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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

3

acute emesis

0-24 hours of chemo

4

delayed emesis

24 hours- 5 days after chemo

5

anticipatory emesis

learned response to chemo

6

breakthrough emesis

nausea or vomiting through prophylaxis

7

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

8

antiemetic agents: lower therapeutic index

metoclopramide, phenothiazine derivatives, butyripenones, canabinoids, BZD

9

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

17

canibinoids ADRs

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

18

benzodiazepine MOA

- antegrade amnesia- prevents short term memory
- decreases anxiety
-lorazepam

19

benzo ADRs

amnesia, sedation, hypotension

20

corticosteroids MOA

- PG blocking
- changes in cellular permeability
- dexamethasone, methylprednisolone

21

corticosteroid ADRs

- minimal with short duration
- euphoria, anxiety, insomnia, fluid retention, hyperglycemia, GI upset, demargination

22

5HT3 receptor antagonists MOA

- central and peripheral antagonism
- dolasetron, granisetron, ondansetron: short acting
palnosetron (aloxi): longer T1/2

23

5HT3 RA ADRS

HA, transient transaminase elevations, constipation

24

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

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