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1.2.10: Develop and implement individualized treatment plans, taking into consideration adverse effects and drug-induced illness

A premenopausal woman with ER negative, node positive breast cancer is starting doxorubicin and cyclophosphamide adjuvant treatment. What would you recommend to determine the severity of the most common toxicity associated with this treatment regimen?

(A) An electrocardiogram 1 week after chemotherapy

(B) A complete blood count including platelets 1 week after administration of the chemotherapy

(C) Serum bilirubin and aspartate transaminase 1 week after chemotherapy

(D) Urinalysis 1 week after chemotherapy

The Correct Answer is: B

Myelosuppression (neutropenia, thrombocytopenia) is the most common treatment related adverse effect associated with this adjuvant treatment regimen. Nearly 100% of patients receiving this treatment regimen will experience myelosuppression (B).

Doxorubicin has been associated with cardiomyopathy that increases in incidence with cumulative doses exceeding 400 mg/m 2 . The incidence of cardiomyopathy in patients administered cumulative doses exceeding 400 mg/m 2 is in the range of 5%. It is not the most common toxicity associated with this treatment regimen (A). Although these drugs may cause elevations of serum bilirubin and aspartate transaminase (C), it occurs less frequently than myelosuppression. Although urinalysis (D) could be useful in detecting hematuria caused by cyclophosphamide, this adverse effect (hemorrhagic cystitis) occurs infrequently with this adjuvant chemotherapy regimen.

What toxicity has been associated with the administration of both trastuzumab and bevacizumab?

(A) Myelosuppression

(B) GI perforation

(C) Alopecia

(D) Infusion reactions

The Correct Answer is: D

Trastuzumab and bevacizumab are monoclonal antibodies administered by IV infusion. Infusion reactions (the onset of chills, fever, changes in blood pressure within 1 hour of administration), (D) have been reported to occur with both agents.

Trastuzumab and bevacizumab are monoclonal antibodies that are rarely associated with myelosuppression (A). Although GI perforation (B) is a known bevacizumab toxicity, it has not been associated with administration of trastuzumab. Monoclonal antibodies are not associated with hair loss (C).

What appropriate premedication regimen is recommended for administration prior to the administration of paclitaxel?

(A) Dexamethasone and ranitidine

(B) Ranitidine and diphenhydramine

(C) Dexamethasone and diphenhydramine

(D) Dexamethasone, ranitidine, and diphenhydramine

The Correct Answer is: D

A combination of a corticosteroid and an H1 and H2 antagonist (D) are recommended for administration prior to paclitaxel infusions, to decrease the incidence and ...

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