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Management of Side Effects & Comorbidities
Management of Side Effects & Comorbidities
57
Pharmacology
Professional
09/07/2012

Additional Pharmacology Flashcards

 


 

Cards

Term
What is myelosuppression
Definition

decrease in bone marrow activity resulting in fewer red blood cells, white blood cells, and platelets

Term
Is myelosuppression associated with most chemotherapy?
Definition
Yes
Term
Which of the blood cells are affected the most by myelosuppression
Definition

Neutrophils and platelets are often affected since these cells have a short lifespan and consequently have rapid turnover

Term
What physiological affect does myelosuppression have on the body?
Definition

A reduction in white blood cells places the patient at an increased risk of infection due to the body's decreased ability to fight infection. If red blood cells decrease, the patient becomes anemic - with weakness and fatigure. If plateletes decrease, there is a risk of serious bleeding

Term

How long does it take for the body's cells (white, red &c.) to reach their lowest point?

 

How long does it take for the cell lines to recover?

 

Definition

Lowest Point: 10-14 days

Cell Line Recovery: 3-4 weeks

Term
When is the next dose of chemotherapy given?
Definition
after the patients's cells have returned to a safe level
Term
How are all agents used to treat myelosuppression given?
Definition
SC injection
Term
Are all anemias treated with erythropoiesis stimulating agents (ESA)?
Definition

Up until recently, yes. However, most anemias are not life-threatening and there is now awareness that the ESAs can shorten survival and increase tumor progression in some cancers.

 

Medguides are dispensed with ESAs to patients to educate of this risk

Term
What program must be carried out for patients to receive ESAs
Definition
ESA APPRAISE Onconology Program
Term
What is used to assess anemia?
Definition
hemoglobin levels
Term
The normal levels for hemoglobin
Definition

Females: 12 -16 g/dL

Males: 13 - 18 g/dL

[image][image][image][image]

Term
Normal levels for heatocrit?
Definition

Females: 36 - 46%

Males: 37 - 49%

Term
What levels must be normal for ESAs to work?
Definition

Ferritin, serum iron and a total iron binding capacity (TIBC). ESAs cannot work well to correct anemia if iron levels are inadequate.

 

Term
Frequency and route of Epoetin alpha
Definition

Q weekly, SC injection

 

Term
Brand name for Epoetin alpha
Definition
Procrit, Epogen
Term
Frequency and route of Darbepoetin
Definition
Q 2-3 weeks (less frequent dosing), SC usually
Term
Brand name of Darbepoetin
Definition
Aranesp
Term
What legalities must be done for ESAs to be precribed
Definition

In order to be able to prescribe ESAs for cancer, the prescriber must be enrolled and certified by the ESA APPRISE Oncology Program. The patient must sign a form that states they have received counseling about risk and benefits

Term
What must the patient receive when being on ESAs
Definition

The patient MUST receive the ESAs MedGuide when ESA therapy begins and at least monthly, if continuing

Term
When should ESAs be used for anemia
Definition

ESAs should only be used if the hemoglobin level is <10 g/dL  and the patient should be symptomatic

Term
ESA side effects
Definition

ESA use is associated with CHF, chest pain, thrombosis, arrhythmias, cardiovascular death and in some cases acceleration of tumor growth

Term
What is neutropenia and why is it bad
Definition

Lw neutrophils increase infection risk and make it difficult to fight infection

Term
Under what level of neutrophil count places the patient at risk?
Definition

An absolute neutrophil count (ANC) of < 500 mm3 places the patient at a high risk for a poor outcome. An ANC of < 100 mm3 is a severe risk

Term
Name the colony stimulating factors (CSFs)
Definition

Sargramostim

Filgrastim

Pegfilgrastim

 

Term
Are CSFs economical?
Definition

CSFs are expensive and do not improve overall survival outcomes

Term
Why are CSFs given?
Definition

To shorten the time that a patient is at risk due to neutropenia and reduces infectious mortality when given prophylactically in patients at a high risk of febrile neutropenia

