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NAPLEX > Oncology SE Management > Flashcards

Oncology SE Management Flashcards

1
Q

Breast Cancer Screening

A
  • Begin yearly mammograms from 45-54 yo

- >= 55 yo, continue yearly or increase to Q2y

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2
Q

Cervical Cancer Screening

A
  • 21-29 yo: Pap smear Q3y

- 30-65 yo: Pap smear + HPV DNA test Q5y

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3
Q

Colon Cancer Screening

A
  • Stool-based tests - fecal occult blood test (gFOBT, Qy >= 45yo) or stool DNA test (Q3y)
  • Visual exams of colon and rectum - colonoscopy Q10y and sigmoidoscopy Q5y
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4
Q

Lung Cancer Screening

A
  • CT scan annually at 55-74 yo IF:
  • In good health
  • Have 30 pack-year smoking history
  • Still smokes or quit within the past 15 years
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5
Q

Prostate Cancer Screening

A

IF patient chooses to be tests, involves:

  • PSA test
  • +/- DRE
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6
Q

Bleomycin Dose Limit

A

Lifetime Cumulative Dose of 400u

-Reason: pulmonary toxicity

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7
Q

Doxorubicin Dose Limit

A

Lifetime Cumulative Dose of 450-550 mg/m^2

-Reason: Cardiotoxicity

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8
Q

Cisplatin Dose Limit

A

Dose per cycle shouldn’t exceed 100 mg/m^2

-Reason: Nephrotoxicity

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9
Q

Vincristine Dose Limit

A

Single dose capped at 2 mg

-Reason: Neurotoxicity

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10
Q

Myelosuppression Agents/Tx

A
  • All chemo EXCEPT Asparaginase, bleomycin, vincristine
  • Neutropenia => CSF
  • Anemia => RBC transfusions, ESAs in palliative ONLY
  • Thrombocytopenia => platelet transfusions
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11
Q

N/V Agents/Tx

A
  • Cisplatin, cyclophosphamide, ifosfamide

- Tx: Neurokinin-1 receptor antagonist (NK1-RA), 5HT3 antagonist, dexamethasone, IV/PO fluid hydration

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12
Q

Mucositis Agents/Tx

A
  • Fluorouracil, MTX
  • Tx: symptomatic; mucosal coating agents, topical anesthetics (2% viscous lidocaine), antifungals/virals (Nystatin susp. or clotrimazole troches)
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13
Q

Diarrhea Agents/Tx

A
  • Irinotecan, capecitabine, fluorouracil, MTX
  • Tx: IV/PO fluid hydration, antimotility meds (loperamide, max 16 mg/d)
  • Irinotecan specific: atropine for early-onset (prevent or tx)
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14
Q

Constipation Agents/Tx

A
  • Vincristine

- Tx: Stimulant laxatives, PEG 3350

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15
Q

Xerostomia Agents/Tx

A
  • Radiation to head/neck

- Tx: Artificial saliva substitutes, pilocarpine

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16
Q

Cardiotoxicity Agents/Tx

A
  • Cardiomyopathy: Anthracyclines
  • QT Prolongation: Arsenic trioxide and many TKIs (ECG monitoring)
  • Be sure not to exceed lifetime cumulative doses
  • Give dexrazoxane prophylactically in doxorubicin pts
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17
Q

Pulmonary Toxicity Agents/Tx

A
  • Fibrosis: Bleomycin, busulfan, carmustine, lomustine
  • Pneumonitis: Immune therapy MAbs
  • Don’t exceed lifetime cumulative dose of bleomycin
  • Give steroids if autoimmune mechanism is suspected
18
Q

Hepatotoxicity Agents/Tx

A
  • Antiandrogens: bicalutamide, eflutamide, nilutamide

- Give steroids if autoimmune mechanism is suspected (immune therapy MAbs)

19
Q

Nephrotoxicity Agents/Tx

A
  • Cisplatin, MTX (high doses)
  • Cisplatin specific: Amifostine (Ethyol) given prophylactically, don’t exceed dose limitation
  • Ensure adequate hydration
20
Q

Hemorrhagic Cystitis Agents/Tx

A
  • Ifosfamide, cyclophosphamide (high doses)
  • Mesna (Mesnex) - always given prophylactically with ifosfamide and sometimes with cyclophosphamide
  • Ensure adequate hydration
21
Q

Neuropathy Agents/Tx

A
  • Peripheral: Vinca alkaloids, platinums, taxanes
  • Vincristine limited to 2 mg/dose
  • Avoid cold temperatures and beverages with oxiplatin
22
Q

