oncology I Flashcards
breast cancer screening
40-44 annual optional
45-54 begin yearly mammograms
>=55 years mammograms every 2 years or continue yearly
cervical
21-29 pap smear every 3 years
30-65 pap smear +HPV DNA test every 5 years
colon
> = 45 stool-based tests- if positive, follow-up w/ colonoscopy, every 3 years
colonoscopy every 10 years
dosing considerations for select highly drugs
Bleomycin
Lifetime cumulative dose: 400 units
reason: pulmonary toxicity
dosing considerations for select highly drugs
Doxorubicin
lifetime cumulative dose: 450-550 mg/m^2
reason: cardiotoxicity
Cisplatin
dose per cycle not to exceed 100mg/m^2
reason: nephrotoxicity
Vincristine
single dose “capped” at 2mg
reason: neuropathy
all pt prego and breastfeeding
all pt regardless of gender must avoid conceiving during tx
N- nitrosoureas
Lomustine, carmustine
neurotoxicity
C- Platinum-based
Cisplatin, Carboplatin
nephrotoxic/ototoxic
M- methotrexate
mucositis
B- Bleomycin, Busulfan, Carmustine, Lomustine
Pulmonary Fibrosis
D- Doxorubicin & other anthracyclines
cardiotoxic
AI- Immunotherapy
targeting CTLA-4 or PDL-1: ipilimumab, atezolizumab, durvalumab, nivolumab, pembrolizumab
autoimmune syndromes (widespread effects)
IP- ifosfamide & cyclophosphamide
Hemorrhagic cystitis
VT- vinca alkaloids and taxanes
vinca alkaloids (vincristine, vinblastine & vinorelbine) and Taxanes (paclitaxel, docetaxel)
peripheral neuropathy
BMS- bone marrow suppression
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)
chemotherapy adjunctive tx
cisplatin
amifostine (ethyol) and hydration
prophylaxis to prevent nephrotoxicity
chemotherapy adjunctive tx
doxorubicin
dexrazoxane (totect)
prophylaxis to prevent cardiomayopathy
chemotherapy adjunctive tx
fluorouracil
leucovorin or levoleucovorin
given w/ fluorouracil to enhance efficacy (as a cofactor)
chemotherapy adjunctive tx
fluorouracil or capecitabine
uridine triacetate
antidote: use within 96 hrs for an over dose or to tx severe, life-threatening or early-onset of tox
ifosfamide
Mesna (Mesnex) and hydration
prophylaxis to prevent hemorrhagic cystitis
irinotecan
atropine- prevent or treat acute diarrhea
loperamide- treat delayed diarrhea
methotrexate
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
myelosuppression- three major groups
red blood cells
platelets
white blood cells
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)
myelosuppression
platelets
- decrease platelets- causing thrombocytopenia
- symptom: bleeding
- platelet transfusion, if platelets are very low (<10,000 cells/mm^3)
myelosuppression
white blood cells
- decrease WBC- means leukopenia (decreased immune response)
- symptoms: fever/infection
drug tx:
- colony-stimulating factors (CSF)
—> filgrastim (Neupogen)
—> pegfilgrastim (Neulasta)
WBC nadir
lowest point in WBC which occurs about 7-14 days after chemotherapy
RBC nadir
lowest point in RBC
generally after several months of tx, due to the long life-span of RBC (120 days average)
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
neutropenia
<1,000 cells/mm^3
severe neutropenia
< 500 cells/mm^3
profound neutropenia
<100 cells/mm^3
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
sargramostim
used only for stem cell transplants
G-CSF
filgrastim
Neupogen
biosimilar: tbo-filgrastim (granix)
daily dosing- tx through post naider
- colony-stimulating factor
pegylated G-CSF
Pegfilgrastim
Neulasta
biosimilars: a lot with letters infront of it lol
sc once per chemo cycle
- colony-stimulating factor
GM-SCF
sargramostim
leukine
limited to use in stem cell transplant
- colony-stimulating factor
major SE for colony-stimulating factors?
