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Supportive Care Flashcards

1
Q

Which NTs/receptors are responsible for the N/V associated with chemotherapy?

A
  • Serotonin and its receptor
  • Substance P and NK-1 receptor
  • Dopamine and its receptors
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2
Q

How is the peripheral emetic response pathway mediated?

A

Serotonin
- Originates in GI tract
- Activated in first 24h of chemo
- Acute emesis associated

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3
Q

How is the central emetic response pathway mediated?

A

NK-1 receptor
- Occurs in brain
- Delayed CINV associated

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4
Q

What are risk factors for CINV?

A
  • Age <50
  • Female
  • Emesis during pregnancy
  • History of CINV
  • Prone to motion sickness
  • Anxiety/pretreatment expectations
  • Little or no previous alcohol use
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5
Q

What is the day 1 emesis prevention regimen for high-risk patients?

A
  • Olanzapine
  • Dexamethasone
  • NK1 RA
  • 5-HT3 RA
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6
Q

What is the day 2-4 emesis prevention regimen for high-risk patients

A
  • Olanzapine
  • Dexamethasone
  • Aprepitant
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7
Q

T/F: IF a drug is given IV on the first day of CINV prevention, it should not be given on days 2-4

A

TRUE

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8
Q

How many drugs should be used for CINV prevention if the patient is at moderate risk and taking IV chemotherapy?

A

2-3

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9
Q

How many drugs should be used for CINV prevention if the patient is at low risk and taking IV chemotherapy?

A

1

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10
Q

Which drug options for monotherapy do we have for low emetic risk patients taking IV chemotherapy?

A
  • Dexamethasone
  • Metoclopramide
  • Prochlorperazine
  • 5-HT3 RA
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11
Q

How many drugs should be used for CINV prevention if the patient is at minimal risk and taking IV chemotherapy?

A

0

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12
Q

What prophylaxis should be given to patients at moderate-high risk and taking PO chemotherapy?

A

5-HT3 RA monotherapy

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13
Q

What prophylaxis should be given to patients at minimal-low risk and taking PO chemotherapy?

A

PRN

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14
Q

What options do we have breakthrough emesis?

A
  • Olanzapine*
  • Lorazepam
  • Dronabinol (solution has higher bioavailability)
  • 5-HT3 RA
  • Prochlorperazine
  • Dexamethasone
  • Metoclopramide
  • Scopolamine
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15
Q

Which drug is helpful in anticipatory, anxiety-related emesis?

A

Lorazepam

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16
Q

What non-pharmacologic options do we have for anticipatory emesis?

A
  • Avoid strong smells
  • Acupuncture
  • Hypnosis
  • Relaxation
  • Yoga
  • Biofeedback
  • Guided imagery
  • Cognitive distraction
  • Progressive muscle relaxation
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17
Q

What are side effects of dexamethasone?

A
  • Insomnia
  • Dyspepsia (take with food, consider PPI/H2)
  • Hyperglycemia
  • Hypertension
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18
Q

Which generation of 5-HT3 RAs can be used for both acute AND delayed CINV?

A

2nd generation - long t1/2

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19
Q

What are side effects of 5-HT3 RAs?

A
  • Headache
  • Constipation
  • QTc prolongation
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20
Q

Which 5-HT3 RA is 2nd generation?

A

Palonosetron

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21
Q

T/F: NK1 RAs can be used to treat CINV

A

FALSE: only used for prevention

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22
Q

Which NK1 RA does not have a CYP drug interaction with dexamethasone?

A

Rolapitant

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23
Q

Why should olanzapine be given at bedtime?

A

It is sedating unless using as premedication - consider a lower dose for elderly

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23
Q

What is the minimum length of time between rolapitant doses?

