Chemotherapy Adverse Effects Overview

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to Lesson

Podcast

Play an AI-generated podcast conversation about this lesson

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?

  • Doxorubicin
  • Cisplatin (correct)
  • Methotrexate
  • Cyclophosphamide

What is the main neurotransmitter implicated in the genesis of acute nausea and vomiting associated with chemotherapy?

  • Acetylcholine
  • Serotonin (correct)
  • Histamine
  • Dopamine

In the context of chemotherapy-induced nausea and vomiting (CINV), which receptors are targeted by antiemetics to prevent the emetic response?

  • Histamine and opioid receptors
  • 5-HT3 and NK1 receptors (correct)
  • Dopamine and GABA receptors
  • Muscarinic and adrenergic receptors

What complication is characterized by a decreased white blood cell count due to chemotherapy, increasing the risk of infections?

<p>Febrile neutropenia (D)</p> Signup and view all the answers

What is one of the key factors influencing the rate of emesis in patients undergoing chemotherapy?

<p>Individual patient risk factors (D)</p> Signup and view all the answers

Which symptom is a common characteristic of chemotherapy-induced nausea and vomiting (CINV)?

<p>General GI upset and reflux (A)</p> Signup and view all the answers

What is the purpose of prophylaxis in managing chemotherapy-induced nausea and vomiting?

<p>To prevent emesis based on the patient's risk level (C)</p> Signup and view all the answers

Which of the following is NOT typically considered a potential adverse effect of chemotherapy?

<p>Cardiac arrest (C)</p> Signup and view all the answers

What is the primary objective of administering IV fluids in bladder management?

<p>To irrigate the bladder (B)</p> Signup and view all the answers

Which treatment may be required if saline lavage is ineffective in removing blood clots?

<p>Surgical removal of blood clots under anesthesia (D)</p> Signup and view all the answers

Which of the following agents is specifically highlighted for use in severe cases of cystitis caused by radiation and cyclophosphamide?

<p>Hyperbaric oxygen (HBO) (D)</p> Signup and view all the answers

What potential side effect is associated with the use of alum for irrigation in bladder treatment?

<p>Aluminum toxicity, especially in children (B)</p> Signup and view all the answers

Which nonpharmacologic measure is recommended to facilitate saline lavage and evacuation of blood clots?

<p>Use of a large-diameter, multihole urethral catheter (C)</p> Signup and view all the answers

What is the primary aim of pharmacologic therapy in bladder management?

<p>To resolve bladder symptoms including pain and hemorrhage (D)</p> Signup and view all the answers

What should be monitored daily to evaluate potential renal dysfunction?

<p>Urinary output and serum chemistries (C)</p> Signup and view all the answers

What is a recommended pharmacologic treatment for managing bladder spasms?

<p>Oxybutynin 5 mg taken orally (B)</p> Signup and view all the answers

Under what circumstances should vancomycin be included in initial therapy?

<p>Known colonization with antibiotic-resistant bacteria (B)</p> Signup and view all the answers

What action should be taken if a gram-positive organism is susceptible to other anti-bacterials?

<p>Switch to the susceptible antibacterial agent (C)</p> Signup and view all the answers

What is the commonly used agent for empirical antifungal therapy in neutropenic patients after 5 to 7 days?

<p>Amphotericin B (A)</p> Signup and view all the answers

What is the main cause of hemorrhagic cystitis in patients undergoing chemotherapy?

<p>Cyclophosphamide and ifosfamide (A)</p> Signup and view all the answers

What is a necessary monitoring step for patients receiving nephrotoxic agents?

<p>Daily evaluation of vital signs (D)</p> Signup and view all the answers

What should be done first in the treatment of hemorrhagic cystitis?

<p>Discontinue the offending agent (C)</p> Signup and view all the answers

Which treatment option can be used for vancomycin-resistant organisms?

<p>Linezolid (C)</p> Signup and view all the answers

What is the desired outcome for treating hemorrhagic cystitis?

<p>Maintain urine outflow (A)</p> Signup and view all the answers

Which of the following adjunct treatments can help reduce the incidence of hemorrhagic cystitis?

<p>Administration of Mesna (A)</p> Signup and view all the answers

For what duration should vancomycin be considered after starting initial therapy?

<p>At least 3 to 5 days (B)</p> Signup and view all the answers

Which of the following is NOT a recommended evaluation for the treatment of febrile neutropenia?

<p>Daily monitoring of blood pressure only (C)</p> Signup and view all the answers

What should be monitored in patients receiving cyclophosphamide or ifosfamide to aid in preventing hemorrhagic cystitis?

<p>Urine output and renal function (C)</p> Signup and view all the answers

What medication is equivalent to conventional amphotericin B but less toxic?

<p>Liposomal amphotericin B (D)</p> Signup and view all the answers

Which factor is NOT considered a patient risk factor for febrile neutropenia (FN)?

<p>History of previous chemotherapy (A)</p> Signup and view all the answers

What is the primary goal of treatment during the neutropenic period?

<p>Prevent morbidity and mortality (C)</p> Signup and view all the answers

Which prophylactic antibiotic is specifically recommended for Pneumocystis jiroveci pneumonia?

<p>Sulfamethoxazole–trimethoprim (SMZ-TMP) (C)</p> Signup and view all the answers

When should colony-stimulating factors (CSFs) be initiated in patients receiving chemotherapy?

<p>When risk of FN is ≥ 20% (B)</p> Signup and view all the answers

In which scenario should an indwelling catheter be removed according to IDSA guidelines?

<p>Recurrent infection or no response to antibiotics (A)</p> Signup and view all the answers

Which statement regarding high-risk febrile neutropenia (FN) treatment options is true?

<p>Monotherapy lacks significant gram-positive coverage. (A)</p> Signup and view all the answers

What is the recommended action for empiric therapy before culture results are known?

<p>Start therapy immediately after cultures are taken. (B)</p> Signup and view all the answers

Which of the following is NOT a factor influencing the choice of initial antimicrobial agents?

<p>Patient's dietary restrictions (B)</p> Signup and view all the answers

What is the least expensive and simplest modality for preventing infection in neutropenic patients?

<p>Vigilant hand hygiene (D)</p> Signup and view all the answers

For patients hospitalized with febrile neutropenia and a MASCC risk-index score less than 21, what is indicated?

<p>Inpatient hospitalization for treatment (A)</p> Signup and view all the answers

Which factor does NOT describe common characteristics of dual therapy for febrile neutropenia?

<p>Is always less costly than monotherapy (D)</p> Signup and view all the answers

Which of the following patients would benefit most from secondary prophylaxis with a CSF?

<p>A patient who had a prior episode of febrile neutropenia (B)</p> Signup and view all the answers

Which immunization is important for neutropenic patients to receive annually?

<p>Influenza vaccine (C)</p> Signup and view all the answers

What action should be taken if a specific etiology is identified in a neutropenic patient?

<p>Continue appropriate therapy for 7 days after neutropenia resolves (A)</p> Signup and view all the answers

What is the timeframe for acute nausea and vomiting after chemotherapy administration?

<p>Within the first 24 hours (A)</p> Signup and view all the answers

Which patient-related factor does NOT increase the risk of chemotherapy-induced nausea and vomiting (CINV)?

<p>Age over 50 (D)</p> Signup and view all the answers

In prevention of delayed CINV, which agent is preferred?

<p>Dexamethasone (C)</p> Signup and view all the answers

What distinguishes anticipatory nausea and vomiting from other types of CINV?

<p>It is a conditioned reflex response. (D)</p> Signup and view all the answers

Which of the following is NOT a pharmacologic therapy for CINV?

<p>Citalopram (D)</p> Signup and view all the answers

What type of nausea/vomiting occurs despite the use of appropriate antiemetics?

<p>Breakthrough Nausea/Vomiting (D)</p> Signup and view all the answers

Which nonpharmacologic therapy is NOT mentioned as an effective adjunct for CINV?

<p>Nutritional supplements (C)</p> Signup and view all the answers

Which class of drugs is effective in preventing both acute and delayed emesis in high emetic risk chemotherapy?

<p>4-drug combinations including dexamethasone and olanzapine (B)</p> Signup and view all the answers

What is the primary cause of mucositis associated with chemotherapy?

<p>Cytotoxicity to basal epithelial cells (B)</p> Signup and view all the answers

In which type of cancer patients is the reported incidence of mucositis from chemoradiation approximately 85%?

<p>Head and neck cancer (D)</p> Signup and view all the answers

How soon after chemotherapy do symptoms of mucositis typically begin to appear?

<p>5 to 7 days (B)</p> Signup and view all the answers

What treatment is recommended for breakthrough nausea or vomiting?

<p>Dopamine antagonists like prochlorperazine (C)</p> Signup and view all the answers

Which treatment regimen is indicated for low emetic risk IV chemotherapy?

<p>Single-agent antiemetic prophylaxis (D)</p> Signup and view all the answers

Which one of these procedures may be effective for preventing anticipatory nausea?

<p>Guided imagery (B)</p> Signup and view all the answers

What is the primary goal of nonpharmacologic treatment for mucositis?

<p>To reduce the bacterial load (C)</p> Signup and view all the answers

Which agent is FDA-approved specifically for the prevention and treatment of mucositis in patients receiving high-dose chemotherapy?

<p>Palifermin (B)</p> Signup and view all the answers

What is the definition of febrile neutropenia (FN)?

<p>A combination of fever and an absolute neutrophil count under 500/µL (D)</p> Signup and view all the answers

What is a significant contributor to the shift from gram-negative to gram-positive organisms in bloodstream infections in cancer patients?

<p>Widespread use of central venous catheters (B)</p> Signup and view all the answers

Which treatment is considered appropriate for managing pain associated with mucositis?

<p>Both opioids and topical anesthetic products (A)</p> Signup and view all the answers

In patients with severe neutropenia, which infection is particularly significant and may emerge as a pathogen?

<p>Candida albicans (A)</p> Signup and view all the answers

Which of the following is NOT recommended according to clinical practice guidelines for mucositis prevention?

<p>Magical mouthwash (C)</p> Signup and view all the answers

What factor is NOT considered when evaluating the risk of infection during periods of neutropenia?

<p>Age of the patient (B)</p> Signup and view all the answers

What should be the principal method for evaluating the effectiveness of interventions for mucositis?

<p>Measurement of pain scales and ability to eat or drink (A)</p> Signup and view all the answers

Which type of therapy is associated with the use of low-level laser therapy to prevent mucositis?

<p>Hematopoietic cell transplant (A)</p> Signup and view all the answers

What is the most likely outcome if fever is the only sign of infection in neutropenic patients?

<p>The patient might be at increased risk for severe complications (B)</p> Signup and view all the answers

Which treatment option is typically advised against for mucositis prevention despite some occasional use in practice?

<p>Magic-mouthwash compounded rinses (B)</p> Signup and view all the answers

What is the maximum benefit window for palifermin administration regarding myelotoxic therapy?

<p>Three days before and three days after treatment (C)</p> Signup and view all the answers

Which of the following is involved in calculating the Absolute Neutrophil Count (ANC)?

<p>Total white blood cell count multiplied by the percentage of segmented neutrophils and bands (B)</p> Signup and view all the answers

What is a common outcome of febrile neutropenia if untreated?

<p>Increased risk of morbidity and mortality (D)</p> Signup and view all the answers

Flashcards

Chemotherapy-induced nausea and vomiting (CINV)

Nausea and vomiting as a side effect of chemotherapy treatment.

Emetic risk levels

Categorization of chemotherapy drugs based on their potential to cause vomiting.

5-HT3 receptors

Receptors playing a key role in triggering vomiting, located in the chemoreceptor trigger zone and GI tract.

Neurokinin-1 (NK1) receptors

Receptors involved in triggering vomiting, located in the emetic center of the medulla.

Signup and view all the flashcards

Serotonin

A chemical that can stimulate vomiting during chemotherapy.

Signup and view all the flashcards

Prophylaxis for CINV

Treating nausea and vomiting before it occurs, to reduce symptoms.

Signup and view all the flashcards

Tumor Lysis Syndrome (TLS)

A serious complication that can occur when cancer cells die quickly; can involve increased blood potassium, uric acid, etc..

Signup and view all the flashcards

Myelosuppression

A decrease in the production of blood cells caused by chemotherapy.

Signup and view all the flashcards

Febrile neutropenia (FN)

A serious condition involving a fever and a low count of neutrophils.

Signup and view all the flashcards

Hemorrhagic cystitis

Inflammation and bleeding of the bladder caused by chemotherapy.

Signup and view all the flashcards

Mucositis

Inflammation of the mucous membranes of the mouth, throat, or gastrointestinal tract.

