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Fall 2021: Therapeutics III > Supportive Care I (Weddle) > Flashcards

Supportive Care I (Weddle) Flashcards

1
Q

List the 5 types of nausea/vomiting.

A
  1. Anticipatory
  2. Acute
  3. Delayed
  4. Breakthrough
  5. Refractory
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2
Q

List the 5 neurotransmitters implicated in CINV.

A
  1. Dopamine
  2. Histamine
  3. Acetylcholine
  4. Serotonin
  5. Substance P
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3
Q

Level ___ and ___ agents do not contribute to the emetogenicity of a drug regimen.

A

1 and 2

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4
Q

Adding level ___ or ___ agents increases the emetogenicity of the regimen by 1 level per agent.

A

3 and 4

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5
Q

List some risk factors for CINV.

A
  1. Women
  2. Younger age
  3. History of motion sickness
  4. History of morning sickness
  5. History of CINV
  6. Anxiety/anticipation of nausea
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6
Q

What condition can actually be protective against CINV?

A

Chronic ethanol

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7
Q

Give some examples of serotonin (5-HT3) antagonists.

A
  • Ondansetron
  • Granisetron
  • Dolasetron
  • Palonosetron
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8
Q

What are some common toxicities associated with serotonin (5-HT3) antagonists?

A
  • Headache
  • EKG changes
  • Constipation
  • Increased transaminases
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9
Q

Give an example of a corticosteroid.

A

Dexamethasone

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10
Q

What are some common toxicities associated with corticosteroids?

A

With short-term use:

  • Anxiety
  • Euphoria
  • Insomnia
  • Hyperglycemia
  • Increased appetite
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11
Q

Give some examples of substance P (NK-1) antagonists.

A
  • Aprepitant (oral and injectable)
  • Fosaprepitant
  • Rolapitant
  • Netupitant
  • Fosnetupitant
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12
Q

What are some common toxicities associated with NK-1 antagonists?

A
  • Hiccups
  • Drug interactions
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13
Q

Give some examples of dopamine antagonists.

A
  • Chlorpromazine
  • Haloperidol
  • Metoclopramide
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14
Q

Give some examples of common toxicities associated with dopamine antagonists.

A
  • Extrapyramidal side effects
  • Diarrhea
  • Sedation
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15
Q

Give an example of an atypical antipsychotic.

A

Olanzapine

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16
Q

What are some comon toxicities associated with atypical antipsychotics?

A
  • Dystonic reactions
  • Sedation
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17
Q

Give some examples of phenothiazines.

A
  • Prochlorperazine
  • Promethazine
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18
Q

What are some common toxicities associated with phenothiazines?

A
  • Sedation
  • Akathisia
  • Dystonia
  • Tissue damage (IV promethazine)
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19
Q

Give an example of a cannabinoid.

A

Dronabinol

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20
Q

What are some common toxicities associated with cannabinoids?

A
  • Drowsiness
  • Dizziness
  • Euphoria
  • Mood changes
  • Hallucinations
  • Increased appetite
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21
Q

Give an example of a benzodiazepine.

A

Lorazepam

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22
Q

What are some common toxicities associated with benzodiazepines?

A
  • Sedation
  • Hypotension
  • Urinary incontinence
  • Hallucinations
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23
Q

Give an example of an anticholinergic drug.

A

Scopolamine (patch)

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24
Q

What are some common toxicities associated with anticholinergics?

A

Inhibits SLUD (salivation, lacrimation, urination, defecation)

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25
Q

Provide an appropriate regimen for a highly emetogenic drug combination.

A

A. NK-1 → dexamethasone → 5-HT3 → olanzapine

B. olanzapine → palonosetron → dexamethasone

C. NK-1 → dexamethasone → 5-HT3

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26
Q

Provide an appropriate regimen for a moderately emetogenic drug combination.

A

D. dexamethasone → 5-HT3

E. olanzapine → palonosetron → dexamethasone

F. NK-1 → dexamethasone → 5-HT3

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27
Q

Provide an appropriate regimen for a low emetogenic drug combination.

A

Any 1 of the following:

  • Dexamethasone
  • Metoclopramide
  • Prochlorperazine
  • Dolasetron
  • Granisetron
  • Ondansetron
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28
Q

What eight drug classes may be used for breakthrough nausea/vomiting?

