rxprep oncology 1

What is the recommended for the prevention of colorectal cancer?

low dose aspirin

When should mammograms be started and how often?

Yearly starting at age 45, can be done every 2 years above 55.

When should Pap smears be started and how often?

25-65:

- pap spear every 3 years

- HPV every 5 years

- pap spear +. HPV every 5 years

When should colonoscopies be started and how often?

Starting at age 45, every 10 years.

When is an annual chest CT recommended for lung cancer screening?

≥50 yo old, 20 pack year history, still smoking or quit within past 15 years.

What tests are used for prostate cancer screening?

PSA +/- DRE for men > 50 years.

What is the lifetime cumulative dose of bleomycin?

400 units due to pulmonary toxicity.

What is the lifetime cumulative dose of doxorubicin?

450-550 mg/m2 due to cardiotoxicity.

What is the maximum dose per cycle of cisplatin?

Not to exceed 100mg/m2 due to nephrotoxicity.

What is the maximum single dose of vincristine?

Capped at 2mg due to neuropathy.

____, ____ and ____ do not cause myelosuppresion

asparaginase, bleomycin, vincristine

how to tx neutropenia?

CSF

how to tx anemia?

RBC transfution

palliative: ESA

How to treat thrombocytopenia?

platelet transfusion

Which chemotherapy drugs commonly cause nausea and vomiting?

Cisplatin, cyclophosphamide, ifosfamide,

______ and___ cause mucositis

Fluorouracil and MTX

_____, _____, _____ and ______ cause diarrhea

irinotecan, capecitabine, fluoruracil, methotrexate

What should be given for acute diarrhea with irinotecan?

Atropine

Which chemotherapy drug commonly causes constipation?

Vincristine

how to tx constipation?

stimulant laxative

Miralasx

______ helps with xerostomia

pilocarpine

What are the key toxicities of doxorubicin and other anthracyclines?

Cardiomyopathy

What can be used to prevent HF in patients taking anthracyclines?

dexrazoxane (zinecard)

Which chemo agents can cause pulmonary fibrosis?

bleomycin, busulfan, carmustine, and lomustine

Which class of drugs is associated with hepatotoxicity?

Antiandrogens (bicalutamide, flutamide, nilutamide)

What are the 2 nitrosoureas?

lomustine and carmustine

Which drugs are antiandrogens?

bicalutamide

flutamide

nilutamide

_____ and ____ cause nephrotoxicity

cisplatin and MTX

What can be given to prevent nephrotoxicity with cisplatin therapy?

Amifostine (ethyol). and hydration

What is the key toxicity of ifosfamide and cyclophosphamide and when is the risk the greatest?

hemorrhagic cystitis

Doses > 1 gram/m2

What can be given with ifosfamide/cyclophosphamide to prevent hemorrhagic cystitis?

Mesna (mesnex) and hydration.

Peripheral neuropathy can be caused by ____, ____ and ____

vinca alkaloids, platinums, taxanes

What 3 meds are vinca alkaloids?

vincristine, vinblastine, vinorelbine

What is the key toxicity of nitrosoureas (lomustine, carmustine)?

Neurotoxicity

What precautions should be taken with oxaliplatin?

Avoid cold temperatures and drinking cold beverages.

Thromboembolic risk with ______ and ____

aromatase inhbiitors (anastrozole, letrozole) and SERMs (tamoxifen, faloxifen)

What are the key toxicities of vinca alkaloids?

Peripheral neuropathy, autonomic neuropathy.

What are 2 platinum based drugs?

cisplatin and carboplatin

What are the toxicities of platinum-based chemotherapy?

Nephrotoxicity, ototoxicity

methotrexate causes _____

mucositis

Which chemo agents can cause pulmonary fibrosis?

bleomycin, busulfan, carmustine, lomustine

doxorubicin is _____

cardiotoxic

______ and _____ cause hemorrhagic cystitis

cyclophosphamide and ifosfamide

____ and ____ cause peripheral neuropathy

vinca alkaloids and taxanes

cisplatin plus _____ to prevent _____

amifostine

nephrotoxicity

doxorubicin plus _____ to prevent _____

dexrazoxane

cardiomyopathy

fluoruracil plus _____ to enhance _____

leucovorin

efficacy

antidote for fluorouracil or capecitabine

uridine triacetate (within 96 hours)

ifosfamide plus _____ to prevent _____

mesna

hemorrhagic cystic

irinotecan plus _____ to prevent/treat _____

atropine

diarrhea

methotrexate plus _____ to prevent _____

leucovorine

myelosuppresion/mucositis

antidote to methotrexate

glucarpidase (within 48-60 hours)

What is the definition of neutropenia?

