Supportive Care I [NEED TO FINISH] Flashcards
What is the pathophysiology of Chemotherapy Induced Nausea/Vomiting?
- Begins in the GI Tract cytotoxic chemotherapy that damages the epithelial cells [Enterochromaffin] releasing LARGE amounts of serotonin
Basically a lot of Serotonin?
When the serotonin is released, what gets activated?
- Chemoreceptor Trigger Zone [CTZ] stimulating vomiting center
What are some of the complications that can occur with vomiting?
- Dehydration, Electrolyte Abnormaliltes, Fatigue, Depression
What are the different types of Nausea/Vomiting?
- Anticipatory, Acute, Delayed, Breakthrough, Refractory
What is Anticipatory Nausea/Vomiting?
- Conditioned by previous emetic reactions that are provoked by sight, sound or smell
What is Acute Nausea/Vomiting?
- Occurs within 24 hours of Chemotherapy
What is Delayed Nausea/Vomiting?
- Occurs > 24 hours of Chemotherapy
What is Breakthrough Nausea/Vomiting?
- Occurs even if on anti-emetics
What is Refractory Nausea/Vomiting?
- Persists despite anti-emetics [FAILED]
What neurotransmitters are affected with CINV?
- Dopamine, Histamine, Acetylcholine, Serotonin, Substance P
What is the MOST emetogenic chemotherapy agent?
- Cisplatin
What are some of the risk factors for CINV?
- Women > Men
- Young > Old
- Previous Motion or Morning Sickness
- Anxiety
What important things to know about the treatment guidelines for CINV?
- Prophylaxis
- 5-HT can be substituted between each-other
- Oral = IV
What are the drug regimens used in HIGHLY emetogenic patients?
- A: NK-1 Antagonist, Steroid, 5-HT3 Antagonist, Antipsych
- B: NK-1 Antagonist, Steroid, 5-HT3 Antagonist
- C: Steroid, 5-HT3 Antagonist, Antipsych
What are the drugs regimens used in MODERATELY emetogenic patients?
- A: Steroid, 5-HT3 Antagonist
- B: Steroid, 5-HT3 Antagonist, Antipsych
- C: NK-1 Antagonist, Steroid, 5-HT3 Antagonist
What are the drug regimens used in LOW emetogenic patients?
- Steroid, 5-HT3 Antagonist [PICK ONE]
What are some of the drugs that can be used for Breakthrough Nausea/Vomiting?
- Dopamine Antagonist [Haloperidol, Metoclopramide]
- Phenothiazines [Procholorperazine, Promethazine]
- Antipsych [Olanzapine]
- Benzo [Lorazepam]
- Cannabinoids [Dronabinol, Nabilone]
- Serotonin Antagonist [“-setron”]
- Steroids [Dexamethasone]
- Anticholinergic [Scopolamine]
What are some of the drugs that are used for Delayed Nausea/Vomiting?
- Dexathasone OR…
- NK-1 Antagonist OR…
- Olanzapine
What are some of the drugs that are used for Anticipatory Nausea/Vomiting?
- PREVENTION
- Behavioral [Relax, Hypnosis, yoga…]
- Lorazepam
What are some of the common toxicites for 5-HT3 Antagonist?
- Headache [switch 5-HT3s], QTC prologation, Constipation
What are some of the common toxicities for Corticosteroids?
- Insomia, Hyperglycemia
What are some of the common toxicities for Substance P Antagonist [“-pitant”]?
- Hiccups, drug interactions [steriods]
What are some of the common toxicities for Dopamine antagonist?
- Diarrhea, Sedation
What are some of the common toxicities for Olanzapine?
- Sedation
What are some of the common toxicities for Phenothiazines?
- Sedation, Tissue Damage [promethazine]
What are some of the common toxicities for Cannibaniods?
- Drowsiness, dizziness, hallucination
What are some of the common toxicities for Lorazepam?
- Sedation, Hallucination
What are some of the common toxicities for Scopolamine?
- Anticholinergic
What are some important principles that are related to emetogenicity prevention and management?
- Emetogenicity is additive [Two Mod agents = 1 high agent]
- Tailored accordingly
- PROPHYLAXIS [5-30 mins before chemo]
What is the Pathophysiology for Mucositis?
- GI mucosa that has a rapid turnover rate –> inflammation or ulcerations [top to bottom]
What are some of the risk factors for Mucositis?
- Poor Dental hygiene
- Combo treatments [Chemo & Rads]
What is Neutropenia?
- Decreased WBC [<500] –> Increases life-threatening infections
What is important to know about Neutropenia?
- Myelosuppression is dose limiting [chemo]
- Occurs 10-14 days after chemo
What is Severe Neutropenia & Febrile Neutropenia?
- Severe: ANC < 500 [increase infection]
- Febrile: ANC < 500 + 101 F
Within netropenia, what is the main treatment?
- Colony Stimulating Factors [Increases WBC]
- Primary Prophylaxis: receives chemo >20% of febrile netropenia
- Secondary Prophylaxis: Netropenic event from previous cycle
What are the different Conlony stimulating agents that are used in Netropenia?
- Filgrastim [main]
- Pegfilgrastim [pegylated]
What are some of the averse effects of Colony stimulating agents?
- $$$
- Flu-like symptoms [because of WBC], bone and joint pain, DTV
What is Thrombocytopenia?
- Platelet count of < 100 x 10^3/uL
What is the treatment for Thrombocytopenia?
- GIVE PLATELETS
What is anemia?
- Decrease in blood cell production
- Blood loss
What is the main thing to do when a patient has chemotherapy induced anemia?
- Symptomatic?
- Transfuse, ESAs [not really recommended],Iron
What are the two main ESAs that are used in Anemia?
- Erythropoietin, Darbepoetin
What is important to know about Iron in anemic cancer patients?
- ALL patients that have ESA should have IRON studies[Serum Ferritin, Iron, Iron Saturation]
What is important to know about the iron products in Anemia?
- Iron Dextran: IN infusion
- Iron Surcrose: IV injection
- Ferric Gluconate: Iv Injection
What are some of the classic chemo toxicites?
Pains? Bladder? Cardio? Neruo? Pulmonary?
- Pains: -Taxenes & AI [use NSAIDS or Opioids]
- Bladder: Cyclophosphamide [HYDRATE or Mesna]
- Cardio: -Rubicins & HER2+ [Dexrazoxane]
- Neuro: -taxanes, vincas, plats [Gabapentin]
- Pulmonary: Bleomycin [corticosteroids]
What is Mesna and what does it help?
- Decreases the risk of Hermorrahgic Cyctitis [from cyclophosmide]
- BINDS the acrolin
What causes the cardiotoxicities within cancer?
- Formation of iron-oxygen free radicals [from the “rubicins” making irreversible damages
What are the types that are related to chemo induces cardiac dysfunction?
- Type I
– Acute: like heart attack
– Chronic: getting a year of rubicins [DANGER]
– Late-onset: Several years of therapy - Type II
- HER2 [Reverisble]