A
  1. Dopamine antagonists
  2. Atypical antipsychotics
  3. Phenothiazines
  4. Benzodiazepines
  5. Cannabinoids
  6. Serotonin (5-HT3) antagonists
  7. Steroids
  8. Anticholinergics
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29
Q

Which agents are typically used for delayed nausea/vomiting?

A
  • Dexamethasone
  • NK-1 antagonist
  • Olanzapine
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30
Q

How can you prevent CINV from an oral chemotherapy regimen that has moderate to high emetogenic risk?

A

Start a 5-HT3 antagonist before chemo and continue daily

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31
Q

How can you prevent CINV from an oral chemotherapy regimen that has minimal to low emetogenic risk?

A

Start either metoclopramide, prochlorperazine, or a 5-HT3 antagonist before chemotherapy and maybe give daily or PRN

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32
Q

How soon before chemotherapy should anti-emetics be given?

A

At least 5-30 minutes prior to chemotherapy

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33
Q

What are the hallmark signs and symptoms of mucositis?

A

Can range from mild inflammation to bleeding ulcerations

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34
Q

The course of mucositis progresses in a stepwise fashion, and parallels the __________________.

A

neutrophil nadir

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35
Q

When does mucositis typically begin?

A

Day 5-7 after chemotherapy

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36
Q

What two chemotherapy drugs are MOST associated with mucositis?

A

5-FU and doxorubicin

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37
Q

What are some risk factors associated with mucositis?

A
  • Pre-existing oral lesions
  • Poor dental hygiene or ill-fitting dentures
  • Combined modality of treatment (patients getting chemo and radiation)
38
Q

How can a patient adjust their diet to avoid/not exacerbate mucositis?

A
  • Avoid rough food, spices, salt, and acidic food
  • Avoid smoking and alcohol
39
Q

Give some general mouth care strategies for mucositis.

A
  • Baking soda (+/- salt) rinse
  • Soft toothbrush
  • Saliva substitute
40
Q

Provide 4 pain management strategies for mucositis.

A
  1. Topical anesthetics (magic mouthwash)
  2. Oral cryotherapy (ice chips)
  3. Sucralfate
  4. Opioid analgesics
41
Q

Although Mary’s Magic Mouthwash will often provide adequate relief, provide one drawback.

A

short-lived effect

42
Q

Oral cryotherapy works to decrease mucositis by what mechanism?

A

vasoconstriction may decrease chemotherapy delivery to the oropharyngeal mucosa

43
Q

Through what mechanism could oral sucralfate be effective in mucositis pain management?

A

forms a protective barrier, also increases local production of prostaglandin E2 (a mucosal protectant)

44
Q

What is a potential drawback of using sucralfate for mucositis pain?

A

potentially nauseating taste/texture, not much good data to support use

45
Q

Why should mucositis patients be weary of using oral analgesic solutions OTC?

A

many contain a high percentage of alcohol, which may burn

46
Q

Neutropenia is the incidence of decreased ______________.

A

white blood cells

47
Q

What WBC count qualifies as neutropenia?

A

< 0.5 x 103 /µL

48
Q

Define nadir.

A

the lowest value the blood count falls to (described by ANC)

49
Q

Neutropenic patients are at an increased risk of ____________.

A

infection

50
Q

How do you calculate ANC?

A

WBC x % granulocytes (segs + bands)

51
Q

What ANC level qualifies as severe neutropenia?

A

< 0.5 x 103 / µL

52
Q

What ANC and temperature qualify as febrile neutropenia?

A

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

53
Q

When would CSFs be used for primary prophylaxis of febrile neutropenia?

A

if the patient is to receive a chemotherapy regimen that is expected to cause ≥ 20% incidence of febrile neutropenia

54
Q

When would CSFs be used for secondary prophylaxis of febrile neutropenia?

A

the patient experienced a neutropenic complication from a previous cycle of chemotherapy and now you want to prevent that again

55
Q

True or false: CSFs are 1st line for the treatment of neutropenic fever.

A

false; lackluster outcomes and high cost

56
Q

CSFs can be used to support patients through ___________ chemotherapy.

A

dose dense

57
Q

What happens after filgrastim is discontinued?

