Oncology overview and side effect management Flashcards
What are the warning signs of cancer?
What are the screening guidelines?
What are the MAX DOSES for dose limiting agents?
CAUTION, change in bowel habits, a sore that does not heal, unusual bleeding or discharge, thickening or lump in breast or elsewhere, indigestion or difficulty swallowing, obvious change in wart or mole, nagging cough or hoarseness.
Breast is yearly mammograms at 45-54, mammograms every 2 years after 55 or continue annually. Cervical is pap smear q3 years in 20’s. Pap Smear + HPV test every 5 years until 65. Colon is stool-based tests, FOBT, Colonoscopy every 10 years. FSIG every 5 years. Lung is annual CT scan of chest if have smoking history, Prostate is PSA if opting to be tested +/- a digital rectal exam.
Bleomycin is 400 units(pulmonary toxicity), Doxorubicin( 450-550 mg/m2(cardiotoxicity), Cisplatin is 100 mg/m2(nephrotoxicity), Vincristine is single dose at 2 mg due to neuropathy.
What common chemos cause myelosuppression and how do you manage it?
What common chemos cause N/V and how do you manage it?
What common chemos cause mucositis and how do you manage it?
Almost all EXCEPT Asparaginase, Bleomycin, Vincristine. Neutropenia is managed by CSF’s.
Cisplatin, Cyclophosphamide, Ifosfamide. NK1-RA antagonist, 5HT3 antagonist, Dexamethasone, Metoclopramide, Prochlorperazine. IV/PO fluid hydration.
5-FU, capecitabine, irinotecan, methotrexate and many TKI’s including the nibs. Mucosal coating agents and topical local anesthetics.
What common chemos cause diarrhea and how do you manage it?
What common chemos cause constipation and how do you manage it?
How do you treat xerostomia associated with radiation of the head or neck?
5-FU, capecitabine, irinotecan. IV/PO fluid hydration, antimotility agents (loperamide). Irinotecan: atropine.
Vincristine, stimulant laxatives, Polyethylene glycol.
Artificial saliva substitutes, pilocarpine.
What chemos cause cardiomyopathy and how do you manage it?
What chemos cause QT prolongation and how do you monitor it?
What chemos cause pulmonary fibrosis and how do you manage it?
Anthracyclines, Lifetime cumulative dose of 450-550 mg/m2 for doxorubicin, dexrazoxane can be administered prophylactically in certain patients to help who receive doxorubicin.
Arsenic Trioxide, many TKI’s. ECG.
Bleomycin, Busulfan, carmustine, lomustine. Stop therapy, symptoms, sometimes steroids.
What chemos cause hepatotoxicity and how do you manage it?
What chemos cause nephrotoxicity and how do you manage it?
What chemos cause hemorrhagic cystitis and how do you manage it?
Antiandrogens(bicalutamide, flutamide, nilutamide). Symptom management.
Cisplatin, Methotrexate. Amifostine (ethyol), hydration, max dose of 100 mg/m2/cycle.
Ifosfamide(all doses), cyclophosphamide(higher doses). Mesna(mesnex) is always given prophylactically with ifosfamide and sometimes with cyclophosphamide to reduce the risk. always ensure adequate hydration.
What chemos cause neuropathy and how do you manage it?
What chemos cause thromboembolic risk?
What chemos required adjunctive medications?
Vinca alkaloids, platinums, taxanes. Limit vincristine to 2 mg per week. Oxaliplatin is to avoid cold temps and avoid cold beverages.
Aromatase inhibitors, SERMs, DVT/PE, stroke, MI monitor.
Cisplatin(amifostine)(nephro), Doxo(dexrazoxane)(cardiomyopathy and extravasation),5-fu(leucovorin to enhance efficacy) 5-fu or capecitabine(uridine triacetate is antidote), ifosfamide(mesna)(hemorrhagic cystitis), irinotecan(atropine and loperamide for diarrhea), Methotrexate(leucovorin or glucarpidase) give after methotrexate as an antidote for mucositis. Can also give mannitol and hypertonic saline to increase urine output for cisplatin and ifosfamide stuff.
What is the difference between neutropenia and severe?
What to know about G-CSF?
How do you treat high emetic risk N/V?
Neutropenia is <1000, Severe is <500.
Filgrastim(neupogen, zarxio) Tbo-filgrastim(granix)., PEGfilgrastim is Neulasta. Watch for bone pain, fever, bone pain, arthralgias, myalgias, rash. Peg is pegylated for longer acting, once per chemo cycle. Store in fridge and protect from light, administer 24 hours after chemo, report any signs of enlarged spleen(left upper abdomen pain).
NK1-RA + 5HT3-RA + Dexamethasone. Netupitant/palonosetron (akynzeo) + dex. Olanzapine, Palonosetron + dex.
What to know about the NK1-RA drugs?
What are the 5HT3 receptor antagonists?
What side effects dose dexamethasone cause?
Aprepitant(emend), Fosaprepitant(EMEND), is an injection. Dose of dex should be decreased. inhibit substance P/nk1 receptor. and augment the activity of the other drugs.
All may be given prior to chemo on day 1 except granisetron patch which is started prior to day 1. Ondansetron(zofran and zuplenz film), granisetron(sancuso), dolasetron(anzemet), palonosetron(aloxi). Do not use with apomorphine, watch for serotonin syndrome, headache, constipation, Dolasetron IV not indicated for CINV due to QT prolongation.
Fluid retention, insomnia.
What are the dopamine antagonists?
What side effects to know about the dopamine antagonists?
What to know about the cannabinoids?
Prochlorperazine(compazine), Promethazine(phenergan), Metoclopramide(reglan). Block dopamine receptors in the CTZ.
Promethazine: Do not use in children <2, do not give via intra arterial or SC, serious tissue injury if extravasation. Meto: TD that can be irreversible. Droperidol: QT prolongation and serious arrhythmias. Sedation, lethargy, acute EPS, lower seizure threshold, high qt risk.
Dronabinol(marinol), nabilone(cesamet). Somnolence, euphoria, increased appetite.
What solution of lidocaine do you use for mucositis?
How do you treat hypercalcemia of malignancy?
What are the major vesicants?
2%.
Hydration with normal saline and loop diuretics, Calcitonin(miacalcin), Zoledronic acid(zometa), do not confuse with Reclast which is used for osteoporosis. Denosumab(Xgeva), do not confuse with prolia, every 6 months for osteoporosis. MAB that blocks the interaction between RANKL and RANK.
anthracyclines and vinca alkaloids., hyaluronidase helps with vinca, dexrazoxane and dimethyl sulfoxide with anthracyclines.
What chemos can be given intrathecally?
What drug is FATAL intrathecally?
When do you time vaccines with chemo?
Cytarabine, methotrexate, hydrocortisone, thiotepa and they must be preservative free.
Vincristine, Do not dispense vincristine in a syringe.
During is avoided, precede chemo by 2 weeks.
