ONS ONCC CHEMO RENEWAL NEWEST ACTUAL -

ONS ONCC CHEMO RENEWAL NEWEST ACTUAL -

EXAM 62 QUESTIONS WITH 100% CORRECT ANSWERS GRADED

A+/VERIFIED

Mr. Rylan is receiving doxorubicin as part of his chemotherapy regimen. The patient's ejection fraction should be tested prior to starting doxorubicin. Periodic monitoring is also suggested in addition to testing ejection fraction one year post completion of therapy. Per the prescribing information, one should assess left ventricular cardiac function (e.g., MUGA or echocardiogram) prior to initiation of doxorubicin, during treatment to detect acute changes, and after treatment to detect delayed cardiotoxicity - ----Answers----Since you know that Mr. Rylan is getting R-CHOP, which of the following pretreatment test results do you feel is a priority to review prior to starting his chemotherapy?

Lifetime cumulative dose of doxorubicin is 550 mg/m2 except when patient has received prior chest irradiation or when receiving concomitant cyclophosphamide where the cumulative dose decreases to 450 mg/m2. Mr. Rylan is receiving cyclophosphamide as part of RCHOP regimen so therefore should not exceed 450 mg/m2. - ----Answers---- Mr. Rylan is receiving RCHOP. What is the lifetime cumulative dose of doxorubicin that Mr. Rylan should not exceed?

The risk of cardiotoxicity is generally proportional to the cumulative exposure of doxorubicin. The probability of developing cardiotoxicity is estimated to be 1 to 2% at a total cumulative dose of 300 mg/m2 of doxorubicin, 3 to 5% at a 1 / 3

dose of 400 mg/m2, 5 to 8% at a dose of 450 mg/m2, and 6 to 20% at a dose of 500 mg/m2, when doxorubicin is administered every 3 weeks. There is an additive or potentially synergistic increase in the risk of cardiotoxicity in patients who have received radiotherapy to the mediastinum or concomitant therapy with other known cardiotoxic agents such as cyclophosphamide, taxanes, and trastuzumab. Cardiotoxicity can occur at lower doses in patients who have received mediastinal radiation or those that have underlying heart disease. Coadministration of coenzyme Q10 has actually shown potential benefit in decreasing cardiotoxicity. - ----Answers-- --Which of the following offers the highest risk for developing cardiotoxicity?

Per the NCCN guidelines

(http://www.nccn.org/professionals/physician_gls/pdf/antieme

sis.pdf) on Antiemesis, the most likely classes of agents that would be used as premedication for a moderately emetic risk

regimen include: Steroids usually dexamethasone, 5HT3

antagonists like palonosetron or ondansetron, with or without neurokinin 1 antagonists like aprepitant or fosaprepitant.Prokinetic agents like metoclopramide are sometimes used PRN for low risk regimens and breakthrough CINV. Other classes of agents like proton pump inhibitors, H2 blockers, and benzodiazepines are utilized for CINV prevention and control as well and sometimes are included as premedications prior to chemotherapy. - ----Answers----Which of the following classes of agents would you not anticipate to be a part of Mr.Rylan's orders for premedication to prevent CINV?

Avoiding fresh fruits and vegetables is no longer recommended to prevent infection. Fresh fruits and vegetables 2 / 3

can and should be eaten as long as they are washed thoroughly. - ----Answers----The next thing you discuss with Mr. Rylan is neutropenia and the risk for infection that goes along with it. You state that you will monitor his blood counts closely and that his physician may decide to use a colony- stimulating factor to enhance his neutrophil count. You review some of the things that Mr. Rylan can do to hopefully prevent getting an infection like good hand washing.

Although all the other Answers listed can happen with rituximab, you are most concerned about the potential for a hypersensitivity reaction since this is rituximab and it is the patient's first dose. - ----Answers----What is the most important toxicity that you will monitor for with rituximab especially since this is the patient's first dose of the agent?

Oncovin (vincristine) can cause neurotoxicity of the smooth muscle of the GI tract which can lead to decreased peristalsis and paralytic ileus. Constipation, abdominal pain, and paralytic ileus can be seen with vincristine use. - ----Answers---- Which of the following medications is the likely cause of Mr.Rylan's constipation?

A dose-limiting toxicity of cyclophosphamide is hemorrhagic cystitis. Although it is more commonly seen with high-dose therapy, it can still occur in patients receiving R-CHOP. - ---- Answers----Which of the agents that Mr. Rylan is receiving in R-CHOP would be the likely culprit if this is hemorrhagic cystitis?

• / 3