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Questions and Answers
Which chemotherapy agent is known to have a 'high' emetic risk, potentially causing emesis in more than 90% of cases without prophylaxis?
Which chemotherapy agent is known to have a 'high' emetic risk, potentially causing emesis in more than 90% of cases without prophylaxis?
What is the main neurotransmitter implicated in the genesis of acute nausea and vomiting associated with chemotherapy?
What is the main neurotransmitter implicated in the genesis of acute nausea and vomiting associated with chemotherapy?
In the context of chemotherapy-induced nausea and vomiting (CINV), which receptors are targeted by antiemetics to prevent the emetic response?
In the context of chemotherapy-induced nausea and vomiting (CINV), which receptors are targeted by antiemetics to prevent the emetic response?
What complication is characterized by a decreased white blood cell count due to chemotherapy, increasing the risk of infections?
What complication is characterized by a decreased white blood cell count due to chemotherapy, increasing the risk of infections?
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What is one of the key factors influencing the rate of emesis in patients undergoing chemotherapy?
What is one of the key factors influencing the rate of emesis in patients undergoing chemotherapy?
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Which symptom is a common characteristic of chemotherapy-induced nausea and vomiting (CINV)?
Which symptom is a common characteristic of chemotherapy-induced nausea and vomiting (CINV)?
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What is the purpose of prophylaxis in managing chemotherapy-induced nausea and vomiting?
What is the purpose of prophylaxis in managing chemotherapy-induced nausea and vomiting?
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Which of the following is NOT typically considered a potential adverse effect of chemotherapy?
Which of the following is NOT typically considered a potential adverse effect of chemotherapy?
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What is the primary objective of administering IV fluids in bladder management?
What is the primary objective of administering IV fluids in bladder management?
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Which treatment may be required if saline lavage is ineffective in removing blood clots?
Which treatment may be required if saline lavage is ineffective in removing blood clots?
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Which of the following agents is specifically highlighted for use in severe cases of cystitis caused by radiation and cyclophosphamide?
Which of the following agents is specifically highlighted for use in severe cases of cystitis caused by radiation and cyclophosphamide?
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What potential side effect is associated with the use of alum for irrigation in bladder treatment?
What potential side effect is associated with the use of alum for irrigation in bladder treatment?
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Which nonpharmacologic measure is recommended to facilitate saline lavage and evacuation of blood clots?
Which nonpharmacologic measure is recommended to facilitate saline lavage and evacuation of blood clots?
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What is the primary aim of pharmacologic therapy in bladder management?
What is the primary aim of pharmacologic therapy in bladder management?
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What should be monitored daily to evaluate potential renal dysfunction?
What should be monitored daily to evaluate potential renal dysfunction?
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What is a recommended pharmacologic treatment for managing bladder spasms?
What is a recommended pharmacologic treatment for managing bladder spasms?
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Under what circumstances should vancomycin be included in initial therapy?
Under what circumstances should vancomycin be included in initial therapy?
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What action should be taken if a gram-positive organism is susceptible to other anti-bacterials?
What action should be taken if a gram-positive organism is susceptible to other anti-bacterials?
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What is the commonly used agent for empirical antifungal therapy in neutropenic patients after 5 to 7 days?
What is the commonly used agent for empirical antifungal therapy in neutropenic patients after 5 to 7 days?
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What is the main cause of hemorrhagic cystitis in patients undergoing chemotherapy?
What is the main cause of hemorrhagic cystitis in patients undergoing chemotherapy?
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What is a necessary monitoring step for patients receiving nephrotoxic agents?
What is a necessary monitoring step for patients receiving nephrotoxic agents?
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What should be done first in the treatment of hemorrhagic cystitis?
What should be done first in the treatment of hemorrhagic cystitis?
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Which treatment option can be used for vancomycin-resistant organisms?
Which treatment option can be used for vancomycin-resistant organisms?
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What is the desired outcome for treating hemorrhagic cystitis?
