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NAPLEX > Oncology: SE management > Flashcards

Oncology: SE management Flashcards

1
Q

N & V

A

Cause: Cisplatin

Txt: NK-1 RAntag, 5ht3-RAntag, Dexmethasone + IV/PO fluid hydration

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2
Q

Mucositis

A

Cause: Fluorouracil (adrucil), Capecitabine( Xeloda), Irinotecan, Methotrexate

TXT: mucosal coating agents, topical local anesthetics

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3
Q

Diarrhea

A

5-FU, Xeloda, irinotecan and many TKI’s

Txt: delay Antimotility agents (Loperamide)
Early: Atropine for irinotecan

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4
Q

Constipation

A

VinCristine, Pomalidomide, Thalidomide

TXT: Stimulant Laxatives, PEG

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5
Q

Cardiotoxicity - Cardiomyopathy

A

Anthracylines, HER2 inhibitors

Mon: Left ventricular EF

TXT: Dexrazoxane (Zinecard), do not exceed 450 - 550mg/m2 lifetime dose

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6
Q

Cardiotoxicity - QT prolongation

A

Cause: Arsenic Trioxide, TKIs,

Mon: ECG, K, Mg, Ca

TXT: Hold therapy if QT is above 500

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7
Q

Pulm Toxicity

A

Causes: Bleomycin, Busulfan, Carmustin, Lomustine

Mon: Maximum Lifetime does of bleomycin 400mg (IU)

TXT: Stop Therapy

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8
Q

Nephrotoxicity

A

Cisplatin, MTX

TXT: Amifostine (Ethyol) given with cisplatin. Ensure adequate hydration

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9
Q

Hemorrhagic cystitis

A

Causes: Ifosfamide (all Doses) Cyclophosphomide doses higher than 1g/m2

TXT: Mesna with drugs above always ensure adequate hydration

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10
Q

Neuropathy

A

Vinca Alkaloids (VinCristine, VinBLASTine, Vinorelbine), Platinums (cis and oxiplatin) Taxanes (pacil, docetax, cabazitaxel)

Txt of:
Vincristine: Limit dose to 2mg /week

Oxaplatin: Avoid cold temp and drinks (ACute cold-mediated sensory)

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11
Q

Myelosupression (Bone marrow supression)

A

Causes: ALL except: Bleomycin, Vincristine,Asparaginase, TKI and Monoclonal antibodies.

Mon: CBC w/ Diff

Txt of:
Neutropenia: Colony stimulating factors

Anemia: ESA

Thrombocytopenia: PLT transx

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12
Q

Amifosine

Brand, use

A

Ethyol

Prophylaxis to prevent nephrotox

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13
Q

Dexrazoxane

Brand, use

A

Zincard = prevent cardiac toxicity

Totect = Txt of extravasation

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14
Q

Leucovorin

Brand and use

A

Levo-Leucovorin (Fusilev)

enhance 5-FU efficacy & decrease myelosupression and mucosititis from MTX

Antidote for MTX toxicity

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15
Q

Uridine Triacetate

Brand and use

A

Vistogard

Antidote for 5-FU toxicity use within 96 hours

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16
Q

Mesna

Brand and use

A

Mesnex

Use with Ifosfamide (or cyclophosphamide doses > 1g) to prevent hemorrhagic cystitis

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17
Q

Atropine

Use

A

Causes: Irinotecan

TXT: acute/early diarrhea

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18
Q

Loperamide

use

A

Causes:
TXT: Delay diarrhea

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19
Q

Glucarpidase

Brand and use

A

Voraxaze
Antidote for MTX Tox or to decrease MTX supression and mucositis

Expensive Drug so just use Leucovorin

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20
Q

Nadir

A

WBC Lowest point occurs after 7 - 14 days after chemo. recovers about 3 - 4 weeks post txt.

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21
Q

Neutropenia

A

ANC <1,000

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22
Q

Severe Neutropenia

A

ANC < 500

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23
Q

Profound Neutropenia

24
Q

Calculate ANC

A

WBC x ( Segs% + bands% )

