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NAPLEX Prep > Oncology I: Overview and Side Effect Management > Flashcards

Oncology I: Overview and Side Effect Management Flashcards

1
Q

neoadjuvant vs adjuvant

A

neoadjuvant is prior to chemo and adjuvant is after chemo

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2
Q

cancer warning signs

A

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

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3
Q

Breast Cancer Screening

A

40-44 annual mamo optional
45-54 annual mamo
>/=55 annual or q2yr mamo

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4
Q

cervical cancer screening

A

female 25-65 yo
papsmear q3yr
HPV test q5yr

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5
Q

At what age should patient receive colonoscopy

A

45 years old and every 10 years thereafter

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6
Q

What smoking frequency requires chest CT

A

20+ pack year history

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7
Q

max lifetime dose of doxorubicin
why?

A

450-550mg/m2
cardiotoxicity

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8
Q

max lifetime dose of vincristine
why?

A

2mg/single dose
peripheral neuropathy

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9
Q

max lifetime dose of bleomycin
why?

A

400 units
pulmonary toxicity

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10
Q

max lifetime dose of cisplatin
why?

A

100mg/m2 per cycle
nephrotoxicity
ototoxicity

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11
Q

methotrexate common toxicity

A

mucositis

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12
Q

nitrosureas common toxicity
drugs in class

A

lomustine
carmustine

neurotoxcity

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13
Q

common toxicity of vinca alkaloids and taxanes
drugs

A

vincristine
vinblastine
vinelorbine

paclitaxel
docetaxel

peripheral neuropathy

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14
Q

doxorubicin-induced cardiotoxicity prophylaxis treatment

A

dexrazoxane

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15
Q

cisplatin-induced neurotoxicity prophylaxis treatment

A

amifostine and water

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16
Q

5-FU-induced overdose treatment

A

uridine triacetate

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17
Q

cyclophosphamide or ifosfamide-induced hemorrhagic cystitis prophylaxis

A

mesna and hydration

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18
Q

irinotecan acute vs delayed diarrhea treatment

A

acute - loperamide
delayed - atropine

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19
Q

treatment for MTX toxicity prevention vs methotrexate antidote

A

prevention= leucovirin
antidote = glucarpidase

20
Q

nadir

definition
when occurs
when recovers
consequence

A

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

21
Q

At what platelet value do you transfuse platelets

A

<10,000

22
Q

neutropenia vs severe neutropenia vs profound neutropenia

A

WBC 500-1000 ntp
100-500 severe
<100 profound

23
Q

treatment of neutropenia

A

G-CSF
- filgrastim (Neupogen) 5mcg/kg/day until ANC >2,000

Pegylated G-CSF
- Pegfilgrastim (Neulasta) 6mg SC x1/cycle (>14 days apart)

24
Q

Adverse effects of G-CSF and pegylated G-CSF

A

bone pain, fever, arthralgias, rash
monitor for s/sx enlarged spleen

25
Q

what is the benefit of pegylated G-CSF

A

longer half-life

26
Q

febrile neutropenia dx

A

temp >/=38.3 once or >/= 38 for 1 hour
PLUS
ANC <500 or <1000 and expected to decrease to <500 in next two days

27
Q

febrile neutropenia treatment

A

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)

28
Q

risk factors for chemotherapy induced nausea and vomiting (CINV)

A

female
<50
anxiety, depression
dehydration
hx of CINV or motion sickness

29
Q

what is the appropriate timing for CINV treatment

A

initiate antiemetics 30 min prior to chemo

30
Q

5-HT3 receptor antagonists used in CINV

A

ondansetron
palonosetron
granisetron
dolasetron

31
Q

NK1RAs used in CINV

A

aprepitant po
aprepitant IV
fosaprepitant IV
rolapitant

32
Q

Akynzeo generic

A

netupitant/palonosetron PO
or
fosnetupitant/palonosetron IV

33
Q

which chemo agent has highest emetic risk

A

cisplatin

34
Q

which antiemetics are used acutely (<24h after chemo)

A

5HT3 RAs
NK1RAs
dexamethasone
olanzapine

35
Q

which antiemetics are used in delayed CINV (>24h after chemo)

A

NK1RA
corticosteroids
olanzapine
palonosetron
granisetron ER SQ

36
Q

Patient is initiated on low emetic risk chemo. Which agents can be used for CINV ppx? How are these administered?

A

One of the following as IV
1. dexamethasone
2. metoclopramide
3. prochlorperazine
4. 5HT3 RA

PO option = 5HT3RAs

LOW RISK = ONE MED

37
Q

Patient is to start a moderate CINV risk chemotherapy. What are CINV ppx options? How are they administered?

A

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

38
Q

Patient is to start a high CINV risk chemotherapy. What are CINV ppx options? How are they administered?

A

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

39
Q

prochlorperazine, metoclopramide, promethazine
MOA
use
ADE

A

DA-R antagonists
breakthrough CINV
sedation, EPS, acute dystonia

40
Q

chemo induced diarrhea treatment

A

irinotecan
atropine/diphenoxylate

41
Q

oral mucositis
common causative chemo agents
treatment

A

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

42
Q

treatment for patients that develop oral candidiasis from chemo-induced mucositis

A

nystatin suspension or clotrimazole troches

43
Q

viscous lidocaine 2% for oral mucositis in chemo is contraindicated in what age group

A

<3 yo

44
Q

hand-foot-mouth disease (plamar-plantar-erythrodysesthesia = PPE) common causative chemo agents
treatment options

A

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

45
Q

tumor lysis syndrome
laboratory findings
treatment

A

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

46
Q

hypercalcemia of malignancy
patho
treatment

A

cancer causes calcium resorption into blood which increases fracture risk and serum Ca

treatment: zolendronic acid (bisphosphonate) 4mg IV x1 and IV NS

47
Q

how long before chemotherapy initiation should vaccines be given

A

at least 2 weeks before

NAPLEX Prep (57 decks)

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