What is the desired outcome for treating hemorrhagic cystitis?
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Which of the following adjunct treatments can help reduce the incidence of hemorrhagic cystitis?
Which of the following adjunct treatments can help reduce the incidence of hemorrhagic cystitis?
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For what duration should vancomycin be considered after starting initial therapy?
For what duration should vancomycin be considered after starting initial therapy?
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Which of the following is NOT a recommended evaluation for the treatment of febrile neutropenia?
Which of the following is NOT a recommended evaluation for the treatment of febrile neutropenia?
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What should be monitored in patients receiving cyclophosphamide or ifosfamide to aid in preventing hemorrhagic cystitis?
What should be monitored in patients receiving cyclophosphamide or ifosfamide to aid in preventing hemorrhagic cystitis?
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What medication is equivalent to conventional amphotericin B but less toxic?
What medication is equivalent to conventional amphotericin B but less toxic?
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Which factor is NOT considered a patient risk factor for febrile neutropenia (FN)?
Which factor is NOT considered a patient risk factor for febrile neutropenia (FN)?
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What is the primary goal of treatment during the neutropenic period?
What is the primary goal of treatment during the neutropenic period?
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Which prophylactic antibiotic is specifically recommended for Pneumocystis jiroveci pneumonia?
Which prophylactic antibiotic is specifically recommended for Pneumocystis jiroveci pneumonia?
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When should colony-stimulating factors (CSFs) be initiated in patients receiving chemotherapy?
When should colony-stimulating factors (CSFs) be initiated in patients receiving chemotherapy?
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In which scenario should an indwelling catheter be removed according to IDSA guidelines?
In which scenario should an indwelling catheter be removed according to IDSA guidelines?
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Which statement regarding high-risk febrile neutropenia (FN) treatment options is true?
Which statement regarding high-risk febrile neutropenia (FN) treatment options is true?
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What is the recommended action for empiric therapy before culture results are known?
What is the recommended action for empiric therapy before culture results are known?
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Which of the following is NOT a factor influencing the choice of initial antimicrobial agents?
Which of the following is NOT a factor influencing the choice of initial antimicrobial agents?
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What is the least expensive and simplest modality for preventing infection in neutropenic patients?
What is the least expensive and simplest modality for preventing infection in neutropenic patients?
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For patients hospitalized with febrile neutropenia and a MASCC risk-index score less than 21, what is indicated?
For patients hospitalized with febrile neutropenia and a MASCC risk-index score less than 21, what is indicated?
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Which factor does NOT describe common characteristics of dual therapy for febrile neutropenia?
Which factor does NOT describe common characteristics of dual therapy for febrile neutropenia?
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Which of the following patients would benefit most from secondary prophylaxis with a CSF?
Which of the following patients would benefit most from secondary prophylaxis with a CSF?
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Which immunization is important for neutropenic patients to receive annually?
Which immunization is important for neutropenic patients to receive annually?
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What action should be taken if a specific etiology is identified in a neutropenic patient?
What action should be taken if a specific etiology is identified in a neutropenic patient?
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What is the timeframe for acute nausea and vomiting after chemotherapy administration?
What is the timeframe for acute nausea and vomiting after chemotherapy administration?
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Which patient-related factor does NOT increase the risk of chemotherapy-induced nausea and vomiting (CINV)?
Which patient-related factor does NOT increase the risk of chemotherapy-induced nausea and vomiting (CINV)?
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In prevention of delayed CINV, which agent is preferred?
In prevention of delayed CINV, which agent is preferred?
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What distinguishes anticipatory nausea and vomiting from other types of CINV?
What distinguishes anticipatory nausea and vomiting from other types of CINV?
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Which of the following is NOT a pharmacologic therapy for CINV?
Which of the following is NOT a pharmacologic therapy for CINV?
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What type of nausea/vomiting occurs despite the use of appropriate antiemetics?
What type of nausea/vomiting occurs despite the use of appropriate antiemetics?
