Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

703 > Supportive Care > Flashcards

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is the central emetic response pathway mediated?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

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

A
  • Olanzapine
  • Dexamethasone
  • NK1 RA
  • 5-HT3 RA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

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

A
  • Olanzapine
  • Dexamethasone
  • Aprepitant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

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

A

1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

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

A

0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

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

A

5-HT3 RA monotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

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

A

PRN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What options do we have breakthrough emesis?

A
  • Olanzapine*
  • Lorazepam
  • Dronabinol (solution has higher bioavailability)
  • 5-HT3 RA
  • Prochlorperazine
  • Dexamethasone
  • Metoclopramide
  • Scopolamine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

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

A

Lorazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are side effects of dexamethasone?

A
  • Insomnia
  • Dyspepsia (take with food, consider PPI/H2)
  • Hyperglycemia
  • Hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

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

A

2nd generation - long t1/2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are side effects of 5-HT3 RAs?

A
  • Headache
  • Constipation
  • QTc prolongation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which 5-HT3 RA is 2nd generation?

A

Palonosetron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

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

A

FALSE: only used for prevention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

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

A

Rolapitant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why should olanzapine be given at bedtime?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the minimum length of time between rolapitant doses?

A

2 weeks (long t1/2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Why should metoclopramide be avoided >12 weeks of use?

A

Tardive dyskinesia

25
Q

Which cannabinoid is only indicated for refractory CINV?

A

Dronabinol (rarely used)

26
Q

Which mechanism causes scopolamine to be rarely used outside of refractory CINV?

A

Anticholinergic

27
Q

Which drugs are offenders for cancer treatment-induced diarrhea (CTID)?

A
  • Fluorouracil
  • Capecitabine
  • Irinotecan
  • Pertuzumab
  • Abemaciclib
28
Q

What defines grade 1 diarrhea?

A

Increase of <4 stools/day over baseline

29
Q

What defines grade 2 diarrhea?

A

Increase of up to 6 stools/day over baseline

30
Q

What defines grade 3 diarrhea?

A

Increase of at least 7 stools/day over baseline

31
Q

What defines grade 4 diarrhea?

A

Life threatening consequences
Urgent intervention indicated

32
Q

What can be given for the cholinergic-related acute diarrhea caused by irinotecan?

A

Atropine

33
Q

T/F: Irinotecan can cause both acute and delayed diarrhea

A

TRUE

34
Q

What is the first line treatment to manage CTID?

A

Loperamide 4mg, followed by 2mg q4h or with every unformed stool

35
Q

What is the second line treatment to manage CTID?

A

Diphenoxylate-atropine

36
Q

What are refractory options for CTID?

A
  • Octreotide
  • Tincture of opium
  • Probiotics
  • Rule out c. diff and infection colitis
37
Q

What are complications of mucositis?

A
  • Poor oral intake
  • Infection risk
  • Pain
38
Q

What is the difference between mucositis and stomatitis?

A

Mucositis can occur anywhere in the GI tract while stomatitis is localized to the oral cavity.

39
Q

What are patient-specific risk factors for mucositis?

A
  • Smoking
  • Poor oral hygiene
  • Oral lesions at baseline
  • Female sex
  • Pretreatment nutritional status
40
Q

What is cryotherapy for mucositis?

A

Holding ice chips in the mouth before/during chemotherapy to prevent mucositis

41
Q

Which patients should always receive G-CSF?

A

> 20% risk for febrile neutropenia

42
Q

When should patients consider G-CSF?

A

10-20% with 1-2 risk factors

43
Q

Which G-CSF is short-acting?

A

Filgrastim (give daily until ANC recovery)

44
Q

Which G-CSF is indicated for both prophylaxis and treatment of febrile neutropenia?

A

Filgrastim

45
Q

In which cases should we give G-CSF in established febrile neutropenia?

A
  • 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
Q

What should you do after a patient experiences febrile neutropenia despite receiving prophylactic G-CSF?

A

Consider dose reduction or switching cancer treatment regimen

47
Q

Which type of pain invades bone, muscle, or connective tissue?

A

Somatic

48
Q

Which type of pain is aching, stabbing, throbbing, or pressure?

A

Somatic

49
Q

Which type of pain invades internal organs and vessels?

A

Visceral

50
Q

Which type of pain is gnawing, cramping, aching, or sharp pain?

A

Visceral

51
Q

Which type of pain is burning, tingling, shooting, or electric/shocking pain

A

Neuropathic

52
Q

What is the first line treatment for cancer pain?

A

Non-opioids +/- adjuvants

53
Q

What can we use for persisting or increasing pain?

A

Opioids +/- non-opioids +/- adjuvants

54
Q

When should we switch to long-acting pain relief?

A

For more chronic, around-the-clock pain after IR products were tried for an appropriate amount of time

55
Q

What should we do for grade 3-4 immune-mediated adverse events?

A
  • Hold immunotherapy
  • Give corticosteroid therapy
  • Give additional immunosuppressant if steroids don’t work
  • Consider hospitalization
56
Q

Which steroids and doses do we give for immune-related AEs?

A

Prednisone 0.5-2 mg/kg/day
Methylprednisolone 1-2 mg/kg/day

57
Q

What are long-term effects of steroids?

A
  • HTN
  • Osteoporosis
  • Weight gain
  • Insomnia
  • Mental status changes
  • Metabolic dysfunction
  • Increased infection risk
58
Q

What should we give for patients at risk for gastritis when taking steroids?

A

PPI or H2 considered for duration of therapy

59
Q

What should we give for patients taking prednisone equivalent >20 mg for >4 weeks?

A

PJP prophylaxis: Bactrim

60
Q

What osteoporosis-preventing agents should we give for patients on long-term steroids?

A

Vitamin D and calcium

703 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions