Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHRM864 > Oncology Part 2 > Flashcards

Oncology Part 2 Flashcards

1
Q

anticipatory nausea/vomiting

A

learned response conditioned by severity and duration of previous emetic reactions from prior cycles of chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

acute nausea/vomiting

A

emetic response correlating with the administration of chemotherapy; usually within 24 hours of receiving chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

delayed nausea/vomiting

A

related to chemotherapy; usually occurs > 24 hours following completion of chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

breakthrough nausea/vomiting

A

occurs even if on scheduled anti-emetics prior to chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

refractory nausea/vomiting

A

persistent nausea/vomiting despite appropriate anti-emetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

pathophysiology of chemotherapy induced nausea/vomiting (CINV)

A

-begins in GI tract with cytotoxic chemotherapy inducing damage to epithelial cells lining GI tract
-enterochromaffin cells contain large stores of serotonin, which are released in massive quantities after exposure to chemotherapy
-serotonin activates chemoreceptor trigger zone (CTZ) which stimulates the vomiting center (located in nucleus tractus solitarii in medulla)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

nausea

A

inclination to vomit or a feeling in the throat or epigastric region alerting an individual that vomiting is imminent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

wretching

A

labored movement of abdominal and thoracic muscles before vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

vomiting

A

ejection or forced expulsion of gastric contents through the mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

neurotransmitters involved in CINV

A

-dopamine
-histamine
-acetylcholine
-serotonin
-substance P

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

levels of emetogenic risk

A

-highly emetogenic (>90% frequency of emesis; level 5)
-moderately emetogenic (>30-90% frequency of emesis; level 3-4)
-low emetic risk (10-30% frequency of emesis; level 2)
-minimal emetic risk (<10% frequency of emesis; level 1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What levels of emetogenic risk contribute to the emetogenicity of the chemotherapy regimen?

A

≥ level 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

risk factors for CINV

A

-female
-children
-prior history of motion sickness, morning sickness, and/or CINV
-anxiety/high pre-treatment anticipation of nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What can be a protective factor for CINV?

A

chronic alcohol use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is the medication regimen for prophylaxis of acute nausea/vomiting determined?

A

emetogenic potential of chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What drug class can be substituted for each other for prophylaxis of acute nausea/vomiting?

A

5-HT3 receptor antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the four drug classes that can be included in a highly emetogenic CINV regimen?

A

-NK-1 antagonist
-steroid
-5-HT3 antagonist
-atypical antipsychotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What two drug classes are always included in a CINV medication regimen?

A

-steroid
-5-HT3 antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the suffix of NK-1 antagonists?

A

-pitant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What steroid is used for CINV?

A

dexamethasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the suffix of 5-HT3 antagonists?

A

-setron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What atypical antipsychotic is used for CINV?

A

olanzapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What two drug classes can be added to a CINV medication regimen for toxicities?

A

-benzodiazepine
-H2 blocker/proton pump inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What benzodiazepine can be added to a CINV medication regimen for toxicities?

A

lorazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How many medications are in a low emetogenic CINV regimen?

A

one

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What drug classes are used to treat breakthrough nausea/vomiting?

A

-dopamine receptor antagonists
-phenothiazines
-antipsychotic
-benzodiazepine
-cannabinoids
-serotonin antagonists
-steroid
-anticholinergic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What dopamine receptor antagonists are used to treat breakthrough nausea/vomiting?

A

-haloperidol
-metoclopramide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What phenothiazines are used to treat breakthrough nausea/vomiting?

A

-prochlorperazine
-promethazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What cannabinoids are used to treat breakthrough nausea/vomiting?

A

-dronabinol
-nabilone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What anticholinergic is used to treat breakthrough nausea/vomiting?

A

scopolamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What drug classes are typically used to treat delayed nausea/vomiting?

A

-steroid
-NK-1 antagonist
-atypical antipsychotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the treatment options for anticipatory nausea/vomiting?

A

-prophylaxis
-behavioral therapy
-acupuncture/acupressure
-benzodiazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the treatment guidelines for radiation induced emesis?

A

-start pre-treatment for each day of radiation therapy
-5-HT3 antagonist (PO) +/- dexamethasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

common toxicities for 5-HT3 antagonists

A

-headache
-asymptomatic and transient ECG changes
-constipation
-increased transaminases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How can headaches due to 5-HT3 antagonists be addressed?

