Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Fall 2024 > Therapeutics Exam 2 (Supportive Care) > Flashcards

Therapeutics Exam 2 (Supportive Care) Flashcards

1
Q

What is the most feared complication of chemotherapy?

A

Chemotherapy Induced Nausea and Vomiting (CNV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 5 types of Nausea/Vomiting?

A

Anticipatory
Acute
Delayed
Breakthrough
Refractory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is anticipatory nausea/vomiting?

A

-A learned response conditioned by previous emetic reactions from prior cycles of chemotherapy
-Can be provoked by sight, sound, or smell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is acute nausea/vomiting?

A

-Emetic response that correlates with the administration of chemotherapy

within 24 hours of receiving chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is delayed nausea/vomiting?

A

-Related to chemotherapy but occurs >24 hours after completion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is breakthrough nausea/vomiting?

A

Occurs even though the patient is on scheduled anti-emetics prior to chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is refractory nausea/vomiting?

A

Persists despite appropriate anti-emetic therapy
-Patient has failed other therapies at this point

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does chemotherapy cause CINV?

A

It begins in the GI tract where cytotoxic chemotherapy induces damage to epithelial cells lining the GI tract

Enterochromaffin cells that line the GI tract contain large amounts of serotonin which is released in massive quantities

The chemoreceptor trigger zone (CTZ) stimulates the vomiting center (located in the medulla)

Input to the vomiting center from higher cortical centers such as the pharynx and GI tract induce emesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which cells are responsible for the massive release of serotonin in the GI tract after chemotherapy that leads to CINV?

A

Enterochromaffin cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which neurotransmitter can be targeted to treat breakthrough CINV?

A

Dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the 2 most commonly targeted neurotransmitters for treatment of CINV?

A

Serotonin
Substance P

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which receptor mediates the action of substance P?

A

neurokinin-1 receptor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which chemotherapy produces the most nausea?

A

Cisplatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does the combination of chemotherapies affect emetogenicity?

A

Level 1 and 2 agents do not contribute to the regimen’s emetogenicity

Level 3 and 4 agents increase the emetogenicity of the combination regimen by 1 level per agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Who is at a higher risk for CINV: Men or Women?

A

Women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Who is at a higher risk for CINV: Younger Patients or Older Patients

A

Younger Patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are 4 risk factors of CINV?

A

Prior history of motion sickness

Prior history of morning sickness

Previous CINV

Anxiety/high pretreatment anticipation of nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What trait can be protective against CINV?

A

Chronic ethanol use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do we decide what prophylaxis to use for acute nausea and vomiting?

A

It is based on the emetogenic potential of the chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which is more efficacious: Oral or IV CINV prophylaxis

A

NEITHER, their are equally effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How many highly emetogenic regimens exist for acute N/V?

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the 4 types of drugs included in the acute N/V highly emetogenic regimen A?

A

NK-1 Antagonist (“tant”)
(Aprepitant, Fosaprepitant, Rolapitant, Netupitant/palonosetron, Fosnetupitant/palonosetron)

Steroid
(Dexamethasone)

5-HT3 Antagonist (“setron”)
(Dolasetron, Granisetron, Ondansetron, Palonosetron)

Atypical Antipsychotic
(Olanzapine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the 3 types of drugs included in the acute N/V highly emetogenic regimen B?

A

Atypical Antipsychotic
(Olanzapine)

Steroid
(Dexamethasone)

5-HT3 Antagonist
(Palonosetron)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the 3 types of drugs included in the acute N/V highly emetogenic regimen C?

A

NK-1 antagonist
(“tant”)

Steroid
(Dexamethasone)

5-HT3 Antagonist
(“setron”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What three drugs can be added to any regimen at any emetogenicity if the patient is experiencing toxicities that might warrant a benzodiazepine or PPI?

A

Lorazepam

H2 Blocker (Pepcid/famotidine, calcium carbonate)

PPI (omeprazole, esomeprazole, pantoprazole)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

For the moderately emetogenic regimen a, what are the 2 types of agents that should be used?

A

Steroid (dexamethasone)

5-HT3 Antagonist (dolasetron, granisetron, ondansetron, palonosetron)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

For the low emetogenic regimen, what are the agents that you can pick from? (Pick 1)

A

Dexamethasone
Metoclopramide
Prochlorperazine

5-HT3 antagonists (Dolasetron, Granisetron, Ondansetron)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Treatment for delayed nausea/vomiting typically involves the use of one of which 3 agents?

A

Dexamethasone
NK-1 Antagonist
Olanzapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which drug can be used for treatment of anticipatory nausea and vomiting?

A

Lorazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When/how long should drugs be given for the highly/moderately emetogenic regimen?

A

Start before chemotherapy
Continue daily (5-HT3 antagonists)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When/how long should drugs be given for the highly/moderately emetogenic regimen?

A

Start before chemotherapy
May be given daily or prn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the treatment for radiation induced emesis?

A

Granisetron PO +/- dexamethasone
Ondansetron PO +/- dexamethasone

(5HT3 inhib + Steroid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

For which radiopharmaceutical is nausea associated with the amino acid infusion that accompanies treatment?

