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NAPLEx > oncology I > Flashcards

oncology I Flashcards

1
Q

breast cancer screening

A

40-44 annual optional
45-54 begin yearly mammograms
>=55 years mammograms every 2 years or continue yearly

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2
Q

cervical

A

21-29 pap smear every 3 years
30-65 pap smear +HPV DNA test every 5 years

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3
Q

colon

A

> = 45 stool-based tests- if positive, follow-up w/ colonoscopy, every 3 years
colonoscopy every 10 years

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4
Q

dosing considerations for select highly drugs
Bleomycin

A

Lifetime cumulative dose: 400 units
reason: pulmonary toxicity

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5
Q

dosing considerations for select highly drugs
Doxorubicin

A

lifetime cumulative dose: 450-550 mg/m^2
reason: cardiotoxicity

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6
Q

Cisplatin

A

dose per cycle not to exceed 100mg/m^2
reason: nephrotoxicity

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7
Q

Vincristine

A

single dose “capped” at 2mg
reason: neuropathy

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8
Q

all pt prego and breastfeeding

A

all pt regardless of gender must avoid conceiving during tx

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9
Q

N- nitrosoureas

A

Lomustine, carmustine
neurotoxicity

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10
Q

C- Platinum-based

A

Cisplatin, Carboplatin
nephrotoxic/ototoxic

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10
Q

M- methotrexate

A

mucositis

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11
Q

B- Bleomycin, Busulfan, Carmustine, Lomustine

A

Pulmonary Fibrosis

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12
Q

D- Doxorubicin & other anthracyclines

A

cardiotoxic

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13
Q

AI- Immunotherapy

A

targeting CTLA-4 or PDL-1: ipilimumab, atezolizumab, durvalumab, nivolumab, pembrolizumab
autoimmune syndromes (widespread effects)

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14
Q

IP- ifosfamide & cyclophosphamide

A

Hemorrhagic cystitis

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15
Q

VT- vinca alkaloids and taxanes

A

vinca alkaloids (vincristine, vinblastine & vinorelbine) and Taxanes (paclitaxel, docetaxel)
peripheral neuropathy

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16
Q

BMS- bone marrow suppression

A

common toxicity of many chemotherapy agents including: alkylators, anthracyclines, platinum-based compounds (cisplatin), taxanes, topoisomerase I and II inhibitors, antimetabolites and vinca alkaloids (vinblastine and vinorelbine)

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17
Q

chemotherapy adjunctive tx
cisplatin

A

amifostine (ethyol) and hydration
prophylaxis to prevent nephrotoxicity

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18
Q

chemotherapy adjunctive tx
doxorubicin

A

dexrazoxane (totect)
prophylaxis to prevent cardiomayopathy

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19
Q

chemotherapy adjunctive tx
fluorouracil

A

leucovorin or levoleucovorin
given w/ fluorouracil to enhance efficacy (as a cofactor)

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20
Q

chemotherapy adjunctive tx
fluorouracil or capecitabine

A

uridine triacetate
antidote: use within 96 hrs for an over dose or to tx severe, life-threatening or early-onset of tox

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21
Q

ifosfamide

A

Mesna (Mesnex) and hydration
prophylaxis to prevent hemorrhagic cystitis

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22
Q

irinotecan

A

atropine- prevent or treat acute diarrhea
loperamide- treat delayed diarrhea

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23
Q

methotrexate

A

leucovorin or levoleucovorin- given prophylactically after high-dose methotrexate to decrease myelosuppression and mucositis

glucarpidase- an antidote to decrease excessive methotrexate levels due to acute renal failure

