Therapeutics Iii Exam 3 - Complications Of Cancer Therapy Questions

Front 1

What are the 2 classifications of nausea and vomiting?

Back 1

1. Simple - self-limiting
2. Complex - not relieved after administration of antiemetics; leads to secondary fluid and electrolyte imbalances

Front 2

What are the sensory centers that send impulses related to nausea/vomiting?

Back 2

1. chemoreceptor trigger zone
2. cerebral cortex
3. visceral afferents from the pharynx and GI tract

Front 3

What is anticipatory N/V and how is it treated?

Back 3

It is a conditioned response to previously experienced posttreatment N/V. The preferred agent is lorazepam 0.5-2 mg PO 4-12 hours prior to chemotherapy.

Front 4

What is acute phase N/V?

Back 4

Occurs within 24 hours of chemotherapy administration

Front 5

What is delayed phase N/V?

Back 5

24-72 hours after chemotherapy administration

Front 6

Which chemotherapy agents are considered high risk for N/V?

Back 6

carmustine
cisplatin
cyclophosphamide (>1500mg/m2)
dacarbazine
dactinomycin
mechlorethamine

Front 7

Which chemotherapy agents are considered moderate risk for N/V?

Back 7

carboplatin
cytarabine (>1gm/m2)
cyclophosphamide (<1500mg/m2)
daunorubicin
doxorubicin
epirubicin
idarubicin
ifosfamide
irinotecan
oxalaplatin

Front 8

Which chemotherapy agents are considered low risk for N/V?

Back 8

bortezomib
cetuximab
cytarabine (<1gm/m2)
docetaxel
etoposide
fluorouracil
gemcitabine
methotrexate
paclitaxel
topotecan
trastuzumab

Front 9

Which chemotherapy agents are considered minimal risk for N/V?

Back 9

bevacizumab
bleomycin
busulfan
fludarabine
rituximab
vinblastine
vincristine
vinorelbine

Front 10

What is the percent chance of N/V for minimal, low, moderate and high risk agents?

Back 10

minimal - <10%
low - 10-30%
moderate - 30-90%
high - >90%

Front 11

What rules do we follow when assigned N/V risk when using combination chemo therapy?

Back 11

low risk + low risk = moderate risk
low risk + moderate risk = high risk
moderate risk + moderate risk = high risk

Front 12

Which histamine H2 antagonists are used as chemotherapy antiemetics?

Back 12

famotidine
ranitidine

Front 13

What is the MOA for histamine H2 antagonists used as chemotherapy antiemetics?

Back 13

they alleviate symptoms of simple N/V associated with heartburn or GI reflux

Front 14

Which antihistamine-anticholinergic agents are used as chemotherapy antiemetics?

Back 14

diphenhydramine
hydroxizine
meclizine
scopolamine

Front 15

What is the MOA for antihistamine-anticholinergic agents used as chemotherapy antiemetics?

Back 15

they interupt visceral afferent pathways that stimulate N/V; useful in the treatment of simple N/V

Front 16

Which phenothiazines are used as chemotherapy antiemetics?

Back 16

prochlorperazine
promethazine
chlorpromazine

Front 17

What is the MOA for phenothiazines used as chemotherapy antiemetics?

Back 17

appear to block dopamine receptors in the CTZ; most useful in the treatment of simple N/V

Front 18

Which corticosteroids are used as chemotherapy antiemetics?

Back 18

dexamethasone
methylprednisolone

Front 19

Which dopaminergic receptor antagonists are used as chemotherapy antiemetics?

Back 19

metoclopramide

Front 20

What is the MOA for dopaminergic receptor antagonists used as chemotherapy antiemetics?

Back 20

block dopaminergic receptors centrally in the CTZ; also accelerates gastric emptying and bowel transit time

Front 21

What substance P/neurokinin1 receptor inhibitor is used as a chemotherapy antiemetic?

Back 21

aprepitant (Emend)

Front 22

What is the MOA of aprepitant (Emend)? How is it given?

Back 22

It blocks substane P receptor. Substance P and serotonin are responsble for the acute phase of N/V, but substance P takes over as the primary mediator of delayed phase N/V. It must be started as a premed and continued for 3-4 days as it will not work PRN.

Front 23

Which SSRIs are used as chemotherapy antiemetics?

Back 23

dolasetron
granisetron
ondansetron
palonosetron

Front 24

What is the MOA of SSRIs that are used as chemotherapy antiemetics?

Back 24

They block presynaptic serotonin receptors on sensory vagal fibers in the gut wall, effectively blocking the acute phase of CINV. These agents are less effective in the delayed phase.

Front 25

Which agents are used for simple N/V?

Back 25

Histamine H2 antagonists
Antihistamine-anticholinergic agents
Phenothiazines

Front 26

What is typically given for low emetic risk chemotherapy?

Back 26

dexamethasone

Front 27

What is typically given for moderate emetic risk chemotherapy?

