Term
| stages of the cell cycle and checkpoints |
|
Definition
G1
G1 check - cell size, nutrients, growth factors, DNA damage
G0 - optional resting state
S - DNA synthesis
G2
G2 check - cell size, DNA replication
Rest - optional
M - mitosis
M spindle assembly check - chromosome attachment to spindle |
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Term
| define phase specific drug |
|
Definition
| works on specific phase of the cell cycle |
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|
Term
| define non-phase specific drug |
|
Definition
| works on multiple phases of the cell cycle |
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Term
|
Definition
| initial treatment of disease with chemotherapy |
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Term
|
Definition
| drug therapy as follow up after remission from induction therapy |
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|
Term
|
Definition
| drug therapy after initial surgery or radiation |
|
|
Term
|
Definition
| drug therapy before surgery or radiation that in itself is insufficient to cure |
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|
Term
|
Definition
| drug therapy after failure of primary therpay |
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|
Term
| define pallative treatment |
|
Definition
| treatment of symptoms without curative intent |
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|
Term
|
Definition
| no clinical evidence of disease for 1mo |
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|
Term
|
Definition
| >50% reduction in tumor mass without new tumor |
|
|
Term
|
Definition
| no change in size of mass number, increase <25% |
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|
Term
| define progressive disease |
|
Definition
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|
Term
| explain gompertization model of growth |
|
Definition
| growth rate of tumor cells decreases with time, response to chemo is rapid in initial growth phase |
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|
Term
| explain goldie-coldman hypothesis |
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Definition
| a fraction of tumor cells may develop resistance to treatment, more tumor cells means more potential for resistance, basis of benefit of debulking |
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|
Term
| methotrexate - MOA, phase, toxicity |
|
Definition
blocks THF acid production blocking DNA synthesis
s-phase
myelosuppression, mucositis, elevated LFTs, renal toxicity |
|
|
Term
| fluorouracil - phase, MOA, toxicity |
|
Definition
s-phase
blocks DNA
cerebellar syndrome, cardiac ischemia, lacrimal duct stenosis, myelosuppression |
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|
Term
| gemcitabine - phase, MOA, toxicity |
|
Definition
s-phase
blocks DNA
myelospuuression, flu like symptoms |
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|
Term
| vinca alkaloids - names, moa, phase, toxicity |
|
Definition
vincristine, vinblasting, vinorelbine
m-phase
blocks spindle formation
neuropathy, alopecia |
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|
Term
| taxanes - names, moa, toxicities, phase |
|
Definition
m-phase
stabilizes microtubules
paclitaxel, docetaxel
neuropathy, myelosuppression, alopecia, allergic reaction |
|
|
Term
| topotecan - moa, toxicity, phase |
|
Definition
G2 - phase
topoisomerase 1 inhibitor
myelosuppression |
|
|
Term
| etoposide - moa, toxicity, phase |
|
Definition
topoisomerase 2 inhibitor
g2 phase
myelodysplastic syndrome, mucositis |
|
|
Term
| what is the antidote to hemorrhagic cystitis |
|
Definition
|
|
Term
| cyclophosphamide - moa, phase, toxicity |
|
Definition
aklalating agent, binds dna causing breaks
myelosuppression, alopecia, hemorrhagic cystitis, cardiac necrosis
non-phase specific |
|
|
Term
| isfosfamide - moa, phase, toxicity |
|
Definition
aklalating agent, binds DNA causing breaks
non-phase specific
myelosuppression, alopecia, hemorrhagic cystitis, neurologic (confusion, coma) |
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|
Term
| doxyrubicin - moa, phase, toxicity |
|
Definition
non-phase specific
interclates DNA pairs, anthracycline
cardiomyopathy, vesicant, alopecia |
|
|
Term
| dactinomycin - moa, phase, toxicity |
|
Definition
non-phase specific
antibiotic, causes DNA breaks
renal/pulmonary toxicity |
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|
Term
| bleomycin - moa, phase, toxicity |
|
Definition
non-phase specific
antibiotic, causes DNA breaks
renal/pulmonary toxicity, pulmonary fibrosis |
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|
Term
| cisplatin - moa, phase, toxicity |
|
Definition
phase non-specific
cross links to DNA/RNA
myelosuppression, nausea, vomiting, renal failure, neuropathy, ototoxicity |
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|
Term
| carboplatin - moa, phase, toxicity |
|
Definition
phase non-specific
cross links to DNA/RNA
myelosuppression, nausea, vomiting, renal failure, neuropathy is rare |
