Supportive Care in Oncology Flashcards
1
Q
What are the disease risks factors of Mucositis?
A
- Head and neck cancer
- Treatment plan
- Chemo vs radiation
- Duration of treatment
- Dose of therapy
- Frequency of therapy
2
Q
What are the patient risks factors of Mucositis?
A
- Smoking
- Baseline oral hygiene
- Younger age
- Female sex
- Pretreatment nutritional status
3
Q
Which old chemotherapy promotes mucositis?
A
- Antimetabolites (5-FU and Methotrexate)
- Platin-Derived (Cisplatin and Carboplatin)
- Taxanes (Docetaxel and Paclitaxel)
- Anthracyclines (Doxorubicin)
- Alkylating agents (Cyclophosphamide)
- Irinotecan
4
Q
Which new chemotherapy promotes mucositis?
A
- mTOR inhibitors (Everolimus)
- EGFR inhibitors (Cetuximab)
- Tyrosine kinase inhibitors (Afatinib)
- Multi kinase inhibitors (Sunitinib)
- CTLA-4 inhibitors (Ipilimumab)
5
Q
How do you prevent mucositis for chemotherapy?
A
- Prophylactic oral care
- Professional dental assessment – if high risk
- Cryotherapy
- Mucoadhesive hydrogel rinses (MuGard)
- Supersaturated calcium phosphate rinses (BioSal)
6
Q
How do you prevent mucositis for radiation?
A
- Prophylactic oral care
- Professional dental assessment
- Shielding and limiting of mucosal exposure
- Dietary modifications
- Mucoadhesive hydrogel rinses
- Supersaturated calcium phosphate rinses
- Low-level laser therapy
7
Q
How do you treat mucositis due to chemotherapy?
A
- Bland rinses (NS or baking soda)
- 2% viscous lidocaine swish and spit
- Diet modification
- 2% morphine mouthwash swish and spit
- Systemic opiates
8
Q
How do you treat mucositis due to radiation?
A
- Bland rinses (NS or baking soda)
- 2% viscous lidocaine swish and spit
- Gabapentin
- Low-level laser therapy
- 2% morphine mouthwash swish and spit
- Doxepin-containing mouthwashes
- Systemic opiates
9
Q
How do you treat mucositis due to targeted agents?
A
- Dexamethasone mouthwash (for everolimus)
- Systemic steroids (for refractory mTOR inhibitor mucositis)
10
Q
What drugs are irritants?
A
- Antimetabolite
- Liposomal
- Platin salts
- Alkylating agents
- Topoisomerase I inhibitors
- Arsenic
- Bleomycin
- Bortezomib
- Brentuximab
- Etoposide
11
Q
Which drugs are vesicants?
A
- Platinums
- Vinca alkaloids
- Anthracyclines
- Antitumor antiobitcs
12
Q
What are the symptoms of extravasation?
A
- Tingling
- Burning
- Discomfort
- Pain
13
Q
What are signs of extravasation?
A
- Swelling
- Redness or blanching
- Absence of blood return
- Resistance during IV bolus administration
14
Q
What are the patient risk factors of extravasation?
A
- Circulatory issues:
- PVD, Raynaud’s
- Small/fragile vein
- Obesity
- Multiple venipunctures
- Impaired communication:
- Dementia, aphasia
- Medication side effects
15
Q
What are the iatrogenic risk factors of extravasation?
A
- Inexperience
- Multiple cannulation attempts
- Unsuitable access site
- Infusion pump use
- Prolonged infusion
16
Q
How do you treat extravasation?
A
- Stop & disconnect infusion and Leave needle in place
- Identify extravasated drug
- Attempt to gently aspirate as much extravasated drug as possible and Avoid manual pressure over area as needle is removed
- Draw an outline around injury area
- Notify prescriber and Start specific treatment measures ASAP
- Elevate affected limb and administer analgesia if needed
17
Q
What are the contributing factors of hypercalcemia?
A
- Calcium supplements/TPN
- HCTZ/Chlorthalidone
- Lithium
- Vitamin D
- Sedatives/hypnotics
- Opioids
- Renal impairment
18
Q
What is the treatment of hypercalcemia?
A
- Discontinue contributing meds
- Stabilize the patient
- Acutely lower serum calcium to safer level
- Treat the underlying cause
- Chemotherapy and/or RT (if possible)
19
Q
IV Fluids
Hypercalcemia
A
- Aggressive hydration = 1st line treatment
- Rationale: Dilute serum Ca2+ and increases its excretion
- Onset: within hours duration: short-lived
20
Q
Antiresorptive Therapy
Hypercalcemia
A
- Bisphosphonates
- Pamidronate (Aredia)
- Zoledronic Acid (Zometa)
- RANKL (Receptor Activator of Nuclear Factor k-beta Ligand) Inhibitor
- Denosumab (Prolia)
- Goal: Prevent further Ca2+ release from bone
21
Q
Bisphosphate
A
- Guideline-recommended for moderate or severe HCM
- Dose may be repeated 7 days later if poor response
- Monitoring: Scr (can cause ATN); Ca level
22
Q
Which Bisphosphonate to choose?
Hypercalcemia
A
- Zoledronic acid preferred over Pamidronate for HCM
- Note: Pamidronate contraindicated if Scr > 3 mg/dL or ClCr < 30 mL/min
- Zoledronic acid contraindicated when Scr ≥ 4.5 mg/dL
23
Q
Denosumab
Hypercalcemia
A
- Guidelines suggest instead of bisphosphonate for moderate or severe HCM (low LOE)
- Less recurrent HCM; fewer skeletal-related events
- Monitoring: Ca** [new boxed warning]
o **NEED Calcium + Vit D supplementation
24
Q
Calcitonin
A
- Guideline-recommended for severe HCM - Rationale: Inhibits osteoclasts & prevents Ca2+ reabsorption
25
Q
What is the severe HCM treatment plan?
A
- IV fluids
- Calcitonin
- Zoledronic Acid