Thromboembolism Agents/Tx

A
  • Aromatase inhibitors, SERMs
  • Can cause stroke, DVT/PE, MI
  • Consider thromboprophylaxis based on risk factors
23
Q

Leucovorin

A
  • Given with fluorouracil to enhance efficacy
  • Given prophylactically after MTX to decrease myelosuppression and mucositis (high-dose therapy)
  • Can also use levoleucovorin (Fusilev)
24
Q

Vistogard

A
  • Uridine Triacetate
  • Antidote to Fluorouracil or capecitabine
  • Use within 96 hours for an overdose to treat severe/life-threatening early-onset toxicity
25
Q

Voraxaze

A
  • Glucarpidase

- Antidote to decrease excessive MTX due to acute renal failure

26
Q

Levels of Neutropenia

A
  • Neutropenia: <1000
  • Severe Neutropenia: <500
  • Profound Neutropenia: <100
27
Q

Neutropenia Abx Requirements

A
  • If fever occurs (>38.3 C, 101 F), start empiric abx immediately
  • Treated with neutrophil <500 or anticipated to drop under 500 within 48 hours
  • MUST have Gram”-“ coverage to avoid sepsis, including P. aeruginosa coverage
28
Q

Low-Risk Empiric Abx Regimen

A

When ANC =< 500 for =<7 days

-Oral: Cipro OR Levofloxacin PLUS Augmentin OR Clindamycin

29
Q

High-Risk Empiric Abx Regimen

A

When ANC =<100 for >7 days, comorbidities, renal/hepatic impairment, IV!:

  • Cefepime OR
  • Ceftazadime OR
  • Meropenem OR
  • Imipenem/cilastatin OR
  • Zosyn
30
Q

ESA Use Requirements

A
  • Cancer must not have curative intent
  • Hgb must < 10
  • Use lowest dose possible
  • TSAT, TIBC, and ferritin must be assessed first, ESAs will not work well if iron levels are inadequate
31
Q

Platelet Transfusion Use Criteria

A
  • Plt < 10,000

- Plt <30,000 AND active bleeding is occuring

32
Q

CINV Risk Factors

A
  • Female
  • <50 yo
  • Anxiety
  • Depression
  • Dehydration
  • Hx of motion sickness
  • Hx of N/V with other regimens
33
Q

Acute N/V Definition/Tx

A
  • Within 24 hours of chemo

- 5HT3 antagonists are preferred (Zofran)

34
Q

Delayed N/V Definition/Tx

A
  • > 24 hours after chemo
  • NK1-RA, corticosteroids, or palonosetron
  • PLUS olanzapine
35
Q

Anticipatory N/V Definition/Tx

A
  • Before chemo

- BZD started the evening prior to chemo

36
Q

High Emetic Risk Regimen Options

A
  1. NK1-RA + 5HT3-RA + Olanzapine + Dexamethasone (preferred)
  2. Palonosetron + Olanzapine + Dexamethasone
  3. NK1-RA + 5HT3-RA + Dexamethasone
    * *Example of High-Emetic Risk: Cisplatin**
37
Q

Hand-Foot Syndrome

A
  • Palmar-Plantar erythrodysesthesia
  • Occurs frequently with fluorouracil and capecitabine
  • Cool hands/feet for temporary relief
  • Steroids and analgesics can also be used to lessen pain/inflammation
  • Emollients for retaining moisture in hands/feet
38
Q

Tumor Lysis Syndrome

A
  • Can cause HYPER K/Phos, and HYPOcalcemia
  • Also hyperuricemia which crystallizes and causes kidney damage
  • First: Allopurinol and hydration to control uric acid levels
  • Second: Add rasburicase (expensive) if first-line doesn’t control UA or isn’t an option (SE/allergy/etc)
39
Q

Hypercalcemia of Malignancy

A
  • Cancers leaching Ca from bones; causes them to be weak and prone to fracture
  • Mild: hydration and loop diuretics
  • Mod-Severe (symptomatic): IV hydration (NS), Calcitonin sometimes initially (only 48 hours duration; tachyphylaxis), IV bisphosphonates (zoledronic acid, pamidronate) are usually first line (alt: denosumab)
40
Q

Extravasation with Anthracyclines

A
  • Use cold compresses

- Dexrazoxane (Totect) or dimethyl sulfoxide as antidote

41
Q

Extravasation with Vinca Alkaloids/Etoposide

A
  • Use warm compress

- Hyaluronidase as antidote

NAPLEX (59 decks)

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