ONCOLOGY SE MENAGEMENT

Question 1

WHAT IS NADIR AND WHEN DOES IT OCCUR DURING CHEMOTHERAPY

Answer 1

THE LOWEST POINT THAT WBC AND PLATELETS REACH
OCCURS ABOUT 7-14 DAYS AFTER CHEMO

Question 2

HOW LONG DOES IT TAKE FOR WBC AND PLATELETS TO RECOVER

Answer 2

3-4 WEEKS POST TREATMENT

Question 3

NEUTROPENIA AT WHAT ANC?

Answer 3

< 1000 CELLS/MM3

Question 4

SEVERE NEUTROPENIA AT WHAT ANC

Answer 4

< 500 CELLS/MM3

Question 5

WHAT ARE G-CSFs AND THEIR NAMES?

Answer 5

GROWTH COLONY STIMULATING FACTORS STIMULATE WBC PRODUCTION
FILGRASTIM AND PEGFILGRASTIM

Question 6

WHEN ARE CSFs GIVEN AND WHY?

Answer 6

GIVEN PROPHYLACTICALLY AFTER CHEMO TO SHORTEN TIME A PT IS AT RISK FOR INFECTION AND REDUCE MORTALITY FROM INFECTION.
PREVENT NEUTROPENIA

Question 7

G-CSF SIDE EFFECTS

Answer 7

BONE PAIN, FEVER, ARTHRALGIAS, MYALGIAS, RASH

Question 8

WHAT IS FEBRILE NEUTROPENIA

Answer 8

WHEN A FEVER IS PRESENT IN A NEUTROPENIC PATIENT.
AT RISK OF DEATH FROM SEPSIS

Question 9

FEBRILE NEUTROPENIA DIAGNOSIS REQUIREMENTS

Answer 9

ORAL TEMP > 38.3 C
ANC < 500

Question 10

FEBRILE NEUTROPENIA EMPIRIC ANTIBIOTICS STARTED WHEN AND COVER WHAT?

Answer 10

IMMEDIATELY AFTER FEVER OCCURS
SHOULD HAVE ADEQUATED GN COVERAGE, INCLUDING PSEUDOMONAS

Question 11

FEBRILE NEUTROPENIA ABX FOR LOW RISK

Answer 11

LOW RISK = ANC < 500 FOR ≤ 7 DAYS AND NO COMORBIDITIES
ORAL ANTI-PSUDOMONAL: (CIPRO OR LEVO) + (AUGMENTIN OR CLINDAMYCIN)

Question 12

FEBRILE NEUTROPENIA ABX FOR HIGH RISK

Answer 12

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)

Question 13

WHAT ARE ESAs

Answer 13

ERYTHROPOIESIS-STIMULATING AGENTS
EPOETIN-ALFA (EPOGEN, PROCRIT) AND DARBEPOETIN ALFA (ARANESP)
STIMULATE RBC

Question 14

WHEN TO GIVE ESAs

Answer 14

FOR PALLIATIVE ONLY
WHEN HGB < 10

Question 15

RISK FACTORS FOR N&V

Answer 15

FEMALE
<50 YEARS
ANXIETY/DEPRESSION
DEHYDRATION
HX OF N&V (MOTION, PRIOR CHEMOS)

Question 16

FOR CINV, WHEN DOES ONE ADMINISTER ANTIEMETICS

Answer 16

AT LEAST 30 MINUTES PRIOR TO CHEMOTHERAPY
PROVIDE TAKE-HOME ANTIEMETICS FOR BREAKTHROUGH

Question 17

ACUTE CINV MANAGEMENT

Answer 17

ONSET WITHIN 24 HOURS AFTER CHEMO
5HT3-RA
NK1-RA
DEXAMETHASONE
OLANZAPINE

Question 18

DELAYED CINV MANAGEMENT

Answer 18

ONSET > 24 HOURS AFTER CHEMO
NK1-RA
CORTICOSTEROIDS
PALONOSETRON
OLANZAPINE

Question 19

WHICH CHEMO AGENT HAS THE HIGHEST EMETIC RISK POTENTIAL

Answer 19

CISPLATIN

Question 20

WHAT IS THE PROPHYLACTIC REGIMEN IF THERE IS A HIGH-EMETIC RISK

Answer 20

3 OR 4 DRUGS
1) NK1-RA + 5HT3-RA + OLANZAPINE + DEXAMETHASONE
2) PALONOSETRON + OLANZAPINE + DEXAMETHASONE
3) NK1-RA + 5HT3-RA + DEXAMETHASONE

Question 21

WHICH CLASSES CAN BE USED FOR BREAKTHROUGH CINV

Answer 21

5HT3-RA
DA-R ANTAGONISTS
CANNABINOIDS
OLANZAPINE

Question 22

NK1-RA - WHAT ARE THEY?

Answer 22

SUBSTANCE P/NEUROKININ 1 RECEPTOR ANTAGONISTS
AUGMENTS THE ACTIVITY OF 5HT3-RA AND CORTICOSTEROIDS
APREPITANT AND FOSAPREPITANT (EMEND)

Question 23

NK1-RA DDI NOTE

Answer 23

NK1-RAs ARE CYP3A4 INHIBITORS
NEED TO DECREASE DEXAMETHASONE DOSE (CYP3A4 SUBSTRATE) IF USED CONCURRENTLY

Question 24

WHICH 5HT3-RA IS AVAILABLE AS A PATCH?

