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87 Cards in this Set
- Front
- Back
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5HT3 antagonists efficacy of PO vs IV
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Equally effective
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too rapid of infusion of dexamethasone may cause
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transient and intense perianal, vaginal, or anal burning
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pediatric dosing dolasetron
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1.8mg/kg (45 mg/m2) PO or IV
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pediatric dosing granisetron
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20-40 mcg/kg IV before chemo
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pediatric dosing ondansetron
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0.45 mg/kg PO or IV in single or divided doses
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pediatric guideline for moderate to highly emetogenic chemo prophylaxis
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dex + 5HT3
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pediatric guideline for mildly emetogenic chemo prophylaxis
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5HT3 only
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pediatric guideline for low emetogenic chemo prophylaxis
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No prophylaxis
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RINV prophylaxis:
High risk- total body irrad |
5HT3 + dex
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RINV prophylaxis:
moderate- upper abdomen |
5HT3
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RINV prophylaxis:
low risk- lower thorax, pelvis |
rescue with 5HT3 or 5HT3 only
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RINV prophylaxis:
minimal risk- breast, head&neck, extremeties |
rescue w/ dopamine antagonist (prochlorperazine, haloperidol) or 5HT3
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current std of therapy in mgmt of anorexia/cachexia & dose
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megestrol acetate 800mg/day
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anabolic steroid to gain weight and lean tissue mass (with dose)
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oxandrolone 20mg PO qd
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oxandrolone drug interaction
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warfarin (decrease dose by 80-85%) & oral hypoglycemics
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dexamethasone dose for dex w/ anorexia
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0.75mg QID
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constipation causing chemo agents (3) and prevention agent
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vinca's (esp vincristine), arsenic trioxide, thalidomide-
PREVENT w/ scheduled STIMULANT laxative |
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diarrhea causing chemo agents (worst offenders, 5)
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irinotecan, fluorouracil, MTX, cytarabine, stem cell conditioning
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disease causes of diarrhea (3)
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graqft vs host disease following allogenic stem cell transplant, after surgical resection for Gi tumors, secretory tumors (carcinoid)
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loperamide dosing w/ irinotecan diarrhea
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4mg Po to start, then 2mg q4h until 12hr with out diarrhea (no maximum dose)
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octreotide for diarrhea dosing
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100-150mcg SQ tid up to max 500mcg
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single agent used for mucositis
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allopurinol
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ineffective agents for mucositis (3)
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chlorhexidine, magic mouthwash, sucralfate
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oral glutamine for mucositis
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2GM/m2/dose (max 4GM) not shown to be effective
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amifostine dose to prevent xerostomia
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200mg/m2 IV over 3 minutes
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pilocarpine dose for xerostomia
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5mg 3-4 times daily (max 30mg/day) 30 min prior to meals
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natural erythropoietin response is due to
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level of hypoxia, not number of RBCs
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threshold to begin epoetin or darbepoetin therapy in chemo induced anemia
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Hb conc approaching 10 g/dl
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recommendation to DC ESA therapy in non-responders criteria
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no response (<1-2 g/dl rise in Hb or no decrease in transfusion requirements) after 6-8 weeks
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target Hgb for ESAs
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12 g/dl
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darbepoetin initial dose
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2.25 mcg/kg/week or 500mcg q3W
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epoetin initial dose
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150 U/kg TIW or 40,000U/week
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darbepoetin dose increasing schema
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increase to 4.5 mcg/kg if < 1 g/dl increase in Hb after 6wk
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epoetin dose increasing schema
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increase to 300 U/kg if no change in transfusion req or rise in Hb w/ TIW
increase to 60,000U/week if no increase in Hb >=1 g/dl after 4 weeks in absence of RBC transfusion |
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darbepoetin dose reduction schema
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decrease by 40% when Hb reaches level needed to avoid transfusion of Hb increases >1 dl in a 2 wk period
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epoetin dose reduction schema
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decrease dose by 25% when Hb reaches level needed to avoid transfusion or Hb increases >1 g/dl in 2 wks
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darbepoetin dose holding
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if Hb >12, restart 40% below previous dose
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epoetin dose holding
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if Hb >12, restart 25% below previous dose
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Absolute iron deficiency defined
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ferritin < 30ng/ml, transferrin sat <15%
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Functional iron deficiency
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ferritin <300 ng/ml, transferrin sat <20%
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parenteral iron- test doses required for
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iron dextran= 25mg IVP and wait 1hr before giving rest
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neutropenia, defined
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ANC < 0.5 x 10(9)
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febrile neutropenia, defined
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ANC < 0.5 x 10(9) and oral temp > 101 F for at least 1 hr
