mg/dL
21
Q
general treatment approach for hypercalcemia of malig
A
hydration saline +/- furosemide
IV bisphosphonates
22
Q
calcitonin use is limited to 48 hours due to
A
tachyphylaxis
23
Q
anemia is a Hgb of
A
<13 g/dl in men
<12 in women
24
Q
presentation of anemia
A
fatigue, sob, tachycardia, angina, hypotension, dizziness, etc
25
amount of oxygen carrying protein
hgb
26
% of blood volume occupied by erythrocytes
Hct
27
estimate of the hgb content in blood, actual count of RBCs/unit of blood
RBC count
28
mean cell volume of RBCs
mean corpuscular volume
29
most sensitive lab indicating iron deficiency anemia
LOW serum ferritin
30
3 PO iron options for IDA
ferrous sulfate, gluconate, fumarate
31
% elemental iron in ferrous sulfate
20%
32
% elemental iron in ferrous sulfate exsiccated
30%
33
% elemental iron in ferrous gluconate
12%
34
% elemental iron in ferrous fumarate
33%
35
DDIs that decrease absorption of PO Fe
antacids, PPIs, h2ras, tetracycline, doxycycline, cholestyramine
36
DDI drugs that are decreased by oral Fe
-dopa, levothyroxine, quinolones, tetracycline, doxycycline, mycophenolate, penicillamine
37
how should PO iron be taken
every other day
38
iron sucrose dosing? unless?
200 mg IV x 5 days unless got prbcs then lower dose
39
what is a key point about initiating IV iron
MAKE SURE NO INFECTION
40
5 IV iron options
iron sucrose, sodium ferric gluconate, ferric carboxymaltose, iron dextran, ferumoxytol
41
iron deficiency anemia is a ___ anemia
microcytic
42
a type of macrocytic anemia
and what is it caused by
megaloblastic anemia
low B12 or folate
43
key labs for B12 def anemia
high mcv, mma, homocysteine
low b12
44
treatment for b12 anemia
b12 po im sq
45
labs in folate def anemia
high mcv and homocysteine
low folate
normal mma
46
treatment of folate def anemia
folic acid
47
type of normocytic anemia
anemia of inflammation
48
labs in anemia of inflammation
low TIBC and TSAT
normal ferritin, high during inflam
49
2 treatments for anemia of inflammation
ESAs or pRBCs
50
2 ESAa
epoetin alfa
darbepoetin alfa
51
when to d/c ESAs? when to hold or dec dose?
d/c if hgb >12
hold/dec dose if hgb >1 g/dl in 2 weeks
52
hyperleukocytosis in AML is classified as WBC
>= 100,000 mcL
53
how to treat hyperleukocytosis in AML
hydroxyurea
54
AEs of hydroxyurea
NVD, tumor lysis, mucositis
55
what assessment must be done before starting AML treatment
cardiac assessment
56
2 subtypes of FLT3 mutation in AML
ITD
TKD
57
second mutation type for AML (not FLT3)
IDH1 & IDH2
58
signs of favorable risk AML
normal karyotype, core-binding factor
59
what is the AGGRESSIVE 7+3 chemo regimen for AML
cytarabine + daunorubicin or idarubicin
60
aggressive chemo option for t-AML or AML with MRC
liposomal daunorubicin + cytarabin
61
3 NOT AGGRESSIVE low intensity chemo options for AML
decitabine or azacitidine + venetoclax
low dose cytarabine + venetoclas
ivosidenib + venetoclax
62
when is ivosidenib + venetoclax indicated for low intensity AML chemo
IDH1 mutation
63
2 options for post-remission therapy after aggressive induction AML chemo
high dose cytarabine (HiDAC)
liposomal daunorubicin + cytarabine if used initially
64
AEs of daunorubicin, idarubicin, mitoxantrone
myelosuppression, hepatotoxicity, cardiac toxicity
red- dauno, ida
blue/green- mitox
65
AEs of high dose cytarabine
what needs to be done?
neurotoxicity, hand/foot syndrome, conjunctivitis
neuro checks before each dose
dex 0.1% eye drops
66
when in gemtuzumab & ozogamicin (GO) used in AML
adjunct to 7+3 backbone for induction or post-remission if favorable/intermediate cytogenetics
67
AEs of gemtuzumab + oxogamicin (GO)
what needs to be done?
