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864 > Supportive Care: I > Flashcards

Supportive Care: I Flashcards

1
Q

complications of N/V

  • most feared complication of chemo despite ___ nature
  • can result in the inability to deliver intended dose of chemo
A

limited
- dehydration
- electrolyte
- abnormalities
- fatigue
- depression

before 5-HT3 anti-emetics, it was expected to vomit 5-12 times per day

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2
Q

Types of N/V

anticipatory
- ___ response conditioned by severity and duration of previous emetic reactions from prior cycles of chemo
- non-PCOL like hypnosis helpful
- can be provoked by sight, sound, or smell

A

learned

cancer patients have hightened senses

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3
Q

Types of N/V

Acute
- emetic response correlating with the administration of chemo
- within __ hours of receiving chem

Delayed
- Related to chemotherapy occurring > ___ hours following completion of chemotherapy
– Mechanism is not fully understood, but there is ↑
evidence that substance P binding to ___ receptor may play a role

A

24
24
neurokinin 1

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4
Q

Types of N/V

Breakthrough
- occurs even if on scheduled anti-emetics ___ to chemotherapy

Refractory
- persists despite ___ anti-emetics
- Failed other therapies

A
  • prior
  • appropriate
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5
Q

Patho of CINV

  • Chemo is toxic to GI tract inducing damage to the epithelial cells
  • Enterochromaffin cells lining the GI tract contain large stores of ___ that are released in massive quantities after exposure to chemo
  • chemoreceptor trigger zone (CTZ)
    stimulates the vomiting center
  • Located in the nucleus tractus solitarii in the ___ which stimulates the emetic response
  • Input to the vomiting center from the higher cortical centers, pharynx, and GI
    tract can induce emesis
A
  • serotonin
  • medulla
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6
Q

Neurotransmitters implicated in CINV (5)

A
  • dopamine
  • histamine
  • acetylcholine
  • serotonin
  • substance P
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7
Q

highly emetogenic chemo (level 5)

single agent

A
  • Carboplatin
  • Carmustine
  • Cisplatin
  • Cyclophosphamide
  • Dacarbazine
  • Doxorubicin
  • Epirubicin
  • Fam-trastuzumab-deruxtecan
  • Ifosfamide
  • Mechlorethamine
  • Melphalan
  • Sacituzumab govitecan-hziy
  • Streptozocin
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8
Q

Combo Chemo

when considering combo chemo, need to consider emetogenicity
- level 1 or 2 agents do not contribute to the emetogenicity of the regimen
- adding level 3 or 4 ___ the emetogenicity of the combo by 1 level per agent
- add the different levels together to decide on which antiemetics to use

A

increasing

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9
Q

Oral Anticancer Agents

Moderate to high emetic risk:
(≥ 30% risk) Prophylaxis required on days of oral anticancer agent administration

A
  • Azacitidine
  • Busulfan
  • Ceritinib
  • Cyclophosphamide
  • Fedratinib
  • Lomustine
  • Midostaurin
  • Mitotane
  • Selinexor
  • Temozolomide
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10
Q

Oral Anticancer Agents

Moderate to high emetic risk:
(≥ 30% risk) As needed dosing is initially appropriate on days of oral anticancer agent administration

A
  • Adagrasib
  • Elacestrant
  • Avapritinib
  • Binimetinib
  • Bosutinib
  • Cabozantinib
  • Crizotinib
  • Dabrafenib
  • Enasidenib
  • Encorafenib
  • Estramustine
  • Etoposide
  • Imatinib
  • Lenvatinib
  • Niraparib
  • Olaparib
  • Procarbazine
  • Rucaparib
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11
Q

risk factors for CINV

  • women __ men
  • younger __ older
  • prior history of ___ and ___ sickness
  • previous CINV tend to do worse
  • anxiety/high pretreatment ___ of nausea
  • chronic ethanol can be ___
A
  • >
  • >
  • motion, morning
  • anticipation
  • protective
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12
Q

treatment guidelines

___ for acute N/V is based on the emetogenic potential of chemo
- ___ receptor antagonists may be substituted for each other
- oral efficacy = IV efficacy

A

prophylaxis
- 5HT3

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13
Q

highly emetogenic regimens

A) 4 drug
B) 3 drug
C) 3 drug

A

A) NK-1 antagonist, steroid, 5-HT3 antagonist, atypical anti-psychotic
B) atypical antipsychotic, 5HT-3 antagonist, steroid
C) NK-1 antagonist, steroid, 5-HT3 antagonist

