Hem/Onc Module > EXAM TWO > Flashcards

EXAM TWO Flashcards

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1
Q

What are the 3 types of Oncologic Emergencies?

A
  1. Metabolic
  2. Structural
  3. Hematologic
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2
Q

What is Tumor Lysis Syndrome TLS?

A

Release of intracellular components into the bloodstream following cell lysis = metabolic abnormalities

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3
Q

Define Hyperuricemia

A

Uric Acid >8 mg/dL or 25% increase from baseline

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4
Q

Define Hyperkalemia

A

Potassium >6 mEq/L or 25% increase from baseline

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5
Q

Define Hyperphosphatemia

A

Phosphorous >6.5 mg/dL or 25% increase from baseline

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6
Q

Define Hypocalemia

A

Calcium <7 mg/dL or 25% decrease from baseline

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7
Q

What are the Risk Factors for TLS?

A
  1. Uric Acid >8 mg/dL at baseline
  2. Allergy to Allopurinol
  3. WBC >50,000
  4. LDH >500 units
  5. Creatinine >1.8
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8
Q

What is the presentation of Hyperkalemia?

A
  1. Muscle Cramps/Weakness
  2. N/V/D
  3. EKG Changes/Arrhythmias
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9
Q

What is the presentation of Hyperuricemia?

A

Acute Renal Failure

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10
Q

What is the presentation of Hyperphosphatemia?

A
  1. Muscle Cramps
  2. Seizures
  3. Arrhythmias
  4. Renal Failure
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11
Q

What is the presentation of Hypocalcemia?

A
  1. Muscle Cramps
  2. Tetany
  3. Mental Status Changes
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12
Q

What 4 things can be considered in the Prevention of TLS?

A
  1. Agressive IV Fluid Hydration
  2. Close Electrolyte Monitoring
  3. Discontinue Contributing Agents
  4. +/- Anti-Hyperuricemic Agents
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13
Q

Aggressive IV Fluid Hydration in Prevention of TLS includes what?

A

Normal Saline 2-3 L/m2/day for 1-2 days prior to therapy

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14
Q

Step 3 of Preventing TLS is to DC Contributing Agents, list all agents:

A
  1. ACE/ARBs
  2. Diuretics
  3. Potassium Chloride
  4. Sodium Phosphate
  5. Supplements/Vitamins
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15
Q

Low Risk of TLS +/- Anti-Hyperuricemic Agents

A
  1. Hydration
  2. Clinical Consideration
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16
Q

Intermediate Risk of TLS +/- Anti-Hyperuricemic Agents

A
  1. Hydration
  2. Allopurinol
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17
Q

High Risk of TLS +/- Anti-Hyperuricemic Agents

A
  1. Hydration
  2. Rasburicase
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18
Q

Hyperuricemia is the most common lab finding for TLS and prevention is aimed here, when does it usually occur?

A

48-72 hours after treatment

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19
Q

What are the 2 Antihyperuricemic Agents?

A
  1. Allopurinol
  2. Rasburicase
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20
Q

Allopurinol Indication and MOA

A
  1. PREVENTION ONLY
  2. Xanthine Oxidase Inhibitor: prevents formation of more uric acid, does not decrease the amount already present
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21
Q

Allopurinol AEs and Max Dose

A
  1. Rash
  2. Urticaria
  3. MAX = 800 mg/day
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22
Q

Rasburicase Indication and MOA

A
  1. Prevention AND Treatment
  2. Recombinate Urate Oxidase: breaks down uric acid into allantoin
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23
Q

Rasburicase AEs

A
  1. Hypersensitivity
  2. Methemoglobinemia
  3. Headache
  4. Peripheral Edema
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24
Q

Hyperkalemia is an Immediate Threat because it can lead to cardiac death, when does it occur?

