Supportive Care Cancer Final Exam Flashcards
What is the MOA of n/v in chemo
- chemo induces damage to GI mucosa
- Lots of serotonin released from GI
- chemo receptor trigger zone stimulates vomiting center
- emesis
what are risk factors for CINV
women > men
younger > older
hx of motion sickness and or morning sickness
previous CINV
anxiety w/ nausea
chronic ethanol can be protective
what are the regimens for highly emetogenic
4 drug or 3 drug regimen
what are the regimens for moderately emetogenic
2 drug or 3 drug
what are the drug regimens for low emetogenic
1 drug
what drugs are in the 4 drug regimen
any NK-1 antagonist
steroid (dex)
5HT3
olanzapine
what drugs are in the 3 drug regimen
5HT3
Steroid
NK1 antagonist or olanzapine
what drugs are in the 2 drug regimen
steroid
5HT3
what drug is in the 1 drug regimen
Dex, metoclopramide, prochlorperazine, or any 5HT3
what are NK1 antagonists for CINV
aprepitant
fosaprepitant
rolapitant
what is the steroid for CINV
dexamethasone
what are the 5HT3 antagonists for CINV
dolasetron
granisetron
ondansetron
palonsetron
what other drugs can be added to CINV drug regimens
Lorazepam PRN or H2/PPI
what are good add ons for breakthrough NV
haloperidol
metoclopramide
prochlorperazine
promethazine
lorazepam
cannabinoids
what drugs should be utilized in delayed NV
steroid, NK1, 5HT3
what should be used in anticipatory NV
benzos, behavioral, prevention
how to prevent radiation induced emesis
pretreat for each day of radiation 5HT3 +/- dex
what are toxicities of 5HT3 drugs
EKG changes
constipation
headache
what are risk factors for mucositis
continuous chemo infusions
hx oral lesions
poor dental hygiene
chemo and radiation at the same time
how to prevent mucositis
avoid trigger foods
choose soft/simple foods
avoid smoking and alcohol
what are the pain management options for mucositis
topical anesthetics (magic mouthwash)
cryotherapy
sucralfacte
po/iv opioids (PCA pump)
what is the most common dose limiting toxicity of chemo
bone marrow suppression
what is neutropenia
< 0.5 x 10^3 WBC
when does neutropenia usually occur
at the nadir
10-14 days after chemo
should you administer chemo if a patient is neutropenic?
Depends. Only if curable disease and they can tolerate it
when to use primary prophylaxis for neutropenia
-if patient is getting chemo that causes febrile neutropenia
-high risk patients (pre-existing neutropenia, extensive prior hemo, irradiation of bones with lots of marrow)
when to use secondary prophylaxis for neutropenia
if patient had neutropenic complication from previous chemo cycle
what are the CSFs to use for neutropenia
filgrastim
pegfilgrastim
biosimilars
when to give platelets
count is less than 100 x 10^3
when to treat anemia in cancer
if hemoglobin is really low (around 7)
how to treat anemia in cancer
-transfusions
-treat symptoms
-iron
-esa
when are ESAs not recommended
curative cancer
pts not getting chemo
non-myelosuppressive chemo
when to use ESAs
CKD
palliative chemo
how to dose ESAs
dose to maintain lowest hemoglobin level
what chemo causes myalgias/arthralgias
microtubules (taxels)
aromatase inhibitors
what chemo causes hemorrhagic cystitis
cyclophosphamide
what chemo causes heart failure
doxorubicin
trastuzumab
what chemo causes peripheral neuropathy
taxanes, platinums, vinca alkaloids
what chemo causes pulmonary toxicity
bleomycin
what are the common opioids for cancer pain
morphine
hydromorphone
oxycodone
fentanyl
methadone
what opioids should be avoided in liver dysfunction
morphine, hydromorphone, oxycodone
when to use methadone
morphine allergy
pain refractory
long acting, low cost option
who should avoid methadone
syncope or arrhythmias
what is the preferred route for opioids
oral
how to treat opioid induced constipation
stimulant +/- stool softener
how to treat opioid induced over sedation
wait for tolerance
hold sedatives
dose reduce
how to treat pruritis with opioids
decrease dose or switch drug
add antihistamine if needed
how to treat opioid induced respiratory depression
hold opioid
give low dose naloxone slowly to bring back
what is the equation for corrected calcium
serum calcium + 0.8(4 - serum albumin)
what is the normal calcium level
8.5-10
what are the degrees of hypercalcemia
< 12 mild
12-14 moderate
> 14 severe
how to treat mild HCM
hydration
d/c meds
how to treat moderate HCM
hydrate IV/loops
bisphosphonate
what drugs can be used in HCM
zoledronic acid
pamidronate
how to treat severe HCM
hydration/loops
bisphosphonates
calcitonin
how to treat bony mets
radiation
chemotherapy
IV agents
do you renal adjust bisphosphonates for Skeletal Related Events
yes
when to use denosumab
bony mets from solid tumors
what should be done before starting denosumab
correct calcemia prior to start
what are AEs of bone agents
Osteonecrosis of jaw
renal dysfunction
hypocalcemia
bone pain
Nausea
Diarrhea
Fatigue