A

Lutetium Lu-177 dotatate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the common side effects associated with the 5HT3 Inhibitors? (trons)

A

Headache
Constipation
QTc prolongation

*note: if side effects occur you CAN switch to another agent in the same class, not a class effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the common side effects associated with dexamethasone? (corticosteroid)

A

Hyperglycemia
Weight Gain (increased appetite)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the common side effects of Substance P Antagonists? (NK-1 antagonists) (tants)

A

Hiccups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the common side effects of the Dopamine Antagonists? (chlorpromazine, haloperidol, metoclopramide)

A

Extrapyramidal side effects
Diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the common side effects of olanzapine?

A

sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the common side effects of phenothiazines? (prochlorperazine, promethazine)

A

Sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the common side effects of the cannibanoids? (dronabinol)

A

Drowsiness
Weight Gain (increased appetite)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the side effects of lorazepam?

A

Sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What side effects are associated with the scopolamine patch?

A

Anticholinergic Side Effects
(can’t see, pee, shit, spit)

**Note: older people do not do well on this, primarily for use in young people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

When are antiemetics most effective?

A

When given as prophylaxis
(5 to 30 mins before chemotherapy)

-Administer around-the-clock until chemotherapy is complete and provide prn agents for breakthrough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

True or False: Mucositis is only in the mouth

A

False

-it can affect the entire GI tract all the way down to the colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is mucositis?

A

Ranges from mild inflammation to bleeding ulcers

-GI mucosa is comprised of epithelial cells and has a rapid turnover rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are the steps of progression for mucositis?

A

Parallels the neutrophil nadir

-Begins on day 5-7 after chemotherapy
-Improves as the neutrophil count increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are 2 chemotherapies to remember that cause mucositis?

A

5-FU
Anthrocycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the 3 risk factors for mucositis?

A

Pre-existing oral lesions

Poor dental hygiene or poor fitting dentures

Combined chemo+radiation therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are 3 dietary prevention methods to prevent mucositis development?

A

Avoid rough food, spices, salt, and acidic foods

Eat soft food or liquid food

Avoid smoking and alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are 3 mouthcare strategies for mucositis?

A

Baking soda rinses

Soft-bristled toothbrush

Saliva substitute (for radiation-induced xerostomia where the salivary glands are killed off)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What pain management strategies can be used for mucositis?

A

Topical anesthetics + Magic mouthwash (lidocaine, diphenhydramine, and antacid combos)

Oral cryotherapy

Sucralfate (swish and swallow, forms a protective barrier, can induce nausea)

Oral or IV opioids (for moderate to severe cases) PCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How does oral cryotherapy reduce the risk for mucositis?

A

Causes vasoconstriction which may lower the amount of chemotherapy delivered to the oropharyngeal mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the only way to get rid of mucositis?

A

Increase white blood cell counts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What white blood cell count is indicative of severe neutropenia?

A

<0.5 x 10^3/uL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is the most common dose-limiting toxicity of chemotherapy?

A

Bone marrow suppression/ Neutropenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the nadir?

A

The lowest value that the blood counts fall to during a cycle of chemotherapy

-Usually described by the absolute neutrophil count
-Generally occurs 10-14 days after chemo
-Counts normally recover by 3-4 weeks after chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

How do we calculate Absolute Neutrophil Count (ANC)?

A

WBC x % Granulocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are the typical guidelines used to assess if chemotherapy is safe to administer based on blood counts?

A

WBC > 3
ANC > 1.5
Platelet count > or = 100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

True or False: Neutropenic patients are at an increased risk of developing infections

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What values define febrile neutropenia?

A

ANC < 0.5

Single oral temperature >101F or >/= 100.4F for at least an hour

Get to hospital with this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Why is it so important for a patient to go to the hospital if they experience neutropenic fever?

A

The usual signs of infection (abscess, pus, and infiltrates on a chest x-ray) are not present because of the low levels of white blood cells

Fever is the only reliable indicator of infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What can we use to increase WBC counts when they are low?

A

Colony Stimulating Factors (CSF’s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What patients should receive primary prophylaxis for neutropenia?

A

-If they receive a chemo regimen expected to cause >/= 20% incidence of febrile neutropenia

-If they are high risk:
–Have preexisting neutropenia due to disease
–Extensive prior chemotherapy
–Previous irradiation to pelvis or other
areas with large amounts of bone marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What patients should receive secondary prophylaxis for neutropenia?

A

-Patient experienced a neutropenic complication from a previous cycle of chemo and now you want to prevent it from happening again

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What 3 CSF’s can be used to treat neutropenia?

A

Filgrastim
Pegfilgrastim
Sargramostim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Which has the longer half-life: Filgrastim or Pegfilgrastim?

A

Pegfilgrastim
-more expensive
-1 time injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Which medication used for treatment of neutropenia gets cleared more quickly as neutrophil counts increase?

A

Pegfilgrastim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Which form of filgrastim is not considered a biosimilar?

A

Tbo-Filgrastim (Granix)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Which form of filgrastim was the first approved biosimilar?

A

Filgrastim-sndz (Zarxio)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Which drug used for treatment of neutropenia is available as the Onpro kit?

(on-body self-injector kit that injects a dose of medication 24 hours after chemotherapy is received and prevents patient from coming having to come back to the hospital)

A

Pegfilgrastim

(note that this acts as a one-time injection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

When do we start filgrastim and how long is it continued?

A

Start 3-4 days after completion of chemo

Continue until post-nadir ANC recovers to normal or near normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

When do we start pegfilgrastim and how long is it continued?

