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444-Oncology and Neurology > Prevention and Management of Antineoplastic AEs > Flashcards

Prevention and Management of Antineoplastic AEs Flashcards

1
Q

what does the CTCAE stand for

A

common terminology criteria for AEs

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2
Q

Asymptomatic or mild sx
Clinical or diagnostic observations only
Interventions not needed

A

grade 1

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3
Q

Minimal sx
Local or noninvasive intervention indicated

A

grade 2

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4
Q

Severe or medically significant but not immediately life threatening
Hospitalization or prolongation of hospitalization indicated

A

grade 3

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5
Q

Life threatening consequences
Urgent intervention indicated

A

grade 4

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6
Q

death grade

A

5

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7
Q

mouth related AEs to chemo

A

cracked, dry lips
dry mouth
mucositis
taste changes
cavities
thick saliva

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8
Q

define oral mucositis

A

acute inflammation and or ulceration of the oral or oropharyngeal mucosal membranes
can cause pain/ discomfort and interfere with eating, swallowing, and speech

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9
Q

causes of oral mucositis

A

radiation of head, neck, salivary glands, total body
chemo continuous or at high doses
hematopoietic stem cell transplant (HSCT)

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10
Q

RF for oral mucositis

A

xerostomia
poor oral health
dehydration
alcohol/ tobacco use
O2 therapy

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11
Q

prevention for oral mucositis

A

good oral hygrine
alcohol free chlorhexidine rinses
bland mouth rinses after meals
cryotherapy

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12
Q

what should be used as an extra precaution against oral mucositis if there is head/neck radiation treatment

A

high fluoride toothpaste or fluoride trays

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13
Q

when should cryo not be used as a precaution against oral mucositis?

A

if using oxaliplatin

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14
Q

how to do cryo for oral mucositis prevention

A

hold ice chips, popsicles, or cold water in mouth 5 min prior, during, and 30 min after infusion (do not use with oxiplatin)

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15
Q

what should be avoided in oral mucositis

A

Commercial mouthwashes with alcohol, hard/ acidic/ spicy/ salty foods, poorly fitting dentures (may need to refit after weight loss), caffeine, alcohol, tobacco

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16
Q

Moderate pain, not interfering with oral intake, modified diet indicated grade for oral mucositis

A

grade 2

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17
Q

oral mucositis that is interfering with eating is classified as

A

grade 3

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18
Q

treatment for grade 1-2 oral mucositis includes (4 things)

A

bland rinses
benzdyamine HCL rinses
pain control with systemic or topical analgesics
sips of water

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19
Q

treatment for grade 2-3 oral mucositis

A

switch from toothbrush to oral sponge
pink ladies
akabutu’s mouthwash

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20
Q

what is pink ladies for oral mucositis

A

lidocaine + aluminium hydroxide + magnesium hydroxide

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21
Q

caution with pink ladies

A

fatal arrhythmias from systemic eff of lidocaine

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22
Q

why is akabutu’s mouthwash sus

A

thrush (d/t corticosteroid)
resistance due to subtherapeutic lvl of nystatins
may not be better than saline for healing time
expensive