bone pain, fever
sargramostim: fever, arthralgias, myalgias, rash, bone pain
pt should report what w/ colony-stimulating factor
amu signs of enlarged spleen (pain in left upper abdomen or respiratory distress syndrome)
what should you document w/ pegfilgrastim?
must document when given, should have at least 12 days before the next chemotherapy cycle
- colony-stimulating factor
storage
store in the refrigerator, and protect vials from light
neutropenia diagnosis
fever: oral tem >38.3 or >38.0 for >1hr
neutropenia: ANC <500 or expected to drop below <500
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)
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
Hgb normal
female: 12-16 g/dL
male: 13.5- 18 g/dL
initiate ESA only wne HgB <10g/dL
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)
w/ ESA make sure:
iron levels are adequate. other wise ESA will not work
thrombocytopenia
can result in spontaneous uncontrolled bleeding
normal range: 150,000-450,000
spontaneous risk for bleed increases when <10,000
thrombocytopenia
when to start platelet transfusion
<30,000 or active bleeding is present
chemotherapy N/V
acute
- within 24hrs after chemo
- serotonin and substance P
drug tx: - 5HT-3 antagonist
- NK1 receptor antagonist
- dexamethasone, olanzapine
chemotherapy N/V
delayed
- > 24 hrs after chemo
- substance P and dopamine
drug tx: - NK1 antagonists
- corticosteroids
- palonosetron
- olanzapine
chemotherapy N/V
anticipatory
- before chemo
- GABA
drug tx: - benzo: start the evening prior to chemo
5HT3- receptor antagonists (RA)
- ondasetron
- granisetron
- palonsetron
NK1- RA
- aprepitant PO
- fosaprepritant IV
- rolapitant
combo 5HT3- RA and NK1-RA
- netupitant /palonsetron PO (Akynzeo)
- Fosnetupitant/ palonosetron IV (Akynzeo)
other… N/V
olanzapine
steroid… N/V
dexamethasone
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
aprepitant
Emend
- substance P/NK-1 RA antagonists
Fosaprepitant
Emend
- substance P/NK-1 RA antagonists
ondansetron
Zofran, Zuplenz film
- 5HT-3 RA
granisetron
Sancuso
- 5HT-3 RA
Palonosetron
Aloxil
injection
PO only incombo (Akynzeo)
- 5HT-3 RA
warnings w/- 5HT-3 RA
- QT prolongation
- serotonin syndrome
contra: w/ apomorphine (apokyn)- due to severe hypotension nad loss of consciousness
dexamethasone
decadron
contra: in systemic fungal infection…
- corticosteroids
dopamine receptor antagonists
blocks dopamine in CNs and chemoreceptor trigger zone
prochlorperazine
compazine
increased mortality in elderly pt w/ dementia-related psychosis
- dopamine receptor antagonists
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
metoclopramide
Reglan
can cause irreversible TD! Decrease dose w/ renal impairment
- dopamine receptor antagonists
Olanzapine
zyprexa
second gen psych…
- dopamine receptor antagonists
droperidol
injection
QT prolongation, and arrhythmias risk
- dopamine receptor antagonists
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)
dronabinol
Marinol
refrigerate
- cannabinoids
nabilone
cesamet
- cannabinoids
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
tumor lysis syndrome can cause
hyperkalemia (can cause arrrhthmais)
hypocalcemia (can cause anorexia, nausea, and seizures
hyperuricemia (gout)
gout
use allopurinol, but remember HLAB testing… if you cant use it, use:
rasburicase- it is expensive, contra: G6PD deficiency
Hypercalcemia tx
hydration w/ NS and loop diuretics
- increase real Ca exretion
- onset min to hrs
- mild, moderate, severe cases
Hypercalcemia tx
calcitonin
calcitionin (miacalcin)
- inhibits bone resorption, increases renal Ca recreation
- onset 2-6 hrs
- moderate, severe cases
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
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
anthracyclines
extravasated
antidote: dexrazoxane (totect) or dimethyl- sulfoxide
vinca alkaloids and etoposide
extravasated
hyaluronidase
vax and chemo
- avoid live vax (immunocompro state)
- precede chemo >= 2 weeks
