Supportive Care 1 Flashcards
Side effects of 5-HT3 antagonists
headache
constipation
EKG changes (do not exceed 16 mg)
Side effects of dexamethasone
anxiety
euphoria
insomnia
hyperglycemia
increased appetite
Side effects of NK-1 antagonists
hiccups
drug interactions
Side effects of D2 antagonists
EPS
diarrhea
sedation
Side effects of atypical antiphsycotics
dystonia
sedation
weight gain
Side effects of Phenothiazines
sedation
EPS
Side effects of Cannabinoids
drowsiness
dizziness
euphoria
mood changes
hallucinations
increases appetite
Side effects of Benzodiazepines
sedation
urinary incontinence
hypotension
hallucinations
Filgrastim
CSF
Administration: daily subQ
Initiation: 3-4 days after completion of chemo and continue post-nadir ANC recovery til normal
Effects: regulates production, maturation, and function of neutrophil cell line
SE: Flu-like symptoms
Bone and joint pain: treat with Tylenol, NSAIDS, loratadine, DVT
Pegfilgrastim
Administration: 1-time SubQ
Initiation: 24 hours after chemo up to 2-4 days after chemo
At least 2 weeks should be spent before next cycle of chemo
Effects: regulation production, maturation, function of neutrophil cell line
SE: Flu-like symptoms, bone and joint pain, DVT
Pearls: Non-linear PK increase clearance with increased neutrophil count
Offered in an on-body injector that is injected 24 hours after chemo
Filgrastim biosimilars
Filgrastim-sndz
Filgrastim-aafi
Filgrastim-ayow
TBO-FILGRASTIM IS NOT A BIOSIMILAR
Epoetin alfa
ESA
Frequency: SubQ weekly
Dose adjustments: If Hb has increased by > 1g/dL in a 2-week period–>decrease dose by 25%
Darbepoetin
Frequency: SubQ weekly or every 3 weeks
Dose adjustments: If Hb increase by > 1g/dL in a 2-week period–>decrease dose by 40%
Neutropenia
Normal: 4.8-10.8 x103
Severely low: < 0.5 x 103
neutropenia, leukopenia, gransulocytopenia
Febrile: < 0.5 x 103 AND temperature > 101 or > 100.4 for an hour
Risks: serious infections
Fever is the only reliable factor
Thrombocytopenia
Normal 140-440 x 103
Severely low: < 100 x 103
Transfusion required: < 10 x 103
Risks: bleeding
Anemia
Normal: 4.6-6.2 x 1012
Workup: Hb < 11g/dL OR > 2g/dL drop from baseline
Risks: hypoxia and fatigue
ESA’s do not use
Patients receiving myelosuppressive chemo with curative intent
Patients receiving non-myelosuppressive chemo
Patients with cancer not receiving chemo
ESA’s consider use in
Cancer + CKD
Palliative chemo
Without identifiable cause
Type 1 Chemotherapy-related Cardiac Dysfunction ACUTE
Immediate after a single dose
Uncommon, transient
Abnormal EKG changes, QTc prolongation, ST-T wave changes, arrhythmias
NOT RELATED TO CUMULATIVE DOSE
Type 1 Chemotherapy-related cardiac dysfunction CHRONIC
Occurs within a year
Common, life-threatening
Rapid onset, progressive, irreversible
RELATED TO CUMULATIVE DOSE
DO NOT RECHALLENGE
Type-2 Chemotherapy-Related Cardiac dysfunction
NOT RELATED TO CUMULATIVE DOSE
MAY RECHALLENGE
Not associated with cardiac damage–>reversible
Myalgias/Arthralgia’s
Cause: Taxanes, Aromatase inhibitors
Solution: NSAIDS, Opioids
Hemorrhagic cystitis
Cause: Cyclophosphamide, ifosfamide
Solution: MESNA, Hydration
Heart failure
Cause: doxorubicin, cyclophosphamide, HER2 targeted therapies
Solution: monitor cumulative dose, risk factors, dexrazoxane
Peripheral neuropathy
Cause: Vinca alkaloids, taxanes, platinum
Solution: change infusion rates, gabapentin, amitriptyline
Pulmonary toxicities
Cause: Bleomycin
Solution: Corticosteroids