ANC count < 1000

What is the definition of severe neutropenia?

ANC count < 500

What is the definition of profound neutropenia?

ANC count < 100

why are CSFs given?

prophylactically to stimulate production of WBC, reduce mortality and prevention of neutropenia

Brand of filgrastim

Neupogen

Brand of pegfilgrastim

Neulasta

CSFs cause _____

bone pain, report any signs of enlarged spleen (pain in upper left abdomen)

where must CSFs be stored?

refrigerator

Which CSF requires documentation?

pegfilgrastim

What is febrile neutropenia?

Fever > 38.3 once and ANC < 500

Which type of bacteria poses the highest risk in neutropenic patients?

Gram-negative bacteria, specifically pseudomonas

When should ESAs be used?

only palliative, if intent is NOT cure

when hemoglobin is < 10

What are the 2 ESAs?

Aranesp (darbepoetin)

Epogen, Procrit (epoetin alfa)

ESAs will not work well to correct anemia if ________

iron levels are inadequate (look at ferritin, TSAT, TIBC)

ESAs can increase _____ and ______

Can increase tumor progression and shorten survival- only used palliatively

When should platelet transfusions be given?

If platelet count < 10,000 cells/m3

what is difference between acute, delayed and anticipatory N/V?

acute: within 24 hours after chemo

delayed: >24hrs after chemo

anticipatory: before chemo

What is drug tx for acute N/V?

5ht3 ra

What is drug tx for delayed N/V?

NK1-RA, corticosteroids, palonsetron, olanzapine

What is drug tx for anticipatory N/V?

benzos start evening prior to chemo

______ is high emetic risk

cisplatin

What medications are used for acute nausea and vomiting?

5HT3RA (ondansetron, granisetron, palonosetron)

What medications are used for delayed nausea and vomiting?

NK1-RA (aprepitant, fosaprepitant), corticosteroids, olanzapine

What medications are used for anticipatory nausea and vomiting?

Benzodiazepines night before

What should be given prophylactically for patients at high-risk of nausea and vomiting?

3-4 medications

(NK1-RA, 5HT3RA, olanzapine, dexamethasone)

or palonosetron+ olanzpatine +dexamethasone

or NK1 RA + 5ht3 ra + dexamethasone

What should be given prophylactically for patients at moderate-risk of nausea and vomiting?

2-3 medications

What should be given to patients at risk of nausea and vomiting prior to chemotherapy?

Anti-emetics 30 minutes prior to chemotherapy + home medication for breakthrough

Which chemotherapy drugs commonly cause mucositis?

Fluorouracil (5-FU)

methotrexate

Breakthrough CINV ____, _____, ____ and ___

5ht3, dopamine receptor antag, cannbinoids, olanzaptine

5HT3 can cause _____ and ____

migraine like HA and constipation

what are 3 dopamine antagonist?

metoclopramide, prochlorperazine, promethazine

T/F dopamine antagonists are activating

false sedating

Acute dystonic reactions should be treated with

anticholinergics (benztropine and Benadryl)

How to treat mucositis?

Viscous lidocaine, magic mouthwash, nystatin or clotrimazole for oral thrush

NK1 receptor antag are ____ and ___

aprepitant (emend) and fosaprepitatn (emend) injection

5HT3 antag are CI with ____

apomorphine due to hypotension

which 5HT3 has a patch?

sancuso (granisetron) 24-48 hours before chemo

Dopamine antagonists exacerbate ____

Parkinson disease symptoms

promethazine must be avoided in _____ and not given ____

children <2

avoid intra-arterial or SC admin due to extravasation

Metoclopramide (reglan) causes _____

TD that is irreversible, so decrease dose in renal impairment

Haldol/droperidol causes _____

QT prlongation

what cannabinoids are used for CINV?

dronabinol (Marino) and nabilone (cesamet)

somnolence, euphoria, munchies

which benzo is used in CINV?

LORAZEPAM

What is uridine triacetate used for?

Antidote for 5FU and capecitabine

What is glucarpidase used for?

Antidote for methotrexate

What is key toxicity associated with aromatase inhibitors and SERMs?

Increased risk of thrombotic events

Which chemotherapy drugs commonly cause Hand-Foot Syndrome/palmar-plantar erythrodysesthesia (PPE)?

Capecitabine, fluorouracil

How to treat hand-foot syndrome (PPE)?

Cold compresses, aquaphor, steroids, pain meds, limit activities, avoid hot water