Oncology I: Part II Flashcards Preview

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Flashcards in Oncology I: Part II Deck (26)
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1
Q

What is myelosupression?

A

Decr in bone marrow activity, which leads to fever RBCs, WBCs, platelets

2
Q

How long does it take to see effects of myelosuppression?

A

7-14 days for decr in WBCs/platelets
usually recover 3-4 weeks post-treatment
RBCs: Several months

3
Q

Neutropenia

A

ANC < 1000
Severe < 500

ANC = WBC x [(% segs + % bands)/100]

4
Q

Whats meds are used to treat neutropenia?

A
Colony stimulating factors (CSF):
G-CSF - Filgrastim (Neupogen, Zarxio)
- Tbo-Filgrastim (Granix)
Pegylated G-CSF - Pegfilgrastim (Neulasta) - longer acting - give one per cycle
GM-CSF - Sargramostim (Leukine)

Does not improve overall mortality
Shorten time of pt being at risk for infection
reduces mortality from infections (when given prophylactically)

5
Q

Notes on colony stimulating factors

A

all can cause bone pain
stored in fridge
post chemo recovery = ANC 2000-3000
Administer 1st no sooner than 24 hrs after chemo (up to 72 hrs)

6
Q

Febrile neutropenia definition

A

Oral temp of > 38 C for 1 hr and ANC < 500 (or suspected to drop to < 500 in 48 hrs)

high risk for developing sepsis

7
Q

Febrile neutropenia treatment

A
empiric coverage against pseudomonas
Low risk: oral antibiotics
Cipro + Augmentin
Cipro +/- clindamycin
Levofloxacin
High Risk (ANC < 100): IV beta lactams:
Cefepime
Ceftazadime
meropenem
Imipenem-cilastatin
Zosyn
8
Q

Treatment options for anemia

A

recover on its own
RBC transfusions
erythropoiesis-stimulating agents (ESA) -rarely used
shown to shorten survival and incr tumor progression in studies for breast, non-SC lung, head and neck, lymphoid, cervical cancers
Only use ESAs if Hgb < 10
Also monitor levels of iron, folate and B12

9
Q

Treatment for thrombocytopenia

A

platelet transfusion

plt < 10,000 (or 20,000 if active bleed)

10
Q

Acute CINV

A

N/v w/in 24 hrs after chemo

usually caused by serotonin

11
Q

Delayed CINV

A

1 to 7 days after chemo

mainly caused by substance P

12
Q

Anticipatory CINV

A

Before chemo

given BZDs before chemo to help relax

13
Q

Available 5Ht-3 receptor antagonist and info

A
Ondansetron (Zofran) po/iv
Granisetron (Kytril Sancuso [patch], Sustol [sc}
Dolasetron (Anzemet) po
Palonosetron (aloxi) po
Warnings: 
dose-dependent incr in QT (more with IV)
Serotonin syndrome with other serotonergic drugs
SEs:
HA, fatigue, dizziness, constipation
14
Q

Available sub P/Neurokinin-1 antagonist and info

A
used to augment the effects of 5HT3 antagonist and/or steroids (don't use alone)
Aprepitant (Emend) PO
Fosaprepitant (Emend) IV
Netupitant + palonosetron (Akynzeo) PO
Rolapitant (Varubi) PO
SE's: 
Dizziness, fatigue, constipation, weakness, hiccups
Emend/ Akynzeo: CYP3A4 inhibitors
Varubi: Cyp2D6 inhibitor
15
Q

Which corticosteroid is commonly used for CINV?

A
Dexamethasone (Decadron)
off-label dosing 
High risk; given for 3-4 days
Mod risk: given for 3 days
Low risk: given on days of chemo
Short-term side effects:
Incr appetite/weight, fluid retention, mood swings, insomnia, GI upset, incr BP and BG
16
Q

Dopamine receptor antagonists used for CINV and notes

A

Prochlorperazine (Compazine, Compro) - po/iv/rectal
Promethazine (Phenergan) - po/iv/im/ rectal
Metoclopramide (reglan) - po/iv
SEs:
Sedation, lethargy, hypotension, QT prolongation, acute EPS (give benztropine or diphenhydramine), decr seizure threshold
antocholinergic side effects (Reglan can cause diarrhea)

17
Q

Recommended regimen for high emetic risk agents

A

3 drugs (in some cases 4 drugs)
NK1-RA + 5ht3-RA + dexamethasone
Olanzapine + palonosetron + dexamethasone

18
Q

Recommended regimen for moderate emetic risk agents

A

2 or 3 drugs

Low risk: only 1 drugs (not NK1-RA alone)

19
Q

2nd line agents used for CINV

A
Cannabinoids
Dronabinol (Marinol, Syndros): 
avail as caps, solution
refrigerated, schedule C-III
Nabilone (Cesamet):
oral 1-2 mg BID
non-refrig, schedule C-II
SEs:
somnolence, euphoria, incr appetite, orthostatic hypotension, lower seizure threshold
20
Q

Drugs used to treat chemotherapy- induced diarrhea

A

Loperamide:
normal max dose is 16 mg/day
can use 24 mg/day under direct supervision
Diphenoxylate + atropine (Lomotil)

incr risk of diarrhea when FU/capcitabine is used with leukovorin

21
Q

Oral mucositis

A

symptoms usually peak around 7 days after chemo
resolve 4- 8 days later
Treatments:
Mucosal Barrier Gel (Episil, MuGard, etc)
Lidocaine 2% solution
15 mL q 3h prn
Avoid ingestion of foof 60 mins after use due to impaired swallowing
Magic Mouthwash

22
Q

Drugs used to treat xerostomia

A

Usually caused by radiation near the neck/head
Artificial saliva subs (Biotene, etc)
Pilocarpine (Salagen)
5-10 mg TID (reduce dose if hepatic impairment)
SEs:
flushing, sweating, nausea, urinary frequency

23
Q

Hand-Foot syndrome

A
palmar-plantar erythrodysesthesia
redness, swelling, pain, blisters of the palms and soles
Treatment:
Reduce chemo dose
cold compresses
EMollients
Corticosteroids and pain meds
24
Q

Hypercalcemia of malignancy

A

common in breast, lung, muliple myelnoma cancers
Symptoms: n/v, fatigue, dehydration, renal failure, mental status changes
rehydration is usually always needed (with normal saline, then give loop diuretics)

25
Q

Treatment of hypercalcemia of malignancy

A
1st line: Bisphosphonates
Zoledronic acid (Zometa)
4 mg IV x 1, repeat in 7 days if needed
Pamidronate (Aredia) 60-90 mg IV over 2-24 hrs
onset: 24-72 hrs
for mild-severe hypercalcemia
2nd line: Denosumab (Xgeva)
120 mg SC on days 1, 8, 15, then monthly 
onset: 24-72 hrs
for mod-severe
Adjunct: Calcitonin (Miacalcin)
lowers serum Ca in 2-6 hrs
used in pts with symptomatic hypercalcemia
26
Q

Vaccines in cancer pts

A

Avoid vaccines due to inadequate immune response
Give 2 weeks prior to imitating of chemo, if possible.
No live vaccines
Annual flu shot can be given in between chemo cycles

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