A

6-72 hours, EKG changes

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25
What is used to Stabilize the Heart with Hyperkalemia?
1. Calcium Gluconate, it does NOT lower potassium levels, works within 30-60 mins to stabilize heart
26
What 3 Drugs can be used as Cation Exchange Resins to get rid of K+?
1. Sodium Polystyrene Sulfate 2. Patiromer/Veltassa 3. Zicronium/Lokelma
27
What is the K+ Lowering Ranges of the 3 Cation Exchange Resin Drugs?
1. Sodium Polystyrene Sulfate = 1 mEq 2. Patiromer/Veltassa = 0.5-1 mEq 3. Zicronium/Lokelma = 0.7 mEq
28
What other 2 MISC Agents can be used for Hyperkalemia?
1. Dextrose 50% + Insulin 2. Beta Agonist
29
How does Dextrose 50% + Insulin work for treatment of Hyperkalemia? How much K+ Lowering does it do?
1. Shifts K+ Intracellularly 2. 0.5 - 1.2 mEq/L
30
What are the treatment options for Hyperphosphatemia?
1. Restrict Phosphate Containing Food 2. Phosphate Binders
31
List the Phosphate Binders
1. Aluminum Hydroxide 2. Sevelamer/Renagel 3. Calcium Acetate/PhosLo
32
What are the treatment options for Hypocalcemia?
1. Fix the Phosphate 2. Calcium Gluconate ONLY if Symptomatic
33
Calcium Homeostasis involves what organs?
1. GI Tract 2. Bone 3. Kidneys
34
What is the Stimulus and Result relating to Parathyroid Hormone PTH?
Stimulus: Decreased Calcium Result: Increased Calcium
35
What is the Stimulus and Result relating to Calcitriol?
Stimulus: Increase PTH Result: Increase Calcium
36
What is the Stimulus and Result relating to Calcitonin?
Stimulus: Increase Calcium Result: Decrease Calcium
37
What is the formula for Corrected Calcium?
Corrected Calcium = Measured Calcium + [ 0.8 x (4-albumin)]
38
What are the ranges of Hypercalcemia using Corrected Calcium values?
MILD = <12 -- only treat if symptomatic MOD = 12 - 13.9 -- usually treated SEVERE = >14 -- immediately treated
39
What are the Symptoms of Hypercalcemia?
1. Painful Bones 2. Renal Stones 3. Abdominal Groans 4. Psychic Moans
40
What are the Principles of Treatment for Hypercalcemia?
1. Rehydration/Secretion 2. Stop Bone Resorption 3. Treat Underlying Causes 4. Remove Exogenous Sources of Calcium
41
What are the agents used for Hypercalcemia?
1. Hydration 2. Diuretics: specifically those that cause hypocalcemia 3. Bisphosphonates 4. Calcitonin
42
Causes of Hypercalcemia: VITAMIN, know N
V: vitamin A/D I: immobilizaiton T: thyrotoxicosis A: addison's M: milk I: inflammatory disorders N: NEOPLASTIC DISEASES
43
Causes of Hypercalcemia: STRAP, know T/R
S: sarcoidosis T: THIAZIDES, other drugs R: RENAL FAILURE, rhabdomyolysis A: aids P: parathyroid disease
44
What is initial acute therapy for Hypercalcemia? And how does it work?
1. Fluids: dilution effect as dehydration is corrected, helps increase renal calcium excretion 2. Diuretics: increases urinary excretion of calcium
45
Can diuretics be given as mono therapy for Hypercalcemia T/F?
False, must be given with fluids
46
IV Bisphosphonates and RANK Ligand Inhibitors are utilized as management of Hypercalcemia, but are NOT acute therapy. When should they be administered?
The SAME time as acute treatment since they have a LONG onset
47
List IV Bisphosphonates used for Hypercalcemia and their MOA
1. Zolendronic Acid 2. Pamidronate Inhibits osteoclastic bone resorption
48
List RANK Ligand Inhibitors used for Hypercalcemia and their MOA
1. Denosumab Inhibits RANKL resulting in inhibition of osteoclast recruitment, maturation, and action
49
What are the AEs of IV Bisphosphonates?
