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

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

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

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?

Lowest Point: 10-14 days

Cell Line Recovery: 3-4 weeks

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

Females: 12 -16 g/dL

Males: 13 - 18 g/dL

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Females: 36 - 46%

Males: 37 - 49%

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

Q weekly, SC injection

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

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

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

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

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

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

Sargramostim

Filgrastim

Pegfilgrastim

CSFs are expensive and do not improve overall survival outcomes

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

Both forms of G-CSF:

Filgrastim (G-CSF)

Pegfilgrastim (G-CSF)

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

when the count falls below 10,000/mm³

What medication is used to for thrombocytopenia prevention?

Oprelvekin

Anthracyclines

Carboplatin

Oxaliplatin

And:

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

Dexamethasone

Ondansetron or other 5-HT3 receptor blocker

Aprepritant (a neurokinin-1 receptor blocker)

Dronabinol (Marinol)

Nabilone (Cesamet)

Ondansetron

Granlsetron

Dolasetron

Palonosetron

Ondansetron:

IV; PO; ODT, solution 4-24 mg

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sores in the mouth

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

Chlorhexidine rinse (magic mouth wash)

Palifermin

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

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).

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

zolendronic acid (Zometa) and pamidronate (Aredia)

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

Reclast: 5mg/year

Zometa: 4mg/month