BCPS_Oncology_Suppotive_Care

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kkheal
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293421
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BCPS_Oncology_Suppotive_Care
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2015-02-13 21:39:33
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BCPS BPS BCPSexam Pharmacy
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Flashcards for BCPS exam
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  1. Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including:
    -Nausea and vomiting
    Question:
    Per NCCN guidelines, a common 5 drug CINV regimen would include 5HT, NK1, Steroid, Lorazepam, H2A or PPI.
    What is the role of the PPI or H2A in regimen?
    Consider using a histamine-2 blocker or proton pump inhibitor (PPI) to prevent dyspepsia which is heartburn or impaired digestion.
  2. OBJECTIVE: Recommend appropriate pharmacotherapy for managing MYELOSUPPRESSION/BONE SUPPRESION (common chemotherapy complication)
    -Myelosuppression and appropriate use of growth factors
    Question:
    Ditto
  3. Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including:
    -Infection
    Ditto
  4. Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including:
    -Anemia and fatigue
    Ditto
  5. Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including:
    -Cardiotoxicity
    Ditto
  6. Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including:
    -Extravasation injury
    Ditto
  7. Recommend appropriate pharmacotherapy for managing cancer-related pain
    Ditto
  8. Recommend appropriate pharmacotherapy for managing oncologic emergencies including:
    -Hypercalcemia
    Ditto
  9. Recommend appropriate pharmacotherapy for managing oncologic emergencies including:
    -Tumor lysis syndrome
    Ditto
  10. Recommend appropriate pharmacotherapy for managing oncologic emergencies including:
    -Spinal cord compression
    Ditto
  11. Vomiting (emesis) is the ejection or expulsion of gastric contents through the mouth.
    Acute onset: Occurs 0–24 hours after chemotherapy administration and commonly resolves within
    24 hours (intensity peaks after 5–6 hours) 

    Whats chemo agent causes delayed onset N/V as per Chemo?
    • Delayed onset: Occurs more than 24 hours after chemotherapy administration
    • Delayed symptoms are best described with cisplatin, although they are commonly reported in association with other agents as well (carboplatin and/or doxorubicin)
  12. Radiation therapy can also cause nausea and vomiting. Why type of radiation can be classified as Highly Emetogenic?
    • a. Mildly emetogenic—Radiation to the head and neck or to the extremities
    • b. Moderately emetogenic—Radiation to the upper abdomen or pelvis or craniospinal radiation
    • c. Highly emetogenic—Total body irradiation, total nodal irradiation, and upper-half-body irradiation 
  13. Recommend a CINV regimen for Highly emetogenic agent?
    • The most common antiemetic regimen for highly emetogenic chemotherapy/radiation is the combination of
    • -Neurokinin 1 (NK1) receptor antagonist (Aprepitant/Fosaprepitant)
    • -Serotonin receptor antagonist-Ondansetron etc
    • -Corticosteroid: Dexamethasone
  14. There are 10 Chemotherapy agents that are listed as highly Emetogenic.

    List the 3 (Three) that start with "C"  
    • Carmustine > 250mg
    • Cisplatin-also causes delayed n/v
    • Cyclosphosphamide >1500mg
    • A/C-Doxorubicin with Cyclophosphamide

    Dacarbazine, Doxorubicin >60mg, Ifosfamide >2000mg, Mechlorethamine, Streptozosin
  15. OBJECTIVE:
    Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including: -Nausea and vomiting
    Question:
    What is the appropriate three drug antiemetic regimen for Highly/moderately emetogenic chemotherapy or radiation?
    • The most common antiemetic regimen for highly emetogenic chemotherapy/radiation is the combination:
    • Serotonin receptor antagonist: eg Ondansetron, palonosetron
    • Neurokinin 1 (NK1) antagonist: Aprepitant 125mg/80mg/80mg; Fosaprepitant 150mg 
    • Corticosteroid: Dexamethasone or methylprednisolone
  16. OBJECTIVE:Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including: -Nausea and vomiting
    Question:
    Considering the 3-drug regimen for Hughly/moderately emetogenic CINV, Which serotonin receptor antagonist does the NCCN guideline recommend and why?
    • Palonosetron is indicated for the prevention of acute CINV for highly emetogenic chemotherapy and acute and delayed CINV for moderately emetogenic chemotherapy
    • Dose: 0.25 mg IV push 30 minutes before chemotherapy administration
    • Has the Longest Half-Life (40 Hours)
  17. OBJ: Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including: -Nausea and vomiting
    Question:
    What are the class side effects of the Serotonin-3 (5-HT3) receptor antagonists (dolasetron, granisetron, ondansetron, and palonosetron)
    Serotonin-3 (5-HT3) receptor antagonists (dolasetron, granisetron, ondansetron, and palonosetron)

    • a. Mechanism of action (MOA): Block serotonin receptors peripherally in the gastrointestinal tract and centrally in the medulla
    • b. Adverse events: Headache and constipation, occurring in 10%–15% of patients. May increase liver function tests and cause QT prolongation
  18. OBJ: Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including: -Nausea and vomiting
    Question:
    Which of the several properties; make lorazepam useful in combination with or as an adjunct to other antiemetics
    • Benzodiazepines (lorazepam)
    • a. Lorazepam as a single agent has minimal antiemetic activity.
    • i. Anterograde amnesia helps prevent anticipatory nausea and vomiting.  Anticipatory vomiting (or nausea) is triggered by sights, smells, or sounds and is a conditioned response; it is more likely to occur in patients whose previous postchemotherapy nausea/vomiting was not well controlled.
    • This is different from delayed onset CINV caused by Cisplatin, Carboplatin and Doxorubicin.
  19. Olanzapine is approved by the U.S. Food and Drug Administration (FDA) for the treatment of schizophrenia and bipolar disorder, this thienobenzodiazepine is used off-label as an alternative agent for the prevention of nausea/vomiting in highly emetogenic regimens and may be used as an option for breakthrough nausea/vomiting
    Question:
    List the the complete regimen on day 1 for a chemo Pt with or without olanzapine?
    • With Olanzapine(doesnt contain NK-1)
    • Palonosetron 0.25 mg IV day 1
    • Dexamethasone 20 mg IV day 1
    • Olanzapine 10 mg PO day 1
    • ± Lorazepam
    • ± H-2 blocker or PPI
    • Without Olanzapine(contains NK-1)
    • Palonosetron 0.25 mg IV day 1
    • Aprepitant 125mg on day 1
    • Dexamethasone 20 mg IV day 1
    • ± Lorazepam
    • ± H-2 blocker or PPI
  20. OBJECTIVE:Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including: -Nausea and vomiting
    Question:What agents do you use for mildly emetogenic CINV?
    • Single-agents of:
    • Phenothiazine (Promethazine, Prochloperazine, Chlorpromazine) 
    • Butyrophenone (haloperidol, droperidol)
    • Steroids (Dexamethasone, Methylpred) 
    • are used for mildly to moderately emetogenic regimens and are given on either a scheduled or an "as-needed" basis for prolonged symptoms (i.e., breakthrough symptoms)
  21. OBJECTIVE:Recommend appropriate pharmacotherapy for managing 6 (Six) common complications of cancer chemotherapy, including: -Nausea and vomiting
    Question:Which agents do you use for CINV when everything else has failed and refractory?
    • Cannabinoids (dronabinol, nabilone)
    • are generally used after other regimens have failed or to stimulate appetite

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