Signup and view all the flashcards

Mucositis

Inflammation of the mucous membranes, often in the mouth, throat, or GI tract, caused by factors like chemotherapy.

Signup and view all the flashcards

Nonpharmacologic Mucositis Prevention

Methods to reduce mucositis that don't involve medication, such as good oral hygiene (brushing, flossing), and nutritional support.

Signup and view all the flashcards

Pharmacologic Mucositis Treatment

Using medications to prevent or reduce mucositis, such as Amifostine or Palifermin.

Signup and view all the flashcards

Febrile Neutropenia (FN)

A serious condition with fever and low neutrophil counts (a type of white blood cell), a common risk after chemotherapy.

Signup and view all the flashcards

Neutropenia Cause

A decrease in neutrophil count (a type of white blood cell) often caused by cancer treatment, increasing the risk of infection.

Signup and view all the flashcards

Absolute Neutrophil Count (ANC)

The number of neutrophils in a blood sample, used to measure the severity of neutropenia (low neutrophil count).

Signup and view all the flashcards

FN Risk Factors

Factors influencing the risk of febrile neutropenia, including the duration and severity of low neutrophil counts.

Signup and view all the flashcards

Febrile

Referring to a fever, a body temperature above a certain threshold.

Signup and view all the flashcards

Infectious Complications

Problems triggered by infection, especially in patients with low neutrophil counts, often after cancer treatment.

Signup and view all the flashcards

Chemotherapy-Induced Nausea and Vomiting (CINV)

Nausea and vomiting caused by chemotherapy drugs.

Signup and view all the flashcards

Acute CINV

Nausea and vomiting occurring within the first 24 hours after chemotherapy.

Signup and view all the flashcards

Delayed CINV

Nausea and vomiting occurring 24 hours to 5 days after chemotherapy.

Signup and view all the flashcards

Anticipatory CINV

Conditioned nausea/vomiting triggered by stimuli associated with previous chemotherapy.

Signup and view all the flashcards

Breakthrough CINV

Nausea and vomiting despite treatment.

Signup and view all the flashcards

Emetogenicity

The tendency of a chemotherapy drug to cause nausea and vomiting.

Signup and view all the flashcards

Prophylaxis

Treatment to prevent CINV.

Signup and view all the flashcards

Dexamethasone

A corticosteroid used to prevent CINV, especially delayed nausea/vomiting.

Signup and view all the flashcards

5-HT3 antagonist

A class of drugs that block serotonin receptors, often used to prevent CINV.

Signup and view all the flashcards

NK1 receptor antagonist

Medications that block NK1 receptors to prevent CINV.

Signup and view all the flashcards

Mucositis

Inflammation of the mucous membranes caused by radiation or chemotherapy.

Signup and view all the flashcards

Stomatitis

Inflammation of the oral cavity caused by targeted cancer drugs like everolimus.

Signup and view all the flashcards

Nonpharmacologic Therapy

Methods to control CINV that do not use drugs, like relaxation techniques or dietary changes.

Signup and view all the flashcards

Breakthrough Nausea/Vomiting

Nausea and vomiting despite existing treatment regimens.

Signup and view all the flashcards

Vancomycin use in FN

Vancomycin, a broad-spectrum antibiotic, should only be used initially in severe FN cases with specific criteria, such as positive gram-positive blood cultures, clinical instability, or known colonization with resistant organisms.

Signup and view all the flashcards

Vancomycin resistant organisms

Bacteria that are resistant to treatment with vancomycin.

Signup and view all the flashcards

Empiric antifungal agents

Fungal drugs used in the absence of knowing the precise type of infection.

Signup and view all the flashcards

Amphotericin B

A potent antifungal with broad-spectrum activity, often a first-line treatment option, but with significant nephrotoxicity limitations.

Signup and view all the flashcards

Liposomal amphotericin B

A less toxic, but more expensive, form of amphotericin B that is shown to have better results in empiric therapy.

Signup and view all the flashcards

Hemorrhagic Cystitis

Bladder bleeding, often caused by certain medications, especially alkylating agents like cyclophosphamide and ifosfamide.

Signup and view all the flashcards

Acrolein

A metabolite of cyclophosphamide and ifosfamide that damages the bladder lining and is associated with hemorrhagic cystitis.

Signup and view all the flashcards

Mesna

A protective medication used to prevent hemorrhagic cystitis, in conjunction with cyclophosphamide or ifosfamide.

Signup and view all the flashcards

Hypersaline Hydration

A treatment strategy using large amounts of saline solutions to prevent hemorrhagic cystitis in some chemotherapy patients.

Signup and view all the flashcards

Febrile Neutropenia (FN)

A serious condition where a fever occurs along with a very low count of neutrophils (a type of white blood cell) in the blood.

Signup and view all the flashcards

Risk Factors for FN

Factors increasing the chance of developing Febrile Neutropenia, categorized by patient and chemotherapy aspects.

Signup and view all the flashcards

Patient Factors (FN)

Patient characteristics linked to an increased chance of Febrile Neutropenia, including age, underlying conditions, and cancer stage.

Signup and view all the flashcards

Chemotherapy Factors (FN)

Chemotherapy aspects increasing the risk of Febrile Neutropenia, such as treatment type, and dose density, previous chemo history, etc.

Signup and view all the flashcards

Prevention of FN

Strategies to reduce the occurrence of Febrile Neutropenia, encompassing hand hygiene, prophylactic antibiotics, and colony-stimulating factors.

Signup and view all the flashcards

Prophylactic Antibiotics

Antibiotics given to prevent infections, frequently used before a patient's immune system is compromised (e.g., in chemo patients).

Signup and view all the flashcards

Colony-Stimulating Factors (CSFs)

Medicines to stimulate the production of neutrophils, used to prevent Febrile Neutropenia by boosting the immune function before chemo.

Signup and view all the flashcards

Treatment Approach for FN

Involves risk assessment to determine outpatient vs. inpatient treatment, followed by empiric broad-spectrum antibiotics if inpatient.

Signup and view all the flashcards

Nonpharmacologic FN Prevention

Strategies focused on improving hygiene, preventative vaccinations, and minimizing contact with infection sources

Signup and view all the flashcards

Desired Outcomes for FN Treatment

Primary goal is preventing morbidity and mortality during neutropenia, accomplished by effectively treating infections early before they become serious.

Signup and view all the flashcards

Empiric Therapy (FN)

Treatment started immediately after blood cultures are collected, based on the likely presence of infection, without waiting for results of culture tests to confirm.

Signup and view all the flashcards

IV fluid administration for bladder irrigation

Aggressive IV fluid administration is crucial to flush the bladder and clean it of blood clots.

Signup and view all the flashcards

Maintaining hematologic values

Blood and platelet transfusions might be needed to keep blood counts normal.

Signup and view all the flashcards

Pain Management in Hemorrhagic Cystitis

Opioid analgesics are used to control pain.

Signup and view all the flashcards

Local intravesicular therapies

Treatments directly applied to the bladder are used if bleeding doesn't stop with other methods.

Signup and view all the flashcards

Urethral catheter insertion

A large-diameter catheter is put into the urethra to help flush the bladder and remove blood clots.

Signup and view all the flashcards

Surgical clot removal

Surgical removal of blood clots may be needed if flushing doesn't work.

Signup and view all the flashcards

Cauterization of bleeding areas

Cauterizing isolated bleeding areas with an electrode or laser might stop the bleeding.

Signup and view all the flashcards

Urinary diversion procedures

These might be needed for severe cases that don't respond to other treatments.

Signup and view all the flashcards

Local hemostatic agents

Directly applied agents like alum or formalin to stop bleeding.

Signup and view all the flashcards

Systemic hemostatic agents

Medication that's taken as a pill or injection to control bleeding.

Signup and view all the flashcards

Antispasmodic agents for bladder spasms

Used to decrease bladder contractions and spasms.

Signup and view all the flashcards

Opioid analgesics for pain

Pain medications to control pain intensity.

Signup and view all the flashcards

Monitoring urinary output

Keeping track of how much urine is produced to assess kidney function.

Signup and view all the flashcards

Serum chemistry monitoring

Checking blood levels of electrolytes and toxins to assess kidney function.

Signup and view all the flashcards

CBC monitoring for blood counts

Daily blood tests to monitor hemoglobin and platelets for healthy blood.

Signup and view all the flashcards

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.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Quiz Team

More Like This

Pharmacologie Révisions Semestre 5
71 questions
Antiemetics and Nausea Management
44 questions
Use Quizgecko on...
Browser
Browser