Supportive Care 1

Question 1

Side effects of 5-HT3 antagonists

Answer 1

headache
constipation
EKG changes (do not exceed 16 mg)

Question 2

Side effects of dexamethasone

Answer 2

anxiety
euphoria
insomnia
hyperglycemia
increased appetite

Question 3

Side effects of NK-1 antagonists

Answer 3

hiccups
drug interactions

Question 4

Side effects of D2 antagonists

Answer 4

EPS
diarrhea
sedation

Question 5

Side effects of atypical antiphsycotics

Answer 5

dystonia
sedation
weight gain

Question 6

Side effects of Phenothiazines

Answer 6

sedation
EPS

Question 7

Side effects of Cannabinoids

Answer 7

drowsiness
dizziness
euphoria
mood changes
hallucinations
increases appetite

Question 8

Side effects of Benzodiazepines

Answer 8

sedation
urinary incontinence
hypotension
hallucinations

Question 9

Filgrastim

Answer 9

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

Question 10

Pegfilgrastim

Answer 10

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

Question 11

Filgrastim biosimilars

Answer 11

Filgrastim-sndz
Filgrastim-aafi
Filgrastim-ayow
TBO-FILGRASTIM IS NOT A BIOSIMILAR

Question 12

Epoetin alfa

Answer 12

ESA

Frequency: SubQ weekly

Dose adjustments: If Hb has increased by > 1g/dL in a 2-week period–>decrease dose by 25%

Question 13

Darbepoetin

Answer 13

Frequency: SubQ weekly or every 3 weeks

Dose adjustments: If Hb increase by > 1g/dL in a 2-week period–>decrease dose by 40%

Question 14

Neutropenia

Answer 14

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

Question 15

Thrombocytopenia

Answer 15

Normal 140-440 x 103

Severely low: < 100 x 103

Transfusion required: < 10 x 103

Risks: bleeding

Question 16

Anemia

Answer 16

Normal: 4.6-6.2 x 1012

Workup: Hb < 11g/dL OR > 2g/dL drop from baseline

Risks: hypoxia and fatigue

Question 17

ESA’s do not use

Answer 17

Patients receiving myelosuppressive chemo with curative intent

Patients receiving non-myelosuppressive chemo

Patients with cancer not receiving chemo

Question 18

ESA’s consider use in

Answer 18

Cancer + CKD

Palliative chemo

Without identifiable cause

Question 19

Type 1 Chemotherapy-related Cardiac Dysfunction ACUTE

Answer 19

Immediate after a single dose
Uncommon, transient
Abnormal EKG changes, QTc prolongation, ST-T wave changes, arrhythmias

NOT RELATED TO CUMULATIVE DOSE

Question 20

Type 1 Chemotherapy-related cardiac dysfunction CHRONIC

Answer 20

Occurs within a year
Common, life-threatening
Rapid onset, progressive, irreversible

RELATED TO CUMULATIVE DOSE
DO NOT RECHALLENGE

Question 21

Type-2 Chemotherapy-Related Cardiac dysfunction

Answer 21

NOT RELATED TO CUMULATIVE DOSE
MAY RECHALLENGE
Not associated with cardiac damage–>reversible