Oncology I: Overview and Side Effect Management Flashcards
neoadjuvant vs adjuvant
neoadjuvant is prior to chemo and adjuvant is after chemo
cancer warning signs
CAUTION
Change in bowel/bladder habits
A sore that wont heal
Unusual bleeding or discharge
Thickening or lump
Indigestion or difficulty swallowing
Obvious changes in wart or mole
Nagging cough or hoarseness
Breast Cancer Screening
40-44 annual mamo optional
45-54 annual mamo
>/=55 annual or q2yr mamo
cervical cancer screening
female 25-65 yo
papsmear q3yr
HPV test q5yr
At what age should patient receive colonoscopy
45 years old and every 10 years thereafter
What smoking frequency requires chest CT
20+ pack year history
max lifetime dose of doxorubicin
why?
450-550mg/m2
cardiotoxicity
max lifetime dose of vincristine
why?
2mg/single dose
peripheral neuropathy
max lifetime dose of bleomycin
why?
400 units
pulmonary toxicity
max lifetime dose of cisplatin
why?
100mg/m2 per cycle
nephrotoxicity
ototoxicity
methotrexate common toxicity
mucositis
nitrosureas common toxicity
drugs in class
lomustine
carmustine
neurotoxcity
common toxicity of vinca alkaloids and taxanes
drugs
vincristine
vinblastine
vinelorbine
paclitaxel
docetaxel
peripheral neuropathy
doxorubicin-induced cardiotoxicity prophylaxis treatment
dexrazoxane
cisplatin-induced neurotoxicity prophylaxis treatment
amifostine and water
5-FU-induced overdose treatment
uridine triacetate
cyclophosphamide or ifosfamide-induced hemorrhagic cystitis prophylaxis
mesna and hydration
irinotecan acute vs delayed diarrhea treatment
acute - loperamide
delayed - atropine
treatment for MTX toxicity prevention vs methotrexate antidote
prevention= leucovirin
antidote = glucarpidase
nadir
definition
when occurs
when recovers
consequence
lowest point in platelet or WBC lab value
occurs at 7-14 days post chemo
recovers 3-4 weeks post treatment
increased risk of infection
At what platelet value do you transfuse platelets
<10,000
neutropenia vs severe neutropenia vs profound neutropenia
WBC 500-1000 ntp
100-500 severe
<100 profound
treatment of neutropenia
G-CSF
- filgrastim (Neupogen) 5mcg/kg/day until ANC >2,000
Pegylated G-CSF
- Pegfilgrastim (Neulasta) 6mg SC x1/cycle (>14 days apart)
Adverse effects of G-CSF and pegylated G-CSF
bone pain, fever, arthralgias, rash
monitor for s/sx enlarged spleen
what is the benefit of pegylated G-CSF
longer half-life
febrile neutropenia dx
temp >/=38.3 once or >/= 38 for 1 hour
PLUS
ANC <500 or <1000 and expected to decrease to <500 in next two days
febrile neutropenia treatment
low risk (ANC <100 and no comorbidities) –> po cipro or levofloxacin as anti pseud PLUS amox/clav (clinda if allergy)
high risk (ANC <100 with comorbidities, CrCl <30 or LFTs >5x ULN) –> IV antipseud (pip/tazo, cefepime, ceftazidime, meropenem, imepenem/cilastatin)
risk factors for chemotherapy induced nausea and vomiting (CINV)
female
<50
anxiety, depression
dehydration
hx of CINV or motion sickness
what is the appropriate timing for CINV treatment
initiate antiemetics 30 min prior to chemo
5-HT3 receptor antagonists used in CINV
ondansetron
palonosetron
granisetron
dolasetron
NK1RAs used in CINV
aprepitant po
aprepitant IV
fosaprepitant IV
rolapitant
Akynzeo generic
netupitant/palonosetron PO
or
fosnetupitant/palonosetron IV
which chemo agent has highest emetic risk
cisplatin
which antiemetics are used acutely (<24h after chemo)
5HT3 RAs
NK1RAs
dexamethasone
olanzapine
which antiemetics are used in delayed CINV (>24h after chemo)
NK1RA
corticosteroids
olanzapine
palonosetron
granisetron ER SQ
Patient is initiated on low emetic risk chemo. Which agents can be used for CINV ppx? How are these administered?
One of the following as IV
1. dexamethasone
2. metoclopramide
3. prochlorperazine
4. 5HT3 RA
PO option = 5HT3RAs
LOW RISK = ONE MED
Patient is to start a moderate CINV risk chemotherapy. What are CINV ppx options? How are they administered?
NEED >/= 2 AGENTS administered IV
* = preferred regimen
Day 1 Day 2-3
*dexam dexam or
*5HT3RA 5HT3RA
olanzapine olanzapine
dexam
palonosetron
NK1RA NK1RA (aprepitant po day 2-3 if po given on day 1)
dexam
5HT3RA
TIP=if olanzapine is given on day 1, must be given day 2-3
Patient is to start a high CINV risk chemotherapy. What are CINV ppx options? How are they administered?
NEED >/= 3 AGENTS administered IV
* = preferred regimen
Day 1 Day 2-FOUR
*dexam dexam
*olanzapine olanzapine
*NK1RA NK1RA (aprepitant po day 2-4 if po given on day 1)
*5HT3RA 5HT3RA
olanzapine olanzapine
dexam
palonosetron
NK1RA NK1RA (aprepitant po day 2-3 if po given on day 1)
dexam dexam
5HT3RA
TIP=if olanzapine is given on day 1, must be given day 2-4
prochlorperazine, metoclopramide, promethazine
MOA
use
ADE
DA-R antagonists
breakthrough CINV
sedation, EPS, acute dystonia
chemo induced diarrhea treatment
irinotecan
atropine/diphenoxylate
oral mucositis
common causative chemo agents
treatment
5-FU and MTX
2% viscous lidocaine
soft toothbrush
ice chips (vasoconstrict and prevent chemo delivery to mouth mucosa)
can rinse with NaCl or NaHCO3 solutions
treatment for patients that develop oral candidiasis from chemo-induced mucositis
nystatin suspension or clotrimazole troches
viscous lidocaine 2% for oral mucositis in chemo is contraindicated in what age group
<3 yo
hand-foot-mouth disease (plamar-plantar-erythrodysesthesia = PPE) common causative chemo agents
treatment options
5-FU, liposomal doxorubicin, TK-i (sorafetinib, sunitinib), cytirabine, capecitabine
tx: emollients (aquaphor), topical steroids, pain meds, cool compress
avoid abrasive activities and tasks requiring clenching hands
tumor lysis syndrome
laboratory findings
treatment
hyperkalemia
hypocalcemia (potassium binds Ca and deposits in kidneys)
hyperphosphatemia
hyperuricemia (leads to gout)
tx = allopurinol 400 to 800 mg/day with IV NS to flush kidneys
hypercalcemia of malignancy
patho
treatment
cancer causes calcium resorption into blood which increases fracture risk and serum Ca
treatment: zolendronic acid (bisphosphonate) 4mg IV x1 and IV NS
how long before chemotherapy initiation should vaccines be given
at least 2 weeks before
