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
2
Q
management of neuropathy d/t oxaliplatin
A
avoid cold temperatures in every sense
drugs
3
Q
most important drugs regarding hemorrhagic cystitis
A
ifosfamide at all doses
cyclophosphamide at doses >1g/m2
4
Q
definition of profound neutropenia
A
ANC < 100
5
Q
NCCN percentage-chance of FN cutoff warranting G-CSF
A
20%
6
Q
how is pegfilgrastim used in FN/myelosuppresion?
A
it is given one time 24hrs after chemo-cycle is started
7
Q
antiemetic regimens for low-risk?
A
1 drug regimens that don’t include NK1-RA
5HT3-RAs
dex
prochlorperazine
metoclopramide
8
Q
NK1-RAs brand/generic?
A
aprepitant (Emend) fosaprepitant (Emend) - specific IV formulation netupitant -only as component of Akynzeo rolapitant (Varubi)
9
Q
what is Akynzeo?
A
netupitant + palonosetron
10
Q
cannabinoids used for CINV?
A
dronabinol (Marinol, Syndros)
nabilone (Cesamet)
11
Q
boxed warning for prochloperazine
A
mortality in elderly w/ dementia-related psychosis
12
Q
percentage associated with low emetic-risk chemo regimens?
A
10% or less
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
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.
15
Q
management of radiation-induced xerostomia
A
artificial saliva substitutes
pilocarpine (Salagen)
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
17
Q
most important drugs regarding thromboembolic risk
A
Aromatase inhibitors
SERMs
18
Q
GM-CSF used for stem cell transplantation
A
sargramostin (Leukine)
19
Q
most important drugs regarding mucositis
A
fluorouracil capecitabine irinotecan methotrexate TKIs (nib's)
20
Q
most important drugs regarding constipation
A
vincristine
21
Q
management of neuropathy d/t vincristine
A
maximum dose
drugs
22
Q
brand name of tbo-filgrastim
A
Granix
23
Q
patient should report signs of what while on CSFs? how will they know?
A
splenomegaly
left upper abdomen pain
24
Q
what are the main SEs of dex?
A
fluid retention
insomnia
25
when should vaccinations be given in relation to chemotherapy?
2 week prior
26
ESAs for chemo-induced anemia?
```
epoetin alfa (Epogen, Procrit)
darbepoetin (Aranesp)
```
27
percentage associated with moderate emetic-risk chemo regimens?
30-90%
28
pegfilgrastim
Neulasta
29
what is Zinecard and what is it used for?
dexrazoxane
used to prevent cardiomyopathy d/t doxorubicin
30
most important drugs regarding N/V
cisplatin
cyclophosphamide
ifosfamide
31
how are filgrastim (Neupogen, Zarxio) and tbo-filgrastim (Granix) used in FN/myelosuppresion?
they are started 24-72hrs after starting chemo-cycle and used daily until ANC nadir is >2-3k
32
boxed warning for promethazine
not for children < 2
not for intra-arterial or SQ and severe tissue necrosis if extravasation from IV; deep IM preferred
33
maximum dose of cisplatin and reason why
up to 100mg/m2 per cycle b/c of nephrotoxicity
34
how to calculate ANC
ANC =
| WBC
*
%neutrophils + %bands
35
consideration regarding anti-emetic regimens including an NK1-RA and dexamethasone?
the dex dose should be lower compared to the other regimens b/c NK1-RAs are 3A4 inhibitors
36
dopamine agonists brand/generic? (for CINV)
prochlorperazine (Compazine)
Promethazine (Phenergan)
metoclopramide (Reglan)
olanzapine (Zyprexa)
37
management of hand-foot syndrome?
```
cold compresses
- warm with vinca alkaloids and etoposide
emollients
steroids
analgesics
```
38
management of febrile-neutropenia (FN)
empiric antibiotics
39
management of pulmonary toxicities
symptom management, then stop therapy if necessary
corticosteroids for some immunotherapy agents
40
what is Aloxi?
palonosetron
41
management of QT prolongation
control K, Mg, and Ca
hold therapy if QTc > 500msec
42
what is Xgeva
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.
43
maximum dose of vincristine and reason why
up to 2mg per dose b/c of neuropathy
44
what is Anzemet?
dolasetron
45
IDSA definition of low-risk FN?
expected ANC <500 for 7 days or less
and
no significant comorbidities
46
boxed warning for metoclopramide
irreversible tardive dyskinesia
47
hydration fluids for nephrotoxicity and hemorrhagic cystitis
mannitol
| hypertonic saline
48
what is Zometa?
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
management of chemo-induced nausea and vomiting (CINV)?
```
NK1-RAs
5HT3-RAs
dexamethasone
metoclopramide
prochlorperazine
```
IV/PO fluid hydration
50
what are leucovorin and Fusilev and what are they used for?
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
management of nephrotoxicity d/t any drug
hydration
52
what is Emend?
could be aprepitant for fosaprepitant (which is only IV)
53
most important drugs regarding hand-foot syndrome?
fluorouracil
capecitabine
cytarabine
liposomal dosorubicin
54
empiric ABXs for high-risk FN?
```
IV:
cefepime
ceftazidime
meropenem
imipenem-cilastin
pip-tazo
```
55
most important drugs regarding pulmonary toxicity
Pulmonary fibrosis:
- belomycin and 3 specific alkylators: busulfan, carmustine, lomustine (think chemo man bleomycin lungs)
Pneumonitis:
- Methotrexate
- Immune therapy MABs
56
meds for oral complications of chemo?