1. Nephrotoxic 2. Osteonecrosis of the Jaw
50
What are the AEs of RANK Ligand Inhibitors?
1. Osteonecrosis of the jaw
51
What is used ACTUELY for Severe cases of Hypercalcemia? And what it is the AEs?
1. Calcitonin: adjust therapy only use in symptomatic patients -Tachyphylaxis, MAX 8 DOSES
52
What is the treatment of Mild Hypercalcemia Asymptomatic?
1. Increase fluid intake 2. Stop offending drugs
53
What are offending drugs in Hypercalcemia?
1. Calcium supplements 2. Thiazide diuretics 3. Vitamin D
54
What is the treatment of Mild Hypercalcemia Symptomatic?
1. Hydration 2. +/- loop diuretics after hydration 3. Consider IV bisphosphonates
55
What is the treatment of Moderate Hypercalcemia?
1. Hydration 2. +/- Loop diuretics after hydration 3. IV Bisphosphonates 4. Consider calcitonin
56
What is the treatment of Severe Hypercalcemia?
1. Hydration 2. +/- Loop diuretics after rehydration 3. IV Bisphosphonates 4. Calcitonin
57
What is Refractory Hypercalcemia?
If calcium levels remain elevated after 2 doses of bisphophonate
58
What can be considered in Refractory Hypercalcemia?
1. Steroids 2. Denosumab 3. Dialysis
59
Neutropenic Fever is considered a medical emergency, why?
Neutropenic patients are at a higher risk for serious infections, fever is only a sign of infection
60
What is Nadir?
Lowest point of WBC possible
61
When does Neutropenia usually occur?
10-14 days of chemotherapy administration
62
Fever occurs >80% during chemotherapy induced neutropenia from what type of cancers?
Hematologic Malignancies
63
What are the 3 common sites for tissue-based infection?
1. Intestinal Tract 2. Lungs 3. Skin
64
What are the 3 main components in the initial patient workup?
1. H&P 2. Vitals 3. Medications
65
What is the Outpatient Treatment Criteria?
1. No critical lab values 2. Able to swallow PO meds 3. Psychosocial/Logistic Requirement 4. Prior FQ prophylaxis
66
Define Neutropenic Fever
1. Single temperature equivalent to >38.3C (101F) orally 2. Temperature >38C (100.4F) orally, sustained over 1 hour period
67
Define Neutropenia
1. ANC <500 neutrophils/uL 2. ANC <1000 neutrophils/uL and a predicted decline to <500/uL over next 48 hours
68
Define Prolonged Neutropenia
>7 days
69
Define Profound Neutropenia
<100 neutrophils/uL
70
How do you calculate Absolute Neutrophil Count ANC?
[(WBC) x (% segments + % bands)]/100
71
What is the most common Outpatient Treatment of Neutropenic Fever?
Ciprofloxacin or Levofloxacin + Augmentin
72
What is used in Outpatient Treatment of Neutropenic Fever with Severe Penicillin Allergy?
Clindamycin + FQ
73
What is most commonly used for Inpatient Empiric Treatment of Neutropenic Fever?
1. Cefepime 2. Pip/Taz
74
IV Antibiotic Therapy for Inpatient Empiric Treatment of Neutropenic Fever must be started when?
Within 1 hour of patient presentation
75
If the patient has a severe beta-lactam allergy, what would inpatient therapy be for neutropenic fever?
1. Vanco 2. Azetreonam 3. ID Consult
76
Cefepime has good CNS penetration and what?
NO anaerobic coverage
77
Does Zosyn have anaerobic coverage?
Yes
78
Ceftazidime has weak gram positive and no anaerobic coverage, it also has higher resistance with what?
Higher resistance with gram neg
79
Should Vancomycin be used in routine empiric IV coverage of Neutropenic Coverage?
NO, but can be used it needed for gram pos pathogen must reassess in 2-3 days
80
Is double coverage for gram negatives routinely recommended in Neutropenic Fever treatment?
NO