A

Start at least 24 hours after chemo

Can be given up to 3-4 days after chemo

(at least 14 days should elapse between the dose and the next cycle of chemo)

OnPro body injector can be applied the same day as chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What are the common adverse effects of CSF’s?

A

Flu-like symptoms
*Bone + Joint Pain
DVT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What drug can be used to help with the side effects of CSF’s?

A

Loratadine
-because pain is thought to be due to histamine release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What is thrombocytopenia?

A

A platelet count < 100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

At what platelet count should a transfusion be considered?

A

</=10

*may also be indicated at higher levels if the patient has active bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What patients should undergo a work-up for anemia?

A

Hgb </= 11 g/dL OR >/= 2 g/dL drop from baseline

-want to determine cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

If a patient is experiencing symptomatic anemia, what are the 3 options for treatment?

A

Transfuse as indicated

Erythropoietic Stimulating Agents (ESA)

Perform Iron Study (need adequate iron for drugs to work)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What drug class has a black box warning for use in cancer patients and what is the warning?

A

Erythropoietin Stimulating Agents (ESA’s)

-cause shortened overall survival and/or increased risk of tumor progression

*note: use the lowest doses possible of these agents
*these are not used as commonly as they used to be

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Who should ESA’s not be used in?

A

Patients receiving myelosuppressive chemotherapy with curative intent

Patients not receiving chemotherapy

Patients receiving non-myelosuppressive chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Who should ESA’s be considered in?

A

Cancer and chronic kidney disease

Patients undergoing palliative chemo

Patients without other identifiable causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What are the 2 commonly used ESA’s for chemotherapy-associated anemia?

A

Epoetin alfa (erythropoietin)

Darbapoetin (Aranesp)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

When should we decrease the doses of epoetin alpha and darbepoetin during treatment of anemia?

A

If the Hgb increases > 1g/dL in a 2-week period

-Decrease epoetin dose by 25%
-Decrease darbepoetin dose by 40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What patients should have baseline iron studies performed?

A

All patients prescribed ESA therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What are the 3 iron products that can be given to patients?

A

Low Molecular Weight Iron Dextran (Dexferrum)

Iron Sucrose (Venofer)
Ferric Gluconate (Ferrlecit)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Mesna should be used with doses of what chemotherapy?

A

Isofosfamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Mesna is used to prevent what?

A

Hemorrhagic cystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

How does cardiac toxicity occur?

A

Iron-dependent oxygen free radicals form

-Cause catalysis of electron transfer

-The myocardium is susceptible because it has lower levels of enzymes capable of detoxifying oxygen free radicals compared to other tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Which chemotherapy agents are most likely to cause Type 1 cardiac dysfunction?

A

Anthracyclines (doxorubicin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Which chemotherapy agent is most likely to cause Type 2 cardiac dysfunction?

A

Trastuzumab

*not dose related
*not associated with cardiac damage (reversible)
-Involves the EGFR pathway (can restart therapy once EGFR goes back to normal)

Note: risk increases when used with anthracyclines, do not use these together

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What are the assessment questions for pain?

A

OPQRSTU

-What is the onset?
-What provokes the pain?
-What is the quality of pain?
-Does the pain radiate?
-How severe is the pain?
-Time of pain?
-Understanding and Impact (what is the
patient’s understanding of their pain and
what is their goal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What patient factors should we consider when determining appropriate analgesic therapy?

A

-Pain severity
-Medication access (price)
-Hepatic/renal function
-Previous analgesic therapy (did it work?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What should Step 1 pain therapy consist of (mildest pain)(1-3 rating)?

A

Non-opioid
Adjuvant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What should Step 2 pain therapy consist of (moderate pain)(4-6 rating)?

A

Opioid for mild to moderate pain
Non-opioid
Adjuvant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What should Step 3 pain therapy consist of (most severe pain)(7-10 rating)?

A

Opioid for moderate to severe pain
Non-opioid
Adjuvant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

When should morphine not be used?

A

Renal dysfunction!

-metabolites are excreted renally and will build up in renal failure

*use caution in liver dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Can hydromorphone be used in renal and hepatic dysfunction?

A

Yes but:
-Has renally excreted metabolites, lower dose or use longer dosing intervals in renal insufficiency
-Use caution in liver dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What is oxycodone metabolized by?

A

CYP2D6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Can oxycodone be used in renal and hepatic dysfunction?

A

Use caution in both

-Over sedation and CNS toxicity have been reported in renal failure patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What formulation does oxycodone NOT come in?

A

No IV formulations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What opioid is the safest to use in renal dysfunction?

A

Fentanyl

metabolized in the liver but is safe in dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Besides renal dysfunction, Fentanyl also acts as a great alternative in which patients?

A

Refractory nausea/vomiting

Head/neck/esophageal cancer patients unable to maintain adequate PO intake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What is the REMS warning on fentanyl for?

A

Transmucosal and Nasal Preparations

-Risk of addiction, abuse, and misuse
-Respiratory depression
-Accidental exposure from improper disposal

-Avoid having the patch on a direct external heat source as this increases vasodilation, increases uptake, and can lead to overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Who should not receive fentanyl?

A

Opioid naive patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Who should methadone be considered in?

A

Patients with:
-True morphine allergy
-Opioid-induced adverse drug reaction
-Refractory pain with other high dose opioids
-Neuropathic pain
-Who need long-acting po form at low cost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Who should not receive methadone?