A

switch to another 5-HT3 antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

common toxicities for corticosteroids

A

-anxiety
-euphoria
-insomnia
-hyperglycemia
-increased appetite (weight gain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

common toxicities for NK-1 antagonists

A

-hiccups
-drug interactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

common toxicities for dopamine antagonists

A

-extrapyramidal side effects
-diarrhea
-sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

common toxicities for atypical antipsychotics

A

-dystonic reactions
-sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

common toxicities for phenothiazines

A

-sedation
-akathisia
-dystonia
-tissue damage (IV promethazine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

common toxicities for cannibanoids

A

-drowsiness
-dizziness
-euphoria
-mood changes
-hallucinations
-increased appetite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

common toxicities for benzodiazepines

A

-sedation
-hypotension
-urinary incontinence
-hallucinations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

common toxicities for anticholinergics

A

-vision problems
-inability to urinate
-xerostomia
-constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

When are anti-emetics most effective?

A

at least 5-30 minutes before chemotherapy as prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What should always be provided to patients after chemotherapy?

A

PRN anti-emetics for at home use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

When does the onset of mucositis usually occur?

A

5-7 days after chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

When does mucositis improve?

A

increase of neutrophil count

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What type of chemotherapy is most likely to cause mucositis?

A

continuous infusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What drugs are most likely to cause mucositis?

A

-anthracyclines
-5-fluorouracil (5-FU)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

risk factors for mucositis

A

-pre-existing oral lesions
-poor dental hygiene or ill-fitting dentures
-combined modality treatment (i.e., chemotherapy and radiation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

diet recommendations for mucositis

A

-avoid rough food, spices, salt, and acidic fruit
-eat soft or liquid foods, non-acidic fruit, soft cheeses, and eggs
-avoid smoking, alcohol, and OTC mouthwash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What patients should receive pre-treatment dental screening?

A

-radiation therapy to oral mucosa
-high-dose chemotherapy with bone marrow transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are general mouth care strategies to prevent mucositis?

A

-baking soda rinses 2-4 times daily
-soft-bristled toothbrush to minimize gingival irritation
-saliva substitute for radiation-induced xerostomia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What are the treatment options for pain management of mucositis?

A

-topical anesthetics
-oral cryotherapy
-sucralfate
-oral and parenteral opioid analgesics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

clinical pearls of topical anesthetics for pain management of mucositis

A

-short-term effects
-various combinations of lidocaine, diphenhydramine, and antacids (magic mouthwash)
-swish and spit (or swallow) every few hours PRN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

clinical pearls of oral cryotherapy for pain management of mucositis

A

-vasoconstriction may decrease chemotherapy delivery to oropharyngeal mucosa
-use ice chips 30 minutes before chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

clinical pearls of sucralfate for pain management of mucositis

A

-forms protective barrier
-swish and swallow
-taste and texture may be nauseating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

clinical pearls of oral and parenteral opioid analgesics for pain management of mucositis

A

-moderate to severe mucositis
-oral solutions may contain high concentrations of alcohol, which burns
-use of patient-controlled analgesia (PCA) pump is common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

decreased white blood cells (WBC)

A

-neutropenia
-leukopenia
-granulocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

decreased platelets

A

thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

decreased red blood cells (RBC)

A

anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is the most common dose-limiting toxicity of chemotherapy?

A

bone marrow suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

nadir

A

lowest value blood counts fall to during cycle of chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

When does the onset of neutropenia usually occur?

A

10-14 days after chemotherapy administration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

When does neutropenia usually recover by?

A

3-4 weeks after chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What are the lab values necessary in order for chemotherapy to be administered?

A

-WBC > 3x10^3/uL OR
-absolute neutrophil count (ANC) > 1.5x10^3/uL AND
-platelet count ≥ 100x10^3/uL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

severe neutropenia lab value

A

ANC < 0.5x10^3/uL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

febrile neutropenia

A

severe neutropenia with single oral temperature > 101ºF OR ≥ 100.4ºF for at least 1 hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

neutropenia presentation

A

fever with no other s/s of infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

primary prophylaxis of neutropenia guidelines

A

-if patient is to receive chemotherapy expected to cause ≥ 20% incidence of febrile neutropenia
-high risk patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What patients are defined as high risk for primary prophylaxis of neutropenia?

A

-pre-existing neutropenia due to disease
-extensive prior chemotherapy
-previous radiation to pelvis or other areas containing large amounts of bone marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

secondary prophylaxis of neutropenia guidelines

A

use colony stimulating factor (CSF) preventively with next cycle of chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What are other uses for CSFs?

A

-dose-dense chemotherapy
-alone or with plerixafor after chemotherapy to mobilize peripheral blood progenitor cells
-stem cell transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

CSF drugs

A

-filgrastim
-pegfilgrastim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

route and frequency of administration for filgrastim

A

SQ QD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

clinical pearls of pegfilgrastim

A

-pegylated molecule
-longer half-life than filgrastim
-more expensive
-non-linear PK
-self-injector available

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What drug is not a biosimilar to filgrastim but works through a similar mechanism of action?