81
When would double coverage be necessary in Neutropenic Fever treatment?
1. Higher risk or resistant cases 2. High local resistance rates 3. History of previous psudeomonas infections
82
When would you need additional gram + coverage for Neutropenic Fever?
1. Pneumonia 2. Cellulitis/SSTI 3. Device/Line Inflammation
83
When would you need additional anaerobic coverage for Neutropenic Fever?
1. Oral/GI Involvement 2. Abdominal Symptoms 3. Peri-Rectal Pain
84
When would you need additional fungal coverage for Neutropenic Fever?
1. Thrush 2. Invasive Fungus
85
When would you need additional antiviral coverage for Neutropenic Fever?
1. Vesicular Lesions
86
What would you need to do in terms of diarrhea for Neutropenic Fever patients?
1. C. diff testing 2. Fidaxomicin or PO Vancomycin
87
Treatment Modification After Initial Presentation: Low Risk Inpatient, Clinically Stable, and Adequate GI Absorption
IV --> PO
88
Treatment Modification After Initial Presentation: Etiology Identified
Treat Per Infection
89
Treatment Modification After Initial Presentation: Persistently Febrile
Broaden Coverage and Continue Fever Workup
90
When should you consider empiric treatment for Antifungal in Neutropenic Fevers?
Consider addition if >4days of empiric antibiotics in high-risk patients with no symptom improvement
91
What are the risk factors related to Fungal Neutropenic Fevers?
1. Neutropenia >10 days 2. Allogeneic HCT Recipients 3. High dose corticosteroids
92
If a patient is receiving Fluconazole for anti-yeast prophylaxis what should it be changed to?
Change to empirical anti fungal with mold coverage
93
If a patient is receiving Anti-Mold prophylaxis what should it be changed to?
Consider switch to alternative anti fungal with mold coverage
94
What drugs are consider antifungals?
1. Triazoles 2. Amphotericin B 3. Micafungin
95
List all the Triazoles
1. Fluconazole 2. Itraconzaole 3. Voriconazole 4. Posaconazole 5. Isavuconazole
96
Fluconazole is NOT active against what?
MOLDS
97
Itraconzole has what CI?
Significant cardiac systolic dysfunction
98
Voriconazole has an AE of visual disturbances/hallucinations but what is it's caution?
Hepatic Impairment
99
Isavuconazole should be considered if intolerant or refractory to first line therapy, but what is it's main concern?
Can SHORTEN QTc
100
Amphotericin has what 2 concerns?
1. Renal Toxicity 2. Electrolyte Wasting (K+/Mg2+)
101
Micafungin has a great safety profile but POOR penetration in what 3 areas?
1. CNS 2. Urinary Tract 3. Eye Penetration
102
What are the outpatient treatment options for Covid-19?
1. Paxlovid 2. Remdesivir 3. Molnupravir
103
What are the inpatient treatment options for Covid-19?
1. Remdesivir +/- Dexamethasone 2. Immunomodulator Agents 2. Convalescent Plasma
104
What are the treatment options for HSV/VZV?
1. Acyclovir 2. or Valacyclovir
105
What are the treatment options for HSV/VZV/CMV?
1. Ganciclovir 2. or Valganciclovir BOTH cause bone marrow suppression
106
Duration Consideration: Afebrile + ANC >500
DC therapy
107
Duration Consideration: Afebrile + ANC <500
Continue, DC, or move to prophylaxis
108
Duration Consideration: Documented Infection
Treat pathogen
109
Duration Consideration: Febrile, no known source
Patient Factors
110
What is the Duration Treatment for Skin/Soft Tissue Bacterial Pneumonia?
5-17 days
111
What is the Duration Treatment for Uncomplicated Bacteremia?
7-14 days
112
What is the Duration Treatment for S.Aureus Bacteremia?
4 weeks
113
What is the Duration Treatment for Sinusitis?
7-14 days
114
What is the Duration Treatment for Candida?
Minimum 2 weeks after 1st neg blood culture
115
What is the Duration Treatment for Molds?
Minimum 12 weeks
116
What is the Duration Treatment for HSV/VSV?
7-10 days
117
What is the Duration Treatment for Influenza?
Minimum 5 days
118
What is the preferred agent for Prophylaxis of Neutropenic Fever: Antibacterial?
Levofloxacin
119
What is the preferred agent for Prophylaxis of Neutropenic Fever: Antiviral?
Acyclovir or Valacyclovir
120
What is the preferred agent for Prophylaxis of Neutropenic Fever: Antifungal?
Fluconazole or Posaconazole
121
What is the preferred agent for Prophylaxis of Neutropenic Fever: Anti-Pneumocystis PJP?
Bactrim
122
Myelosuppression is the most common __ __ side effect and the most common site of toxicity is the __ __.
1. Dose-Limiting 2. Bone Marrow
123
What chemotherapy drugs do NOT cause myelosuppression?
1. Vincristine 2. Bleomycin 3. Hormones 4. Corticosteroids 5. L-Asparaginase 6. Intergerons 7. Methotrexate + Leucovorin Rescue
124
What drugs are eliminated Renally?
1. Cisplatin 2. Carboplatin 3. Methotrexate 4. Topotecan
125
What drugs are eliminated Hepatically?
1. Anthracyclines 2. Vinca Alkaloids 3. Taxanes 4. Irinotecan
126
What drug is Renal Toxic?
Cisplatin
127
What is the most common cause of treatment delay and dose reductions in chemotherapy?
Neutropenia
128
What is the Primary Prevention for Neutropenia?
1. Prophylatic Granulocyte Colony-Stimulating Factors (G-CSFs) of treatment at REDUCED dose 2. Given at FIRST DOSE of chemo
129
What is the Secondary Prevention for Neutropenia?
1. Measures taken to prevent neutropenia from reoccurring with subsequent courses 2. Dose Reduction or Prophylatic G-CSFs
130
When should G-CSFs be used for primary prophylaxis of neutropenia?
1. Required and Recommended for Dose DENSE regimens 2. Risk of neutropenic fever >20% 3. Recommended for high risk patients
131
Is G-CSF useful in the treatment of Neutropenia?
NO, more effective in prophylaxis than treatment
132
G-CSF Prophylaxis Dosing Schedule
ALL must be given >24 hrs but <72 hrs after chemotherapy
133
Pegfilgrastim (G-CSF) Dosing
1. SINGLE DOSE 2. Start 1-2 days after completion of chemotherapy
134
What is the MOST common toxicity with G-CSFs?
Bone Pain
135
What drugs are MOST commonly associated with thrombocytopenia?
1. Topotecan 2. Carboplatin 3. Gemcitabine 4. Bortezombi
136
What is the treatment for Established Thrombocytopenia?
Platelet transfusions for platelet counts <10,0000 or <50,000 with active bleeding
137
Define Anemia
Hemoglobin <11 g/dL or >2 g/dL below baseline
138
Anemia is common with what two marrow toxic agents?
1. Docetaxel 2. Carboplatin
139
What is used for management of Anemia?
1. Epoetin Alfa 2. Darbepoetin Alfa
140
What are the risks associated with giving ESAs?
1. Increased risk of thrombosis and hypertension 2. Increased risk of mortality in patients with cancer 3. Risk of tumor progression
141
ESAs should NOT be used when?
When treatment intent is CURATIVE
142
When should ESAs be used in chemotherapy patients?
Used in chemotherapy-induced anemia and DC once chemotherapy is complete
143
Define Direct Stomatoxicity Mucositis
Due to cytotoxic agents
144
Define Indirect Stomatoxicity Mucositis
Due to concurrent neutropenia thrombocytopenia
145
List the Agents that are associated with Mucositis
1. 5-Fluorouracil 2. Methotrexate 3. Doxorubicin 4. Pemetrexed 5. Stem Cell Transplantation Process
