Supportive Care 1

Risk Factors for CINV? What can be be protective

Women, younger, prior history of motion sickness, previous history of morning sickness, anxiety/ high pretreatment anticipation of nausea. Chronic ethanol use can be protective

Types of Nausea Vomiting

Acute, Delayed, Anticipatory, Breakthrough, Refractory

Describe Acute vs. Delayed CINV

Acute is within 24 hours, delayed is over 24 hours after

What type of nausea/vomiting as is decribed as a learned response and is provoked by sight, sound, or smell? What can be used to treat this?

Anticipatory and hypnosis can be used

What type of n/v is characterized by the fact that it occurs even if on scheduled anti-emetics prior to chemo

breakthrough

What type of n/v is characterized by the fact that it persists despite appropriate anti-emetics and failed other therapies

refractory

Highly Emetogenic : Regimen A

NK-1 Antagonist like aprepitant, dexamethasone, 5-HT3 antagonist like ondansetron, olanzapine

Highly Emetogenic Regimen B

5-HT3 antagonist, Dexamethasone, and olanzapine

Highly Emetogenic Regimen C

5HT3 antagonist, Dexamethasone, NK-1 antagonist

Moderately Emetegonic Regimen

1) how many drugs

2) Core drugs

Always 2 or 3 drugs. Always 5HT3 antagonist and steroid

Low Emetogenic Regimens

Either dexamethasone or a 5HT3 antagonist

For high to moderate emetogenic risk 

1) When do you start anti-emetics and how to continue

2) What drug

Start before chemo ad continue daily. Use a 5-HT3 antagonist

For low to minimal emetogenic risk 

1) When do you start anti-emetics and how to continue

2) What drug

Start before chemo and continue daily or as needed. Start 5HT3 antagonist, prochlorperazine, or metoclopramide

For Radiation Induced Emesis, what anti-emetic should you start and when

5HT3 antagonist ± dexamethasone. Start on each day of radiation therapy

When should antiemetics be given prior to start of amino acid transfusion with radiopharmaceuticals

30 minutes

Common toxicity with 5HT3 antagonist

headache, ekg changes, and constipation

Common toxicities with dexamethasone

hyperglycemia and anxiety

Common toxicities with NK-1 anatagonist

hiccups

Anti-emetics are most effective when given how?

Prophylaxis

patho of Mucositis

Rapid epithelial turnover that ranges from mild inflammation to bleeding ulcerations

What does mucositis affect

the entire lenght of the GI tract

Stepwise of mucositis

intiation, upregulation, signaling/amplification, ulceration, healing

How prevent and treat chemo-induced mucositis

Avoid rough foods,spices, salty, and acidic foods. Avoid smoking or alcohol. Pre-dental screening, baking soda rinses, use a soft toothbrush, saliva substitute

Pain management of chemo-induced mucositis

Magic mouthwash, oral cryotherapy 30 minutes before 5-Fu, sucraflate which forms a mucosal barrier, oral and parenteral opioid analgesics

Define severe neutropenia

ANC <0.5×10³

Define febrile neutropenia

ANC <0.5×10³ and a single oral temp >101 degrees F or temp > 100.4 degree F for over an hour

What is the purpose of CSF

Prophylaxis use following chemo for neutropenia

Indications for CSF

Primary prophylaxis which is when there is at least 20% of febrile neutropenia following chemo or you are at high risk wiht pre-existing neutropenia, extensive prior chemo, or previous irradiation to pelvis. Secondary prophylaxis which is when neutropenia occured in previous cycle of chemo. Dose-dense chemo, stem cell transplant, or post-transplant neutropenia

What is filgrastim and pegfilgrastim used for? What are their differences

Used to combat neutropenia. Half life of pegfilgrastim is longer than filgrastim. Pegfilgrastim is a one time dose started 24 hours after chemo and requires a 14 day elapse between the dose and next chemo cycle. Filgrastim is a daily dose that is started 3-4 days after chemo

Adverse effects of filgrastim and pegfilgrastim

flu-like symptoms, bone or joint pain, dvt

What to do if a patient is chemo-induced anemia symptomatic

transfuse as indicated, consider ESA, and perform iron studies

When should ESAs not be considered?

If patients are receiving myelosuppressive chemo with curative intent, patients with cancer no receiving chemo, or patients receiving non-myelosuppressive chemo

When should ESAs be considered

If pt has cancer and CKD, if patient is undergoing palliative chemo, and if patient is without other identifiable cause

What are the risks vs benefits of ESA

Risks are increased thrombotic events, decreased sruvival, and time to tumor progression is shorted. Benefits are transfusion avoidance and improvement of anemia

Epoetin alfa and Darbepoetin should be dosed how? What should be done along with being given ESAs?

Adjusted to maintain the lowest Hgb level. Test iron

What chemotherapy causes pulmonary toxicities? How to treat?

Bleomycin. Treat with corticosteroids

What chemotherapy causes peripheral neuropathy? How to treat?

Taxanes, vinca alkaloids, and platinums. Treated with changing infusion rates and adjunctive pain medications like gabapentin

What chemotherapy causes heart failure? How to treat?

anthracycline, high dose cyclophosphamide, and trastuzumab. Treat by monitoring cumulative dose, assess for risk factors, and dexrazoxane

what chemotherapy causes hemorrhagic cystitis? how to treat

High dose cyclophosphamide and isofamide. Hydrationfor prevention and mesna used to prevent

What chemotherapy causes myalgias? How to treat it?

Taxanes, anastrozole, letrozole, and exemestane. Treat with nsaids and may use opioids

What chemotherapy causes hemorrhagic cystitis? How to treat it?

high dose cyclophosphamide. hydration for prevention and mesna used to prevent

What chemotherapy causes heart failure? How to treat it?

anthracycline, cyclophosphamide, trastuzumab (or any HER2). Treat by monitoring cumulative dose, assess for risk factors, and dexrazoxane

Difference between acute and chronic type 1 chemo-related cardiac dysfunction

acute is rare, transient, and has ecg changes. chronic is rapid, life-threatening, and looks like congestive heart failure

Chemo induced thrombocytopenia

1) defined as

2) how to treat

Defined as platelet count less than 100× 10³ uL but increased bleeding risk if less than 20× 10³ uL. Treat with platelet transfusion threshold of 10× 10³uL