Oncology I: Side Effect Management Flashcards
Risk factors for CINV
- Female gender
- Age < 50 years
- Anxiety
- Depression
- Dehydration
- Hx of motion sickness
- Hx N/V
What medication can be given to prevent hemorrhagic cystitis in patients receiving high doses of cyclophosphamide & all doses of ifosfamide?
Mesnex
High emetic risk chemotherapy agent
Cisplatin
Side effects of 5HT3-RAs
Migraine-like headaches and constipation
Advantage of using darbepoetin over epoetin alfa
Less frequent dosing
What is recommended to alleviate hand-foot syndrome symptoms (painfully dry, red hands)?
- Emollient moisturizer
2. Cold compresses, systemic steroids & pain medications for the pain
Rationale for using leucovorin
- Decrease toxicity of MTX
2. Increase efficacy of drugs like fluorouracil
Myelosuppression with chemotherapy
- Thrombocytopenia treatment is platelet transfusions
- Nadir (lowest point of WBCs & Platelets) occurs 7-14 days post chemo; recover 3-4 weeks after treatment
- Neutropenia increases risk of infection
Max dose of vincristine
2 mg
Prophylaxis of doxorubicin-induced cardiomyopathy & treatment of anthracycline extravasation
Dexrazoxane
Pg. 802
Medications can cause pulmonary fibrosis
Bleomycin
Busulfan
Carmustine
Lomustine
B.B.C.L
Chronic use of MTX causes what
Pneumonitis
Mucositis is a toxicity of which chemotherapy agent(s)?
Fluorouracil & MTX
MTX boxed warning
Stomatitis & mucositis
Brand name of arepitant
Emend
High emetic risk anti-emetic regimens
—-4 drug regimen—-
NK1-RA + 5HT3-RA + Olanzapine + Dex***
—–3 drug regimen——
“Same regimen minus NK1-RA or Olanzapine”
Palonosetron + Olanzapine + Dex
NK1-RA + 5HT3-RA + Dex
Medications used to increase the hemoglobin level (Brand/Generic)
Procrit (Epoetin alfa)
Aranesp (darbepoetin)
Hg < 10 g/dL
Drugs that can be given intrathecally
Cytarabine
MTX
HC
Thiopeta
“MUST BE Preservative-free”
Neupogen generic
Filgrastim
Which chemotherapy agent administered intrathecal is fatal?
Vincristine
Zofran MOA
5HT3 receptor antagonist
Palonosetron Brand
Aloxi
Why is ESA agents considered limited use in cancer patients?
Shortened survival & increased tumor progression
Medications used to treat chemotherapy-induced diarrhea
Loperamide
Atropine
Diphenoxylate-atropine
Medication associated with the highest risk of hand-foot syndrome
Fluorouracil
Capecitabine (prodrug of fluorouracil)
Which chemotherapy agent is most likely to cause a reduced left ventricular ejection fraction?
Doxorubicin
Ondansetron film formulation - Brand name
Zuplenz
Sancuso
Generic/Formulation/Dosing
Generic: Granisetron
Formulation: patch
Dosing: applied 24-48 hours prior to chemo and can be left in place for up to 7 days
Neurokinin-1 Receptor Antagonists drugs
Aprepitant PO, Fosaprepitant IV (Emend)
Bone pain is a side effect of
filgrastim (Neupogen)
pegfilgrastim (Neulasta)
Drug class of choice for anticipatory N/V associated with chemotherapy
Benzodiazepines
Extravasation of chemotherapy non-pharmacologic therapy
Cold compresses for all chemotherapy agents except vinca alkaloids & etoposide, which require warm compresses
Treatment(s) for hypercalcemia of malignancy
Hydration with NS & loop diuretics
Calcitonin (Miacalcin)
IV bisphosphonate
- zoledronic acid (Zometa)
Mab blocks RANKL
- denosumab (Xgeva)Antidote for fluorouracil or capecitabine overdose
Uridine triacetate (Vistogard)
Prodrug of fluorouracil (Brand/Generic)
Xeloda - capecitabine
Adjunctive treatment for proohylaxis to prevent toxicity of doxorubicin
Dexrazoxane
Adjunctive treatment for proohylaxis to prevent toxicity of for cisplatin
Ethyol - amifostine & hydration
Chemotherapeutic class that causes constipation
Vinca alkaloids
Screening tests used to screen for colon cancer
Stool DNA test
Flexible sigmoidoscopy
Colonoscopy
Fecal occult blood test
Risks associated with prochlorperazine
Sedation & lethargy
Decrease seizure threshold
Acute extrapyramidal symptoms
MOA: blocks dopamine receptors
When should colony-stimulating factors (CSF) be given to prevent neutropenia?
Given IV/SC, starting no sooner than 24 hours after chemotherapy
prevent neutropenia –> decrease risk of infections
Long-acting colony-stimulating factor agent
Neulasta (pegfilgrastim) > Neupogen (filgrastim)
What chemo agent has a lifetime cumulative dose of 400 units & causes what toxicity?
Bleomycin
Pulmonary fibrosis
What chemo agent has a lifetime cumulative dose of 450 - 550 mg/m^2 & causes what toxicity?
Doxorubicin
Cardiomyopathy
What chemo agent dose should not exceed 100 mg/m^2 & causes what toxicity?
Cisplatin
Nephrotoxicity
What chemo agent has a single dose “capped” at 2 mg & causes what toxicity?
Vincristine
Neuropathy –> constipation
Absolute neutrophil count (ANC) equation
WBC × (Segs + Bands)
A patient is taking allopurinol to control hyperuricemia resulting from chemotherapy. Which of the following would have to have its dose reduced to prevent toxicity?
A. 5-FU B. 6-MP C. 6-TG D. Fludarabine E. Cytarabine
B. 6-MP
Mercaptopurine is metabolized to 6-thiouric acid by xanthine oxidase.
What chemotherapy drugs do NOT cause myelosuppression?
Asparaginase
Bleomycin
Vincristine
What type of drugs require premedications of Tylenol & diphenhydramine?
Monoclonal antibodies (Mabs)
Hand-foot syndrome frequently occurs following treatment of which chemotherapy agents?
Capecitabine
Fluorouracil
Hyaluronidase is the antidote for extravasation which what chemotherapy agent(s)?
Vina alkaloids
Etoposide
Describe intrathecal route of administration
Injecting drug into the cerebrospinal fluid by performing a lumbar puncture
What medications are recommended to treat chemo-induced appetite weight loss?
Megestrol (Megace) Dronabinol (Marinol) Dexamethasone (Decadeon) Metoclopramide (Reglan) Olanzapine (Zyprexa)
What drug classes have to be monitored for signs and symptoms of DVT/PE, stroke and MI (thromboembolic risks)?
Aromatase inhibitors (anastrazole/letrozole) & SERMs (tamoxifen/raloxfiene)
