Flashcards in Exam 2- 8/9/10 Deck (68):
1
performance status
0-health, 4- bed bound. helps determine if patient should be receiving chemo
2
neurotransmitters in Emesis
5HT3, D2, NK1
also H1 and M
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acute emesis
0-24 hours of chemo
4
delayed emesis
24 hours- 5 days after chemo
5
anticipatory emesis
learned response to chemo
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breakthrough emesis
nausea or vomiting through prophylaxis
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emesis risk factors
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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antiemetic agents: lower therapeutic index
metoclopramide, phenothiazine derivatives, butyripenones, canabinoids, BZD
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antiemetic agents: highest therapeutic index
corticosteroids, 5HT3 RA, NK1/substrate P antagonist, olanzapine
10
metoclopramide MOA
- block DA receptors at the CTZ
- prokinetic effect by increasing gut motility
- 5HT receptor antagonist at higher doses
11
metoclopramide ADR
diarrhea, EPS, sedation
12
phenothiazine MOA
block DA receptors at CTZ
- prochloperazine, promethazine
13
phenothiazine ADRs
sedation, restlessness, hypotension, EPS
14
butyrophenones MOA
- block DA receptors
- more potent antiDA action in the peripheral NS than phenothiazines
- haloperidol, droperidol
15
butyrophenones ADRs
sedation, hypotension, EPS (less)
16
canabinoids MOA
unknown
- dronabinol, nabilone
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canibinoids ADRs
sedation, euphoria, hypotension, hallucinations, dry mouth, disorientation
18
benzodiazepine MOA
- antegrade amnesia- prevents short term memory
- decreases anxiety
-lorazepam
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benzo ADRs
amnesia, sedation, hypotension
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corticosteroids MOA
- PG blocking
- changes in cellular permeability
- dexamethasone, methylprednisolone
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corticosteroid ADRs
- minimal with short duration
- euphoria, anxiety, insomnia, fluid retention, hyperglycemia, GI upset, demargination
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5HT3 receptor antagonists MOA
- central and peripheral antagonism
- dolasetron, granisetron, ondansetron: short acting
palnosetron (aloxi): longer T1/2
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5HT3 RA ADRS
HA, transient transaminase elevations, constipation
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palonosetron
(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
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
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substance P/NK1 receptor antagonist ADRs
tiredness, Nausea, hiccups, constipation/diarrhea, loss of appetite, elevated LFTs
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aprepitant
Emend w/ dex
- day 1: 125mg PO /150mg IV
- day 2-3: 80mg PO
- increases efficac of dex (lower dose)
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olanzepine
- potent antagonistic activity on 5HT3A and 5ht2C, D1-4, H1 and alpha1-adrenergic receptors
- option for prophylaxis and breakthrough emesis
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olanzepine BBW/precautions
- death in patients with dementia-related psychosis
- T2DM and hyperglycemia
- life threatening arrhythmias
- EPS
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prophylaxis is essential for
delayed emesis
- cisplatin, carboplatin, cyclophosphamide, anthracyclines
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high risk chemo (cisplatin)- acute emesis
1. aprepitant, 5HT3 RA and dexamethasone (day 1)
2. olansepine (1-4), palonesetron (1), dex (1)
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high risk chemo (cisplatin)- delayed emesis
1. aprepitant (2,3) and dex (2-4)
2. olanzepine (2-4)
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moderate risk chemo- acute emesis
5HT3 antagonist and dex =/- NK1
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moderate risk chemo delayed emesis
1. dex (3-5)
2. metoclopramide or 5HT3
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low risk chemo- acute emesis
dex, prochloperazine, metoclopramide or 5HT3
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minimal risk chemo
no antiemetic routinely administered
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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
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anemia causing agents
cisplatin, docetaxel, 5-FU, paclitaxel, topotecan, vinorelbine
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treatments for anemia
transfusions, ESAs, Non ESAs (Fe), dietary supplementation
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ADRs of ESAs
fever, dehydration, vomiting, diarrhea, dyspnea, arthralgi, pneumonia, fatigue, edema, HTN, seizure, thrombotic events*
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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
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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
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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
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sources of stem cells
bone marrow
peripheral blood stem cells
cord blood
63
what source of stem cell collection involves apheresis
peripheral blood
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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