A

rapid drop in WBCs and neutrophils (50% decrease in 24 hours)

58
Q

Which has a longer half-life: filgrastim or pegfilgrastim?

A

pegfilgrastim (Neulasta)

59
Q

Which is a biosimilar: tbo-filgrastim or filgrastim-sndz?

A

filgrastim-sndz

60
Q

What are the most common adverse effects associated with filgrastim?

A
  • flu-like symptoms
  • bone/joint pain
  • DVT
61
Q

What rare adverse effect is associated with filgrastim?

A

splenic enlargement/rupture

62
Q

How is thrombocytopenia traditionally defined?

A

platelet count < 100 x 103 /µL

63
Q

At what platelet count does an increased risk of bleeding occur?

A

< 20 x 103 /µL

64
Q

Most institutions will not tranfuse a thrombocytopenia patient until they are ____________.

A

symptomatic

65
Q

At what platelet count does ASCO recommend transfusion?

A

10 x 103 /µL

66
Q

What are the four general causes of anemia?

A
  1. decreassed RBC production
  2. decreased erythropoietin production
  3. decreased body stores of B12/iron/folic acid
  4. blood loss
67
Q

What should be done if a chemotherapy-induced anemia patient is symptomatic (short of breath)?

A
  • transfuse as indicated
  • consider ESAs
  • perform iron studies
68
Q

Which patient groups should be considered for ESA use?

A
  • cancer and CKD
  • underdoing palliative chemo
  • without other identifiable causes
69
Q

Patients with previous risk factors of ___________ events may be at a higher risk with ESA use.

A

thrombotic

70
Q

_______ will yield gradual improvement in anemia-related symptoms, while _________ will yield rapid improvement.

A

ESAs; RBC transfusions

71
Q

Epoetin alfa is a glycoprotein that stimulates _______ production.

A

RBC

72
Q

In what groups is epoetin alfa contraindicated?

A
  • uncontrolled HTN
  • albumin hypersensitivity
  • mammalian cell-derived product hypersensitivity
73
Q

Epoetin alfa increases the risk of ________ in patients on dialysis.

A

seizures

74
Q

How does darbepoetin stimulate erythropoiesis?

A

binds to the epoetin receptor like erythropoietin

75
Q

What makes darbepoetin biochemically distinct from epoetin alfa?

A

addition of a sialic acid

76
Q

Which has a longer half-life: epoetin alfa or darbepoetin?

A

darbepoetin

77
Q

In which groups is darbepoetin contraindicated?

A
  • uncontrolled HTN
  • epoetin alfa hypersensitivity
78
Q

Why should we NOT increase Hgb by < 1 g/dL in a 2-week period?

A

associated with increased risk of cardiovascular events

79
Q

All oncology patients prescribed ESA therapy should have baseline _______________ performed.

A

iron studies

80
Q

True or false: patients with an active infection are allowed to receive iron therapy.

A

false

81
Q

What chemo drugs are known to cause myalgias?

A

taxanes and aromatase inhibitors

82
Q

What treatment options are available for chemotherapy-induced myalgias?

A

NSAIDs, maybe opioids

83
Q

What chemotherapy drugs are known to cause hemorrhagic cystitis?

A

high-dose cyclophosphamides and ifosfamide

84
Q

What drugs can be used to prevent chemotherapy-induced hemorrhagic cystitis?

A

mesna

85
Q

What non-pharmacologic strategy can be employed to prevent hemorrhagic cystitis?

A

hydration

86
Q

What chemotherapy agents are known to cause heart failure?

A
  • anthracyclines
  • high-dose cyclophosphamides
  • trastuzumab
87
Q

What drug is a chemoprotectant against chemotherapy-induced heart failure?

A

dexrazoxane

88
Q

What chemotherapy agents are known to cause peripheral neuropathy?

A

taxanes, vinca alkaloids, and platinums

89
Q

Provide two treatment strategies for chemotherapy-induced peripheral neuropathy.

A
  • change infusion rates (i.e. paclitaxel)
  • adjunctive pain meds (gabapentin, amitriptyline)
90
Q

What chemotherapy drug is known to cause pulmonary toxicities?

A

bleomycin

Fall 2021: Therapeutics III (25 decks)

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