Oncology 1 Flashcards
What are the CAUTION signs of cancer?
Change in bowel or bladder habits
A sore that won’t heal
Thickening or lump
Indigestion or difficulty swallowing
Obvious change in wart or mole
Nagging cough or hoarseness
What cancer screening is recommended starting at age 21? How often is screening recommended?
Pap smear every 3 years
What cancer screening is recommended starting at age 30? How often is screening recommended?
Pap smear every 3 years and HPV tests every 5 years
What cancer screening is recommended starting at age 45 in females? How often is screening recommended?
Mammogram every year
What cancer screening is recommended starting at age 45? How often is screening recommended?
Stool based colon test every year and/or colonoscopy every 10 years
What is the maximum dose of bleomycin? Why does it have a maximum?
lifetime cumulative dose of 400 units due to pulmonarytoxicity toxicity
What is the maximum dose of doxorubicin? Why does it have a maximum?
lifetime cumulative dose of 450-550 mg/m^2 due to cardiomyopathy
What is the maximum dose of cisplatin? Why does it have a maximum?
Cycle maximum dose of 100mg/m^2 due to nephrotoxicity
What is the maximum dose of vincristine? Why does it have a maximum?
Single dose maximum of 2mg due to neuropathy
What chemotherapies commonly cause myelosuppression?
All except asparaginase, bleomycin, vincristine
What chemotherapies commonly cause nausea and vomiting?
Cisplatin, cyclophosphamide, ifosfamide, doxorubicin
What chemotherapies commonly cause mucositis?
Fluorouracil, methotrexate, capecitabine, irinotecan
What chemotherapies commonly cause diarrhea?
Irinotecan, capecitabine, fluorouracil, methotrexate
What chemotherapies commonly cause constipation?
Vincristine
What chemotherapies commonly cause cardiomyopathy?
Anthracyclines, HER2 inhibitors, fluorouracil
What chemotherapies commonly cause QT prolongation?
TKIs and leuprolide
What chemotherapies commonly cause pulmonary fibrosis?
Bleomycin, busulfan, carmustine
What chemotherapies commonly cause pneumonitis?
Immune check point inhibitors, methotrexate
What chemotherapies commonly cause hepatotoxicity?
Bicalutamide,flutamide, nilutamide, methotrexate
What chemotherapies commonly cause nephrotoxicity?
Cisplatin, methotrexate
What chemotherapies commonly cause hemorrhagic cystitis?
Ifosfamide, cyclophosphamide at doses > 1 gm/m^2
What chemotherapies commonly cause peripheral neuropathy?
Vinca alkaloids, platinums, taxanes
What chemotherapies commonly cause autonomic neuropathy?
Vinca alkaloids
What chemotherapies commonly carry a thromboembolic risk?
Aromatase inhibitors, SERMs, immunomodulators
When does the nadir occur? when do patients normally recover?
The WBC and platelet nadir occurs 7-14 days after chemotherapy and recovers 3-4 weeks after treatment
What therapies are given to prevent neutropenia?
Filgrastim (Neupogen) daily
Pegfilgrastim (Neulasta) once per cycle
What are the diagnostic requirement for febrile neutropenia
oral temp > 38.3 degrees celsius and ANC less than 500 cell/mm^3
What initial empiric antibiotics are given for febrile neutropenia?
Gram positive and gram negative including pseudomonas
Gram negative bacteria have the highest risk for causing spesis
What therapy is given for anemia?
Natural recovery or blood transfusions
if hemoglobin is <10 g/dL ESAs
How long are patients at risk of experiencing nausea and vomiting after chemotherapy?
three days after receiving their dose
How many antiemetic therapies are recommended for high emetic risk chemotherapy?
3 to 4
What antiemetic therapies are are used for chemotherapy induce nausea and vomiting?
5HT3 RAs, NK1-RAs, dopamine RAs, olanzepine, and dexamethasone
What drugs are NK1-RAs?
Aprepitant (Emend), Fosprepitant (Emend), Netipitant + palonosetron (Akynzea)
What are side effects of NK1-RAs?
hiccups, dizziness, constipation, fatigue
What drugs are 5HT3 RAs?
Ondansetron (zofran), Granisetron (Sancuso), and Palonosetron (Aloxil)
What are side effects of 5HT3 RAs?
HA, constipation,seretonin syndrome, increased QT interval (more with IV)
What medication is contraindicated to use with 5HT3 RAs?
apomorphine because the combination can cause severe hypotension
What medications are dopamine RAs?
Prochlorperazine (Compazine), Promethazine (Phenergan), and Metoclopramide (Reglan)
What are side effects of dopamine RAs?
sedation, lethargy, acute EPS, and anticholinergic side effects
What is the black box warning for prochlorperazine?
Compazine carries an increased risk of mortality in elderly patients with dementia-related psychosis
What is the black box warning for promethazine?
Phenergan can cause serious tissue injury if given subcutaneously due to extravasation
What is the black box warning for metoclopramide?
Reglan can cause irreversible tardive dyskinesia avoid using for more than 12 weeks and decrease the dose for renal impairment
What is the black box warning for droperidol?
Droperidol can cause QT prolongation and serious arrhythmias. It is not used for CINV
What drugs are cannabinoids?
Dronabinol (Marinol) and discontinued nabilone (Cesamet)
What is the maximum dose of loperamide?
16 mg/day
What types of diarrhea can irinotecan cause and what it used to treat them?
Irinotecan can cause early-onset diarrhea treated with atropine and delayed diarrhea treated with loperamide
How is mucositis managed?
good oral hygiene, salt or baking soda rinse, 2% viscous lidocaine or dexamethasone risen for MTOR inhibitors
What is hand and foot syndrome?
Tenderness, pain, inflammation and peeling of palms and soles of the feet due to chemotherapy leaking out of capillaries
What drugs cause hand and foot syndrome and how is it managed?
-Fluorouracil, capecitabine, sorafenib, and sunitinib
-Cool hands/feet, apply emollients, topical pain and steroid medications, prophylactic urea cream
