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oncology > Exam 2- 8/9/10 > Flashcards

Exam 2- 8/9/10 Flashcards

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1
Q

performance status

A

0-health, 4- bed bound. helps determine if patient should be receiving chemo

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2
Q

neurotransmitters in Emesis

A

5HT3, D2, NK1

also H1 and M

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3
Q

acute emesis

A

0-24 hours of chemo

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4
Q

delayed emesis

A

24 hours- 5 days after chemo

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5
Q

anticipatory emesis

A

learned response to chemo

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6
Q

breakthrough emesis

A

nausea or vomiting through prophylaxis

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7
Q

emesis risk factors

A

intrinsic emetogenecity of chemo, combo therapy, dose, rate of administration, younger patients, women more than men, heavy alcohol associated with REDUCED risk

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8
Q

antiemetic agents: lower therapeutic index

A

metoclopramide, phenothiazine derivatives, butyripenones, canabinoids, BZD

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9
Q

antiemetic agents: highest therapeutic index

A

corticosteroids, 5HT3 RA, NK1/substrate P antagonist, olanzapine

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10
Q

metoclopramide MOA

A
  • block DA receptors at the CTZ
  • prokinetic effect by increasing gut motility
  • 5HT receptor antagonist at higher doses
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11
Q

metoclopramide ADR

A

diarrhea, EPS, sedation

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12
Q

phenothiazine MOA

A

block DA receptors at CTZ

- prochloperazine, promethazine

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13
Q

phenothiazine ADRs

A

sedation, restlessness, hypotension, EPS

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14
Q

butyrophenones MOA

A
  • block DA receptors
  • more potent antiDA action in the peripheral NS than phenothiazines
  • haloperidol, droperidol
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15
Q

butyrophenones ADRs

A

sedation, hypotension, EPS (less)

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16
Q

canabinoids MOA

A

unknown

- dronabinol, nabilone

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17
Q

canibinoids ADRs

A

sedation, euphoria, hypotension, hallucinations, dry mouth, disorientation

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18
Q

benzodiazepine MOA

A
  • antegrade amnesia- prevents short term memory
  • decreases anxiety
  • lorazepam
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19
Q

benzo ADRs

A

amnesia, sedation, hypotension

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20
Q

corticosteroids MOA

A
  • PG blocking
  • changes in cellular permeability
  • dexamethasone, methylprednisolone
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21
Q

corticosteroid ADRs

A
  • minimal with short duration

- euphoria, anxiety, insomnia, fluid retention, hyperglycemia, GI upset, demargination

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22
Q

5HT3 receptor antagonists MOA

A
  • central and peripheral antagonism
  • dolasetron, granisetron, ondansetron: short acting
    palnosetron (aloxi): longer T1/2
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23
Q

5HT3 RA ADRS

A

HA, transient transaminase elevations, constipation

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24
Q

palonosetron

A

(Aloxi)

