Oncology Supportive Care Flashcards
When should prophylactic antiemetics be used? ie emetogenic class of chemo and radiation
moderately or highly emetogenic chemo agents and highly emetogenic radiation
What chemo agents are best known for delayed N/V?
cisplatin
doxorubicin/cyclophosphamide
How many days should patients be protected for full period of risk for NV?
3 days if highly emetogenic and 2 days if moderately
What anti-emetogenic regimen is used for highly emetogenic chemo and radiation?
-Neurokinin (NK1) receptor antagonist
-Serotonin receptor antagonist
-Dexamethasone
+/- OLZ
+/- Lorazepam
+/- H2RA or PPI
What anti-emetogenic regimen is used for moderately emetogenic chemo and radiation?
-Serotonin receptor antagonist
-Dexamethasone
+/-Neurokinin (NK1) receptor antagonist
What are the most common serotonin-3 receptor antagonists?
dolasetron, granisetron, ondansetron, and palonosetron
What are some special considerations to take into account when prescribing palonosetron?
Half-life is ~40 hours, generally just give one dose
-PO can be given as combo product with NK1 antagonist
When should corticosteroid antiemetics be avoided?
-Immune checkpoint inhibitors when administered without cytotoxic chemo
-avoid for 3-5 days before and 90 days after CAR T-cell therapies
What are the most common NK1 receptor antagonists?
-aprepitant
-fosapripant
-rolapitant
When can NK1 receptor antagonists be used alone?
never, must be used in combo with serotonin receptor antagonists and dex
Common NK1 DDI?
Metabolized by CYP 3A4 and minor metabolism by CYP1A2 and CYP2C19
-oral contraceptives
-warfarin
-caution with R-CHOP
Common side effects of NK1 RAs?
Headachem asthenia, dyspepsia, constipation
What emesis treatment should be used for highly emetogenic oral chemo?
-Serotonin antagonist
+/- Lorazepam
+/- H2RA or PPI
What antiemetic should be used for low emetogenic risk oral chemos?
Metoclopramide OR prochlorperazine or serotonin RA
What is the MOA of benzamide analogs? What is the most common benzamide analog?
MOA -blockage of Dopamine receptors, stimulation of cholinergic activity in gut, increase gut motility
Ex: metoclopramide
What is the MOA of phenothiazines? What are the most common phenothiazines?
MOA: block dopamine receptors
Ex: prochlorperazine, chlorpromazine, promethazine
When should bisphosphinates be started in patients with breast cancer?
Start in pts with evidence of bone metastases
-Give pamidronate or zolendronic acid every 3-4 weeks
When does the nadir generally occur?
10-14 days after chemo administration
How is the ANC calculated?
If the WBC is 4500 and 10% segmented neutrophils and 5% band neutorophils what is the ANC?
ANC= WBC x percentage of granulocytes or neutrophils
4500 (0.1+0.05)= 675
What is the WBC, ANC, and platelet count cut off to determine if a PT should receive chemo?
WBC >3000, ANC >1500, platelet count >100,000
There are exceptions to these rules
What is the definition of neutropenia?
ANC <500 or count of less than 1000 with a predicted decrease to less than 500 during the next 48 hours
What ANC indicates a CSF should be used?
-As primary prophylaxis which chemo regs associated with 20% or greater risk of febrile neutropenia, continue until post-nadir ANC is >10,000
-Use as secondary prophy if post-nadir ANC is
When should CSF be used for patients with established neutropenia?
PT who have febrile neutropenia and risk factors for complications
How should macrocytic anemia be treated?
IM or PO vitamin B12 replacement
What are common erythropoiesis-stimulating agents [ESAs]. When are they approved to be used?
Epstein and darbepoetin Alfa
-Can be used for chemo associated (not cancer associated) anemia once Hgb <10
What is dexrazoxane?
Chelating agent to decrease anthracycline-induced free radical damage
What are examples of anthracyclines?
-Suffix “rubicin”
Danorubicin, doxorubicin, idarubicin, epirubicin
What is amifostine? Why is it not commonly used in clinical practice?
Prevents nephrotoxicity from cisplatin, can cause dangerous hypotension
When is mesna used and why?
Used when acrolein is present in the bladder, Acrolein is a metabolite of cyclophosphamide and ifosfamide and mesna inactivates Acrolein and prevents its interaction with the bladder
When does leucovorin need to be used?
may be used after methotrexate doses >100 mg/m2 and should be used in doses >500mg/m2,
-Continue until 24048 hour methotrexate level is <0.1mM
What are factors that increase likelihood of methotrexate toxicity?
Renal dysfunction, third-space fluid
What kind of toxicity does methotrexate cause?
Mucous membrane toxicity, renal and hepatic toxicity, CNS toxicity and myelosupprossion
What is Glucarpidase?
Carboxypeptidase indicated for treating toxic methotrexate concentrations ( do not give leucovorin within 2 hours before or after a dose of glucarpidase)
Should you use heat, cold, hyaluronidase, or sodium thiosulfate for doxorubicin, danorubicin, and epirubicin?
Cold
Should you use heat, cold, hyaluronidase, or sodium thiosulfate for vincristine, vinblastine, and vinorelbine?
Heat
Should you use heat, cold, hyaluronidase, or sodium thiosulfate for mecholrethamine?
Sodium thiosulfate
Should you use heat, cold, hyaluronidase, or sodium thiosulfate for vinal alkaloids?
Hyaluronidase
