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IV Therapies in Oncology Recordings, Nov 2021

IV Therapies in Oncology CME Exam

You must submit the CME Exam by 12:00 AM to receive your certificate.

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Receptors Opiate class, Drugs can interact with include

Mop (mu)

Dop ( delta)

Kop (Kappa)

All of these receptors

A deadly complication of opiate overdose includes respiratory depression

True

False

When administering LDN (low dose naltrexone) to a patient on opiate therapy, due to break through pain

Use caution in dosing

Dosing is safe any amount

Which is true about bone marrow response to Chemo therapeutic drugs?

An RDW of Normal or High is a good marker for bone marrow response. It means that marrow is producing immature erythroblasts, triggering marrow response- This is GOOD!!

An RDW of Normal or High is a good marker for bone marrow response. It means that marrow is producing immature erythroblasts, triggering marrow response- This is BAD!!

RDW only gives a functional marker of oxidative status in the patient. The RBC is the only marker that gives a measurement of marrow response.

Marrow response can only be assessed by the RBC and WBC, showing Normal to pancytopenia.

What is true about the measurement of kidney function?

The eGFR is a good way to measure kidney function but the 24hr-creatinine clearance test is the best

The most accurate measurement of kidney function is the 24hr renal clearance of 125I-iothalamate.

Serum Cystatin C is better than Levy calculation, serum creatinine clearance or 24hr urine creatinine clearance for the measurement of kidney function.

Levy is the most accurate measurement of kidney function.

How long after an IV should you wait to draw blood for liver and renal function?

24 hours only

48 hours, but better taken after 72 hours.

Best taken 24-48 hours after IV.

There is no immediate effect of Liver or Renal function on blood work

Will Normal Saline effect blood lab results? Electrolytes for 24 hours

No, Normal Saline is given all the time without any effect on blood lab results

Yes, blood lab results are effected by certain carrier fluids like Lactated Ringers, but not Normal Saline.

Yes, the RBC will be abnormal for 24 hours

Yes, the CMP electrolytes will be abnormal on lab blood work for 24 hours.

What is a way to assess and monitor hypoxia and pro-oxidant therapies in your patient?

The decrease of GGT correlates with high levels of Glutathione and anti-oxidants

The decrease in ALT/AST shows the increased use of and increased levels of Glutathione and anti-oxidants.

The increase of GGT enzymes correlates with the increased use of Glutathione and antioxidants, leading to the decreased levels of glutathione and antioxidants in the body.

The low ALT/AST levels correspond with high levels of hypoxia in the body and can indicate your therapy is working well in the patient.

Match which of these statements are correct about measuring inflammation with blood markers.

Marker of tissue damage in the body
Marker of oxidative damage in the body
Highly sensitive marker of inflammation in the body
Marker shows the presence of plasma proteins from increased inflammation
Marker associated with poor outcome in malignancies.

GGT

(Use list from above)

CRP-hs

(Use list from above)

LDH

(Use list from above)

ESR

(Use list from above)

Fibrinogen

(Use list from above)

D-Dimer

(Use list from above)

Which statement is true about high fibrinogen levels?

There is a higher risk of clot for a peripheral stick

There is a higher risk of clot and therefore you should only use a central line

Serum Iodine and B12 will increase due to an increase or reoccurrence in cancer.

True

False

What is the function of NLR (Lymphocyte-Neutrophil Ratios)?

Neutral Liver Reticulocytes is used to assess the progression of cancer

Is used to assess the probability of a viral vs bacterial infection

NLR is used to assess the function of the immune system.

This is not really a thing

What is the definition of Pseudo-Progression?

Appearance of disease progression on scans without disease progression by symptoms and/or labs.

No Appearance of disease progression on scans with no disease progression by symptoms and/or labs.

Appearance of disease improvement on scans without disease progression by symptoms and/or labs.

Appearance of disease improvement on scans with disease progression by symptoms and/or labs.