A

tbo-filgrastim (Granix)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What drugs are biosimilars to filgrastim?

A

-filgrastim-sndz (Zarxio)
-filgrastim-aafi (Nivestym)
-filgrastim-ayow (Releuko)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

dosing recommendations for filgrastim

A

-start up to 3-4 days after chemotherapy
-continue until post-nadir ANC recovers to at least near normal levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

dosing recommendations for pegfilgrastim

A

-start at least 24 hours after chemotherapy
-can be administered up to 3-4 days after chemotherapy
-leave at least 14 days between dose and next cycle of chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

CSF adverse effects

A

-flu-like symptoms
-bone, joint, and/or musculoskeletal pain
-deep vein thrombosis (DVT)
-splenic enlargement (long-term use)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What medications can be used to treat bone, joint, and/or musculoskeletal pain due to CSF use?

A

-acetaminophen
-non-opioid analgesics
-loratidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

When are platelet transfusions indicated for thrombocytopenia?

A

-≤ 10x10^3/uL (varies by institution)
-active bleeding
-before surgical procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

causes of anemia

A

-decreased RBC production
-decreased erythropoietin production
-decreased vitamin B12, iron, or folic acid
-blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

When should patients undergo a work-up for chemotherapy induced anemia?

A

-hemoglobin (Hgb) ≤ 11 g/dL OR
-≥ 2 g/dL drop from baseline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

chemotherapy induced anemia symptomatic patient treatment guidelines

A

-transfuse as indicated
-consider use of erythropoietic stimulating agents (ESAs)
-perform iron studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What drug class has a black box warning for use in cancer patients?

A

ESAs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

When should ESAs not be used in patients with chemotherapy induced anemia?

A

-myelosuppressive chemotherapy with curative intent
-not receiving chemotherapy
-non-myelosuppressive chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

When should ESAs be considered for use in patients with chemotherapy induced anemia?

A

-cancer and chronic kidney disease (CKD)
-palliative chemotherapy
-no other identifiable causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What is the frequency of administration of epoetin alfa?

A

weekly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What is the benefit of darbepoetin vs. epoetin alfa?

A

prolonged half-life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

darbepoetin indication for cancer

A

chemotherapy induced anemia due to chemotherapy of non-myeloid malignancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Which cancer patients on ESA therapy should have baseline iron studies performed?

A

all

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What chemotherapies cause myalgias/arthralgias?

A

-taxanes
-aromatase inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What is the recommended treatment of myalgias/arthralgias due to chemotherapy?

A

-NSAIDs
-opioids (if necessary)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What chemotherapies cause hemorrhagic cystitis?

A

-high dose cyclophosphamide
-ifosfamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What is the recommended treatment of hemorrhagic cystitis due to chemotherapy?

A

-hydration
-mesna

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What chemotherapies cause heart failure?

A

-anthracyclines
-high-dose cyclophosphamide
-HER2 targeted therapies (i.e., trastuzumab)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What is the recommended treatment of heart failure due to chemotherapy?

A

-monitor cumulative dose
-assess for risk factors
-dexrazoxane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What chemotherapies cause peripheral neuropathy?

A

-taxanes
-vinca alkaloids
-platinums

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What is the recommended treatment of peripheral neuropathy due to chemotherapy?

A

-change infusion rates
-adjunctive pain medications (i.e., gabapentin, amitriptyline)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What chemotherapy causes pulmonary toxicities?

A

bleomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What is the recommended treatment of pulmonary toxicities due to chemotherapy?

A

corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

acute type I chemotherapy related cardiac dysfunction

A

-occurs immediately after single dose or course of therapy with anthracycline
-uncommon
-not related to cumulative dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

chronic type I chemotherapy related cardiac dysfunction

A

-onset usually within 1 year of anthracycline therapy
-need to discontinue anthracycline
-common and life-threatening
-related to cumulative dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What are symptoms of chronic type I chemotherapy related cardiac dysfunction?

A

-tachycardia
-tachypnea
-exercise intolerance
-pulmonary and venous congestion
-ventricular dilation
-poor perfusion
-pleural effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

late onset type I chemotherapy related cardiac dysfunction

A

-develops several years after therapy
-manifests as ventricular dysfunction, congestive heart failure (CHF), conduction disturbances, and arrhythmias
-more common in pediatric cancer patients who received anthyracyclines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What does the risk of cardiotoxicity depend on when administering chemotherapy?