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|
Term
| acute radiation toxicity symptoms |
|
Definition
| diarrhea, urinary frequency, abdominal cramps, dysuria, hematoschezia, hematuria |
|
|
Term
| chronic radiation toxicity symptoms |
|
Definition
| proctosigmoiditis, SBO, fistula, necrosis, strictures |
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|
Term
| how is radiation for cervical cancer set up |
|
Definition
point A - 2cm lateral to midline, 2cm above lateral vaginal fornices - approximates ureter and parametria
point B - 3cm lateral to point A - approximates sidewalls and nodes
cisplatin - radiosensitizer
combination ERBT/brachy |
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|
Term
| incidence of anemia in chemotherapy |
|
Definition
|
|
Term
| types of anemia in chemotheray and how to distinguish |
|
Definition
absolute Fe deficiency - ferritin <30
functional Fe deficiency - ferritin 30-800 |
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|
Term
| causes of anemia in chemo patients |
|
Definition
| inadequate production, increased destruction, abnormal RBC loss (tumor bleeding, phlebotomy), Fe deficiency, mucosal bleeding, CKD, erythropoetin decrease |
|
|
Term
| when should erythropoetin be given in patients with chemo anemia |
|
Definition
not recommended when undergoing curative chemo as can cause rapid disease progression and increases VTE risk
must have good iron stores
if ferritin >500
DC 6-8wk post non curative chemo |
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|
Term
| 1000mg Fe sucrose causes how much increase in hBG over 4wk |
|
Definition
|
|
Term
| why is IV Fe used in chemo patients |
|
Definition
| their gonna throw up the oral |
|
|
Term
| why is Fe sucrose used and not Fe dextran for Fe in chemo patients |
|
Definition
| dextran has high rates of allergic reaction |
|
|
Term
| what is the goal Hbg level in chemo patients, why not higher |
|
Definition
| 11, >13 associated with VTE |
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|
Term
| risks for bone marrow toxicity with chemo |
|
Definition
persistent neutropenia >65yo
poor performance status
poor nutrition status
history febrile neutropenia
extensive radio/chemo therapy
tumor marrow involvement
other comorbidities |
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|
Term
| who should get primary G-CSF to prevent marrow suppression |
|
Definition
| patients with >2% risk of febrile neutropenia |
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|
Term
| on the day of chemo start, what level of granulocytes should delay chemo |
|
Definition
|
|
Term
| on the day of chemo start, what level of platelets should delay chemo |
|
Definition
|
|
Term
| on the day of cycle nadir, what level of granulocytes should reduce dose, stop dose, and add G-CSF |
|
Definition
<1,500 - reduce dose
<1,000 - add G-CSF if fever, reduce dose |
|
|
Term
| on the day of cycle nadir, what level of platelets should reduce dose, and what should transfuse |
|
Definition
<50,000 + bleeding - reduce
<25,000 - reduce
<10,000 - transfuse |
|
|
Term
| risk factors for emesis with chemo |
|
Definition
| <50yo, women, history of motion sickness, history of pregnancy nausea/vomiting, less alcohol in past, history of chemo vomiting |
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|
Term
| medications of chemo nausea/vomiting |
|
Definition
zofran and other 5HT3 agonists
NK1R agonists - aprepitant
phenothiazines
butyrophenones
cannaboids
lorazepam - reduces anxiety about being nausiated |
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|
Term
| management of high risk nausea/vomiting >90% risk chemo med |
|
Definition
3 drug combination - 5HT3, NK1R, palonosetron
dexamethasone |
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|
Term
| management of moderate risk nausea/vomiting 30-90% risk chemo med |
|
Definition
dexamethasone
5HT3 agonist |
|
|
Term
| management of pediatric patients using a high-moderate risk nausea/vomiting chemo med |
|
Definition
5HT3 agonist
dexamethasone - 5d |
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|
Term
| work up for febrile neutropenia in chemo patients |
|
Definition
| CBC with diff, Cr, BUN, lytes, LFTs, bili, blood cultures (peripherial, all access sites), UCx, sputum Cx, CXR |
|
|
Term
| "high risk" characteristics in febrile neutropeneia |
|
Definition
| absolute neutrophils <100, anticipated neutropenia >7d, comorbidities (hypotension, pneumonia, abdominal pain, neurologic changes, CPOD), previous fungal infection, dehydration, >60yo |
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|
Term
| when do you admit someone with chemo related febrile neutropenia |
|
Definition
risk score <21 admit
>21 consider outpatient |
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|
Term
| outpatient management febrile neutropenia |
|
Definition
ciproflaxacin + ampicillin/sublactam
clinda if PCN allergy |
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|
Term
| inpatient management febrile neutropenia |
|
Definition
antipseudomonal B-lactam agent (meropenum, pipericillin-taxobactam)
continue until absolute neutrophil >500 |
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|
Term
| radiation cystitis incidence |
|
Definition
6% in 5y, 7% in 10y
most common late radiation complication |
|
|
Term
| risks of radiation cystitis |
|
Definition
| total radiation dose, dose per fraction, volume bladder radiated, diabetes, CT disorders, blood thinners (esp warfarin), secondary radiation induced cancer, recurrent cancer |
|
|
Term
| work up for radiation cystitis |
|
Definition
| UA, UCx, r/o malignancy, urine cytology, upper GU U/S, cystoscopy |
|
|
Term
| signs of acute radiation cystitis |
|
Definition
| urgency, frequency, dysuria, nocturia |
|
|
Term
| management of acute radiation cystitis |
|
Definition
|
|
Term
| signs of chronic radiation cystitis |
|
Definition
| decreased bladder capacity, sclerosis, fistula, hematuria, ureter stenosis, urinary retention, bladder cramps |
|
|
Term
| management of chronic radiation cystitis |
|
Definition
| bladder, irrigation, evacuation of clots, IV fluids, blood transfusion if indicated, endoscopic coagulation, diluted formalin or estrogen irrigation, embolization, hyperbaric oxygen, laser cystoscopy, diversion, cystectomy |
|
|
Term
| #1 location of radiation enteritis |
|
Definition
| terminal ileum - watershed area |
|
|
Term
| management of radiation enteritis |
|
Definition
conservative - bowel rest, low residue diet, IVF, lytes, antiemetics, antidiarrheals, analgesics
hyperbaric oxygen - angiogenesis promotion, for refractory cases
surgery - resection for refractory cases, fistula, perforation, complete obstruction, active bleeding, high morbidity and mortality after radidation |
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|
Term
| risk of platinum allergic reaction |
|
Definition
|
|
Term
| risk factors for platinum allergic reaction |
|
Definition
| re-introduction after break, IV rather than IP, allergies to other drugs, history of reaction |
|
|
Term
| signs of platinum allergic reaction |
|
Definition
| SOB, hibes, pruritis, changes in BP, anaphylaxis, CV collapse, edema, syncope, CP, tachycardia, nasuea, vomiting, chills, feeling of impending doom, changes in bowel function |
|
|
Term
| when does platinum allergic reaction usually happen |
|
Definition
| after 2nd treatment, usually C6 |
|
|
Term
| management of mild (hot flashes, rash, pruritis) platinum allergic reaction |
|
Definition
| decrease infusion rate, H1 blocker, H2 blocker, steroids |
|
|
Term
| management of severe (SOB, BP changes, GI symptoms) platinum allergic reaction |
|
Definition
stop infusion, neb bronchodilators, H1 blocker, steroids, epi if indicated
desensitization before continuing |
|
|
Term
| management of lifethreatening (anaphylaxis, hives, severe hypotension) platinum allergic reaction |
|
Definition
stop infusion, epi, neb bronchodilator, H1 and H2 blocker, steroids
desensitization before continuing |
|
|
Term
| side effect memorization - florouracil |
|
Definition
| the flower smell made me fall over cry and have a heart attack |
|
|
Term
| side effect memorization - gemcitibine |
|
Definition
| if you go to the citi right now youll feel like you got the flu |
|
|
Term
| side effect memorization - vincristine |
|
Definition
| vin = vibrate = neuropathy, V is for vesicant |
|
|
Term
| side effect memorization - paclitaxel |
|
Definition
| taxanes make you tingle - allergy, neuropathy |
|
|
Term
| side effect memorization - etoposite |
|
Definition
| etoposite may help you but will give you cancer too |
|
|
Term
| side effect memorization - bleomycin |
|
Definition
| you bleo with your mouth and lungs - mucocytosis, pulmonary fibrosis |
|
|
Term
| side effect memorization - dactinomycin |
|
Definition
| if you "don't act now" you "mycin" get a red arm - vesicant |
|
|
Term
| side effect memorization - cyclophosphamide |
|
Definition
| cyclo = circle = ovary/bladder = ovarian failure, hemorrhagic cystitis. cyclone = confusion and coma |
|
|
Term
| side effect memorization - doxyrubicin |
|
Definition
| red = heart, red arm = cardiomyopathy, vesicant |
|
|
Term
| side effect memorization - PARP inhibitors |
|
Definition
| PARp = PARib = niarPARib, rubaPARib, olaPARib. OLA i'm the most important. rib = bone = marrow = AML |
|
|
Term
| side effect memorization - bevacuzamib |
|
Definition
| Bev has HTN, renal problems, and poop problems. HTN dose limiting can lead to PRES. Bowel perforation which causes hemorrhage. Renal toxicity. |
|
|
Term
| side effect memorization - cisplatin vs carboplatin |
|
Definition
| carbs are not scary. but cysts are scary. cisplatin has more SE. cys=conn= cystplatin ototoxicity nephrotoxicity neuropathy |
|
|
Term
|
Definition
| dactinomycin, doxyrubicin, vincristine |
|
|
Term
| radiosensitivity of abdominal organs most to least - 4 |
|
Definition
| we abSORB radiation = SI > ovary > renal > bladder |
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|
