ONCOLOGY SE MENAGEMENT Flashcards
WHAT IS NADIR AND WHEN DOES IT OCCUR DURING CHEMOTHERAPY
THE LOWEST POINT THAT WBC AND PLATELETS REACH
OCCURS ABOUT 7-14 DAYS AFTER CHEMO
HOW LONG DOES IT TAKE FOR WBC AND PLATELETS TO RECOVER
3-4 WEEKS POST TREATMENT
NEUTROPENIA AT WHAT ANC?
< 1000 CELLS/MM3
SEVERE NEUTROPENIA AT WHAT ANC
< 500 CELLS/MM3
WHAT ARE G-CSFs AND THEIR NAMES?
GROWTH COLONY STIMULATING FACTORS STIMULATE WBC PRODUCTION
FILGRASTIM AND PEGFILGRASTIM
WHEN ARE CSFs GIVEN AND WHY?
GIVEN PROPHYLACTICALLY AFTER CHEMO TO SHORTEN TIME A PT IS AT RISK FOR INFECTION AND REDUCE MORTALITY FROM INFECTION.
PREVENT NEUTROPENIA
G-CSF SIDE EFFECTS
BONE PAIN, FEVER, ARTHRALGIAS, MYALGIAS, RASH
WHAT IS FEBRILE NEUTROPENIA
WHEN A FEVER IS PRESENT IN A NEUTROPENIC PATIENT.
AT RISK OF DEATH FROM SEPSIS
FEBRILE NEUTROPENIA DIAGNOSIS REQUIREMENTS
ORAL TEMP > 38.3 C
ANC < 500
FEBRILE NEUTROPENIA EMPIRIC ANTIBIOTICS STARTED WHEN AND COVER WHAT?
IMMEDIATELY AFTER FEVER OCCURS
SHOULD HAVE ADEQUATED GN COVERAGE, INCLUDING PSEUDOMONAS
FEBRILE NEUTROPENIA ABX FOR LOW RISK
LOW RISK = ANC < 500 FOR ≤ 7 DAYS AND NO COMORBIDITIES
ORAL ANTI-PSUDOMONAL: (CIPRO OR LEVO) + (AUGMENTIN OR CLINDAMYCIN)
FEBRILE NEUTROPENIA ABX FOR HIGH RISK
HIGH RISK = ANC < 100 FOR ≥10 DAYS AND COMORBIDITIES OR RENAL OR HEPATIC IMPAIRMENT
IV ANTI-PSEUDOMONA BETA-LACTAM (CEFEPIME, CEFTAZIDIME, MEROPENEM, IMI/CILASTATIN, PIP/TAZO)
WHAT ARE ESAs
ERYTHROPOIESIS-STIMULATING AGENTS
EPOETIN-ALFA (EPOGEN, PROCRIT) AND DARBEPOETIN ALFA (ARANESP)
STIMULATE RBC
WHEN TO GIVE ESAs
FOR PALLIATIVE ONLY
WHEN HGB < 10
RISK FACTORS FOR N&V
FEMALE
<50 YEARS
ANXIETY/DEPRESSION
DEHYDRATION
HX OF N&V (MOTION, PRIOR CHEMOS)
FOR CINV, WHEN DOES ONE ADMINISTER ANTIEMETICS
AT LEAST 30 MINUTES PRIOR TO CHEMOTHERAPY
PROVIDE TAKE-HOME ANTIEMETICS FOR BREAKTHROUGH
ACUTE CINV MANAGEMENT
ONSET WITHIN 24 HOURS AFTER CHEMO
5HT3-RA
NK1-RA
DEXAMETHASONE
OLANZAPINE
DELAYED CINV MANAGEMENT
ONSET > 24 HOURS AFTER CHEMO
NK1-RA
CORTICOSTEROIDS
PALONOSETRON
OLANZAPINE
WHICH CHEMO AGENT HAS THE HIGHEST EMETIC RISK POTENTIAL
CISPLATIN
WHAT IS THE PROPHYLACTIC REGIMEN IF THERE IS A HIGH-EMETIC RISK
3 OR 4 DRUGS
1) NK1-RA + 5HT3-RA + OLANZAPINE + DEXAMETHASONE
2) PALONOSETRON + OLANZAPINE + DEXAMETHASONE
3) NK1-RA + 5HT3-RA + DEXAMETHASONE
WHICH CLASSES CAN BE USED FOR BREAKTHROUGH CINV
5HT3-RA
DA-R ANTAGONISTS
CANNABINOIDS
OLANZAPINE
NK1-RA - WHAT ARE THEY?
SUBSTANCE P/NEUROKININ 1 RECEPTOR ANTAGONISTS
AUGMENTS THE ACTIVITY OF 5HT3-RA AND CORTICOSTEROIDS
APREPITANT AND FOSAPREPITANT (EMEND)
NK1-RA DDI NOTE
NK1-RAs ARE CYP3A4 INHIBITORS
NEED TO DECREASE DEXAMETHASONE DOSE (CYP3A4 SUBSTRATE) IF USED CONCURRENTLY
WHICH 5HT3-RA IS AVAILABLE AS A PATCH?