A

Patients with:
-Numerous drug interactions
-Risks for syncope or arrythmia
-History of non-adherence
-Poor cognition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Can methadone be used in renal dysfunction?

A

Can be used in renal failure (no reported adverse effects)

BUT DO NOT USE IN SEVERE LIVER FAILURE
-QT prolongation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

When switching between opioid agents, how much should we dose reduce by?

A

25% due to cross tolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What side effect in opioids do patients not develop tolerance to?

A

Constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Who can receive a Patient Controlled Analgesia (PCA) pump?

A

Only patients who are awake, oriented, and able to self-administer their doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

How do we calculate a patients total opioid usage with a PCA?

A

24-hour dose: Basal rate + Number of hits used daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

How do we decide what breakthrough (prn) dosing of opioids should be?

A

10-20% of patient’s total 24-hour oral dose
available every 4 hours prn (more often if IV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What is the celiac plexus?

A

A group of nerves that supply organs in the abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Who is a celiac plexus block mostly used in?

A

Patients with pancreatic cancer
(due to involvement of celiac plexus)

114
Q

Who can recieve an intrathecal pain pump?

A

Patients who are refractory to other opioid therapies or have increased toxicities

-patients who are not obtaining relief with opioid therapy and are reaching levels of toxicity

115
Q

What is the conversion factor of oral morphine to intrathecal morphine?

A

300:1

*note that intrathecal morphine is extremely potent

116
Q

In what scenarios is radiation therapy used to relieve pain?

A

Bony metastases
Brain metastases
Spinal cord compression

117
Q

What agents should be considered for neuropathic pain?

A

Gabapentin
Pregabalin
Duloxetine

118
Q

Using the RECIST criteria, what is a complete response (CR)?

A

Disappearance of all target lesions

119
Q

Using the RECIST criteria, what is a partial response (PR)?

A

30% decrease in the sum of the longest diameter of target lesions

120
Q

Using the RECIST criteria, what is progressive disease (PD)?

A

20% increase in the sum of the longest diameter of target lesions

121
Q

Using the RECIST criteria, what is stable disease (SD)?

A

Small changes that do not meet other criteria

122
Q

What is the #1 cancer in females and second most cause of death of all cancers in the US?

A

Breast cancer

123
Q

What % of patients will not have any risk factors for breast cancer but still develop it?

A

60%

124
Q

What % of breast cancers are familial?

A

5-10%

125
Q

What are the 2 tumor suppressor genes in breast cancer?

A

BRCA-1

BRCA-2

126
Q

What is the GAIL risk model?

A

Mathematical risk assessment tool used to determine the relative risk in % of developing breast cancer compared to an age-matched control at 5 years and during one’s lifetime

127
Q

What are the 2 types of invasive breast cancer carcinoma?

A

Invasive ductal carcinoma (IDC) *most common

Invasive lobular carcinoma (ILC)

*note that these have invaded beyond the basement membrane of the duct or lobule

128
Q

What is the most common type of breast cancer that accounts for 70% of all breast cancers?

A

Invasive ductal carcinoma (IDC)

129
Q

What are the 2 types of non-invasive breast cancer?

A

Ductal carcinoma in situ (DCIS)
–normal cells have undergone pre-malignant
transformation

Lobular carcinoma in situ (LCIS)
–has not yet invaded beyond the lobule basement
membrane

130
Q

What is inflammatory breast cancer?

A

-Aggressive form with a rapid onset and poor prognosis
-Onset is days or weeks

Symptoms: edema, redness, warmth, inflammation, peau d’orange

131
Q

What is FISH testing?

A

Testing for HER2 status done in two ways:

-Immunohistochemistry: Detects protein overexpression (0=neg, 1+=low, 2+=do FISH test, 3+=high use HER2 therapy)

-Fluorescence In-Situ Hybridization (FISH): detects gene amplification ( if gene:chromosome copies are >/=2 it is positive)

132
Q

What is Oncotype DX?

A

Genetic test for expression of 21 genes which gives a recurrence score
(predicts recurrence risk and whether the patient is likely to benefit from chemo)

133
Q

What is a low risk Oncotype DX score and how does this affect the therapy we choose for breast cancer?

A

Low risk is <26

*Hormone therapy only

134
Q

What is a high risk Oncotype DX score and how does this affect the therapy we choose for breast cancer?

A

High risk is >26

*Use both chemotherapy and hormone therapy

135
Q

What group of people still incur benefits from chemotherapy even though they have a low Oncotype DX score?

A

Women <50 years of age with a score of 16-25

*use chemotherapy in these women

136
Q

What is an adjuvant?

A

Treatment given after surgery

137
Q

What is a neoadjuvant?

A

Treatment given before surgery

138
Q

For what stages of breast cancer is the goal to cure the patient?

A

1-3

Stage 4 is palliative care

139
Q

Which breast cancer patients should receive neoadjuvant therapy?

A

Patients with tumors > 1cm

140
Q

What are the benefits of neoadjuvant therapy?

A

Allows for less extensive surgery by shrinking the tumor

Allows you to see the tumor’s response to chemo while it is still intact

141
Q

For tumors </= 0.5 cm what adjuvant therapy should be used?

A

Adjuvant endocrine therapy

142
Q

For tumors > 0.5cm or 1-3 positive nodes, what adjuvant therapy should be used?

