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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

A

ANC <100

24
Q

Calculate ANC

A

WBC x ( Segs% + bands% )

25
Q

Fligrastim

Brand, MOA, SE

A

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
Q

Pegfilgrastim

A

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
Q

Sargramostim

A

Leukine

MOA: GM-CSF

SE: Fever, Bone pain, Myalgias, Arthralgias, rash

28
Q

Fibrile neutropenia

A

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
Q

ABX in febrile neutropenia

A

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
Q

Anemia in cancer

A

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
Q

Thrombocytopenia

A

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
Q

Chemo induced N&V

A

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
Q

High Emetic Risk drugs therapy

A

3 drug regiment:
NK-1 RA + 5HT3-RA + Dex
Dex + Akynzeo (Netupitant/Palonestron)
Olanzapine + Palonosetron + Dex

34
Q

Mod emetic Risk

A

2 or 3 drugs:
same as High emetic risk drug therapy

5HT3-RA + DEX

35
Q

Low emetic Risk

A

1 drug (except NK-1 RA):

5HT3-RA
Dex
Prochlorperazine
Metoclopramide

36
Q

Aprepitant

A

Emend

CYP3a4 inhibitors so if given with dexamethasone decrease dose

37
Q

Fosaprepitant

A

Emend

CYP3a4 inhibitors so if given with dexamethasone decrease dose

38
Q

Netupitant/Palonosetron

A

Akynzeo

CYP3a4 inhibitors so if given with dexamethasone decrease dose

39
Q

Rolapitant

A

Varubi

Is a 2D6 inhibitor! so you can give dex at regular dose

40
Q

Ondansetron

A

Zofran( ODT, tablets) Zuplenz (Film)

SE: Constipation & HA

41
Q

Granisetron

A

Kytril, Sancuso(Patch), Sustol (SC)

SE: Constipation & HA

42
Q

Dolasetron

Brand, SE, Warning

A

Anzemet
SE: Constipation & HA
IV form isnt indicated due to LONG QT PROLONGATION

43
Q

Palonosetron

A

Aloxi

SE: Constipation & HA due to being a serotonin agonist

44
Q

Dexamethasone

A

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
Q

Prochlorperazine

Brand and BBW

A

Campazine, Compro

BBW: Increase death in elderly with dementia-related psychosis

46
Q

Promethazine

Brand and BBW

A

Phernergan, Phenadoz, Promethegan

BBW: Do not give to children under the age of 2 years (Resp Depression) and only give IM.

47
Q

Metoclopromide

Brand and BBW

A

Reglan

BBW: TD. avoid for longer than 12 weeks

48
Q

Droperidol

BBW

A

BBW: QT prolongation

49
Q

Dronabinol

Brand and Storage

A

Marinol, Syndros (liquid)

Refrigerate, Contains 50% alcohol (syndros)

50
Q

Nabilone

A

Casemet

51
Q

Pilocarpine

Brand MOA

A

Salagen (Think salivate again)

MOA: Cholinergic Stimulant

52
Q

Hand-Foot Syndrome

A

TXT: Cold compression, Emollients (moisturize), steriods

Avoid: exposure to heat, pressure on palms and feet, dishwashing gloves, friction

53
Q

Mild Hypercalcemia of malignancy

A

Corrected calcium less than 12 + asymptomatic

Txt: IV fluids, loop diurectics after correcting dehydration (to eliminate calcium)

54
Q

Severe Hypercalcemia of malignancy

A

Corrected calcium greater than 12 or symptomatic

TXT: IV Bisphosphonates

55
Q

Zoledronic Acid

A

Zometa (IV for hypercalemia), Reclast (IV for osteoprosis)

56
Q

Denosumab

A

Xgeva ( 120 mg 1, 8, 15, then monthly), Prolia ( 60mg SC q 6 months )

57
Q

Timing of Vaccines

A

Give vaccines at least 2 weeks before chemotherapy. do not give live vaccines.

NAPLEX (13 decks)

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