A

cycles of chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What drug causes type II chemotherapy related cardiac dysfunction?

A

trastuzumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

type II chemotherapy related cardiac dysfunction

A

-not dose-related
-ranges widely in severity
-not associated with cardiac damage
-REVERSIBLE (can restart therapy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

OPQRSTU

A

-Onset
-Provoking factors
-Quality
-Radiation
-Severity
-Time
-Understanding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

assessment of pain questions

A

-What other symptoms do you have associated with pain?
-What are your bowel movements?
-What medications have you used in the past?
-What medication allergies do you have?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What medications are used for stage 1 of pain?

A

non-opioid +/- adjuvant agent

114
Q

What medications are used for stage 2 of pain?

A

opioid for mild to moderate pain +/- non-opioid +/- adjuvant agent

115
Q

What medications are used for stage 3 of pain?

A

opioid for moderate to severe pain +/- non-opioid +/- adjuvant agent

116
Q

What levels of pain should non-opioids be used for?

A

1-3

117
Q

What levels of pain should combination products/mild opioids be used for?

A

4-6

118
Q

What levels of pain should opioids be used for?

A

7-10

119
Q

What are non-opioid medication options?

A

-acetaminophen
-ibuprofen
-aspirin

120
Q

What are combination product/mild opioid medication options?

A

-hydrocodone/acetaminophen
-hydrocodone/ibuprofen
-tramadol
-oxycodone/acetaminophen
-oxycodone/aspirin
-oxycodone/ibuprofen
-codeine/acetaminophen

121
Q

What are opioid medication options?

A

-morphine
-hydromorphone
-oxycodone
-fentanyl
-methadone

122
Q

What medication class does not have maximum doses?

A

opioids

123
Q

morphine clinical pearls

A

-toxicity in patients with renal insufficiency
-use with caution in liver dysfunction

124
Q

What dosage forms is morphine available in?

A

-short-acting tablets
-long-acting tablets
-solutions (regular and concentrated)
-IV
-parenteral

125
Q

hydromorphone clinical pearls

A

-use lower doses or longer dosing intervals in patients with renal insufficiency
-use with caution in liver dysfunction
-more potent than morphine

126
Q

What dosage forms is hydromorphone available in?

A

-short-acting tablets
-long-acting tablets
-solution
-IV
-parenteral

127
Q

oxycodone clinical pearls

A

-metabolized by CYP2D6
-sedation and CNS toxicity (patients with renal failure)
-use with caution in liver dysfunction

128
Q

What dosage forms is oxycodone available in?

A

-short-acting tablets
-long-acting tablets
-solution

129
Q

fentanyl clinical pearls

A

-very potent
-do not start for opioid naive patients

130
Q

What dosage forms is fentanyl available in?

A

-patch
-IV
-buccal
-nasal spray
-lozenges

131
Q

What patients is fentanyl ideal for?

A

-refractory nausea/vomiting
-head/neck/esophageal cancer patients who cannot maintain adequate oral intake

132
Q

What dosage forms does fentanyl have REMS for?

A

transmucosal and nasal

133
Q

What patients should be considered for methadone use?

A

-true morphine allergy
-opioid-induced adverse drug reactions (ADRs)
-pain refractory to high-dose opioids
-neuropathic pain
-need long-acting oral dosage form at low cost

134
Q

What patients should methadone be avoided in?

A

-numerous drug interactions
-risks for syncope or arrhythmias
-history of unpredictable adherence
-poor cognition

135
Q

methadone clinical pearls

A

-avoid in severe liver dysfunction
-half-life very unpredictable
-risk of QT prolongation (need baseline ECG)

136
Q

What percentage can a dose be reduced by when switching opioid agents?

A

25%

137
Q

What is the preferred route of administration for opioids?

A

oral

138
Q

How can constipation due to opioids be managed?

A

mild stimulant laxative +/- stool softener upon initiation of opioids

139
Q

How can sedation due to opioids be managed?

A

-hold sedatives and/or anxiolytics
-consider dose reduction

140
Q

How can nausea/vomiting due to opioids be managed?

A

-change opioid
-consider adding scheduled anti-emetic therapy (should resolve in 7-10 days)

141
Q

How can pruritus due to opioids be managed?

A

-decrease dose or change opioid
-consider adding scheduled anti-histamine therapy (i.e., diphenhydramine)

142
Q

What opioid is pruritus most commonly seen with?

A

morphine

143
Q

What common toxicity of opioids do patients not develop a tolerance to?

A

constipation

144
Q

How can hallucinations due to opioids be managed?

A

-decrease dose or change opioid
-consider adding neuroleptic medication

145
Q

How can confusion/delirium due to opioids be managed?