(Hormone+, Lymph node +/-, HER2-)

A

First: Complete a 21 gene RT-PCR assay

If not done: Endocrine therapy or chemo followed by endocrine therapy

RS<26: Endocrine therapy

RS>/= 26: Chemo followed by endocrine therapy

*give chemo in younger women

143
Q

What adjuvant therapy should women with breast cancer receive if:
Hormone+, Lymph Node+/-, and HER2+

A

Tumor </= 0.5cm: endocrine therapy +/- chemotherapy with HER2 targeted therapy

Tumor >0.6cm: Chemo with HER2 targeted therapy followed by endocrine therapy

144
Q

What hormonal adjuvant therapy should pre-menopausal women receive that post-menopausal women do not need?

A

Oopherectomy

-remove the ovaries which is the largest producer of estrogen (estrogen drives these tumors)

145
Q

How long does adjuvant therapy in breast cancer typically last?

A

5 years, then reassess and determine if 5 more years are needed

146
Q

How many cycles of chemotherapy are typically used in breast cancer treatment and how often are they given?

A

4-6 cycles of chemotherapy given every 3-4 weeks

147
Q

How many cycles of chemotherapy does neoadjuvant treatment in breast cancer typically consist of?

A

4-6 cycles

148
Q

When deciding on a breast cancer chemotherapy regimen, what is the most important factor to keep in mind?

A

Cardiac risks
(do not use anthracyclines in patients with these risks)

149
Q

If a breast cancer patient has cardiac problems, what chemotherapies can we consider using?

A

Docetaxel
Cyclophosphamides (TC)

*avoid anthracyclines

150
Q

What HER2 targeted therapy can be added on to a breast cancer patient’s chemo regimen for HER2+ disease?

A

Trastuzumab
Pertuzumab

151
Q

How long should HER2 targeted therapy (Trastuzumab and Pertuzumab) be continued in breast cancer treatment?

A

1 year

152
Q

What treatment should be added to the chemotherapy regimen for patients with Triple Negative Breast Cancer?

A

Immunotherapy
(pembrolizumab)

153
Q

Who may be better to receive hormonal therapy in metastatic breast cancer?

A

-Long drug free period with prior therapy
-Assess menopausal status
**ER+/PR+
-Prior response to therapy
-Bone only disease

154
Q

Who may be better to receive chemotherapy in metastatic breast cancer?

A

-Short disease-free period
-Rapidly progressing disease
-Disease refractive to hormonal therapy
**ER-/PR- disease
-Better performance status patients

155
Q

True or False: Combination chemotherapy in metastatic breast cancer patients has not been shown to be more effective

A

True

156
Q

Which regimen in metastatic breast cancer is used only for HER2 low patients (1+)?

A

Fam-trastuzumab
Deruxtecan

157
Q

What are the CDK 4/6 inhibitors?

A

Abemaciclib
Palbociclib
Ribociclib

158
Q

What are the common side effects of the CDK4/6 inhibitors?

A

Abemaciclib: Diarrea
Palbociclib:
Ribociclib: QTc Prolongation (need to check EKG)

***all need a complete blood count (CBC) to be done
*Check these drugs monthly

159
Q

At what age can you start having mammograms?

A

40

160
Q

At what age should you start having annual mammograms?

A

45

161
Q

What is the most common type of cancer in men?

A

Prostate cancer

162
Q

Prostate cancer is driven by what?

A

Testosterone
(growth signal to the prostate)

Alterations in the androgen receptor

163
Q

What are the risk factors for prostate cancer?

A

Older age (increased lifetime exposure to testosterone)

Race (African Americans have higher risk, Asians have lower risk)

Family history

164
Q

What are the methods used to diagnose prostate cancer?

A

Physical exam
PSA level
Biopsy of prostate
Transrectal ultrasound

164
Q

Where are the most common places that prostate cancer will metastasize to?

A

Bone
Lung
Liver

165
Q

What is the most common histology of prostate cancer?

A

Adenocarcinoma (99%)

166
Q

What is the Gleason score and what does it mean?

A

Score to rank prostate cancers

-Scores assigned to primary and secondary growth patterns, then added together

Score of 2-4: slow-growing, well differentiated
Score 8-10: aggressive, poorly differentiated

*Lowest= 1+1=2
*Highest= 5+5=10

Note: the higher the score, the higher the risk of extracapsular spread

167
Q

What is the normal Prostate Specific Antigen (PSA) range?

A

0-4

168
Q

What PSA level requires evaluation?

A

> 4

169
Q

What PSA level is highly suspicious for malignancy?

A

> 10

170
Q

What PSA velocity is suspicious for malignancy?

A

> 0.75 rise per year

171
Q

What does m1 mean in prostate cancer?

A

metastatic

172
Q

What does m0 mean in prostate cancer?

A

non-metastatic (only thing that is off is that the PSA is increasing)

173
Q

What is HSPC?

A

Hormone sensitive prostate cancer

174
Q

What is CRPC?

A

Castration resistant prostate cancer

175
Q

What is the treatment for localized prostate cancer?

A

Monitoring!

-Active surveillance (if it progresses, initiate potentially curative therapy)

-Expectation to deliver palliative therapy for symptom development, change in exam, or PSA suggesting symptoms are coming

-If cancer progresses, use radiation therapy or surgery

176
Q

What are the 2 types of radiation therapy that can be used in localized prostate cancer?