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14
Q

These 3 agents can be added with any regimen and any emetogenicity if patients are experiencing these toxicities

A

+/- Lorazepam 0.5 mg to 2 mg PO or IV or sublingual either every 4 or 6 hours as needed
+/- H2 blocker or proton pump inhibitor

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15
Q

moderately emetogenic

A) 2 drug
B) 3 drug
C) 3 drugs

A
  • steroid, 5-HT3
  • anti-psychotic, steroid, 5-HT3
  • NK-1, steroid, 5-HT3 antagonist
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16
Q

low emetogenic regimens

only 1 needed
- steroid ( ___ )
- metoclopramide
- prochlorperazine
- 5-HT3 (3)

A
  • dexamethasone
  • dolasetron, granisetron, ondansetron
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17
Q

Breakthrough Nausea and Vomiting

give an additional agent from a different drug class as needed

A
  • haloperidol or metoclopramide
  • prochlorperazine or promethazine
  • olanzapine
  • lorazepam
  • dronabinol or nabilone
  • dolasetron, granisetron, or ondansetron
  • dexamethazone
  • scopolamine

Depending on the severity of the N/V, you can schedule these agents

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18
Q

Delayed Nausea and Vomiting

typically involves use of one of the following (3)

A
  • dexamethasone
  • NK-1 antagonist
  • olanzapine
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19
Q

Anticipatory N/V

___ - Use optimal antiemetic therapy during
every cycle of treatment
___ - 0.5 to 1 mg orally beginning the night before treatment and then again 1 to 2 hours prior to beginning of
chemotherapy

A
  • prevention
  • lorazepam
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20
Q

other prevention guidelines

Oral chemotherapy - High to moderate emetogenic risk
- Start ___ chemotherapy and continue daily
- ___ antagonists

Low to minimal emetogenic risk
- Start ___ chemotherapy and maybe given daily or prn
– ___
– ___
– ___ antagonists

A
  • before
  • 5-HT3
  • before
  • Metoclopramide
  • Prochlorperazine
  • 5-HT3
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21
Q

Other Prevention Guidelines

Radiation Induced Emesis
- Start pretreatment for each day of radiation
therapy
- ___ PO +/- dexamethasone
- ___ PO +/- dexamethasone

A

Granisetron
Ondansetron

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22
Q

Radiopharmaceuticals

  • Nausea is associated with the ___ infusion accompanying treatment
  • Antiemetics should be given ___ minutes prior to start of infusion

Recommendations for antiemetics include:
- ___ or ___ antagonists
- NOT ___ due to down regulation of somatostatin receptors

A
  • amino acid
  • 30
  • 5-HT3, NK-1
  • steroids
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23
Q

Common Toxicities Across Classes

Serotonin (5-HT3) antagonists
- Ondansetron
- Granisetron
- Dolasetron
- Palonosetron single agent or combination products (+/- netupitant
or fosnetupitant)

A
  • Headache
  • asymptomatic and transient EKG changes (max doses)
  • constipation
  • increased transaminases
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24
Q

Common Toxicities Across Classes

Corticosteroids
- Dexamethasone

A

(Short term use):
- Anxiety
- euphoria
- insomnia
- hyperglycemia
- ↑’d appetite

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25
Q

Common Toxicities Across Classes

Substance P antagonists
- Aprepitant
- Aprepitant injectable emulsion
- Fosaprepitant
- Rolapitant
- Netupitant
- Fosnetupitan

A
  • Hiccups
  • worry about drug
    interactions
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26
Q

Common Toxicities Across Classes

Dopamine antagonists
- Chlorpromazine
- Haloperidol
- Metoclopramide

A
  • Extrapyramidal side effects
  • diarrhea
  • sedation
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27
Q

Common Toxicities Across Classes

Atypical antipsychotic
- Olanzapine

A
  • dystonic reactions
  • sedation
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28
Q

Common Toxicities Across Classes

Phenothiazines
- Prochlorperazine
- Promethazine

A
  • Sedation
  • akathesia
  • dystonia
  • IV promethazine = tissue damage
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29
Q

Common Toxicities Across Classes

Cannibanoids
- Dronabinol

A
  • Drowsiness
  • dizziness
  • euphoria
  • mood changes
  • hallucinations
  • ↑’d appetite
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30
Q

Common Toxicities Across Classes

Benzodiazepines
- Lorazepam

A
  • sedation
  • hypotension
  • urinary
  • incontinence
  • hallucinations
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31
Q

