Oncology Flashcards

1
Q

Bleomycin maximum dose and toxicity

A

LCD: 400 units; Pulmonary toxicity

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2
Q

Doxorubicin maximum dose and toxicity

A

LCD: 450-550 mg/m2; Cardiotoxicity

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3
Q

Cisplatin maximum dose and toxicity

A

Dose per cycle max 100 mg/m2; Nephrotoxicity

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4
Q

Vincristine maximum dose and toxicity

A

Single-dose “capped” at 2 mg; Nephrotoxicity

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5
Q

Neutropenia management

A

colony-stimulating factors (CSFs)

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6
Q

Thrombocytopenia management

A

platelet transfusion

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7
Q

Chemo-induced N/V management

A

NK-1 receptor antagonist, Serotonin-3 receptor antagonist, dexamethasone, metoclopramide, prochlorperazine; and IV/PO fluid hydration

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8
Q

Mucositis management

A

symptomatic management (mucosal coating agents, topical local anesthetics)

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9
Q

Diarrhea management

A

IV/PO fluid hydration, antimotility agent (eg. loperamide), irinotecan (atropine for early onset diarrhea)

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10
Q

Constipation management

A

Stimulant laxatives, Polyethylene glycol

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11
Q

Xerostomia management

A

artificial saliva substitues, pilocarpine

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12
Q

Cardiotoxicity management

A

{Cardiomyopathy: DNE LCD for doxorubicin. Dexrazoxane can be given prophylactically in some patients receiving doxorubicin.} [QT prolongation: Maintain K, Mg, Ca WNL. Hold therapy if QTc > 500msec}

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13
Q

Pulmonary toxicity management

A

Stop therapy. symptom management. Corticosteroid may be used if autoimmune mechanism is suspected

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14
Q

Hepatotoxicity management

A

Symptom management. Consider stopping. Corticosteroids if an autoimmune mechanism for PD-1 immunotherapy.

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15
Q

Nephrotoxicity management

A

Amifostine (Ethyol) for prophylaxis with cisplatin. Adequate hydration. DNE maximum cisplatin dose.

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16
Q

Hemorrhagic cystitis management

A

Mesna (Mesnex) is always given with IFOSFAMIDE (and sometimes with cyclophosphamide) prophylactically. Adequate hydration!

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17
Q

Neuropathy management

A

Symptom management.
{Vincristine: limit dose to 2mg/wk regardless of BSA}

[Bortezomib: SC administration has less risk than IV]

18
Q

Thromboembolic risk management

A

thromboprophylaxis (anticoagulants) based on risk factors.

19
Q

Causes myelosuppression

A

almost all except: asparaginase, bleomycin, vincristine*, most monoclonal antibodies, and many TKIs

20
Q

Causes N/V

A

cisplatin, cyclophosphamide, ifosfamide*, doxorubicin, epirubicin

21
Q

Causes mucositis

A

Methotrexate, fluorouracil, irinotecan, capecitabine, many TKIs

22
Q

Causes diarrhea

A

fluorouracil, irinotecan, capecitabine*, many TKIs

23
Q

Causes constipation

A

vincristine*, pomalidomide, thalidomide

24
Q

Causes cardiotoxicity

A

{cardiomyopathy: anthracyclines*, HER2 inhibitors, fluorouracil, lapatinib}

25
Q

Causes pulmonary toxicity

A

{pulmonary fibrosis: Bleomycin, busulfan, carmustine, lomustine}

26
Q

Causes hepatotoxicity

A

ANTIANDROGENS (bicalutamide, flutamide, nilutamide), FOLATE ANTIMETABOLITES*** (mtx, pemetrexed, pralatrexate), PYRIMIDINE ANALOG ANTIMETABOLITES (cytarabine, gemcitabine), many TKIs, ipilimumab, pembrolizumab, nivolumab, atezolizumab

27
Q

Causes nephrotoxicity

A

Cisplatin, mtx (high dose), pemetrexed, pralatrexate, carfilzomib, bevacizumab, nivolumab, pembrolizumab, ipilimumab, atezolizumab

28
Q

Causes hemorrhagic cystitis

A

ifosfamide* (all dose), cyclophosphamide* (higher doses eg. > 1g/m2)

29
Q

Causes neuropathy

A

{Peripheral Sensory Neuropathy: Vinca alkaloids, platinums, taxanes*, proteasome inhibitors, thalidomide, ado-trastuzumab, cytarabine-high dose, and brentuximab} [Autonomic neuropathy: vinca alkaloids]

30
Q

Causes clotting

A

aromatase inhibitors, SERMs (eg. tamoxifen), immunomodulators (thalidomide, lenalidomide, pomalidomide)

31
Q

Cisplatin adjunctive agent

A

Amifostine - prevent nephrotoxicity

32
Q

Doxorubicin adjunctive agent

A

Dexrazoxane - prevent cardiomyopathy (Zinecard); treatment of extravasation (Totect)

33
Q

Fluorouracil adjunctive agent

A

Leucovorin or levoleucovorin - enhance efficacy as a cofactor

34
Q

Fluorouracil or capecitabine adjunctive agent

A

Uridine triacetate - antidote (use w/in 96 hours)

35
Q

Ifosfamide adjunctive agent

A

Mesna - prevent hemorrhagic cystitis

36
Q

Irinotecan adjunctive agent

A

Atropine - prevent/treat diarrhea;

Loperamide - treat delayed diarrhea

37
Q

MTX adjunctive agent

A

Leucovorin or levoleucovorin or Glucarpidase - reduce myelosuprression, mucositis antidote, mtx removal in acute renal failure

38
Q

Colony Stimulating Factors (CSF)

A

Filgrastim (G-CSF: Neupogen, Zarxio), Pegfilgrastim (Pegylated G-CSF: Neulasta), and Sargaramostim (GM-CSF: Leukine). – GM-CSF is only for stem cell transplant

39
Q

G-CSF (filgrastim and pegfilgrastim) SEs and Notes

A

SEs are bone pain, fever, glomerulonephritis, rash, injection site pain. Store in the refrigerator. First dose window is 24 to 72 hours after chemo. Look for enlarged spleen Sx (left upper abd pain or RDS). Filgrastim is QD and Pegfilgrastim is once per cycle.

40
Q

GM-CSF (sargramostim) SEs and Notes

A

SEs are bone pain, fever, arthralgia, myalgia, rash, dyspnea, peripheral edema, HTN, and chest pain. Store in the refrigerator. First dose window is 24 to 72 hours after chemo. Look for enlarged spleen Sx (left upper abd pain or RDS). QD dosing.