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PHRM 864 therapeutics > Supportive Care Cancer Final Exam > Flashcards

Supportive Care Cancer Final Exam Flashcards

1
Q

What is the MOA of n/v in chemo

A
  1. chemo induces damage to GI mucosa
  2. Lots of serotonin released from GI
  3. chemo receptor trigger zone stimulates vomiting center
  4. emesis
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2
Q

what are risk factors for CINV

A

women > men
younger > older
hx of motion sickness and or morning sickness
previous CINV
anxiety w/ nausea
chronic ethanol can be protective

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3
Q

what are the regimens for highly emetogenic

A

4 drug or 3 drug regimen

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4
Q

what are the regimens for moderately emetogenic

A

2 drug or 3 drug

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5
Q

what are the drug regimens for low emetogenic

A

1 drug

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6
Q

what drugs are in the 4 drug regimen

A

any NK-1 antagonist
steroid (dex)
5HT3
olanzapine

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7
Q

what drugs are in the 3 drug regimen

A

5HT3
Steroid
NK1 antagonist or olanzapine

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8
Q

what drugs are in the 2 drug regimen

A

steroid
5HT3

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9
Q

what drug is in the 1 drug regimen

A

Dex, metoclopramide, prochlorperazine, or any 5HT3

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10
Q

what are NK1 antagonists for CINV

A

aprepitant
fosaprepitant
rolapitant

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11
Q

what is the steroid for CINV

A

dexamethasone

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12
Q

what are the 5HT3 antagonists for CINV

A

dolasetron
granisetron
ondansetron
palonsetron

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13
Q

what other drugs can be added to CINV drug regimens

A

Lorazepam PRN or H2/PPI

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14
Q

what are good add ons for breakthrough NV

A

haloperidol
metoclopramide
prochlorperazine
promethazine
lorazepam
cannabinoids

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15
Q

what drugs should be utilized in delayed NV

A

steroid, NK1, 5HT3

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16
Q

what should be used in anticipatory NV

A

benzos, behavioral, prevention

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17
Q

how to prevent radiation induced emesis

A

pretreat for each day of radiation 5HT3 +/- dex

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18
Q

what are toxicities of 5HT3 drugs

A

EKG changes
constipation
headache

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19
Q

what are risk factors for mucositis

A

continuous chemo infusions
hx oral lesions
poor dental hygiene
chemo and radiation at the same time

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20
Q

how to prevent mucositis

A

avoid trigger foods
choose soft/simple foods
avoid smoking and alcohol

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21
Q

what are the pain management options for mucositis

A

topical anesthetics (magic mouthwash)
cryotherapy
sucralfacte
po/iv opioids (PCA pump)

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22
Q

what is the most common dose limiting toxicity of chemo

A

bone marrow suppression

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23
Q

what is neutropenia

A

< 0.5 x 10^3 WBC

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24
Q

when does neutropenia usually occur

A

at the nadir
10-14 days after chemo

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25
Q

should you administer chemo if a patient is neutropenic?

A

Depends. Only if curable disease and they can tolerate it

26
Q

when to use primary prophylaxis for neutropenia

A

-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)

27
Q

when to use secondary prophylaxis for neutropenia

A

if patient had neutropenic complication from previous chemo cycle

28
Q

what are the CSFs to use for neutropenia

A

filgrastim
pegfilgrastim
biosimilars

29
Q

when to give platelets

A

count is less than 100 x 10^3

30
Q

when to treat anemia in cancer

A

if hemoglobin is really low (around 7)

31
Q

how to treat anemia in cancer

A

-transfusions
-treat symptoms
-iron
-esa

32
Q

when are ESAs not recommended

A

curative cancer
pts not getting chemo
non-myelosuppressive chemo

33
Q

when to use ESAs

A

CKD
palliative chemo

34
Q

how to dose ESAs

A

dose to maintain lowest hemoglobin level

35
Q

what chemo causes myalgias/arthralgias

A

microtubules (taxels)
aromatase inhibitors

36
Q

what chemo causes hemorrhagic cystitis

A

cyclophosphamide

37
Q

what chemo causes heart failure

A

doxorubicin
trastuzumab

38
Q

what chemo causes peripheral neuropathy

A

taxanes, platinums, vinca alkaloids

39
Q

what chemo causes pulmonary toxicity

A

bleomycin

40
Q

what are the common opioids for cancer pain

A

morphine
hydromorphone
oxycodone
fentanyl
methadone

41
Q

what opioids should be avoided in liver dysfunction

A

morphine, hydromorphone, oxycodone

42
Q

when to use methadone

A

morphine allergy
pain refractory
long acting, low cost option

43
Q

who should avoid methadone

A

syncope or arrhythmias

44
Q

what is the preferred route for opioids

A

oral

45
Q

how to treat opioid induced constipation

A

stimulant +/- stool softener

46
Q

how to treat opioid induced over sedation

A

wait for tolerance
hold sedatives
dose reduce

47
Q

how to treat pruritis with opioids

A

decrease dose or switch drug
add antihistamine if needed

48
Q

how to treat opioid induced respiratory depression

A

hold opioid
give low dose naloxone slowly to bring back

49
Q

what is the equation for corrected calcium

A

serum calcium + 0.8(4 - serum albumin)

50
Q

what is the normal calcium level

A

8.5-10

51
Q

what are the degrees of hypercalcemia

A

< 12 mild
12-14 moderate
> 14 severe

52
Q

how to treat mild HCM

A

hydration
d/c meds

53
Q

how to treat moderate HCM

A

hydrate IV/loops
bisphosphonate

54
Q

what drugs can be used in HCM

A

zoledronic acid
pamidronate

55
Q

how to treat severe HCM

A

hydration/loops
bisphosphonates
calcitonin

56
Q

how to treat bony mets

A

radiation
chemotherapy
IV agents

57
Q

do you renal adjust bisphosphonates for Skeletal Related Events

A

yes

58
Q

when to use denosumab

A

bony mets from solid tumors

59
Q

what should be done before starting denosumab

A

correct calcemia prior to start

60
Q

what are AEs of bone agents

A

Osteonecrosis of jaw
renal dysfunction
hypocalcemia
bone pain
Nausea
Diarrhea
Fatigue

PHRM 864 therapeutics (26 decks)

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