Common Toxicities Across Classes

Anticholinergic
- Scopolamine Patch

A
  • Anti-cholinergic side effects
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32
Q

Important Principles for Prevention and Management

  • Review medical history, diagnosis, and
    concurrent medications
    – Consider any contributing causes to
    nausea/vomiting, and treat appropriately
    – ___ is a risk with phenothiazines and
    metoclopramide
  • Evaluate the emetogenic potential and
    pattern of the chemotherapeutic regimen to be given
A

EPS

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33
Q

Important Principles for Prevention and Management

  • Emetogenicity is ___
  • Emetogenic potential may be different on different days of treatment (stronger day 1 than 2 and 3)
  • acute/delayed N/V
  • most guidelines are tailored to chemo on day 1
A

additive

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34
Q

Important Principles for Prevention and Management

T or F: Anti-emetics are most effective when given as
prophylaxis

A

T
- Begin therapy at least 5 to 30 minutes prior to
chemo
- Administer around-the-clock until chemo is complete and provide PRN agents for breakthrough N/V
- Always provide patients with additional PRN anti-emetics to take home

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35
Q

Mucositis

GI mucosa is comprised of epithelial cells and has a rapid turnover rate
- Initiation -> Up-regulation with generation of messengers -> Signaling and amplification -> Ulceration -> Healing
- range from mild inflammation to bleeding ulcerations
- It can affect the entire length of the GI tract from top to bottom
- Course parallels the neutrophil nadir and begins on day 5 to 7 after chemotherapy and improves as the neutrophil count ___

A

increases

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36
Q

chemo induced mucositis

Continuous infusions ___ short IV infusions

A

>

37
Q

risk factors to mucositis

  • Pre-existing oral lesions
  • Poor dental hygiene or ill-fitting dentures
  • Combined modality treatment ( ___ + ___ )
A
  • chem + radiation
38
Q

Prevention and Treatment

Diet recommendations:
– Avoid rough food, spices, salt and acidic fruit
– Mainly eat soft or liquid foods nonacidic fruits, soft cheeses,
and eggs
– Avoid ___ and alcohol

Pre-treatment dental screening, especially in patients receiving ___ therapy to the oral mucosa or those receiving high-dose
chemo with a ___ transplant
– Baking soda rinses, soft-bristled toothbrush to minimize gingival
irritation, saliva substitute for radiation-induced xerostomia

A
  • smoking
  • radiation
  • bone marrow
39
Q

Pain Management - mucositis

Topical anesthetics
– Often provide adequate relief, but the effect tends to be short-lived
– Various combinations of lidocaine,
diphenhydramine, and antacids have been used with success ( ___ ___ )
- Patients should be instructed to swish and spit or swallow depending on the location of the mucositis) every few hours as needed

Ice Chips - vaso ___ decreased chemo delivery to mouth
- 30 min prior to ___ doses decreases incidence/severity

Sucralfate
- nauseating

A

magic mouthwash
vasoconstriction
5-FU

40
Q

Pain Management - mucositis

Oral and parenteral opioid analgesics
- Often required in moderate to severe mucositis
- Many oral solutions contain a high percentage of alcohol, which may burn (dont get OTC)
- Opioids are best administered ___ for patients with moderate to severe mucositis
- Use of ___ is common

A
  • around the clock
  • PCA
41
Q

neutropenia

White blood cells (WBC):
- Normal range of 4.8-10.8 x10 3 /μL
- Decreased WBC = Neutropenia (< 0.5 x 103 /μL), leukopenia, or granulocytopenia
- Risk of life-threatening ___

Megakaryocytes (platelets)
- Normal range of 140 - 440 x 10 3 /μL
- ___ platelets = Thrombocytopenia (< 100 x 103 /μL)
- Risk of ___

Red blood cells (RBC)
- Normal range of 4.6 to 6.2 x1012 /L
- Decreased RBC = ___
- Risks of hypoxia and __

A
  • infection
  • decreased
  • bleeding
  • anemia
  • fatigue
42
Q

Neutropenia

___ suppression is the most common dose-limiting toxicity of chemo

The ___ (usually described by the absolute neutrophil count or ANC) is the lowest value the blood counts fall to during a cycle of chemo
- Generally, occurs ___to ___ days after chemo administration and counts usually recover by 3 to 4
weeks after
- Some exceptions include mitomycin C and nitrosoureas which nadirs 4 - 6 weeks after treatment