A

-decrease dose or change opioid
-consider adding neuroleptic medication

146
Q

How can myoclonic jerking due to opioids be managed?

A

consider changing opioid or treating underlying causes

147
Q

How can respiratory depression due to opioids be managed?

A

-hold opioid
-give low dose naloxone (chronic pain)

148
Q

What are other therapeutic options for pain due to cancer?

A

-patient controlled analgesia (PCA)
-celiac plexus block
-intrathecal pain pump
-radiation therapy
-bisphosphonate therapy

149
Q

What patients should a PCA be used with caution?

A

patients with sleep apnea

150
Q

What patients are at highest risk of oversedation and respiratory depression with opioid use?

A

patients during first 24 hours after surgery

151
Q

How should PCAs be adjusted?

A

-decrease or stop basal rate when patient no longer needs it
-if receiving multiple bolus doses, then increase basal dose rate

152
Q

How to change dose of controlled PCA?

A

-calculate 24-hour dose of current drug
-convert to equivalent 24-hour dose of new agent
-reduce dose by ~25%
-divide 24-hour dose into appropriate dose
-add breakthrough PRN dosing (~10-20% of 24-hour dose Q4H PRN)

153
Q

When are celiac plexus blocks used?

A

patients with pancreatic cancer

154
Q

When are intrathecal pain pumps used?

A

patients refractory to other opioid therapies or increased toxicities

155
Q

How should oral doses be adjusted for intrathecal pain pumps?

A

decreased

156
Q

What are commonly used opioid medications for intrathecal pain pumps?

A

-morphine
-hydromorphone
-fentanyl
-clonidine
-baclofen
-ziconotide
-bupivacaine

157
Q

When is radiation therapy commonly used for pain?

A

-painful bony metastases
-brain metastases
-spinal cord compression

158
Q

adjuvant pain therapy alternatives

A

-dexamethasone
-NSAIDs

159
Q

complete response (CR)

A

disappearance of all target lesions

160
Q

partial response (PR)

A

30% decrease in sum of longest diameter of target lesions

161
Q

progressive disease (PD)

A

20% increase in sum of longest diameter of target lesions

162
Q

stable disease (SD)

A

small changes that do not meet other criteria

163
Q

invasive carcinoma in breast cancer

A

invasion beyond basement membrane of duct or lobule in breast

164
Q

What is the most common type of breast cancer?

A

invasive ductal carcinoma

165
Q

ductal carcinoma in situ (DCIS)

A

normal cells undergo pre-malignant gene transformation

166
Q

lobular carcinoma in situ (LCIS)

A

tumor has not invaded beyond lobule basement membrane

167
Q

inflammatory breast cancer

A

aggressive form of breast cancer with rapid onset and poor prognosis

168
Q

presentation of inflammatory breast cancer

A

-edema
-redness
-warmth
-inflammation
-orange skin

169
Q

If the recurrence score (RS) is < 26, what type of therapy is indicated for breast cancer?

A

hormonal therapy

170
Q

If the RS is ≥ 26, what type of therapy is indicated for breast cancer?

A

chemotherapy and hormonal therapy

171
Q

stages I, II, and IIIA breast cancer general treatment strategies

A

-lumpectomy and radiation
-modified radical mastectomy (MRM) +/- radiation
-neoadjuvant chemotherapy (stage II and IIIA)
-adjuvant therapy

172
Q

stages IIIB and IIIC breast cancer general treatment strategies

A

-neoadjuvant chemotherapy
-MRM OR lumpectomy AND radiation
-adjuvant therapy

173
Q

stage IV breast cancer general treatment strategies

A

-palliative treatment
-radiation (palliative)
-surgery (palliative)

174
Q

What therapy is not indicated for neoadjuvant treatment of breast cancer?

A

radiation

175
Q

What are the treatment guidelines if a patient has ER/PR+, LN-, and HER2- breast cancer with a tumor ≤ 0.5 cm?

A

adjuvant hormonal therapy

176
Q

What are the treatment guidelines if a postmenopausal patient has ER/PR+, LN-, and HER2- breast cancer with a tumor > 0.5 cm OR 1-3 positive nodes and no 21 gene RT-PCR assay completed?

A

-adjuvant hormonal therapy OR
-adjuvant chemotherapy then hormonal therapy

177
Q

What are the treatment guidelines if a postmenopausal patient has ER/PR+, LN-, and HER2- breast cancer with a tumor > 0.5 cm OR 1-3 positive nodes and RS < 26?

A

adjuvant hormonal therapy

178
Q

What are the treatment guidelines if a postmenopausal patient has ER/PR+, LN-, and HER2- breast cancer with a tumor > 0.5 cm OR 1-3 positive nodes and RS ≥ 26?