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24
myelosuppression- three major groups
red blood cells platelets white blood cells
25
myelosuppression red blood cells
- decrease in RBC- anemia (decrease in Hgb/Hct) - symptoms: weakness/fatigue - can resolve on its own or with an RBC transfusion Drug tx: - erythropoiesis-stimulating agents (ESA) ---> epoetin alfa (epogen, procrit) ---> darbepoetin alfa (Aranesp)
26
myelosuppression platelets
- decrease platelets- causing thrombocytopenia - symptom: bleeding - platelet transfusion, if platelets are very low (<10,000 cells/mm^3)
27
myelosuppression white blood cells
- decrease WBC- means leukopenia (decreased immune response) - symptoms: fever/infection drug tx: - colony-stimulating factors (CSF) ---> filgrastim (Neupogen) ---> pegfilgrastim (Neulasta)
28
WBC nadir
lowest point in WBC which occurs about 7-14 days after chemotherapy
29
RBC nadir
lowest point in RBC generally after several months of tx, due to the long life-span of RBC (120 days average)
30
WBCs and platelets generally recover
3-4 weeks post tx. the next dose of chemothera[y is given after the WBCs and platelets and return to a safe level next cycle can be delayed to give more time to recover
31
neutropenia
<1,000 cells/mm^3
32
severe neutropenia
< 500 cells/mm^3
33
profound neutropenia
<100 cells/mm^3
34
growth colony stimulating factors
G-CSF or simply CSFs, stimulate the production of WBC in the bone marrow. they are given prophylactically after chemo to shorten the time the pt is at risk for infection due to neutropenia and to reduce mortality - they are used to prevent (or reduce) neutropenia- NOT used for acute tx
35
sargramostim
used only for stem cell transplants
35
G-CSF filgrastim
Neupogen biosimilar: tbo-filgrastim (granix) daily dosing- tx through post naider - colony-stimulating factor
36
pegylated G-CSF Pegfilgrastim
Neulasta biosimilars: a lot with letters infront of it lol sc once per chemo cycle - colony-stimulating factor
37
GM-SCF sargramostim
leukine limited to use in stem cell transplant - colony-stimulating factor
38
major SE for colony-stimulating factors?
bone pain, fever sargramostim: fever, arthralgias, myalgias, rash, bone pain
39
pt should report what w/ colony-stimulating factor
amu signs of enlarged spleen (pain in left upper abdomen or respiratory distress syndrome)
40
what should you document w/ pegfilgrastim?
must document when given, should have at least 12 days before the next chemotherapy cycle
41
- colony-stimulating factor storage
store in the refrigerator, and protect vials from light
42
neutropenia diagnosis
fever: oral tem >38.3 or >38.0 for >1hr neutropenia: ANC <500 or expected to drop below <500
43
neutropenia low-risk tx
expected to drop ANC <500 for <=7 days and no cormbidimites oral anti-pseudomonal antibiotics: cipro or levo + augmentin (for gram +) or clinda (if allergy)
44
neutropenia high-risk tx
expected ANC <=100 for >7 days and presence of comorbidities (renal or hepatic impairment) IV anti-pseudomonal beta-lacatams: cefepime or ceftazidime or meropenem or imipenem/cilastatin or piperacillin/tazo
45
Hgb normal
female: 12-16 g/dL male: 13.5- 18 g/dL initiate ESA only wne HgB <10g/dL
46
ESAs for tx anemia
can shorten survival and increase tumor progression, NOT recommend in pt w/ curative intent! epoetin alfa (Epogen, procrit) epoetin alfa-ebx (retacrit) longer-acting darbepoetin alfa (Arnesp)
47
w/ ESA make sure:
iron levels are adequate. other wise ESA will not work
48
thrombocytopenia
can result in spontaneous uncontrolled bleeding normal range: 150,000-450,000 spontaneous risk for bleed increases when <10,000
49
thrombocytopenia when to start platelet transfusion
<30,000 or active bleeding is present
50
chemotherapy N/V acute
- within 24hrs after chemo - serotonin and substance P drug tx: - 5HT-3 antagonist - NK1 receptor antagonist - dexamethasone, olanzapine
51
chemotherapy N/V delayed
- >24 hrs after chemo - substance P and dopamine drug tx: - NK1 antagonists - corticosteroids - palonosetron - olanzapine