A

External beam

Brachy therapy (implanted pellets around prostate)

177
Q

If a patient with progressed localized prostate cancer is immediate or low risk, what adjuvant can we add onto their regimen?

A

Androgen deprivation therapy (ADT)

178
Q

For locally advanced/high risk prostate cancer, what treatment has been shown to be effective?

A

Androgen deprivation therapy with External beam radiation therapy

179
Q

When Androgen deprivation therapy (ADT) and external beam radiation therapy are used together, how should they be dosed?

A

Start ADT prior to radiation
Continue ADT during radiation therapy and for 1-3 years after

180
Q

For localized prostate cancer, what is the definitive curative therapy?

A

Radical Prostatectomy (prostate removal) + Pelvic lymph node dissection (PLND)

181
Q

What is the goal of androgen deprivation therapy?

A

Induce castration levels of testosterone

182
Q

What drugs/drug class are considered Androgen Deprivation Therapy?

A

LHRH agonists
-Leuprolide
-Goserelin

183
Q

True or False: LHRH agonists (leuprolide and goserelin) cause reversible castration in males with prostate cancer

A

True

184
Q

What is the main toxicity associated with LHRH agonists?

A

Tumor flares (elevate hormones until receptors eventually shut down and cause castration)

185
Q

What drug can be used instead of LHRH agonists in patients with cardiac history or need an oral drug?

A

Relugolix

186
Q

What are the anti-androgen drugs?

A

Flutamide
Bicalutamide*****
Nilutamide

187
Q

When are anti-androgens (flutamide, bicalutamide, nilutamide) used in prostate cancer?

A

Metastatic setting
-given in combination with LHRH agonists and used to prevent the hormone flare that these can cause

188
Q

What are the 3 principles that should be considered in metastatic prostate cancer?

A
  1. Goal is palliation of disease and to suppress testosterone production
  2. Determine whether this is a PSA recurrence or overt metastatic disease
  3. Determine PSA doubling time
189
Q

Which prostate cancer patients can consider using intermittent ADT therapy?

A

Men with biochemical failure only

190
Q

When metastatic prostate cancer is not responding to ADT and the PSA is increasing, what drugs can we add?

A

Enzalutamide
Apalutamide (not for m0 group)
Darolutamide

191
Q

What is the moa of enzalutamide?

A

Blocks androgen binding and translocation of androgen receptor

192
Q

Who should enzalutamide be used with caution in?

A

Patients with seizure history

193
Q

What is the moa of apalutamide?

A

Non-steroidal androgen receptor inhibitor

194
Q

Which drug in prostate cancer is metabolized by CYP3A4?

A

Darolutamide

195
Q

What is m1HSPC?

A

Prostate cancer that now has visceral metastases and is hormone sensitive

-determine therapy based on high or low volume

196
Q

What is the treatment for low volume m1HSPC?

A

ADT: LHRH agonist or antagonists

Continue ADT and add one of the following:
-Abiraterone+Prednisone
-Enzalutamide
-Apalutamide

197
Q

Which drug must be given with prednisone and why?

A

Abiraterone

-because it causes adrenal insufficiency (prednisone blocks this)

198
Q

What is the moa of abiraterone?

A

Inhibits CYP17 which is an enzyme required for androgen synthesis

-inhibits testosterone precursor formation

199
Q

What is the 1st line therapy for High Volume m1HSPC?

A

Docetaxel+ ADT

can also use:
ADT+Docetaxel+Abiraterone (+prednisone)
ADT+Docetaxel+Darolutamide

200
Q

When do we consider using chemotherapy in prostate cancer treatment?

A

High Volume m1HSPC

201
Q

What is the second-line chemotherapy that can be used in high volume metastatic prostate cancer?

A

Cabazitaxel

202
Q

What drug can be used in prostate cancer tumors that express dMMR or MSI-H?

A

Pembrolizumab

203
Q

How is goserelin administered?

A

Subq implant

204
Q

How is leuprolide administered?

A

Subq or IM injection

205
Q

At what age should men start screening for prostate cancer?

A

50

206
Q

What PSA level indicated the need for annual screenings?

A

PSA>/= 2.5

207
Q

WHat PSA level indicates the need for screening every 2 years?

A

PSA<2.5

208
Q

EGFR mutations in lung cancer predict sensitivity to what?

A

Tyrosine kinase inhibitor (TKI) therapy

209
Q

K-RAS mutations in lung cancer predict resistance to what?

A

Predict resistance to Tyrosine kinase inhibitors (TKI)

210
Q

What 2 mutations in lung cancer may appear in individuals who have never smoked/are light smokers?

A

ALK inhibition (anaplastic lymphoma kinase)

ROS-1 mutations

*also typically do not have PD-1 expression (this does not affect outcomes)

211
Q

Which form of lung cancer has a clear relationship to smoking?

A

Small cell lung cancer

212
Q

Which form of lung cancer has rapid cell growth?

A

Small cell lung cancer

(this type of cancer responds well to chemo)

213
Q

Which form of lung cancer has slow growth?

A

Non-small cell lung cancer

(moderate sensitivity to chemo and radiation)

214
Q

What is limited stage lung cancer?

A

Tumor is confined to hemithorax and contained in a radiation port, no distant metastases

-Only 30% of patients have this

215
Q

What is extensive stage lung cancer?