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23
Q

what is akabutu’s mouthwash

A

nystatin, lido, NaCl, hydrocortisone, glycerin

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24
Q

how to use akabutu’s mouthwash

A

swish 15-20mL F1min, spit, q4-6hrs PRN

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25
what to use for grade 3-4 oral mucositis
topical opioid mouthwash (morphine) lidocaine viscous 2% tetracaine 0.5% lollipops systemic pain control- maybe opioids
26
which of the following mouthwashes can you swallow? 1. lidocaine viscous 2% 2. morphine mouthwash 3. tetracaine mouthwash 4. akabutu's mouthwash 5. pink ladies
lidocaine viscous for pharyngeal mucositis
27
tx for grade 4 oral mucosotis
hospitalization + pt controlled analgesia of iV opioids
28
____ can be given for oral mucositis for those on everolimus
dexamethasone 0.5mg/5mL
29
what is doxepin 0.5% mouthwash used for?
oral mucositis
30
what is hand food syndrome or PPE
redness and pain on palms of hands and feet
31
RF for PPE
>65yrs female friction heat excessive alcohol use
32
most common culprits of PPE
capecitabine, 5FU, sorafenib, cytarabine, docetaxel and paclitaxel
33
first sx of PPE
tingling and numbness of soles and palms
34
PPE prevention
skincare / hygiene avoid head (including wearing gloves while washing the dishes) foot care- comfy fitted shoes hand care- avoid chemicals and stressing actions (clapping)
35
Minimal skin changes or dermatitis (erythema, edema, or hyperkeratosis without pain)
grade 1
36
Skin changes (peeling, blisters, bleeding, edema, or hyperkeratosis) with pain, limiting instrumental ADH
grade 2
37
Severe skin changes (peeling, blisters, bleeding, edema, or hyperkeratosis) with pain, limiting self care ADL
grade 3
38
PPE treatment
oral analgesics, topical CS, cool packs on palms emollients oral dexamethasone celecoxib
39
when would you not recommend flossing to a pt with oral mucositis
if it causes pain/ bleed or if platelets <50
40
chemo induced alopecia usually sets in by
1-3wks
41
how long after chemo will hair come back?
6-8wks
42
most common antineoplastics for alopecia
cyclophosphamide anthracyclines taxanes etoposides
43
what antineoplastics are commonly associated with hypersensitivity rxns
taxanes platinums bleomycin monoclonal abx (rituximan)
44
when do hypersensitivity/ infusion reactions to antineoplastics usually happen
first few min/hours of first dose but can be up to 48hrs later
45
how to prevent hypersensitivity reactions to chemo
follow recommendations of spec meds incorporate 1 or more: systemic CS, HH1 antagonist, H2 antagonist, and an antipyretic
46
what are some systemic CSs that can be incorporated to prevent hypersens rxns
hydrocortisone prednisone dexamethasone
47
what to do if hypotension is a concern for chemo pt
if they have antihypertensives- ask them to hold for 24hrs pre chemo
48
what to do if pt has a hypersensitivity rxn to chemo
stop infusion, start supportive care with CS, antihistamines, antipyretics, oxygen rechallenge if mild-mod reaction
49
what antineoplastic agents are commonly associated with constipation
vinca alkaoids 5HT3RA opioids
50
what should chemo pts do after meals if they're prone to constipation?
try to poop 30-60min after eating to take advantage of gastrocolic reflex
51
what should be avoided for constipation if pt is on myelosuppressive chemo?
suppositories, enemas, rectal exams due to lo platelet count or neutropenia
52
what should be monitored if pt is constipated on chemo
BM frequency, stool appearances, effort to defecate
53
what are some warnng sgns of bowel obstructon
can't pass gas sudden watery darrhea after constpaton
54
f pt has no BM after ____days they need pharm help
3
55
what are some symptoms of possible spinal cord compression
sensory loss and motor weakness = refer to ER
56
Occasional or intermittent sx, occasional use of stool softeners, laxatives, dietary mod, or edema
grade 1
57
Persistent sx w/ regular laxatives or enemas, limiting instrumental ADLs
grade 2
58
Constipation with manual evacuation indicated, Limiting self care ADL
grade 3
59
what types of laxatives should be given to chemo induced constipaiton?
sennosides PEG is sennosides are too harsh
60
how to use sennosides for chemo induced constipation
start with regular dosing then progressively increase until normal bowel pattern restored and movements are soft and comfortable to pass
61
how long does PEG take to work?
2-3d
62
when can you use rectal products for chemo induced constipation
if pt not at risk of neutropenia or thrombocytopenai
63
if constipation with pervious chemo sessions, consider ___________
prophylactic PEG3350

444-Oncology and Neurology (22 decks)

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