Back 27

dexamethasone + SSRI

Front 28

What is typically given for high emetic risk chemotherapy?

Back 28

dexamethasone + SSRI + aprepitant (Emend)

Front 29

What steps can be to prevent mucositis?

Back 29

1. good oral hygeine
2. mouth rinses
3. oral cryotherapy (ice in mouth)
4. palifermin (Kepivance) which is a keratinocyte growth factor approved for use in patients receiving high-dose chemoradiotherapy prior to stem cell transplantation (very expensive)

Front 30

What should we prophylax for when concerned about mucositis?

Back 30

herpes simplex virus (acyclovir)
oral candida (nystatin, clotrimazole, fluconazole)

Front 31

What is considered fever in neutropenic patient?

Back 31

-a single temp of >38.3 C (101.3 F)
-a sustained temp of >38 C (100.4 F)

Front 32

How do you calculate ANC (absolute neutrophil count)?

Back 32

WBC X [neutrophils(%) + bands(%)]
*bands are immature granulocytes

Front 33

What is neutropenia?

Back 33

An abnormally reduced number of neutrophils circulating in peripheral blood. It is considered neutropenia when ANC is < 1000 cells/mm3.

Front 34

Facts about neutropenic patients and infection.

Back 34

At least 50% of febrile neutropenic patients have an established infection.
20% of profoundly neutropenic patients (ANC <100cells/mm3)experience bactermia.

Front 35

Pseudomonas and neutropenic patients.

Back 35

There is significant morbidity and mortality in neutropenic patients with Pseudomonas aeruginosa. Empric therapy must provide coverage. If not covered, it can kill in 48 hours.

Front 36

Criteria for high-risk neutropenia in febrile patients

Back 36

Severe neutropenia (ANC <100 cells/mm3) lasting greater than 14 days

Front 37

Criteria for moderate-risk neutropenia in febrile patients

Back 37

Neutropenia with an ANC <500 cells/mm3 for a duration of 7-14 days

Front 38

Criteria for low-risk neutropenia in febrile patients

Back 38

Neutropenia with an ANC <500 cells/mm3 for up to 7 days

Front 39

Which drugs are good to use in cancer patients needing Pseduomonas coverage?

Back 39

ceftazidime
imipenem
Zosyn
Levaquin

Front 40

Treatment of cancer patient with fever and neutropenia who is considered low risk

Back 40

Give 2 drugs
Levaquin + Augmentin

Front 41

Treatment of cancer patient with fever and neutropenia who are considered moderate risk

Back 41

Start with IV therapy
Use cefepime, ceftazidime, or carbapenem (or any IV anti-Pseudomonal)
Use monotherapy or add vancomycin depending on patient

Front 42

Treatment of cancer patient with fever and neutropenia who are considered high risk

Back 42

Use vancomycin
with Levaquin, cefepime, ceftazidime, or carbapenem
+/- aminoglycoside

Front 43

What is tumor lysis syndrome?

Back 43

It is a spectrum of metabolic derangements usually associated with the initiation of cytotoxic therapy. TLS is an oncologic emergency that is caused by massive tumor cell lysis with the release of large amounts of potassium, phosphate, and nucleic acid into systemic circulation.

Front 44

What are the most common malignancies associated with Tumor Lysis Syndrome?

Back 44

1. Non-Hodgkin's lymphoma
2. Acute Lymphoid Leukemia

Front 45

What are the characterisitics of a malignancy that leads to tumor lysis syndrome?

Back 45

1. high proliferative rate
2. sensitivity to treatment
3. bulky tumor
4. elevated LDH levels
5. some patients are dehydrated
6. renal insufficiency
7. Hyperuricemia, hypercalemia, hyperphosphatemia, and hyperkalemia are present before treatment

Front 46

Laboratory classificatin of tumor lysis syndrome.

Back 46

Uric acid above 8 mg/dl
Potassium above 6 mEq/L
Phosphorus above 4.5 mg/dl
Calcium less than 7 mg/dl
Patient needs to have 2 or more of these as well as being a 25% change from baseline for it to be considered TLS

Front 47

What are the metabolic consequences of tumor lysis syndrome?

Back 47

1. hyperkalemia
2. hyperphosphatemia
3. secondary hypocalcemia
4. hyperuricemia
5. acute renal failure

Front 48

What are the main treatment options for tumor lysis syndrome?

Back 48

1. Hydration fluids - (2000-3000 ml/m2/24 hours; minimizes uric acid precipitation; monitor for fluid overload)
2. Allopurinol (decreases uric acid production)
3. Rasburicase (enzyme that converts uric acid to a more soluble compound)
4. Phosphate binders (AlOH, PhosLo, sevelamer)

Front 49

Monitoring parameter for tumor lysis syndrome

Back 49

1. Serum electrolytes (Na, K, CO2, Cl, Mg, PO4, calcium, uric acid) every 6-12 hours
2. Renal function and liver function tests