A

Tumor is not confined to hemithorax, not contained in a radiation port, and has distant metastases

-70% of patients have this

216
Q

For small cell lung cancer limited stage disease, what is the treatment?

A

Radiation + Chemo combined

Cisplatin + Etoposide (platinum doublet) 4-6 cycles
Radiation daily (M-F) for 6-7 weeks

217
Q

Which form of lung cancer has a high risk of brain metastases?

A

Small Cell Lung Cancer

218
Q

What is the treatment for small cell lung cancer extensive stage disease?

A

Platinum doublet chemo + Immunotherapy

Cisplatin + Etoposide +Atezolizumab/Durvalumab

219
Q

What are the side effects of cisplatin?

A

Nausea/vomiting
Nephrotoxicity
Ototoxicity (do not use in patients with hearing loss)
Neuropathy

220
Q

What drug can be used in patients with metastatic SCLC who have progressed on platinum-based therapy?

A

Pembrolizumab

221
Q

What is the neoadjuvant regimen for resectable NSCLC?

A

Nivolumab + Platinum doublet (Cisplatin+Etoposide)

222
Q

What is the adjuvant chemotherapy regimen for resectable NSCLC?

A

Non-squamous: Cisplatin + Pemetrexed

Squamous: Cisplatin + Gemcitabine, Cisplatin + Docetaxel

223
Q

If a lung cancer patient has a targetable mutation and is PD-L1+ what therapies are preferred to use first?

A

Oral therapies

(then move to immunotherapy later)

224
Q

What targeted therapy should be used in lung cancer patients with EGFR mutations (Exon 19 deletion, Exon 21 L858R mutation?

A

Osimertinib

225
Q

What targeted therapy should be used in lung cancer patients with BRAF mutations?

A

Dabrafenib + Trametinib

(BRAF inhibitor + MEK inhibitor)
-BRAF inhibitors can cause skin cancer, this is prevented by the MEK inhibitor

226
Q

What drug should be added on as subsequent therapy in patients with a K-RAS G12C mutation?

A

Sotorasib

227
Q

In patients with PD-L1 positivity >/= 1% what treatment do we use?

A

Pembrolizumab

228
Q

All mutation negative, non-squamous, NSCLC patients should receive what therapy?

A

Carboplatin + Pemetrexed + Pembrolizumab

229
Q

What is the treatment for squamous NSCLC?

A

Pembrolizumab + Carboplatin + Paclitaxel

230
Q

Who should be screened for lung cancer?

A

High risk patients

Age 55–74

30-year history of smoking and still smoking or quit in last 15 years

In good health

*Willing to have curative surgery if detected

231
Q

What is the clinical presentation of skin lesions? (remember ABCDE)

A

Asymmetric
irregular Borders
variety of Colors
Diameter >6mm
Evolution of a mole may indicate cancer

232
Q

If a melanoma is a clinical stage IV, it should be tested for what?

A

BRAF V600E and K mutations

233
Q

What is Moh’s surgery?

A

Used for melanoma removal

-take paper thin slices of tissue, keep looking under the microscope until there is no evidence of disease

234
Q

What did the checkmate 238 trial do?

A

Compared nivolumab to ipilimumab in melanoma

-found that toxicities were higher with ipilimumab

*This made nivolumab a category 1 recommendation

235
Q

What did the KEYNOTE-054 trial do?

A

Pembrolizumab was compared to placebo in stage III melanoma

-Pembrolizumab improved recurrence free survival and reduced risk of metastases

236
Q

What is the most common side effect of Dabrafenib + Trametinib?

A

Pyrexia (fevers)

237
Q

What did KEYNOTE-006 trial do?

A

Compared pembrolizumab with ipilimumab

-pembrolizumab has less toxicity
-pembrolizumab worked better

238
Q

What are the ipilimumab toxicities in melanoma?

A

Since response is based on the patient’s immune system’s ability to kill the melanoma, some patients have tumor growth prior to immune system activation

*all patients should receive all 4 doses unless they experience life threatening toxicity

239
Q

What age does screening for colorectal cancer start?

A

45

240
Q

What 2 disease states increase the risk for development of colorectal cancer?

A

Ulcerative colitis

Crohn’s disease

(inflammatory conditions of the GI tract)

241
Q

What hereditary syndromes increase the risk for colorectal cancer?

A

Familial Adenomatous Polyposis (FAP)

-development of 100’s to 1000’s adenomatous polyps
-Nearly 100% lifetime risk of developing colon cancer
*undergo colectomy when polyps appear

Hereditary Nonpolyposis Colorectal Cancer (HNPCC)

242
Q

What age does screening for colorectal start for patients with Familial Adenomatous Polyposis (FAP)?

A

10-12 years old

243
Q

> 95% of colorectal cancers have what origin?

A

Adenocarcinomas (glands)

244
Q

What does Defective DNA mismatch repair (dMMR) test for? (in colorectal cancer)

A

Microsatellite instability (MSI)
or
Loss of genes involved in DNA mismatch repair (MMR)

245
Q

dMMR or MSI-H tumors in colorectal cancer predict what?

A

Decreased benefit from adjuvant 5-FU therapy for Stage II disease

*note: Stage III disease still benefits

246
Q

What drugs are included in FOLFOX?