infusion rxn, hepatotoxicity
premedicate
68
BBW for gemtuzumab + ozogamicin
hepatotoxicity
69
AEs of hypomethylating agents (HMAs)
decitabine, azacitidine
what needs to be done
constipation- bowel regimen
low/mod emetogenicity- ondansetron premed
70
venetoclax needs dose adjustment for
3A4 or P-gp inhibitors
71
when is quizartinib used for AML
FLT3-ITD mutation added to 7+3 backbone
72
when is midostaurin used for AML
NEWLY DIAGNOSED FLT3+ mutation added to 7+3 backbone
73
when is gilteritinib used for AML
relapsed/refractory FLT3+ mutation
74
when is ivosidenib used for AML
new dx OR relapse/refract with IDH 1 mutation
75
when is enasidenib used for AML
relapse/refractory with IDH2 mutation
76
when is revumenib used for AML
KMT2A rearranged relapsed/refract
77
when are RBC or PLT infusions indicated for AML
RBC if Hgb <8
PLT if <10,000 mcL
78
infection prophylaxis in AML while neutropenic
acyclovir, levofloxacin, posaconazole
79
common genetic factor of CML
translocation between chromosome 9 & 22 --> Philadelphia chromosome
80
2 common presentations of CML
asymptomatic or splenomegaly
81
4 common labs in CML
leukocytosis, thrombocytosis, blasts <10%, Ph+
82
1st line for CML
tyrosine kinase inhibitors
83
what are the 6 TKIs for CML
imatinib
bosutinib
dasatinib
nilotinib
ponatinib
asciminib
84
2 options for CML with T3151 mutation
ponatinib or ascitinib
85
treatment for accelerated phase/blast crisis CML
high dose TKI
86
common AEs of imatinib
potency?
edema, diarrhea, NV, rash
least potent
87
DDI to avoid with dasatinib
PPIs, H2RAs
88
AEs of dastinib
pleural or pericardial effusions
89
which TKIs are contraindicated with T3151 mutation
dasatinib, nilotinib, bosutinib
90
which 2 TKIs must be taken on AN EMPTY STOMACH
nilotinib, asciminib
91
AEs and BBW for nilotinib
cardiac tox and QTc prolongation
bbw- QTc prolong
92
AE of bosutinib?
how is its mutation activity
diarrhea
good against many except T3151
93
which TKI is a STAMP inhibitor
asciminib
94
last line TKI for T3151 mutation or if no other TKI therapy is indicated
ponatinib
95
AEs of ponatinib
elev pancreatic enzymes, HTN, skin tox, thrombotic events
96
BBW for ponatinib
vascular occlusion, HF, hepatotoxicity
97
2 classifications of non-hodg lymphoma
b cell
t cell
98
2 common presentations for lymphoma
B symptoms- fever, night sweats, weight loss
lymphadenopathy
99
3 symptoms associated with hodgkin lymphoma
alcohol intolerance, pruritic, chronic cough
100
important baseline screening to do before starting lymphoma therapy
echocardiogram
101
important + immunophenotype in non-hodgkin b cell lymphoma
CD20+
102
what makes non-hodg lymphoma double or triple hit
MYC and BCL2
103
preferred CNS prophylaxis for non-hodg lymphoma
IT methotrexate 12 mg x 4 doses
104
preferred active treatment for CNS involvement in non-hodg lymphoma
methotrexate 15 mg, cytarabine, hydrocortisone
105
2 preferred treatment regimens for stage I-IV non-hodg lymphoma
R-CHOP or Pola-R-CHP
106
when is Pola-R-CHP preferred over R-CHOP? (5)
males, age >60, IPI score 3-5, bulky disease, ABC subtype
107
preferred regimen for double and triple hit lymphoma
or if poor LVEF
dose-adjusted R-EPOCH
108
what 5 medications are in R-CHOP
rituximab, cyclophosphamide, vincristine, doxorubicin, prednisone
109
what 5 medications are in Pola-R-CHP
rituximab, polatuzumab vedotin, cyclophosphamide, doxorubicin, prednisione
110
what 6 medications are in dose adjusted R-EPOCH
rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin
111
all patients who receive dose-adjusted R-EPOCH must also get
antimicrobial prophylaxis and growth factor
112
preferred dosing method for rituximab
body weight dosing
113
AE of rituximab and how to manage
infusion reaction
premedicate
1st dose is extended infusion
114
AEs of cyclophosphamide
hemorrhagic cystitis, cardiotoxicity, mod/high emetic potential, etc
115
AEs of doxorubicin
red urine/sweat/tears, cardiomyopathy, secondary malignancy
116
major toxicity of doxorubicin
cardiotoxicity
max lifetime 550 mg/m2
117
AEs of vincristine
constipation, peripheral neuropathy, extravasation, SIADH, voice hoarseness
118
AEs of polatuzumab vedotin?
