Summary
Summary Oncology Key Points for PEBC Exam
Key points on oncology material required to be successful on the PEBC MCQ Exam.
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ONCO QUICK LESSONCINV
Patho Acute: <24h
Delayed: >24h
Periph pathway: predom acute, in GIT 5-HT3
Central pathway: predom delayed, in brain substance P, DA
Risk Emetogenicity of chemo, age (<50yo ↑ risk), women, hx OH use (↓ OH intake), hx of N/V
- Min: bevacizumab, bleomycin, busulfan, cladribine, fludarabine, vinblastine, vincristine,
vinorelbine
- Low: bortezomib, cetuximab, cytarabine, docetaxel, etoposide, 5-FU, gemcitabine, ixabepilone,
lapatinib, TMX, mitoxantrone, paclitaxel, pemetrexed, temsirolimus, topotecan, trastuzumab
- Mod: carboplatin, cyclosphosphamide, cytarabine (>1g/BSA), daunorubicin, doxorubicin,
epirubicin, idarubicin, ifosafamide, irinotecan, oxaliplatin
- High: carmustine, cisplatin, cyclophosphamide (1.5g/BSA), dacarbazine, mechlorethamine,
streptozocin
Nonpharm Small, light meals, avoid foods w heavy aroma, bland foods, avoid, triggers, stay well hydrated,
relaxation techniques, individualized exercise programs, sleep, acupressure/acupuncture mb effective
Treatment
Breakthrough
Should always have antiemetic px for BT
- Adult: olanzapine, chlorpromazine, prochlorperazine, promethazine, lorazepam, methylpred,
metoclopramide, dex, nabilone
Granisetron, dolasetron, ondans are effective for B/T
Agents 5-HT3 Ant: 1st line for preventing acute phase CINV
- Not as good for delayed (except palonosetron: ↑ affinity)
- All equally effective but may benefit from switching wi class
- Heart arrhythmia risk: max dose IV ondans 16mg
- constipation
CS: 1st line for CINV and radiation induced N/V effective for acute/delayed
- Can be used alone for low chemo or combo (most effective in triple regimen)
- When used w aprepitant, ↓ dex dose by 50% (DEX is CYP3A4 substrate)-from 20mg to 8-12mg
NK-R Ant: 1st line for high emetogenic, combined w triple therapy (not used as monotherapy)
- ↑ dose for acute, ↓ dose for delayed
- Constipation, 3A4, induces CYP2C9
Olanzapine: px for PTs for acute and delayed high emetogenicity, used for B/T
Phenothiazines: Px for low emetogenicity regimens, B/T
Butyrophenones (haloperidol): only used in palliative setting, refractory N/V
Metoclopramide: px of acute CINV, in combo w dex for px of delayed, BT
- 5-HT Ant at high doses, DA Ant at standard doses
- Dose-limiting diarrhea and EPS
Antihistamines/anticholinergics: simple N/V
Nabilone: last resort for B/T for PTs who have not responded to first line
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