A

adjuvant chemotherapy then hormonal therapy

179
Q

What are the treatment guidelines if a premenopausal patient has ER/PR+, LN-, and HER2- breast cancer with an RS ≤ 15?

A

adjuvant hormonal therapy +/- ovarian suppression (OS)

180
Q

What are the treatment guidelines if a premenopausal patient has ER/PR+, LN-, and HER2- breast cancer with an RS 16-25?

A

-adjuvant hormonal therapy +/- OS OR
-adjuvant chemotherapy then hormonal therapy

181
Q

What are the treatment guidelines if a premenopausal patient has ER/PR+, LN-, and HER2- breast cancer with an RS ≥ 26?

A

adjuvant chemotherapy then hormonal therapy

182
Q

What are the treatment guidelines if a patient has ER/PR+ and HER2+ breast cancer with a tumor size ≤ 0.5 cm?

A

adjuvant hormonal therapy +/- chemotherapy with HER2 targeted therapy

183
Q

What are the treatment guidelines if a patient has ER/PR+ and HER2+ breast cancer with a tumor size > 0.5 cm?

A

adjuvant chemotherapy with HER2 targeted therapy then hormonal therapy

184
Q

What does an oopherectomy do?

A

removes largest source of estrogen

185
Q

tamoxifen clinical pearls

A

-estrogen agonist (bones, lipids) and antagonist (breast)
-reduces risk of developing contralateral breast cancer

186
Q

What is the dose of tamoxifen?

A

20 mg QD

187
Q

What is the major toxicity of tamoxifen?

A

hot flashes

188
Q

What is the dosing frequency for LNRH analogs?

A

QM or Q3M

189
Q

What are the third-generation aromatase inhibitors (AIs)?

A

-anastrozole
-letrozole
-exemestane

190
Q

Which third-generation AI is non-steroidal?

A

exemestane

191
Q

third-generation AI clinical pearls

A

-only for postmenopausal patients
-if used in premenopausal patients, need OS
-fewer adverse effects, but no bone protection

192
Q

What hormone therapy guidelines are recommended for premenopausal patients diagnosed with breast cancer?

A

-tamoxifen for 5 years +/- OS
-AI for 5 years WITH OS

193
Q

What is the preferred hormone therapy guideline for postmenopausal patients diagnosed with breast cancer?

A

AI for 5 years then consider AI for additional 5 years

194
Q

What are the most common chemotherapy agents for breast cancer?

A

-doxorubicin
-epirubicin
-cyclophosphamide
-methotrexate
-fluorouracil
-carboplatin
-paclitaxel
-docetaxel

195
Q

What is the schedule of a standard chemotherapy regimen for breast cancer?

A

4-6 cycles given Q3-4W

196
Q

What are the medications in the dose dense anthracycline chemotherapy regimen preferred for HER2- breast cancer?

A

-doxorubicin
-cyclophosphamide
-paclitaxel
-growth factors

197
Q

What are the medications in the TC chemotherapy regimen preferred for HER2- breast cancer?

A

-docetaxel
-cyclophosphamide

198
Q

When should an anthracycline chemotherapy regimen be avoided in patients with breast cancer?

A

history of cardiac problems or cardiac risks

199
Q

What are the medications in the APT chemotherapy regimen for HER2+ breast cancer?

A

-paclitaxel
-trastuzumab

200
Q

What are the medications in the TCH chemotherapy regimen for HER2+ breast cancer?

A

-docetaxel
-carboplatin
-trastuzumab

201
Q

What are the medications in the TCH and pertuzumab chemotherapy regimen for HER2+ breast cancer?

A

-docetaxel
-carboplatin
-trastuzumab
-pertuzumab

202
Q

What is the standard of care for triple negative breast cancer?

A

pembrolizumab (for 1 year)

203
Q

What is the preferred chemotherapy regimen for triple negative breast cancer?

A

-paclitaxel
-carboplatin
-doxorubicin
-cyclophosphamide
-pembrolizumab

204
Q

What are the recommended treatment options for asymptomatic visceral ER/PR+ metastatic breast cancer with bone metastases?

A

-hormonal therapy +/- bisphosphonate or denosumab (for bone disease only)
-clinical trials

205
Q

What is the recommended treatment option for symptomatic visceral or hormone refractory ER/PR- HER2+ metastatic breast cancer?

A

anti-HER2 therapy +/- chemotherapy

206
Q

What is the recommended treatment option for symptomatic visceral or hormone refractory ER/PR- HER2- metastatic breast cancer?