how to manage 1?
peripheral neuropathy, serious infection, infusion reaction
premedicate, 1st dose over 90 min
119
supportive care given with R-CHOP
acyclovir, anti-emetic +/- GF
120
supportive care given with Pola-R-CHP
acyclovir, bactrim, anti-emetic, GF
121
supportive care given with DA-R-EPOCH
acyclovir, bactrim, fluconazle, levofloxacin, anti-emetic, GF
122
2 immunophenotypes for hodgkin lymphoma
CD30, CD20 -
123
preferred treatment for stage I-II hodgkin lymphoma
ABVD
124
preferred regimen for stage III-IV hodgkin lymphoma
N-AVD, BrECADD
125
4 things in ABVD for hodgkins
doxorubicin, bleomycin, vinblastine, dacarbazine
126
4 things in N-AVD for hodgkins
nivolumab, doxorubicin, vinblastine, dacarbazine
127
7 things in BrECADD for hodgkins
brentuximab vedotin, etoposide, doxorubicin, cyclophosphamide, Mesna, dacarbazine, dexamethasone
128
all patients who get BrECADD must also get what 3 things
antiinfectives, antiemetic, growth factor
129
major toxicity of bleomycin?
need to do what before starting med?
pulmonary toxicity
PFTs before starting
130
risks for pulmonary toxicity with bleomycin (4)
older, cumulative dose >400 U, baseline drug dysfunction, GROWTH FACTOR ADMIN
131
AEs of vinblastine
constipation, peripheral neuropathy, jaw pain, extravasation, SIADH
132
aes of brentuximab?
how to manage?
peripheral neuropathy, pulmonary toxicity, infusion reaction, bone marrow suppression
premed and give GF
133
main AE of nivolumab?
immune related reactions
134
avoid what when using nivolumab
corticosteroids
135
supportive care for ABVD or N-AVD
antiemetic
136
supportive care for BrECADD (6)
acyclovir, bactrim, levofloxacin, fluconazole, antiemetic, GF
137
presentation of MultMyel
bone pain (back ribs hips), fracture, frequent infection, anemia
138
3 major consequences of the patho of MM
bone disease, renal impairment, anemia
139
2 regimens for MM primary induction in a transplant candidate
Dara-VRd or VRd
140
MM primary induction regimen if NOT a candidate for transplant
VRd
others- dara/lena/dexa, isa/borte/lena/dexa, lena + LD dexa
141
when is doublet therapy (lenalidomide + LD dexamethasone) for MM
older frail patients
142
alternative regimen option for emergent MM treatment of if poor renal function
VCd- cyclophosphamide instead
143
what 4 things are in Dara-VRd
daratumumab, lenalidomide, bortezomib, dexamethason
144
when is quad therapy with Dara-VRd preferred for MM induction
high risk cytogenetics
145
what 3 things are in VRd for MM
bortezomib, lenalidomide, dexamethasone
146
preferred dosing for daratumumab
SQ flat dose
147
major AE of daratumumab and how to manage
delayed infusion reaction
premed and postmed
148
preferred admin of bortezomib
SQ
149
AE of bortezomib
peripheral neuropathy
150
4 AEs of lenalidomide (among others)
birth defects, thrombotic events, somnolence, increased risk secondary malignancy
151
what is required to be initiated if taking lenalidomide
intensive anticoag
enoxaparin 40 mg QD
apixaban 2.5 mg BID
152
what is used for thrombotic prophy after intensive anticoagulation for lenalidomide
ASA 81 mg daily
153
which med for MM has a REMS? why?
lenalidomide
birth defects
effective birth control
154
2 supportive care options for bone changes in MM
adjust for?
bisphosphonates- adjust renal
denosumab
155
what is used for hypercalcemia in MM? dose adjust?
zoledronic acid
DO NOT ADJUST DOSE
156
antimicrobial prophy for MM
acyclovir, levofloxacin, entecavir (if Hep B+)
