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34 Cards in this Set
- Front
- Back
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What is the most common regimen for highly emetogenic chemotherapy?
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Combination of a serotonin receptor antagonist and dexamethasone.
Can add corticosteroids to a serotonin receptor antagonist to improve efficacy Can add aprepitant to increase efficacy and prevent delayed N/V |
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What are the highly emetogenic chemotherapy agents
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Doxorubicin or epirubicin
Carmustine Cisplatin Cyclophosphamide |
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What agents are considered serotonin receptor antagonists
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Dolasetron, granisetron, ondansetron and palonosetron
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What is palonosetron approved for
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Prevention of acute and delayed CINV
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What are the common side effects of serotonin receptor antagonists
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Headache and constipation
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What are the neurokinin-1 receptor antagonists
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Aprepitant, fosaprepitant
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What is aprepitant and fosaprepitant approved for and how is it dosed
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Approced for prevention of acute and delayed nausea
Aprepitant 125mg day1, 80mg day 2 and 3 Fosaprepitant IV on day 1, then aprepitant 80mg on day 2 and 3 |
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What major interactions occur with aprepitant and fosaprepitant
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Decrease OC effectiveness
Decrease INR with warfarin Decrease decadron dose if given together |
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What are the benzamide analogs
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Metoclopramide - blocks dopamine receptors
ADE: Drowsiness, hypotension, akathisia, dystonia, EPS |
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What are the phenothiazines
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Prochlorperazine, chlorpromazine, promethazine
Blocks dopamine receptors |
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What are butyrophenones
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Haloperidol, droperidol
At least as effective as phenothiazines, if not more effective |
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What is the treatment algorithim for high emetogenicity regimens
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Day 1 -5HT3 antagonist AND steroid AND neurokinin-1 antagonist
Day 2 and 3 - steroid, neurokinin1 antagonist |
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What is the treatment algorithim for medium emetogenicity regimens
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Day 1 - 5HT3 antagonist AND steroid with/without NK1 antagonist
Day 2-3: 5HT3 antagonist or steroid or NK1 antagonist |
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What is the treatment regimen for low emetogenicity chemo
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Day 1 - steroid or metoclopramide as needed
Day 2 -3: Steroid or metoclopramide as needed or prochlorperazine as needed |
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Oral to IV morphine ratio
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1:3
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What is the role of bisphosphonates in pain
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1) Breast cancer with bony metastases - receive either pamidronate 90mg over 2 hours or zoledronic acid every 3-4 weeks
2) Women with above abnormal bone scan should also receive above bisphosphonates 3) Do not use bisphosphonates in women who are asymptomatic with radiologic findings is NOT recommended 4) Different in multiple myeloma. Patients with osteopenia but not radiologic evidence can receive bisphosponates |
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What are the ADE's of bisphosphonates
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n/v, fever, nephrotoxicity, osteonecrosis
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What are the adjuvant analgesics
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1) Antidepressants and anticonvulsants for neuropathic pain
2) Transdermal lidocaine for localized neuropathic pain 3) Corticosteroids - pain by nerve compression or inflammation, bone pain 4) BZD - muscle spasms 5) Strontium - radionuclide for treatment of bone pain 6) NSAIDS - recommended for pain caused by bone metastases |
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What is a normal range for WBC
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5-10k cells/mm3
Risk greatest with ANC <500 |
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When does the nadir usually occur
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Usually 10-14 days after chemotherapy finishes
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How do you calculate ANC
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ANC = WBC X % granulocytes or neutrophils (segmented neutrophils plus bands neutrophils).
Example: WBC = 4500 with 10% segmented bands and 5% band neutrophils. 4500x(0.1+0.05)=675 |
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What is the normal range for megakaryocytes (platelets)?
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140,000 - 440,000
Greatest risk when platelets drop to less than 10,000 |
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What is the definition of neutropenia
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Neutropenia is defined as an ANC less than 500 or less than 1000 with a decrease to less than 500 in 48 hours
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What are the 3 CSF's available for neutropenia
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G-CSF: filgrastim
pegylated G-CSF (pegfilgrastimn) GM-CSF (sargramostim) |
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Is it appropriate to administer CSF's in patients who are neutropenic but not febrile
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No
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What is the definition of thrombocytopenia
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Platelets less than 100,000
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What is oprelvekin
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Interleukin-11
Approved for prevention of severe thrombocytopenia in patients undergoing chemotherapy Treatment is continued until a post-nadir platelet count of 50000 or greater. Dosing beyond 21 days is not recommended ADE: edema, SOB, tachycardia |
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What is the purpose of dexrazoxane?
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Intracellular chelating agent for anthracyclines
Approved for use in breast cancer patients Also approved for use as antidote for extravasation |
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What is amifostine used for
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Used to prevent nephrotoxicity from cisplatin and xerostomia from radiation therapy
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What is mesna used for
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Decreases risk of hemorrhagic cystitis from cyclophosphamide
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What is calculation to correct for calcium
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Corrected Ca = (4-albumin) + 0.8xcalcium
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How do you treat severe hypercalcemia
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Bisphosphonates, calcitonin, steroids
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How do you manage extravasation for anthracyclines
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Cold therapy and topical dimethyl sulfoxide
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How do you manage extravasation for vincas
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Heat therapy and hyaluronidase
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