25
Fligrastim | Brand, MOA, SE
Neupogen, Zarxio, Granix (tbo-filgrastim) MOA: Granulocyte - Colony stimulating agent SE: Bone paine, fever Dose no sooner than 24 hours up to 3 days
26
Pegfilgrastim
Neulasta MOA: G-CSF SE: Bone pain, Fever do not give within 14 days of next cycle. since 1 dose of this is equivalent to 14 doses of filgrastim
27
Sargramostim
Leukine MOA: GM-CSF SE: Fever, Bone pain, Myalgias, Arthralgias, rash
28
Fibrile neutropenia
FEVER: Single oral temp > 38.3 C (101F) or ORal temp > 38C (100.4F) for over an hour Neutropenia: ANC <500 or ANC is expected to be less than 500 in 48 hours
29
ABX in febrile neutropenia
Cover for gram - (P. Ag) Low risk Oral anti-psuedomonas agents: Ciprofloxacin + Augementin Cipro +/- Clindamycin Levo ``` High risk (IV anti-psuedomonas agents): Cefepime, Ceftazidime, Mero/imipenem, pip-tazo ```
30
Anemia in cancer
ESA Increase mortality in cancer patients so use only if the intent is NOT curative. If using ESA add 2 months of chemo to the current regiment initiat when Hgb is less than 10 (use lowest dose possible)
31
Thrombocytopenia
Give Transfx if PLT is below 10,000 or 20,000 with bleeding. AVOID NSAIDS since it reduces function of PLT due to inhibiting TXA
32
Chemo induced N&V
Acute - within 24 h (Serotonin is responsible so use 5HT3 - RA) Delayed - 1 to 7 days after chemo ( supstance P is responsible so use NK-1 RA , palonosetron or dexmethasone) Anticipatory - before chemo (BZD)
33
High Emetic Risk drugs therapy
3 drug regiment: NK-1 RA + 5HT3-RA + Dex Dex + Akynzeo (Netupitant/Palonestron) Olanzapine + Palonosetron + Dex
34
Mod emetic Risk
2 or 3 drugs: same as High emetic risk drug therapy 5HT3-RA + DEX
35
Low emetic Risk
1 drug (except NK-1 RA): 5HT3-RA Dex Prochlorperazine Metoclopramide
36
Aprepitant
Emend | CYP3a4 inhibitors so if given with dexamethasone decrease dose
37
Fosaprepitant
Emend | CYP3a4 inhibitors so if given with dexamethasone decrease dose
38
Netupitant/Palonosetron
Akynzeo | CYP3a4 inhibitors so if given with dexamethasone decrease dose
39
Rolapitant
Varubi | Is a 2D6 inhibitor! so you can give dex at regular dose
40
Ondansetron
Zofran( ODT, tablets) Zuplenz (Film) | SE: Constipation & HA
41
Granisetron
Kytril, Sancuso(Patch), Sustol (SC) | SE: Constipation & HA
42
Dolasetron | Brand, SE, Warning
Anzemet SE: Constipation & HA IV form isnt indicated due to LONG QT PROLONGATION
43
Palonosetron
Aloxi | SE: Constipation & HA due to being a serotonin agonist
44
Dexamethasone
Decadron Short term SE: Fluid Retention, insomnia, weight gain, emotional instability, GI Upset Dose 12mg x 1 then days 2-4 8mg qd with 3a4 inhibitors 20mg po then 8 po qd on day 2-3 w/o inhibitors
45
Prochlorperazine | Brand and BBW
Campazine, Compro | BBW: Increase death in elderly with dementia-related psychosis
46
Promethazine | Brand and BBW
Phernergan, Phenadoz, Promethegan | BBW: Do not give to children under the age of 2 years (Resp Depression) and only give IM.
47
Metoclopromide | Brand and BBW
Reglan | BBW: TD. avoid for longer than 12 weeks
48
Droperidol | BBW
BBW: QT prolongation
49
Dronabinol | Brand and Storage
Marinol, Syndros (liquid) Refrigerate, Contains 50% alcohol (syndros)
50
Nabilone
Casemet
51
Pilocarpine | Brand MOA
Salagen (Think salivate again) | MOA: Cholinergic Stimulant
52
Hand-Foot Syndrome
TXT: Cold compression, Emollients (moisturize), steriods Avoid: exposure to heat, pressure on palms and feet, dishwashing gloves, friction
53
Mild Hypercalcemia of malignancy
Corrected calcium less than 12 + asymptomatic Txt: IV fluids, loop diurectics after correcting dehydration (to eliminate calcium)
54
Severe Hypercalcemia of malignancy
Corrected calcium greater than 12 or symptomatic TXT: IV Bisphosphonates
55
Zoledronic Acid
Zometa (IV for hypercalemia), Reclast (IV for osteoprosis)
56
Denosumab
Xgeva ( 120 mg 1, 8, 15, then monthly), Prolia ( 60mg SC q 6 months )
57
Timing of Vaccines
Give vaccines at least 2 weeks before chemotherapy. do not give live vaccines.

NAPLEX (13 decks)

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