A
  • bone marrow
  • nadir
  • 10, 14
43
Q

Neutropenia

ANC = WBC x % granulocytes (Segs + Bands)
- To administer chemotherapy safely the patient’s counts should be as assessed prior to administration. These are typical guidelines:
– WBC > __ x103 /μL OR
– Absolute neutrophil count (ANC) of > ___ x103 /μL AND platelet count > ___ x103 /μL

A
  • 3
  • 1.5, 100
44
Q

neutropenia

Severe neutropenia is defined as ANC < ___ x 103 /μL
* Neutropenic patients are at an ↑’d risk of developing serious infections
* ___ neutropenia (FN) is defined as:
– ANC < 0.5 x 103 /μL and a single oral temperature > 101°F (> 38.3°C) or > 100.4°F (> 38.0°C) for at least an hour

A
  • 0.5
  • febrile
45
Q

neutropenia

Other factors affecting myelosuppression:

A
  • previous chemotherapy
  • previous radiation therapy
  • direct bone marrow involvement
46
Q

neutropenia

T or F: The usual s/s of infection (abscess, pus, infiltrates on chest x-ray) are absent with fever being the only reliable indicator

A

T
WBC low = no pus

47
Q

Colony Stimulating Factors (CSFs)

Prophylactic use following chemo has demonstrated decreased:
- Incidence of ___ neutropenia
- Length of hospitalization
- Confirmed ___
- Duration of ___

A
  • febrile
  • infections
  • antibiotics
48
Q

CSF guidelines (ASCO NCCN)

Primary prophylaxis
If the patient is to receive a chemo regimen that is expected to cause > 20% incidence of ___ neutropenia

High risk patients defined as:
- Preexisting neutropenia due to disease
- Extensive prior chemo
- Previous irradiation to the pelvis or other areas containing large amounts of ___

A
  • febrile
  • bone marrow
49
Q

CSF guidelines (ASCO)

Secondary prophylaxis
- The patient experienced a neutropenic complication from a previous cycle of chemo and now you want to prevent
that again
– Use a CSF ___ with next cycle of
chemo

A

preventively

50
Q

Other uses for CSF’s:

  • Used to support patients through dose ___ chemo
  • Can be used alone, after chemo, or in combination with ___ to mobilize peripheral blood progenitor cells
  • After a __ transplant to reduce the duration of severe neutropenia
  • Guidelines for pediatric use are available and should be followed
A
  • dense
  • plerixafor
  • stem cell
51
Q

CSF agents (3)

A
  • filgrastim
  • pegfilgrastim
  • sargramostim
52
Q

CSF - filgrastim

  • Regulates the production, maturation, and function of neutrophil cell line
  • Dose dependent elevation in neutrophil count, rapid drop in WBC and neutrophil count following ___ (approximately 50% decrease within 24 hours)
A

discontinuation

53
Q

CSF - pegfilgrastim

  • Differs from filgrastim due to a 20-kD pegylated molecule that is attached to
    the N-terminus of filgrastim
  • Stimulates production & maturation of neutrophil precursors like filgrastim
  • ___ pharmacokinetics & clearance ___ with increasing
    neutrophil count
A
  • Non-linear
  • increases
54
Q

CSF - Sargramostim

  • Effects on phagocytic accessory cells which mediates its action on the neutrophil lineage
  • Drop in WBC & neutrophil count following ___ (approximately 50% decrease within 24 hours)
A
  • discontinuation
55
Q

CSF - Biosimilars: Similar or Not?

  1. Tbo-Filgrastim (Granix)
  2. Filgrastim-sndz (Zarxio)
  3. Filgrastim-aafi (Nivestym)
  4. Filgrastim-ayow (Releuko)
A

Tbo-filgrastim is not considered a biosimilar and received an original biologic license through the FDA
- Filgrastim-sndz was the first biosimilar approved in the US in March 2015
- Did NOT receive interchangeable status
Patient should remain on whichever agent it is started on and not switch between manufactured products

56
Q

Dosing and Adverse Effects

Filgrastim: 5 mcg/kg/day
– Start up to 3 - 4 days ___ completion of chemotherapy and continue until post-nadir ANC recovery to ___ ish levels

A
  • after
  • normal
57
Q

Dosing and Adverse Effects

Pegfilgrastim: 6 mg SQ x 1 dose
- Start at least 24 hours ___ chemo and can be given up to 3 – 4 days after chemo
- At least __ days should elapse between dose and the next
cycle of chemo
- Same day therapy is generally not recommended
- OnPro® body injector can be applied same day

A

after
14

58
Q

CSF Adverse Effects

A
  • Flu-like symptoms
  • bone and joint pain
  • DVT
59
Q

CSF Adverse Effects

Bone or musculoskeletal pain occurs in 20-30% of patients receiving CSF’s
- Attributed to rapid proliferation of the bone marrow myeloid cells
- Can use acetaminophen/non-opioid analgesics
- Data with use of ___ . Why? Thought is that pain is due to histamine release.