A

chemotherapy

207
Q

When should hormonal therapy be administered to breast cancer patients?

A

-ER and/or PR+
-long disease-free survival
-prior response to therapy
-bone only disease

208
Q

When should chemotherapy be administered to breast cancer patients?

A

-ER/PR-
-short disease-free survival
-rapidly progressing disease
-disease refractive to hormonal therapy

209
Q

What are the preferred chemotherapy single agents for breast cancer?

A

-doxorubicin
-liposomal doxorubicin
-paclitaxel
-capecitabine
-gemcitabine
-vinorelbine
-eribulin
-sacituzumab govitecan-hziy

210
Q

What is the recommended first-line treatment for HER2+ metastatic disease?

A

-trastuzumab
-pertuzumab
-docetaxel or paclitaxel

211
Q

What is the recommended second-line treatment for HER2+ metastatic disease?

A

fam-trastuzumab deruxtecan-nxki

212
Q

What are the recommended first-line single agents for triple negative breast cancer (TNBC)?

A

carboplatin and cisplatin

213
Q

When are pembrolizumab and chemotherapy preferred over platinums for TNBC?

A

combined positive score ≥ 10

214
Q

What treatment is preferred for TNBC if there is no positive score?

A

platinum-based chemotherapy

215
Q

What is the preferred first-line hormonal therapy for metastatic breast cancer?

A

AI and CDK 4/6 inhibitor

216
Q

What CDK 4/6 inhibitors are preferred for breast cancer?

A

-abemaciclib
-palbociclib
-ribociclib

217
Q

What are the preferred second-line hormonal therapies for metastatic breast cancer?

A

-fulvestrant and CDK 4/6 inhibitor (if not used before)
-everolimus and hormonal therapy

218
Q

What endocrine therapies are preferred for breast cancer?

A

-exemestane
-fulvestrant
-tamoxifen

219
Q

What hormonal therapies are useful in certain circumstances for breast cancer?

A

-megestrol acetate
-ethinyl estradiol
-abemaciclib

220
Q

What are the monitoring parameters for abemaciclib?

A

-complete blood count
-diarrhea

221
Q

What is the monitoring parameter for palbociclib?

A

complete blood count

222
Q

What are the monitoring parameters for ribociclib?

A

-complete blood count
-QTc prolongation

223
Q

How often should a complete blood count be completed for CDK 4/6 inhibitors?

A

monthly

224
Q

What are the screening guidelines for breast self exams?

A

-age ≥ 20 years old
-discuss benefits and limitations

225
Q

What are the screening guidelines for clinical breast exams?

A

not recommended

226
Q

What are the screening guidelines for mammograms?

A

-age 40-44: opportunity for annual exams
-age 45-54: annual mammograms
-age ≥ 55: biennial mammograms or opportunity for annual exams

227
Q

signs and symptoms of early prostate cancer

A

asymptomatic

228
Q

signs and symptoms of advanced prostate cancer

A

-alterations in urinary habits
-impotence
-lower extremity edema
-weight loss
-anemia

229
Q

What grading scale is used to measure severity of disease for prostate cancer?

A

Gleason score

230
Q

What does a 2-4 on the Gleason scale mean?

A

slow-growing, well-differentiated prostate cancer

231
Q

What does an 8-10 on the Gleason scale mean?

A

aggressive, poorly differentiated prostate cancer

232
Q

normal range of prostate specific antigen (PSA)

A

0-4 ng/mL

233
Q

What does a PSA of > 4 ng/mL indicate?

A

further evaluation

234
Q

What does a PSA of > 10 ng/mL and/or > 0.75 ng/mL/year indicate?

A

highly suspicious of malignancy

235
Q

What does treatment choice for prostate cancer depend on?

A

-stage
-grade of disease
-age of patient
-health status
-personal preference

236
Q

How often should PSA levels be measured?

A

every 6 months

237
Q

What does localized treatment of prostate cancer include?

A

-active surveillance
-radiation therapy
-surgery

238
Q

What are complications of radiation for prostate cancer?

A

-bladder and/or rectal symptoms
-erectile dysfunction
-radiation proctitis

239
Q

How long is radiation therapy for prostate cancer?

A

8-9 weeks

240
Q

When should androgen deprivation therapy (ADT) be added on in prostate cancer treatment?

A

patients at intermediate to high risk

241
Q

What is the timeline for adjuvant ADT?

A

-start before radiation therapy
-continue during radiation therapy
-continue 1-3 years after radiation therapy

242
Q

What is the definitive curative therapy for prostate cancer?

A

radical prostatectomy and pelvic lymph node dissection (PLND)

243
Q

What is the goal level of testosterone after 1 month of therapy for prostate cancer?

