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PHRM 864: Therapeutics IV > Supportive Care I [NEED TO FINISH] > Flashcards

Supportive Care I [NEED TO FINISH] Flashcards

1
Q

What is the pathophysiology of Chemotherapy Induced Nausea/Vomiting?

A
  • Begins in the GI Tract cytotoxic chemotherapy that damages the epithelial cells [Enterochromaffin] releasing LARGE amounts of serotonin

Basically a lot of Serotonin?

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2
Q

When the serotonin is released, what gets activated?

A
  • Chemoreceptor Trigger Zone [CTZ] stimulating vomiting center
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3
Q

What are some of the complications that can occur with vomiting?

A
  • Dehydration, Electrolyte Abnormaliltes, Fatigue, Depression
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4
Q

What are the different types of Nausea/Vomiting?

A
  • Anticipatory, Acute, Delayed, Breakthrough, Refractory
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5
Q

What is Anticipatory Nausea/Vomiting?

A
  • Conditioned by previous emetic reactions that are provoked by sight, sound or smell
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6
Q

What is Acute Nausea/Vomiting?

A
  • Occurs within 24 hours of Chemotherapy
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7
Q

What is Delayed Nausea/Vomiting?

A
  • Occurs > 24 hours of Chemotherapy
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8
Q

What is Breakthrough Nausea/Vomiting?

A
  • Occurs even if on anti-emetics
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9
Q

What is Refractory Nausea/Vomiting?

A
  • Persists despite anti-emetics [FAILED]
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10
Q

What neurotransmitters are affected with CINV?

A
  • Dopamine, Histamine, Acetylcholine, Serotonin, Substance P
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11
Q

What is the MOST emetogenic chemotherapy agent?

A
  • Cisplatin
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12
Q

What are some of the risk factors for CINV?

A
  • Women > Men
  • Young > Old
  • Previous Motion or Morning Sickness
  • Anxiety
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13
Q

What important things to know about the treatment guidelines for CINV?

A
  • Prophylaxis
  • 5-HT can be substituted between each-other
  • Oral = IV
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14
Q

What are the drug regimens used in HIGHLY emetogenic patients?

A
  • A: NK-1 Antagonist, Steroid, 5-HT3 Antagonist, Antipsych
  • B: NK-1 Antagonist, Steroid, 5-HT3 Antagonist
  • C: Steroid, 5-HT3 Antagonist, Antipsych
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15
Q

What are the drugs regimens used in MODERATELY emetogenic patients?

A
  • A: Steroid, 5-HT3 Antagonist
  • B: Steroid, 5-HT3 Antagonist, Antipsych
  • C: NK-1 Antagonist, Steroid, 5-HT3 Antagonist
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16
Q

What are the drug regimens used in LOW emetogenic patients?

A
  • Steroid, 5-HT3 Antagonist [PICK ONE]
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17
Q

What are some of the drugs that can be used for Breakthrough Nausea/Vomiting?

A
  • Dopamine Antagonist [Haloperidol, Metoclopramide]
  • Phenothiazines [Procholorperazine, Promethazine]
  • Antipsych [Olanzapine]
  • Benzo [Lorazepam]
  • Cannabinoids [Dronabinol, Nabilone]
  • Serotonin Antagonist [“-setron”]
  • Steroids [Dexamethasone]
  • Anticholinergic [Scopolamine]
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18
Q

What are some of the drugs that are used for Delayed Nausea/Vomiting?

A
  • Dexathasone OR…
  • NK-1 Antagonist OR…
  • Olanzapine
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19
Q

What are some of the drugs that are used for Anticipatory Nausea/Vomiting?

A
  • PREVENTION
  • Behavioral [Relax, Hypnosis, yoga…]
  • Lorazepam
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20
Q

What are some of the common toxicites for 5-HT3 Antagonist?

A
  • Headache [switch 5-HT3s], QTC prologation, Constipation
21
Q

What are some of the common toxicities for Corticosteroids?

A
  • Insomia, Hyperglycemia
22
Q

What are some of the common toxicities for Substance P Antagonist [“-pitant”]?

A
  • Hiccups, drug interactions [steriods]
23
Q

What are some of the common toxicities for Dopamine antagonist?

