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Oncology APP > symptom and side effect management > Flashcards

symptom and side effect management Flashcards

1
Q

what are 3 risk factors for nonmedical opioid use?

A

personal or FH of drug or alcohol abuse, personal or FH of mental health disorder, (anxiety, depression, history of abuse, history of PTSD)

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2
Q

reaction type which is uncommon, unpredictable, and unrelated to a drug’s mechanism of action

A

idiosyncratic reaction

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3
Q

infusion reaction mediated by IgE and requires previous exposure

A

allergic reaction

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4
Q

resembles a type I interaction with mast cell degranulation

A

pseudo-allergic or anaphlactoid reaction

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5
Q

reaction characterized by fever, nausea, headache, tachycardia, hypotension, rash, and shortness of breath

A

cytokine release syndrome

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6
Q

this type of hypersensitivity reaction occurs in seconds to minutes

A

Gell and Coombs type I, IgE mediated reactions

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7
Q

this type of hypersensitivity reaction occurs in minutes to hours

A

Gell and Coombs type II, antibody mediated cytotoxic reaction

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8
Q

this type of hypersensitivity reaction occurs in several hours

A

Gell and Coombs type III, immune complex mediated reaction

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9
Q

this type of hypersensitivity reaction occurs in hours to days

A

Gell and Coombs type IV, delayed t-cell mediated responses

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10
Q

carboplatin and oxiloplatin generally cause what G&C type reaction

A

type I, IgE mediated reaction

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11
Q

which drugs produce reactions that aren’t a true type I hypersensitivity, but are indistinguishable and may be a result of direct effects on immune cells

A

paclitaxel and docetaxel

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12
Q

what excipiant used in what drug has been shown to induce histamine release and hypotension?

A

cremaphor, paclitaxel. Albumin bound paclitaxel doesn’t contain cremaphor

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13
Q

what type of reaction doesn’t require prior exposure and is more likely to occur at the first exposure?

A

infusion related reaction

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14
Q

what anti-CD20 monoclonal antibody causes infusion reaction in up to 80% of patients

A

rituximab

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15
Q

what percent of patients have an infusion reaction after the 4th infusion of rituximab

A

30%

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16
Q

true or false- premedication reduces the risk of anaphylaxis

A

false- it does reduce the risk of infusion related reactions, however

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17
Q

fever, headache, tachycardia, headache, and rash are symptoms of what type of hypersensitivity reaction?

A

cytokine release syndrome

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18
Q

common terminology criteria for adverse effects should not be used for cytokine release syndrome if it is the result of

A

CAR T-cell therapy

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19
Q

how to manage grade III or below CRS?

A

short term cessation of the infusion, antipyretics, histamine blockers, and corticosteroids

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20
Q

what grade CRS reaction should prompt permanent discontinuation of the inciting drug? What are features of this grade of reaction?

A

grade IV, life threatening consequences with urgent intervention required

21
Q

what is the overall incidence rate of hypersensitivity reactions to chemotherapy?

A

5%

22
Q

In infusion reactions, what percent of patients experience a mucocutaneous symptom like pruritis/itching, rash/desquamation, or urticaria

A

90%

23
Q

In infusion reactions, what percent of patients experience a respiratory symptom like dyspnea, broncospasm, and wheezing?

A

40%

24
Q

In infusion reactions, acute laryngo-pharyngeal dysesthesia (a cold related sensation of dyspnea, difficulty of swallowing or talking, and odd sensations in the tongue or pharynx) occurs with what drug?

A

oxaliplatin

25
Q

In infusion reactions, what percent of patients experience a circulatory symptom of hypo/hypertension

A

30-35%

26
Q

In infusion reactions, what GI symptoms can present?

A

N/V, cramping, diarrhea

27
Q

fever, hypotension responding to fluids, and hypoxia responding to <40% O2 is what CTCAE grade of CRS?