A

5-Flurouracil
Leucovorin
Oxaliplatin

247
Q

What drugs are included in CapeOX?

A

Capecitabine
Oxaliplatin

248
Q

What did the MOSAIC trial show?

A

FOLFOX significantly increased 6-year survival in colorectal cancer patients

249
Q

What did the IDEA trial test?

A

Evaluated if 3 months of oxiplatin therapy (FOLFOX and CapeOx) was non-inferior to 6 months of oxiplatin therapy (FOLFOX and CapeOx)

Results: Longer time resulted in more toxicity (neuropathy) and lower adherence

CapeOx: 3 months was equally effective as 6 months
FOLFOX: 6 months was MORE effective

250
Q

How does administration of FOLFOX differ from CapeOx?

A

FOLFOX: port, 2-day continuous pump at home, repeat every 2 weeks

CapeOx: PO for 14 days then off for 7

251
Q

If a patient with colorectal cancer has neuropathy, what drug may not be a good option for them?

A

Oxaloplatin

252
Q

If a patient with colorectal cancer has a UGT1A1 deficiency, what drug needs to have its dose changed?

A

Irinotecan

253
Q

KRAS mutations predict lack of response to which drugs?

A

anti-EGFR monoclonal antibodies

(do not use cetuximab or panitumumab)

254
Q

Which two screening tests are used to detect colorectal cancer?

A

Fecal occult blood test (FOBT)
-high false negative rate

Fecal immunohistochemical test (FIT)

255
Q

Which tests are used to detect colorectal cancer and advanced lesions?

A

Endoscopy (Colonoscopy)

Radiological exams

256
Q

At what age should patients start being screened for colon cancer?

A

45

257
Q

How often should a colonoscopy be done?

A

Every 10 years

258
Q

If a patient has a family history of a 1st degree relative with colon cancer, when should they start screening?

A

Age 40

OR: 10 years younger than the youngest age of diagnosis in the family

259
Q

What treatments are available to prevent colon cancer?

A

Cyclooxygenase inhibitors (celecoxib)

NSAIDs or Aspirin

Colectomy (if family history)

260
Q

What is a proposed cause of ovarian cancer?

A

“Incessant ovulation” theory

-risk of developing ovarian cancer is related to her number of ovulatory cycles because each ovulation results in disruption and repair of epithelial lining in the ovaries

261
Q

What genetic mutations increase the likelihood of getting ovarian cancer?

A

BRCA 1
BRCA 2
p53

262
Q

What is Lynch II syndrome?

A

Hereditary nonpolyposis colorectal cancer

-Familial predisposition to colon cancer, endometrial cancer, and ovarian cancer

263
Q

True or False: Most patients with Stage I and Stage II ovarian cancer are asymptomatic

A

True

*most patients present with advanced disease

264
Q

When should a woman seek medical attention regarding ovarian cancer symptoms?

A

If she experiences symptoms for 12 or more days out of a month for 2 consecutive months

265
Q

How does ovarian cancer progress?

A

Starts in ovary and spreads throughout the peritoneal cavity (abdominal cavity)

266
Q

True or False: Ovarian cancer responds well to chemo

A

True!

-but most patients will experience reoccurrence within the first 3 years

267
Q

After a patient receives surgery for ovarian cancer they are split into two groups, what patients are considered “optimally debulked”?

A

<1 cm of disease remaining

268
Q

After a patient receives surgery for ovarian cancer they are split into two groups, what patients are considered “sub-optimally debulked”?

A

> 1 cm of disease remaining

269
Q

What is the standard chemotherapy regimen used in ovarian cancer?

A

Paclitaxel + Carboplatin every 3 weeks for 6 cycles

270
Q

When taking carboplatin, what causes a Type I reaction to develop?

A

Drug/antigen specific IgE’s that have high binding affinity to receptors on mast cells and basophils

-receptor cross-linking triggers histamine and inflammatory mediators release

271
Q

When taking carboplatin, what causes a Type IV reaction to develop?

A

-Delayed hypersensitivity reaction

-Occurs when antigen sensitized cells release cytokines after subsequent contact

272
Q

How many cycles of carboplatin result in an increased risk of developing a Type IV hypersensitivity reaction?

A

> /= 8 cycles (this is considered repeat exposure)

273
Q

Can you give a patient paclitaxel again if they have had a hypersensitivity reaction?

A

YES

-use small dilutions and slowly ramp up

(*note: can also do this with carboplatin)

274
Q

What is the biggest side effect associated with PARP inhibitors? (olaparib, niraparib, rucaparib)

A

Anemia

275
Q

What does it mean for an ovarian cancer patient to be “platinum sensitive”?

A

They relapse > 6 months after completion of their initial platinum containing regimen

**Can be treated with original regimen again

276
Q

What does it mean for an ovarian cancer patient to be “platinum resistant”?

A

They relapse < 6 months after completion of their initial platinum containing regimen

**Now should be treated with a salvage regimen

277
Q

What does it mean for an ovarian cancer patient to be “platinum progressive”?

A

They have no response/ progression of disease while on the original platinum chemotherapy treatment

278
Q

What is the first-line single agent used in patients who are platinum resistant?

A

Liposomal Doxorubicin

279
Q

True or False: There are no effective screening tools for ovarian cancer

A

True

280
Q

How do we diagnose skeletal related events?

A

Radionucleotide bone scan

281
Q
A

Fall 2024 (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions