Term
| T/F CSFs are recommended for treatment of neutropenic fever? |
|
Definition
| False, they are for prevention only |
|
|
Term
| what is the dose of Filgrastim for neutropenic fever prophylaxis? |
|
Definition
| 5 mcg/kg SQ until ANC > 10,0000 |
|
|
Term
| what is the dose of Pegfilgrastim for febrile neutropenia prophylaxis? |
|
Definition
| Pegfilgrastim 6 mg SQ x 1 dose |
|
|
Term
| When is the appropriate start time for either Pegfilgrastim or Filgrastim? |
|
Definition
| Both start after 24h but before 72h after start of chemotherapy |
|
|
Term
| How long before next chemo dose should you stop Filgrastim? When should you stop Pegfilgrastim? |
|
Definition
Filgrastim must be stopped within 24 hours of next dose (convenient)
Pegfilgrastim must be stopped within 14 days of next chemo dose |
|
|
Term
| T/F the G-CSFs show an overall mortality benefit for neutropenic fever? |
|
Definition
| False, just help recovery. |
|
|
Term
| a contraindication to Filgrastim and Pegfilgrastim would be? |
|
Definition
| hypersensitivity to E.Coli derived proteins |
|
|
Term
| Primary prophylaxis with CSF is recommended for? |
|
Definition
Risks of FN > 20%
dose dense regimens
pts with high risk of FN due to:
Age
Medical history
Disease characteristics
Myelotoxicity of the chemotherapy regimen |
|
|
Term
Predictors of reduced
RDI (<85%) |
|
Definition
Age >65 years
Regimen: CAF or CMF
28-day schedule
Body surface area >2 m2
No G-CSF support |
|
|
Term
Which of the following is false? Prophylactic Filgrastim use results in:
1 Reduced duration of neutropenia
2 Fewer days of hospitalization
3 Fewer days of IV antibiotic use
4 Fewer chemotherapy dose delays and reductions
5 No change in infection-related or overall mortality
6 None of the above. (all statements are true) |
|
Definition
| 6. All statements are true. |
|
|
Term
| When should neulasta (pegfilgrastim) be administered? |
|
Definition
| approximately 24h after the administration of cytotoxic chemo, but no later than 14 days prior to the next cycle |
|
|
Term
| A unique thing about the clearance rate of neulasta is.. |
|
Definition
| its clearance is proprotional to the rise in ANC |
|
|
Term
| Name agents commonly associated with thrombocyopenia |
|
Definition
Topotecan
Carboplatin
Gemcitabine
Bortezomib |
|
|
Term
| prevention of thrombocytopenia can be done with what drug |
|
Definition
| Interleukin-11 (oprelvekin, Neumega) 50 mcg/kg SQ until platelets > 100k |
|
|
Term
| How should Oprelvekin be used? |
|
Definition
| Start 6-24h post chemo and admin. 50 mcg/kg SQ until platelets > 100k or for 21 days |
|
|
Term
| Adverse Effects and Contraindications of Oprelvekin (IL-11) |
|
Definition
Fluid retention, pleural effusion
Tachycardia, atrial fibrillation, atrial flutter
Conjunctival redness with injection
Use with caution in patients with:
CHF, cardiac arrhythmias
Preexisting visual disturbance
Leukemia or multiple myeloma |
|
|
Term
Anemia can occur as a direct effect of the cancer, by substances produced by the cancer, or as a result of treatment (eg, chemotherapy or radiotherapy
Often, however, there are no signs of bone marrow infiltration, blood loss, hemolysis, renal, hepatic or endocrine disorders, or nutritional deficiencies |
|
Definition
|
|
Term
| T/F in cancer EPO is produced at a lower rate than iron deficiency levels even as Hgb levels increase |
|
Definition
|
|
Term
| What is the dose of Procrit (human epo)? |
|
Definition
| 100-150 units/kg SQ three times a week (40k units/week commonly used) |
|
|
Term
| what is the dose of darbepoetin? |
|
Definition
| FDA approved dose is 2.25 mcg/kg/week (200 mcg everyother week is commonly used or 500 mcg q3w) |
|
|
Term
| T/F pts. at high risk for anemia and Hgb <10 can be give Epo prophylactic? |
|
Definition
|
|
Term
| what is the difference between epo and darbe? |
|
Definition
epo - rHuEPO? 3 N-linked CHO chains (40% cHO)
darbe - NESP 5 N-link CHO chains (51% CHO)
Darbe has increased serum half-life, EPO has decreased receptor binding..? |
|
|
Term
| T/F the time course of mucositis typically parallels myelosuppression? |
|
Definition
|
|
Term
| although Bleomycin doesn't directly cause myelosuppression, it can cause _____, which is linked to myelosuppression |
|
Definition
|
|
Term
| Palifermin (Kepivance) is a keratinocyte GF approved for transplant patients to help with what chemo adverse effect? |
|
Definition
|
|
Term
| what agents are largely responsible for chemo related diarrhea? |
|
Definition
|
|
Term