52
chemotherapy N/V anticipatory
- before chemo - GABA drug tx: - benzo: start the evening prior to chemo
53
5HT3- receptor antagonists (RA)
- ondasetron - granisetron - palonsetron
54
NK1- RA
- aprepitant PO - fosaprepritant IV - rolapitant
55
combo 5HT3- RA and NK1-RA
- netupitant /palonsetron PO (Akynzeo) - Fosnetupitant/ palonosetron IV (Akynzeo)
56
other... N/V
olanzapine
57
steroid... N/V
dexamethasone
58
substance P/NK-1 RA antagonists
inhibit the substance P/neurkinin 1 receptor, therefore augmenting the antiemetic activity of 5HT-3 receptors antagonist and corticosteroids to inhibit acute and delayed phases of chemotherapy-induced emesis
59
aprepitant
Emend - substance P/NK-1 RA antagonists
60
Fosaprepitant
Emend - substance P/NK-1 RA antagonists
61
ondansetron
Zofran, Zuplenz film - 5HT-3 RA
62
granisetron
Sancuso - 5HT-3 RA
63
Palonosetron
Aloxil injection PO only incombo (Akynzeo) - 5HT-3 RA
64
warnings w/- 5HT-3 RA
- QT prolongation - serotonin syndrome contra: w/ apomorphine (apokyn)- due to severe hypotension nad loss of consciousness
65
dexamethasone
decadron contra: in systemic fungal infection... - corticosteroids
66
dopamine receptor antagonists
blocks dopamine in CNs and chemoreceptor trigger zone
67
prochlorperazine
compazine increased mortality in elderly pt w/ dementia-related psychosis - dopamine receptor antagonists
68
Promethazine
Phenergan do not use in children<2, respiratory depression do not give via intra-arterial or Sc admin. IV route can cause serious tissue injury if extravasation. Deep IM injection preferred - dopamine receptor antagonists
69
metoclopramide
Reglan can cause irreversible TD! Decrease dose w/ renal impairment - dopamine receptor antagonists
70
Olanzapine
zyprexa second gen psych... - dopamine receptor antagonists
71
droperidol
injection QT prolongation, and arrhythmias risk - dopamine receptor antagonists
72
big warning w/ - dopamine receptor antagonists
symptoms of Parkinson's disease can be exacerbated. Avoid use in pt w/ parkinson disease - EPS( common SE in children- antidote is diphenhydramine and benzo) - can decrease seizure threshold - QT prolongation (droperidol highest risk)
73
dronabinol
Marinol refrigerate - cannabinoids
74
nabilone
cesamet - cannabinoids
75
irinotecan
I- RUN- TO- THE- CAN cause cholinergic excess- acute diarrhea w/ abdominal cramping atropine: classic anticholinergic- prevent acute diarrhea pilocarpine: classic anticholinergic used for dry mouth (xerostomia) cause salvation, tears (lacrimation) for dry eyes
76
tumor lysis syndrome can cause
hyperkalemia (can cause arrrhthmais) hypocalcemia (can cause anorexia, nausea, and seizures hyperuricemia (gout)
77
gout
use allopurinol, but remember HLAB testing... if you cant use it, use: rasburicase- it is expensive, contra: G6PD deficiency
78
Hypercalcemia tx hydration w/ NS and loop diuretics
- increase real Ca exretion - onset min to hrs - mild, moderate, severe cases
79
Hypercalcemia tx calcitonin
calcitionin (miacalcin) - inhibits bone resorption, increases renal Ca recreation - onset 2-6 hrs - moderate, severe cases
80
Hypercalcemia tx IV bisphosphonates
- zoledronic acid (zometa) 4mg IV once, may repeat in 7 days DO NOT confuse w/ reclast which is 5mg IV yearly for osteoporosis! - inhibits bone resorption by stopping osteoclast function - onset 24-72 hrs - mild, moderate, severe cases
81
Hypercalcemia tx denosumab
denosumab (Xeva) 120mg SC dosing... DO NOT confuse w/ prolia which is dosed at 60mg SC every 6 months for osteoporosis! - monoclonal antibody that blocks the interaction between RANK l and RANK preventing osteoclast formation - onset 24-72hrs - moderate, severe cases
82
anthracyclines extravasated
antidote: dexrazoxane (totect) or dimethyl- sulfoxide
83
vinca alkaloids and etoposide extravasated
hyaluronidase
84
vax and chemo
- avoid live vax (immunocompro state) - precede chemo >= 2 weeks

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