Oncology: side effect management Flashcards
Screening for breast cancer
Aged 20 to 40 clinical breast exam every one to three years
Age greater than 40: clinical breast exam and mammography yearly
Warning signs
CAUTION
C: change in bowel or bladder habits A: sore that does not heal U: unusual bleeding or discharge T: thickening or lump in breast or elsewhere I: indigestion or difficulty swallowing O: obvious change and worked on mole N: Megan cough or hoarseness
Colon Cancer screening
Age greater than 50: annual physical oculist blood test or SQL immuno chemical test and one of the following: every five years sigmoidoscopy, contrast enema, CT scan or colonoscopy (every 10 years)
Screening for cervical cancer
Age 21 to 29: Pap smear only every three years
Age 30 to 65: Pap every three years or pap plus HPV testing every five years
Screening for prostate cancer
Start discussion at age 40 to 50 for a PSA with or without digital rectal exam
Screening for a lung cancer
Age 55–74 with greater than or equal to 30 pack your smoking history and are either still smoking or have quit for less than 15 years (low-dose CT scan)
Things that can reduce the risk of cancer
Stay away from tobacco products, stay at a healthy weight, get regular physical activity, eat healthy with plenty of fruits and vegetables, limit alcohol, protect your skin, know yourself your family and your risk, have regular checkups and cancer screenings
myelosuppression: anemia, neutropenia, thrombocytopenia
The lowest point that the white blood cells and platelets for each, also referred as the nadir, occurs about 7 to 14 days after chemotherapy
The someone’s generally recovered 3 to 4 weeks post treatment
Anemia: erythropoietin stimulating agents are not used as routinely anymore as it shortened survival and increases tumor progression
ESA agents now follow a rems program
Iron levels must be obtained as ESA’s will not work well to correct anemia if iron levels are inadequate
Erythropoietin stimulating agent
Blackbox warning: shortened overall survival and/or increased risk of tumor progression or recurrence; must follow the ESA apprise oncology program; patient must receive med guide monthly; use the lowest dose necessary to avoid the need for red blood cell transfusions; should only be used if hemoglobin is less than 10 and at least two additional months of chemotherapy are planned
These agents are not indicated for patients receiving myelosuppressive chemotherapy when the anticipated outcome is a cure
Drugs: Epoetin Alfa (Epogen, Procrit); Darbepoetin (Aranesp)
Contraindication: uncontrolled hypertension, pure red cell aplasia that begins after treatment, multidose vials containing benzyl alcohol contraindicated in neonates, infants, pregnancy and lactation
Side effects: hypertension, fever, headache, bone pain, rash, nausea, call my thrombosis, edema, chills, dizziness
Monitoring: Hgb, HCT, iron, blood pressure
Notes: store in the refrigerator
Management of neutropenia
Result: increase infection risk and inability to fight infection
ANC= WBC x (%segs + %bands)/100
Neutropenia = ANC < 1000 Severe neutropenia = ANC 20% chance of developing febrile neutropenia: myeloid growth factors 1. Sargramostin (leukine) 2. Filtration (Neupogen) 3. Pegfilgrastim (Neulasta)
Side effects (2,3): bone pain, fever, rash Side effects (1): fever, bone pain, arthralgia, myalgia, rash, dyspnea, peripheral Adema, pericardial effusion, cardiovascular edema, hypertension, chest pain
Notes: store in the refrigerator; Edminister first dose 24–72 hours after the end of chemotherapy
Thrombocytopenia management
A.k.a. low platelets (may result in spontaneous bleeding) chemotherapy should be held until the platelet count recovers
Platelet transfusions are generally indicated when the count falls below 10,000 per millimeter^3 or 20,000 if an active bleed is present
Chemotherapy induced nausea and vomiting
Prevention is essential
Risk factors which increase the risk: female gender, less than 50 years of age, dehydration, history of motion sickness, and history of nausea/vomiting with prior regimens
Give antiemetics at least 30 minutes prior to chemotherapy and provide take-home antimanic medications such as ondansetron, prochlorpromazine, or metoclopramide
Three drug regimen:
1. Aprepitant (Emend) AND
2. Dexamethasone AND
3. Ondansetron, Granisetron, Dolasetrom, palonosetron
4 . ± Lorazepam, ± H2 receptor antagonist or proton pump inhibitor
Alternative to three drug typical anti-emetic regimen
Alternative for highly or moderately emetogenic regimens
- Olanzapine AND
- Dexamethasone AND
- Palonosetron
Regimen for moderate emetic risk chemotherapy
Typically a two drug combination of a steroid and a five HT3 antagonists with or without a neurokinin one antagonist
Low emetic risk regimen
Typically a one drug regimen of either a five HT three antagonist, dexamethasone, prochlorperazine or metoclopramide
