NAPLEX _ Oncology I - Brand / Generics

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  1. Neupogen
    Zarxio
    • Filgrastim
    • "G-CSF"
    • -- given IV/SC Daily (treat until ANC > 2,000-3,000 cells/mm3)
    • -- administer first dose 24-72 hours after chemo
    • SE: bone pain
    • NOTES: store in refrigerator || protect from light
  2. Granix
    • Tbo-filgrastim (biosimilar of filgrastim)
    • "G-SCF"
  3. Neulasta
    • Pegfilgrastim
    • "Pegylated G-CSF"
    • -- given SC ONCE per chemo cycle
    • -- administer after 24 hours of chemo infusion AND not within 14 days of next cycle of chemo
    • SE: bone pain
    • NOTES: store in refrigerator || protect from light
  4. Leukine
    Sargramostim

    • "GM-CSF"
    • ** Limited to use in stem cell transplantation **
  5. Low Risk Febrile Neutropenia
    • expected ANC <500 cells/mm3 for </= 7 days
    • no comorbidities

    • Oral anti-pseudomonal antibodies
    • -- Ciprofloxacin + augmentin
    • OR
    • -- Ciprofloxacin +/- clindamycin
    • OR
    • -- Levofloxacin
  6. High Risk Febrile Neutropenia
    • expected ANC <500 cells/mm3 for > 7 days
    • presence of comorbidities
    • evidence of renal or hepatic impairment (CrCl <30 mL/min or LFTs > 5x UNL)

    • Intravenous Anti-pseudomonal beta-lactams
    • -- Cefepime
    • OR
    • -- Ceftazidime
    • OR 
    • -- Meropenem
    • OR
    • -- Imipenem-cilastatin
    • OR
    • -- Zosyn (piperacillin-tazobactam)
  7. High Emetic Risk _ Antiemetic Regimens (3)
    (emesis frequency >90%)
    • ** 3 drugs **
    • NK1-RA + 5HT3-RA + Dexamethasone
    • Akeynzeo (netupitant/palonosetron) + Dexamethasone
    • Olanzapine + Palonosetron + Dexamethasone
  8. Moderate Emetic Risk _ Antiemetic Regimens (4)
    (emesis frequency 30-90%)
    • ** 2 or 3 drugs **
    • NK1-RA + 5HT3-RA + Dexamethasone
    • 5HT3-RA + Dexamethasone
    • Akeynzeo (netupitant/palonesetron) + Dexamethasone
    • Olanzapine + Palonesetron + Dexamethasone
  9. Low Emetic Risk _ Antiemetic Regimens (4)
    (emesis frequency 10-30%)
    • ** 1 drug ** (ANY except NK1-RA)
    • 5HT3-RA
    • Dexamethasone
    • Proclorperazine
    • Metoclopramide
  10. Antiemetics for Breakthrough CINV
    5HT3-RA -- well-tolerated with SE of HA and constipation

    • Dopamine Receptor Antagonist -- commonly prescribed --> MORE unpleasant SE of sedation and anticholinergics
    • == prochlorperazine || promethazine || metocloperamide

    • Cannabinoids -- 2nd-Line agents
    • == dronabinol || nabilone
  11. Substance P/Neurokinin-1 Receptor Antagonist (NK1-RA) (3)
    • Aprepitant (Emend) _ PO
    • -- given 3 days total
    • Fosaprepitant (Emend) _ IV
    • -- only ONCE - lasts for 3-5 days
    • Rolapitant (Valubi)
  12. 5HT3-RA Antagonist (4)
    • Ondansetron (Zofran || Zuplenz film)
    • -- CI concomitant use of apomorphine (Apokyn) = enhanced hypotensive effects of apomorphine
    • Granisetron (Kytril || Sancuso || Sustol)
    • Dolasetron (Anzemet)
    • Palonesetron (Aloxi)
    • -- preferred due to longer T1/2 (last ~7 days)
  13. Combination
    (NK1-RA + 5HT3-RA)
    Netupitant + Palonesetron (Akynzeo)
  14. Decadron
    Dexamethasone

    • Corticosteroid
    • -- dose should be decreased when used concurrently with NK1-RA (= CYP 3A4 inhibitor)
  15. Dopamine Receptor Antagonists (3)
    • Prochlorperazine (Compazine || Compro)
    • -- increased risk of mortality in elderly patients with dementia-related psychosis
    • Promethazine (Phenergan || Phenadoz || Promethagan)
    • -- do not use in children age <2 years == risk of resp depression
    • Metoclopramide (Reglan || Metozolv ODT)
    • -- tardive dyskinesia can be irreversible
  16. Chemotherapy-Induced Diarrhea (CID)
    = life-threatening dehydration and electrolyte imbalances
    Fluorouracil (5-FU) | Capecitabine | Irenotecan -- commonly cause CID that occurs several days after chemotherapy

    • ANTIMOTILITY agents:
    • - Loperamide (max dose 16 mg/day | can increased to 24 mg/day when treating CID under medical supervision)
    • - Diphenoxylate + Atropine
  17. Hypercalcemia Of Malignancy Treatment
    (corrected calcium +/- 12 mg/dL)
    • ** CORRECTED CALCIUM _ < 12 mg/dL (mild):
    • -- oral/IV hydration
    • --> then Loop diuretics

    • ** CORRECTED CALCIUM _ > 12 mg/dL (moderate - severe):
    • -- IV hydration ONLY
    • -- IV Bisphosphonates [zoledronic acid (zometa)] -OR- Denosumab (Xgeva)
    • -- +/- Calcitonin (Maicalcin) = can be used concurrently with IV bisphosphonates or denosumab to lower serum calcium in 2-6 hours in patients with symptomatic hypercalcemia
  18. Vaccinations
    • !! Avoided during chemotherapy 
    • -- vaccination should precede initiation of chemotherapy >/= 2 weeks
    • NO LIVE vaccines to Immunocompromised patients --> 3 months AFTER discontinuation of chemotherapy

Card Set Information

Author:
HNguyen0287
ID:
334778
Filename:
NAPLEX _ Oncology I - Brand / Generics
Updated:
2017-10-03 22:21:21
Tags:
Naplex Rxprep Oncology
Folders:
RxPREP
Description:
RxPREP _ NAPLEX Review - Oncology I _ Brand/Generics
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