A

grade 2

28
Q

this hypersenitivity reaction is considered grade 3 when there is bronchospasm or IV intervention indicated

A

allergic reaction

29
Q

this hypersensitivity reaction is characterized by breathing difficulty, hypotension, urticaria, cyanosis and requires close monitoring for the next 24 hours.

A

anaphylaxis

30
Q

what drug takes advantage of the fact that acute lymphoblastic leukemia cells and some other suspected tumor cells are unable to synthesize a non-essential amino acid, whereas normal cells are able to make their own; thus leukemic cells require higher amount of this amino acid.

A

L-asparaginase

31
Q

l-asparaginase, taxanes, platinums, epipodophyllotoxins (etoposide, teniposide), and some monoclonal antibodies (cetuximab, daratumumab, and ofatumumab) have what potential for hypersensitivity reactions?

A

high potential

32
Q

anthracyclines like doxorubicin, daunorubicin, and even the pegylated liposomal doxorubicin have what potential frequency for hypersensitivity reactions?

A

occasional potential

33
Q

what potential for hypersensitivity reactions do antibiotics, alkylating agents, antimetabolites, vinca alkaloids, and immunotherapy have?

A

rare potential

34
Q

how to manage anaphylaxis? If bradycardia? If hypotension? If pt taking beta blockers?

A

epinephrine, NS, h1/h2 antagonists, if bradycardia: atropine, if hypotension: dopamine or vasopressin, if beta-blocker treatment: glucagon infusion, corticosteroids

35
Q

skin symptoms and signs are present in what percent of anaphylactic episodes?

A

90%

36
Q

Skin or mucosal symptoms and signs (such as hives, itching, flushing, and angioedema), which are helpful in making the diagnosis, are absent or unrecognized in what percent of episodes of anaphylaxis?

A

up to 10 percent of all episodes.

37
Q

an acute episode of hypotension and what other symptoms could indicate anaphylaxis?

A

GI distress, respiratory symptoms, cardiovascular symptoms

38
Q

when considering anaphylaxis, skin or mucosal symptoms and signs (such as hives, itching, flushing, and angioedema), which are helpful in making the diagnosis, are absent or unrecognized in what percent of episodes?

A

up to 10 percent

39
Q

what is defined as a recurrence of symptoms meeting anaphylaxis diagnostic criteria that develops within 1 to 48 hours following the apparent resolution of the initial anaphylactic episode with no additional exposure to the causative agent.

A

Biphasic anaphylaxis. Occurs in about 5 percent of cases

40
Q

the preferred route for initial administration of epinephrine for anaphylaxis in most settings and in patients of all ages

A

IM

41
Q

what drug can be used to manage VOD/SOS if there is pulmonary or renal compromise

A

defibrotide

42
Q

what potentially fatal liver-related syndrome is signaled by weight gain and early water retention?

A

veno-occlusive disease/ sinusoidal obstruction syndrome VOD/SOS

43
Q

when treating anaphylaxis, what is the starting dose of epinephrine for adults?

A

Patients who weigh >50 kg can be given 0.5 mg (0.5 mL of the 1 mg/mL solution)

44
Q

when treating anaphylaxis, IM epinephrine may be repeated at what interval if there is no response or an inadequate response or even sooner if clinically indicated.

A

5- to 15-minutes

45
Q

Note that for anaphylaxis, the dose is how much less of the IV epinephrine dose used in cardiac arrest (advanced cardiac life support)

A

1/10th or less

46
Q

if a patient taking beta-blockers appears to be refractory to epinephrine, what can be administered because it has inotropic and chronotropic effects that are not mediated through beta-receptors

A

glucagon

47
Q

when using opiates for cancer pain, what percentage increase is indicated for mild to moderate pain refractive to the current dose?

A

25-50% increase

48
Q

when using opiates for cancer pain, what percentage increase is indicated for severe pain refractive to current dose?

A

50-100% increase

49
Q

when using extended release opiates for cancer pain, what percentage of total daily dose is indicated for breakthrough dosing?

A

5-20% of total daily dose of ER dosing

Oncology APP (9 decks)

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