What are 2 lab values that can be used to assess immune function and activity?

WBC and RBC are lab values to check for immune function.

RDW and LDH are the first markers to check for immune dysfunction

NK cell function and N:L are lab values to check and/or calculate for immune activity.

CRP and Fibrinogen are 2 labs are accurately evaluate the immune response to cancer.

The functions of the Liver are:

Glutathione Recycling, Methylation, activates Vitamin D

Sulfation, Detoxification, RBC synthesis

Erythrocytes, Protein Synthesis, Detoxification

Glutathione recycling, Methylation, Protein synthesis

Which minerals are involved in Glutathione recycling?

Magnesium, Selenium

Molybdenum, Iodine

Molybdenum, Selenium

Magnesium, Molybdenum

Studies show that after cancer treatments,

All nutrients in the body are decreased

Glutathione levels in the body are decreased

Mental help is needed to deal with the cause

The immune system will resume normal function

Methylation is both pro or anti-cancer in most cancers.

True

False

When optimizing methylation pathways,

we never stimulate just one methyl pathway. All methyl pathways need to be stimulated.

we activate the least active methyl pathway to prime the pump.

we use specific methyl nutrients to obtain balance within the methyl pathways.

all methyl nutrients should be supplemented for essential optimization of all methyl pathways.

Glutamine is stimulatory to most cancer from a supplementary source.

True

False

Does Glutathione and Glutamine supplementation feed most cancers?

Cancer makes its own Glutathione and Glutamine and does not use supplemental Glutathione and Glutamine to feed its cancer

Glutathione is required for life and we must get it from a food or supplemental source sine we do not make our own.

Only in the presence of Vitamin C

Supplementation only makes expensive urine since supplements are not utilized by the body, therefore they cannot be utilized by cancer

Do we need to supplement with B12 or Iodine if the labs are high?

No supplementation is needed. Serum levels or B12 and Iodine are high

When there is an increase or reoccurrence in cancer, the liver dumps B12 and Iodine, leading to a supplemental need from an immediate deficiency

B12 supplementation is needed but we never supplement with Iodine unless there is a thyroid condition

We need to supplement with B12 and Folic Acid to make up for the transient deficiency made by the increased utilization by the cancer

HDIVC and nutrients should be given on same day to stimulate all the co-factor associated with the oxidative process.

True

False

Which oxidative therapy releases cytokines intracellularly?

Ozone

H2O2

Ozone with Glutathione

High Dose Vitamin C

Which statement is true?

High Dose Vitamin C produces H2O2 intracellularly and has the potential for cell damage by this mechanism.

H2O2 infusion gets intracellularly when using DMSO to drive it into the cell. Providing the mechanism for H2O2 mediated cell damage.

High Dose Vitamin C produces H2O2 extracellularly and in the plasma.

Ozone is the only oxidative therapy that can produce H2O2 intracellularly

What shifts in electrolytes are seen when infusing High Dose Vitamin C and must be accounted for with your Vitamin C infusion to reduce side effects?

Hypocalcemia, Hypokalemia, Hyponatremia, Hypochloremia

Hypercalcemia, Hyperkalemia, Hyponatremia, Hyperchloremia

Hypocalcemia, Hypokalemia, Hypernatremia, Hypermagnesemia

Hypocalcemia, Hypokalemia, Hypernatremia, Hypochloremia

Zinc Cl can be added to HDIVC.

True

False

Which additives can be added to High Dose Vitamin C?

Amino Acids

B Vitamins

Minerals

Glutathione

Which is true when administering HDIVC:

If watching kidney/liver functions closely, do labs every week when doing HDIVC

It is ok to do a series of 10-15 IV’s. Check kidney or liver function when the series of all IV’s are completed.

Hydration does not matter as much as the speed of dosage

B Vitamins complete the biochemistry of the oxidative process and better outcomes are seen.

How long do you typically continue HDIVC protocols?