Term
Sargramostim (GM-CSF) is limited to use in what?
Definition
stem cell transplantation
Term
Which CSFs are indicated in febrile neutropenia?
Definition

Both forms of G-CSF:

 

Filgrastim (G-CSF)

Pegfilgrastim (G-CSF)

 

Term
Primary side effect of CSF?
Definition
bone pain
Term
What is thrombocytopenia?
Definition

low platelets (thrombocytes) can result in spontaneous, uncontrolled bleeding

Term
Normal range for platelets
Definition
150 - 450,000/mm3
Term
When are platelet transfusions indicated
Definition

when the count falls below 10,000/mm3

 

Term

What medication is used to for thrombocytopenia prevention?

Definition

Oprelvekin

 

Term
Is Oprelvekin used a lot?
Definition
No because of its myraid of side effects
Term
Is nause and vomitting common with chemotherapy?
Definition
Yes. Prevention is essential
Term
Which agents are associated with high risk of vomitting
Definition

Anthracyclines

Carboplatin

Oxaliplatin

 

And:

[image]

Term

What three drugs are used in combination for highly or moderately emetogenic (vomit causing) drugs

Definition

Dexamethasone

Ondansetron or other 5-HT3 receptor blocker

Aprepritant (a neurokinin-1 receptor blocker)

 

 

Term
What are acceptable secondary antiemetic agents?
Definition

Dronabinol (Marinol)

Nabilone (Cesamet)

Term
Name the 5-HT3 serotonin recepotr antagonists
Definition

Ondansetron

Granlsetron

Dolasetron

Palonosetron

Term
Brand name for odansetron
Definition
Zofran
Term
Whcih of the antiemetic agents come in four different formulations?
Definition

Ondansetron:

 

IV; PO; ODT, solution 4-24 mg

[image][image][image][image]

Term
[image]
Definition
Statement. Not a question.
Term
What is the age restriction for phenothiazine?
Definition
Do not use in children < 2 years old
Term
Brand name for prochlorperazine
Definition
Compazine
Term
[image]
Definition
Statement. Not a question.
Term
[image]
Definition
Statement. Not a question.
Term
What is mucositis?
Definition

sores in the mouth

 

Term

What is a common treatment for the prevention of mucositis (FDA unnapproved)

Definition

Chlorhexidine rinse (magic mouth wash)

 

Term
What is the one FDA approved agent used to prevent mouth sores?
Definition

Palifermin

 

Term
Brand name for palifermin
Definition
Kepivance
Term
When is palifermin indicated?
Definition

Its use is restricted to high dose chemo prior to cell transplant. Patients at risk for mucositis should be counseled to use a saline rinse several times daily

 

Term
Is hypercalcemia common in cancer?
Definition

Yes. Hypercalcemia is the most common metabolic complication of breast cancer and also occurs commonly with lung cancer and multiple myeloma.

 

The bone destruction results in hypercalcemia causes significant symptoms for the patient, including nausea, vomiting, fatigue, dehydradation and mental status changes.

 

Bone pain can be significant and the complication carriers a high risk of long-term skeletal damage (fractures, spinal cord compression, etc).

Term
Why are bisphosphonates used in metastatic cancer?
Definition
To prevent skeletal related events.
Term
How is hypercalcemia generally treated?
Definition

with aggressive hydration, forced diuresis (loop diuretics) and IV bisphosphonates

Term
What are the IV agents indicated for hypercalcemia of malignancy?
Definition

zolendronic acid (Zometa) and pamidronate (Aredia)

Term
What's the difference between Reclast and Zometa?
Definition

Reclast and Zometa are both zoledronic acid. But Reclast is indicated for osteoporosis - this is injection only - and the dose is different.

Term
The difference in dosing between Reclast compared to Zometa?
Definition

Reclast: 5mg/year

Zometa: 4mg/month

 

 

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