146
What is used in Mucostitis Prevention?
1. Oral hygiene 2. Palifermin/Kepivance
147
What is Palifermin (Kepivance)?
1. Human keratinocyte growth factor 2. Indicated for prevention of mucositis following chemotherapy in patients requiring stem cell transplant
148
What patients are at the highest risk for diarrhea from chemotherapy?
Elderly and Females
149
What chemotherapy agents are known to cause diarrhea? (I ran to the can)
1. 5-FU and Capecitabine 2. Immunotherapy 3. Irinotecan
150
What can be used for prevention of diarrhea in chemotherapy?
1. Atropine for Irinotecan
151
What can be used for treatment of Diarrhea in Chemotherapy?
1. Loperamide: NOT safe in immunotherapy 2. Octreotide: SEVERE patients
152
What drug is the "poster child" for Diarrhea association?
Irinotecan
153
What should be given for Irinotecan Early Onset Diarrhea that occurs during or within hours of infusion?
Atropine 0.25-1 mg SQ or IV
154
What should be given for Irinotecan Late Onset Diarrhea that occurs >12 hrs after drug administration?
HIGH dose Loperamide
155
What genetic deficiency leads to worse diarrhea and neutropenia with Irinotecan?
Homozygous UGT1A1
156
What chemotherapy agents most commonly cause Constipation?
1. Vinca Alkaloids --> especially VINCRISTINE
157
What is used for prevention of Chemotherapy Induced Constipation?
1. Stool Softeners 2. Laxatives
158
What can be used for treatment of Chemotherapy Induced Constipation?
1. Enema 2. PAMORA: Methylnaltrexone
159
What are appetite stimulants that can be used for chemotherapy induced Anorexia and Cachexia?
1. Megestrol Acetate 2. Corticosteroids 3. Olanzapine 4. Dronabinol
160
What chemotherapy agents are known to cause Cardiac Toxicity?
1. Anthracyclines -Doxorubicin -Daunorubicin -Idarubicin 2. HER2 Targeted Agents -Trastuzumab
161
How does Anthracyclines cause Cardiac Toxicity?
Free Radicals + Iron Combo cause direct damage to myocardial tissue
162
What is the main consequence for use of Anthracyclines?
CHF 5-10 yrs after treatment
163
What 4 things should be done to prevent Cardiac Toxicity with Anthracyclines?
1. Baseline MUGA with EF>50% 2. Prolong Infusion 3. Limit Total Cumulative Dose 4. Dexrazoxone
164
What is the MAX lifetime dose for Doxorubicin and Daunorubicin?
550 mg/m2
165
What is Dexrazoxane (Zinecard)?
Metachelator that strips Doxorubicin from Iron Complexes and prevents generation of free oxygen radicals
166
Dexrazoxane protects against anthracycline induced cardiomyopathy but use limited to patients with what?
Advanced Breast Disease who have received >300 mg/m2 of Doxorubicin
167
Trastuzumab can cause Cardiac Toxicity however, it is different from Anthracyclines how?
Reversible cardiac toxicity, anthracyclines = permanent
168
What agent is known to cause Pulmonary Toxicity?
Bleomycin
169
What is used to treat Pulmonary Toxicity?
Steroids
170
What agents are known cause Renal Toxicity?
1. Cisplatin 2. HIGH dose Methotrexate
171
How can you prevent Renal Toxicity with Cisplatin?
Hydration with normal saline + electrolytes (K/Mg)
172
What is the treatment for Renal Toxicity with Cisplatin or Methotrexate?
1. Hydrations with normal saline 2. DC nephrotoxins
173
How can you prevent Renal Toxicity with Methotrexate?
Alkalinization of urine to PH >7
174
What agents are known to cause Bladder Toxicity?
1. Cyclophosphamide 2. Ifosfamide
175
How do the Nitrogen Mustard Alkylating Agents cause Bladder Toxicity?
