Oncology Supportive Care

Question 1

What are the high emetic risk chemotherapies?

Answer 1

AC (anthracycline and cyclophosphamide combo, carboplatin AUC >4, cisplatin, cyclophosphamide (high doses).

Question 2

What is the prophylaxis treatment for high emetic risk chemo?

Answer 2

3 or 4 drug regimen.

NK1 (apreptitant, foraprepitant, rolapitant) AND Serotonin-3 antagonist AND Steroid +/1 Olanzapine (preferred), lorazepam, or H2 blocker or PPI on day 1.

Day 2-4 is Dex and if aprepitant on Day 1, give on days 2 and 3 also.

Question 3

What is prophylaxis treatment for moderate emetic risk chemo?

Answer 3

Serotonin-3 antagonist and steroid (dex) on day 1. Days 2 and 3 is Serotonin-3 antagonist or dex.

Question 4

How to treat mild to moderate pain in cancer?

Answer 4

1st step is a non-opioid analgesic (NSAID or Tylenol), can consider slow titration of short-acting opioids.

Question 5

How to treat persistent or moderate to severe pain

Answer 5

Add a weak opioid (Codeine or hydrocodone in combo with a non opioid analgesic)

Question 6

How to treat persistent or severe pain?

Answer 6

Replace weak opioid with a strong one (morphine, oxycodone).

Question 7

What is the ANC formula?

Answer 7

WBC * (Neutrophils +Bands)/100

Question 8

When is it appropriate to use CSF?

Answer 8

In a curative setting.

Question 9

What is peg filgrastims side effect?

Answer 9

Bone pain

Question 10

How to treat febrile neutropenia?

Answer 10

Definitely need anti pseudomnal coverage. Cefepime, Pip/Tazo, Carbapenem.

Question 11

Can you use ESAs in cancer?

Answer 11

Yes but Hgb <10 and chemotherapy associated anemia. Only use in patients with non-curable cancer.

Question 12

What is micro vs macrocytic anemia?

Answer 12

Micro is iron deficiency, macro is b12 or folate deficiency.

Question 13

How much elemental iron is in oral ferrous sulfate?

Answer 13

65 mg. Treatment for microcytic is 200 divided twice or 3 times daily for 3-6 months. Take with food, Vitamin C may increase absorption.

Question 14

Which parental iron product needs a test dose?

Answer 14

Iron dextran.

Question 15

What does dexrazoxane do?

Answer 15

Protects from anthracycline (doxorubicin, etc.) and anthracenedione cardiomyopathy in patients who received 300 mg/m2 of doxorubicin. It also helps with doxorubicin extravasation

Question 16

What does amifostine do?

Answer 16

Protects from nephrotoxicity from cisplatin.

Question 17

What does mesna do?

Answer 17

Used with ifosfamide and cyclophosphamide and prevents sterile hemorrhagic cystitis.

Question 18

What does leucovorin help with?

Answer 18

Methotrexate toxicity.

Question 19

What drug helps with treating toxic methotrexate concentrations?

Answer 19

Glucarpidase.

Question 20

What is corrected calcium equation?

Answer 20

(4-albumin) X 0.8 + serum cal. Lethargic, confused, anorexia, nausea, etc. symptoms

Question 21

How to treat hypercalcemia?

Answer 21

Hydration, loop diuretics, bisphosphantes, calcitonin, steroids, phosphate if hypophosphatemic and hypercalcemia, dialysis may be needed in renal failure

Question 22

How to treat spinal cord compression?

Answer 22

Dexamethasone and radiation therapy or surgery

Question 23

How to manage extravasation?

Answer 23

Heat for V’s, cold for others.

Question 24

How to prevent TLS?

Answer 24

Parenteral hydration with NS and allopurinol

Question 25

How to manage diarrhea?

Answer 25

Loperamide for irinotecan. Sometimes atropine.

Question 26

What ANC is needed for a patient to receive chemo?

Answer 26

1500. Less than 500 has life threatening infection risk, less than 100 is the greatest risk.