A

2 weeks (long t1/2)

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24
Why should metoclopramide be avoided >12 weeks of use?
Tardive dyskinesia
25
Which cannabinoid is only indicated for refractory CINV?
Dronabinol (rarely used)
26
Which mechanism causes scopolamine to be rarely used outside of refractory CINV?
Anticholinergic
27
Which drugs are offenders for cancer treatment-induced diarrhea (CTID)?
- Fluorouracil - Capecitabine - Irinotecan - Pertuzumab - Abemaciclib
28
What defines grade 1 diarrhea?
Increase of <4 stools/day over baseline
29
What defines grade 2 diarrhea?
Increase of up to 6 stools/day over baseline
30
What defines grade 3 diarrhea?
Increase of at least 7 stools/day over baseline
31
What defines grade 4 diarrhea?
Life threatening consequences Urgent intervention indicated
32
What can be given for the cholinergic-related acute diarrhea caused by irinotecan?
Atropine
33
T/F: Irinotecan can cause both acute and delayed diarrhea
TRUE
34
What is the first line treatment to manage CTID?
Loperamide 4mg, followed by 2mg q4h or with every unformed stool
35
What is the second line treatment to manage CTID?
Diphenoxylate-atropine
36
What are refractory options for CTID?
- Octreotide - Tincture of opium - Probiotics - Rule out c. diff and infection colitis
37
What are complications of mucositis?
- Poor oral intake - Infection risk - Pain
38
What is the difference between mucositis and stomatitis?
Mucositis can occur anywhere in the GI tract while stomatitis is localized to the oral cavity.
39
What are patient-specific risk factors for mucositis?
- Smoking - Poor oral hygiene - Oral lesions at baseline - Female sex - Pretreatment nutritional status
40
What is cryotherapy for mucositis?
Holding ice chips in the mouth before/during chemotherapy to prevent mucositis
41
Which patients should always receive G-CSF?
>20% risk for febrile neutropenia
42
When should patients consider G-CSF?
10-20% with 1-2 risk factors
43
Which G-CSF is short-acting?
Filgrastim (give daily until ANC recovery)
44
Which G-CSF is indicated for both prophylaxis and treatment of febrile neutropenia?
Filgrastim
45
In which cases should we give G-CSF in established febrile neutropenia?
- Sepsis syndrome - Age >65 - ANC <100 - Neutropenia expected to be >10 days - Pneumonia or other clinically documented infections - Invasive fungal infection - Hospitalization at the time of fever - Prior episode of febrile neutropenia
46
What should you do after a patient experiences febrile neutropenia despite receiving prophylactic G-CSF?
Consider dose reduction or switching cancer treatment regimen
47
Which type of pain invades bone, muscle, or connective tissue?
Somatic
48
Which type of pain is aching, stabbing, throbbing, or pressure?
Somatic
49
Which type of pain invades internal organs and vessels?
Visceral
50
Which type of pain is gnawing, cramping, aching, or sharp pain?
Visceral
51
Which type of pain is burning, tingling, shooting, or electric/shocking pain
Neuropathic
52
What is the first line treatment for cancer pain?
Non-opioids +/- adjuvants
53
What can we use for persisting or increasing pain?
Opioids +/- non-opioids +/- adjuvants
54
When should we switch to long-acting pain relief?
For more chronic, around-the-clock pain after IR products were tried for an appropriate amount of time
55
What should we do for grade 3-4 immune-mediated adverse events?
- Hold immunotherapy - Give corticosteroid therapy - Give additional immunosuppressant if steroids don't work - Consider hospitalization
56
Which steroids and doses do we give for immune-related AEs?
Prednisone 0.5-2 mg/kg/day Methylprednisolone 1-2 mg/kg/day
57
What are long-term effects of steroids?
- HTN - Osteoporosis - Weight gain - Insomnia - Mental status changes - Metabolic dysfunction - Increased infection risk
58
What should we give for patients at risk for gastritis when taking steroids?
PPI or H2 considered for duration of therapy
59
What should we give for patients taking prednisone equivalent >20 mg for >4 weeks?
PJP prophylaxis: Bactrim
60
What osteoporosis-preventing agents should we give for patients on long-term steroids?
Vitamin D and calcium

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