Week 4: APL and supportive care Flashcards
What is this?
Disseminated intravascular coagulation; oncologic emergency indicative of APL (M3 AML)
What is the treatment of APL?
All-trans retinoic acid (directly addresses maturation block)
Arsinic tri-oxide (induces degradation of chimeric protein, induces apoptosis at higher doses)
What are the three contexts that nausea is considered?
Anticipatory, acute, delayed (>24 hours)
What is the central pathway of nausea and vomiting involved in? Where is it located?
Involved in the delayed phase of chemotherapy-induced nausea and vomiting; Primarily in the brain
What is the peripheral pathway of nausea and vomiting involved in? Where is it located?
Predominantly involved in the acute phase of chemotherapy-induced nausea and vomiting; Found in GI tract
What are the “Old School” drugs that can be helpful for nausea/vomiting?
ABCD: ativan (lorazepam), Benadryl (diphehydramine), Compazine (mostly olanzapine), Dexamethasone
What does NK1-receptor antagonists do in terms of nausea/vomiting? Where does it act?
Acts in brain to block substance P release
What do 5-HT3 receptor antagonists do in terms of nausea and vomiting? Where do they act?
Prevent binding of Serotonin onto vagal nerve in GI tract
What are the cancers that primarily form blood clots?
Pancreas, breast, prostate, bladder, lung and CNS cancers
What are the markers of hypercoagulability that are associated with poor survival?
elevated D-dimer, elevated INR
What is considered in the assessment of DVT risk?
site of cancer, platelet count, low Hgb, leukocyte count, BMI
What drug is the best to use for management of DVT in cancer?
low-molecular weight heparin (LMWH)
Why are bones so attractive for mets?
contains many growth factors
What are the cancers that mostly affect bone?
Breast and prostate cancers
What cancers respond to bone-directed treatment?
Meyloma, Breast and Renal Cell (NOT PROSTATE)
What is the mechanism of bisphosphanates?
Prevents the loss of bone mass
What is the most potent bisphosphanate?
Zoledronic acid
What is zoledronic acid?
bisphosphonate used to prevent the resorption of bone
What is treatment of constipation?
polyethylene glycol, mineral oil (lubricant)
When writing a prescription for narcotics, what should you always discuss specific measures for?
constipation
What should you remember during the treatment of diarrhea?
electrolye replacement, fiber supplementation
What are treatments for diarrhea?
Tincture of opium, somatostatin analogues
What drug can be given to prevent myelosuppression?
Granulocyte colony stimulating factor (G-CSF)
What can present in young people receiving moderate myelosuppressive therapy?
long-acting form causes bad low back pain that may present to the ER
T/F: pushing Hgb above 10 with EPO is associated with worse outcomes
True
Should EPO be used for chemotherapy patients?
No; restricted to transfusino-dependent marrow failure
What are eltrombopag and romiplostim?
thrombopoietin receptor agonists