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Which nonpharmacologic therapy is NOT mentioned as an effective adjunct for CINV?
Which nonpharmacologic therapy is NOT mentioned as an effective adjunct for CINV?
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Which class of drugs is effective in preventing both acute and delayed emesis in high emetic risk chemotherapy?
Which class of drugs is effective in preventing both acute and delayed emesis in high emetic risk chemotherapy?
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What is the primary cause of mucositis associated with chemotherapy?
What is the primary cause of mucositis associated with chemotherapy?
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In which type of cancer patients is the reported incidence of mucositis from chemoradiation approximately 85%?
In which type of cancer patients is the reported incidence of mucositis from chemoradiation approximately 85%?
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How soon after chemotherapy do symptoms of mucositis typically begin to appear?
How soon after chemotherapy do symptoms of mucositis typically begin to appear?
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What treatment is recommended for breakthrough nausea or vomiting?
What treatment is recommended for breakthrough nausea or vomiting?
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Which treatment regimen is indicated for low emetic risk IV chemotherapy?
Which treatment regimen is indicated for low emetic risk IV chemotherapy?
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Which one of these procedures may be effective for preventing anticipatory nausea?
Which one of these procedures may be effective for preventing anticipatory nausea?
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What is the primary goal of nonpharmacologic treatment for mucositis?
What is the primary goal of nonpharmacologic treatment for mucositis?
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Which agent is FDA-approved specifically for the prevention and treatment of mucositis in patients receiving high-dose chemotherapy?
Which agent is FDA-approved specifically for the prevention and treatment of mucositis in patients receiving high-dose chemotherapy?
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What is the definition of febrile neutropenia (FN)?
What is the definition of febrile neutropenia (FN)?
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What is a significant contributor to the shift from gram-negative to gram-positive organisms in bloodstream infections in cancer patients?
What is a significant contributor to the shift from gram-negative to gram-positive organisms in bloodstream infections in cancer patients?
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Which treatment is considered appropriate for managing pain associated with mucositis?
Which treatment is considered appropriate for managing pain associated with mucositis?
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In patients with severe neutropenia, which infection is particularly significant and may emerge as a pathogen?
In patients with severe neutropenia, which infection is particularly significant and may emerge as a pathogen?
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Which of the following is NOT recommended according to clinical practice guidelines for mucositis prevention?
Which of the following is NOT recommended according to clinical practice guidelines for mucositis prevention?
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What factor is NOT considered when evaluating the risk of infection during periods of neutropenia?
What factor is NOT considered when evaluating the risk of infection during periods of neutropenia?
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What should be the principal method for evaluating the effectiveness of interventions for mucositis?
What should be the principal method for evaluating the effectiveness of interventions for mucositis?
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Which type of therapy is associated with the use of low-level laser therapy to prevent mucositis?
Which type of therapy is associated with the use of low-level laser therapy to prevent mucositis?
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What is the most likely outcome if fever is the only sign of infection in neutropenic patients?
What is the most likely outcome if fever is the only sign of infection in neutropenic patients?
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Which treatment option is typically advised against for mucositis prevention despite some occasional use in practice?
Which treatment option is typically advised against for mucositis prevention despite some occasional use in practice?
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What is the maximum benefit window for palifermin administration regarding myelotoxic therapy?
What is the maximum benefit window for palifermin administration regarding myelotoxic therapy?
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Which of the following is involved in calculating the Absolute Neutrophil Count (ANC)?
Which of the following is involved in calculating the Absolute Neutrophil Count (ANC)?
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What is a common outcome of febrile neutropenia if untreated?
What is a common outcome of febrile neutropenia if untreated?
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Study Notes
Chemotherapy Adverse Effects
- General: Cancer treatments, and the cancer itself, can cause serious side effects. Supportive care (symptom management) is used to treat these complications.
Chemotherapy-Induced Nausea and Vomiting (CINV)
-
Types:
- Acute: Within the first 24 hours.