Mucosal Barrier Gel Spray
| lidocaine 2% topical solution for mouth/throat
57
management of delayed CINV?
NK1-RA
corticosteroids
palonosetron (specifically)
58
management of neuropathy d/t any drug
drugs
59
how is sargramostin (Leukine) used in stem cell transplantation?
it is given daily until post-nadir recovery
60
maximum dose of bleomycin and reason why
400 units in lifetime b/c of pulmonary toxicity
61
management of neuropathy d/t bortezomib
Stick to SQ over IV
62
5HT3-RAs brand/generic?
```
ondansetron (Zofran, Zuplenz flm)
granisetron (Sancuso)
dolasetron (Anzemet)
palonosetron (Aloxi)
- also component of Akynzeo
```
63
G-CSFs used for FN
filgrastim (Neupogen, Zarxio)
tbo-filgrastim (Granix)
pegfilgrastim (Neulasta)
64
subtypes of CINV?
acute
- w/in 24hrs of admin
delayed
- 1-7d after admin
anticipatory
- before admin
65
MOA of 5HT3-RAs?
block seratonin:
- peripherally
- at vagal nerve terminals
- in CNS chemoreceptor trigger zone
66
management of chemo-induced diarrhea
IV/PO fluid hydration
loperamide
diphenoxylate + atropine
for irinotecan specifically:
atropine
67
management of chemo-induced constipation
stimulant laxatives
| PEG
68
management of anticipatory CINV?
benzos
69
most important drugs regarding cardiotoxicity
Cardiomyopathy:
- Anthracyclines
QT Prolongation:
- arenicic trioxide
- TKIs (nib's)
70
what is Voraxaze and what is it used for?
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
percentage associated with high emetic-risk chemo regimens?
90%
72
maximum dose of doxorubicin and reason why
450-550mg/m2 in lifetime b/c of cardiomyopathy
73
antiemetic regimens for moderate-risk?
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
brand names of filgrastim
Neupogen
| Zarxio
75
side effects of cannabinoids?
somnolence
euphoria
increased appetite
76
what is Varubi?
rolapitant
77
storage consideration for CSFs?
store in refrigerator
| protect from light
78
most important drugs regarding hepatotoxicity
Antiandrogens:
bicalutamide
flutamide
nilutamide
79
management of hepatotoxicity d/t PD-1 immunotherapy agents
symptom management, then stop therapy if necessary
corticosteroids
80
management of hypercalcemia of malignancy?
hydration + loop diuretics
calcitonin (Miacalcin)
zoledronic acid (Zometa)
denosumab (Xgeva)
81
management of chemo-induced mucositis
mucosal coating agents
| topical local anesthetics
82
MOA of NK1-RAs
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
what is Totect and what is it used for?
dexrazoxane
used to treat extravasation d/t doxorubicin
84
what are the main side effects of GM-CSFs?
bone pain, fever, arthralgias, myalgias, and rash
85
antiemetic regimens for high-risk?
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
management of acute CINV?
5HT3-RA
87
what bacteria are you most concerned with in regards to sepsis in setting of FN?
gram negative bacteria, most importantly: P. aeruginosa
88
when are 5HT3-RAs given in relation to chemo? what is the exception?
on day 1
| exception: granisetron patches (Sancuso) are placed 1 day prior to chemo.
89
most important drugs regarding myelosuppresion
almost everything EXCEPT:
asparaginase
bleomycin
and vincristine
90
management of hemorrhagic cystitis d/t ifosfamide/cyclophosphamide (HD)
mesna (Mesnex)
| hydration
91
what is the main side effect of G-CSFs?
bone pain
92
most important drugs regarding neuropathy
Vinca alkaloids
Platinum agents
Taxanes
93
most important drugs regarding diarrhea
fluorouracil
capecitabine
irinotecan
94
lab-based requirements for ESA-therapy?
Hgb less than 10
normal ferritin, transferrin saturation (TSAT), and total iron-binding capacity (TIBC)
95
what is Sancuso?
granisetron patches
96
management of cardiomyopathy
dose-limits
97
management of hepatotoxicity d/t antiandrogens
symptom management, then stop therapy if necessary
98
Cancer screening recommendations in men:
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
definition of severe neutropenia
ANC < 500
100
management of nephrotoxicity d/t cisplatin
maximum dose
amifostine (Ethyol)
hydration
101
IDSA definition of high-risk FN?
expected ANC of 100 or less for more than 7 days
or
significant comorbidities
102
what is Zuplenz film?
ondansetron
103
definition of neutropenia
ANC < 1000
104
MOA of dopamine agonists with regards to N/V?
they block dopamine receptors in the CNS chemoreceptor trigger zone.
105
empiric ABXs for low-risk FN?
```
Oral:
cipro + augmentin
cipro + clindamycin
cipro
levo
```
106
most important drugs regarding nephrotoxicity
Platinum agents, Cisplatin most importantly, and MTX.
Hemorragic cystitis is apparently considered a separate complication.
107
antiemetics for breakthrough CINV?
5HT3-RAs
dopamine receptor agonists
cannabinoids (2nd line)
108
MOA of cannabinoids with regards to N/V?
activate cannabinoid receptors w/in CNS and/or inhibit vomiting control mechanism in medulla oblongata
109
what is hyaluronidase used for?
extravasation of vinca alkaloids
110
management of neutropenia, anemia, and thrombocytopenia d/t myelosuppression
G-CSFs
ESAs
Platelet transfusions
