Supportive care Flashcards

Question

Common toxicities for Dopamine antagonists

Answer 1

Extrapyramidal side effects, diarrhea, sedation

Answer 2

Dystonic reation, sedation

Answer 3

Sedation, akathesia, dystonia, IV promethazine = tissue damage

Answer 4

Drowsiness, dizziness, euphoria, mood changes, hallucinations, increased appetite

Answer 5

Sedation, hypotension, urinary incontinence, hallucinations

Answer 6

cant see, cant hear, cant spit, cant shit, cant piss

Answer 7

emetogenicity is additive so if a patient is on two agents that are each moderately ematogenic that makes it a highly emetogenic regimen anti-emetics should be tailored accordingly for patients on multiple day chemotherapeies do to different emetogenic levels (higher on day one and moderate on day 2 and 3) anti-emetics are more effective when given 5 to 30 minutes prior to chemotherapy

Answer 8

The pathopysiology is still missunderstood but can be described as initiation, upregulation with generation of messengers, ulceration, healing May range from mild inflamation to bleeding ulceration can affect the entire GI tract from mouth all the way down

Answer 9

pre-existing oral lesions, poor dental hygiene or ill fitting dentures, combined modality treatment (chemo and radiation)

Answer 10

avoid foods that are spicy, salty, and/ or acidic fruit mainly eating soft liquid foods soft cheese, eggs, purees, custards avoid smoking and alcohol

Answer 11

pre treatment dental screening, especially in patients receiving radiation therapy to the oral mucosa or those receiving high dose chemotherapy Baking soda rinses - twice - four times daily soft bristle toothbrush saliva substitue for radiation induced xerostomia

Answer 12

Topical anesthetics - lidocaine in them sucking on ice cubes during treatment sucralfate - forms a protective barrier oral and parenteral opioid analgesics - Patient controlled analgesia pump is common

Answer 13

- white blood cells normal range 4.8-10.8 x 10^3/ul Decreased WBC = neutropenia <0.5 x 10^3/ul bone marrow suppression is the most common dose limiting toxicity of chemotherapy Nadir is known as the lowest neutrophil cound or ANC and is used to describe the lowest level the blood count falls to during a cycle of chemotherapy usually drop happens 10-14 days into chemo and will return to normal after 3 to 4 weeks after chemo

Answer 14

ANC = WBC x % granulocytes (neutrophils + bands) - patients counts should always be assessed before chemo administration WBC > 3 x 10^3/ul or ANC of > 1.5x10^3/ul AND platelet count greater than or equal to 100 x 10^3/ul

Answer 15

< 0.5 x 10^3/ul

Answer 16

ANC < 0.5 x 10^3/ul and a single oral temperature > 101 degrees F or greater than or equal to 100.4 degrees F for at LEAST an hour

Answer 17

PRIMARY - if pt is on regimen that is excpected to cause greater than or equal to 20% incidence of febrile neutropenia High risk pts are defined as: preexcisting neutropenia due to disease, extensive prior chemotherapy, previous irradiation to the pelvis or any area with large amount of bone marrow Secondary - when a patient that has had previous neutropenia troubles on a previous cycle and now we want to prevent that again use a CSF preventively with next cycle of chemotherapy

Answer 18

Filgrastim G-CSF - regulats production and function of neutrophil cell lines, dont abrublty D/C as can see rapid drop in neutrophil count if you do Pegfilgrastim (Neulasta) - Has a non-linera pharmacokinestics and clearence - the drug is removed more rapidly with patients who have increasing neutrophil count Sargamostim GM-CSF - effects phagocytic accessory cells, dont abruptly D/C as it will cause rapid drop in WBC and Neutrophils

Answer 19

5mcg/kg/day - start up to 3-4 days after completion of chemotherapy and continue until post nadir ANC recovery to normal or near normal levels AEs - flu like symptoms, bone and joint pain, DVT

Answer 20

6mg SQ x 1 dose (has onpro body injector to iliminate the need for patients to come back for doing after first day of chemo) - start at least 24 hours after chemotherapy and can be given up to 3-4 days after chemotherapy (14 day inbetween cycle) AEs - flu like symptoms, bone and joint pain, DVT

Answer 21

usually defined as platelet count < 100 x 10^3/ul, however increased risk of bleeding occurs when platelet count is less than or equal to 20 x 10^3/ul may require transfusion - transfusions usually will not occur unless patient is symptomatic (ecchymosis, petechiae, hemoptysis, hematemesis)

Answer 22

Blood transfusion usually 40-50 x 10^3 ul for major invasive procedures or greater than 20 x 10^3/ul for other minor procedures

Answer 23

Decreased red blood cell production, decreased erythropoietin production, decreased body stores of vitamin B12, iron, or folic acid, blood loss low hemoglobin levels have been correlated with poor performance status which has been correlated with decreased survival

Answer 24

patient with Hgb less than or equal to 11 g/dL or greater than or equal to 2g/dL drop from baseline should undergo a workup

Answer 25

assess patients symptoms, institutional guidelines, published guidelines and give transfusion if indicated consider ESA treatment if the patients is untreatable in the long run, patients without other identifiable causes, cancer and chronic kidney disease

Answer 26

Dose should be adjusted to maintain the lowest Hgb level

Answer 27

stimulated erythropoiesis indicated for anemia in patient with non-myeloid malignancies where anemia is caused by chemotherapy

Answer 28

All patients with ESA treatment should have baseline iron studies performed if patient is iron deficient a work up should be done LMW iron dextran - first choice IV infusion Iron sucrose (venofer) - IV injection and infusion Ferric gluconate - IV injection and infusion

Answer 29

* Occurs immediately after a single dose or course of therapy with an anthracycline * Uncommon and transient * May involve abnormal ECG findings, including QT-interval prolongation, ST-T wave changes, and arrhythmias * Rarely, congestive heart failure (CHF) and/or pericarditis are observed * Not related to cumulative dose and is uncommon

Answer 30

* Onset usually within a year of receiving anthracycline therapy * Rapid onset and progression * Common and life threatening * Related to cumulative dose patient received * Symptoms include tachycardia, tachypnea, exercise intolerance, pulmonary and venous congestion, ventricular dilatation, poor perfusion, and pleural effusion

Answer 31

* Develops several years or even decades after therapy * Manifests as ventricular dysfunction, CHF, conduction disturbances, and arrhythmias * Occurs more often in childhood / adolescence cancer survivors who received anthracyclines

Answer 32

Trastuzumab – Does note appear to be dose related or occur in all patients – Ranges widely in severity – Has not been associated with cardiac damage – Mechanism involves EGFR pathway which normally blunts the effects of stress signaling pathways (a stunning effect) that are required to maintain cardiac function, structure, and contractility

Answer 33

* Trastuzumab – Appears to be largely reversible and short lived – Incidence is ~ 3% in non-anthracycline treated patients and increases to 5% in those who have received previous anthracyclines – If trastuzumab is given concurrently with anthracycline, the incidence can increase up to 27% cardiac toxicity (NYHA class III/IV)