A
  • Diarrhea, Sedation
24
Q

What are some of the common toxicities for Olanzapine?

A
  • Sedation
25
Q

What are some of the common toxicities for Phenothiazines?

A
  • Sedation, Tissue Damage [promethazine]
26
Q

What are some of the common toxicities for Cannibaniods?

A
  • Drowsiness, dizziness, hallucination
27
Q

What are some of the common toxicities for Lorazepam?

A
  • Sedation, Hallucination
28
Q

What are some of the common toxicities for Scopolamine?

A
  • Anticholinergic
29
Q

What are some important principles that are related to emetogenicity prevention and management?

A
  • Emetogenicity is additive [Two Mod agents = 1 high agent]
  • Tailored accordingly
  • PROPHYLAXIS [5-30 mins before chemo]
30
Q

What is the Pathophysiology for Mucositis?

A
  • GI mucosa that has a rapid turnover rate –> inflammation or ulcerations [top to bottom]
31
Q

What are some of the risk factors for Mucositis?

A
  • Poor Dental hygiene
  • Combo treatments [Chemo & Rads]
32
Q

What is Neutropenia?

A
  • Decreased WBC [<500] –> Increases life-threatening infections
33
Q

What is important to know about Neutropenia?

A
  • Myelosuppression is dose limiting [chemo]
  • Occurs 10-14 days after chemo
34
Q

What is Severe Neutropenia & Febrile Neutropenia?

A
  • Severe: ANC < 500 [increase infection]
  • Febrile: ANC < 500 + 101 F
35
Q

Within netropenia, what is the main treatment?

A
  • Colony Stimulating Factors [Increases WBC]
  • Primary Prophylaxis: receives chemo >20% of febrile netropenia
  • Secondary Prophylaxis: Netropenic event from previous cycle
36
Q

What are the different Conlony stimulating agents that are used in Netropenia?

A
  • Filgrastim [main]
  • Pegfilgrastim [pegylated]
37
Q

What are some of the averse effects of Colony stimulating agents?

A
  • $$$
  • Flu-like symptoms [because of WBC], bone and joint pain, DTV
38
Q

What is Thrombocytopenia?

A
  • Platelet count of < 100 x 10^3/uL
39
Q

What is the treatment for Thrombocytopenia?

A
  • GIVE PLATELETS
40
Q

What is anemia?

A
  • Decrease in blood cell production
  • Blood loss
41
Q

What is the main thing to do when a patient has chemotherapy induced anemia?

A
  • Symptomatic?
  • Transfuse, ESAs [not really recommended],Iron
42
Q

What are the two main ESAs that are used in Anemia?

A
  • Erythropoietin, Darbepoetin
43
Q

What is important to know about Iron in anemic cancer patients?

A
  • ALL patients that have ESA should have IRON studies[Serum Ferritin, Iron, Iron Saturation]
44
Q

What is important to know about the iron products in Anemia?

A
  • Iron Dextran: IN infusion
  • Iron Surcrose: IV injection
  • Ferric Gluconate: Iv Injection
45
Q

What are some of the classic chemo toxicites?

Pains? Bladder? Cardio? Neruo? Pulmonary?

A
  • Pains: -Taxenes & AI [use NSAIDS or Opioids]
  • Bladder: Cyclophosphamide [HYDRATE or Mesna]
  • Cardio: -Rubicins & HER2+ [Dexrazoxane]
  • Neuro: -taxanes, vincas, plats [Gabapentin]
  • Pulmonary: Bleomycin [corticosteroids]
46
Q

What is Mesna and what does it help?

A
  • Decreases the risk of Hermorrahgic Cyctitis [from cyclophosmide]
  • BINDS the acrolin
47
Q

What causes the cardiotoxicities within cancer?

A
  • Formation of iron-oxygen free radicals [from the “rubicins” making irreversible damages
48
Q

What are the types that are related to chemo induces cardiac dysfunction?

A
  • Type I
    – Acute: like heart attack
    – Chronic: getting a year of rubicins [DANGER]
    – Late-onset: Several years of therapy
  • Type II
  • HER2 [Reverisble]

PHRM 864: Therapeutics IV (28 decks)

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