Answer 24

GRANISETRON

Question 25

5HT3-RA CONTRAINDICATION

Answer 25

DO NOT USE WITH APOMORPHINE

Question 26

5HT3-RA WARNINGS

Answer 26

QT PROLONGATION SEROTONIN SYNDROME WITH OTHER SEROTONERGIC AGENTS

Question 27

WHICH 5HT3-RA IS AVAILABLE AS COMBO AGENTS?

Answer 27

PALONOSETRON WITH NETUPITANT

Question 28

WHICH DA RECEPTOR ANTAGONISTS ARE USED FOR CINV

Answer 28

PROCHLORPERAZINE PROMETHAZINE METOCLOPRAMIDE OLANZAPINE

Question 29

PROMETHAZINE BOXED WARNING

Answer 29

DO NOT USE IN CHILDREN < 2 YO (RESPIRATORY DEPRESSION) DO NOT GIVE INTRA-ARTERIAL OR SC DUE TO SERIOUS TISSUE INJURY. DEEP IM PREFERRED

Question 30

METOCLOPRAMIDE BOXED WARNING

Answer 30

TD THAT CAN BE IRREVERSIBLE. DC AT FIRST SIGNS

Question 31

CHEMOTHERAPY INDUCED DIARRHEA MANAGEMENT

Answer 31

LOPERAMIDE (MAX 16 MG/DAY) DIPHENOXYLATE + ATROPINE

Question 32

WHICH AGENTS COMMONLY CAUSE DELAYED ONSET CHEMO INDUCED DIARRHEA

Answer 32

FLUOROURACIL CAPECITABINE IRINOTECAN

Question 33

WHICH CHEMO AGENT CAUSES EARLY ONSET DIARRHEA? WHAT OTHER SYMPTOMS ACCOMPANY THIS?

Answer 33

IRINOTECAN CHOLINERGIC EXCESS (CRAMPING, RHINITIS, LACRIMATION, SALIVATION) TREAT W/ ANTICHOLINERGIC ATROPINE

Question 34

WHICH CHEMO AGENTS ARE LIKELY TO CAUSE HAND-FOOT SYNDROME

Answer 34

CAPECITABINE, FLUOROURACIL

Question 35

TUMOR LYSIS SYNDROME ELECTROLYTE ABNORMALITY

Answer 35

HYPERKALEMIA HYPERPHOSPHATEMIA HYPOCALCEMIA HYPERURICEMIA

Question 36

WHAT AGENT IS USED TO PREVENT HYPERURICEMIA CAUSED BY TLS

Answer 36

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

Question 37

WHY DOES HYPERCALCEMIA OCCUR IN CANCER?

Answer 37

CERTAIN CANCERS CAUSE CA TO LEACH FROM THE BONE CAUSING HYPERURICEMIA AND BONES THAT ARE WEAK

Question 38

MILD HYPERCALCEMIA MANAGEMENT

Answer 38

ASYMPTOMATIC HYDRATION AND LOOP DIURETICS

Question 39

MOD-SEV HYPERCALCEMIA MANAGEMENT

Answer 39

N/V, FATIGUE, DEHYDRATION, CONFUSION CA > 12 IV HYDRATION WITH NS, CALCITONIN IV BISPHOSPHONATES OR DENOSUMAB

Question 40

WHICH BISPHOSPHONATES ARE IV

Answer 40

PAMIFRONATE ZOLEDRONIC ACID

Question 41

PREMEDICATIONS FOR MONOCLONAL ANTIBODY TREATMENTS

Answer 41

APAP AND DIPHENHYDRAMINE

Question 42

MOST CHEMO AGENTS ARE MAJOR VESICANTS, NAME THE 2 BIG GROUPS

Answer 42

ANTHRACYCLINES VINCA ALKALOIDS

Question 43

IF EXTRAVASATION OCCURS WHAT SHOULD BE DONE? WHAT IS THE EXCEPTION?

Answer 43

COLD COMPRESSES EXCEPT VINCA ALKALOIDS AND ETOPOSIDE, USE WARM COMPRESS

Question 44

WHAT IS THE ANTIDOTE IN THE EVENT OF ANTHRACYCLINE EXTRAVASATION

Answer 44

DEXRAZOXANE DIMETHYL SULFOXIDE

Question 45

WHAT IS THE ANTIDOTE IN THE EVENT OF VINCA ALKALOID OR ETOPOSIDE EXTRAVASATION

Answer 45

HYALURONIDASE

Question 46

WHICH CHEMO DRUGS CAN BE GIVEN INTRATHECALLY

Answer 46

CYTARABINE METHOTREXATE HYDROCORTISONE THIOPTA

Question 47

ALL MEDICATIONS THAT ARE GIVEN INTRATHECALLY SHOULD NOT HAVE WHAT?

Answer 47

PRESERVATIVES

Question 48

WHICH CHEMO AGENT IF GIVEN INTRATHECALLY IS FATAL

Answer 48

VINCRISTINE