| What causes both early and lately diarrhea? |
|
Definition
|
|
Term
| Diarrhea caused by Irinotecan is inversely proportional to: |
|
Definition
| glucoronidation by UGT 1A! |
|
|
Term
| If you have been taking loperamide for >1 day with no symptom relief what should you do? |
|
Definition
| after 24h take levofloxacin and call your doctor |
|
|
Term
| when can you stop taking loperamide post chemo induced diarrhea |
|
Definition
| after 12 hours without symptoms |
|
|
Term
| agent most commonly associated with constipation? |
|
Definition
|
|
Term
| drugs most commonly responsible for renal toxicity? |
|
Definition
|
|
Term
| To prevent renal toxicity you can prehydrate cisplatin treamtne with: |
|
Definition
| 1 liter of NS + 20 mEq KCl & 8 mEq MgSO4 over 1-2h to obtain urine flow rate of 100 ml/h, posthydration with same fluid |
|
|
Term
| T/F leucovorin will help with MTX nephrotoxicity |
|
Definition
|
|
Term
|
Definition
prevention of renal toxicity with Cisplatin therapy, active in normal tissues to bind free radicals from radiation, no tumor protection.
D/C HTN meds before use |
|
|
Term
| when should you administer Amifostine |
|
Definition
| 30 mins before chemotherapy, IV inf. over 15 mins once daily. t12 of minutes |
|
|
Term
| to prevent renal toxicity of MTX you can |
|
Definition
| administer 12h prior to MTX and 24h after |
|
|
Term
| agents known to cause bladder toxicity |
|
Definition
| cyclophosphamide, ifosfamide |
|
|
Term
| what binds acrolein in kidneys and bladder to prevent bladder toxicity with ifosfamide? |
|
Definition
|
|
Term
| what % of the ifosfamide dose do you use for IV mesna? |
|
Definition
|
|
Term
| Mesna IV regimen %(of ifosfamide dose) and timing |
|
Definition
20% at start of ifosfamide
20% 4 hours after
20% 8 hours after |
|
|
Term
| Mesna PO regimen (% of ifosfamide dose) and timing |
|
Definition
20% at start
40% 2 hours after
40% 4 hours after |
|
|
Term
| all patient's should have what baseline testing done before taking anthracyclines? what should their EF be? |
|
Definition
|
|
Term
Metal chelator that strips doxorubicin from iron complexes, & prevents generation of free oxygen radicals
Protects against anthracycline-induced cardiomyopathy
Use limited to patients with advanced breast disease who have received > 300 mg/m2 of doxorubicin
Dosed in a 10:1 ratio with doxorubicin |
|
Definition
|
|
Term
| Hypertension is a specific cardiac toxicity seen especially with agents that target what pathway? |
|
Definition
|
|
Term
| Long-term studies suggest that cardiac dysfunction from what drug responds to medical therapy for CHF, and is at least partially reversible upon stopping treatment, and it is not related to cumulative dose. |
|
Definition
|
|
Term
| what agents cause pulmonary toxicity |
|
Definition
|
|
Term
to prevent pulomnary toxicity Limit total cumulative dose
< 400 units total of bleomycin
< 500mg of busulfan
< 1,000/m2 of carmustine |
|
Definition
|
|
Term
| treatment of pulmonary toxicity |
|
Definition
|
|
Term
| what can cause neurotoxicity? |
|
Definition
vinca alkaloids
oxaliplatin
ifosfamide |
|
|
Term
| what neurotoxicities are associated with vinca alkaloids? |
|
Definition
| peripheral neuropathy and ototoxicity |
|
|
Term
| oxaliplatin neurotoxicities |
|
Definition
| acute and chronic, cold sensitivity |
|
|
Term
| how does ifosfamide nuerotoxicity present |
|
Definition
| confusion, somnolence, not usually tingling |
|
|
Term
| what chemo drugs cause alopecia? |
|
Definition
|
|
Term
| what can cause hand-foot syndrome (4 drugs)? |
|
Definition
| capecitabine, 5-FU via cont. inf., sunitinib, sorafenib |
|
|
Term
| what can cause hyperpigmentation? |
|
Definition
|
|
Term
| what chemo agents can cause rash? |
|
Definition
|
|
Term
| what agents cause photosensitivity? |
|
Definition
| 5-FU, MTX, ATRA, EGFR agents |
|
|
Term
| what agents are vesicants? |
|
Definition
| Anthracyclines, vinca alkaloids, nitrogen mustards (mechlorethamine) |
|
|
Term
| to prevent vesicant reaction one should |
|
Definition
Use of central venous catheters
Good administration technique by certified oncology nurses |
|
|
Term
| specific antidotes for vesicants |
|
Definition
Nitrogen mustard
4ml 10% sodium thiosulfate mixed with 6ml sterile water for injection (1/6M) solution injected SQ around extravasation site
Vinca alkaloids: (hyaluronidase 1ml as an antidote)
Anthracyclines: (99% DMSO 1-2 ml applied to site every 6 hours for 7-14 days) |
|
|
Term
|
Definition
dose is based on the patient’s body surface area.
Day 1: 1000 mg/m2, Day 2: 1000 mg/m2, Day 3: 500 mg/m2
Totect should not exceed 2000 mg
Mixed with 50 mL of diluent.
Use immediately (within 2 hours)
Inject the mixed volume into the infusion bag with 1000 mL 0.9% NaCl.
Repeat steps 1 and 2. in order to obtain the required dose, and inject all the required mixed solutions into the same 1000 mL 0.9% NaCl bag.
Infused over 1 to 2 hours at room temperature and normal light conditions
give for 3 days in different veins |
|
|
Term
| what should cetuximab pts. be premedicated with? |
|
Definition
|
|
Term
Occur in 2%-5% of patients and may be fatal
90% occur during the first infusion
Patients who develop reactions are largely in “Bible Belt” of United States
Incidence estimated to be 20.8% in Tennessee, 6.1% in northern California, and 0.6% in Boston, MA1
Chung et al identified a specific IgE antibody against cetuximab (specific for galactose-α-1,3-galactose)1 |
|
Definition
|
|
Term
| ice packs for all vesicant drugs EXCEPT what class (uses heat) |
|
Definition
|
|
Term
| chemo agents known to cause allergic reactions: |
|
Definition
L-asparaginase
Paclitaxel
Bleomycin
Monoclonal antibodies |
|
|
Term
| prevention of hypersensitivity reactions |
|
Definition
| premedication with steroids every time |
|
|
Term
| High emetogenicity agents |
|
Definition
| cisplatin, dacarbazine, mechlorethamine |
|
|
Term
|
Definition
| carboplatin, cyclophosphamide < 1500 mg/m2, anthracyclines, oxaliplatin |
|
|
Term
| low emetogenic risk drugs |
|
Definition
|
|
Term
| minimal risk emetogenic risk drugs |
|
Definition
|
|
Term
| what drugs work on the emetic center? |
|
Definition
antihistamines
anticholinergics |
|
|
Term
| what drugs work on the cortical system of brain? |
|
Definition
|
|
Term
|
Definition
phenothiazines
butyrophenones
metoclopramide
5ht3 antagonists |
|
|
Term
| should you take single daily dose or multiple daily doses of 5ht3 antagonists? |
|
Definition
| single daily dose is preferred |
|
|
Term
| what is the 3 day oral Aprepitant and the single dose IV? |
|
Definition
125 PO day 1, 80 day 2, 80 day 3
150 mg IV single dose |
|
|
Term
| what level emetogenicity is adreomycin + cyclophosphamide considered? |
|
Definition
| high emetogenicity (notoriously delayed NV) |
|
|
Term
| delayed emesis regimen of metoclopramide |
|
Definition
| metoclopramide 0.5mg/kg PO QID + dexamethasone 8mg PO BID scheduled on day 1 and 2 after chemo |
|
|
Term
|
Definition
| AC regimen (moderate) or high emetogenicity |
|
|
Term
|
Definition
|
|
Term
| low emetogenicity regemina |
|
Definition
|
|
Term
| presentation of cancer in children |
|
Definition
fever
HA
lymphadenopathy
bone/joint pain
mediastinal masses
abdominal masses
bleeding
blood ct abnormal |
|
|
Term
| what 3 things can amifostine be used to prevent |
|
Definition
| renal tox, neurotox, nephrotox |
|
|
Term
| the difference between non-hodgkin lymphoma in adults vs children is that it behaves like |
|
Definition
| ALL, bone marrow involvement, skin, CNS |
|
|
Term
| majority of pediatric brain tumors are these fast growing type |
|
Definition
|
|
Term
| your dad smokes so you got |
|
Definition
|
|
Term
| rib bones CA or pelvic CA |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what age group is least likely to have CA |
|
Definition
|
|
Term
|
Definition
| measured calcium + 0.8(4-alb) |
|
|
Term
|
Definition
| shorted QT, lethargy, constipation, polyuria |
|
|