One and done!

Make sure your patient knows this is a long-term therapy and 12-15 IVs are typical protocol

Until normal cancer marker levels are achieved, then protocol can be terminated

For 4 months, every year for the rest of the patients life.

Dietary changes make a difference in cancer treatment outcomes.

True

False

If oral Vitamin A is tolerated well, but levels are exceptionally low, it is ok to start with IV Vitamin A to eliminate absorption challenges.

True

False

Which B Vitamin, diluated and given IV, can mimic some of the effects of DCA?

1000 mg Thiamine HCl diluted in 250 mL normal saline

5000mg Pyridoxine diluted in 250mL ½ normal saline

500mg Dexpanthenol diluted in 250 mL normal saline

5000mcg Methylcobalamin diluted in 250 mL normal saline

Is synergistic with oxidative therapies?

No, and should never be given on the same day

Yes, it can be given on the same day but should not be combined with other therapies at time of administration.

Yes, it can be given on the same day and can be administered at the same time with HDIVC

No, it is not to be while a course of oxidative therapies are being given.

Since Iron is used in the metabolism of Artesunate, should we give Iron with Art?

No, it is not necessary. This reaction will happen despite Iron levels being low.

No, not enough is used to create an Iron deficiency

Yes, this keeps further symptoms and exacerbation of iron anemia

Yes, it is a good idea despite patient’s iron status since it is used in the metabolism of Artesunate.

Which therapies can be used on closed brain tumors?

Mistletoe, H2O2

Nutrients only

None, pack your bags and go to Hawaii

HBOT and Artesunate

What are some serious side effects of Artemisia? Neutropenia, anemia

B12 deficiency, usually only seen with oral use

Iron deficiency anemia, usually only seen with IV use

Neutropenia and anemia, usually only seen with oral use

Thalassemia, usually only seen with oral use

Artemisia and its various types are all synergistic with chemotherapy.

True

False

Which of these statements about Artesunate is FALSE?

ART and HDIVC have a synergistic relationship

Start at low dose, can be given rapidly

Not to be given in the same bag as HDIVC. Give ART, clear the line, then HDIVC

This is a good therapy to give continuously while doing other therapies. It does not need to be pulsed- done on and off every so often.

Which statements are TRUE about Artesunate?

Only compatible with IV nutrient therapies, not oxidative therapies

It must be given slow enough to tolerance due to the bitter quality which can stimulate vomiting.

Resistance does not develop to Artesunate

Must be given very slow at higher doses

Apoptosis is initiated by which cell structure?

RBC

Erythrocyte

Cell Membrane

Mitochondria

What are 3 strong eliminators of glyphosates?

Fulvic acid, Humic acid, Glycine

Glutathione, Mud, NAC

EDTA, DMSO, DMPS

Magnesium, Water, Fiber

Mistletoe efficacy, dosing and frequency of use is based on:

Experience

Patient symptoms and tolerance

Protocol

All of the above

What is the common terminology of Mistletoe seen in research literature?

HBOT

Viscum Album Extract Therapy

Mistletoe Injection Therapy

Immunoglobulin Therapy

Mistletoe has low adverse events unless:

Practitioner doesn’t have enough training

Practitioner doesn’t keep up with current the literature and protocol

There is a high (2 or more) on the prognostic score guide, such as cytokine syndrome or autoimmunity

All of the above

Mistletoe is an immune modulation vs stimulator.

True

False

Oral form does not work well for cancer.

True

False

Third Choice

Oral forms of mistletoe are not commonly used for:

Cancer

Hepatitis

Degenerative Joint Disease

Hypertension

When administering Mistletoe by injection

Less is more, titrate from low to higher dose based on watching the reaction of the patient

Administer SubQ at a 45 degree, with taunt skin

The previous reaction should completely resolve before next dose is administered

All of the above are true

Which of these are not contraindicated when administering Mistletoe

High IL8

Active Autoimmune flare

Active infection

Pain syndrome

Which of these statements are false about Mistletoe?