  • T1/2 40 hours
  • indicated for prevention of N/V due to moderate and highly emetogenic chemo
  • acute and delayed
  • should not repeat dose within 7 days
  • Ha, constipation, prolonged QT interval
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25
substance P/NK1 receptor antagonists
- indicated for prevention of N/V with moderately and highly emetogenic chemo- acute and delayed - not studied for treatment - aprepitant, rolapitant, netupitant
26
substance P/NK1 receptor antagonist ADRs
tiredness, Nausea, hiccups, constipation/diarrhea, loss of appetite, elevated LFTs
27
aprepitant
Emend w/ dex - day 1: 125mg PO /150mg IV - day 2-3: 80mg PO - increases efficac of dex (lower dose)
28
olanzepine
- potent antagonistic activity on 5HT3A and 5ht2C, D1-4, H1 and alpha1-adrenergic receptors - option for prophylaxis and breakthrough emesis
29
olanzepine BBW/precautions
- death in patients with dementia-related psychosis - T2DM and hyperglycemia - life threatening arrhythmias - EPS
30
prophylaxis is essential for
delayed emesis | - cisplatin, carboplatin, cyclophosphamide, anthracyclines
31
high risk chemo (cisplatin)- acute emesis
1. aprepitant, 5HT3 RA and dexamethasone (day 1) | 2. olansepine (1-4), palonesetron (1), dex (1)
32
high risk chemo (cisplatin)- delayed emesis
1. aprepitant (2,3) and dex (2-4) | 2. olanzepine (2-4)
33
moderate risk chemo- acute emesis
5HT3 antagonist and dex =/- NK1
34
moderate risk chemo delayed emesis
1. dex (3-5) | 2. metoclopramide or 5HT3
35
low risk chemo- acute emesis
dex, prochloperazine, metoclopramide or 5HT3
36
minimal risk chemo
no antiemetic routinely administered
37
anticipatory emesis treatment
- behavior modification or benzo | - lorazepam/ alprazolam
38
erythropoietin is generated
in the kidney when oxygen is low
39
you need erythropoietn for maturation of
erythrocytes
40
anemia Hgb levels
males less than 14 | females less than 12
41
predisposing factors for anemia
chemo (platinum; combo), radiation, chomorbidities, myelodysplastic syndrome, chronic renal failure
42
anemia causing agents
cisplatin, docetaxel, 5-FU, paclitaxel, topotecan, vinorelbine
43
treatments for anemia
transfusions, ESAs, Non ESAs (Fe), dietary supplementation
44
ADRs of ESAs
fever, dehydration, vomiting, diarrhea, dyspnea, arthralgi, pneumonia, fatigue, edema, HTN, seizure, thrombotic events*
45
safety of ESAs
decreased overall survival in patients who have used ESAs
46
you never give ESAs in a patient with
cancer that can be cured | - cancer-induced anemia (leukemia/lymphomas)
47
goal of ESA therapy for patients with chemo-induced anemia is to
reduce RBC transfusion requirements
48
what is the most common dose-liming toxicity of chemo?
neutropenia
49
prevention of neutropenia
- dose reduction/delay | - hematopoietic GF (G-CSF: filgrastin, pegfilgrastim), GM-CSF (sargramostim)
50
treatment of neutropenia
antibiotics (febrile), hematopoeitc GF
51
filgrastim (G-CSF) MOA
regulates the production of neutrophils within the bone marrow and affects neutrophil proliferation, differentiation and functional activation
52
2 important G-CSF uses
1. most common- post chemo febrile neutropenia (when the risk of febrile neutropenis is 20%) 2. potent inducer of hematopoietic stem cell mobilization for stem cell transplantation
53
G-CSF can be used for
primary prophylaxis secondary prophylaxis therapeutic use
54
G-CSF agents
filgrastim (neupogen) pegfilgrastim (neulasta) sargramostim (Leukine)
55
G-CSF ADRs
common: bone pain, fever, leukocytosis, elevated LFTs, elevated uric acid, injection site redness, arthralgia/myalgia - serious: splenic rupture, sick cell crisis, anaphylaxis, respiratory distress
56
clinical pearls of G-CSF
- begin at least 24 hours after last chemo dose - no change in infection-related or overall mortality with treatment - prevention of febrile neutropenia is better than treatment - expensive
57
indications for KGF
- hematologic malignancy - high dose chemo + total body irradiation - stem cell transplant palifermin (Kepivance)
58
ADRs for KGF
skin erythema, fatigue, tongue feeling thick or discoloration, taste disturbances, amylase and lipase elevation, arthralgia, edema
59
indications for HSCT
- most commonly used in cancers or syndromes that affect the blood and bone marrow - primarily leukemias, myelodysplastic syndrome, lymphomas, and multiple myeloma some solid tumors bone marrow failure syndromes
60
autologous indications for HSCT
multiple myeloma, NHL, hodgkins, AML, neuroblastoma, ovarian cancer, germ- cell cancers
61
allogenic indications for HSCT
AML, ALL, CML, myelodysplastic syndromes, NHL, hodgkin,chronic lymphocytic leukemia
62
sources of stem cells
bone marrow peripheral blood stem cells cord blood
63
what source of stem cell collection involves apheresis
peripheral blood
64
rationale for use of autologous BMT
primarily as a means to dose escalate
65
rationale for use of allogeneic BMT
- to replace missing hematopoietic or lymphoid component - to rescue recipient from myeloablative therapy - eradicate abnormal hematopoietic cells and replace with normal - establish graft-versus-tumor effect
66
Graft-versus-tumor effect:
stem cells from the donor will help kill the tumor
67
which BMT is preferred for leukemias?
allogenic
68
autologous BMT is preferred for
lymphomas, multiple myeloma and solid tumors

oncology (6 decks)

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