GRANISETRON
5HT3-RA CONTRAINDICATION
DO NOT USE WITH APOMORPHINE
5HT3-RA WARNINGS
QT PROLONGATION
SEROTONIN SYNDROME WITH OTHER SEROTONERGIC AGENTS
WHICH 5HT3-RA IS AVAILABLE AS COMBO AGENTS?
PALONOSETRON WITH NETUPITANT
WHICH DA RECEPTOR ANTAGONISTS ARE USED FOR CINV
PROCHLORPERAZINE
PROMETHAZINE
METOCLOPRAMIDE
OLANZAPINE
PROMETHAZINE BOXED WARNING
DO NOT USE IN CHILDREN < 2 YO (RESPIRATORY DEPRESSION)
DO NOT GIVE INTRA-ARTERIAL OR SC DUE TO SERIOUS TISSUE INJURY. DEEP IM PREFERRED
METOCLOPRAMIDE BOXED WARNING
TD THAT CAN BE IRREVERSIBLE. DC AT FIRST SIGNS
CHEMOTHERAPY INDUCED DIARRHEA MANAGEMENT
LOPERAMIDE (MAX 16 MG/DAY)
DIPHENOXYLATE + ATROPINE
WHICH AGENTS COMMONLY CAUSE DELAYED ONSET CHEMO INDUCED DIARRHEA
FLUOROURACIL
CAPECITABINE
IRINOTECAN
WHICH CHEMO AGENT CAUSES EARLY ONSET DIARRHEA? WHAT OTHER SYMPTOMS ACCOMPANY THIS?
IRINOTECAN
CHOLINERGIC EXCESS (CRAMPING, RHINITIS, LACRIMATION, SALIVATION)
TREAT W/ ANTICHOLINERGIC ATROPINE
WHICH CHEMO AGENTS ARE LIKELY TO CAUSE HAND-FOOT SYNDROME
CAPECITABINE, FLUOROURACIL
TUMOR LYSIS SYNDROME ELECTROLYTE ABNORMALITY
HYPERKALEMIA
HYPERPHOSPHATEMIA
HYPOCALCEMIA
HYPERURICEMIA
WHAT AGENT IS USED TO PREVENT HYPERURICEMIA CAUSED BY TLS
ALLOPURINOL - XANTHINE OXIDASE INHIBITOR TO PREVENT PURINES (FROM THE LYSED CELLS) FROM BEING CONVERTED TO URIC ACID AND DAMAGING THE KIDNEYS
RASBURICASE CAN BE USED WHEN ALLOPURINOL IS NOT ADEQUATE OR ALLUPURINOL-INDUCED RASH HAS OCCURRED
WHY DOES HYPERCALCEMIA OCCUR IN CANCER?
CERTAIN CANCERS CAUSE CA TO LEACH FROM THE BONE CAUSING HYPERURICEMIA AND BONES THAT ARE WEAK
MILD HYPERCALCEMIA MANAGEMENT
ASYMPTOMATIC
HYDRATION AND LOOP DIURETICS
MOD-SEV HYPERCALCEMIA MANAGEMENT
N/V, FATIGUE, DEHYDRATION, CONFUSION
CA > 12
IV HYDRATION WITH NS, CALCITONIN
IV BISPHOSPHONATES OR DENOSUMAB
WHICH BISPHOSPHONATES ARE IV
PAMIFRONATE
ZOLEDRONIC ACID
PREMEDICATIONS FOR MONOCLONAL ANTIBODY TREATMENTS
APAP AND DIPHENHYDRAMINE
MOST CHEMO AGENTS ARE MAJOR VESICANTS, NAME THE 2 BIG GROUPS
ANTHRACYCLINES
VINCA ALKALOIDS
IF EXTRAVASATION OCCURS WHAT SHOULD BE DONE? WHAT IS THE EXCEPTION?
COLD COMPRESSES
EXCEPT VINCA ALKALOIDS AND ETOPOSIDE, USE WARM COMPRESS
WHAT IS THE ANTIDOTE IN THE EVENT OF ANTHRACYCLINE EXTRAVASATION
DEXRAZOXANE
DIMETHYL SULFOXIDE
WHAT IS THE ANTIDOTE IN THE EVENT OF VINCA ALKALOID OR ETOPOSIDE EXTRAVASATION
HYALURONIDASE
WHICH CHEMO DRUGS CAN BE GIVEN INTRATHECALLY
CYTARABINE
METHOTREXATE
HYDROCORTISONE
THIOPTA
ALL MEDICATIONS THAT ARE GIVEN INTRATHECALLY SHOULD NOT HAVE WHAT?
PRESERVATIVES
WHICH CHEMO AGENT IF GIVEN INTRATHECALLY IS FATAL
VINCRISTINE