A

< 50 ng/dL

244
Q

What anti-androgens are used for prostate cancer treatment?

A

-bicalutamide
-nilutamide
-flutamide
-abiraterone
-enzalutamide

245
Q

What LHRH agonists are used for ADT in prostate cancer?

A

-leuprolide
-goserelin
-triptorelin
-histerelin

246
Q

What is the frequency of LHRH agonists?

A

every 3 months/12 weeks

247
Q

What are acute toxicities of LHRH agonists?

A

-tumor flare
-gynecomastia
-hot flashes
-erectile dysfunction
-edema
-injection site reaction

248
Q

What are long-term toxicities of LHRH agonists?

A

-osteoporosis
-fracture
-obesity
-insulin resistance
-changes in lipids
-increased risk of diabetes and CV events

249
Q

What drug has less CV events compared to LHRH agonists?

A

relugolix

250
Q

Which anti-androgen has the most toxicities?

A

nilutamide

251
Q

When are LHRH agonists and anti-androgens administered in combination?

A

metastatic prostate cancer

252
Q

What anti-androgen is most commonly administered for prostate cancer?

A

bicalutamide

253
Q

What are the general principles of first-line therapy for metastatic prostate cancer?

A

-goal: palliative therapy
-need to determine PSA recurrence or overt metastatic disease
-determine PSA doubling time

254
Q

When can ADT be delayed for prostate cancer?

A

PSA recurrence

255
Q

When should ADT be considered for prostate cancer?

A

rapid PSA velocity OR short PSA doubling time AND long life expectancy

256
Q

When should ADT be administered for prostate cancer?

A

if PSA doubling time < 6 months

257
Q

What is a treatment option for m0 hormone sensitive prostate cancer (HSPC)?

A

orchiectomy

258
Q

What are symptoms of disease flare due to LHRH agonists in prostate cancer?

A

-bone pain
-increased urinary symptoms

259
Q

What patient population should be considered for intermittent ADT?

A

patients with biochemical failure

260
Q

m0 castrate resistant prostate cancer (CRPC)

A

increasing PSA with no response to ADT, but no distant metastasis found on scans

261
Q

What are the recommended treatment guidelines for m0CRPC?

A

-continue ADT (LHRH agonist)
-add enzalutamide, apalutamide, or darolutamide

262
Q

What drugs should be avoided with enzalutamide?

A

CYP2C8 inhibitors

263
Q

What drug does enzalutamide decrease serum concentrations of?

A

warfarin

264
Q

What patient population should enzalutamide be used with caution in?

A

patients with history of seizures

265
Q

What patient population should apalutamide be used with caution in?

A

history of:
-seizures
-QTc prolongation
-falls
-thyroid dysfunction

266
Q

What anti-androgen for prostate cancer has less toxicities?

A

darolutamide

267
Q

Out of enzalutamide, apalutamide, and darolutamide, which drug has the most toxicities?

A

enzalutamide

268
Q

What are the recommended treatment guidelines for low volume m1HSPC?

A

-ADT
-continue ADT and add abiraterone AND prednisone, enzalutamide, or apalutamide

269
Q

What drug must abiraterone acetate be co-administered with to prevent adrenal insufficiency?

A

prednisone

270
Q

What is a counseling point for abiraterone acetate?

A

take on an empty stomach

271
Q

What are treatment options for high volume m1HSPC?

A

-ADT
-ADT + abiraterone + prednisone
-ADT + enzalutamide
-ADT + apalutamide
-chemotherapy

272
Q

What are the NCCN guideline recommended chemotherapy regimens for high volume m1HSPC?

A

-ADT + docetaxel + abiraterone
-ADT + docetaxel + darolutamide

273
Q

What are the recommended treatment guidelines for metastatic CRPC?

A

continue ADT and maintain castrate testosterone concentrations

274
Q

What is the recommended first-line chemotherapy treatment for metastatic prostate cancer?

A

docetaxel and prednisone

275
Q

What is the consistency of a normal prostate similar to?

A

tip of nose

276
Q

What is the consistency of a prostate with cancer similar to?

A

chin

277
Q

What exam is indicated after an abnormal PSA or digital rectal exam (DRE)?

A

transrectal ultrasonography

278
Q

At what age should men start getting scheduled prostate cancer screenings?

A

≥ 50 years old

279
Q

What is an optional screening test for prostate cancer?

A

DRE

280
Q

At what PSA level are annual prostate cancer screenings recommended?

A

≥ 2.5 ng/mL

281
Q

At what PSA level are biennial prostate cancer screenings recommended?

A

< 2.5 ng/mL

PHRM864 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions