Chemo Bare Bones + Anemia + SCD

When does breast cancer screening start

age 45-54, yearly mammogram

When does colorectal cancer screening start

45, stool tests or colonoscopy

When does lung cancer screening start

50-80 if smoker or hx of 20 pack years

Pack years

Packs per day X Years smoked

Carcinoma
Leukemia
Lymphoma
Sarcoma
Multiple Myeloma

Carcinoma	Epithelial cells
Leukemia	Bone marrow
Lymphoma	Lymphatic system
Sarcoma	Connective tissue (muscle, bone, cartilage)
Multiple Myeloma	Plasma cells fo bone marrow

Drugs that target M phase of cell cycle (Mitosis)

Taxanes (Taxels)

Vinca Alkoids (cristines)

Drugs that target S phase of cell cycle (DNA replication)

Anitmetabolites- Methoxtrexate, 5FU, Capcitabine

Topoisomerase I inhibitors - Irinotecan, topotecan

Drugs that target G2 phase of cell cycle (Growth)

Etoposide

Bleomycin

Drugs do not target specific cell cycle

Alkylating agents- cyclophosphamide,

Anthracyclines- Doxarubicin

Platinum compounds- Cisplatin, carboplatin, oxiplatin

BSA Equation

Square root of (Ht cm x Wtkg)/3600

Chemo Man

Chemo Extravasation Management

Taxanes boxed warning and management

Taxanes (eg, paclitaxel) have a boxed warning for hypersensitivity reactions and require premedication with a corticosteroid (eg, dexamethasone), histamine-1 receptor antagonist (eg, diphenhydramine), and histamine-2 receptor antagonist (eg, famotidine).

Target cancer therapies

tu= tumors eg rituximab

ci- circulators eg bevacizumab

li= immune eg ipilimumab

Breast Cancer treatment

IF HR positive (ER or PR +) and pre menopausal—> Tamoxifen

IF HR positive (ER or PR +) and post menopausal—> Tamoxifen or anastrazole

IF HER2+—> Add traztuzumab or pertuzumab

IF triple negative—> Taxanes and anthracyclines, no hormone therapies

Prostate Cancer Algorithm

GnRH Agonist (Leuprolide, Goserelin) + Antiandrogen (-mide)

or

GNRH antagonists (Degarelix, Relugolix)

Tumor Lysis Syndrome Effects

Hyperkalemia

Hypocalcemia

Hyperuricemia

Acute renal Failure

Causes of anemia

MCV< 80 microcytic: iron deficiency

MCV 80-100 normocytic: CKD, cancer, acute blood loss, bone marrow failiure, hemolysis

MCV>100: folate, B12 deficiency

How should iron be taken

empty stomach, 1 QD or QOD, separate from PPI H2RA, quinolones

When to start ESA

Hgb<10, CKD or cancer usually

What drugs can cause hemolytic anemia via coombs

Penicillins, Cephs

Isoniazid

Levodops

Methyldopa

Rifampin

Quinidine, Quinine

Sulfonamides

What drugs can cause hemolytic anemia via G6PD

dapsone, methylene blue, macrobid, primaquin, quinidine, quinine, sulfonamides, pegloticase, rasburicase

SCD pneumococcal prophy

Penicillin BID, unti age of 5 or indefintely if spleen removed/prior infection

Females with SCD

Progestin only or IUD BC

Hydroxyura

Contraception requried for males and females and 6-12 months after stopping

Do not breastfeed

Take folic acid while on it

Drug	Adjunct	Why
Capectabine, 5FU
Cisplatin
Cyclophosphamide, Ifosfamide
Doxorubicin
5FU
Irinotecan
Methotrexate

Drug	Adjunct	Why
Capectabine, 5FU	Uridine triacetate	Treats overdose/toxicity
Cisplatin	Amifostine	Prevents nephrotoxicity
Cyclophosphamide, Ifosfamide	Mesna	Prevents hemorrhagic cysitis
Doxorubicin	Dextrazoxane	Prevents cardiomyopathy
5FU	Leucovorin	Enhances efficacy
Irinotecan	Atropoine	Precents and treats acute diarrhea
Methotrexate	Leucovorin Glucarpidase	Prevent toxiicity

Drug	Max
Bleomycin
Doxorubicin
Cisplatin
Vincristine

Drug	Max
Bleomycin	400 units LIFETIME
Doxorubicin	450-550 mg/m2 LIFETIME
Cisplatin	100 mg/m2 per CYCLE
Vincristine	2mg per DOSE

What chemo causes Hand-foot syndrom

pyrimidine analog antimetabolites (eg, fluorouracil) that causes painful erythema and skin peeling on the palms of the hands and soles of the feet.