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Oncology 1: Evan Flashcards

1
Q

place in therapy for ESAs used to treat chemo-induced anemia? why?

A

for chemo-induced anemia in setting non-myeloid malignancies (obvious why)

for chemo-induced anemia d/t non-curative regimens b/c they are known to shorten patient survival times and increase tumor progression and recurrence

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2
Q

management of neuropathy d/t oxaliplatin

A

avoid cold temperatures in every sense

drugs

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3
Q

most important drugs regarding hemorrhagic cystitis

A

ifosfamide at all doses

cyclophosphamide at doses >1g/m2

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4
Q

definition of profound neutropenia

A

ANC < 100

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5
Q

NCCN percentage-chance of FN cutoff warranting G-CSF

A

20%

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6
Q

how is pegfilgrastim used in FN/myelosuppresion?

A

it is given one time 24hrs after chemo-cycle is started

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7
Q

antiemetic regimens for low-risk?

A

1 drug regimens that don’t include NK1-RA

5HT3-RAs

dex

prochlorperazine

metoclopramide

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8
Q

NK1-RAs brand/generic?

A 
aprepitant (Emend)
fosaprepitant (Emend)
- specific IV formulation
netupitant
-only as component of Akynzeo
rolapitant (Varubi)
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9
Q

what is Akynzeo?

A

netupitant + palonosetron

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10
Q

cannabinoids used for CINV?

A

dronabinol (Marinol, Syndros)

nabilone (Cesamet)

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11
Q

boxed warning for prochloperazine

A

mortality in elderly w/ dementia-related psychosis

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12
Q

percentage associated with low emetic-risk chemo regimens?

A

10% or less

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13
Q

Cancer screening recommendations in women:

A

Once 21 yo: pap smear q3yr

Once 30 yo: pap smear + HPV test q5yr

Once 45 yo: mammograms yearly, AND [fecal occult blood test yearly OR stool DNA test q3yr], AND [colonoscopy q10yr OR sigmoidoscopy q5yr]

Once 55 yo: CT of chest yearly IF smoking Hx

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14
Q

what is hypercalcemia of malignancy?

A

hypercalcemia, for whatever reason causes intravascular depletion and leads to dehydration, renal failure, mental status changes, N/V, and fatigue.

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15
Q

management of radiation-induced xerostomia

A

artificial saliva substitutes

pilocarpine (Salagen)

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16
Q

IDSA definition of FN?

A

a single oral temp > 38.3/101 and an ANC < 500
or
oral temp > 38/100.4 sustained for 1hr and an ANC that is expected to decrease to < 500 w/in 48 hours

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17
Q

most important drugs regarding thromboembolic risk

A

Aromatase inhibitors

SERMs

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18
Q

GM-CSF used for stem cell transplantation

A

sargramostin (Leukine)

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19
Q

most important drugs regarding mucositis

A 
fluorouracil
capecitabine
irinotecan
methotrexate
TKIs (nib's)
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20
Q

most important drugs regarding constipation

A

vincristine

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21
Q

management of neuropathy d/t vincristine

A

maximum dose

drugs

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22
Q

brand name of tbo-filgrastim

A

Granix

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23
Q

patient should report signs of what while on CSFs? how will they know?

A

splenomegaly

left upper abdomen pain

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24
Q

what are the main SEs of dex?

A

fluid retention

insomnia

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25
Q

when should vaccinations be given in relation to chemotherapy?

A

2 week prior

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26
Q

ESAs for chemo-induced anemia?

A 
epoetin alfa (Epogen, Procrit)
darbepoetin (Aranesp)
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27
Q

percentage associated with moderate emetic-risk chemo regimens?

A

30-90%

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28
Q

pegfilgrastim

A

Neulasta

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29
Q

what is Zinecard and what is it used for?

A

dexrazoxane

used to prevent cardiomyopathy d/t doxorubicin

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30
Q

most important drugs regarding N/V

A

cisplatin
cyclophosphamide
ifosfamide

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31
Q

how are filgrastim (Neupogen, Zarxio) and tbo-filgrastim (Granix) used in FN/myelosuppresion?

A

they are started 24-72hrs after starting chemo-cycle and used daily until ANC nadir is >2-3k

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32
Q

boxed warning for promethazine

A

not for children < 2

not for intra-arterial or SQ and severe tissue necrosis if extravasation from IV; deep IM preferred

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33
Q

maximum dose of cisplatin and reason why

A

up to 100mg/m2 per cycle b/c of nephrotoxicity

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34
Q

how to calculate ANC

A

ANC =

WBC
*
%neutrophils + %bands

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35
Q

consideration regarding anti-emetic regimens including an NK1-RA and dexamethasone?

A

the dex dose should be lower compared to the other regimens b/c NK1-RAs are 3A4 inhibitors

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36
Q

dopamine agonists brand/generic? (for CINV)

A

prochlorperazine (Compazine)
Promethazine (Phenergan)
metoclopramide (Reglan)
olanzapine (Zyprexa)

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37
Q

management of hand-foot syndrome?