Inactive metabolite Acrolein binds to and irritates blood vessels in bladder, leads to bleeding
176
How do you prevent Bladder Toxicity caused by Ifosfamide?
Mensa: 20% of ifosfamide dose immediately before then 4 and 8 hrs after
177
What is Mensa?
Protective Drug against Acrolein Binds to acrolein in kidneys and bladder
178
What agents are known to cause Neurotoxicites?
1. Oxaliplatin: acute/chronic neuropathies 2. Taxanes: peripheral neuropathy
179
Peripheral Neuropathy Symptoms of Pain, Numbness, and Tingling are related to what drugs?
Taxanes
180
What type of Oxaliplatin Neuropathy has peripheral symptoms exacerbated by COLD?
Acute = Reversible
181
What type of Oxaliplatin Neuropathy has a dose adjustment approach as "stop and go"?
Chronic = Persistent >14 days
182
List the 4 types of Dermatologic Toxicity
1. Alopecia 2. Photosensitivity 3. Hand-Food Syndrome 4. EGFR Inhibitor Skin Toxicity
183
What are ways to manage EGFR-Associated Rash?
1. Topical Corticosteroids if MILD 2. Oral Antibiotics: doxycycline/minocycline 3. Topical Antibiotics: clindamycin 4. Systemic Corticosteroids if SEVERE
184
Define Vesicants
Leakage of drug from the vein into the surrounding tissue resulting in necrosis
185
What drugs are known Vesicants?
1. Anthracyclines 2. Vinca Alkaloids 3. Nitrogen Mustards 4. Mitomycin C
186
Warm or Cold Compress for: Nitrogen Mustards?
COLD
187
Warm or Cold Compress for: Vinca Alkaloids?
WARM
188
Warm or Cold Compress for: Anthracyclines?
COLD
189
What is Dexrazoxane (Totect)?
Indicated for treatment of extravasation resulting from IV anthracyclines chemotherapy
190
How long should Dexrazoxane be used for?
Administered over 3 consecutive days
191
What chemotherapy agents are known to cause Allergic Reactions?
1. L-asparaginase 2. Paclitaxel 3. Bleomycin 4. Carboplatin 5. Cetuximab and other monoclonal antibodies
192
What is used for prevention of hypersensitivity for Bleomycin and Cetuximab?
Test Doses
193
What is used for prevention of hypersensitivity for Paclitaxel and Cetuximab?
Premedication
194
Hypersensitivity of Paclitaxel is due to what?
Cremophor EL solubility vehicle
195
What 3 drugs are used for Premedication?
1. Dexamethasone 2. Diphendramine 3. Famotidine
196
Ipilimumab CTLA-4 Inhibitor is known to have irAEs that are severe, what is the most common?
Diarrhea/Colitis
197
Nivolumab, Pembrolizumab, Atezolizumab PD-1 Inhibitors are known to cause irAEs, what are the most common?
Endocrinopathies, Pneumonitis, Hepatitis, Colitis
198
What side effect would NOT stop immunotherapy and be managed with separate medications?
Hypothyroidism Give Levothyroxine
199
What is the formula for Body Surface Area BSA?
square root [((height cm) x weight kg))/3600]
200
What weight should be used for dosing in oncology?
ABW
201
What is the dose limit of Vincristine due to Neurotoxicity?
2 mg
202
List Chemotherapy of the Order Components
1. Name 2. Drug Sequence 3. Dose 4. Rate and Route
203
Drug Interactions Concerns: GI Absorption
Changes in pH d/t coadministration of H1 antagonists, PPIs, and antacids
204
Drug Interactions Concerns: Transport and Metabolism
Intestinal transporters/enzymes 1. Pgp Pump 2. CYP3A4, 2C19
205
Drug Interactions Concerns: Additive Toxicity
QTc prolongation
206
Non-Melanoma Skin Cancer Treatment NMSC
Surgery > Systemic
207
Melanoma Skin Cancer Treatment
Surgery +/- Systemic
208
What is the etiology of Melanoma?
Direct damage to melanocytes in epidermis by UV (UVB>UVA) --> DNA Damage --> Somatic Mutations --> Uncontrolled Growth = Cancer
