Supportive Cancer Care (Exam 1 Cut Off) Flashcards
1
Q
Chemo-Induced Myelosuppression
A
- Major dose-limiting toxicity of chemo agents
- Limits many chemo regimens to intervals or every 2-3 weeks (possible longer)
- Affects short-lived WBCs (neutrophils) and platelets particularly
- Results in febrile neutropenia which can lead to morbidity, mortality, and extra costs
2
Q
CSF Pharmacology
A
- Dose-related increase in WBCs with considerable patient variability
- GM-CSF also stimulates the production of macrophages
- WBCs produced are CSF influence and functionally identical to normally produced ones
- EPO and darbopoetin produce dose-related increases in RBCs
3
Q
CSF for FN Prevention
A
- Indicated with receiving chemo regimen with significant risk of FN or prior DN with same chemo regimen
- Not effective when employed therapeutically to treat already established FN
- Not useful when bone marrow suppression is occurring from cancer as well
4
Q
CSF ADRs
A
- Bone pain (antihistamines can possibly manage)
- Rashes
- Fever
- Dyspnea
- Pulmonary edema
5
Q
CSF Agent Information
A
- Filgrastim (G-CSF) - D/C when ANC > 200,000
- Pegfilgrastim - most convenient and costly option
- Sargramostim (GM-CSF) - continue until ANC > 1500 for 3 days straight, can be dosed SQ as well
6
Q
EPO for Anemia in Onc Patients
A
- Approved and commonly used for chemo-induced anemia
- Black Box: Higher chance of serious/life-threatening SE/death like CV events and could speed up disease progression
7
Q
Febrile Neutropenia
A
- Fever > 38.2 with ANC < 1000
- Prevention: sterile technique when starting central lines, using certain central lines
8
Q
Management of FN
A
- Hospitalization
- Broad spectrum antibiotic therapy
- Fungicidal agent initiated in those who are still febrile and neutropenic after 4-7 days of broad spectrum therapy or in those who develop sepsis that isn’t responsive to therapy
9
Q
Anti-fungals + FN
A
- Conventional Amp B (infusion related toxicity, mephrotox, phlebitis)
- AmBisome: similar efficacy and less fever/chills/nephrotox than conventional Amp
- Caspofungin - less nephrotox and infusion reactions than AmBisome
DON’T use conazoles
10
Q
Mucositis
A
- Mucosal injury from chemo
- Lasts 3-5 days but variable
- Most commonly associated with high-dose methotrexate, 5-FU, and anthracyclines
- All who receive radiotherapy to head/neck are likely to develop
- Grade 3/4 require hospitalization, TPN, and/or opiates
- Increases secondary infection risk
- May need to reduce doses or delay therapy if this occurs
- Prevention: Correct oral disease before starting chemo
11
Q
Mucositis Grading
A
- Grade 0 - no mucositis
- Grade 1 - painless ulcers, erythema, or mild soreness
- Grade 2 - painful erythema, edema, or ulcers but can eat
- Grade 3 - painful erythema, edema, or ulcers, cannot eat
- Grade 4 - requires parenteral or enteral support
12
Q
Mucositis Options
A
- Benzydamine mouthwash , oral cryotherapy, Palifermin before/after chemo, PCA with morphine to treat pain
- Preventions: oral care protocols, low-level laser therapy for H/N RT, oral zinc supplements
- Management: morphine or doxepin mouthwash
13
Q
Chemo Extravasation Injury
A
Two Categories
- Don’t bind to tissue nucleic acids: immediate tissue damage but quickly metabolized/inactivated, similar to a burn
- Bind to tissue nucleic acids: immediate injury, lodges in tissue, binds to DNA, prolonged course of injury, results in extravasation injuries and necrosis of skin/SQ tissue. Heals at a slow rate and can damage tendons in the area too
14
Q
Binding Agent Presentation
A
- Burning sensation during drug infusion
- Tissue will become red and firm which can progress to ulceration
- Key feature: progressive (small and gets worse)
15
Q
Binding Agent Management
A
- Prevention: Central venous catheter use, administer in free flowing IV, assure catheter is in vein before admin.
- If there is a complaint of burning/stinging or local swelling occurs, stop infusion and attach a syringe to draw back on catheter
- If extravasation is expected, use intermittent ice packs and elevation