A 
cold compresses
- warm with vinca alkaloids and etoposide
emollients
steroids
analgesics
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38
Q

management of febrile-neutropenia (FN)

A

empiric antibiotics

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39
Q

management of pulmonary toxicities

A

symptom management, then stop therapy if necessary

corticosteroids for some immunotherapy agents

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40
Q

what is Aloxi?

A

palonosetron

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41
Q

management of QT prolongation

A

control K, Mg, and Ca

hold therapy if QTc > 500msec

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42
Q

what is Xgeva

A

its denosumab used for hypercalcemia of malignancy.

It’s different from Prolia in that it is used on days 1, 8, and 15, and then monthly.

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43
Q

maximum dose of vincristine and reason why

A

up to 2mg per dose b/c of neuropathy

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44
Q

what is Anzemet?

A

dolasetron

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45
Q

IDSA definition of low-risk FN?

A

expected ANC <500 for 7 days or less
and
no significant comorbidities

46
Q

boxed warning for metoclopramide

A

irreversible tardive dyskinesia

47
Q

hydration fluids for nephrotoxicity and hemorrhagic cystitis

A

mannitol

hypertonic saline

48
Q

what is Zometa?

A

its zoledronic acid used for hypercalcemia of malignancy.

It’s different from Reclast in that is it used once and then again in 7-days as needed.

49
Q

management of chemo-induced nausea and vomiting (CINV)?

A 
NK1-RAs
5HT3-RAs
dexamethasone
metoclopramide
prochlorperazine

IV/PO fluid hydration

50
Q

what are leucovorin and Fusilev and what are they used for?

A

fibrinic acid and levoleucovorin

used as a cofactor for fluorouracil and given after MTX in patients with acute renal failure, or after HD-MTX, to decrease myelosuppression and mucositis

51
Q

management of nephrotoxicity d/t any drug

52
Q

what is Emend?

A

could be aprepitant for fosaprepitant (which is only IV)

53
Q

most important drugs regarding hand-foot syndrome?

A

fluorouracil
capecitabine
cytarabine
liposomal dosorubicin

54
Q

empiric ABXs for high-risk FN?

A 
IV:
cefepime
ceftazidime
meropenem
imipenem-cilastin
pip-tazo
55
Q

most important drugs regarding pulmonary toxicity

A

Pulmonary fibrosis:
- belomycin and 3 specific alkylators: busulfan, carmustine, lomustine (think chemo man bleomycin lungs)

Pneumonitis:

  • Methotrexate
  • Immune therapy MABs
56
Q

meds for oral complications of chemo?

A

Mucosal Barrier Gel Spray

lidocaine 2% topical solution for mouth/throat

57
Q

management of delayed CINV?

A

NK1-RA
corticosteroids
palonosetron (specifically)

58
Q

management of neuropathy d/t any drug

59
Q

how is sargramostin (Leukine) used in stem cell transplantation?

A

it is given daily until post-nadir recovery

60
Q

maximum dose of bleomycin and reason why

A

400 units in lifetime b/c of pulmonary toxicity

61
Q

management of neuropathy d/t bortezomib

A

Stick to SQ over IV

62
Q

5HT3-RAs brand/generic?

A 
ondansetron (Zofran, Zuplenz flm)
granisetron (Sancuso)
dolasetron (Anzemet)
palonosetron (Aloxi)
- also component of Akynzeo
63
Q

G-CSFs used for FN

A

filgrastim (Neupogen, Zarxio)
tbo-filgrastim (Granix)
pegfilgrastim (Neulasta)

64
Q

subtypes of CINV?

A

acute
- w/in 24hrs of admin

delayed
- 1-7d after admin

anticipatory
- before admin

65
Q

MOA of 5HT3-RAs?

A

block seratonin:

  • peripherally
  • at vagal nerve terminals
  • in CNS chemoreceptor trigger zone
66
Q

management of chemo-induced diarrhea

A

IV/PO fluid hydration
loperamide
diphenoxylate + atropine

for irinotecan specifically:
atropine

67
Q

management of chemo-induced constipation

A

stimulant laxatives

PEG

68
Q

management of anticipatory CINV?

69
Q

most important drugs regarding cardiotoxicity

A

Cardiomyopathy:
- Anthracyclines

QT Prolongation:

  • arenicic trioxide
  • TKIs (nib’s)
70
Q

what is Voraxaze and what is it used for?

A

glucarpidase

given after MTX as antidote to rapidly lower levels: in patients with acute renal failure, or after HD-MTX where levels aren’t dropping despite adequate hydration, in order to decrease myelosuppression and mucositis

71
Q

percentage associated with high emetic-risk chemo regimens?

72
Q

maximum dose of doxorubicin and reason why

A

450-550mg/m2 in lifetime b/c of cardiomyopathy

73
Q

antiemetic regimens for moderate-risk?