Rare Adverse Effects
- ___ enlargement with long term CSF use

A
  • loratidine
  • splenic
60
Q

Thrombocytopenia

Usually defined as a platelet count
< ___ x 10 3 /μL, however increased risk of bleeding occurs when platelet count is < 20 x 10 3 /μL and therefore may require transfusion
- Most institutions do not transfuse until patient becomes ___
- ASCO guideline recommends a threshold for platelet transfusion of ___ x 10 3 /μL

A
  • 100
  • symptomatic
  • 10
61
Q

General Causes of Anemia

Decreased red blood cell production
- Cancer therapy: Radiation or chemo
- Tumor infiltration into the ___

Decreased erythropoietin production
- ___ dysfunction
- Decreased body stores of vitamin B12, iron, or folic acid
- Blood loss

A
  • bone marrow
  • renal
62
Q

Significance of Anemia in Cancer

Fatigue has been reported in several
surveys as more troubling to cancer patients than nausea, vomiting, or pain
- Low ___ levels have been correlated with poor performance status which has been correlated with decreased survival and quality of life

A

hemoglobin

63
Q

Chemotherapy Induced Anemia

Patients with a Hgb ≤ __ g/dL or ≥ __ g/dL drop from baseline should undergo a work-up:

A

11, 2

64
Q

Chemotherapy Induced Anemia

If patient is symptomatic:
- ___ as indicated
- Consider use of ___
- Perform ___ studies:

A
  • transfuse
  • ESA
  • iron

patients need to be counseled on the risks and benefits of therapy

65
Q

ESA warnings

A

WARNING: ESAs INCREASE THE RISK OF DEATH, MYOCARDIAL INFARCTION, STROKE, VENOUS THROMBOEMBOLISM, THROMBOSIS OF VASCULAR ACCESS AND TUMOR PROGRESSION OR RECURRENCE

boxed warnings

66
Q

Considerations for Use of ESA’s

ESAs are NOT recommended:
– In patients receiving myelosuppressive chemotherapy
with ___ intent
– In patients with cancer NOT receiving chemo
– In patients receiving non- ___ chemo

A
  • curative
  • myelosuppressive
67
Q

Considerations for Use of ESA’s

Consider using:
– Cancer and ___
– Patient’s undergoing ___ chemotherapy
– Patients without other identifiable causes

A
  • CKD
  • palliative
68
Q

Risks and Benefits of Therapy

Survival studies:
- 3 meta-analyses demonstrated ___ survival when taking ESAs to correct Hgb > 12 g/dL
- 2 meta-analysis did not show differences in survival
when ESAs utilized
- Additional ongoing trials are underway to guide optimal use

A
  • decreased
69
Q

Risk and Benefits of Therapy

Risks
1. Increased ___ events
2. Possible ___ survival
3. Time to tumor progression ___

Benefits
1. ___ avoidance
2. Gradual improvement in
___ related symptoms

A
  • thrombotic
  • decreased
  • shortened
  • transfusion
  • anemia
70
Q

Risk and Benefits of Therapy

Risks
1. Transfusion ___
2. Transfusion related circulatory overload
3. Virus transmission (hepatitis, HIV,
etc.)
4. Bacterial contamination
5. Iron overload
6. Increased ___ events
7. Possible decreased survival

Benefits
1. Rapid increase of ___
and hematocrit levels
2. Rapid improvement in anemia
related symptoms like ___

A
  • reactions
  • thrombotic
  • hemoglobin
  • fatigue
71
Q

Epoetin alfa (Erythropoietin, Epoetin)

Pharmacology
- Glycoprotein which stimulates ___ production
- Stimulates ___ and ___ of committed
erythroid progenitors in the bone marrow
- Produced in the ___
- Endogenous production regulated by level of tissue oxygenation

A
  • RBC
  • division, differentiation
  • kidney
72
Q

Epoetin alfa (Erythropoietin, Epoetin)