209
What is the most common mutation in Melanoma?
MAPK/ERK Pathway
210
Most melanoma's start with a radial phase which is what?
Vertical Growth Phase
211
What are the main targets for chemotherapy agents for Melanoma?
1. PDL1 2. PD1 3. CTLA4
212
What are the hallmark characteristics in changing nevous of Melanoma?
1. Color 2. Shape 3. Borders 4. Bleeding/Irritation
213
What agents can be used for Systemic Therapy in Stage 1 Melanoma?
Pembrolizumab
214
What agents can be used for Systemic Therapy in Stage III Melanoma?
1. Pembrolizumab 2. Nivolumab 3. Dabrafenib/Trametinib
215
What agents can be used for Systemic Therapy in Stage IV Melanoma?
1. Ipilimumab/Nivolumab 2. Nivolumab/Relatimab-rmbw
216
What is the MOA of Pembrolizumab and Nivolumab?
Anti PD-1 -Inhibits T cell downregulation and decrease response
217
What are the AEs of Pembrolizumab and Nivolumab?
1. Rash, Diarrhea 2. Hepatitis 3. Myocarditis/Pericarditis
218
What is the MOA of Dabrafenib and Trametinib?
BRAF and MEK Inhibitor Combo
219
BRAF/MEK Inhibitor combos elicit response much faster than immunotherapy, what are their specific pearls?
Dabrafenib: take on empty stomach Trametinib: protect from light
220
What are the AEs of Dabrafenib and Trametinib?
1. Pyrexia 2. Skin Rash: SJS 3. Hyperglycemia
221
What is the emetic potential of Dabrafenib and Trametinib?
Dabrafenib = moderate Trametinib = low
222
What is the MOA and Dosing of the Ipi/Nivo Combination?
PD1 and CTLA4 Inhibitor MAX 4 Cycles
223
What is the MOA of Nivo/Relatilimab Combination?
Anti PD1 + Anti LAG3 = immunotherapy
224
When comparing the combinations which has a lower reported ADR?
Nivo/Relatilimab
225
If patient has Pyrexia, they must hold therapy and restart at what dose?
Restart at same dose upon resolution
226
If patient's has recurrent Pyrexia start what treatment?
Prednisone
227
Skin Toxicity: Rash, Hives, and SJS is most common with what therapy?
BRAF Monotherapy
228
Skin and GI toxicities are most common, however toxicity is more severe with what type of agents?
Combinations
229
What is the therapy for Skin Immunotherapy Toxicity Grade 1?
Topical emollients and corticosteroids
230
What is the therapy for Skin Immunotherapy Toxicity Grade 2?
1. GI Management 2. Consider holding therapy 3. Consider 1 mg/kg oral prednisone + taper
231
What is the therapy for Skin Immunotherapy Toxicity Grade 3?
1. GI management 2. Hold therapy 3. 1-2 mg/kg methylprednisone + taper
232
What is the therapy for Skin Immunotherapy Toxicity Grade 4?
1. GI management 2. Permanent dc 3. 1-2 mg/kg methylprednisone + slow taper
233
What is the therapy for GI Immunotherapy Toxicity Grade 1?
Consider holding therapy
234
What is the therapy for GI Immunotherapy Toxicity Grade 2?
1. Hold therapy 2. 1 mg/kg prednisone + taper
235
What is the therapy for GI Immunotherapy Toxicity Grade 3?
1. Hold therapy 2. Consider hospitalization 3. 1-2 mg/kg prednisone + taper 4. Consider IV for refractory
236
What is the therapy for GI Immunotherapy Toxicity Grade 4?
1. G3 management 2. Permanent dc 3. 1-2 mg/kg methylprednisone + slow taper
237
What 3 things can be done to prevent cutaneous melanoma?
1. Avoid direct exposure 10am - 4pm 2. Avoid tanning beds 3. Sunscreen SPF 15 or higher
238
What is the identification principles of melanoma?
A = asymmetric B = borders are irregular C = color D = diameter E = evolving characteristics
Hem/Onc Module
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