- Delayed: 24 hours to 5 days after treatment.
- Anticipatory: Learned response to a stimulus associated with prior treatment.
- Breakthrough: Despite appropriate antiemetic use.
- Risk Factors: Chemotherapy drug type, dose, schedule; patient factors (female, young age, history of motion sickness, pregnancy nausea, poor previous control).
- Prevention: Prophylactic pharmacologic therapy is crucial, based on the emetic risk of the chemotherapy regimen (high, moderate, low, minimal). High risk regimens warrant a four-drug combination.
- Management:
- Acute: Focus on prevention.
- Delayed: Dexamethasone is often used.
- Breakthrough: Different mechanism medications, like dopamine antagonists.
Mucositis
- Definition: Inflammation of the mucosal lining in the oral cavity and GI tract, often causing ulcers due to radiation or chemotherapy. Stomatitis is a related term specifically for oral cavity inflammation, often seen with mTOR inhibitors.
- Epidemiology: Incidence varies by patient and treatment, but can reach 85% in head and neck cancer patients receiving chemoradiation. Specific agents causing moderate to severe mucositis: taxanes, anthracyclines, platinum analogues, methotrexate, fluoropyrimidines.
- Pathophysiology: Direct cytotoxicity from treatment to basal epithelial cells, resulting in ulcers from lack of regeneration, potentially compounded by trauma or microorganisms.
- Prevention: Good oral hygiene (brushing, rinsing); optimal nutritional support. Ice chips, low-level laser therapy beneficial for certain situations.
-
Treatment:
- Nonpharmacologic: Oral hygiene, nutritional support.
- Pharmacologic: Amifostine (radiation), protective gels, often including H2 antagonists (e.g., omeprazole) to alleviate pain/reflux. Topical anesthetics, opioids, or antimicrobial therapy if infection is suspected.
Febrile Neutropenia (FN)
- Definition: Fever (≥38.3°C or ≥38.0°C for at least 1 hour) and an absolute neutrophil count (ANC) <500/µL, or a predicted decrease to <500/µL within the next 48 hours.
- Risk Factors: Patient age, bone marrow involvement, low hemoglobin/albumin, advanced cancer stage, recent surgery, persistent neutropenia; treatment intent (curative or palliative), chemotherapy regimen, and dose density.
- Etiology: Increased incidence of gram-positive bloodstream infections likely due to increased use of central lines and aggressive chemotherapy.
- Prevention:
- Hand Hygiene.
- Prophylactic antibiotics: SMZ-TMP (gram-positive coverage) or quinolones (gram-negative).
- Colony-stimulating factors (CSFs): Filgrastim, pegfilgrastim, sargramostim. Helpful for high risk cases, regardless of cure intent.
- Treatment:
- General: Risk assessment; hospitalization for high-risk patients; prompt broad-spectrum antibiotics.
- Choices: Monotherapy or dual therapy; Vancomycin may be added if specific concerns exist about gram-positive bacteria. Empiric antifungal agents after 5-7 days if neutropenia is sustained.
Hemorrhagic Cystitis
- Definition: Bleeding from the bladder lining, commonly induced by certain medications.
- Etiology: Mostly alkylating agents (cyclophosphamide, ifosfamide), radiation to the pelvic area, and sometimes viral infections.
- Prevention: Mesna, hyperhydration (IV fluids), and bladder irrigation/catheterization.
- Treatment: Discontinue offending agents; administer IV fluids; blood/platelet transfusions, pain management with opioids; local intravesicular therapies for hematuria; surgical diversion in severe cases.
- General Approaches: Focus on stopping the bleeding source, maintaining urine outflow, and avoiding obstruction/renal compromise.
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Description
This quiz explores the adverse effects of chemotherapy, with a focus on chemotherapy-induced nausea and vomiting (CINV). Participants will learn about the types of CINV, risk factors, prevention strategies, and management options. It is essential for those in the medical field to understand and manage these complications effectively.