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NCCN guidelines for prophylaxis w/ neutropenia (ANC <1) > 7 days
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fluoroquinolones (levofloxacin preferred)
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CMV prophylaxis
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acyclovir and valacyclovir
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pneumocystis jiroveci or pneumocystis carinii prophylaxis
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trimethoprim/sulfamethoxazole
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CMV surveillance for what 2 reasons
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6 months following allogenic HSCT and alemtuzumab
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pneumocystis jiroveci prophylaxis for what 3 reasons
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alemtuzumab, allogenic transplant recipients, temozolomide+XRT
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what vaccines at least 2 weeks prior to splenectomy
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pneumococcal, Hib, meningococcal
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varicella zoster virus prophylaxis agents
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acyclovir, valacyclovir, famciclovir
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what situations increase risk for varicella zoster infection (5)
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autologous HSC recipients, alentuzumab, fludarabine, calcineurin inhibits, bortezomib
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MASCC score for high risk patients
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<21
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empiric therapy for FN
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cefepime
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nader usually 10-14 days except for these
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nitrosoureas and mitomycin C
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typical low risk FN patient may receive to treat infection
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ciprofloxacin + amoxicillin/clav or ciprofloxacin + clindamycin
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treatment of choice for candida
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amphotericin B 0.7-1mg/kg/d
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treatment of choice for aspergillosis
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voriconazole
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NO CSF is indicated in chemotherapy that is
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Low risk (<10% risk FN)
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usual dose filgrastim
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5mcg/kg/day
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usual dose pegfilgrastim
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6mg x 1 dose per cycle
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usual dose sargramostim
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250mcg/m2/day
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usual dose oprelvekin
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50mcg/kg/day
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left ventricular dysfunction that may occur with oprelvekin due to
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edema- decrease salt intake, may require K+ sparing diuretic
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class of antineoplastic with greatest risk of infertility
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alkylating agents
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recommended waiting period from end of chemo to attempt pregnancy
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1 year
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perhaps most problematic side effect of AIs
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arthralgias/myalgias
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glutamine's effect on preventing the development and/or severity of myalgias/arthralgias
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NO EFFECT
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metabolite of ifosfamide and cyclophosphamide that causes hemorrhagic cystitis
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acrolein
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prevention of hemorrhagic cystitis
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adequate hydration, frequent voiding, use of mesna with ifosfamide
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mesna mechanism of action
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binds to acrolein in bladder and detoxifies it
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IV dosing of mesna with ifosfamide
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60% to 100% of ifosfamide dose administered as 20% before, 20 % during, and 20% after
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oral dosing conversion of mesna
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50% bioavailable- need to double the IV dose (tablets are 400mg)
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IV mesna continuous infusion dosing
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20% bolus prior to ifosfamide, then 40% CIV for 12-24 hr following ifosfamide completion
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oral mesna dosing
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20% bolus prior to ifosfamide, follow at 2hr and 6hr with 40% doses (100% daily dose = ifosfamide dose)
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if oral mesna vomited?
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patients vomiting within 2hr of dose should repeat or get IV
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dosing of dexrazoxane for prevention of cardiotoxicity
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10:1- 500mg/m2 dexrazoxane to 50mg/m2 doxorubicin given slow IVP or short infusion
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dexrazoxane in pediatric patients
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not recommended by ASCO
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mitoxantrone max lifetime dose
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140 mg/m2
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antibiotic & dose for grade 2 acneiform rash from EGFR
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doxycycline 100mg/d x 3-6 wk,
minocycline 200mg bid x 1 day then100mg bid, SMZ/TMP DS bid |
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cyclophosphamide dose reduction-
bilirubin 3-5 |
25%
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cyclophosphamide dose reduction-
bilirubin >5 |
omit dose
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cytarabine increased AST/ALT
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decrease 50%
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taxane hypersensitivity prevention
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dex 10-20mg PO 12 + 6 hr prior + diphenhydramine 50mg Po 12 + 6hr prior
H2+ dex20mg+diphanhydramine 50mg 30 min prior |
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alemtuzumab premeds
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oral antihistamine + APAP
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gemtuzumab premeds
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oral diphenhydramine + APAP
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ixabepilone premeds
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H1 + H2 blockers
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docetaxel dex premedication
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8mg PO bid x 3 days beginning day before chemo to decrease edema, HSR, N/V
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