For chemotherapy-associated anemia
- Dose should be adjusted to maintain the ___ Hgb level
- If the Hgb increases > __ g/dL in a 2-week period, the dose should be decreased by __ % for epoetin alfa and __ % for darbepoetin

A
  • lowest
  • 1
  • 25, 40
73
Q

Darbepoetin (Aranesp)

Stimulates erythropoiesis by binding to the ___ receptor like erythropoietin
- Biochemically distinct from epoetin alfa by the addition of a sialic acid
- half life 2 - 3 x ___ than epoetin

Indications
- Anemia in patients with non- ___
malignancies where anemia is caused by chemo

Dosing
- Titrate to response same as with epoetin alfa

A
  • epoetin
  • longer
  • myeloid
74
Q

Iron in Anemic Cancer Patients

T or F: All oncology patients who are prescribed ESA therapy should have baseline iron studies performed

A

T

75
Q

Iron in Anemic Cancer Patients

Serum ferritin, iron, iron saturation
- If a patient is iron deficient, a workup should be done
- If no other causes for anemia is identified, oral iron supplementation is ___
- Iron absorption will be ___ (by as much as half) if food is eaten 2 hours before or 1 hour after ingestion

A
  • recommended
  • decreased
76
Q

Iron Dosing

  • Low Molecular Weight Iron Dextran (Dexferrum) - IV ___
  • Iron Sucrose (Venofer) - IV ___ , ___
  • Ferric Gluconate (Ferrlecit) - IV ___ , ___

Patients with an active ___ should not receive iron therapy

A
  • infusion
  • infusion, injection
  • infusion, injection
  • infection
77
Q

Classic Chemotherapy Toxicities

Toxicity: Myalgias/Arthralgias

Chemo (5)

Treatment (2)

A
  • Paclitaxel, Docetaxel
    Anastrozole, Letrozole,
    Exemestane
  • NSAIDs, opioids
78
Q

Classic Chemotherapy Toxicities

Toxicity: Hemorrhagic cystitis

Chemo (2)

Treatment (2)

A
  • High dose cyclophosphamide,
    Ifosfamide
  • Hydration (prevention), Mesna (prevention)
79
Q

Classic Chemotherapy Toxicities

Toxicity: Heart Failure

Chemo (3)

Treatment (3)

A
  • Anthracyclines, High dose cyclophosphamide, Trastuzumab (other HER2 targeted therapies)
  • Monitor cumulative dose, assess for risk factors, Dexrazoxane (chemoprotectant)
80
Q

Classic Chemotherapy Toxicities

Toxicity: Peripheral Neuropathy

Chemo (3)

Treatment (2)

A
  • Taxanes, Vinca Alkaloids,
    Platinums
  • Change infusion rates (i.e., Paclitaxel), Adjunctive pain medications (ex. Gabapentin, amitriptyline)
81
Q

Classic Chemotherapy Toxicities

Toxicity: Pulmonary

Chemo: (1)

Treatments (1)

A
  • bleomycin
  • Corticosteroids (no good treatment once
    it happens)
82
Q

Mesna

Mesna should be used with standard
ifosfamide ( ___ ) doses of < 2.5 g/m2 /day to decrease risk of hemorrhagic cystitis
- toxic metabolite: ___

A
  • cyclophosphamide
  • acrolein
83
Q

Cardiac Toxicity

Mechanism
- Formation of iron-dependent oxygen free ___ due to stable anthracycline-iron complexes, which cause catalysis of electron transfer
- Myocardium is more susceptible due to lower levels of ___ capable of detoxifying oxygen free radicals compared with other tissues

A
  • radicals
  • enzymes
84
Q

Type I Chemotherapy Related: Cardiac Dysfunction

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

A

anthracycline

85
Q

Type I Chemotherapy Related: Cardiac Dysfunction

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

A
  • year
  • anthracycline
  • cumulative
86
Q

Type I Chemotherapy Related Cardiac Dysfunction

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

A
  • decades
  • anthracyclines
87
Q

Type II Chemotherapy Related Cardiac Dysfunction

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

A
  • damage
  • EGFR
88
Q

Type II Chemotherapy Related Cardiac Dysfunction

Trastuzumab
- Appears to be largely ___ 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 ___ with anthracycline, the incidence can increase up to ___ % cardiac toxicity (NYHA class III/IV)

A
  • reversible
  • concurrently
  • 27%
89
Q
A

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