Inducing a fever with Mistletoe is never a concern, this is the desired effect

It is preferred to administer Vitamin C and Mistletoe at separate times, not in the same bag.

Not a stand-alone therapy

Never give Mistletoe when there is already a fever present

When using Mistletoe therapies, wait at least 4 weeks before another image or scan to get a most accurate image.

True

False

There are 3 main species that are matched to tumor type

True

False

All types are created equal, with equal dosing.

True

False

What is the most common preservative used with IV Curcumin products?

Sodium Bicarb- check for patient intolerances

Sodium Hydroxide- check for patient intolerances

ETOH- check for patient intolerances

Potassium Sorbate- check for patient intolerances

Lipocurc, at high doses, can cause what as a side effect?

RBC damage

Liver damage

Kidney damage

Musculoskeletal Pain

Which statement is FALSE about IV Curcumin?

Safe at doses used in common protocols

Start low and titrate up to dose needed

IV form is a lipid

The water soluble form is safe and comfortable for IV administration.

Quercetin can be used orally, nebulized, intravenous, and topically.

True

False

Quercetin cannot be nebulized with NAC for lung conditions.

True

False

What is the function of Quercetin?

Mast cell destabilizer

An oxidative therapy

Tyrosine Kinase inhibition and tumor growth suppression

Inflammatory agent, used to modulate the immune system

Which statement is FALSE about Quercetin?

IV Quercetin is well tolerated and safe

Dosed to patient tolerance, not just by protocol

Incompatible with other IV nutrients

Mixed in the same bag as Vitamin C

When chelating Copper out of the body, it is important to…

Consider limiting high Copper foods but it really doesn’t make enough difference to restrict Copper from the diet

Restrict Copper containing foods, as they contribute as a significant Copper exposure

Supplement with Zinc to prevent a Zinc deficiency

Supplement with other minerals to prevent deficiencies

What is the purpose of TM as a therapy?

To act as a stand alone therapy

Enhances Radio and chemotherapies

To enhance cell counts

Increases Copper levels

What are some side effects of TM when used in conjunction with Chemo?

Mild anti-coagulant

Depression

It can reduce RBC, WBC and cell counts

Liver disease

What are some side effects of Ozone?

Oxidative- can cause hemolysis at >80mcg/ml

Immune Inhibitory at high doses

Contraindicated use with Heparin when Heparin allergies present

All of the above

What can Ozone be used for in Cancer?

Can be used as a single stand-alone therapy

Tumor hypoxia, cancer related fatigue, rashes and burns

Immune suppressive

Anti-chemotherapy agent

Which of these statements are true regarding Ozone therapy?

A regular IV line can be used and will not clot due to filter size

Cannot be used topically

Lab work of a G6PD must be obtain before initiating treatment

It’s ok to use Heparin even when there is a Heparin allergy, to make sure the ozonated blood won’t clot.

Normal tissue and wounded tissue respond the same to HBOT

True

False

Increasing the intake of antioxidants just before pro-oxidant therapies will enhance the benefits.

True

False

Mistletoe should be discontinued if the patient spikes a fever of 102

True

False

If not responding to immune therapy, I.E. LDN or mistletoe, look at:

Fatty acid balance

Vitamin D level

All the above

None of the above

For the safest delivery of HDIVC, only ascorbic acid should be added to the base solution?

True

False

Any antitumor immune response can cause the appearance of disease progression, either as tumor growth or appearance of new lesions. This can be caused by:

immune cells infiltrate the tumor site

disease progression

All the above

None of the above

Would these labs CBC, CMP and G6PD be required for delivering ozone systemically?

True

False

What IV adjuvant would be avoided in the recommendations directly for treatment: after oxidative treatments such as H202, Ozone, HDIVC, Artesunate?

Zinc

Alpha Lipoic acid

Magnesium

Glutathione

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