A

2 or 3 drug regimens +/- adjuncts

Pretty much same as high-risk

The 2 drug regimen is:
5HT3-RA + dex

You can’t add in olazapine to 3-drug regimen though.

74
Q

brand names of filgrastim

A

Neupogen

Zarxio

75
Q

side effects of cannabinoids?

A

somnolence
euphoria
increased appetite

76
Q

what is Varubi?

A

rolapitant

77
Q

storage consideration for CSFs?

A

store in refrigerator

protect from light

78
Q

most important drugs regarding hepatotoxicity

A

Antiandrogens:

bicalutamide
flutamide
nilutamide

79
Q

management of hepatotoxicity d/t PD-1 immunotherapy agents

A

symptom management, then stop therapy if necessary

corticosteroids

80
Q

management of hypercalcemia of malignancy?

A

hydration + loop diuretics
calcitonin (Miacalcin)
zoledronic acid (Zometa)
denosumab (Xgeva)

81
Q

management of chemo-induced mucositis

A

mucosal coating agents

topical local anesthetics

82
Q

MOA of NK1-RAs

A

inhibit substance P and neurokinin 1 receptors, which apparently augment 5HT3-RAs and dex to be able to treat both acute and delayed phase emesis.

83
Q

what is Totect and what is it used for?

A

dexrazoxane

used to treat extravasation d/t doxorubicin

84
Q

what are the main side effects of GM-CSFs?

A

bone pain, fever, arthralgias, myalgias, and rash

85
Q

antiemetic regimens for high-risk?

A

3 (or 4) drug regimens +/- adjuncts

NK1-RA + 5HT3-RA + dex (+/- olanzapine)

Akynzeo + dex

olanzapine + palono + dex

Also: can use lorazepam PRN, H2RAs, or PPIs.

86
Q

management of acute CINV?

87
Q

what bacteria are you most concerned with in regards to sepsis in setting of FN?

A

gram negative bacteria, most importantly: P. aeruginosa

88
Q

when are 5HT3-RAs given in relation to chemo? what is the exception?

A

on day 1

exception: granisetron patches (Sancuso) are placed 1 day prior to chemo.

89
Q

most important drugs regarding myelosuppresion

A

almost everything EXCEPT:
asparaginase
bleomycin
and vincristine

90
Q

management of hemorrhagic cystitis d/t ifosfamide/cyclophosphamide (HD)

A

mesna (Mesnex)

hydration

91
Q

what is the main side effect of G-CSFs?

92
Q

most important drugs regarding neuropathy

A

Vinca alkaloids

Platinum agents

Taxanes

93
Q

most important drugs regarding diarrhea

A

fluorouracil
capecitabine
irinotecan

94
Q

lab-based requirements for ESA-therapy?

A

Hgb less than 10

normal ferritin, transferrin saturation (TSAT), and total iron-binding capacity (TIBC)

95
Q

what is Sancuso?

A

granisetron patches

96
Q

management of cardiomyopathy

A

dose-limits

97
Q

management of hepatotoxicity d/t antiandrogens

A

symptom management, then stop therapy if necessary

98
Q

Cancer screening recommendations in men:

A

Once 45 yo: [fecal occult blood test yearly OR stool DNA test q3yr], AND [colonoscopy q10yr OR sigmoidoscopy q5yr]

Once 50 yo: if patient opts to be treated: PSA +/- DRE

Once 55 yo: CT of chest yearly IF smoking Hx

99
Q

definition of severe neutropenia

100
Q

management of nephrotoxicity d/t cisplatin

A

maximum dose
amifostine (Ethyol)
hydration

101
Q

IDSA definition of high-risk FN?

A

expected ANC of 100 or less for more than 7 days
or
significant comorbidities

102
Q

what is Zuplenz film?

A

ondansetron

103
Q

definition of neutropenia

A

ANC < 1000

104
Q

MOA of dopamine agonists with regards to N/V?

A

they block dopamine receptors in the CNS chemoreceptor trigger zone.

105
Q

empiric ABXs for low-risk FN?

A 
Oral:
cipro + augmentin
cipro + clindamycin
cipro
levo
106
Q

most important drugs regarding nephrotoxicity

A

Platinum agents, Cisplatin most importantly, and MTX.

Hemorragic cystitis is apparently considered a separate complication.

107
Q

antiemetics for breakthrough CINV?

A

5HT3-RAs
dopamine receptor agonists
cannabinoids (2nd line)

108
Q

MOA of cannabinoids with regards to N/V?

A

activate cannabinoid receptors w/in CNS and/or inhibit vomiting control mechanism in medulla oblongata

109
Q

what is hyaluronidase used for?

A

extravasation of vinca alkaloids

110
Q

management of neutropenia, anemia, and thrombocytopenia d/t myelosuppression

A

G-CSFs

ESAs

Platelet transfusions

NAPLEX: Evan (7 decks)

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